Experience with electronic communication in ethics committees at two hospitals is reviewed and discussed. A listserver of ethics committee members transmitted a synopsis of the ethics consultation shortly after the consultation was initiated. Committee comments were sometimes incorporated into the recommendations. This input proved to be most useful in unusual cases where additional, diverse inputs were informative. Efforts to ensure confidentiality are vital to this approach. They include not naming the patient in the e-mail, requiring a password for access to (...) the listserver, and possibly encryption. How this electronic communication process alters group interactions in ethics committees is a fruitful area for future investigation. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of (...) life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

The Ethos of Medicine in Postmodern America is an analysis of medical care, medical education and medical professionalism with reference to the cultural touchstones of the postmodern era: consumerism, computerization, destruction of meta-narratives, and “stakeholder late capitalism.” The prism of postmodern thought provides a powerful heuristic to grasp the fundamental changes that have occurred and substantively changed the ethos of healthcare delivery, the patient-physician relationship, the physician-corporate entanglement, and the addition of more stakeholders in healthcare delivery.

Purpose. Nietzschean proponents classify people into seemingly two distinct groups: those possessing 'Master' moralities and those with 'Slave' moralities. Each type of person is characterized to have certain qualities, traits, ideologies, and methods of dealing with everyday situations. This paper attributes these moralities to the personnel working in the corporate sector of Pakistan to observe their prospects of success. Originality. A specialized survey instrument was designed to gauge different Morality Types of the study subjects by calculating a Morality Quotient. The (...) respondents were then categorized into three categories possessing, Slave, Master and Neutral or Mixed traits. These traits are then contrasted to the position held by the subjects to see which morality type was more prevalent in higher management levels and whether the association was significant. Conclusions. Our results prove to be contradictory to common wisdom and shows that despite the leadership-like qualities of those with Master moralities, the proportion of those with Slave moralities was significantly higher at senior management levels of the corporate sector in Pakistan. Moreover, a trend of declining Master morality traits is observed with the rise in managerial level. In addition, an association between work experience and Morality type was also observed indicating adaptability of cross morality traits with increasing job experience. These findings are in line with the increasing focus on democratic and adaptable leadership instead of autocratic leadership styles in contemporary organizations. (shrink)

IntroductionIn this study we compared the effects of a mindfulness-based intervention with a story reading intervention on the executive functions and psychological profile of children in two different public schools in São Paulo, Brazil.MethodsIn this controlled clinical trial, 207 children aged 8 to 9 years old responded to the Five-Digit Test, stress levels, depression, anxiety, positive and negative affect, at baseline and 8 weeks later. From T0 to T1, school 1 participated in MBI classes and school 2 in IS classes.ResultsIn (...) school 1, children improved their scores on all tests except reading and counting compared with school 2. No differences were observed between groups in terms of emotional health.ConclusionIt is feasible to implement MBI or SI in Brazilian public schools. Students in the MBI group presented broader effects in executive functions, while students in the SI group showed a trend toward reduced negative affect and depression symptoms. (shrink)

In the middle of last century metaphysics was widely criticized, ridiculed, and committed to the flames. During this period a handful of philosophers, against several anti-metaphysical trends, defended metaphysics and articulated novel metaphysical doctrines. Donald C. Williams was one of these philosophers. But while his contributions to metaphysics are well known his defence of metaphysics is not and yet it played a key part in the development and revival of metaphysics. In this paper I present his defence of metaphysics in (...) its historical context. I also show how his defence is relevant in response to recent attacks on metaphysics. (shrink)

A Student of ethics cannot but be struck by some fundamental difference of outlook in the ethics of the East and the West. This has a particular bearing on the problem of the relation of the individual to society. In practice this has given rise to a question of supreme importance to every thinking man: is an individual completely subservient to society, or is society completely subservient to the demands of individuality? I.e., is the moksha of any individual impossible till (...) all the needs of society have been completely satisfied, or is an individual free to use or not to use society as a field for his own spiritual expansion? There is no doubt a fundamental discrepancy in these outlooks as thus conceived, and the problem is : can we reconcile them? (shrink)

On theories in Indian Philosophical Systems.

Appearing in the “Cairo Declaration on Human Rights in Islam” as an undefined referent for the limits on freedom of expression in Islam, Shariah is still to be chased as an indefinable referent which restricts freedom of the expression in the Islamic Republic of Iran. Iran’s Press Law as well as Constitution unveil Shariah’s referent to be a person: the Jurist-Ruler around whom a cult of personality is legalized in terms of “Imamate” and around whom all the limits on freedom (...) of expression revolve. Interpretation of Shariah is not a solution but part of the problem in Iran. Such problem can be dealt in terms of three modes of self-expression which were invented by the Iranian Reformists to avoid self-censorship. The notion of master-signifier can be the key to unraveling the problem of self-referentiality in freedom of expression and its Reformist solution in Iran’s legal system. (shrink)

We derive the schemes of from certain weak forms of the same.

_The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, non-malfeasance, (...) autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy, Religion, and Spirituality in Psychiatry. It includes topics like (a) relevance of philosophy to psychiatry; (b) psychiatry, religion, spirituality, and culture; (c) ancient Indian concepts and contemporary psychiatry; (d) Indian holism and Western reductionism; (e) science, humanism, and the nomothetic-idiographic orientation. The last part, called Final Goal, talks of the need for a grand unified theory. The whole discussion is put in the form of refutable points._. (shrink)

B. R. Frieden uses a single procedure, called extreme physical information, with the aim of deriving 'most known physics, from statistical mechanics and thermodynamics to quantum mechanics, the Einstein field equations and quantum gravity'. His method, which is based on Fisher information, is given a detailed exposition in this book, and we attempt to assess the extent to which he succeeds in his task.

A law, say, prohibits homosexual conduct or punishes the prostitute for plying her trade. According to some it is a bad law, according to others a necessary one. Those who argue that it is a bad law do so on a variety of grounds—that it is sheer folly to try to change human nature by law, that such legislation can only be effective at the price of the right to privacy, that the punishment of acts arising from compelling desires is (...) cruel and excessive, that the law has no business meddling in what people do to others with their consent. Those who argue that it is a necessary law do so on one ground, that the act in question is immoral, and that what is wrong must be punished, lest the law itself fall into disrepute by failing to carry out a consistent campaign against wrong-doing. (shrink)

Please note that this article belongs to the Special Issue on the Legacy of David Lewis but was included in issue 195:5 by mistake. It should be regarded as part of this selection of articles.