In Beyond Blood Identities, Jason D. Hill presents a bold defense of a form of cosmopolitanism according to which only individual persons—not cultures, races, or ethic groups—are the bearers of rights and the possessors of an inviolable status worthy of respect.

This essay examines the symbolic significance of blood in the twentieth century and its role in determining the composition of a national community along racial lines. By drawing parallels between Nazi notions of blood and racial purity and historically contemporaneous U.S. policies regarding blood and blood products, Polsky reveals a disturbing proximity in discourse and policy. While the Nazis attempted to locate Jewish racial essence and inferiority in blood and instituted eugenic measures and laws forbidding (...) racial admixture, similar policies existed in the U.S. based on the so-called one drop rule that systematically discriminated against African Americans. (shrink)

Religious belief can complicate the usual management of seriously ill patients when the patient is a Jehovah’s Witness and the treatment is a blood transfusion. This narrative highlights critical points in a discussion of two cases wherein the process to promote an exercise of free will also becomes an exercise for the ethics consultant and healthcare team. Despite a medical care program’s carefully considered additions to an electronic healthcare record, additional conversation, investigation, preparation, and an open mind are required. (...) Helping conflicted family members and considering whether and in what context to contact the Jehovah’s Witness Hospital Liaison Committee complicates the approach. (shrink)

Jehovah's Witnesses are students of the Bible. They refuse transfusions out of obedience to the scriptural directive to abstain and keep from blood. Dr Muramoto disagrees with the Witnesses' religious beliefs in this regard. Despite this basic disagreement over the meaning of Biblical texts, Muramoto flouts the religious basis for the Witnesses' position. His proposed policy change about accepting transfusions in private not only conflicts with the Witnesses' fundamental beliefs but it promotes hypocrisy. In addition, Muramoto's arguments about pressure (...) to conform and coerced disclosure of private information misrepresent the beliefs and practices of Jehovah's Witnesses and ignore the element of individual conscience. In short, Muramoto resorts to distortion and uncorroborated assertions in his effort to portray a matter of religious faith as a matter of medical ethical debate. (shrink)

Child maltreatment not only leads to epigenetic changes, but also increases the risk of related behavioral deficits and mental disorders. These issues presumably are most closely associated with epigenetic changes in the brain, but epigenetic changes in peripheral tissues like blood are often examined instead, due to their accessibility. As such, the reliability of using the peripheral epigenome as a proxy for that of the brain is imperative. Previously, our lab has found aberrant methylation at the Brain-derived neurotrophic factor (...) gene in the prefrontal cortex of rats following aversive caregiving. The current study examined whether aversive caregiving alters Bdnf DNA methylation in the blood compared to the prefrontal cortex. It was revealed that DNA methylation associated with adversity increased in both tissues, but this methylation was not correlated between tissues. These findings indicate that group trends in Bdnf methylation between blood and the brain are comparable, but variation exists among individual subjects. (shrink)

Class line is a fundamental line of the Party. To be the Communist Party is to make revolution, eradicate the bourgeoisie and promote the proletariat, stress class status, and implement the proletarian class line!

A follow-up to the popular "God Is Not . . .," this book is highly readable and provocative.

What makes Jehovah's Witnesses tick? What motivates practitioners of medicine? How is benevolent human behaviour to be interpreted? The explanation that fear of censure, mind-control techniques or enlightened self-interest are the real motivators of human conduct is questioned. Those who believe that man was created in "God's image", hold that humanity has the potential to rise above selfishly driven attitudes and actions, and reflect the qualities of love, kindness and justice that separate us from the beasts. A comparison of general (...) medical ethics and disciplines, and those of the Jehovah's Witness community, is made in this context. The easy charge that frequent deaths result from refusal of blood transfusions is examined. The central source of antipathy towards Jehovah's Witnesses, namely the alleged imposition of extreme and even harmful refusal of blood therapy on our children is addressed. Of course, "...few dilemmas are likely to be resolved wisely or satisfactorily by a blinkered adherence to abstract principles alone. Solutions to most cases will be dictated by a combination of factors. The support of medical ethics by Jehovah's Witnesses, and their willingness to share in reasoned and ethical debate, while at the same time holding firm to their religious and conscientious principles are emphasised. (shrink)

Most of the discussion in bioethics and health policy concerning social responsibility for health has focused on society’s obligation to provide access to healthcare. While ensuring access to healthcare is an important social responsibility, societies can promote health in many other ways, such as through sanitation, pollution control, food and drug safety, health education, disease surveillance, urban planning and occupational health. Greater attention should be paid to strategies for health promotion other than access to healthcare, such as environmental and public (...) health and health research.Lifestyle plays a major role in most of the illnesses in industrialised nations.1 Six of the 10 leading factors contributing to the global burden of disease are lifestyle related: unsafe sex, high blood pressure, tobacco use, alcohol use, high cholesterol and obesity.2 Lifestyle-related illnesses also contribute to the rising costs of healthcare. Spending on healthcare accounts for about 16% of the gross domestic product in the USA, or US$1.9 trillion.3 Although smoking has declined steadily there since the 1960s, smoking-related medical expenses are still about US$75.5 billion per year.4 Obesity, which has been climbing in the past two decades, accounts for about US$75 billion in healthcare costs there each year.5 Alcoholism and drug addiction in the USA account for annual healthcare costs of about US$22.5 billion and US$12 billion, respectively.6,7 Federal government spending on healthcare relating to HIV/AIDS is over US$13 billion per year.8Given the well-documented relationship between lifestyle, disease burden and healthcare costs, it makes economic and medical sense to hold individuals morally responsible for their health-related choices. While this view has a great deal of intuitive appeal, it also faces numerous objections.9–12 First, holding individuals entirely responsible for their own health conflicts with medicine’s obligation to treat the sick and society’s obligation …. (shrink)

Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in (...) order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example – remote parental monitoring of adolescent blood glucose – is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents’ decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families. (shrink)

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians (...) and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians’ ethical obligations, neither adequately reflects the state’s ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah’s Witnesses. (shrink)

The Indiana Court of Appeals, in JKB, Sr. v. Armour Pharmaceutical Co. ), held that the state's Blood Shield Act does not protect pharmaceutical companies that produce blood-derived products from product liability suits based on injuries attributable to tainted blood supplies. Blood shield statutes help to guarantee adequate blood supplies by limiting the liability of blood banks. This holding limits the defenses available to pharmaceutical companies sued under product liability theory.The defendant, Armour Pharmaceutical, produces (...) and sells clotting factor agents, which are derived through plasmapheresis. Plasmapheresis is a costly and complex donation process through which the plasma and red blood cells of a donor's blood are separated. After separation, the process returns the red blood cells to the donor but retains the plasma. (shrink)

‘He was of Rutulian blood, born of a Saguntine mother; but he had Greek blood too, and by his two parents he combined the seed of Italy with that of Dulichium’. So Duff, and Ruperti's ‘Murrus matre Graia et patre Romano progenitus’ is not the whole story. To Silius Saguntine = Greek because, as Duff says, ‘men of Zacynthos had taken part in founding Saguntum’. prole = ‘with his children’—van Veen's Itala may well be right.

In his Gallic War Caesar tells us that the Roman Senate had frequently recognized the Aedui as ‘brothers and kinsmen’. This statement, though prima facie rather odd, is fully supported by Caesar's contemporaries, Cicero and Diodorus Siculus, and a number of later authorities. Ihm was of the opinion that the Aedui were recognized as ‘fratres consanguineosque’ because they were the first tribe in Gallia Comata to enter into alliance with Rome. However, no ancient authority supports this view and it is (...) hardly sufficient to explain the notion of blood relationship implied by these titles. (shrink)

MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die (...) than to survive without blood. Third, he relies on an ambiguous understanding of what is "rational" and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses). (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed (...) by these issues. We describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

Health care workers with needlestick exposures to patients' blood often request a test of the patient for evidence of infection with human immunodeficiency virus. If the patient refuses the test, a conflict develops between the interests of the health care worker and those of the patient. Traditional approaches to this dilemma attempt to balance the rights or utilities of abstract patients and health care workers. While these approaches have the advantage of offering clear guidelines in advance of conflict, the (...) interests of the actual participants may differ from those used to create the guidelines. In nonmedical settings, conflicts are often resolved efficiently through negotiation and monetary exchanges. Although negotiated monetary settlements between health care workers and patients may be an impractical way to resolve medical conflicts, models developed from these perspectives provide insights into the individual interests of physicians and patients. Changing existing rules about medical record documentation, or increasing the penalties for the misuse of medical information, may satisfy the interests on both sides of the conflict and so represent integrative bargaining solutions. Even so, as the relationship between health care workers and their patients evolves, more explicit strategies for negotiation may become a reasonable solution to the problem of conflict. (shrink)

That Jehovah's Witnesses cannot refuse life-saving blood transfusions on behalf of their children has acquired the status of virtual “consensus” among bioethicists. However strong the consensus may be on this matter, this article explores whether this view can be plausibly defended on liberal principles by examining it in light of one particularly well worked-out liberal political theory, that of Rawls. It concludes that because of the extremely high priority Rawls attributes to “freedom of conscience,” and the implication from the (...) original position that parents must act paternalistically toward their children as their protectors, Jehovah's Witnesses cannot legitimately be barred from making decisions on behalf of their children, even when the consequences of such decisions are serious and irremediable. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

“That’s Africa”, or words to that effect, have been directed at me a number of times recently as some form of justification of things not working. Africa is broken and we have to work with what we have got, is the idea. Is this acceptance of the way things are a way of surviving and working in difficult environments or is it actually wrong and medically negligent to accept substandard practice? In many ways, this dilemma can be applied to any (...) part of the world, both developing and developed, but it is most acute in Africa.While observing medical ward rounds in a public hospital in Malawi, I came across two kinds of doctor. One kind would accept the way things were and work within the constraints; the other kind would always be battling against the constraints. I was told that “we can’t give an intravenous infusion because the nurses cannot count the number of drops …” Really? Why can’t they count the number of drops? I see no reason, aside from a complete lack of time . This attitude included everything from delivering blood samples to the laboratory to accessing drugs. …. (shrink)

Recent commentaries by Verheijde et al, Evans and Potts suggesting that donation after cardiac death practices routinely violate the dead donor rule are based on flawed presumptions. Cell biology, cardiopulmonary resuscitation, critical care life support technologies, donation and transplantation continue to inform concepts of life and death. The impact of oxygen deprivation to cells, organs and the brain is discussed in relation to death as a biological transition. In the face of advancing organ support and replacement technologies, the reversibility of (...) cardiac arrest is now purely related to the context in which it occurs, in association to the availability and application of support systems to maintain oxygenated circulation. The 'complete and irreversible' lexicon commonly used in death discussions and legal statutes are ambiguous, indefinable and should be replaced by accurate terms. Criticism of controlled DCD on the basis of violating the dead donor rule, where autoresuscitation has not been described beyond 2 minutes, in which life support is withdrawn and CPR is not provided, is not valid. However, any post mortem intervention that re-establishes brain blood flow should be prohibited. In comparison to traditional practice, organ donation has forced the clarification of the diagnostic criteria for death and improved the rigour of the determinations. (shrink)

Johanna Knapstein,1 Daniel Grimm,1 Marcus A Wörns,1 Peter R Galle,1 Hauke Lang,2 Tim Zimmermann111st Department of Internal Medicine, Johannes Gutenberg-University, Mainz, Germany; 2Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg-University, Mainz, GermanyIntroduction: Hepatitis C virus reinfection occurs universally after liver transplantation, with accelerated cirrhosis rates of up to 30% within 5 years after liver transplantation. Dual antiviral therapy with pegylated interferon-2a and ribavirin only reaches sustained virological response rates of ~30% after liver transplantation. With the approval of viral NS3/4A (...) protease inhibitors telaprevir, boceprevir, and simeprevir and the NS5B polymerase inhibitor sofosbuvir, combination therapy offers new therapeutic options for HCV-infected patients, resulting in considerably higher sustained virological response rates in the nontransplant setting. Case presentation: We report three cases of TVR-based triple antiviral therapy in HCV genotype 1 reinfected patients after liver transplantation, of whom a 57-year-old Caucasian female and a 43-year-old Caucasian male were therapy naïve, and a 49-year-old Caucasian male patient was pretreated ineffectively. After 4 weeks of therapy, viral load decreased one to three log10 and became negative in weeks 6 to 8 in the therapy naïve patients. The pretreated patient showed a negative viral load in week 4. TVR was administered over 12 weeks, 750 mg thrice daily. Doses of immunosuppression with cyclosporine were reduced four to six fold. Initial peg-IFN and RBV doses ranged from 135–180 µg/week and 800–1,200 mg/day, according to the patient's body weight. Doses of peg-IFN and RBV were adapted to 90–135 µg/week and 400–800 mg/day after 2 to 12 weeks of protease inhibitor therapy. Dual therapy was continued for 36 weeks with total treatment duration of 48 weeks in the therapy naïve patients leading to a sustained virological response 12 weeks after the end of therapy. In the pretreated patient a breakthrough was detected in week 24 and therapy was discontinued. Overall, antiviral therapy was well tolerated. Side effects included dysgeusia and anemia leading to erythropoietin application and blood transfusions. Conclusion: This case series emphasizes that triple therapy with TVR is an efficient treatment for therapy naïve HCV genotype 1 reinfected patients after liver transplantation. But therapeutic options for pretreated patients require improvement. Keyword: cyclosporine, interferon, ribavirin, hepatitis C, protease inhibitor. (shrink)

In the second Nekyia Hermes conducts to Hades the souls of the suitors slain by Odysseus: Even in antiquity the identification of the Λευκς πέτρη was a conundrum. It would seem that no ancient Greek scholar could plausibly locate this rock. According to the scholion in the codex Venetus Marcianus 613, one of the many reasons Aristarchos gave for athetising the whole of the second Nekyia was λλ' οδ οικεν ες Ἅιδου λευκν εναι πέτραν. Certainly Hades had πέτραι, but traditionally (...) they were ‘black-hearted’ or ‘blood-red’, not λευκαί. As an example of the lengths to which scholiasts were driven to justify the epithet Λευκάς, the scholion in the British Library codex Harley 5674 has the unhelpful explanation ο γρ νεκροί κλείψαντος το αματος λευκοειδες ρνται. Eustathios' attempt is not much better; he writes στέον δ τι Λευκάδα μέν πέτραν μθος πρς τ Ἅιδπλάττει ἢ κατ ντίρασιν, μλας γρ κε σκότος, ἢ κα δι τούς σχάτους τς κε γς τόπους, ος εκς τν ᾓλιον τι διαλευκαίνειν δυόμενον. At Od. 10.515, in commenting on the πέτρη where the Pyriphlegethôn and the Kôkytos flow into the Acherôn, he ventures the suggestion σως δ εη ν ατη ν τος μετ τατα λεχθησομένη Λευκς πέτρα, which is obviously a mere guess. It would be a waste of time to record the conjectural attempts of modern scholars to locate the Λευκς πέτρη in Hades, for if the ‘Rock Leukas’ was across the Ocean, near the ‘Gates of the Sun’ and the ‘Land of Dreams’, we cannot reasonably hope to identify it. (shrink)

In this paper I shall put forward a version of the so-called logical connection argument to try to show that desires cannot be causes of actions. Now for anyone who wishes to use that kind of argument to show this, the ideal way of proceeding would be to first set out a complete analysis of the causal relation, and then to go on to argue that the relation between desires, certain other conditions, and actions fails to match some essential feature (...) revealed by that analysis. But I cannot proceed in this way; for I do not possess any full-blooded analysis of the causal relation. Nonetheless, I do not think that this places me in a position of real weakness. For the argument I shall present requires the truth of only one claim with respect to the nature of the causal relation. This is the claim that the causal relation is a contingent relation. I think that this claim is a relatively uncontroversial one; I am going to assume that it is true; and the argument which follows will exploit that claim. (shrink)

The modern restorative justice movement, perhaps one of the most important social movements of our time, was born in a Christian home to Christian parents, specifically to Christian peace workers striving to put their faith into action in the public arena. The first major book on the subject was written primarily for a church audience and drew deeply on biblical themes and values. But as restorative justice has moved into the mainstream of criminological thought and policy, the significance of its (...) originating spiritual impulse has been minimized or denied, and subsequent theological scholarship has done little to probe the relevance of restorative perspectives for doctrine and discipleship. In this collection of essays, Christopher D. Marshall, a biblical scholar and restorative practitioner who has devoted his career to exploring the relationship between the two fields, considers how peacemaking Christians can honor the witness and authority of Scripture, including its apparently violence-endorsing strands, as they strive to join in God’s great work in Christ of “reconciling to himself all things, whether on earth or in heaven, by making peace through the blood of his cross” (Col 1:20). (shrink)

Stem cell science, using both embryonic and a variety of tissue-specific stem cells, is advancing rapidly and offers promise to improve medical care in the future. Yet, with the notable exception of hematopoietic stem cell transplantation, a long-established approach to treating certain cancers of the blood system, this promise is long term and most stem cell research focuses on basic scientific questions or the collection of pre-clinical data. Although some clinical trials are underway, most are focused on safety, and (...) novel effective therapy is likely a long way off. Despite the preliminary nature of most stem cell research, however, numerous clinics around the world offer stem cell “therapies” to patients today outside the context of a clinical trial. Although the number of patients who have received these stem cell-based interventions is unknown, anecdotal reports suggest a substantial population of patients is willing to try them, despite unresolved questions about their safety and efficacy. (shrink)

Endosteal stem cells are a subclass of bone marrow skeletal stem cell populations that are particularly important for rapid bone formation occurring in growth and regeneration. These stem cells are strategically located near the bone surface in a specialized microenvironment of the endosteal niche. These stem cells are abundant in young stages but eventually depleted and replaced by other stem cell types residing in a non‐endosteal perisinusoidal niche. Single‐cell molecular profiling and in vivo cell lineage analyses play key roles in (...) discovering endosteal stem cells. Importantly, endosteal stem cells can transform into bone tumor‐making cells when deleterious mutations occur in tumor suppressor genes. The emerging hypothesis is that osteoblast‐chondrocyte transitional identities confer a special subset of endosteal stromal cells with stem cell‐like properties, which may make them susceptible for tumorigenic transformation. Endosteal stem cells are likely to represent an important therapeutic target of bone diseases caused by aberrant bone formation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Confidentiality and Its LimitsMaude Laliberté, John D. Lantos, and Sonia GowdaMultiple sclerosis is believed to be an autoimmune disease of the central nervous system. However, according to Italian physician Paolo Zamboni, it is related to cerebrospinal vascular insufficiency. Zamboni claims that MS can be treated by remedying this condition with venous angioplasty. This surgery is offered as treatment for MS in various countries—Poland, Bulgaria, and Costa Rica, for example. (...) But the Medical Board of Quebec, Canada, does not allow its members to perform the surgery and strongly advises patients against seeking it elsewhere. This opposition is based on the lack of evidence to support the procedure and the serious risks associated with it (including venous thrombosis, stroke, and pulmonary embolism). As a result, many Canadian MS patients have traveled to other countries to receive the surgery. Quebec physicians have been reluctant to provide surgical follow-up for patients who undergo the surgery in other countries due to the lack of information regarding the procedure. No alternative treatments are effective to partially or completely cure MS, and so the treatments available in Canada aim only to manage its symptoms.Jade is a forty-year-old Canadian woman with MS. She is on long-term disability leave, complains of growing fatigue and muscle stiffness, and has painful sensations in her limbs. She has been followed by an interdisciplinary team in a specialized hospital in Quebec for the past twenty years, since she was diagnosed. At her last appointment, Jade told her physical therapist that she recently underwent the experimental Zamboni surgery in Poland, despite her physician’s strong recommendation not to. Jade fears her physician’s reaction, so she asks the physical therapist to keep this information from the rest of her medical team.Jade is shy and tends to distrust health care professionals. It took many years for her physical therapist to gain her trust and to develop a positive therapeutic relationship with her. However, the physical therapist knows that serious complications can occur in patients who have had Zamboni’s surgery. Not telling Jade’s physician about the surgery could result in harm; Jade could have complications that are not recognized. Providing the information to the rest of the team would allow them to adjust her treatment to respond to the surgery and give her information and postoperative education that she will need. Moreover, keeping this secret could threaten team cohesion and trust if they find out about it later.Jade decided to undergo a risky surgery against her doctor’s advice in the hope of improving her quality of life. This was her autonomous choice. How should the physical therapist respond?CommentaryMaude Laliberte (bio)Laws and professional codes of ethics direct clinicians to respect their patients’ autonomy through confidentiality and informed consent unless there are compelling reasons not to do so. Health professionals are deeply committed to helping patients; above all, they want to avoid harming them. Therefore, a key component of this case is the possibility that respecting Jade’s desire to conceal information from the team may put her at direct risk if any postoperative complications are not detected, and at indirect risk if Jade’s trust in her medical team is undermined to the point where she turns away from them.The physical therapist must determine if the possible physical risks to Jade are imminent and serious enough to go against her autonomous choice. One risk that can occur following Zamboni’s surgery is inflammation of a vein caused by a blood clot. This is a life-threatening situation (although it may not be a likely complication for Jade). But the physical therapist can teach Jade to recognize the physical signs that can alert her to this problem, giving her ample time to seek treatment. Thus, even though she may be in danger from a life-threatening risk, there may be ways to manage it besides violating her confidentiality.The respect for autonomous choice is a crucial aspect of our democratic values. It promotes a process of exchange in the therapeutic alliance: the professional guides and informs the patient, but the patient is a partner in care planning and treatment. An important... (shrink)

An autobiographical account of the liposome, from the perplexities of a blood smear to the growth of a multi‐million pound business.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Consistently Pro-Life: The Ethics of Bloodshed in Ancient Christianity by Rob Arner, and: Christ at the Checkpoint: Theology in the Service of Justice and Peace ed. by Paul Alexander, and: Becoming Nonviolent Peacemakers: A Virtue Ethic for Catholic Social Teaching and US Policy by Eli Sarasan McCarthyBrian D. BerryReview of Consistently Pro-Life: The Ethics of Bloodshed in Ancient Christianity ROB ARNER Eugene, OR: Pickwick, 2010. 136 pp. $15.56Review (...) of Christ at the Checkpoint: Theology in the Service of Justice and Peace EDITED BY PAUL ALEXANDER Eugene, OR: Pickwick, 2012. 182 pp. $19.80Review of Becoming Nonviolent Peacemakers: A Virtue Ethic for Catholic Social Teaching and US Policy ELI SARASAN MCCARTHY Eugene, OR: Pickwick, 2012. 259 pp. $27.00In Consistently Pro-Life, Rob Arner (who teaches at Chestnut Hill College in Philadelphia) makes the case that Christians should not kill other human beings—regardless of the circumstances. Taking as his point of departure the vigilante killing of abortion doctor George Tiller in Wichita, Kansas, in 2009, he argues not only that abortion is always morally impermissible but so also is [End Page 217] the murder of abortion doctors and the use of the death penalty to punish those who murder them. In addition, he turns to the early church fathers to contend that, prior to Constantine, “without exception, the church strongly condemned the taking of human life in any form whatsoever”—thus rejecting abortion and infanticide, the blood sport of the Roman games, suicide, and killing in war (120). This was because the New Testament witness to Jesus and his death on the cross required early Christians to view “the means as just as important, if not more important, than the ends” (xiii).Arner supplements this deontological argument for Christian pacifism, which he learned from John Howard Yoder, with a brief consideration of the virtue of patience cultivated in the early churches, reflecting the influence of Stanley Hauerwas on his thought. This “cardinal virtue” connoting “longsuffering, forbearance, patient endurance”—as found in Jesus’s teaching in the Sermon on the Mount (Mt 5:38–48)—enabled early Christians to practice non-violent resistance “deferring personal revenge in favor of God’s vindicating justice” (98). If Christians were to adopt this same consistently pro-life ethic today, argues Arner, it would “lead to greater healing and peace in our blood-soaked world” (121). The book closes with three appendices—one of which is a chart of terminology that dehumanizes vulnerable victims, including unborn human beings. Unfortunately, the book does not have an index.Christ at the Checkpoint, edited by Paul Alexander (professor of Christian ethics and public policy at the Palmer Theological Seminary of Eastern University), includes thirteen plenary addresses delivered at a conference on the Arab-Israeli conflict organized by Palestinian Evangelical Christians at Bethlehem Bible College in March 2010. Almost all of the contributors to this volume—including biblical scholars, theologians, ethicists, pastors, activists, and others—criticize the ideology of Christian Zionism and its support of a theology of dispensationalism that, in their view, distorts the scriptures and fosters violence rather than reconciliation between the Israelis and the Palestinians. In his own presentation titled “What Can Pentecostals and Charismatics Do for Peace with Justice in Israel and Palestine?,” Alexander—who describes himself as a former “one-sided” Christian Zionist who later discovered the writings of Yoder and Hauerwas—appeals to Jesus’s teaching in the Sermon on the Mount and urges Pentecostals to create church communities “that cultivate persons of character and conviction, who through habits, practices, and action live out the core of our faith” (69). Along with being faithful to the “greater challenges” of love, mercy, compassion, and forgiveness, he argues that they should publicly declare that Jesus does not want Israel to continue the occupation of Palestine, and they should engage in the “easier tasks” of promoting human rights, lending support to United Nations Resolutions, and working toward a two-state solution (72). “The time has come in human history,” writes Alexander, “for Pentecostals to speak and act prophetically regarding this present injustice … [End Page 218] and to use every nonviolent weapon in our arsenal—stories, preaching... (shrink)

In this issue, Ahmadi1 reports on the practice of hymenoplasty—a surgical intervention meant to restore a presumed physical marker of virginity prior to a woman's marriage. As Mehri and Sills2 have stated, these women ‘want to ensure that blood is spilled on their wedding night sheets.’ Although Ahmadi's research was carried out in Iran specifically, this surgery is becoming increasingly popular in a number of Western countries as well, especially among Muslim populations.3 What are the ethics of hymen restoration?Consider (...) the role of the physician. Two of the doctors interviewed by Ahmadi reported being in ‘a perpetual state of guilt because of the surgery's inherent aim at deceiving the groom’ and noted their ‘personal conflict’ at being involved in this deception. Yet: "None of the doctors believed that the surgery was unethical, arguing that the girl could be ‘abused’ and ‘can even die’ if she is discovered not … ". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sinai and the Areopagus:Philip Melanchthon, Natural Law, and the Beginnings of Athenian Legal History in the Shadow of the Schmalkaldic WarAlexander D. BatsonIn late August 1546, Philip Melanchthon had some seriously strange dreams. One night, he saw a man in the Elbe struggling to keep his head above the river's powerful current. As Melanchthon approached to help, he recognized the drowning man's visage: Charles V. Despite Melanchthon's attempts to (...) save him, the river dragged the emperor under and carried him away. Another night, he dreamed that while translating Demosthenes with his friend Joachim Camerarius in the Wittenberg castle (a Melanchthon dream if there ever was one!) he looked out a window to see that the Elbe had turned to blood.1 [End Page 713]These ominous visions reflected the precarious world Melanchthon faced in late summer 1546. Martin Luther, the hero of the German Reformation, had died in February, leaving a gaping hole in the evangelical movement. Further, German Protestantism was facing the largest political crisis in its short history. The Schmalkaldic War had begun in July, only a few weeks prior, and the Reformation faced intense military pressure from Charles V. As the emperor slowly advanced, an anxious Melanchthon lived in constant tension between wild hope that Charles would be defeated and grim fear of massive bloodshed.As the war began, Melanchthon was greatly disturbed by the violence and the potential for disastrous defeat of the Protestant cause. In an August 26 letter, he wrote this to a friend: "Often now, when I look over the Elbe River gliding by me, I sigh and think that, even if I could pour forth a river of tears as great as the Elbe's flow, I would never be able to exhaust the sadness which surrounds my soul because of this civil war. If only Charles had not started it!"2 Should the Schmalkaldic League be defeated and political support for the Reformation be crushed, the true church would be in dangerous waters, just like the emperor in Melanchthon's dream.In the midst of this impending catastrophe, on September 1, 1546, Melanchthon published an unusual work: the Collatio actionum forensium Atticarum et Romanarum praecipuarum (A comparison of the principal Attic and Roman legal actions). In this study, Melanchthon organized and compared the legal actions of Athens and Rome, following the order of the Ten Commandments. In 1546, Greek law was a virtually unknown field. Contemporary legal humanists like Andrea Alciato, Ulrich Zasius, and François Baudouin had devoted their attention almost exclusively to Roman or feudal European law.3 Nearly a century before the publication of sprawling [End Page 714] tomes by the Greek legal scholars Samuel Petit, Claudius Salmasius, and Johannes Meursius, Melanchthon treated the law of ancient Athens as a worthy subject.4 Even more puzzling, Melanchthon devoted himself to this arcane work during a moment of dire political crisis. The unusual subject matter of the Collatio and the urgent circumstances surrounding its publication raise a pair of intriguing questions: Why did Melanchthon think Attic legal actions were important? And why did he think they were worth studying while a military and political disaster loomed on the horizon?Melanchthon valued the ancient pagan laws because they showed how God had revealed legal and moral principles to the gentiles. His study of Attic and Roman law demonstrated how, through natural reason, the classical pagans had attained knowledge of the natural law and implemented it in their own societies.5 As a result, the ancient laws became indispensable to Christians studying law and moral philosophy.6 This work on ancient Greek law was an essential part of Melanchthon's pedagogical project of integrating Christianity and the classical world. As he wrote in the introduction, he had decided to write on Attic legal actions "so that students may know that they are not only formulas for litigation, but also a philosophy and a doctrine of virtue."7 By reconstructing the laws of ancient Athens and comparing them with those of Rome, Melanchthon demonstrated that classical moral and legal thought was in complete agreement with the Decalogue and essential for Christian moral development. [End Page 715... (shrink)

This article recounts Foucault’s critical reevaluation of Thomas Hobbes in his 1975-76 lecture course, published as Society Must Be Defended (2003). In probing Hobbes’ pivotal role in the foundation of the modern nation-state, Foucault delineates the ”philosophico-juridical” discourse of Leviathan from the ”historico-political” discourses of the English insurrectionists whose uncompromising demands were ultimately paved over by the more conventional seventeenth century debate between royalists and parliamentarians. In his most sustained engagement with political philosophy proper, Foucault effectively severs the two co-constitutive (...) terms, enumerating the damning consequences of thinking politics apart from history and philosophy apart from the laws and codes that had been “born in the mud and blood of battles.” Displacing himself in the archive, Foucault doubles the Levellers and Diggers’ efforts to restage the violent conquests that undergird our seemingly calm governmental regimes. This doubling, I argue, evinces the profound influence of Deleuze’s innovative ontology of time on Foucault’s genealogical method. Foucault’s research strategy takes a fundamental turn towards specific techniques of cultural memory in the wake of his colleague’s radical reconceptualization of virtuality, difference, and repetition. To this end, I take up Foucault’s review essay ”Theatrum Philosophicum” and his comments on method in ”Nietzsche, Genealogy, History” in order to draw an analogy between what he does in 1976 and what the Levellers and Diggers were doing in 1651. In the final analysis, genealogy means war, and, in this war, it is the very being of the virtual itself that is at stake. (shrink)

As both priest and victim, Christ offered himself through sacrificial actions involving death, entry into the heavenly sanctuary, and cleansing by blood. Hebrews highlights the soteriological, psychological, and social benefits of this sacrifice.

Spontaneous Infra-Slow Fluctuations of the human EEG were discovered 60 years ago when appropriate amplifiers for their recordings were designed. To avoid skin-related artifacts the recording of EEG-ISFs required puncturing the skin under the electrode. In the beginning of the 21st century the interest in EEG-ISFs was renewed with the appearance of commercially available DC-coupled amplified and by observation of ISFs of the blood oxygen level–dependent functional magnetic resonance imaging signal at a similar frequency. The independent components of irregular (...) EEG-ISFs were shown to correlate with BOLD signals which in turn were driven by changes in arousal level measured by galvanic skin response, pupil size and HRV. There is no consensus regarding the temporal organization of EEG-ISFs: some studies emphasize the absence of peaks on EEG-ISFs spectra, some studies report prominent oscillations with frequency around 0.1 or 0.02 Hz, while some emphasize multiple discrete infraslow oscillations. No studies used parameters of EEG-ISFs as neuromarkers to discriminate psychiatric patients from healthy controls. Finally, a set of working hypotheses is suggested that must be tested in future research to solve the enigma of EEG-ISFs. (shrink)