No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)
The conference entitled ‘Best Practices in Clinical Ethics Consultation and Decision-Making’, held in London 8–9 July 2010, was the first of its kind dedicated to identifying best practices in clinical ethics consultation and decision-making. Academics, health and social care professionals, clinical ethics committee members, lawyers, service users and carers from the UK, USA, Europe, Canada, Australia and Asia attended lectures, workshops, parallel paper sessions and clinical ethics case discussions across adult, maternity, children's, older persons, mental health and learning disabilities settings. (...) Seventy-eight best-practice points impacting on the quality of clinical ethics consultations and subsequent decisions were identified and grouped into eight themes: who tells the story; how the story is told; how the analysis, discussion and subsequent decisions are made; how values are weighted and balanced against one another; who decides; how the decision is made; how group dynamics and conflict are handled; how decisions are recorded. (shrink)
Substituted judgement is often used in the absence of advanced directives to guide decision-making when patients lack decisional capacity. We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. (...) This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem ethically appropriate to continue treatment, even with substantial disability the likely outcome. (shrink)
In the later Indian Yogācāra school, yogipratyakṣa, the cognition of yogins is a key concept used to explain the Buddhist goal of enlightenment. It arises through the practice of meditation upon the Four Noble Truths. The method of the practice is to contemplate their aspects with attention (sādara), without interruption (nairantarya), and over a long period of time (dīrghakāla). A problem occurs in this position since Buddhists hold the theory of momentariness: how is possible that a yogin attains yogipratyakṣa even (...) when everything arises and perishes moment by moment. It is not possible for the momentary mind to fix on the object. Neither is the intensification of the practice possible in a stream composed of cognitions different at each moment. To provide a solution of this problem, a renown eleventh century Buddhist logician, Jñānaśrīmitra, assures us that momentariness is incompatible with duration (sthāyitā), but not with the occurrence of dissimilarity (visadṛśotpāda). Even if cognitions are momentary, the vividness of an object continues to intensify in the course of each preceding cognition-moment producing, in turn, its following moment. Jñānaśrīmitra discusses the attainment of yogipratyakṣa in terms of Buddhist ontological distinctions of moment (kṣaṇa) and continuum (santāna). At the level of the continuum, the process of enlightenment is considered gradual. By retaining a strict adherence to the final moment of the practice, on the other hand, the process is considered sudden. (shrink)
Resource allocation decisions are often made on the basis of clinical and cost effectiveness at the expense of ethical inquiry into what is acceptable. This paper proposes that a more compassionate model of resource allocation would be achieved through integrating ethical awareness with clinical, financial and legal input. Where a publicly-funded healthcare system is involved, it is suggested that having an agency that focuses solely on cost-effectiveness leaving medical, legal and ethical considerations to others would help depoliticise rationing decisions and (...) command greater public acceptance. (shrink)
Theorists at the interface of medicine and the humanities have recently suggested that interpretation as a literary activity can be applied to the practice of clinical medicine. This article reviews such theories and their literary metaphors and methods. In pushing these ideas further, it is proposed that a number of guidelines can be applied to interpretation as a practical activity for clinical medicine.
Enlightened experience (i.e. awakened to the truth) is the most valuable one in most religions including Christianity and Buddhism. As well-known cases of such experience are Apocalypse St. Paul and many Grand Zen masters in Zen Buddhism, it is natural for us to believe that the enlighten is for very talented or speciallytrained ones. However, applying the complexity theory on the structure of enlightenment, based on the power law function, selforganized criticality, phase transition, and emergence, it is clear that the (...) full awakening can be experienced by everyone in daily life. Furthermore, such experiences are not necessary to be limited in religious one. Rediscovering the path to full awakening by complexity theory leads to the demythologization of the enlightenment in Korean Zen Buddhism, which emphasizes a hard apprenticeship in temple for long periods for the purpose. (shrink)
The positive reception of Buber’s philosophy does not fully match Buber’s intention in terms of overcoming the problem of the subject–object binary. In other words, a number of authors have remained within the traditional way of thinking by merely replacing the subject and object with Buber’s I and You, establishing a more dogmatic normative subjectivity, paradoxically going against Buber’s intent and even seemingly not noticing this problem. In this article, we will investigate the reasons for these paradoxical readings of Buber. (...) By focusing on the structure and significance of Buber’s ontology of between-humane, we will study the concept of I–You and I–It, suggesting that these are not intentionality-oriented concepts, but a radically relationship-centered one. The theoretical problem caused by Buber himself in the process of adaptation of his dialog-philosophy to his dialog-pedagogy, namely the impossibility of complete mutuality in the educational relationship will be critically examined, based on Buber’s own declaration in his “Afterword” (1957) in I and Thou (1923). With this, we will reflect on the problematic situation of post-Buberian literature in contemporary pedagogy to pave a way to modernize Buber’s dialog-pedagogy. (shrink)
The ethics of Wolfhart Pannenberg has a nomological dimension at its center. Based on the history of the natural law tradition, Pannenberg maintains the possibility of the natural law theory on the following five grounds. -/- The theological ground is his understanding of the Decalogue, the Sermon on the Mount, and the Pauline interpretation of the law. For its historical ground, Pannenberg articulates the natural law theories of Patristic theology and the theologies of Troeltsch and Brunner. The ontological ground is (...) the order of the world, which God established in the process of history. The anthropological ground is the mutuality of human society. The latter two dimensions are related to the epistemological ground, which is based on the hermeneutics of universal history. -/- Pannenberg attempts to combine the law, the gospel, and love in relation to the Kingdom of God. Thus, Pannenberg’s Kingdom ethics is nomological as well as eschatological. (shrink)
Although providing aid in conflict is implicitly political, involving humanitarian actors and aid in conflict resolution initiatives, as Weiss advocates, risks diluting the primary responsibility of humanitarian aid to alleviate suffering.
After a discussion of the possible connections between quantum mechanics and consciousness, and an examination of the circumstances under which some properties of a macroscopic system may be described by a quantum mechanical wave function, we propose three types of experiments in which one may search for the possible existence of quantal interference in mental events.
Medical narrative is normally assumed to be a past tense narrative. Patients’ and students’ past tense narratives should be supplemented by future tense narratives, and in particular by what we call hypothetical narratives—narratives such as those offered by a medical student in response to the instruction “Tell me a story about when you are a doctor”. These narratives are suggested to be especially useful in clinical and educational contexts because they offer greater insight into the narrator’s hopes and expectations than (...) past tense narratives, which can be helpful in planning management and teaching. The narrator’s ethical principles are also exposed more clearly than when using the past tense narrative. Some ethical concerns raised by analysing narratives offered by patients or students, as if they were literary narratives, are avoided by hypothetical narratives. This suggestion is based on Ricoeur’s account of the ethical importance of veracity in narrative, or “attestation of what has occurred”. The patient/doctor or student/teacher relationship is found to have an implicit concern for the narrator’s intention that makes the assumptions underlying literary analysis untenable. (shrink)
As one aspect of China's modernization, the importation of Western psychiatric ideas poses a mystery. How are such ideas integrated with traditional assumptions? The apparently wholesale adoption of Western psychiatric categories runs counter to the fact that the Chinese have been generally reluctant to define problems in highly individualized psychiatric terms. Our lack of knowledge as to how the Chinese and Western medical models interface raises questions about the cross-cultural applicability of psychiatric theory. Ironically, the very conceptual categories intended to (...) facilitate professional discourse obscure cultural, political, and epistemological differences between Chinese and Western thought.This paper focuses on certain incongruities in psychiatric theory and practice in order to underscore many unresolved issues that still exist with respect to our cross-cultural understandings of mental illness. Insofar as the trend has been towards standardizing methodology, taxonomies have been generated without a corresponding development in textured comparison. Originating from Western theoretical frameworks, comparative analyses have been otherwise devoid of culture-specific knowledge. (shrink)
Laws, codes, and rules are essential for any community, public or private, to operate in an orderly and productive fashion. Without laws and codes, anarchy and chaos abound and the purpose and role of the organization is lost. However, danger is significant, and damage serious and far-reaching when individuals or organizations become so focused on rules, laws, and specifications that basic principles are ignored. This paper discusses the purpose of laws, rules, and codes, to help understand basic principles. With such (...) an understanding an increase in the level of ethical and moral behavior can be obtained without imposing detailed rules. (shrink)
Though many philosophers and scientists have been tried to define life, the view of materialism is substantiated by modern bioscience. Reductive approach of biology, however, cannot explain the holistic nature of life. As the science of complexity showed, life form is appeared on earth by emergence with self-organized criticality. From the interdependency of emergent life on others, man could be called as 'Homo interdependant' on network of biosphere. Phylogeny of life in evolutionary process showed 'difference and repetition'. With the emergent (...) nature of life, difference caused the individuality, which is a one of most distinguished features of life. Furthermore, because Individual experience cannot be replaced by others, responsibility of each daily life was also emerging. (shrink)
Researchers in medical education have extensively studied negative reactions to gross anatomy, sometimes grouped under the term “the cadaver experience.” Although there has been disagreement about the extent and importance of such phenomena, several attempts at curricular reform have been designed to “humanize” the student-cadaver encounter. However, some obvious sources linking gross anatomy and the humanities have been consistently overlooked. Such sources—from the history of art, the history of anatomy, and autobiographical and imaginative literature—not only bear witness to the “cadaver (...) experience” for anatomists of the past, but also offer forgotten alternatives for placing present-day reactions in perspective. Former methods of teaching which used such material might serve as models for reintegrating the humanities into the study of gross anatomy as a possible humanizing force. (shrink)
This article describes a model of DNA banking that incorporates appropriate consumer influence on the design and use of DNA data banks. This model values input of consumer stakeholders in key decisions, including contracts between donors, researchers and the bank.
Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)
In his 1958 seminal paper “Saints and Heroes”, J. O. Urmson argued that the then dominant tripartite deontic scheme of classifying actions as being exclusively either obligatory, or optional in the sense of being morally indifferent, or wrong, ought to be expanded to include the category of the supererogatory. Colloquially, this category includes actions that are “beyond the call of duty” and hence actions that one has no duty or obligation to perform. But it is a controversial category. Some have (...) argued that the concept of supererogation is paradoxical because on one hand, supererogatory actions are supposed to be morally good, indeed morally best, actions. But then if they are morally best, why aren't they morally required, contrary to the assumption that they are morally optional? In short: how can an action that is morally best to perform fail to be what one is morally required to do? The source of this alleged paradox has been dubbed the ‘good-ought tie-up’. In our article, we address this alleged paradox by first making a phenomenological case for the reality of instances of genuine supererogatory actions, and then, by reflecting on the relevant phenomenology, explaining why there is no genuine paradox. Our explanation appeals to the idea that moral reasons can play what we call a merit conferring role. The basic idea is that moral reasons that favor supererogatory actions function to confer merit on the actions they favor—they play a merit conferring role—and can do without also requiring the actions in question. Hence, supererogatory actions can be both good and morally meritorious to perform yet still be morally optional. Recognition of a merit conferring role unties the good-ought tie up, and there are good reasons, independent of helping to resolve the alleged paradox, for recognizing this sort of role that moral reasons may play. (shrink)
In 'Jackson on physical information and qualia' Terry Horgan defended physicalism against Frank Jackson's Knowledge Argument by raising what later has been called the 'mode of presentation reply'- arguingthatthe Knowledge Argumentis fallacious because itsubtly equivocates on two different readings of 'physical information'. In 'Mary, Mary, quite contrary' however, George Graham and Terry Horgan maintain that none of the replies against Jackson has yet been successful, not even Horgan's own 1984 rejoinder.Tosubstantiate their claim, they present an allegedly improved version (...) of the Knowledge Argument, the 'Mary Mary Argument' whose default moral is property-dualism. In section 1, I will set the scene by making some clarifying remarks regarding Jackson's original argument. In section 2, I will consider several objections to the most promising physicalist rejoinder to the Knowledge Argument, the mode of presentation reply. In section 3 I will discuss the Mary Mary Argument and propose the indexical account of consciousness that, as it happens, is based on Horgan's own 1984 account as a possible solution. Finally,in section 4, I will argue that to the extent that the Mary Mary Argument exceeds the force of Jackson's original challenge it coincides with Joe Levine's Explanatory Gap Argument. (shrink)
It's time to pick up your fedora and embark on a philosophical journey through Discworld! Terry Pratchett is world-famous for the narrative verve and surreal humour of his novels. But now meet another Terry Pratchett – a man of serious metaphysical ideas and sophisticated philosophical insights. In Philosophy and Terry Pratchett thirteen professional philosophers survey such key philosophical issues as personal identity, the nature of destiny, the value of individuality, the meaning of existentialism, the reality of universals (...) and the existence of alternative realities. In considering these and many other equally fascinating themes, close reference is made to more than 35 Discworld novels as well as to the ideas of some of history's greatest philosophers including Aristotle, Hobbes, Rousseau, Kant, Mill, Kierkegaard, Wittgenstein and Rawls. During your journey, you will be surprised by numerous provocative conclusions including the startling claim that the existence of Discworld is logically possible! (shrink)
Artykuł dotyczy zagadnienia znanego pod nazwą „problemu prostych umysłów” tak, jak klaruje się ono w zestawieniu czterech doniosłych głosów w debacie na temat możliwości przypisywania zwierzętom życia mentalnego bez przypisywania im zdolności do posługiwania się językiem. Głosy te należą do: Donalda Davidsona, Johna McDowella, Petera Carruthersa oraz Jose L. Bermúdeza. Dwaj pierwsi autorzy bronią przekonaniowo-pragnieniowego modelu myślenia, w którym decydującą rolę pełni zdolność do posługiwania się językiem. Dwaj pozostali akceptację modelu przekonaniowo-pragnieniowego łączą z argumentem przeciwko wiązaniu myśli z językiem. Analizując (...) szczegółowo argumenty obu stanowisk przychylam się do rozwiązania proponowanego w ramach podejścia sformułowanego w oparciu o ustalenia Carruthersa i Bermúdeza. (shrink)
In his review of my book, Terry Godlove raises some robust objections to the exegesis of Kant that I present in my recent book, Kant and the Creation of Freedom: a Theological Problem (Oxford/New York: Oxford University Press, 2013). I respond to these criticisms in this article. Properly to locate Godlove’s exegetical objections, I dedicate the first section to setting out the arc of the argument I trace. I then set out and treat in turn Godlove’s main objections to (...) my exegesis: that it depends upon an interpretation of transcendental idealism which makes the doctrine ‘flatly inconsistent and probably just silly’; that I neglect the most plausible account interpretation of Kant’s various statements about transcendental idealism; and that I ‘pick and choose’ supporting texts too narrowly, leading to an unbalanced presentation, which is too convenient to my thesis. I conclude with some general methodological reflections—stimulated by Godlove, but not aimed at him—about how historical philosophical texts are often treated. I express some anxieties about the principle of charity that underlies much current exegesis, and ‘rational reconstruction’ of historical texts, and I propose a case for what might be called ‘creative decomposition’ (not of the text, but of the self). (shrink)
Although the title of this book is misleading, Terry Godlove offers valuable insights into Kant’s approach to concept formation, and how this relates to conceptualizing religion.The book deliberately sets narrow limits to its discussion of a complex and far-ranging topic that spans most of Kant’s major writings. In six loosely-connected chapters, Godlove explores various aspects of the relation between Kant’s epistemology and the way we understand and classify religions, hence eschewing “the ‘official’ philosophy of religion,” including Kant’s own . (...) Godlove generally ignores the predominant approaches to Kant and religion, such as exploring “the denial of the knowledge of God in favor of a moral faith” , which unfortunately for him seems to include the crucial issue of the ethical dimension of religious concepts. He also rejects, quite rightly in my judgment, the endeavors of “those of a traditional theological bent whose views are difficult to square with Kant’s texts” (p. .. (shrink)
The last winter issue of Contemporary Chinese Thought about Li Ling's controversial understanding of Confucius as a "homeless dog" ended with a remark that he himself is in many ways homeless in the academic world. Not only does his own love for Chinese culture clash with the pious proponents of the traditional cultural heritage, but in many other ways, he also lingers in the unhomely gray zones of academia. Simultaneously very much at home—but always on the frontier—in a variety of (...) different disciplines such as archeology, paleography, history of thought, philology, philosophy, religion, medicine, and anthropology, he also moves between various niches of learning such as sinology , China studies , and national studies . The articles translated in this double issue highlight Li Ling's view of how the realities of China fit into these academic niches. (shrink)
Some major leftist thinkers, including Alain Badiou, Slavoj Žižek and Terry Eagleton, have lately offered readings that claim the relevance of alternative interpretations of the Christian tradition in the face both of the conservative turn in the Catholic Church and of the contemporary secular oblivion of anything that has to do with religion. Furthermore, post-colonial studies have tended to blame the West en bloc for the disasters of past and present colonization, and have attacked the western endeavour to extend (...) universal truths as an ethnocentric device to facilitate and justify exploitation. In Holy Terror, Terry Eagleton both condemns western politics and questions its appeal to universals; but he also hears in this tradition a demand for a relationship with the other which offers an alternative to that established by current politics and capitalist exploitation. The other is the excluded, the oppressed, the exploited; the true material, rather than ideal, universal produced by global capitalist exploitation. As a consequence, anything that happens in any part of the planet belongs in our world and indicts us, though we tend to build barriers around an ideally safe and stable identity that ignores part of its own reality and that is therefore haunted by it. Texts like the Bacchae or the New Testament open the gates of the city and of the heart to the excluded. Terrorists — saints for their own communities and satanic for the rest — offer an example of the other that is impossible to comprehend within our conventional ways of life. Nevertheless, only if we hear in their violence a demand for justice can an exit be found from the vicious circle of violence and revenge. (shrink)
In United States v. Hensley, a unanimous Court set forth the rule that, "if police have a reasonable suspicion, grounded in specific and articulable facts, that a person they encounter was involved in or is wanted in connection with a completed felony, then a Terry stop may be made to investigate that suspicion." By expanding the scope of the Terry doctrine, Hensley strengthened the power of law enforcement officials to "stop and frisk" individuals who they believe may pose (...) a threat to the themselves and/or the public. Prior to Hensley, the Court's decisions merely sanctioned Terry stops of individuals that law enforcement officers reasonably suspected were about to commit a crime, or were committing a crime at the time of the stop. Thus, by authorizing Terry stops based on an officer's reasonable suspicion that an individual was involved in an already-completed felony, Hensley extended the types of situations under which law enforcement officers may engage in Terry stops. While explicitly expanding the scope of Terry v. Ohio in the context of completed felonies, the Hensley decision left open one major issue-whether the balancing test set forth in Hensley applies to investigatory stops based on an officer's reasonable suspicion that an individual was involved in a completed misdemeanor. With no answer from the Court, lower federal and state courts have attempted to answer this question on their own; in doing so, they have diverged on the issue. Most recently, in United States v. Grigg, the Ninth Circuit expanded the scope of Hensley and applied its balancing approach to Terry stops for completed misdemeanors. This Note argues against the Ninth Circuit's approach and rather for a per se rule against Terry stops for completed misdemeanors. This Note proposes that, in light of the inherent differences between misdemeanors and felonies, Hensley's balancing test should not extend to completed misdemeanors. Furthermore, the use of Terry stops for completed misdemeanors does not further the government and public interest in crime prevention and solving past crimes to an extent great enough to outweigh the great intrusion on privacy rights that Terry stops cause. Additionally, a per se rule provides for efficiency and guidance to police enforcement on routine patrols. Under such an approach, it is easier for private citizens to comprehend and appreciate their rights and understand when those rights are being violated. (shrink)
Some major leftist thinkers, including Alain Badiou, Slavoj Žižek and Terry Eagleton, have lately offered readings that claim the relevance of alternative interpretations of the Christian tradition in the face both of the conservative turn in the Catholic Church and of the contemporary secular oblivion of anything that has to do with religion. Furthermore, post-colonial studies have tended to blame the West en bloc for the disasters of past and present colonization, and have attacked the western endeavour to extend (...) universal truths as an ethnocentric device to facilitate and justify exploitation.In Holy Terror, Terry Eagleton both condemns western politics and questions its appeal to universals; but he also hears in this tradition a demand for a relationship with the other which offers an alternative to that established by current politics and capitalist exploitation. The other is the excluded, the oppressed, the exploited; the true material, rather than ideal, universal produced by global capitalist exploitation. As a consequence, anything that happens in any part of the planet belongs in our world and indicts us, though we tend to build barriers around an ideally safe and stable identity that ignores part of its own reality and that is therefore haunted by it. Texts like the Bacchae or the New Testament open the gates of the city and of the heart to the excluded. Terrorists — saints for their own communities and satanic for the rest — offer an example of the other that is impossible to comprehend within our conventional ways of life. Nevertheless, only if we hear in their violence a demand for justice can an exit be found from the vicious circle of violence and revenge. (shrink)
Terry Eagleton. The meaning of life: A very short introductionOxford: University Press, 2007, 109 pp.For a very short introduction to the meaning of life, this 109-page volume provokes much reflection upon many possible meanings of life. The topic of the book is examined from innumerable perspectives. While the author does not seem to hide his personal views, he does not manifest them as directly as the reader might wish. The meaning of life is well-written and witty; it has four (...) chapters, about three pages on “Further reading,” a brief Index and a dozen illustrations. Although only the first chapter is entitled “Questions and answers,” I am wondering whether all four chapters could bear that title appropriately. In any case, the first paragraph of the first page raises the question of meaninglessness: whether the question of the meaning of life is a meaningful question at all; whether it really is capable of carrying a meaningful answer. (shrink)
The last winter issue of Contemporary Chinese Thought about Li Ling's controversial understanding of Confucius as a "homeless dog" ended with a remark that he himself is in many ways homeless in the academic world. Not only does his own love for Chinese culture clash with the pious proponents of the traditional cultural heritage, but in many other ways, he also lingers in the unhomely gray zones of academia. Simultaneously very much at home—but always on the frontier—in a variety of (...) different disciplines such as archeology, paleography, history of thought, philology, philosophy, religion, medicine, and anthropology, he also moves between various niches of learning such as sinology, China studies, and national studies. The articles translated in this double issue highlight Li Ling's view of how the realities of China fit into these academic niches. (shrink)