Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge (...) the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice. (shrink)

Seeing art is not as easy as it looks, because there is more to seeing art than meets the eye. This essay examines some of the presuppositions involved in seeing something as art. In opposition to the view of A.C. Danto that to see something as art is merely to identify it as art, I shall suggest that to see something as art is to appreciate it in a specifiable way. In addition, I shall argue that considerations sometimes deemed adventitious (...) are in fact inescapably involved in the appreciation of all works of art, and in particular, that it is impossible to entirely eliminate intentional and genetic considerations from our critical Judgments. (shrink)

Robert Nozick's adherence to Locke's puzzling doctrine about punishment can seem strange. Why does Nozick follow Locke in claiming that individuals in a state of nature have a right to punish any wrongdoer?Here reflection on this question proceeds by stages to a conclusion that Nozick as well as any other state-of-nature theorist of similar stripe should find disturbing. For, as we shall see, what Nozick describes as the general right of a minimal state to punish cannot arise within a state (...) of nature from the more plausible right of individuals to punish only those who harm them. (shrink)

A working hypothesis of computationalism is that Mind arises, not from the intrinsic nature of the causal properties of particular forms of matter, but from the organization of matter. If this hypothesis is correct, then a wide range of physical systems (e.g. optical, chemical, various hybrids, etc.) should support Mind, especially computers, since they have the capability to create/manipulate organizations of bits of arbitrarily complexity and dynamics. In any particular computer, these bit patterns are quite physical, but their particular physicality (...) is considered irrelevant (since they could be replaced by other physical substrata). (shrink)

Se han investigado los principios básicos de tres tecnologías emergentes para pasteurizar y esterilizar alimentos sin empleo del calor Mediante numerosos estudios se ha comprobado la efectividad de los campos eléctricos pulsantes de alta intensidad (CEPAI), los pulsos de luz (PL) y los campos magnéticos oscilantes (CMO) en la destrucción de microorganismos y enzimas de sistemas alimentarios. En la inactivación microbiana por CEPA!, el blanco principal es la membrana celular que, al ser sometida a campos eléctricos de alta intensidad, se (...) hace permeable formando huecos o poros cuyo tamaño se incrementa a medida que aumenta la intensidad del campo eléctrico o el tiempo de tratamiento o se reduce la resistencia iónica del medio de pulsación. Por otra parte, los PL inducen reacciones fotoquímicas y fototérmicas en los alimentos, causando la muerte de gran cantidad de microorganismos, especialmente en productos alimenticios envasados. Los CMO producen simulación o inhibición en el crecimiento y reproducción de los microorganismos, un simple pulso de intensidad de 5-10 teslas y frecuencias de 5-500 kHz es suficiente para reducir el número de microorganismos en un mínimo de 2 ciclos logarítmicos. Se ha comprobado que estas tecnologías alargan la vida de anaquel de diversos productos alimenticios y pueden ser consideradas como sustitutos parciales de los procesos convencionales de pasteurización y esterilización de alimentos por tratamientos térmicos. (shrink)

This study examines the family environments and hormone profiles of 316 individuals aged 2 months-58 years residing in a rural village on the east coast of Dominica, a former British colony in the West Indies. Fieldwork was conducted over an eight-year period (1988–1995). Research methods and techniques include radioimmunoassay of cortisol and testosterone from saliva samples (N=22,340), residence histories, behavioral observations of family interactions, extensive ethnographic interview and participant observation, psychological questionnaires, and medical examinations.Analyses of data indicate complex, sex-specific effects (...) of family environment on endocrine function. Male endocrine profiles exhibit greater sensitivity to presence of father than do female endocrine profiles. Father-absent males tend to have (a) low cortisol levels during infancy, (b) high or abnormal cortisol profiles during childhood and adolescence, and (c) high cortisol and low testosterone levels during adulthood compared with those of males raised with a resident father. These results indicate that early family environment has significant effects on endocrine response throughout male life histories. (shrink)

The Danish scholar Jan Pinborg made outstanding contributions to our understanding of medieval language study. The papers in this volume clearly demonstrate the wealth of Pinborg's scholarly interests and the extent of his influence.Though centered on medieval theories of grammar and language, the collection ranges in time from the fourth century B.C. to the seventeenth century A.D.; theories of the pronoun, of mental language, of supposition, of figurative expressions and of mereology are among the topics discussed; and the papers deal (...) with both humble anonymous teachers of grammar and with such well-known men as Aristotle, Plotinus, Augustine, Peter of Spain, Roger Bacon, Robert Kilwardby, Thomas Aquinas, Dante, William of Ockham, Domingo de Soto, and Suárez. The papers are in English, German, or French. (shrink)

The ethics of physical restraint in the Emergency Department has always been an emotive and controversial issue. Recently a vanguard of advocacy groups and regulatory agencies have...

Self-knowledge is the focus of considerable attention from philosophers: Knowing Our Own Minds gives a much-needed overview of current work on the subject, bringing together new essays by leading figures. Knowledge of one's own sensations, desires, intentions, thoughts, beliefs, and other attitudes is characteristically different from other kinds of knowledge: it has greater immediacy, authority, and salience. The contributors examine philosophical questions raised by the distinctive character of self-knowledge, relating it to knowledge of other minds, to rationality and agency, externalist (...) theories of psychological content, and knowledge of language. Together these original, stimulating, and closely interlinked essays demonstrate the special relevance of self-knowledge to a broad range of issues in epistemology, philosophy of mind, and philosophy of language. (shrink)