Clinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot‐test approaches to train, credential, privilege, and evaluate consultants.

Clinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot‐test approaches to train, credential, privilege, and evaluate consultants.

Cortical stimulation has been used for brain mapping for over a century, and a standard assumption is that stimulation interferes with task execution due to local effects at the stimulation site. Stimulation can however produce afterdischarges which interfere with functional localization and can lead to unwanted seizures. We previously showed that cognitive effort can terminate these afterdischarges, when termination thus occurs, there are electrocorticography changes throughout the cortex, not just at sites with afterdischarges or sites thought functionally important for the (...) cognitive task used, and thresholds for afterdischarges and functional responses can change among stimulation trials. We here show that afterdischarge termination can occur prior to overt performance of the cognitive tasks used to terminate them. These findings, taken together, demonstrate that task-related brain changes are not limited to one or a group of functional regions or a specific network, and not limited to the time directly surrounding overt task execution. Discrete locations, networks and times importantly underpin clinical behaviors. However, brain activity that is diffuse in location and extended in time also affect task execution and can affect brain mapping. This may in part reflect fluctuating levels of attention, engagement, or motivation during testing. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

The purpose of this note is to examine the notion of obligations to future generations, a notion that finds increasing use in discussions of social policies and programs, particularly as concerns population distribution and control and environment control. Thus, it may be claimed, the solution of problems in these areas is not merely a matter of enhancing our own good, improving our own conditions of life, but is also a matter of discharging an obligation to future generations.

This white paper aims to identify an open problem in 'Quantum Physics and the Nature of Reality' -namely whether quantum theory and special relativity are formally compatible-, to indicate what the underlying issues are, and put forward ideas about how the problem might be addressed.

In this paper I hope to show that a conception of human rights requires a view of the social ideal and the good life, and requires a view of the nature of human community. But what I say in favor of these points hardly amounts to a demonstration. Instead I try to exhibit how we think and talk about rights in general, and what the presuppositions of such thought and talk are. Throughout, I emphasize the pragmatic side of rights-discourse and (...) I try to establish some of the contexts in which such discourse can be significantly employed. Much of what I say is motivated by the consideration that an historically important factor in the generation of various rights, their acknowledgement and implementation, and their extension to increasingly larger segments of the population, has been the claims put forward and the demands made by individuals and groups against individuals and groups. This factor constitutes a suggestive clue for the development of a theory of rights. The treatment here, however, is largely programmatic and fragmentary. The space allotted does not permit more. Moreover, I lead up to—but do not go into—the social ideal and the human community. The title of this essay indicates its limited scope. The above points are, of course, hardly novel; many older writers laid great stress upon them. But of late they have not received the attention that they in my view deserve. What does it mean for someone to maintain a conception of human rights? How is this conception given any concrete content? The answers to these questions, I believe, ultimately lead to a consideration of social ideals and the human community. What follows is meant to stimulate new thinking on these old-fashioned topics. (shrink)

The purpose of this essay is to investigate and critically analyse some of the formative factors which led to the spiritual maturation of a leading Vīraśaiva saint, Basava. This inquiry focuses on a single event in the life of this great reformer of medieval times, i.e. his spiritual conflict leading to his rejection of the upanayana ceremony. The study will proceed through an investigation of the earliest and subsequent sources which veil the personality of Basava. The traditional view will be (...) challenged as one-sided. By critically comparing the sources, a more comprehensive and plausible account will be suggested. (shrink)

** The primary topic of this dissertation is the study of the relationships between parts and wholes as described by particular physical theories, namely generalized probability theories in a quasi-classical physics framework and non-relativistic quantum theory. ** A large part of this dissertation is devoted to understanding different aspects of four different kinds of correlations: local, partially-local, no-signaling and quantum mechanical correlations. Novel characteristics of these correlations have been used to study how they are related and how they can be (...) discerned via Bell-type inequalities that give non-trivial bounds on the strength of the correlations. ** The study of quantum correlations has also prompted us to study a) the multi-partite qubit state space with respect to its entanglement and separability characteristics, and b) the differing strength of the correlations in separable and entangled qubit states. Results include a novel classification of multipartite (partial) separability and entanglement, strong constraints on the monogamy of entanglement and of non-local correlations, and many new entanglement detection criteria that are directly experimentally accessible. ** Because of the generality of the investigation these results also have strong foundational as well as philosophical repercussions for the different sorts of physical theories as a whole; notably for the viability of hidden variable theories for quantum mechanics, for the possibility of doing experimental metaphysics, for the question of holism in physical theories, and for the classical vs. quantum dichotomy. (shrink)

The traditional paradox of the stone may be interpreted as posing a competition between a pair of omnipotent beings, represented by God at two different times. The new paradox poses a question about simultaneous competition between a pair of omnipotent beings. We make use of an attractive Thomistic response to the former paradox in arguing that the latter situation is logically possible.

Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

Women who had had breast cancer and had been enrolled in a large genetic breast cancer epidemiological study were interviewed about their experience of participation in the study, their attitudes to the confidentiality of data, and the feedback of personal and general research results. Collection of family history information seemed more salient in indicating the genetic nature of the study than the enrolment information sheet. There were no concerns about confidentiality.While participants would have welcomed general feedback about the results of (...) the study and were critical that this had not been provided, the feedback of personal information proved complicated and, sometimes, difficult. It is suggested that individual feedback of genetic test information in epidemiological studies should be undertaken only when there are specific reasons. (shrink)

Science education is most efficacious and enduring when undertaken within a philosophical framework akin to that of science, itself. This entails recognition that, above all, science is a mode of rational inquiry pursued by those who are curious about the natural world and motivated to seek rational answers to personally meaningful questions. The key to successful science instruction lies in fostering a student' 's self-motivation and productively channeling his innate curiosity. To do this a science educator must convey to students (...) an accurate and sympathetic impression of the importance of science to their cultural development; help students develop an ability to evaluate information critically and arrive at logical conclusions; provide students opportunities to engage in creative, personally meaningful scientific research. (shrink)

Like the virtue it purports to explain, St Thomas Aquinas' treatment of modestia in the Summa Theologiae is something that can easily be overlooked. Such neglect is unfortunate, for it is liable to obscure the surprising character of Aquinas' account, departing as it does from many of his philosophical sources , to say nothing of our own contemporary assumptions. This novel treatment is especially significant given its potential value in addressing the social and political needs of the current age, for (...) rather than being the virtue least fitted for contemporary life, the modesty that emerges in Thomas' moral theology may have an enduring civic significance. This essay therefore begins with an exegesis of Aquinas' account of modestia and concludes with an analysis of its political dimensions. (shrink)

The doctrine of double effect (DOE) has its origins in Roman Catholic thought and has been held to have widespread applications in bioethics. Its applications range over issues of maternal-fetal conflict, organ donation and transplant, euthanasia, and resource allocation, among other controversial issues. Recently, Joseph Boyle, the foremost proponent of the DOE over the past few decades, has argued that the DOE is required by the absolutist context of the Catholic tradition, and, further, that anyone who rejects this particular context (...) is not entitled to use the doctrine. In this essay, I will focus exclusively on the intention condition of the DOE and its central distinction, i.e., intention/side effect. I will proceed by considering in turn (1) Boyle's argument that the absolutist moral framework of the Catholic tradition requires the intention/side effect distinction; (2) the ways in which that framework is made vulnerable by this requirement; and (3) just why the DOE should be viable even outside of the Catholic tradition if it turns out that a feature of (l) is correct and the challenges of (2) can be met. (shrink)

Le 9e siècle marque un tournant dans l'hagiographie byzantine qui devient de plus en plus sécularisée à la fois dans sa forme et dans son contenu. Deux Vitae datant de la fin du 9e siècle, la vie d'Antoine le jeune et la vie de l'impératrice Theodora jouent un rôle pivot dans ce processus de sécularisation. Elles offrent les modèles d'une piété masculine et d'une piété féminine en témoignant de deux formes antithétiques de l'expérience religieuse : celle monastique et celle séculaire. (...) Cette tension trouve ses racines dans l'iconoclasme et reste vivante dans la période post-iconoclaste dans le conflit qui oppose le patriarche Ignace à Photios. (shrink)

IntroductionBisphenol A is highly debated and studied in relation to a variety of health outcomes. This large variation in the literature makes BPA a topic that is prone to selective use of literature, in order to underpin one’s own findings and opinion. Over time, selective use of literature, by means of citations, can lead to a skewed knowledge development and a biased scientific consensus. In this study, we assess which factors drive citation and whether this results in the overrepresentation of (...) harmful health effects of BPA.MethodsA citation network analysis was performed to test various determinants of citation. A systematic search identified all relevant publications on the human health effect of BPA. Data were extracted on potential determinants of selective citation, such as study outcome, study design, sample size, journal impact factor, authority of the author, self-citation, and funding source. We applied random effect logistic regression to assess whether these determinants influence the likelihood of citation.ResultsOne hundred sixty-nine publications on BPA were identified, with 12,432 potential citation pathways of which 808 citations occurred. The network consisted of 63 cross-sectional studies, 34 cohort studies, 29 case-control studies, 35 narrative reviews, and 8 systematic reviews. Positive studies have a 1.5 times greater chance of being cited compared to negative studies. Additionally, the authority of the author and self-citation are consistently found to be positively associated with the likelihood of being cited. Overall, the network seems to be highly influenced by two highly cited publications, whereas 60 out of 169 publications received no citations.ConclusionIn the literature on BPA, citation is mostly driven by positive study outcome and author-related factors, such as high authority within the network. Interpreting the impact of these factors and the big influence of a few highly cited publications, it can be questioned to which extent the knowledge development in human literature on BPA is actually evidence-based. (shrink)

National consciousness, which is primarily a deep awareness of one or another people of its ethnic isolation and originality of historical destiny, is formed under the influence of various objective and subjective factors. Depending on which nationalistic factors are bestowed, distinguish the objectivist and subjectivist theory of the nation.