This paper is a personal account of the events associated with the author’s work at the University of Toronto’s Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, (...) the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author’s academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good. (shrink)

The editors introduce the core areas of current debate within historical theory, bringing the reader as up to date with continuing debates and current developments as is possible. This important handbook brings together in one volume discussions of the role of modernity, empiricism, realism, post-modernity and deconstruction in the historian’s craft. Chapters are written by leading writers from around the world and cover a wide spread of historical sub-disciplines, such as social history, intellectual history, narrative, gender, memory, psycho-analysis and cultural (...) studies, taking in, along the way, the work of thinkers such as Paul Ricouer, Michel Foucault and Hayden White. (shrink)

One could only suppose that the apparently forgotten beginning of any story was unforgettable; perpetually one was subject to the sense of there having had to be a beginning somewhere. Like the lost first sheet of a letter or missing first pages of a book, the beginning kept on suggesting what must have been its nature. One never was out of reach of the power of what had been written first. Call it what you liked, call it a miscarried love, (...) it imparted, or was always ready and liable to impart, the nature of an alternative, attempted recovery or enforced second start to whatever followed. The beginning, in which was conceived the end, could not but continue to shape the middle part of the story, so that none of the realisations along that course were what had been expected, quite whole, quite final. (shrink)

Then we Bishops appeared and took our seats on the tribunal of the cathedral. Clotild was called before us. She showered abuse on her Abbess and made a number of accusations against her. She maintained that the Abbess kept a man in the nunnery, dressed in woman's clothing and looking like a woman, although in effect there was no doubt that he was a man. His job was to sleep with the Abbess whenever she wanted it. “Why! There's the fellow!” (...) cried Clotild, pointing with her finger. Thereupon a man stepped forward, dressed in woman's clothing as I have told you. Everyone stared at him. He said that he was impotent and that that was the reason why he dressed himself up in this way. He maintained that he had never set eyes on the Abbess, although, of course, he knew her by name. He had never spoken to her in his life, and, in any case, he lived more than forty miles out of Poitiers. Clotild failed to prove her Abbess guilty on this count. (shrink)

Having shown the structural affinities between the Critique of Pure Reason and the Critique of Practical Reason, the dissertation takes up the interpretative issue of the "primacy of practical reason." This results in a demonstration that primacy rests upon the importance Kant gave to the spontaneous subject as the determining ground of a priori knowledge. Primacy, then, rests upon the fact that in action, the cognition of this self-active subject is possible. Finally, primacy is directly related to the fact that (...) in action reason's interest in the unconditioned is exhibited. ;This dissertation is a reconstruction of Kant's system of the primacy of practical reason. The reconstruction bases the meaning of "primacy" in the existence of the self-active subject of the second Critique as the Bestimmungsgrund of action, of practical knowledge and theoretical knowledge. The reconstruction proceeds first methodologically and then interpretatively. ;Methodologically models for transcendental arguments, transcendental frameworks and transcendental deduction are articulated expansively enough to explicate the Critique of Practical Reason as a technically rigorous transcendental work. The models used in analyzing the "Analytic" of the second Critique demonstrate the necessity for grounding the unity of the practical phenomenal manifold in the spontaneity of the subject. The resulting unity is an individuated self cognized as a unitary will with a manifold of desire idiosyncratic to it. Such a subject is demonstrated to be dependent upon the constitution of a free and universal subject by virtue of the fact that only through Wille is Willkur possible, since only Wille can provide an a priori organizing principle for cognizing volition. (shrink)

Nancy Gayer, M F Burnyeat; Play and Pleasure, Journal of Philosophy of Education, Volume 5, Issue 1, 30 May 2006, Pages 29–36, https://doi.org/10.1111/j.1467-97.

Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

En los más disímiles contextos universitarios, se generan hoy programas para mejorar los desempeños de los docentes en el proceso formativo; pero, infortunadamente estos no siempre resultan en un mejoramiento de la práctica cotidiana de las universidades, sobre todo en la calidad de la formación de los profesionales. De este hecho, el propósito del presente artículo está dado en realizar una valoración de las principales influencias epistemológicas en lo relativo a la profesionalización del docente universitario y develar aquellos desempeños idóneos (...) esenciales que deben poseer en este nivel de educación como expresión de las competencias que deben desarrollar. Today, in most diverse university contexts, programs are developed to improve the performance of professors in the educational process; but unfortunately, they do not always result in improving the daily practice of universities, especially in the quality of professionals training. Of this fact, the purpose of the present article is to carry out a valuation of the main epistemological influences related to the professionalization of universities` professors; and to determine the main essential suitable performances these professionals should have as an expression of the competences they must develop. (shrink)

Moshe Tati, a sanitation worker in Jerusalem, was among the first of more than a thousand mortally sick Israelis who signed up for illicit and clandestine ‘transplant tour’ packages that included: travel to an undisclosed foreign and exotic setting; five-star hotel accommodation; surgery in a private hospital unit; a ‘fresh’ kidney purchased from a perfect stranger trafficked from a third country. Although Tati’s holiday turned into a nightmare and he had to be emergency air-lifted from a rented transplant unit in (...) a private hospital in Adana, Turkey back to Israel, Moshe became a poster-boy of transplant tourism for the next decade. João Cavalcanti was among the first of 38 residents of the slums of Recife recruited by retired military Captain Ivan da Silva and his sidekick Captain Gadddy Tauber to travel to Durban, South Africa to provide a spare kidney to an Israeli transplant tourist in Durban. This article examines the logics and practices through which kidney buyers and kidney sellers, organs brokers, surgeons and their accessories convince themselves that they are engaged in an illegal but still mutually beneficial ‘medical-recreational’ adventure, an ‘extreme medical sport’ of sorts. While life, health and survival motivate ‘transplant tourism’, a euphemism for human trafficking in spare body parts, the freedom to roam, mobility, is an essential feature of transplant tours for kidney buyers and kidney sellers. (shrink)

As concerns about the negative health effects of unhealthy eating, overweight and obesity have increased, so too have policy efforts to promote healthy eating. Federal, state, and local governments have proposed and implemented a variety of healthy eating policies. Many of these policies are controversial, facing objections that range from the practical (e.g., the policy won’t succeed at improving people’s diets) to the ethical (e.g., the policy is paternalistic or inequitable). Especially controversial have been policies limiting the options offered in (...) the marketplace, limiting access to certain options, or providing disincentives for the purchase of certain options. Examples of such policies include proposed .. (shrink)

When classes of structures are not first-order definable, we might still try to find a nice description. There are two common ways for doing this. One is to expand the language, leading to notions of pseudo-elementary classes, and the other is to allow infinite conjuncts and disjuncts. In this paper we examine the intersection. Namely, we address the question: Which classes of structures are both pseudo-elementary and ${\mathcal {L}}_{\omega _1, \omega }$ -elementary? We find that these are exactly the classes (...) that can be defined by an infinitary formula that has no infinitary disjunctions. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

PurposeIn Western society, the measurement of weight is prioritized over a person’s bodily experience. Hermeneutic philosopher Gadamer warned against the emphasis on measurement, rather than experience, in the medical sciences. An examination of the complexity of the experience of weight provides the opportunity to shift focus from quantifying the connection between health and weight to the experience of the person being weighed.MethodsThis qualitative hermeneutic study aims to understand people’s experiences of weight from the interviews of professionals and lay experts. Interviews (...) were analyzed using an interpretive hermeneutic method.ResultsThe interviews revealed that weight was experienced as a number imbued with meaning and bias, as a number that could be manipulated, and as a constant and anticipated bodily change. Weight change was expected and often unwelcomed, despite weight being a quality of the body that is always in flux. External measures of weight meant to monitor wellness and health inadvertently became an unhealthy fixation that prevented some participants from fully participating in life events and appreciating the stages their bodies were in.ConclusionWeight change is a necessary condition of being human, and bodies are and will be constantly changing. To achieve health and harmony, one must fit together the acceptance of change and their bodily experience of weight. It is often the preoccupation with weight, not weight itself, that gets in the way of living. (shrink)

"I begin to discern the profile of my death." This sentence from Marguerite Yourcenar's novel Memoirs of Hadrian has stuck with me over the decades. In checking the quote, I learned that this sentence from an early draft caught the novelist's attention, and encouraged her to write the book from perspective of the dying Roman emperor. Something of this magic – finding, in one's earlier thoughts, a key that unlocks a story – is at work in F.M. Kamm's Almost Over, (...) a book constructed as a series of rigorous conversations with her own work, that of fellow American philosophers over the past 50 years, and with public policy, aimed at bringing the profile of death into view, considering how mortality shapes the... (shrink)

All Canadian bioethicists need to reflect on the meaning and value of their work, to see more clearly how the ethics of bioethics is being undermined from within. In the case involving Dr Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc, there were countless opportunities for bioethical heroism. And yet, no bioethics heroes emerged from this case. Much has been written about the hospital’s and the university’s failures in this case. But what about the (...) deafening silence from the Canadian bioethics community? Given the duty of bioethicists to “speak truth to power”, this silence is troubling. To date, nothing has been written about the silence. This article is intended as a partial remedy. As well, the article pays tribute to heretofore unsung heroes among Dr Olivieri’s research colleagues. (shrink)