The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

The volume documents, and makes an original contribution to, an astonishing period in twentieth-century philosophy—the progress of Arne Naess's ecophilosophy from its inception to the present. It includes Naess's most crucial polemics with leading thinkers, drawn from sources as diverse as scholarly articles, correspondence, TV interviews and unpublished exchanges. The book testifies to the skeptical and self-correcting aspects of Naess's vision, which has deepened and broadened to include third world and feminist perspectives. Philosophical Dialogues is an essential addition to the (...) literature on environmental philosophy. (shrink)

As a result of in-house discussions stimulated by previous Gonzaga engineering ethics conferences, Coffman Engineers began the implementation of what is to be a company-wide ethics training program. While preparing a curriculum aimed at consulting engineers, we found very little guidance as to how to proceed with most available literature being oriented towards the academic environment. We consulted a number of resources that address the teaching of engineering ethics in higher education, but questioned their applicability for the Consulting Engineering environment. (...) This lack of guidance led us to informal research into the ethical knowledge and attitudes of both consulting engineers and engineering students. Some of our findings were unexpected, and suggest that a simpler approach to teaching ethics to working professionals might be preferred to that typically promoted in higher education. (shrink)

ABSTRACTSince its origin bioethics has been a specialized, academic discipline, focussing on moral issues, using a vast set of globalized principles and rational techniques to evaluate and guide healthcare practices. With the emergence of a plural society, the loss of faith in experts and authorities and the decline of overarching grand narratives and shared moralities, a new approach to bioethics is needed. This approach implies a shift from an external critique of practices towards embedded ethics and interactive practice improvement, and (...) from a legal defence of rights towards fostering interdependent practices of responsibility. This article describes these transitions within bioethics in relation to the broader societal and cultural dynamics within Western societies, and traces the implications for the methodologies and changing roles of the bioethicist. The bioethicist we foresee is not just a clever expert but also a relationally sensitive person who engages stakeholders in reciprocal dialogues about their practice of responsibility and helps to integrate various sorts of knowledge . In order to illustrate this new approach, we present a case study. It concerns a project focusing on an innovation in elderly care, based on the participation of various stakeholders, especially older people themselves. (shrink)

When we discuss the value of a work of art we are confronted immediately with two difficulties: the terms we use, and the peculiar character of art. No one, to my knowledge, has ever doubted that an artist produces a form of some kind, and that in any discussion of art as art that form must somehow be considered; but the terms we use generally have no reference to form. We miss the form in various ways We use terms that (...) are nonartistic—that is, terms that refer to something external to the work, as when we speak of the subject of a painting, of what was depicted rather than the depiction of it, though we know full well that what we respond to is not what was depicted but the depiction of it. "This is a play about Oedipus— what does that tell us of the diverse forms produced by Sophocles, Seneca, Dryden, Voltaire, Gide, Cocteau? Or again, we use terms which are analogical, for example, the "rhythm" of a painting; the difficulty with these is that they are ambiguous and also that, while they may relate to the work, they can designate it only insofar as there is similarity between it and the analogue. Again, we use terms which seem to designate a single form when in fact they refer to forms of the utmost heterogeneity, as when we speak of "the novel"; this usually arises out of the indiscriminate application of the term over some considerable span of history, so that the "historical slippage" of meaning is gradual and goes unnoticed. As the term broadens in meaning to include more and more heterogeneous forms, the essence of each is lost, and the term comes to apply only to accidental analogies between the forms. In the end very little can then be said, involving only the most abstract and general accidents of likeness. Henry James' The Art of Fiction, Percy Lubbock's The Craft of Fiction, and E.M. Forster's Aspects of the Novel illustrate this condition perfectly. The complaint that it is impossible to discuss tragedy because the term has been diversely employed and its proffered justification stem from this condition. The complaint and the justifications are both trivial, and the solution of the difficulty is simple. All that is necessary is to distinguish the different senses of the term by distinguishing the different things to which it is applied. Language is ambiguous, and we use it ambiguously; this in no way implies that the ambiguities cannot be cleared up. Finally, we may use terms which indeed have reference to the form of the work but place the part for the whole; that is, terms which are elements in its definition but do not constitute the complete definition. Thus we designate something, not through the form proper but through the device or method used, as in "drama," "sculpture," "etching," "collage," or through the means or medium, as in "charcoal sketch," "watercolor," "oil painting." The point is not that the object is not, say, a drama or a watercolor; of course it is. The point is rather that these terms do not as such refer to the form and refer to it completely. If in fact they stipulated form, all charcoal sketches would be alike in form, and all oil paintings, and all dramas. One consequence of speaking in such a fashion is that we are likely to confuse the method with the form and talk of, say, "the nature of drama" as though all drama were of the same "nature," whereas the dramatic method is used in a wide variety of forms; or to confuse the medium or means with the form and to assure that the work can have no properties beyond those of its medium, as though artists did not exist and all art were simply nature.Elder Olson, poet and critic, has received numerous awards for his verse . Among his many works are Tragedy and the Theory of Drama, and The Theory of Comedy. His contributions to Critical Inquiry are "The Poetic Process"" , Part 1 of a "Conspectus of Poetry", and Part 2 of a "Conspectus of Poetry". (shrink)

Since its origin bioethics has been a specialized, academic discipline, focussing on moral issues, using a vast set of globalized principles and rational techniques to evaluate and guide healthcare practices. With the emergence of a plural society, the loss of faith in experts and authorities and the decline of overarching grand narratives and shared moralities, a new approach to bioethics is needed. This approach implies a shift from an external critique of practices towards embedded ethics and interactive practice improvement, and (...) from a legal defence of rights towards fostering interdependent practices of responsibility. This article describes these transitions within bioethics in relation to the broader societal and cultural dynamics within Western societies, and traces the implications for the methodologies and changing roles of the bioethicist. The bioethicist we foresee is not just a clever expert but also a relationally sensitive person who engages stakeholders in reciprocal dialogues about their practice of responsibility and helps to integrate various sorts of knowledge (embodied, experiential, visual, and cognitive-scientific). In order to illustrate this new approach, we present a case study. It concerns a project focusing on an innovation in elderly care, based on the participation of various stakeholders, especially older people themselves. (shrink)

Este relato de experiência apresenta resultados da pesquisa sobre a Saúde em Santo Amaro: a partir dos saberes tradicionais das rezadeiras/benzedeiras que teve por objetivo analisar as práticas medicinais e espirituais com o sagrado. A pesquisa etnográfica foi realizada com as rezadeiras, dessa forma, estabelecendo fronteiras com os rituais de cura, fé e devoção, nos processos de aprendizagem, aos mais variados tipos de doenças, as rezas e as curas, sendo assim, realizadas por elas. As rezadeiras/benzedeiras são mulheres cujo valor histórico, (...) tornando-se as suas benzeduras símbolo de resistência humana, na sua prática sobre as benzeduras. Entretanto, vale fomentar na pesquisa, sobretudo, as suas práticas também estão relacionadas a conhecimentos católicos, indígena, africana, com seus “cânticos” e “rezas” religiosas, trazendo consigo o desejo da fé de resultar o seu trabalho por alcances estabelecidos nas suas práticas reverenciadas assim as pessoas que procuram por elas. O objeto é tentar caminhar ao longo da história, em conjunto com as práticas religiosas, percebendo as inúmeras implicações produzidas pela sociedade. O contexto etnográfico da pesquisa foi na cidade de Santo Amaro. Palavras-chave: Saúde, Benzedeira, Espiritualidade. (shrink)

Is there an alternative course to one which sets up hypotheses as to the nature of poetry and then proceeds to illustrate them? Happily, there is. Rather than beginning with the hypothesis we may begin with the fact, and let what may emerge. That is, rather than beginning with some notion of the nature of poetry, we may begin with individual poems and discover what we may of their nature or form. This procedure evidently involves four phases: examination of the (...) characteristics of individual poems, discovery, by comparison with other poems, of likenesses and differences, decision as to which of these likenesses and differences are relevant to poetic form, and the statement of form itself. Once we have discovered a given form, we shall be in a position to discuss the principles underlying the construction of such form, the various possibilities of such construction, and what constitutes excellence in a given form. Elder Olson, poet, critic, and Distinguished Service Professor in the department of English at the University of Chicago, is the author of six volumes of verse, including Collected Poems and Olson's Penny Arcade, and of numerous works of literary criticism. His previous contributions to Critical Inquiry are "The Poetic Process" and "On Value Judgments in the Arts" , the title essay on his most recent collection of criticism. Among the many awards which he has received are the Academy of American Poets award, the Longview Foundation award, the Emily Clark Balsh award and, for Olson's Penny Arcade, the Society of Midland Authors award. Both his poetry and his criticism are the subject of a book by Thomas E. Lucas. Part II of "A Conspectus of Poetry" will appear in the Winter 1977 issue of Critical Inquiry. (shrink)

Faculty in a large, urban school of engineering designed a longitudinal study to assess the critical thinking skills of undergraduate students as they progressed through the engineering program. The Paul-Elder critical thinking framework was used to design course assignments and develop a holistic assessment rubric. This paper presents the analysis of the freshman course artifacts (baseline and course critical thinking assignments) and associated faculty scoring sessions for all three cohorts. A total of 649 first semester freshman students at least (...) 18 years old agreed to participate in the study. The majority were white males with a mean high school grade point average of 3.73, ACT composite score of 28.33, and final freshman engineering course grade of 3.57. There was a statistically significant positive relationship between the freshman course artifacts and the faculty scores. Data from the study are being used to enhance the critical thinking experiences for undergraduate engineering students. (shrink)

Aim To study the views of people in a largely Muslim country, Kuwait, of the acceptability of a life-ending action such as physician-assisted suicide (PAS). Method 330 Kuwaiti university students judged the acceptability of PAS in 36 scenarios composed of all combinations of four factors: the patient's age (35, 60 or 85 years); the level of incurability of the illness (completely incurable vs extremely difficult to cure); the type of suffering (extreme physical pain or complete dependence) and the extent to (...) which the patient requests a life-ending procedure, euthanasia or PAS (no request, some form of request, repeated requests). In all scenarios, the patients were women who were receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Results Five clusters were found. For 44%, PAS was always very unacceptable, no matter what the circumstances. For 23%, it was unacceptable, but less so if the patient was older or requested it repeatedly. For 16%, it was unacceptable if the patient was young but was acceptable if the patient was elderly. For 5%, it was unacceptable if the patient had extreme pain but was acceptable if completely dependent. For 11%, it was unacceptable if the patient did not request it but acceptable if she did. Conclusion The majority of the Kuwaiti university students opposed PAS either categorically or with a slight variation according to circumstances. Nonetheless, a minority approved of PAS in some cases, particularly when the patient was elderly. (shrink)

It is widely supposed that, in Hilary Putnam’s phrase, there are no “ready-made objects” (Putnam 1982; cf. Putnam 1981, Ch. 3). Instead the objects we consider real are partly of our own making: we carve them out of the world (or out of experience). The usual reason for supposing this lies in the claim that there are available to us alternative ways of “dividing reality” into objects (to quote the title of Hirsch 1993), ways which would afford us every bit (...) as much practical and cognitive mastery as we now possess. Hence there is no warrant for supposing that the objects recognized by such alternative schemes are any less real than the objects we actually consider real—unless we are to appeal to a “God’s-eye perspective”, which virtually no one wants to do. The reasonable conclusion, many philosophers suppose, is that any system of objects exists only relative to a particular conceptual scheme or system of predicates. Our system of objects is, in this sense, partly of our own making. But this claim should not be heard as a reaffirmation of the idealism of Fichte or Husserl. It is more accurate to take it merely as a claim about sameness and difference among the objects of the world. It is the claim that sameness and difference, whether at the level of kinds or of individual objects, do not obtain mind-independently, but only relative to a conceptual scheme or predicate system (see, e.g., Putnam 1981, pp. 53-54). That is, whether two objects are of the same kind, and whether one and the same individual object now exists at such-and-such.. (shrink)

James decides that the best price today on pork chops is at Supermarket S, then James makes driving motions for twenty minutes, then James’ car enters the parking lot at Supermarket S. Common sense supposes that the stages in this sequence may be causally connected, and that the pattern is commonplace: James’ belief (together with his desire for pork chops) causes bodily behavior, and the behavior causes a change in James’ whereabouts. Anyone committed to the idea that beliefs and desires (...) are states installed by evolution must, it seems, think something similar. For how can one see beliefs and desires as conferring selective advantage if not by supposing that, by causing bodily behavior in their subjects, they brought about changes in their subjects’ surroundings? Yet many, many philosophers currently think or worry that mental causation is illusory (see, e.g., Heil and Mele 1993, or Macdonald and Macdonald 1995). Any physical changes which a mental state appears to cause can be viewed as a complex event involving microparticles, and for any such complex event, many philosophers suppose, there will have been previous microphysical occurrences sufficient to cause it. Barring routine overdetermination of such complex events, the apparent causation of mental events seems to be excluded. Nor does it help to say that some salient segment of the previous microphysical event just is the mental event, differently described (Davidson 1970). For describing the previous events as microphysical seems to spotlight the very features in virtue of which they did their causal work; the mental features seem epiphenomenal (Yablo 1992b: pp. 425-36; Yablo 1992a). This paper argues that the complex physical events, which mental events seem excluded from causing, are not caused at all. For they are either accidents, in something like Aristotle’s sense (Sorabji 1980: pp. 3-25), or coincidences, in a sense which David Owens has recently sharpened (Owens 1992). (shrink)

To be a realist about modality, need one claim that more exists than just the various objects and properties that populate the world—e.g. worlds other than the actual one, or maximal consistent sets of propositions? Or does the existence of objects and properties by itself involve the obtaining of necessities (and possibilities) in re? The latter position is now unpopular but not unfamiliar. Aristotle held that objects have essences, and hence necessarily have certain properties. Recently it has been argued that (...) the identity of any property is tied to the natural laws in which it figures, which entails that the occurrence of properties involves the obtaining of nomological necessities ([24], pp. 206-33 and 234-60; [23]; cf. [25] and [6]). Somewhat less recently, Wittgenstein ([28], p. 168) worried that the reality of at least some properties—precise shades of colors being a prime example—involved the obtaining in re of certain impossibilities. This paper argues that Wittgenstein’s worries were right, and not just concerning some properties, but all properties whatever. That there are objects and properties in the world at all, then, amounts to there obtaining modal states of affairs. This argument supplements, rather than replaces, the others. The position on property incompatibility advanced here actually helps defend Aristotelian essentialism against epistemological objections, or so I have argued ([15]). And while this paper’s position on property incompatibility diverges from the idea that a property’s nomic profile is essential to it—more on this in the next section—it is at least compatible with the thought that the necessity involved in the laws of nature enters into ontology at the ground level. (shrink)

As a disabled activist, I much prefer Aristotle's concept of ‘eu zen’, or ‘living well’ to that of ‘well-being’. ‘Eu zen’ is part of Aristotle's treatise on ‘eudaimonia’, which Grayling describes as: ‘…. a strong and satisfying sense of well-being and well-doing, of flourishing as only a rational and feeling human individual can flourish when his life and relationships are good’ (emphasis added). Aristotle's concepts are preferable because they promote ‘well-being’ through familial, social and civic activity, whilst recognising that such (...) activity requires resources, both human and material. These concepts are akin to those advocated by disabled people within the ‘independent living movement’; i.e. that the individual's ‘choice’, ‘control’, ‘dignity’ and ‘freedom’, over their lives and lifestyles, are supported by an inclusive community. However, both sets of principles are now being undermined by neoliberal managerial social work practice, which not only deny basic human rights which underpin ‘eu zen’, but lead to fear and a sense of ‘commodification’ or de-personalisation among disabled recipients. Relevant examples will come from experience, both personal as well as that from other disabled people. (shrink)

Most elderly patients die with an order in place that they not be given cardiopulmonary resuscitation . Surveys have shown that many elderly in different parts of the world want to be resuscitated, but may lack knowledge about the specifics of cardiopulmonary resuscitation . Data from countries other than the US is limited, but differences in physician and patient opinions by nationality regarding CPR do exist. Physicians’ own preferences for CPR may predominate in the DNR decision making process for their (...) patients, and many physicians may not want the participation of the elderly or believe that it is necessary. More complete and earlier discussions of a wider range of options of care for patients at the end of life have been advocated. The process ought to include education for patients about the process and efficacy of CPR, and for physicians on how to consider the values and levels of knowledge of their patients, whose preferences may differ from their own. (shrink)

Background: Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day care of older people.Objectives: To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the (...) information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided.Method: A descriptive questionnaire given to 200 patients and 200 relatives during the patients’ stay in hospital.Results: Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives , despite the irregularities observed.Conclusions: The capacity of elderly patients to participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. (shrink)

Modal conventionalism is the view that two crucial forms of sameness are mind-dependent. There is no phenomenon of sameness in kind, on this view, except in virtue of our conventions for individuating nature’s kinds; there is no phenomenon of numerical sameness across time, for an individual member of some natural kind, except in virtue of our conventions for individuating such members.1 Modal conventionalism has its realist opponents. These opponents have argued, following Kripke’s lead more than thirty years ago (Kripke 1972), (...) that the boundaries of at least many of nature’s kinds are carved out by nature itself, and not by our classifi catory practices (e.g., Millikan 2000: passim, e.g., pp. 25 and 72). But they have not generally argued, with anything approaching the same vigor, that modal conventionalism is wrong in its other main claim. They have not in general argued that the world-given connections among properties, that make those properties mind-independently be membership conditions for some natural kind, at the same time make those properties mind-independently be persistence conditions for the members of the kind—properties the departure of which constitutes a ceasing-to-exist for the object that formerly had them. On the contrary, opponents of modal conventionalism have.. (shrink)

In an article published recently in theJournal of Business Ethics, Vitellet al. (1991) found that elderly respondents scored surprisingly high on a measure of Machiavellianism. This paper offers an alternative explanation for this unexpected result — it may be an artifact of the survey format employed — and recommends additional research to help clarify the issues raised by Vitell and his colleagues.

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons in order to explore and describe their moral orientation based on the paradigms of justice and care . The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the reasoning of four women. (...) The implications for ethical decision-making and future research are discussed. (shrink)

The dialogue is a common search for truth, because its aim is to gain insight into reality through the interplay of its participants. The dialogue form, i.e. an exchange of thought processes, reflects the structure of the human mind which is involved in an ongoing process of reflections and constructions. This process mirrors consciously and unconsciously the centrifugal and centripetal movements of the human body and of all organic matter. For these reasons, I argue that the praxis of dialogue represents (...) a truly human lifestyle, not limited to one specific worldview. Its form reveals implicitly various levels of meaning. (shrink)

Background: Intravenous fluids and/or antibiotics are applied to only a limited extent in Norwegian nursing homes, and the patients are often sent to hospital in these situations. A transfer and a stay in hospital may be unnecessary strains for frail older patients. Given this background, a collaborative research project was initiated in a Norwegian county in 2009. A teaching programme was developed, which aimed to strengthen the awareness of ethics, assessments and practical procedures related to intravenous fluid and/or antibiotics among (...) healthcare professionals. Objectives: This qualitative study aimed to increase our knowledge of the ethical problems experienced by nursing home nurses in situations related to the administration of intravenous fluids and/or antibiotics. Research design: An exploratory design was used, and five focus group interviews were conducted with 26 registered nurses. A hermeneutic analytic approach was applied. Ethical considerations: This study was reported to the Norwegian Social Science Data Services in May 2010. The Regional Committee for Medical and Health Research Ethics approved the collaborative research project. Findings: The analysis showed that the nurses experienced difficult decision-making situations, which were interpreted as external pressure and internal pressure. External pressure emerged in interactions with patients and relatives. Organizational factors were also interpreted as external pressure. Internal pressure was interpreted as the nurses’ experience of feeling inadequate in situations where it was difficult to protect the dignity of patients. Discussion: These findings correspond with international studies, which show that ethical problems often arise during decision-making situations. Conclusion: In agreement with the definition of an ethical problem, we found that the nurses experienced uncertainty and disagreements about how situations should be managed. External and internal pressures related to intravenous fluids and/or antibiotics in nursing homes have not been reported in previous studies. Thus, these findings merit further exploration. (shrink)

It is not without a certain emotion that one opens this book devoted to the memory of a great scholar of medieval thought who worked and lived in the certainty that there cannot be a conflict between the Christian faith and science. In a significant essay, Benedict M. Ashley defends the idea of the philosophy of nature as continuous or identical with natural science. Ashley does allow, however, for so many divergences between philosophy of nature and natural science due to (...) later developments in science that this identification must be qualified. Steven E. Baldner points out some of the contradictions of Hartshorne's atomism: Hartshorne denies change and real causality. Anthony J. Celano recalls that Robert Kilwardby was very much aware that happiness as described by Aristotle is quite different from the beatitude promised by the Christian faith. The order of the divine entitative attributes in the Summa theologiae I, qq. 3-11 has baffled many a commentator. Lawrence Dewan connects it with some texts of Aristotle's Metaphysics. Jeremiah Hackett studies Roger Bacon's Moralis philosophia. Dealing with Luther's attitude toward St. Thomas, Denis R. Tanz accepts Erasmus's verdict that the weight given to Thomas in theology was an important factor in propelling Luther out of the Roman Catholic orbit. This opinion, however, confounds appearances with the real reason for leaving, namely, estrangement from several central positions of Catholic doctrine. It is a tribute to the Catholicity of Thomas that after 1519 Luther came to identify the Pope, the Church and all scholastic doctors with the Thomists and said that the Church had become the synagogue of the papists and the Thomists: Thomas had been made the arbiter of heresy. Mark F. Johnson stresses the sapiential character of the sacra doctrina. Mark D. Jordan wrestles with the question why Thomas wrote his Aristotelian commentaries. Arguing in the line of Owens's interpretation he reduces their importance with regard to Thomas's own positions. Jordan seems to think that Thomas's philosophy cannot be formulated without his theology, an explanation which is hardly satisfactory. Armand Maurer submits some reflections on St. Thomas's notion of presence. The question to what extent Albert the Great contributed to Aquinas's treatises of the morality of human acts and of natural law is examined by Ernest J. McCullough. Walter H. Principe points out how, according to Aquinas, food is assimilated into the veritas humanae naturae. Eric A. Reitan retraces Weisheipl's analysis of Aristotle's Physics and of St. Thomas' Commentary: the axiom, "whatever is moved, is moved by another" can be understood only within the context of the general science of nature. In his Liber de causis et processu universitatis Albert came to hold the same position as Thomas on the demonstrability of creation and of its beginning in time. Two final articles concern the difficulties underlying Aristotle's arguments in Physics 7 and 8, and Aquinas and Newton on causality: William Wallace connects Newton's universal gravitation with the axiom that nothing acts on itself. (shrink)

Objectives: To assess whether according to healthcare providers, the creation of an ethics service responds to a need; assess the importance of an ethics service for healthcare providers; determine what ethics services should be offered and the preferred formats of delivery; and identify key issues to be initially dealt with by the ethics service.Design: A survey of healthcare providers in Québec’s Centre Local de Services Communautaires , healthcare institutions dedicated to community health and social services.Findings: 96 respondents agreed that an (...) ethics service was needed, and on average the ethics service project was judged to be very important. Preferred formats for ethics consultation and education were identified, as well as key concerns such as the need of respect for the patient as a person, elder abuse and ethical issues in home care.Conclusion: This survey is helping in the implementation of an ethics service and can guide others in similar healthcare institutions. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

It is always difficult to present a collection of essays, and this the more so if written by twenty-eight authors. However, this imposing and beautifully printed volume has been planned very carefully, so that the various contributions create a fairly complete study of Aquinas’s thought in the Second Part of the Summa theologica. The essays have approximately the same length and are accompanied by numerous scholarly endnotes. L. E. Boyle recalls that St. Thomas’s intention was to connect moral theology to (...) dogmatics, the Second Part being foremost in his mind. It did indeed capture the attention of the students of his order. S. Pinckaers gives a fine survey of the sources used by Thomas in the I-II and brings out the place of the auctoritates in theology. S. J. Pope presents a compact summary of the contents of the Second Part but does not consider its relation to the Commentary on the Nicomachean Ethics. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

This is an interesting and useful book with essays by Lewis White Beck, Ernst Cassierer, Hermann Cohen, Richard Hönigswald, Hansgeorg Hoppe, Edmund Husserl, Ram Adhar Mall, Jeffrie G. Murphy, Alois Riehl, Wolfgang Stegmüller, Martha E. Williams. All thirteen essays or notes reprinted concern the relationship between Hume and Kant. Its publication follows the 200th anniversary of the appearance of the Kritik der reinen Vernunft. Common to both philosophers is the view that scientific knowledge depends on the knowledge of man. In (...) a long introduction the editor briefly recalls Hume's place in the history of philosophy. Turning to Kant he points out that Kant realized that if we take Hume's view of causality seriously, it cannot but lead to scepticism. Thus he felt obliged to look for a foundation of the sciences in the trans-subjective structure of the human mind. However, Kant never became an empiricist, but still subscribed to what Russell called a "pre-Humean rationalism." Nevertheless there is a convergence between both philosophers: Hume feels that one cannot go beyond the presence of percepts in one's own consciousness. Now Kant is equally convinced that our theoretical knowledge is limited to appearances. What lies beyond the appearances--das Ding an sich--cannot be reached. (shrink)

PURPOSE:To report the localization of a gene causing drusen and macular degeneration in a previously undescribed North American family. METHODS:Genetic mapping studies were performed using linkage analysis in a single family with drusen and atrophic macular degeneration. RESULTS:The clinical manifestations in this family ranged from fine macular drusen in asymptomatic middle-aged individuals to atrophic macular lesions in two children and two elderly patients. We mapped the gene to chromosome 6q14 between markers D6S2258 and D6S1644. CONCLUSIONS:In a family with autosomal dominant (...) drusen and atrophic macular degeneration, the gene maps to a 3.2-cM region on chromosome 6q14. This locus appears to be distinct from, but adjacent to, the loci for cone-rod dystrophy 7 (CORD7) and North Carolina macular dystrophy (MCDR1). Future identification of the gene responsible for the disease in this family will provide a better understanding of macular degeneration. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

Reale points out that the good and the demiurgic intelligence are radically distinct, a conclusion denied by J. Seifert in the last paper of the book. Fourteen characteristics of the idea of the good are listed by T. A. Szlezák. It is obvious, he argues, that the theory of principles of Plato’s unwritten doctrines is not identical with what Republic 6 and 7 say about the good, but there is no real opposition. In the next paper, however, H. W. Ausland, (...) after a sober evaluation of the esoteric teachings, suspects that Reale and Szlezák succumb to a certain romanticism. According to L. Brisson, the good belongs to the sphere of being, even if it is not being ; it is not in every way beyond being. Plotinus was the first to place it above being. M. Erler shows what must be the attitude of the philosopher with regard to the information orally received by him. Although Plato did not want to define the good, he pointed out several of its characteristics. The good, M. Migliori notes, combines in itself beauty, proportion, and unity. The Philebus pursues the doctrine of the Republic and goes into the direction of the unwritten doctrines. The ultimate reality, however, is beyond our understanding. E. Cattanei attempts to explain how for Plato mathematics is a way of access to the knowledge of the good. R. Ferber, on the other hand, stresses that Plato nowhere directly says that the essence of the good is the one. Beauty, symmetry, and truth are not the good itself. According to C. Gill, Gadamer demystified the idea of the good, a view which shows some common ground with the position of analytical philosophy: the good is not a transcendent entity. M. Vegetti, however, upholds the transcendent character of the good as a cause of being. G. A. Press argues that over the past hundred years Plato was considered a dogmatic philosopher, and it was believed that the leading speaker in the dialogues states Plato’s own views, but the situation is far more complex. Plato wants us to acquire a vision rather than propositional knowledge. The idea of the good should not be accorded a special position. C. Rowe tries to demystify some current interpretations, whereas F. Ferrari insists on the causality of the good, and sees Plato’s teaching as the origin of the entire tradition of negative theology. Yet some texts give the impression that the good belongs to the ontological order. C. Porebski reminds us that problems of ethics are the starting point of what Plato says about the good in the Republic. According to F. Trabattoni, Aristotle’s description of Plato’s theory of principles is wrong and his philosophy differs fundamentally from Plato’s. The School of Tübingen is a prisoner of Aristotle’s interpretation. Plato’s reluctance to describe the good in detail may mark the beginning of a skeptic trend in the Academy. The Parmenides tells us, E. Berti says, that one has first to remove all hypotheses before a definition of the Good can be given. E. Moutsopoulos draws attention to some simplistic and wrong qualifications of Plato’s thought as related to idealism and mentions Kant and Hegel’s attitudes with regard to Platonism. J. F. Crosby points to a clear leaving behind of the Socratic “no one knowingly does wrong” in the Alcibiades 216b: as Plato explains in the Protagoras, one may live according to one’s lower appetite or follow the insight of the rational soul. G. Santos makes a strong stand in favor of the identity of goodness and reality. L. P. Gerson examines theories of Platos’s development: there is no evidence of a theory of the form of the good earlier than the Republic. Aristotle, J. Dudley writes, upheld an ethical ideal resembling that of Plato, substituting the contemplation of the unmoved mover for that of the idea of the good. In the last paper J. Seifert argues that Plato identified the demiurge and the good. (shrink)

Research necessarily entails the close interrelation of concepts and arguments, including solutions to a range of meta-questions, whether acknowledged explicitly or not. Despite this, few detailed accounts currently exist that support researchers to develop their complex conceptual architectures, especially in critical realist spheres. Indeed, many published accounts often omit much of this ‘messiness’ that sits behind, yet is foundational to, research projects. Those accounts that do seek to portray how/why researchers have made decisions (e.g. about connections between research philosophy, methodology, (...) methods, theory and empirical evidence) tend to focus on one set of meta-questions, or occasionally on the relationships between two sets, at a time. Therefore, this paper presents a flexible framework – supported by specific examples from studies – that we hope will be useful in supporting researchers from all traditions, but especially critical realists, to carefully think through and develop more holistic connections in their conceptual architecture. (shrink)

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state, cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization. Similarly, Baby K was an anencephalic infant whose mother, believing that all (...) life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer. (shrink)

We question whether Plamondon & Alimi's model is useful in accounting for the nonsymmetrical and multiple-peaked velocity profiles observed in young and elderly subjects for ballistic aiming tasks. For these subjects, both data and observation suggest that a central representation initiates the movement in an appropriate direction but that multiple adjustments are made, both early and late, to achieve spatial accuracy.