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

Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s thematic synthesis method was used to synthesise data (...) from identified studies. Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices. (shrink)

A survey of the work of the Majorcan lay theologian and philosopher Ramon Llull (1232-1316), along with examples of its wide influence in late medieval, Renaissance, and early modern Europe and in colonial Spanish America.

The centerpiece of the Analyses is a translation from the German of notes for a series of lectures given by phenomenologist Edmund Husserl in the early twenties, which is to say some eighty years ago. Husserl designated the topic of the lectures 'transcendental logic'. In this context, the term, 'transcendental', is not to be understood in some mystical sense, but rather in a Kantian sense: pertaining to the conditions of possibility of experience. Likewise, the term, 'logic', is not to be (...) taken in the narrow sense of formal logic, but rather in the very general sense it had for Platonic dialectic: a concern with normative guidelines and critical assessment of the possibility of truth. The topic of the lectures is succinctly characterized by Husserl as 'a universal theory of science, and at the same time, a theory of science in principle,' where the latter means 'the science of the a priori of all sciences as such' (p. 1). (shrink)

Faces carry key personal information about individuals, including cues to their identity, social traits, and emotional state. Much research to date has employed static images of faces taken under tightly controlled conditions yet faces in the real world are dynamic and experienced under ambient conditions. A common approach to studying key dimensions of facial variation is the use of facial caricatures. However, such techniques have again typically relied on static images, and the few examples of dynamic caricatures have relied on (...) animating graphical head models. Here, we present a principal component analysis -based active appearance model for capturing patterns of spatiotemporal variation in videos of natural dynamic facial behaviours. We demonstrate how this technique can be applied to generate dynamic anti-caricatures of biological motion patterns in facial behaviours. This technique could be extended to caricaturing other facial dimensions, or to more general analyses of spatiotemporal variations in dynamic faces. (shrink)

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

The integration of genomics into public health and medicine is happening at a faster rate than the accrual of the capabilities necessary to ensure the equitable, global distribution of its clinical benefits. Uneven access to genetic testing and follow‐up care, unequal distribution of the resources required to access and participate in research, and underrepresentation of some descent groups in genetic and clinical datasets (and thus uncertain genetic results for some patients) are just some of the reasons to center justice in (...) genomics. A more just genomics is an imperative rooted in the ethical obligations incurred by a publicly funded science that is reliant on human data. These features of genomics indebt the genomics enterprise and compel the expanded scope of responsibility proposed by the authors of this special report. The report begins to define justice in genomics for different stakeholder groups and proposes substantial shifts in power, resource distribution, scientific practice, and governance that could enable genomics to meet its obligations to humanity. (shrink)

The subjective effects and therapeutic potential of the shamanic practice of journeying is well known. However, previous research has neglected to provide a comprehensive assessment of the subjective effects of shamanic-like journeying techniques on non-shamans. Shamanic-like techniques are those that demonstrate some similarity to shamanic practices and yet deviate from what may genuinely be considered shamanism. Furthermore, the personality traits that influence individual susceptibility to shamanic-like techniques are unclear. The aim of the present study was, thus, to investigate experimentally the (...) effect of shamanic-like techniques and a personality trait referred to as "ego boundaries" on subjective experience including mood disturbance. Forty-three non-shamans were administered a composite questionnaire consisting of demographic items and a measure of ego boundaries (i.e., the Short Boundary Questionnaire; BQ-Sh). Participants were randomly assigned to one of three conditions: listening to monotonous drumming for 15 minutes coupled with one of two sets of journeying instructions; or sitting quietly with eyes closed for 15 minutes. Participants' subjective experience and mood disturbance were retrospectively assessed using the Phenomenology of Consciousness Inventory (PCI) and the Profile of Mood States-Short Form, respectively. The results indicated that there was a statistically significant difference between conditions with regard to the PCI major dimensions of visual imagery, attention and rationality, and minor dimensions of imagery amount and absorption. However, the shamanic-like conditions were not associated with a major reorganization of the pattern of subjective experience compared to the sitting quietly condition, suggesting that what is typically referred to as an altered state of consciousness effect was not evident. One shamanic-like condition and the BQ-Sh subscales need for order, childlikeness, and sensitivity were statistically significant predictors of total mood disturbance. Implications of the findings for the anthropology of consciousness are also considered. (shrink)

This paper describes the introduction of Liebig's ideas on agricultural chemistry into the Netherlands. The aversion to Liebig held by the Utrecht professor G. J. Mulder hindered the direct influence that might have been borne by Liebig's own writings; the introduction was made principally by means of Dutch translations of the text-books of the Scottish agricultural chemist J. F. W. Johnston, who generally followed Liebig's ideas.

Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we (...) examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology. (shrink)

The prospect of using cell-based interventions to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior—brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause (...) for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment. (shrink)

In the twentieth century, celebrations of historical anniversaries abounded. There was the bicentennial of the French Revolution, the 150th anniversary of photography, Bach's 300th anniversary, and the 200th anniversary of the American Constitution, to name just a few. Every year hundreds of anniversaries still attract media attention and government investment in ever greater degrees. Deploying an astonishing array of insights, Celebrations explores the causes and consequences of this major phenomenon of our time. As Johnston shows, anniversaries fulfill a number (...) of needs. They provide the kind of experience of regularity across a lifetime that the weekly cycle supplies in daily life. The use of anniversaries for political ends emerged during the French Revolution and expanded to promote nationalism during the nineteenth century, although there are differences in how they are used. Europeans tend to celebrate cultural heroes, while Americans tend to celebrate events. Entire nations exploit anniversaries of founding events in order to promote national identity. Commercially, there are whole industries built around commemoration, and they provide intellectuals an opportunity to take center stage. Using methods of cultural history, sociology, and religious studies, Johnston shows how the cult of anniversaries reflects postmodern concerns. It fills a void left by the disappearance of ideologies and avant-gardes. In an era when there is little consensus about styles or methods, anniversaries allow intellectuals, businesses, and governments to acknowledge and celebrate every nuance of opinion. By suggesting ways to use anniversaries more creatively, this book offers a broad range of insights. (shrink)

BackgroundDefensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.MethodsA qualitative interview study investigated the views and experiences of (...) physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.ResultsAll participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.ConclusionsThe findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. (shrink)

Colorado has consistently had one of the highest rates of suicide in the United States, and El Paso County has the highest number of suicide and firearm-related suicide deaths within the state. Community-based solutions like those of the Suicide Prevention Collaborative of El Paso County may be more effective in preventing suicide as they are specific to local issues, sensitive to local culture, and informed by local data, community members, and stakeholders.

As this latest volume in the Peace & Policy series shows, sports can be an effective mechanism for peacebuilding, especially when incorporated into conflict-resolution programs. Such programs have been designed to bring children together in post-conflict situations with an ultimate goal of reducing future violence. In examining such programs, the volume's contributors ask key questions: "What are the programs achieving?" and "How are they measuring success?" Although such programs have by and large been successful, some issues need to be addressed (...) if these programs are to hone their effectiveness. Among the questions explored in the volume are: various aspects of culture and how they can help shape sports programs; the role of a coach in creating a culture of peace, and how this culture can fit into a peacebuilding process. Contributors also examine the role of sports in trauma relief programs in Rwanda; the role of universities in sports; and the role of sports in the demilitarization of child soldiers. The last three contributors tackle some of the legitimate concerns raised about using sports for peacebuilding, such as sports being competitive, violent, and focused on winning. Contributors look carefully at these and other issues that have arisen in sports as a tool of conflict resolution, discuss why they have become concerns, and consider some possible ways to deal with these concerns in the future. (shrink)

Next SectionCultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face a (...) perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made. (shrink)

"This well-written, well-researched reference source brings together monastic life with particular attention to three traditions: Buddhist, Eastern Christian, and Western Christian."--"Outstanding Reference Sources," American Libraries, May 2001.

Collingwood and Hegel R. G. Collingwood was a lonely thinker. Begrudgingly admired by some and bludgeoned by others, he failed to train a single disciple, just as he failed to communicate to the reading public his vision of the unity of experience. This failure stands in stark contrast to the success of Georg Wilhelm Friedrich Hegel, who won many disciples to a very similar point-of-view and whose influence on subsequent thought, having been rediscovered since 1920, has not yet been adequately (...) explored. Collingwood and Hegel share three fundamental similarities: both men held overwhelming admiration of the Greeks, both possessed uniquely broad knowledge of academic controversies of their day, and both were inalterably convinced that human experience consti tutes a single whole. If experts find Collingwood's vision of wholeness less satisfactory than Hegel's, much of the fault lies in the atmosphere in which Col lingwood labored. Oxford in the 1920'S and 1930's, sceptical and specialized, was not the enthusiastic Heidelberg and Berlin of 1816 to 183I. What is important in Collingwood is not that he fell short of Hegel but that working under adverse conditions he came so elose. Indeed those unfamiliar with Hegel will find in Collingwood's early works, especially in Speculum M entis, a useful introduction to the great German. (shrink)

Any explanation of the origin and nature of human morality must take into account a powerful and inescapable pan-cultural human awareness. Death is the great pan-cultural human leveller and human awareness of death is a near life-long awareness. However metaphysically or religiously conceived, however long postponed by medical science, however softened by belief or by faith, the basic human fact and fear of death cannot be denied. Neither, in opposition, can the basic human craving for more life.

The depiction of pigs as caricatures and happy farmed animals represents a strategic marketing ploy on behalf of the U.S. Big Agriculture industry to distance the public from real pigs and dull empathy toward farmed animals. As two animal-loving photographers and animal rights activists who live in North Carolina (the state with the second-largest producer of pork in the United States), we created a billboard advocacy project called “Picturing Pigs” to counter Big Agriculture's marketing through positive imagery of rescued pigs. (...) This article contains three parts. First, we discuss the caricatures of pigs in advertising and the media and critique these depictions through a critical animal studies lens. We focus on how these depictions impact how we think about and treat pigs. Second, we discuss our “Picturing Pigs” billboard campaign featuring photography that highlights the benevolent and positive attributes of pigs—qualities missing from media representations. We discuss the resistance we met and the impact the project has had. Third, we share Lucy's story, a piglet we met while working on “Picturing Pigs.” Lucy's story provides an example of the entanglements that pigs face being seen as anything other than a product. (shrink)

Corruption involves greed, money, and risky decision-making. We explore the love of money, pay satisfaction, probability of risk, and dishonesty across cultures. Avaricious monetary aspiration breeds unethicality. Prospect theory frames decisions in the gains-losses domain and high-low probability. Pay dissatisfaction (in the losses domain) incites dishonesty in the name of justice at the individual level. The Corruption Perceptions Index, CPI, signals a high-low probability of getting caught for dishonesty at the country level. We theorize that decision-makers adopt avaricious love-of-money aspiration (...) as a lens and frame dishonesty in the gains-losses domain (pay satisfaction-dissatisfaction, Level 1) and high-low probability (CPI, Level 2) to maximize expected utility and ultimate serenity. We challenge the myth: Pay satisfaction mitigates dishonesty across nations consistently. Based on 6500 managers in 32 countries, our cross-level three-dimensional visualization offers the following discoveries. Under high aspiration conditions, pay dissatisfaction excites the highest- (third-highest) avaricious justice-seeking dishonesty in high (medium) CPI nations, supporting the certainty effect. However, pay satisfaction provokes the second-highest avaricious opportunity-seizing dishonesty in low CPI entities, sustaining the possibility effect—maximizing expected utility. Under low aspiration conditions, high pay satisfaction consistently leads to low dishonesty, demonstrating risk aversion—achieving ultimate serenity. We expand prospect theory from a micro and individual-level theory to a cross-level theory of monetary wisdom across 32 nations. We enhance the S-shaped Curve to three 3-D corruption surfaces across three levels of the global economic pyramid, providing novel insights into behavioral economics, business ethics, the environment, and responsibility. (shrink)

Field-ground reversal underlies Islamic art's use of repeating geometric patterns or tessellations. Encounter with field-ground reversal suggests the notion of ‘oscillationism’ to mean willingness to oscillate between two equally plausible opposites rather than to affirm one or the other of them. This article explores oscillationism as a move for confronting theories of evil and for assessing the merits of foundationalism without succumbing to cognitive dissonance. The article goes on to examine F.D.E. Schleiermacher's suggestion of 1799 that the infinitude of God (...) calls for more, not fewer religions. His reversal of Christian and Muslim assumptions puts contemporary debate in the theology of religions into a postmodernist perspective. Without supplying fresh answers, the spiritual practice of oscillationism provides a fresh way to frame some of the weightiest questions. (shrink)

John Paul II is often misread as more of a philosopher than a theologian. But his Theology of the Body, rightly read, is in its entirety an exercise in exegesis. By focusing on the Bible, he gives a more fully theological account of his topic, one focused on the mystery of redemption by grace, rather than on merely human efforts.

The growth in the availability of counselling services has been accompanied by growing concern about the conduct of counsellors, which in turn has led to the expressed need for an ethics of counselling. This paper will argue that there is an inherent tension between this need and the central tenets of one variety of counselling, client-centred counselling. The tension is identifiable on the basis of an inquiry into the nature of moral judgment which results in the recognition of the implicit (...) value base in client-centred counselling. It is only when this value base is made explicit that any adequate ethics of counselling becomes a viable possibility. (shrink)