When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. (...) In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two (...) geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort. (shrink)

The future of work is forcing the world to adjust to a new paradigm of working. New skills will be required to create and adopt new technology and working methods. Additionally, cognitive skills, particularly creative problem-solving, will be highly sought after. The future of work paradigm has threatened many occupations but bolstered others such as engineering. Engineers must keep up to date with the technological and cognitive demands brought on by the future of work. Using an exploratory mixed-methods approach, our (...) study sought to make sense of how engineers understand and use creative problem solving. We found significant associations between engineers’ implicit knowledge of creativity, exemplified creative problem solving, and the perceived value of creativity. We considered that the work environment is a potential facilitator of creative problem-solving. We used an innovative exceptional cases analysis and found that the highest functioning engineers in terms of knowledge, skills, and perceived value of creativity, also reported working in places that facilitate psychosocially safe environments to support creativity. We propose a new theoretical framework for a creative environment by integrating the Four Ps and psychosocial safety climate theory that management could apply to facilitate creative problem solving. Through the acquisition of knowledge to engage in creative problem solving as individuals or a team, a perception of value must be present to enforce the benefit of creativity to the engineering role. The future of work paradigm requires that organisations provide an environment, a psychosocially safe climate, for engineers to grow and hone their sought-after skills that artificial technologies cannot currently replace. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

The term 'Taoism of Clarified Tenuity' designates a new branch of religious Taoism developed since the 13/14th century by priests of the long-established Heavenly Masters Taoism. They claimed to continue Taoist exorcist traditions that since the Sung-period especially flourished because emperor Sung Hui-tsung (r. 1100?1126) appreciated the exorcism of 'Taoism of the Divine Empyrean' and 'Five Thunders rituals'. The purpose of the exorcist rituals was the expulsion of demoniac molestations, relief from droughts and inundations, and the healing of illnesses. Outstanding (...) priests rationalized the exorcist practice, using theories of a meditative self-cultivation which peaked in the transformation into a Thunder divinity. The priest adopted a divine 'alter ego' for the time of the ritual. 'Taoism of Clarified Tenuity' developed on the basis of these traditions and embraced regionally different religious habits. It adopted and adapted older cults, partly including Buddhist-Tantric practices. Leading priests of 'Clarified Tenuity' presented theoretical essays, discussing the requirements of the personal cultivation of the Taoist to be a worthy performer of exorcism who was entitled to write and use amulets. The amulet was the essential ritual tool. However, the amulets of 'Clarified Tenuity' were remarkably different from the older 'Thunder' amulets of the Sung era. Also, the new branch adopted different attitudes concerning ritual practices such as the transformation into a divinity.0The book features developments of the more recent Taoist history and presents content and intention of 'Taoism of Clarified Tenuity'. The selected canonical texts also show that the priests of 'Clarified Tenuity' insisted on a clear distinction between exorcism in Heavenly Masters Taoism and shamanism that they disavowed. The book presents and analyses several 'Great Rituals' of 'Clarified Tenuity' and features elements of religious Taoism that today can still be traced. (shrink)

The health benefits of male circumcision are wide rangingIn this issue, John Hutson has reiterated the conventional Western medical view that “the surgical argument for circumcision of all neonatal males at present is very weak” and he criticises many of the circumcisions performed in later childhood, without anaesthesia, as “physically cruel and potentially dangerous” [see page 238].1 He is also of the opinion that “the diseases which circumcision is able to prevent are uncommon or even rare”. But therein he errs, (...) and greatly errs.He cites only two publications dealing with the protective effect of male circumcision against HIV infection, and makes no mention of the important recent meta-analysis of Weiss, Quigley, and Hayes2 which shows conclusively from a large number of studies that …. (shrink)

Transhumanist thought on overpopulation usually invokes the welfare of present human beings and the control over future generation, thus minimizing the need and meaning of new births. Here we devise a framework for a more thorough screening of the relevant literature, to have a better appreciation of the issue of natality. We follow the lead of Hannah Arendt and Brent Waters in this respect. With three overlapping categories of words, headed by “natality,” “birth,” and “intergenerations,” a large sample of books (...) on transhumanism is scrutinized, showing the lack of sustained reflection on the issue. After this preliminary scrutiny, a possible defense of natality in face of modern and transhumanist thought is marshaled, evoking a number of desirable human traits. One specific issue, the impact of modern values on natality, is further explored, reiterating that concerns about overpopulation and enhanced humans should keep in sight the natural cycle of birth and death. (shrink)

Decisions about targeting medical assistance in humanitarian contexts are fraught with dilemmas ranging from non-availability of basic services, to massive demographic and epidemiological shifts, and to the threat of insecurity and evacuations. Aid agencies are obliged, due to capacity constraints and competing priorities, to clearly define the objectives and the beneficiaries of their actions. That aid agencies have to set limits to their actions is not controversial, but the process of defining the limits raises ethical questions. In MSF, frameworks for (...) resource allocation are subject to constant reflection and reiteration, and perspectives are sought at all levels, from implementers at the programme level to the operational directors at headquarters. The perspectives of the programmes staff hold considerable weight as they have the knowledge and experience with particular communities to assess the degree of vulnerability and need, and are also the people who ultimately have to give explanations to beneficiaries when changes or closures are going to be instituted. Humanitarian agencies have a responsibility to ensuring that their workers are prepared to reflect on these dilemmas, and challenge the status quo when it costs lives. (shrink)

This exceedingly rich book can be understood as an attempt to grasp the nature of Hegel’s system, specifically the relationship obtaining between that system and its vaunted "transitions." This attempt is carried out through a study of Hegel’s account of Vorstellung and thought. The operational point d'appui of the study is what Clark identifies as the central paradox essentially inherent in his subject, which may be variously formulated as: how language can be the "other" of thought and yet sublated in (...) thought; how pure thought can abide an other; how the Logic can from within itself develop its categories to absolute fulfillment and yet refer beyond itself to its fulfillment; how Hegel can be understood to have "completed" philosophy in the first quarter of the nineteenth century; how one makes sense of the notion of an essentially temporal eternality; how the Logic and the Phenomenology of Mind can each presuppose the other. The developing treatment of this paradox constitutes almost an object lesson in the "preserved" aspect of aufhebung—The or a methodological enactment of the second book of the Logic—for Clark wrestles with the tacky conceptual framework upon which rests the topic under investigation. The whole is deftly handled. Particularly inspired is the close analysis of the Theoretical Mind chapter of the Philosophy of Spirit and its bearing upon the Logic’s "Essence." This coupling, together with a treatment of the Philosophy of Religion constitutes one of the two foci of the book. What comes clear from this extended study is an appreciation of the fundamental difficulties connected with any philosophical explanation that has failed to resolve satisfactorily the relationship between ground and consequent and treats them either as being simply different or from the standpoint of a simply presumed totality. Clark’s considered position is that Hegel’s thought is paradoxical precisely in its intelligibility. Ultimately, he can only reiterate the paradox one final time: "The paradox of a Logic that is at once the whole and but a part of experience is thus a systematic expression of the need for reconciliation of a standpoint that is simply accomplished and a standpoint that is ever accomplishing itself." Now for the misgivings, which are for the most part issues of form. There is an obstinate problem of indistinctness running through the work. The recurrent summaries, both internal and thematic, the forecasts, the exhaustively particularized table of contents, are all tacit concessions to the existence of this problem. Seldom do positions come ringing through with conviction; often, notwithstanding the above-mentioned signposts, their origin, their precise connection to the text, is obscure. This is particularly true of the truncated final passages, where interpretation converts to criticism. In short, a fuller statement of significance might well have been supplied. A second problem, or at the least an annoying inconvenience, is the decision not to translate most of the abundant quotations from Hegel’s works into English. Some of the quotations are, for no apparent reason, in fact translated; and with well over 900 footnotes in a 200-page text anyway, translations would hardly constitute a stylistic blemish.—R. J. G. (shrink)

Despite the fact that today only very few still regard the old socialist ideas with nationalization ofenterprises and central planning as a way to promote more efficient production, greater equality, or a more “just” distribution of income some of its conceptions nevertheless seem to have penetrated into the minds of a majority of socialist scientists. There still is this deeply rooted constructivist belief that every social and economic problem can be solved by “social engineering”, “social planning”, or by just throwing (...) government money at it. Although not openly advocating economic planning, it is widely believed that “social legislation” or “social politics” sold in a more subtle way can be used to achieve an already predetermined end: “social justice”. Most of these attempts, however seem to be little more than a repetition of the old planning idea dressed in emotionally more appealing clothes.Bien que peu nombreux soient ceux qui considèrent encore aujourd’hui les anciennes idées socialistes de nationalisation des entreprises et de planification centrale comme la voie menant à une production plus efficace, à plus d’égalité et à une distribution plus “juste” des revenus, certaines de ces conceptions semblent cependant s’être ancrées dans l’esprit de la majorité des scientifiques socialistes. Le sentiment constructiviste suivant lequel tout problème social ou économique peut être résolu à travers l’“ingénierie social”, la “ planification centrale” ou des dépenses supplémentaires de l’Etat demeure profondément enraciné. Même si leur obédience aux idées centralisatrices n’est pas ouvertement évoquée, la croyance est largement partagée qu’une “législation sociale” ou des “politiques sociales” mises en avant de manière plus subtile peuvent être employées pour atteindre un objectif déterminé à l’avance : la “justice sociale”. Cependant, la plupart de ces politiques ne semblent être rien d’autre que la réitération de l’ancienne illusion de planification centrale simplement revêtue d’une dimension émotionnelle plus attrayante. (shrink)

The target article sought to question the common belief that our decisions are often biased by unconscious influences. While many commentators offer additional support for this perspective, others question our theoretical assumptions, empirical evaluations, and methodological criteria. We rebut in particular the starting assumption that all decision making is unconscious, and that the onus should be on researchers to prove conscious influences. Further evidence is evaluated in relation to the core topics we reviewed (multiple-cue judgment, deliberation without attention, and decisions (...) under uncertainty), as well as priming effects. We reiterate a key conclusion from the target article, namely, that it now seems to be generally accepted that awareness should be operationally defined as reportable knowledge, and that such knowledge can only be evaluated by careful and thorough probing. We call for future research to pay heed to the different ways in which awareness can intervene in decision making (as identified in our lens model analysis) and to employ suitable methodology in the assessment of awareness, including the requirements that awareness assessment must be reliable, relevant, immediate, and sensitive. (shrink)

An initial study of Robin George Collingwood's The Principles of Art and Benedetto Croce's Aesthetic: A Science ofExpression and General Linguistic gives an immediate impression that Collingwood appropriated and incorporated many elements in Croce's work to his own position. This is probably the main reason why Collingwood, in his correspondence with Croce, sincerely expressed his gratitude to the Italian Philosopher for laying the foundation of his art-theory. Collingwood's acknowledgement of Croce's influence and the apparentsimilarity in their theories on art disposes (...) us to wonder if Collingwood mayhave only extended, hence, reiterated the principles of Croce's position. Given this impression, the present article hopes to provide a study between Collingwood's and Croce's theories of art in the hope that we can tease out a crucial difference between their standpoints. If we can demonstrate a significant difference, then we may have provided ourselves with the cudgels to assert that Collingwood's theory of art is also unique. (shrink)

Growing out of a suggestion of Paul Weiss when he served as editor of the Review of Metaphysics, a series of interrogations have been conducted with seven prominent philosophers including Buber, Wild, Wahl, Blanshard, Weiss, Hartshorne and Tillich. Each interrogation has been supervised by a philosopher familiar with the work of the interrogated philosopher and queries submitted by a wide variety of philosophers are carefully organized. Because the questions are frequently pointed and well-formed, the result is lively and informative. Some (...) of the philosophers interrogated are especially adept at facing up to the queries while others seem content to reiterate original formulations of their positions. One feels that he is listening in on genuine philosophic conversations which should prove helpful for anyone who wants to understand and assess the philosophic contribution of the philosophers who are here so incisively questioned.—R. J. B. (shrink)

It is good to have this fine English translation of the second German edition of Kelsen's Reine Rechtslehre, which has heavily influenced so much contemporary thought on jurisprudence and the philosophy of law. Reading Kelsen now one is struck by the stilted and naïve positivism that pervades his thought. At the same time, one is also impressed by the clarity that he brings to what is normally a very muddled area. There is a bold statement of the "pure" theory, a (...) sharp distinction between the legal and the moral orders, a reiteration of the "dualism" of the is and the ought, and a defense of legal norms as the object of the science of law. While Kelsen's quasi-dogmatic pronouncements can provoke disagreements at almost every stage of his argument, the book is certainly one which must be directly encountered by any serious student of the philosophy and theory of law.—R. J. B. (shrink)

The emergence of Big Data has added a new aspect to conceptualizing the use of digital technologies in the delivery of public services and for realizing digital governance. This article explores, via the ‘value-chain’ approach, the evolution of digital governance research, and aligns it with current developments associated with data analytics, often referred to as ‘Big Data’. In many ways, the current discourse around Big Data reiterates and repeats established commentaries within the eGovernment research community. This body of knowledge provides (...) an opportunity to reflect on the ‘promise’ of Big Data, both in relation to service delivery and policy formulation. This includes, issues associated with the quality and reliability of data, from mixing public and private sector data, issues associated with the ownership of raw and manipulated data, and ethical issues concerning surveillance and privacy. These insights and the issues raised help assess the value of Big Data in government and smart city environments. (shrink)

The target article sought to question the common belief that our decisions are often biased by unconscious influences. While many commentators offer additional support for this perspective, others question our theoretical assumptions, empirical evaluations, and methodological criteria. We rebut in particular the starting assumption that all decision making is unconscious, and that the onus should be on researchers to prove conscious influences. Further evidence is evaluated in relation to the core topics we reviewed (multiple-cue judgment, deliberation without attention, and decisions (...) under uncertainty), as well as priming effects. We reiterate a key conclusion from the target article, namely, that it now seems to be generally accepted that awareness should be operationally defined as reportable knowledge, and that such knowledge can only be evaluated by careful and thorough probing. We call for future research to pay heed to the different ways in which awareness can intervene in decision making (as identified in our lens model analysis) and to employ suitable methodology in the assessment of awareness, including the requirements that awareness assessment must be reliable, relevant, immediate, and sensitive. (shrink)

The target article sought to question the common belief that our decisions are often biased by unconscious influences. While many commentators offer additional support for this perspective, others question our theoretical assumptions, empirical evaluations, and methodological criteria. We rebut in particular the starting assumption that all decision making is unconscious, and that the onus should be on researchers to prove conscious influences. Further evidence is evaluated in relation to the core topics we reviewed (multiple-cue judgment, deliberation without attention, and decisions (...) under uncertainty), as well as priming effects. We reiterate a key conclusion from the target article, namely, that it now seems to be generally accepted that awareness should be operationally defined as reportable knowledge, and that such knowledge can only be evaluated by careful and thorough probing. We call for future research to pay heed to the different ways in which awareness can intervene in decision making (as identified in our lens model analysis) and to employ suitable methodology in the assessment of awareness, including the requirements that awareness assessment must be reliable, relevant, immediate, and sensitive. (shrink)

The target article sought to question the common belief that our decisions are often biased by unconscious influences. While many commentators offer additional support for this perspective, others question our theoretical assumptions, empirical evaluations, and methodological criteria. We rebut in particular the starting assumption that all decision making is unconscious, and that the onus should be on researchers to prove conscious influences. Further evidence is evaluated in relation to the core topics we reviewed (multiple-cue judgment, deliberation without attention, and decisions (...) under uncertainty), as well as priming effects. We reiterate a key conclusion from the target article, namely, that it now seems to be generally accepted that awareness should be operationally defined as reportable knowledge, and that such knowledge can only be evaluated by careful and thorough probing. We call for future research to pay heed to the different ways in which awareness can intervene in decision making (as identified in our lens model analysis) and to employ suitable methodology in the assessment of awareness, including the requirements that awareness assessment must be reliable, relevant, immediate, and sensitive. (shrink)

In response to Robert Hartford's criticisms of his Spring 2006 Journal of Ayn Rand Studies essay, "Rand and Choice," Machan reiterates the main point: Prior to the choice to live/think, a human being cannot be aware of any principle of ethics. So the choice to live/think cannot rest on such a principle. Only once that choice has been made—however incrementally, gradually, by fits and starts—can one be rationally expected to live a principled life.

In response to Robert Hartford's criticisms of his Spring 2006 Journal of Ayn Rand Studies essay, "Rand and Choice," Machan reiterates the main point: Prior to the choice to live/think, a human being cannot be aware of any principle of ethics. So the choice to live/think cannot rest on such a principle. Only once that choice has been made—however incrementally, gradually, by fits and starts—can one be rationally expected to live a principled life.

We are now seeing a new wave of literature about the “crisis” of the welfare state. In the earlier wave, some critics charged that social spending significantly detracted from macro‐ or microeconomic performance, while others challenged the legitimacy or efficacy of welfare programs; a third group worried about the effect of macroeconomic problems on the viability of the welfare state. None of these criticisms can be said to have been satisfactory, and continued reiterations of them betray a lack of cross‐national (...) perspective and a priori reasoning about empirical matters. Works with greater historical depth and more recent studies constitute a much‐needed reaction against the “crisis” literature. (shrink)

This study consists of two parts. The first is an examination of the hermeneutical presuppositions underlying the theory of models that Moshe Idel has applied to the study of Jewish mysticism. Idel has opted for a typological approach based on multiple explanatory models, a methodology that purportedly proffers a polychromatic as opposed to a monochromatic orientation associated with Scholem and the so-called school based on his teachings. The three major models delineated by Idel are the theosophical-theurgical, the ecstatic, and the (...) magical or talismanic. Idel’s hermeneutic rests on the assumption that the phenomenon of Jewish mysticism (as the phenomenon of religion more generally) cannot be essentialized, and therefore no one methodological approach should be privileged as the exclusive means to ascertain it. In the second part of this study, I raise the possibility that affirming set patterns of thought and a unified system of symbols that link together kabbalists from different historical periods might not inevitably implicate the scholar in a methodological reductionism. Moving beyond a binary logic, which is still operative in the postmodern dichotomy of truth and dissimulation, I surmise that the polysemic nature of the text that may be elicited from kabbalistic sources is not dependent on the rejection of laying claim to an inherent and original intent that is recoverable through proper philological attunement. Multivocality and essentialism are not mutually exclusive. Kabbalah, I submit, is a cultural-literary phenomenon that illustrates an open system in which each moment is a mix of newness and repetition, each event a renewed singularity. The hermeneutical praxis appropriate to this system displays a temporality linked to the conception of time in its most rudimentary form as an instant of diremptive reiteration, the repetition of the same as different in the renewal of the different as same. The tendency to generalize, therefore, should not be misconstrued as viewing the variegated history of Jewish mystical doctrines and practices monolithically. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Every living entity requires the capacity to defend against viruses in some form. From bacteria to plants to arthropods, cells retain the capacity to capture genetic material, process it in a variety of ways, and subsequently use it to generate pathogen-specific small RNAs. These small RNAs can then be used to provide specificity to an otherwise non-specific nuclease, generating a potent antiviral system. While small RNA-based defenses in chordates are less utilized, the protein-based antiviral invention in this phylum appears to (...) have derived from components of the same ancestral small RNA machinery. Based on recent evidence, it would seem that RNase III nucleases have been reiteratively repurposed over billions of years to provide cells with the capacity to recognize and destroy unwanted genetic material. Here we describe an overview of what is known on this subject and provide a model for how these defenses may have evolved. RNase III nuclease domains are widely used in an array of RNA metabolic functions as well as antiviral defenses. Here, we review their current usage as well as provide insight into how these domains may have shaped all major antiviral pathways over the course of evolution. (shrink)

Understanding terrestrial carbon metabolism is critical because terrestrial ecosystems play a major role in the global carbon cycle. Furthermore, humans have severely disrupted the carbon cycle in ways that will alter the climate system and directly affect terrestrial metabolism. Changes in terrestrial metabolism may well be as important an indicator of global change as the changing temperature signal. Improving our understanding of the carbon cycle at various spatial and temporal scales will require the integration of multiple, complementary and independent methods (...) that are used by different research communities. Tools such as air sampling networks, inverse numerical methods, and satellite data allow us to study the strength and location of the global- and continental-scale carbon sources and sinks. Bottom-up studies provide estimates of carbon fluxes at finer spatial scales and examine the mechanisms that control fluxes at the ecosystem, landscape, and regional scales. Bottom-up approaches include comparative and process studies that provide the necessary mechanistic information to develop and validate terrestrial biospheric models. An iteration and reiteration of top-down and bottom-up approaches will be necessary to help constrain measurements at various scales. We propose a major international effort to coordinate and lead research programs of global scope of the carbon cycle. (shrink)

House of Lords ruling on assisted dyingIn July 2009, the House of Lords ruled that the Director of Public Prosecutions must produce clear guidelines on the prosecution of those who help friends or relatives travel abroad for assisted suicide. 1 As previously reported here, both the High Court and Court of Appeal had rejected Debbie Purdy’s case before it reached the Lords.2 As a person with primary progressive multiple sclerosis, she had asked the court to rule that her husband would (...) not face prosecution if he accompanied her to Switzerland if she decides to end her life. 3By requiring the DPP to publish offence-specific guidelines about the circumstances in which a prosecution would be brought, the law lords did not go so far as to assert a right to assistance in dying by legalising assisted suicide. It was reiterated that any change to the criminal law against aiding and abetting suicide remained a political matter for Parliament. The Lords did, however, acknowledge that the right to privacy, and the associated right to autonomy, was potentially infringed by the absence of a transparent policy about those who are competent and terminally ill, or severely and incurably disabled, and who need help to travel abroad for assisted dying. The five law lords unanimously agreed that Ms Purdy’s right to a private life, as protected by article 8 of the European Convention on Human Rights, included the right to clarity regarding the exercise of the DPP’s discretion as to whether or not to prosecute.Following the Lords’ ruling, the DPP, Keir Starmer, confirmed that the new guidance would apply to all acts of assisted suicide, those taking place within and outside of the jurisdiction.4 He then published an interim policy for wide consultation in September 2009, and is expected to produce the final policy in …. (shrink)

Розкрито сутність поняття «рейтинг». Доведено значущість рейтингової оцінки для суб’єктів фінансового ринку, зокрема для страхових компаній, потенційних страхувальників, інвесторів та кредиторів.

This article explores the reasons women of diverse class, racial ethnic, national, and religious backgrounds give for their decisions not to accept an amniocentesis or, having accepted one, not to pursue an abortion after diagnosis of serious fetal disability. The narratives of refusers reveal conflicts and tensions between the universalizing rationality of biomedical interventions into pregnancy and the wider heterogeneous social frame work to which women respond in their decision-making processes.

Although conventionally tracked in the "overdeveloped world" , assistive reproductive technologies are now available in many parts of the globe. This review essay reports on qualitative social science research on techniques such as In Vitro Fertilization, egg purchase, gestational surrogacy, and sex selection across national boundaries. It highlights the disruptions and recuperations of gender and generational relations; religious and legislative regulation; and the opportunities as well as oppressions that the commercialization of the reproductive body entail.

"Williams's masterful translation satisfies (at last!) a long-standing need. There are lots of good translations of Augustine's great work, but until now we have been forced to choose between those that strive to replicate in English something of the majesty and beauty of Augustine's Latin style and those that opt instead to convey the careful precision of his philosophical terminology and argumentation. Finally, Williams has succeeded in capturing both sides of Augustine's mind in a richly evocative, impeccably reliable, elegantly readable (...) presentation of one of the most impressive achievements in Western thought--Augustine's Confessions." --Scott MacDonald, Professor of Philosophy and Norma K. Regan Professor in Christian Studies, Cornell University. (shrink)

The debate and implementation of Clinical Ethics Consultation is still in its beginnings in Europe and the issue of the patient's perspective has been neglected so far, especially at the theoretical and methodological level. At the practical level, recommendations about the involvement of the patient or his/her relatives are missing, reflecting the general lack of quality and practice standards in CEC. Balance of perspectives is a challenge in any interpersonal consultation, which has led to great efforts to develop “technical”approaches, e.g., (...) in psychological counseling or psychotherapeutic treatment. In ethics, unbalance or partiality is a matter of justice and has provoked significant theoretical work, also relevant for practical medical ethics. A lack of balance seems to be particularly serious in those situations, where ethical conflict is triggering a consultation and where the “parties” involved may try to persuade the consultant that their particular opinion is the most convincing; but to our knowledge the connection between patient/relatives involvement and balance has not yet been discussed in the context of CEC. Central questions of access and involvement of the patient and his/her relatives will be analysed and discussed regarding the challenge of balance and the adequate role or attitude of a Clinical Ethics Consultant. It is argued that the Clinical Ethics Consultant should have a methodological awareness regarding the concepts of “neutrality” versus “advocacy” in his/her role and try to achieve a balanced procedure that allows for an optimum of change of perspectives. The argumentation is developed along the narrative of a real case study. Recommendations concerning the involvement of the patient or the relatives are formulated for the practice of CEC. (shrink)

Clinical ethics consultation not only interprets moral issues at the bedside and is not restricted to giving support for the “technical” handling of these moral issues, but it has to substantively address moral values, norms, and conflicts in the process of discussing cases and problems. We call this the normative dimension and use normative in the sense of embracing moral values and convictions of persons and groups, norms, and relevant professional and ethical guidelines as well as legal frameworks. The roles (...) and activities of the consultant as a person and the quality of CEC as a process are discussed in the American Society of Bioethics and Humanities’ Core Competences for Healthcare Ethics Consultation. (shrink)

The global community is currently being confronted with an increasing urgent demand for dialogue among cultures and religions. The question arises with regards to efficient concepts or tools which will help to shape the encounter of the different religions and cultures of the world with one another. Indicative here is the cognition that hospitality has to do with a factor which is proven in almost all religions and cultures of the world. Hospitality is primarily an existential encounter and as such (...) it brings also the experience of difference in socio-religious traditions and in intercultural relations. Gegenwärtig wird in der Weltöffentlichkeit mit zunehmender Dringlichkeit die Forderung nach einem Dialog der Kulturen und der Religionen erhoben. Vor diesem Hintergrund stellt sich die Frage nach tragfähigen Konzepten, welche die Begegnung der Religionen und Kulturen der Welt gestalten helfen. Wegweisend hierfür ist die Erkenntnis, dass es sich bei der Gastfreundschaft um eine Gegebenheit handelt, welche in nahezu allen Religionen und Kulturen der Welt belegt ist. Gastfreundschaft ist zuallererst existentielle Begegnung und bringt als solche auch die Erfahrung der Differenz in die sozio-religiösen Traditionen und in die interkulturellen Beziehungen. (shrink)

Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another “committee”. One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The (...) most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study. (shrink)

What is the status of empirical contributions to bioethics, especially to clinical bioethics? Where is the empirical approach discussed in bioethics related to the ongoing debate about principlism versus casuistry? Can we consider an integrative model of research in medical ethics and which empirical methodology could then be valuable, the quantitative or the qualitative? These issues will be addressed in the first, theoretical part of the paper. The concept of the “embedded researcher” presented in this article was stimulated by the (...) two questions, (1) how can we safeguard that our research will yield valid and meaningful results to practice? and (2), how can we convince clinical colleagues that medical ethics offers relevant contributions to the analysis and solution of problems? One tentative answer has been our effort to elaborate a coherent methodological research approach in the field of end-of-life issues integrating qualitative and quantitative as well as casuistic methodologies. This development is characterized in the second part describing the ECOPE Study (short title)“Ethical Conditions Of Passive Euthanasia.” The achievements and limitations of the suggested approach of the “embedded researcher” are discussed referring to 3 examples of our joint studies about ethical issues concerning(1) critical decision-making in neonatology(2) limitation of treatment in intensive care(3) problems with doctor-patient conversation at the end of life in oncologyConclusions from our studies are put to discussion in the final part of the paper about how to further develop research in the field of end-of-life care and, maybe,clinical bioethics as a whole. (shrink)

Over the last three decades, an escalating portion of U.S. school children has been classified for special education; those with diagnoses entitled to services now number 15 percent of all public school pupils. At the same time, American scientists have focused increasingly on juvenile brains, studying what one psychiatric epidemiologist labeled ‘‘social incapacities.’’ This article reports on the laboratory labors of two scientific groups: neuroscientists who scan children’s brains in search of resting state differences according to diagnosis and psychiatric epidemiologists (...) who look to epigenetics to distinguish differential diagnostic populations. The article focuses on the medicalization of childhood differences and the harmonies and discordances between what researchers and parents understand to be at the root of children’s learning and social capacities. (shrink)