There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in (...) practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

Developments in biotechnology present difficult social and ethical challenges that need to be resolved by regulators among others. One crucial problem for regulators of new technologies is to ensure that regulation is both clear and sufficiently flexible to respond to new developments. This is particularly difficult to achieve in contentious fields such as medical biotechnology. In the European Union there is a divergence in the solutions to this problem which has lead to different regulatory frameworks for medical biotechnology. This paper (...) compares and contrasts the British and Dutch regulatory frameworks for the selection of embryos by preimplantation genetic diagnosis as an example of the regulation of medical biotechnology. Some of the outcomes of the regulatory choices and possible reasons behind the divergent frameworks are discussed, such as the ethical outlooks and political systems in these countries. (shrink)

Bradford C Bemiss, Chad A WittDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA: Chronic rejection is a major cause of death after the first year following lung transplantation. Bronchiolitis obliterans is the most common pathologic finding on biopsy, characterized by fibrous granulation tissue, which obliterates the lumen of the bronchiole. Clinically, in the absence of tissue for pathology, BO syndrome refers to a progressive irreversible drop in the forced (...) expiratory volume in 1 second. Recently, a broader definition of chronic rejection, termed "chronic lung allograft dysfunction", has been used to encompass a more inclusive definition of posttransplant dysfunction. Recently, the lung transplant community has come to realize that chronic rejection may be the final common result after repetitive epithelial insults. Acute rejection, infection, and alloreactivity to mismatched HLA antigens are a few of these insults that damage the surface of the bronchioles. Recent evidence of autoimmunity to the normally hidden structural proteins collagen V and K-α1 tubulin have been correlated with a BO phenotype as well, perhaps correlating the epithelial damage with a mechanism for developing BO lesions. Many immunomodulatory medications and treatments have been studied for effectiveness for the treatment of chronic lung allograft dysfunction. New drugs, which more precisely target the immune system, are being developed and tested. Further study is required, but recent advances have improved our understanding of the pathogenesis and potential intervention for this common and deadly complication of lung transplantation.Keywords: lung transplant, bronchiolitis obliterans syndrome, rejection. (shrink)

In this volume C.A. (Chet) Bowers, whose pioneering work on education and environmental and sustainability issues is widely recognized and respected around the world, brings together a carefully curated selection of his seminal work on the ideological, cultural, and linguistic roots of the ecological crisis; misconceptions underlying modern consciousness; the cultural commons; a critique of technology; and educational reforms to address these pressing concerns. In the World Library of Educationalists, international scholars themselves compile career-long collections of what they judge to (...) be their finest pieces - extracts from books, key articles, salient research findings, major theoretical and/practical contributions - so the world can read them in a single manageable volume. Readers will be able to follow the themes and strands of their work and see their contribution to the development of a field, as well as the development of the field itself. Contributors to the series include : Michael Apple, James A. Banks, Joel Spring, William F. Pinar, Stephen J. Ball, Elliot Eisner, Howard Gardner, John Gilbert, Ivor F. Goodson, Peter Jarvis. (shrink)

It is no longer possible to claim that the biological characteristics of the future adult are already determined at conception. After all, a zygote may develop into a hydatidiform mole rather than into a human being. The development of an individual human person is determined by genetically and nongenetically coded molecules within the embryo, together with the influence of the maternal environment. Consequently, it is an error to regard the zygote's chromosomal (and other) DNA as sufficient to determine the uniqueness (...) of the future individual. (shrink)

Open peer commentary on the target article “From Objects to Processes: A Proposal to Rewrite Radical Constructivism” by Siegfried J. Schmidt. Upshot: Siegfried J. Schmidt’s process-oriented constructivism, with which he proposes to dissolve the debate about realism, offers myriad intellectual challenges to constructivists from numerous different disciplines. While “From Objects to Processes” seems to represent a review of Schmidt’s work rather than a new addition to the debate, it derives in a convincing fashion the importance of a process- and action-based (...) unending constructivism from a combination of Schmidt’s own previous positions and a number of central epistemological questions. (shrink)

(Statement of Responsibility) by C.A. Stephens ; illustrated.

Our trust in the word of others is often dismissed as unworthy, because the illusory ideal of "autonomous knowledge" has prevailed in the debate about the nature of knowledge. Yet we are profoundly dependent on others for a vast amount of what any of us claim to know. Coady explores the nature of testimony in order to show how it might be justified as a source of knowledge, and uses the insights that he has developed to challenge certain widespread assumptions (...) in the areas of history, law, mathematics, and psychology. (shrink)

C. A. J. Coady; VIII*—Descartes' Other Myth, Proceedings of the Aristotelian Society, Volume 83, Issue 1, 1 June 1983, Pages 121–142, https://doi.org/10.1093/ar.

A new frame of reference, which in its fundamental structuring differs radically from the structuring of the familiar western Indo-European viewpoints (logical, mathematical, scientific, philosophical, etc.), already exists. Recently, by the strategem of systematically disallowing a previously unnoticed untenable assumption encoded in the traditional Western symbolic logics, set theories, etc., in particular and in the Western World-View in general, this frame of reference has generated its own, entirely non-traditional, formalized language. The Notre Dame Journal of Formal Logic has accepted for (...) publication a first paper presenting this non-standard formalized language (Hilgartner, 1975).As one of its accomplishments, this new frame of reference delivers a general theory of living. This theory purports to span the entire domain of what we call living systems, human or non-human. (shrink)

In the current century, geographic and psychological separations from familial and cultural connections have become endemic. The various fields of social sciences have made belonging vis à vis existential alienation a focal issue with an emphasis on the need for localized belonging. This article argues that there is an innate predisposition within the self that must connect to another, a ?re-membering??a compelling humanistic need to connect and become a member, yet again, of a greater collective. It is suggested herein that (...) this predisposition stems from the need to reclaim our anthropocosmic connection of being embedded in the world beyond, as opposed to an anthrocentric view that instigates an entity-in-isolation mentality. (shrink)