Aid‐in‐dying laws in the United States have two important restrictions. First, only patients who are terminally ill, defined as having a prognosis of six months or less to live, qualify. Second, at the time the patients take the lethal medication, they must be competent to make medical decisions. This means that an advance directive requesting aid in dying for a later time when the patient lacks decision‐making capacity would be invalid. However, many people are more concerned about avoiding living into (...) severe dementia for years—a time when they will lack decision‐making capacity—than they are about preventing suffering or the loss of dignity or autonomy for a few months at the end of life.Gillian Bennett is an example of someone determined not to live into severe dementia. She opted for preemptive suicide in 2014, explaining why in a letter she posted online: “Every day I lose bits of myself, and it’s obvious that I am heading toward the state that all dementia patients eventually get to: not knowing who I am and requiring full‐time care.”A major problem with Bennett’s solution, however, is that the individual is likely thereby to be giving up some “good time.” A legal alternative to preemptive suicide is to create an advance directive stating the circumstances under which one wants not to receive any lifesaving or life‐sustaining treatment, even the most basic and noninvasive. This option is our focus in this paper: how to create effective advance directives to avoid living into severe dementia. To be relevant to progressive dementia, the directive would need to state what kinds of care should be withheld and when. At the same time, advance directives for severe dementia face serious challenges. Before addressing these, we review the normative force of directives themselves. (shrink)

Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance. The requirement of contemporary competence is intended to ensure that PAD is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, (...) arguably the strongest objections to legalizing PAD.The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia. (shrink)

Previous research has investigated factors that contribute to the development of different risk-taking behaviors, such as can occur on lab-based behavioral risky decision making tasks. On several of the most common tasks, participants must develop an adequate understanding of the relative risks and benefits associated with each decision in order to learn to decide advantageously. However, contextual factors can affect the decision making process and one’s ability to weigh the risks and benefits of a decision. The present study investigates the (...) extent to which music may be an additional contextual factor that can disrupt decision making and other executive functions. Across four studies we examine whether having music playing passively in the background or having participants actively listen to music affects performance on measures of risky decision making, working memory, processing speed, and problem solving. Participants reported greater distraction for rock music than classical music in the passive listening studies but did not report any differences in distraction across conditions in the active listening studies. Despite this self-reported increased level of distraction, few significant differences were found in task performance across groups and across studies. The Angling Risk Task was sensitive to differences in risk by condition, with music leading to greater risk-taking in a passive listening study, but less risk-taking in an active listening study, compared to no music. The extent to which music serves as a contextual factor disrupting performance on measures of risky decision making and other executive functions may depend in part on whether individuals are actively versus passively listening to the music. (shrink)

Proximate selfish goals reflect the machinations of more fundamental goals such as self-protection and reproduction. Evolutionary life history theory allows us to make predictions about which goals are prioritized over others, which stimuli release which goals, and how the stages of cognitive processing are selectively influenced to better achieve the aims of those goals.

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Smilek, Eastwood, Reynolds, and Kingstone suggests that the studies reported in Beck, M. R., Levin, D. T. and Angelone, B. A. are not ecologically valid. Here, we argue that not only are change blindness and change blindness blindness studies in general ecologically valid, but that the studies we reported in Beck, Levin, and Angelone, 2007 are as well. Specifically, we suggest that many of the changes used in our study could reasonably be expected to occur in the real world. Furthermore, (...) the conclusion from Beck et al. that knowledge about the role of intention and scene complexity in change detection is not readily accessible applies not only to the laboratory studies we conducted but also to real world situations. (shrink)

Previous research demonstrates that implicitly learned probability information can guide visual attention. We examined whether the probability of an object changing can be implicitly learned and then used to improve change detection performance. In a series of six experiments, participants completed 120–130 training change detection trials. In four of the experiments the object that changed color was the same shape on every trial. Participants were not explicitly aware of this change probability manipulation and change detection performance was not improved for (...) the trained shape versus untrained shapes. In two of the experiments, the object that changed color was always in the same general location . Although participants were not explicitly aware of the change probability, implicit knowledge of it did improve change detection performance in the trained location. These results indicate that improved change detection performance through implicitly learned change probability occurs for location but not shape. (shrink)

Observers have difficulty detecting visual changes. However, they are unaware of this inability, suggesting that people do not have an accurate understanding of visual processes. We explored whether this error is related to participants’ beliefs about the roles of intention and scene complexity in detecting changes. In Experiment 1 participants had a higher failure rate for detecting changes in an incidental change detection task than an intentional change detection task. This effect of intention was greatest for complex scenes. However, participants (...) predicted equal levels of change detection for both types of changes across scene complexity. In Experiment 2, emphasizing the differences between intentional and incidental tasks allowed participants to make predictions that were less inaccurate. In Experiment 3, using more sensitive measures and accounting for individual differences did not further improve predictions. These findings suggest that adults do not fully understand the role of intention and scene complexity in change detection. (shrink)

Perhaps the central focus of American bioethics has been to push against medical paternalism on the grounds that it impedes the autonomy of patients—that is, their ability to make choices of their...

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be (...) eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions—as I shall assume in this article—then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want? (shrink)

Suppose that I stand firmly in what Alasdair MacIntyre describes as the Thomistic tradition of moral enquiry. I try my best to recover a historical understanding of Aquinas's teachings, and I refuse to let my philosophical opponents set the terms of debate. Now suppose that you yourself are one of my opponents: a Buddhist, a Jew, a Muslim or perhaps a secular humanist. Finally, suppose that I have always found you a considerate neighbour, a friendly and responsible colleague, and a (...) reliable contributor to worthy causes: you run the neighbourhood recycling programme, do volunteer work at an AIDS hospice, and serve as den mother of your son's Cub Scout troop. All of my experience suggests that you are, by commonly accepted standards, morally admirable; but you don't believe in God, or at least your own understanding of God and God's law differs significantly from my own. Am I, as a loyal Thomist, able to acknowledge your virtues? Or must I dismiss them all as merely apparent? (shrink)

The purpose of One Heart is to illuminate the common sacred ground at the heart of seven faiths: Buddhism, Christianity, Confucianism, Hinduism, Islam, Judaism, and Taoism. Its method is to identify 65 essential principles, among them: Feel what other people feel; Don't harm others; Lead with virtue and concern for others; Be honest ; Practice what you preach; Be content; Don't let anger take over; Choose your companions wisely; Accept the existence of spiritual beings; Seek and you will find. Illustrating (...) each principle are one, two, or three quotations from a wide variety of texts sacred to each of the seven faiths—including the Old and New Testaments, the Talmud, the Mahabarata, the Tao Te Ching, the Bhagavad Gita, the Analects of Confucius, and many other sacred sources. In addition, each chapter also provides guidance on a spiritual theme or practice—prayer beads, a home altar, labyrinth walking—to enhance our understanding of these wise words and universal principles. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Life of Roman Republicanism by Joy ConnollyT. P. WisemanJoy Connolly. The Life of Roman Republicanism. Princeton: Princeton University Press, 2014. xix + 228 pp. Cloth. $39.95.This book was written for the best of reasons. Joy Connolly explains in her preface that she began to study the republican tradition in 2001, when “the Bush administration’s imprudence, paranoia, and disregard of democratic values stoked in me an anger equalled (...) only by the disgust I felt at my own and my fellow citizens’ inability or unwillingness to stand up to it” (xiv). The failure of the Left caused her “to ask questions that might help us to respond more intelligently and humanly to the situation in which we find ourselves” (xv). In particular, in this book her aim has been to exploit texts from the late Roman republic, to which students of political science have not paid enough attention, and thus recover “the suppressed history of republican political thought” (204). As she says in [End Page 372] conclusion, “I have sought to offer practical tools for civic education by articulating learnable practices of knowing the world that characterize late republican texts” (208, author’s emphasis). How well has this admirable ambition been achieved?According to the introduction, “[t]his book seeks to place Cicero’s Verrines, Caesarian orations, Republic, and Laws; Sallust’s Catiline and Jugurtha; and Horace’s Satires at the center of the republican tradition” (1); however, the Verrines and De legibus get only a couple of paragraphs each, and only one of the “Caesarian” orations is discussed at all. The actual contents are: chapter 1 on De republica (“Where Politics Begins”), which “presents Cicero as a thinker concerned with a collective of antagonists and competing interests, against conventional portrayals of his ideal republic as a homogeneous, unified, harmonious community” (20); chapter 2 on Sallust (“Justice in the World”), which argues that “Sallust’s withholding of judgment at the end of Jugurtha signifies the ways in which agents in the decaying republic withhold justice on a larger scale” (20); chapter 3 on Horace Satires I (“Non-Sovereign Freedom”), in which the obvious question (asked only at the end), “what might political and social progressives find worthy of consideration in Horace today?”, is answered with “Horatian satire undoes the claim to sovereignty that usually partners claims to moral judgment” (154); chapter 4 on Cicero’s view of oratory (“Dividual Advocacy”), which “reflects on the Roman preoccupation with faces, situations, the mutability of selfhood, and the degree to which the divided self mirrors the division of the polity” (21); and chapter 5 on Pro Marcello (“Imagination, Finitude, Responsibility, Irony”), which argues that “[b]y adopting hyperbole as the governing figure of this new style of senatorial speech, Cicero holds out the promise not of a morally legible universe, but of a recognition that every Roman now lives in conditions virtually ‘impossible to believe’, the emergence of one ruler, under whom the chains of traditional obligations do not consistently hold” (183). The short conclusion (“The Republic Remastered”) attacks “the tendency, dominant since the nineteenth-century emergence of sociology and economics, to treat human beings primarily as rational calculators or creatures of practical wisdom” (203) and expresses the hope that “close attention to these texts has the capacity to reshape the way we think about civic wisdom—the way schools teach history, literature, civics, and philosophy—about public discourse, especially public commentary on political oratory, and about the conversations we citizens hold among ourselves” (207).I have deliberately used the author’s own words to indicate what the book attempts to do, because I would find it impossible to summarise its argument any other way. Even with these formulae to help, Connolly’s selective and apparently random approach imposes a heavy burden on the reader to construct a coherent framework for her ideas. I think there are two main reasons for this. The first is a direct result of Connolly’s impressive mastery of the political-sciences literature. It is an excellent thing to be so thoroughly familiar with the works of Hannah Arendt, Simon Critchley, John Dewey, Michel Foucault, Dean Hammer, Bonnie Honig, Andreas Kalyvas, George Kareb... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Every Patient is a Teacher—Especially the "Difficult" Ones:Caring for Patients with Borderline Personality DisorderCara ConnaughtonNo one can teach you how to work with a patient living with borderline personality disorder quite like a patient living with borderline personality disorder (BPD). The lesson [End Page E9] isn't on how to be the perfect caregiver or how to meet all the patient's needs. The lesson is to notice that the quality (...) of care and the patient's response are not always mutually dependent and that holding ourselves to impossible standards will only lead to resentment, job dissatisfaction, and potentially burnout.I had a very good teacher on this subject and her name was Sandra.1 Sandra was admitted to our hospital unit with end stage cervical cancer. She had attempted to treat her illness by using only homeopathic remedies, which hadn't abated the disease. While at the hospital, Sandra was intensely controlling over her medications as well as when and how she took them. Sandra had also been diagnosed with BPD. One symptom of her disorder manifested in staff splitting: she saw staff members as either good or bad and treated them as such—her thinking was very black and white. She would talk very badly about other nurses to the current nurse working or talk very well about her favorite nurse in a way that made me and other nurses feel that we weren't measuring up. Sandra also exhibited intense anger toward most staff and had unexpected mood swings—I didn't know what I was going to get when I walked into her room but was fairly certain it would include berating and belittling comments. This same treatment was given to most staff nurses except for one. Sandra's favorite nurse was Bonnie; Bonnie couldn't understand why the rest of the nursing staff found Sandra difficult since she was always treated very well by this patient.I dreaded coming to work to find Sandra as part of my patient assignment for the day. I knew that day would be full of cutting remarks and disappointment from Sandra, no matter how hard I tried to provide compassionate and quality care. Further, trying to meet her seemingly endless needs took away from the care that I could provide for the other patients on my assignment. I could easily spend an hour in Sandra's room doing various tasks while she expressed frustration and anger toward me—I couldn't seem to do anything right.I have cared for many "difficult" patients throughout my years as a bedside nurse—including those who were physically and verbally aggressive—but Sandra always stands out as the most "difficult" because her words and behavior cut right through me. Even the briefest interactions with Sandra left me questioning my competence as a nurse, something I hadn't experienced when caring for other "difficult" patients.A turning point in how I related to Sandra's behavior occurred one day shift when she was part of my patient assignment. Sandra had been off the unit for a treatment from before I'd even started my shift at 7 am. At 11 am, Sandra arrived back on the unit. A few minutes later, I brought her 9 am medications to her room. The medications were technically late, but of course, it would have been impossible for me to bring them to her on time as she wasn't even present on the unit. She said angrily, "These are late! Bonnie never brings my medications late!" At that moment, something switched in my mind—it wasn't me! What a relief. I had to let go of the idea that I needed to make this patient happy in order to be a good nurse. Prior to this incident, I determined how good of a job I was doing based on how happy my patient appeared with their care. I realized that a patient's satisfaction wasn't always dependent on the quality of the care I provided.All of us provided the best care that we could for Sandra. To help us do this while maintaining our own mental wellness, we rotated... (shrink)

To compare a novel to a work of philosophy is, admittedly, a risky exercise in analogy. When the novelist is Lawrence and the philosophical text is the ponderous and dialectical Being and Nothingness, such a comparison may seem willfully perverse and peculiarly open, insofar as it deals with Lawrence's great theme of sexuality, to his anathema of "sex in the head." Furthermore, modern criticism, especially in the Anglo-Saxon world, has tended to be wary of critical approaches that lean on notions (...) that are not derived from literature itself - a tendency that is being reinforced these days by the structuralist insistence on the "literariness" of the Text. Now, despite its metaphorical statement as a form of dramatic "gesture," Sartre's book is very definitely not a work of literature. T.H. Adamowski, associate professor of English at Erindale College, the University of Toronto, has written articles on English, American, and French literature. This essay is part of a larger study on progress on Lawrence's "sexual poetics.". (shrink)

1. Mafhūm al-Tarbiyah al-Islāmīyah -- 2. Mfhm uṣūl al-Tarbiyah al-Islāmīyah -- 3. Mafhūm al-naẓarīyah al-Tarbawīyah al-Islāmīyah -- 4. Mafhūm al-naẓarīyah al-Tarbawīyah al-Islāmīyah -- 5. Mafhūm al-Fikr al-tarbawī al-Islāmī Mafhūm al-Turāth al-tarbawī al-Islāmī -- 6. Mafhūm Falsafat al-Tarbiyah al-Islāmīyah.

In this paper, a survey of 180 inscriptions in Tamil between 1346 CE and 1400 CE is analysed for its notions and visualization of astral themes present in the epigraphical inscriptions as well as for the calendrical practices implicit in those inscriptions. I demonstrate the rich diversity of calendrical practices employed in this period. Although there are clear local usages, the applied methods of identification show that in several cases methods from other Indian calendrical traditions have also been used. This (...) applies both to the year and the month. In contrast, the use of the weekday is not widely seen in the inscriptions of this region following the local system. The study also clarifies that the inscriptions are a useful documentary source for other astronomical observations such as eclipses and solstices undertaken in southern Indian locations in the fourteenth and fifteenth centuries. (shrink)

In this book we provide a collection of writing by eminent scholars in our field, in which we asked them to engage with the thoughts of many of the philosophers and theorists who have influenced thinking and practice about young children and their care and education. Some readers may feel their favourite philosopher or theorist has been omitted or been given little space but we do not claim the Handbook is comprehensive – there is always more to say, more to (...) write about. Further, it would be impossible to provide a real introduction to the vast and exciting discipline of Philosophy, which includes a number of different areas of study. (shrink)

In what follows, I reply to critical appraisals of my book entitled Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. Professors Tollefsen, McPherson, and Potts separately offer these thoughtful critiques. Professor Tollefsen approaches the work from the standpoint of the physician-patient relationship. Professors McPherson and Potts both address it in terms of virtues. Potts treats the theme of virtue generally while McPherson focuses on the virtue of piety. Since virtues attend relationships, in what follows, I discuss, first, (...) the physician-patient relationship ; second, virtue generally ; and third, and finally, the virtue of piety specifically. (shrink)