BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

'The church in danger' : latitudinarians, Socinians, and Hobbists -- Animal spirits and living fibres -- Mortalists and materialists -- Journalism, exile, and clandestinity -- Mid-eighteenth-century materialism -- Epilogue : some consequences.

AI has numerous applications and in various fields, including the military domain. The increase in the degree of autonomy in some decision-making systems leads to discussions on the possible future use of lethal autonomous weapons systems (LAWS). A central issue in these discussions is the assignment of moral responsibility for some AI-based outcomes. Several authors claim that the high autonomous capability of such systems leads to a so-called “responsibility gap.” In recent years, there has been a surge in philosophical literature (...) around the concept of responsibility gaps and different solutions have been devised to close or bridge these gaps. In order to move forward in the research around LAWS and the problem of responsibility, it is important to increase our understanding of the different perspectives and discussions in this debate. This paper attempts to do so by disentangling the various arguments and providing a critical overview. After giving a brief outline of the state of the technology of LAWS, I will review the debates over responsibility gaps using three differentiators: those who believe in the existence of responsibility gaps versus those who do not, those who hold that responsibility gaps constitute a new moral problem versus those who argue they do not, and those who claim that solutions can be successful as opposed to those who believe that it is an unsolvable problem. (shrink)

This is a ground-breaking study of the way educated people were trained to think in Renaissance Europe. As Ann Moss demonstrates, the commonplace-book of quotations which every schoolboy of the period was taught to use opens a window on to the manner in which attitudes were structured, a moral consensus was established, and styles of writing evolved. Printed Commonplace-Books and the Structuring of Renaissance Thought is much more than an account of humanist classroom practice: it is a major work of (...) cultural history. (shrink)

Three female physicians were interviewed as part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experience of being in ethically difficult care situations in the care of elderly people. The interviewees expressed great concern for the low status of care for elderly people, and the need to fight for the specialty and for the care and rights of their patients. All the interviewees’ narratives concerned problems relating to perspectives of both action ethics (...) and relational ethics. The main focus was on problems concerning the latter perspective, expressed as profound concern and respect for the individual patient. Secondary emphasis was placed on relationships with relatives and other professionals. The most common themes in an action ethics perspective were too little treatment and the lack of health services for older patients, together with overtreatment and death with dignity. These results were discussed in the light of Løgstrup’s ethics, which emphasize that human life means expressing oneself, in the expectation of being met by others. Both Ricoeur’s concept of an ethics of memory and Aristotle’s virtue ethics are presented in the discussion of too little and too much treatment. (shrink)

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

Background: Person-centred care is often described as an ideal way of preserving vulnerable persons’ wellbeing and dignity and an essential component of quality-care delivery. However, the staff find that making the care dignified is the most challenging issue, often because of effectivity, everyday stress and overload. In the interests of making the care more person-centred, systematic intervention involving ‘one-to-one contact’ (resident – carer) was trialled for 30 min twice a week over 12 months in two units in a nursing home (...) in Eastern Norway. Objectives: The aim of the study was to elicit healthcare staff’s experiences of implementing ‘one-to-one contact’ between residents and carers in nursing homes. Methods: The study has a grounded-theory inspired design. Two groups of health care staff were each interviewed three times. Data were collected over an 18-month period. Ethical considerations: The study was approved by the Data Protection Official for Research under the auspices of the Norwegian Social Science Data Services. Findings: The core category is ‘One-to-one contact’ at a nursing home is possible, but requires open-mindedness. The core category indicates that open-mindedness is required, since it does not take much for scepticism to take over and cause reversion to habitual practices. The category Expectant but Sceptical describes staff thoughts and experiences before the implementation phase got underway. The category Positive but Undecided describes staff experiences 6 months into the intervention and after 12 months. Conclusions: This study has revealed that systematic ‘one-to-one contact’ between resident and carer in nursing home is achievable, and that such a simple action might be an important step towards achieving more person-centred care as the resident is seen more as a person. However, in order to make a more person-centred and dignified approach to care constant attentiveness and awareness is required, as there were ongoing factors counteracting it. (shrink)

My aim … is to show that the celestial machine is likened not to a kind of divine living being but rather to a clockwork. I consider the human body to be a machine … Although it may exaggerate to say that Descartes fathered the mechanization of biology, it is true that his Treatise of Man provided the first systematic development of the idea that a complete understanding of all the phenomena of life, including all abilities and behaviour of animals, (...) can be achieved by viewing living things as machines. To make this out, Decartes had to learn to think about living things in a new way. My first aim here is to identify the fundamental conceptual innovations at work in Descartes’ attempt to extend the new mechanics to include biology. My second aim is to locate the point at which Descartes’ mechanical imagination runs out. This requires study of Descartes’ scientific work on sense. (shrink)

For more than two thousand years, Confucius has been an inseparable part of China's history. Yet despite this fame,Confucius the man has been elusive. Now, in The Authentic Confucius , Annping Chin has worked through the most reliable Chinese texts in her quest to sort out what is really known about Confucius from the reconstructions and the guesswork that muddled his memory. Chin skillfully illuminates the political and social climate in which Confucius lived. She explains how Confucius made the transition (...) from court advisor to wanderer, and how he reluctantly became a professional teacher as he refined his judgment of human character and composed his vision of a moral political order. The result is an absorbing and original book that shows how Confucius lived and thought: his habits and inclinations, his relation to the people of the time, his work as a teacher and as a counselor, his worries about the world and the generations to come. In this book, Chin brings the historical Confucius within our reach, so that he can lead us into his idea of the moral and to his teachings on family and politics, culture and learning. The Authentic Confucius is a masterful account of the life and intellectual development of a thinker whose presence remains a powerful force today. (shrink)

Three periods in the development of Whitehead's thought are generally recognized : ()-: The period of the writing of Universal Algebra, ...

The 102 dedications composed by the sixteenth-century physician and polymath Conrad Gessner between 1541 and 1565 offer a rich trove of insight into many aspects of his particular career but also into the workings of the Republic of Letters more generally. Although Gessner never benefitted from a major patronage relationship and probably received limited financial support from his dedicatees, he nonetheless managed to publish a number of major works on his initiative, including folio volumes of philology, bibliography, and especially expensive (...) works of illustrated natural history. Crucial to Gessner’s success was his accumulation of smaller contributions in kind from a wide range of people who offered him hospitality or sent him information and specimens, manuscripts and images, which Gessner used in his publications. Gessner rewarded contributors not only by private expressions of thanks, but also in print, and especially visibly in his dedications. Gessner was also unusual in calling attention to the role of learned printers for his work, by composing dedications to them and by advertising that various of his publications were initiated by requests from printers or bequests of manuscripts by recently deceased scholars. Gessner thus used the high visibility of the printed dedication to invite further contributions from learned readers, bequests of unfinished manuscripts, and proposals from printers with which to fuel his remarkable productivity. (shrink)

Der Pravarana in dem kanonischen Vinaya-Texten der Mulasarvastivadin und der Sarvastivadin. Jin-il Chung., Vandenhoek & Ruprecht, Göttingen 1998. 368 pp. ISBN 3-525-26156-X.

Theories of perception have traditionally dismissed the sense of smell as a notoriously variable and highly subjective sense, mainly because it does not easily fit into accounts of perception based on visual experience. So far, philosophical questions about the objects of olfactory perception have started by considering the nature of olfactory experience. However, there is no philosophically neutral or agreed conception of olfactory experience: it all depends on what one thinks odors are. We examine the existing philosophical methodology for addressing (...) our sense of smell: on the one hand appeals to phenomenology that focus on the experiential dimensions of odor perception and on the other approaches that look at odor sources and their material dimensions. We show that neither strategy provides enough information to account for the human sense of smell and argue that the inclusion of the missing dimension of biology, with its concern for the function (or functions) of olfaction, provides the means to develop a satisfactory and empirically informed philosophy of smell. (shrink)

In their report in this supplement on research regulatory systems, Barbara Bierer and Mark Barnes note that, when research misconduct has been detected but not yet proven, the individual with institutional responsibility for oversight of research misconduct investigations “may determine that notification of relevant journals or professional societies and correction or full retraction of implicated papers or presentations is appropriate. In those cases, even when a finding of research misconduct per se has not been made or has not been explicitly (...) stated, the journal, professional society, and their readers or members may draw their own conclusions as to what led to the retraction or correction.” This statement highlights an aspect of the reviewed regulatory schemes that creates vulnerability for institutions of higher education subject to the regulations: while, as the authors suggest, it may be “appropriate” to notify third parties (that is, journals, professional societies, and other academic institutions) of suspected research misconduct, there is no regulatory obligation to provide such a notification, and, in fact, providing early (or any) notification is contrary to the confidentiality provisions of the research misconduct regulations. Moreover, the institution—and individuals acting on behalf of the institution—may face legal exposure for notifying outside entities. (shrink)

This book, spanning the years 1650–1730 in France and England, looks primarily at the history of literary criticism during that period in order to show how the rising interest in the sublime pushes literary critics to entirely alter their approach to theorizing works of literature. It provides a new approach to understanding how eighteenth-century aesthetic theories are indebted to seventeenth-century religious, philosophical, and literary ideas.

Considerations upon the nature of properties and laws have led some philosophers to claim that the correct epistemic attitude with regards to the intrinsic properties of particulars is scepticism. I examine one particularly clear version of this line of argument, and contend that a serious form of scepticism is not established. However, I argue that the theories of properties and laws underlying the argument have unwanted metaphysical implications. These provide a stronger reason to jettison the analyses. I end by sketching (...) an alternative view that avoids these difficulties. -/- . (shrink)

In this first part, Matthew Lipman offers the reader a glimpse at the thought processes that resulted in Philosophy for Children and, in so doing, ...

Individual studies have contributed to our knowledge of corporate philanthropy, but to date they remain fragmented. We proposed to extricate the conceptual and empirical work in corporate social responsibility from the conceptual and empirical work on corporate philanthropy, limiting our review to works that specifically refer to corporate philanthropy, as well as works that are labeled as corporate social responsibility but actually operationalize it as philanthropy. We will present an integrative model of corporate philanthropy research that draws on research from (...) a variety of perspectives and shows how the antecedents, processes, and outcomes of philanthropic process have been studied. We will recommend an agenda for future research that highlights research foci that are understudied, argues for greater theoretical and disciplinary diversity in the study of philanthropy, and points out new opportunities for better understanding the philanthropic process. (shrink)

This powerful study is based on the premise that literary theory is important because literature is important. Bugliani explores the intersection of tragedy with philosophy and psychoanalysis. A threefold purpose is evident: to examine the tension between philosophy and literature, to discuss the teaching of tragedy and finally to discuss that teaching in the works of Lacan, Marcel and, above all, Paul Claudel.

Two significant, apparently unrelated, trends have emerged in American society and medicine. First, American medicine is reexamining its approach to dying. The Institute of Medicine, the American Medical Association and private funding organizations have recognized that too many dying people suffer from pain and other distress that clinicians can prevent or relieve. Second, this past decade has marked a sharp increase in the number of physicians prosecuted for criminal negligence based on arguably negligent patient care. The case often cited as (...) a watershed is People u. Einaugfer, which involved a New York nursing home patient whose physician was convicted in 1993 of two criminal misdemeanors after he ordered an elderly dialysis patient to be tube fed through a peritoneal dialysis Catheter.How is the growing awareness of dying patients’ pain and the increasing willingness of prosecutors to charge physicians with crimes connected? Pain at the end of life is frequently treated with narcotics, prescription drugs that are closely regulated by state and federal law. That complex web of laws—and a growing fear of legal sanctions—has deterred physicians from prescribing controlled substances. As those legal sanctions move from disciplinary actions to criminal charges, physicians’ fears may expand. (shrink)