A sustainable system has all the essential characteristics of an organism?an irreducible whole that develops, maintains and reproduces, or renews, itself by mobilizing material and energy captured from the environment. What is the nature of the material and energy mobilization that makes an organism? I begin with a brief description of a tentative theory of the organism?developed in detail elsewhere (Ho, 1993; 1994a; 1995a,b; 1996b,c)?as a dynamically and energetically closed domain of cyclic non?dissipative processes coupled to irreversible dissipative processes, which (...) effectively frees the organism from thermodynamic constraints so that it is poised for rapid, specific intercommunication, enabling it to function as a coherent whole. I shall then show how this novel theoretical framework may begin to provide normative criteria for sustainable economic systems, thereby also exposing some of the inadequacies of current models and assumptions. (shrink)
Working at the bedside and within communities as patient advocates, nurses frequently intervene to advance individuals’ health and well-being. However, the International Council of Nurses’ Code of Ethics asserts that nurses should expand beyond the individual model and also promote a rights-enabling environment where respect for human dignity is paramount. This article applies the results of an ethnographic human rights study with displaced populations in Rwanda to argue for a rights-based social advocacy role for nurses. Human rights advocacy strategies include (...) sensitization, participation, protection, good governance, and accountability. By adopting a rights-based approach to advocacy, nurses contribute to health agendas that include more just social relationships, equitable access to opportunities, and health-positive living situations for all persons. (shrink)
The rule of rescue describes the powerful human proclivity to rescue identified endangered lives, regardless of cost or risk. Deciding whether or not to perform a decompressive craniectomy as a life-saving or ‘rescue’ procedure for a young person with a severe traumatic brain injury provides a good example of the ethical tensions that occur in these situations. Unfortunately, there comes a point when the primary brain injury is so severe that if the patient survives they are likely to remain severely (...) disabled and fully dependent. The health resource implications of this outcome are significant. By using a web-based outcome prediction model this study compares the long-term outcome and designation of two groups of patients. One group had a very severe injury as adjudged by the model and the other group a less severe injury. At 18 month follow-up there were significant differences in outcome and healthcare requirements. This raises important ethical issues when considering life-saving but non-restorative surgical intervention. The discussion about realistic outcome cannot be dichotomised into simply life or death so that the outcome for the patient must enter the equation. As in other ‘rescue situations’, the utility of the procedure cannot be rationalised on a mere cost–benefit analysis. A compromise has to be reached to determine at what point either the likely outcome would be unacceptable to the person on whom the procedure is being performed or the social utility gained from the rule of rescue intervention fails to justify the utilitarian value and justice of equitable resource allocation. (shrink)
Decompressive craniectomy is a technically straightforward procedure whereby a large section of the cranium is temporarily removed in cases where the intracranial pressure is dangerously high. While its use has been described for a number of conditions, it is increasingly used in the context of severe head injury. As the use of the procedure increases, a significant number of patients may survive a severe head injury who otherwise would have died. Unfortunately some of these patients will be left severely disabled; (...) a condition likened to the RUB, an acronym for the Risk of Unacceptable Badness. Until recently it has been difficult to predict this outcome, however an accurate prediction model has been developed and this has been applied to a large cohort of patients in Western Australia. It is possible to compare the predicted outcome with the observed outcome at 18 months within this cohort. By using predicted and observed outcome data this paper considers the ethical implications in three cases of differing severity of head injury in view of the fact that it is possible to calculate the RUB for each case. (shrink)
Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate decision in a university in Hong Kong, and the factors affecting their attitudes.Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated.Results: A total of 766 students participated in the study. There were statistically (...) significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient’s own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR.Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient’s own wish as most important in DNR decisions. Family wishes were considered less important than the patient’s own wishes. (shrink)
In The Ethics of Food, Gregory E. Pence brings together a collection of voices who share the view that the ethics of genetically modified food is among the most pressing societal questions of our time. This comprehensive collection addresses a broad range of subjects, including the meaning of food, moral analyses of vegetarianism and starvation, the safety and environmental risks of genetically modified food, issues of global food politics and the food industry, and the relationships among food, evolution, and human (...) history. (shrink)
If mental anomalism is to be interpreted as a thesisunique to psychology, the anomalousness must begrounded in some feature unique to the mental,presumably its rational nature. While the ground forsuch arguments from normativity has been notoriouslyslippery terrain, there are two recently influentialstrategies which make the argument precise. The firstis to deny the possibility of psychophysical bridgelaws because of the different constitutive essences ofmental and physical laws, and the second is to arguethat mental anomalism follows from the uncodifiabilityof rationality. In this (...) paper I argue that bothstrategies fail – the latter because it conflates primafacie and all things considered rationality and theformer because it rests on a false premise, theprinciple of the rational character of belief. Idistinguish four different formulations of thisprinciple and argue that those formulations which areplausible cannot support the argument for mentalanomalism. (shrink)
Critically significant parental effects in behavioral genetics may be partly understood as a consequence of maternal brain structure and function of caregiving systems recently studied in humans as well as rodents. Key parental brain areas regulate emotions, motivation/reward, and decision making, as well as more complex social-cognitive circuits. Additional key environmental factors must include socioeconomic status and paternal brain physiology. These have implications for developmental and evolutionary biology as well as public policy.
BackgroundDepressive disorders are a common form of psychiatric illness and cause significant disability. Regulation authorities, the medical profession and the public require high safety standards for antidepressants to protect vulnerable psychiatric patients. Ketamine is a dissociative anaesthetic and a derivative of a hallucinogen. Its abuse is a major worldwide public health problem. Ketamine is a scheduled drug and its usage is restricted due to its abuse liability. Recent clinical trials have reported that ketamine use led to rapid antidepressant effects in (...) patients suffering from treatment-resistant depression. However, various flaws in study designs, and possible biased reporting of results, may have influenced those findings. Further analyses of ketamine use are needed to ensure patient safety.DiscussionThe use of ketamine in research and treatment of depressive disorders is controversial. Recently, mental health professionals raised ethical concerns about an ongoing ketamine trial in the UK. Also, a Canadian agency reviewed the existing evidence and did not recommend prescribing ketamine to treat depressive disorders. Findings obtained from tightly controlled research settings cannot be easily translated to clinical practice as substance abuse is commonly comorbid with depressive disorders. An effective antidepressant should reduce severity of depressive symptoms without liability problems. Although the US FDA has not approved the use of ketamine to treat depressive disorders, some psychiatrists offer off-label repeat prescription of ketamine. Prescribing ketamine for treating depressive disorders requires substantial empirical evidence. Clinicians should also consider research findings on ketamine abuse. Depressive disorders can be chronic conditions and the current evidence does not rule out the risk of substance abuse after repeat prescription of ketamine. Off-label ketamine use in treating depressive disorders may breach ethical and moral standards, especially in countries seriously affected by ketamine abuse. This article presents two real-world clinical vignettes which highlight ethical principles and theories, including autonomy, nonmaleficience, fidelity and consequentialism, as related to off-label ketamine use.ConclusionWe urge clinicians to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine. (shrink)
Previous research conducted in 1999 highlighted ethical concerns behind challenge studies inducing psychosis with ketamine and made recommendations to enhance ethical standards. Recently, a plethora of clinical trials have evaluated the efficacy of ketamine to treat mood disorders, which lead to complex ethical issues. Pharmaceutical companies and researchers hope to profit by developing patentable variations on ketamine for treating depression. Media have labeled ketamine as a “miracle” antidepressant. Some clinics offer expensive off-label use of ketamine to treat mood disorders. This (...) article examines the ecological validity of ketamine trials, measures to protect patients, informed consent procedures, financial inducements to participants and conflict of interest of researchers, therapeutic misconception, concealment, and deception. Further recommendations are purposed to improve ethical standard of clinical research involving ketamine. (shrink)
An attempt to re-think, within and for the tradition of Husserl and Heidegger, certain central contributions of Greek thought. Interpretations of the Philebus and of other Platonic and Aristotelian texts concerned with problems arising therefrom are carried out; they culminate in an analysis of the fruitful union of intellectual power and impotence in philosophy. The existentialist framework often provides suggestions for the interpretation of difficult transitions in the classical works; conversely, the adherence to the arguments of the Greek texts strengthens (...) the existentialist position with respect to such concepts as world and rationality.--C. B. (shrink)
Tento článek se zastává skepticko-realistického tzv. novo- humovského, výkladu Humovy teorie kauzality navzdory kritice ze strany Zuzany Parusnikové. Autor však v souladu se svou vývojovou interpretací hájí tzv. „nového Huma" pouze pro pozdní tvorbu tohoto skot- ského filosofa.
This paper argues that garbage is no longer the site of contempt and fear and has become an object of profound theoretical investigation. The paper reviews some of the salient points in the growing body of theory about garbage and shows that if one thing has come out of this scholarship, it is that waste is both productive and dangerous, spent but agential, rejected but inescapable, and the intensity of disruptions of order potential in waste are immense. I show that (...) two very different poems – one entitled “Above the Water, Under the Water” by South Korean poet Choi Sung-ho, the other entitled “Garbage” by American poet A.R. Ammons –reveal in very different ways both the agentic capacity of garbage and the ascension of garbage to a semiotics of the sublime in the twentieth century, East and West. (shrink)
Are a statue and the lump of clay that constitutes it one object or two? Many philosophers have answered ‘two’ because the lump seems to have properties, such as the property of being able to survive flattening, that the statue lacks. This answer faces a serious problem : it seems that nothing grounds the difference in properties between colocated objects. The statue and lump are in the same environment and inherit properties from the same composing parts. But it seems that (...) differences in properties should be grounded. For this reason, philosophers including Mark Heller, Dean Zimmerman, Theodore Sider, Trenton Merricks, and Eric Olson have rejected the answer ‘two’. -/- I offer a solution to the grounding problem, in order to revive the traditional account. I argue that extrinsic relations contribute to the supervenience base of many kinds or sorts, and these extrinsic relations ground differences between colocated objects, such as statues and lumps of clay, human beings and lumps of tissue, and planets and masses of matter. The same collection of parts can stand in more than one extrinsic relation, with each relation grounding the composition of a distinct kind of object. In cases in which this happens, the properties of each object differ from the properties of other objects that share the same parts. (shrink)
Legal research is not limited to court decisions andappellate reviews. Since police work determines whichcases enter the justice system, police work,especially street patrol, is essentially theembodiment of criminal law. In this paper, usingconversation transcriptions from police-citizenencounters as my data, and applying Lacan's Theory ofFour Discourses, I examine how subjectivities arerepressed and expressed by the police through controlof the situational definition. I provide thelimitations of ``mainstream'' methods of police researchand suggest how a critical semiotic analysis mightovercome some of the deficiencies.