Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues surrounding truth-telling in the doctor-patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the 'truth'. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that honesty is not (...) always the best policy. (shrink)

This volume of essays examines key themes in Jewish philosophy and ethics from the rigorous perspective of philosophical analysis. The first set of essays takes up the challenge of living a Jewish life, and includes essays on pleasure, joy, human suffering, Jewish ritual practice and the philosophical life. The second set of essays analyzes the value and meaning of autonomy, human freedom and tolerance in Jewish thought, crucial themes in western political thought and life. Other essays in the volume examine (...) the many meanings of Jewish texts, and such crucial issues in applied Jewish ethics as ecology, medical ethics, and justified homicide. Finally, a number of essays plumb the depths of one of the most influential and creative Jewish thinkers of the twentieth century, Rabbi Joseph B. Soloveitchik. Taken as a whole, this volume advances the engagement of classical Jewish themes with Anglo-American philosophy, shedding new light both on the Jewish tradition, and on the western philosophical enterprise. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The medical profession’s role should be limited to advice and informationThe medical establishment’s desire to interfere with the autonomous wishes of boxers seems at odds with the principle of respect for autonomy prevalent in contemporary biomedical practice. I argue that the role of the medical profession in boxing should be solely an advisory and informational one. In addition, the distinctions made between boxing and other high risk sports often rely on an insufficient knowledge of the sport. This leads to misdirected (...) criticisms and excessive emphasis on the colourful discourse of boxing, as opposed to the practice of boxing itself. Dr Herrera’s claim in his article that boxing differs from other sports in the acceptability of its acts outside the realm of sport is refuted.1 The importance of consent as a legitimising factor is highlighted, and a number of possible solutions to improve safety within the sport are tentatively suggested.In the United Kingdom, a competent adult may legally refuse medical treatment, irrespective of the severity of his condition or the validity of his reasons. With the pre-eminence of an autonomy based model of bioethics, respecting a patient’s wishes forms an integral part of acting in his best interests. It is puzzling, then, to find that the Australian Medical Association have called for a ban on boxing on the grounds that the activity is excessively hazardous to the health of boxers. The often mentioned principle of respect for autonomy is abandoned once the person drops the privileged title of “patient”. This suggests that being a patient …. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

The public revelation in 2003 that medical students perform intimate examinations without patient consent has engendered much debate in the press and scientific journals. Using this case as a springboard for discussion, I will argue that medical schools should encourage students to raise their ethical concerns and call for a change of policy making it easier for students to do so. I will also address the question of medical students’ moral obligations towards their patients, and conclude that medical students ought (...) to express their discontent when faced with unethical practices or attitudes.In early January 2003, a study appeared in the British Medical Journal revealing that nearly a quarter of rectal and vaginal examinations on anaesthetised patients were performed by medical students without patient consent.1 Although the study did not generate the firestorm of controversy many expected, it engendered much discussion on ethical issues surrounding informed consent and patient autonomy, as well as stressing the need for greater ethics training for medical students. As an ethical problem, however, the case of intimate examinations is, to my mind, relatively uninteresting. If we agree that it is wrong for doctors to perform a vaginal examination on a conscious person without their consent, then it follows that it will still be …. (shrink)

Although telephone consultations are widely used in the delivery of healthcare, they are vulnerable to breaches of patient confidentiality. Current guidelines on telephone consultations do not address adequately the issue of confidentiality. In this paper, we propose a solution to the problem: a password system to control access to patient information. Authorised persons will be offered the option of selecting a password which they will use to validate their request for information over the telephone. This simple yet stringent method of (...) access control should improve security while allowing the continuing evolution of telephone consultations. (shrink)

Case presentations, esthetics, insurance considerations, communicable diseases, referral questions, dental phobia, and legal concerns all play a role in doctor-patient relationships. These topics, and many others, are the subject of this one-of-a-kind resource, designed to show dental students and practitioners how to approach patient relationships.

In preparing for a lecture on the ethics of surgical complications, it became apparent that confusion exists about the definition of a ‘‘surgical complication.’’ Is it, as one medical website states, ‘‘any undesirable result of surgery?’’ [1]. In the European Journal of Surgery, Veen et al. [2] provide a more elaborate definition: ‘‘every unwanted development in the illness of the patient or in the treatment of the patient’s illness that occurs in the clinic’’ [2]. An esteemed historian of science suggests (...) yet another definition in a recent volume on surgical complications: ‘‘a complication, in any sphere of endeavour, is something out of the norm, and the product of extraneous and unexpected factors’’ [3]. Such is the discrepancy in definitions that Rampersaud et al. [4] declared in 2006 that ‘‘presently, there is no clear or consistent definition of a complication in the surgical literature.’’ Much research in surgery aims to reduce the risk of surgical complications. However, until we have a stable and agreed definition of what counts as a surgical complication, we cannot reliably compare different studies to discover what best reduces the chance of surgical complications [5]. Therefore, the topic is more than mere pedantry; defining surgical complications will help us with the broader question of how to improve surgical practice. A basic PubMed search returned nearly 800 articles with the phrases ‘‘surgical complications’’ or ‘‘surgical complication’’ in the title. But unlike the sources above. (shrink)

In February 1828 a Royal Commission was appointed to examine the law of Real Property of England and Wales. The Commission sat for four years and examined a vast amount of material, recommended certain changes in the law, and drafted several bills for consideration by parliament. Four massive reports were eventually presented to parliament in May 1829, June 1830, May 1832, and lastly in April 1833. As a result parliament enacted a limited number of piecemeal reforms, but did not attempt (...) a major revision of the law. (shrink)

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The analysis (...) is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

This chapter contains sections titled: References.

Much research in the field of emotions has shown that people differ in the cues that they use to perceive their own emotions. People who are more responsive to personal cues (personal cuers) make use of cues arising from their own bodies and behavior; people who are less responsive to personal cues (situational cuers) make use of cues arising from the world around them. An evolutionary explanation of this well-documented phenomenon is that it occurs because of the operation of a (...) cognitive module designed to enable the organism to predict its own impending behavior. This theory suggests that situational cuers would be people for whom external factors are the best source of information about their own future behavior, whereas personal cuers are people for whom cues about themselves are the best source of information about their own future behavior. Such a view is founded in the New Realist philosophy of the early twentieth century, a philosophy that affected psychology through the work of E. C. Tolman and J. J. Gibson. (shrink)

We find the idea that infant crying arises from thermoregulation more consistent with a coregulatory account of its evolutionary history than it is with the informational account advocated in the target article.

In 1982, Jonsen, Siegler and Winslade published Clinical Ethics, in which they described the “four quadrants” approach, a new method of analysing clinical ethics cases. Although the book is now in its 6th edition, a literature search has revealed only one academic paper demonstrating the method at work. This paper is an attempt to start filling this gap. As a way of describing and testing the approach, I apply the four quadrants method to a detailed clinical ethics case. The analysis (...) is interspersed with reflections on the method itself. It is hoped that this experiment will encourage ethicists and clinicians to devote more attention to this neglected approach. (shrink)

This essay offers an overview of the diversity of women’s prose writing that emerged on the Czech cultural scene in the post-communist era. To that end it briefly characterizes the work of eight Czech women authors who were born within the first two decades after World War II and began to create during the post-1968 era of ‘normalization’. In this broad sense they belong to a single generation. With rare exception their work was not officially published in their homeland until (...) the 1990s. The writers included are: Lenka Procházková, Tereza Boučková, Alexandra Berková, Zuzana Brabcová, Daniela Hodrová, Sylvie Richterová, Iva Pekárková, and Eva Hauserová. The overview is followed by a concise comparative analysis of texts by three very different writers (Procházková, Pekárková, and Hodrová), using a feminist critical approach. There is also an appendix of works by these writers available in English translation. (shrink)

Is it right for a wife to take sperm from a dying husband in order to create a child posthumously? Daniel Sokol discusses a recent case.

Might viewing a violent horror film damage your moral compass? Daniel Sokol suggests that watching gratuitously violent imagery may be.

The usage of new and progressive technologies brings with it new types of security threats and security incidents. Their number is constantly growing.The current trend is to move from reactive to proactive activities. For this reason, the organization should be aware of the current security situation, including the forecasting of the future state. The main goal of organizations, especially their security operation centres, is to handle events, identify potential security incidents, and effectively forecast the network security situation awareness (NSSA). In (...) this paper, we focus on increasing the efficiency of utilization of this part of cybersecurity. The paper’s main aim is to compare selected statistical models and models based on neural networks to find out which models are more suitable for NSSA forecasting. Based on the analysis provided in this paper, neural network methods prove a more accurate alternative than classical statistical prediction models in NSSA forecasting. In addition, the paper analyses the selection criteria and suitability of time series, which do not only reflect information about the total number of security events but represent a category of security event (e.g. recon scanning), port or protocol. (shrink)

The present review highlights an association between autism, Alzheimer disease , and fragile X syndrome . We propose a conceptual framework involving the amyloid-beta peptide , Abeta precursor protein , and fragile X mental retardation protein based on experimental evidence. The anabolic effect of the secreted alpha form of the amyloid-beta precursor protein may contribute to the state of brain overgrowth implicated in autism and FXS. Our previous report demonstrated that higher plasma sAPPalpha levels associate with more severe symptoms of (...) autism, including aggression. This molecular effect could contribute to intellectual disability due to repression of cell-cell adhesion, promotion of dense, long, thin dendritic spines, and the potential for disorganized brain structure as a result of disrupted neurogenesis and migration. At the molecular level, APP and FMRP are linked via the metabotropic glutamate receptor 5 . Specifically, mGluR5 activation releases FMRP repression of APP mRNA translation and stimulates sAPP secretion. The relatively lower sAPPalpha level in AD may contribute to AD symptoms that significantly contrast with those of FXS and autism. Low sAPPalpha and production of insoluble Abeta would favor a degenerative process, with the brain atrophy seen in AD. Treatment with mGluR antagonists may help repress APP mRNA translation and reduce secretion of sAPP in FXS and perhaps autism. (shrink)

Although in fundamental agreement with Carpendale & Lewis 's position, we discuss a potential source of confusion regarding the socially constituted nature of mental states. Drawing from recent work by Kusch, we argue, more specifically, that mental states are instances of “artificial kinds,” and so, stand between the more common classificatory extremes of “the natural” and “the social.”.

We believe that “caching” a baby would have been too great a danger in human prehistory, and thus could not serve as the context for prelinguistic vocalization. Rather, infants were most likely carried at all times. Thus, the question arises of why the cry of an infant is such a loud vocalization.

This article studies the formats Do we X, Should/Shall we X, and Let’s X in order to deepen our understanding of face-to-face collaborative interactions at the computer. We use 6 hours of data of university students collaborating in British and American English, and our methodology is Conversation Analysis. We demonstrate that the participants display and orient to the immediacy/remoteness of the task, as well as their entitlement to carry out the proposed task, when they put forward a proposed action. To (...) do so, they use specific formats, specific verbs, and display specific tasks depending on their needs, emerging from the unfolding of the collaboration. We argue that collaboration is not only a matter of organising the accomplishment of a set of tasks, but also of displaying what kind of task is being proposed, and to what extent the speaker is entitled to the proposed task. (shrink)

During the post-1989 period, various forms of nationalism came back to haunt Eastern and Central Europe. Why are they so virulent and so dangerous in modern times? Since the modernization of the nineteenth century, language has not only been a normal means of communication and a substantial part of human identity but also plays an increasingly important political role: public opinion, media and politics all depend on a common language, which tends to become the language of the state. The process (...) of linguistic homogenization by the state, which had already been completed in Western Europe, failed in this context. Europe will therefore have to come to terms with its linguistic diversity in the future. Is this nothing more than a hindrance? (shrink)

During the post-1989 period, various forms of nationalism came back to haunt Eastern and Central Europe. Why are they so virulent and so dangerous in modern times? Since the modernization of the nineteenth century, language has not only been a normal means of communication and a substantial part of human identity but also plays an increasingly important political role: public opinion, media and politics all depend on a common language, which tends to become the language of the state. The process (...) of linguistic homogenization by the state, which had already been completed in Western Europe, failed in this context. Europe will therefore have to come to terms with its linguistic diversity in the future. Is this nothing more than a hindrance? (shrink)

SummaryThe writings of the very popular American poet Robert Frost (1874–1963) reveal an unusually specific and detailed knowledge of science. This was particularly evident among the poems of his penultimate volume, Steeple Bush, of 1947. Several of these poems confronted with basic insights issues raised by the period's ‘new physics’. Among those, especially Frost's epigram ‘A Wish to Comply’ wittily confronted an important epistemological difficulty in particle physics. Such science must induce a belief in the fundamental importance of entities invisible (...) to any physical human senses except those aided by complex apparatus used in abstruse experiments. Recondite scientific issues are confronted in other poems published in Steeple Bush such as ‘Skeptic’ (which meditates on the ‘red shift’ evidence for an expanding universe), but these poems are clearly derived from popular theoretical expositions, not practical experience. ‘A Wish to Comply’, on the other hand, clearly records an actual experience of a failed Millikan ‘oil drop’ experiment. This event evidently led to the poet to fake a report of his own observation of an electrically charged oil droplet, for reasons of social pressure. In meditating on these circumstances the epigram opens questions relating to scientific ‘systematic error’, the suppression, ‘trimming’ or ‘cooking’ of experimental data, and a bias toward confirmation of highly respected opinions. Although Frost did not live to know it, two of these questions have been latterly opened in regard to Millikan's own reports of his original oil drop experimental data. (shrink)