Panorama succinct de la réflexion bioéthique à l’aube du XXIe siècle; extension présente du champ de recherche, réseau institutionnel , structures de formation et d’enseignement, revues et journaux... La bioéthique bénéficie aujourd’hui d’un large consensus concernant une série de valeurs. L’auteur s’attache à en préciser les limites et à expliquer par ailleurs les raisons de l’indéniable pluralisme qui marque encore la réflexion en ce domaine. Il souligne enfin la contribution souhaitée de la part des Universités catholiques en la matière.

A adolescência é um período do desenvolvimento acompanhado de importantes mudanças na esfera física, psicológica e social, caracterizando-se como um momento de transição para a vida adulta. A presente pesquisa investigou algumas repercussões que uma doença crônica como a fibrose cística possui dentr..

The child was 2 years, 8 months old and weighed 25 pounds, one-fifth the weight of her mother, for whom she was to be the bone marrow donor. The mother had suffered a relapse of acute myelogenous leukemia; her physicians recommended a bone marrow transplant. The child was the closest human leukocyte antigen match and thus the best donor candidate for her mother's transplant.

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state, cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization. Similarly, Baby K was an anencephalic infant whose mother, believing that all (...) life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer. (shrink)

The Red Market: On the Trail of the World’s Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers Content Type Journal Article Category Book Review Pages 1-3 DOI 10.1007/s11673-012-9361-3 Authors Dominique E. Martin, 39 Eltham Street, Flemington, 3031 Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

Peter French’s and Steven Ratner’s thoughtful comments are helpful in advancing the analysis we offered in our book On Complicity and Compromise. Inevitably, there are areas of disagreement and bones to pick. However, our primary concern in this reply will be to press, with their assistance, the more positive agenda.

Fanconi anemia (FA) is generally classified as a DNA repair disorder, conferring a genetic predisposition to cancer and prominent bone marrow failure (BMF) in early childhood. Corroborative human and murine studies point to a fetal origin of hematopoietic stem cell (HSC) attrition under replicative stress. Along with intriguing recent insights into non‐canonical roles and domain‐specific functions of FA proteins, these studies have raised the possibility of a DNA repair‐independent BMF etiology. However, deeper mechanistic insight is critical as current curative options (...) of allogeneic stem cell transplantation and emerging gene therapy have limited eligibility, carry significant side effects, and involve complex procedures restricted to resource‐rich environments. To develop rational and broadly accessible therapies for FA patients, the field will need more faithful disease models that overcome the scarcity of patient samples, leverage technological advances, and adopt investigational clinical trial designs tailored for rare diseases. (shrink)

No one has the right to say what should be done to their body after deathIn my opinion any concept of property in the human body either during life or after death is biologically inaccurate and morally wrong. The body should be regarded as on loan to the individual from the biomass, to which the cadaver will inevitably return. Development of immunosuppressive drugs has resulted in the cadaver becoming a unique and invaluable resource to those who will benefit from organ (...) donation. Faced with the biological reality, the moral error of any concept of property in the body, and the quantitative failure of voluntary organ donation, I believe that the right of control over the cadaver should be vested in the state as representative of those who may benefit from organ donation.How one regards the dead human body, the cadaver, is in part governed by one’s familiarity with it. At the present time, very few people ever see a cadaver which has not in some way been altered after death, and even fewer touch, handle, deal in any way with the dead human body. In developed countries, death itself most frequently occurs away from the home, in an institution, under the supervision of professional caregivers. For most people, ideas concerning the cadaver, its nature, the proper way to deal with it, are formed under these conditions.As a pathologist specialising in forensic pathology, for 50 years I have been at the other end of the spectrum of experience. In my daily work I have been privileged to examine the cadaver in all its stages after death from the immediate postmortem moments through all the stages of decomposition to bare bones. Working in a relatively small community, I have sometimes been charged with examining the body of someone I …. (shrink)

Looking at Bapedi ancestor veneration constructively, one finds it a source of communication that enhances the community’s norms, values and personal well-being. The Bapedi community has a belief system that is based on the spiritual world, and this includes ancestor veneration. Communication with the spiritual world happens through sacrifices, songs and dance. Malopo is a ritual that not only binds the people to their ancestors but also provides a healing therapy. The purpose of this study was to investigate the religious (...) and social functions of ancestor veneration in the Bapedi society, as well as the relationship between culture, music and identity in veneration in the traditional healing Sepedi context. To achieve this aim, the study employed a naturalistic approach and data were collected through video recordings of malopo rituals, interviews and observations. The main questions the study addressed are what are the religious and social functions of ancestor veneration in the Bapedi society? and what is the relationship between culture, music and identity in veneration in Sepedi traditional healing context? The results demonstrated that ancestors are vital to Bapedi society, and the most effective ways of reaching them are through music and dance – malopo rituals, as well as divination bones. (shrink)

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as (...) a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.1 (2003) 1-20 [Access article in PDF] Crime, Compassion, and The Reader John E. MacKinnon IN "WRITING AFTER AUSCHWITZ," Günter Grass describes how at the age of seventeen he stubbornly refused to believe the evidence arrayed before him and his classmates of Nazi atrocities, the photographs showing piles of eyeglasses, shoes, hair, and bones. "Germans never could have done, never did do a thing like that," (...) he recalls thinking. And "when the Never collapsed," he and other young Germans were assured that they were free of responsibility. "It took several more years," Grass reports, "before I began to realize: This will not go away; our shame cannot be repressed or come to terms with." Later, he confesses that those of his age "belonged to the Auschwitz generation—not as criminals, to be sure, but in the camp of the criminals." 1Although one would be hard-pressed to find a novel more dramatically different in style and narrative development than Grass's own dark, audacious fables, Bernhard Schlink's The Reader 2 nonetheless shares this fascination with the notion of collective guilt, in particular the burden of inheritance endured by Germany's "second generation." Set in a university town in the late 1950s, the novel tells the story of a high school student, Michael Berg, who falls in love with Hanna Schmitz, a woman twenty years his senior. Though capable of genuine concern and deep affection, Hanna is oddly secretive, often brusque and officious, occasionally given to cruelty and sarcasm, and prone to unpredictable fits of pique. She also has an endearing quirk: she likes Michael to read to her. Eventually, and without explanation, she vanishes from Michael's life. It is seven years before he sees her again, when, as a law student, he attends a trial of concentration-camp guards, one of whom is Hanna. She stands accused, along with four other [End Page 1] women, of serving at both Auschwitz and a satellite camp near Cracow, of being actively involved in the selection of prisoners for almost certain death, and of locking several hundred women in a church, where they burned to death during a bombing raid.In light of testimony given at trial, Hanna's puzzling conduct, and his own recollections of their time together, it finally dawns on Michael that Hanna cannot read, that she was and remains illiterate. But while in retrospect this may explain certain episodes of frustration, incomprehension, and overreaction on her part, does it have any bearing on her guilt? What would Michael himself have done if similarly situated, and similarly limited? Thus, the story of Michael and Hanna serves as an allegory of the relation between the two generations of Germans, those who were Nazis, or who at least assisted or accommodated them, and the "lucky late-born." It is against this background that Schlink is able most searchingly to investigate questions of complicity, recrimination, and atonement.As much courtroom drama as rite-of-passage tale, The Reader is also something of a philosophical investigation. According to Eva Hoffman, in fact, Schlink has managed to compose "a fictionalized essay... a kind of philosophical parable." For all the briskly evocative prose, she adds, The Reader "gradually acquires some of the severity of a legal or logical argument, in which propositions are set forth and then tested from various points of view." 3 In a recent article, Jeremiah P. Conway offers a sympathetic interpretation of the novel, attending in particular to the philosophical issues that it raises. Conway challenges Martha Nussbaum's claim that it is logically incoherent for us to feel compassion for one whom we hold responsible for a morally reprehensible act. 4 For in Hanna, he suggests, we have a compelling counterexample, a fit object of our compassion no less than our condemnation. And yet, Conway's challenge is grounded in an even more fundamental denial that The Reader is at all concerned to establish the circumstances of Hanna's life as mitigating her crime.In what follows, I will argue that this interpretation is untenable... (shrink)

How can health plans make fair determinations about when “experimental” (and costly) treatments such as high dose chemotherapy with autologous bone marrow transplantation should be covered despite lack of clear clinical consensus about their benefits? Different models for managing “last chance” therapies evolving in some health plans offer promising examples of how issues of fairness and legitimacy in decisionmaking can be addressed.

My paper will explore boundaries and rights, the public and the private, as to the enforcement of religious legal rules in societies self-consciously founded on Islamic law. I employ as my case-study legal and social controversies aroused by the Saudi Hay’at al-amr bi-al-ma`ruf wa-al-nahy `an al-munkar, the government agency charged with “ordering the good and forbidding the evil.” The paper will first lay out some of the laws fixing the powers of the Hay’at, including various statutes issued by the king (...) but, of equal or greater importance, the received medieval fiqh rules governing the muhtasib . Focus shall be on an issue much debated in the classical law and also a long-time bone of contention in Saudi society, namely the legal limits on the powers of the Hay’at to investigate and punish immoral acts occurring in private. Limits on such powers stem from two sources, both in the law and in social understandings of that law. One source, the more prominent in public debate, concerns revelatory and fiqh and related social norms against spying or prying into people’s behavior and against undue attempts to expose people’s sins. Notably, however, this restriction affects only enforcement. The pervasiveness of laws considered to arise from the relationship of the individual to God still stands. A solitary immoral act performed in privacy can still be a sin and a crime, and punishable if it is somehow legitimately known and proved . The second source of restrictions is more far-reaching, going beyond issues of investigation and proof. As held by the majority of scholars, the Hay’at may not compel or forbid any actions for which the religious-legal ruling is under classical law a matter of legitimate difference of scholarly opinion; or inversely, the Hay’at may compel or forbid only those actions as to which there is a divine command known to a certainty either from a revealed text or from the consensus of scholars. A commonly noted abuse by the Hay’at in Saudi Arabia has been to attempt to enforce rules lacking requisite certainty, such as requiring veiling of the face. Rules known to a certainty have a pervasive role in Islamic constitutional theory. In principle, such rules must be enforced, regardless of whether they concern matters other societies may consider individual or private, such as changing one’s religion. Rules lacking that high degree of certainty cannot – without separate justification on grounds other than religious text – define sins or crimes or be enforced as general rules by the state. Though seemingly scholastic and philosophical, this restriction is potentially crucial in defining a realm of individual autonomy in religious matters and shaping the boundary between public and private in societies self-consciously founded in Islamic law. It is important to examine to what extent the restriction is reflected in legal and social practice in such societies. (shrink)

Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse, providing inconsistent results. The current gold standard (bone pins) is prohibitively invasive. The purposes of the current study are to describe a virtual projection alternative to surface markers for video motion capture (VMC) of the scapula and to compare the results of the projection and surface marker methods to the results of similar existing methods. Ten participants were evaluated using VMC. Surface markers were applied to the trunk and arm (...) in accordance with existing guidelines. Three markers were affixed to plastic base on the skin over the acromion process. Other scapular landmarks were digitized in a neutral position. These landmarks’ locations were defined in reference to the acromion cluster and used to generate the projection. Humerothoracic, glenohumeral, and scapulothoracic kinematics were evaluated during shoulder abduction, flexion, and scaption. Joint angles produced by the surface markers and the projection were compared by Bonferroni-adjusted t tests. The results were compared to prior findings in the literature. The projection resulted in greater scapulothoracic upward rotation, internal rotation, and anterior–posterior tilt and less glenohumeral elevation (p <.0055) than did surface markers. The virtual scapula produced greater estimates of scapular mobility than did surface markers, corresponding to pre-existing results from similar methodologies. The result is a noninvasive measurement tool that produces different and superior results than do scapula surface markers. Measuring scapula kinematics via VMC without bone pins will facilitate future investigations into interactions between upper extremity injury, kinematics, and activity performance. (shrink)

The likely impact of applying the General Agreement on Trade in Services (GATS) to higher education are examined. GATS aims to “open up” services to competition: no preference can be shown to national or government providers. The consequences for teaching are likely to be that private companies, with degree-awarding powers, would be eligible for the same subsidies as public providers. Appealing to the inadequate recently introduced “benchmark” statements as proof of quality, they would provide a “bare bones” service at lower (...) cost. Public subsidies would go: education being reduced to that minimum which could be packaged in terms of verifiable “learning outcomes”. The loss of “higher” aspirations, such education of critically-minded citizens of a democratic and civilised society would impoverish the university’s research culture which demands honesty and openness to public scrutiny. (shrink)

Schelling's 1806 polemic against Fichte, and his last major work on the philosophy of nature. The heat of anger can concentrate the mind. Convinced that he had been betrayed by his former collaborator and colleague, Schelling attempts in this polemic to reach a final reckoning with Fichte. Employing the format of a book review, Schelling directs withering scorn at three of Fichte’s recent publications, at one point likening them to the hell, purgatory, and would-be paradise of Fichtean philosophy. The central (...) bone of contention is the understanding of nature: Fichte sees it as lifeless matter in motion, sheer opposition to be overcome, while Schelling waxes poetic in his defense of a living, organic nature of which humanity is a vital part. Indeed, we do not know ourselves without understanding our connection to nature, argues Schelling, anticipating many thinkers in contemporary environmental ethics. Dale E. Snow’s introduction sets the stage and explains the larger context of the conflict, which was already visible in the correspondence of the two philosophers, which broke off by 1802. Notes are included throughout the text, providing background information and identifying the many references to Fichte. Dale E. Snow is Associate Professor of Philosophy at Loyola University of Maryland and the author of Schelling and the End of Idealism, also published by SUNY Press. (shrink)

Clinical success with human hematopoietic stem cell (HSC) transplantation establishes a paradigm for regenerative therapies with other types of stem cells. However, it remains generally challenging to therapeutically treat tissues after engineering of stem cells in vitro. Recent studies suggest that stem and progenitor cells sense physical features of their niches. Here, we review biophysical contributions to lineage decisions, maturation, and trafficking of blood and immune cells. Polarized cellular contractility and nuclear rheology are separately shown to be functional markers of (...) a hematopoietic hierarchy that predict the ability of a lineage to traffic in and out of the bone marrow niche. These biophysical determinants are regulated by a set of structural molecules, including cytoplasmic myosin‐II and nuclear lamins, which themselves are modulated by a diverse range of transcriptional and post‐translational mechanisms. Small molecules that target these mechanobiological circuits, along with novel bioengineering methods, could prove broadly useful in programming blood and immune cells for therapies ranging from blood transfusions to immune attack of tumors. (shrink)

This chapter contains sections titled: Abstract Introduction Three Objections From Relativism Bare Bones Moral Realism References.

With an overall estimated 5-year survival rate of 67 percent, bone marrow transplant is a potential cure for patients with primary immune regulatory diseases. Given that Sa...

Mucopolysaccharidosis type I (MPS I) is a rare lysosomal storage disorder treated with bone marrow transplantation or enzyme replacement therapy with laronidase, a high-cost orphan drug. Laronidase was approved by the US Food and Drug Administration and the European Medicines Agency in 2003 and by the Brazilian National Health Surveillance Agency in 2005. Many Brazilian MPS I patients have been receiving laronidase despite the absence of a governmental policy regulating access to the drug. Epidemiological and treatment data concerning MPS I (...) are scarce. This study aims to present a demographic profile of Brazilian patients with MPS I, describe the routes of access to laronidase in Brazil, and discuss associated ethical issues relating to public funding of orphan drugs. (shrink)

This article uses one incident, the Athenian efforts to acquire Salamis from Megara during the sixth century B.C.E., to study what Greeks themselves believed about their own past and why the past was so powerful an argument for them. The nature of the evidence is an important part of the discussion, since the written sources date from long after the events and Greek authors' approaches to the past differ from our own. Although only brief fragments of any Megarian historians survive, (...) they are useful in providing a counterbalance to Athenian sources, since their versions of mythological events and portraits of mythological heroes are very different. The archaeological evidence includes inscriptions, vases, and graves; with one possible exception, this material was not exploited either by Solon and the Athenians or by the ancient authors. Sources credited both Solon and Athens with having used five different kinds of arguments to make the Athenian case for Salamis, and this variety indicates that Greeks of later centuries did not really know what happened in the struggle over the island. Hampered by problems of chronography and influenced by cultural attitudes such as a belief in a culture hero, historians, biographers, and travelers wrote accounts which reveal the importance of the past, especially the Trojan War past, to Greeks. (shrink)

The diversity of bone proteoglycan (PG) structure and localisation (pericellular, extracellular in the organic bone matrix) reflects a broad spectrum of biological functions within a unique tissue. PGs play important roles in organizing the bone extracellular matrix, taking part in the structuring of the tissue itself as active regulators of collagen fibrillogenesis. PGs also display selective patterns of reactivity with several constituents including cytokines and growth factors, such as transforming growth factor‐β or osteoprotegerin thereby modulating their bio‐availability and biological activity (...) in the bone tissue. In this review, the complex PG composition in bone will be addressed together with the specific role played by PGs (or their GAGs chains) in bone biology, as regulatory molecules for bone resorption and their involvement in bone tumor development. These roles have been determined after modulation of PG expression or mutations in their corresponding genes, which revealed specific roles for these compounds in bone pathologies (e.g. perlecan or glypican‐3 mutations observed respectively in chondrodysplasia or dysmorphic syndrome). Finally, the potential therapeutic interest of PGs is discussed based on recent data, more particularly on bone tumor‐associated osteolysis as these molecules are involved both in bone resorption and tumor development. BioEssays 29:758–771, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

A dominant, human-centered worldview has brought us to the brink of social, ecological, and climate collapse. Braiding poetic storytelling, deep cultural and climate justice analyses, and knowledge of Earth-centered cultures, The Story is in Our Bones opens a portal to restoration and justice beyond the end of a world"--Provided by publisher.

This paper focuses on the role played by the Geological Survey of Portugal in the emergence and consolidation of geology as a government science in the nineteenth century, within a general policy of control over territory. The period under consideration covers the directorates of its first leaders, Pereira da Costa (1809–1888) and the military engineers Carlos Ribeiro (1813–1882), and Nery Delgado (1835–1908). When the Geological Survey was created in 1857 as part of the Directorate of Geodesic, Chorographic, Hydrographical Works of (...) the Kingdom (Direcção Geral dos Trabalhos Geodesicos, Chorographicos, Hydrographicos do Reino) established at the Ministry of Public Works, Trade and Industry (Ministério das Obras Públicas, Comércio e Indústria), Portugal lacked a geological culture and a tradition in geological research. The Portuguese Geological Survey was to be marked by the idiosyncrasies of the local culture and of the organization of the State. In this paper, the emergence of geology as a government science is analysed, by taking into consideration the structure, organization, and a general overview of contributions to the Survey. A particular emphasis will be given to its subordinate staff—the field assistants—not only because their contributions to the geological knowledge of the country have hitherto been largely ignored, but also because they materialized the only possible way for common people to become involved with geology in nineteenth‐century Portugal. Generally, with only a basic education, field assistants gradually acquired enough expertise to make decisions in the field, and a few of them even became what Nery Delgado termed ‘practical geologists’. The letters in which they reported their work in addition to vivid accounts of less glamorous aspects of fieldwork and its organization provide an image of the country and of its culture by portraying the reactions of civil society to the practice of geology. (shrink)

A philosophical exchange broadly inspired by the characters of Berkeley’s Three Dialogues. Hylas is the realist philosopher: the view he stands up for reflects a robust metaphysic that is reassuringly close to common sense, grounded on the twofold persuasion that the world comes structured into entities of various kinds and at various levels and that it is the task of philosophy, if not of science generally, to “bring to light” that structure. Philonous, by contrast, is the anti-realist philosopher (though not (...) necessarily an idealist): his metaphysic is stark, arid, dishearteningly bone-dry, and stems from the conviction that a great deal of the structure that we are used to attribute to the world out there lies, on closer inspection, in our head, in our “organizing practices”, in the complex system of concepts and categories that unrerlie our representation of experience and our need to represent it that way. (shrink)

A flurry of technological advances in molecular, cellular and developmental biology during the past decade has provided a clearer understanding of mechanisms underlying phenotypic diversification. Building upon such momentum, a recent paper tackles one of the foremost topics in evolution, that is the origin of species‐specific beak morphology in Darwin's finches.1 Previous work involving both domesticated and wild birds implicated a well‐known signaling pathway (i.e. bone morphogenetic proteins) and one population of progenitor cells in particular (i.e. cranial neural crest), as (...) primary factors for establishing beak size and shape. But these results were limited in their ability to explain fully the morphogenetic bases of patterned outgrowth. So in a quest to identify novel genes whose expression correlated with differences in beak anatomy among Darwin's finches, a DNA microarray approach was undertaken using tissues harvested from the Galápagos Islands. The results are striking and point to a protein called calmodulin, which is a mediator of cellular calcium signaling, as a key determinant of beak length. BioEssays 29: 1–6, 2007. © 2006 Wiley Periodicals, Inc. (shrink)

Personal value, i.e., what is valuable for us, has recently been analysed in terms of so- called for-someone's-sake attitudes. This paper is an attempt to add flesh to the bone of these attitudes that have not yet been properly analysed in the philosophical literature. By employing a distinction between justifiers and identifiers, which corresponds to two roles a property may play in the intentional content of an attitude, two different kinds of for-someone's-sake attitudes can be identified. Moreover, it is argued (...) that one of these kinds is particularly difficult to include in an analysis of value simpliciter but not in an analysis of value for. (shrink)

Anti-natalism is the view that persons ought morally to refrain from procreation. We offer a new argument for a principled version of anti-natalism according to which it is always impermissible to procreate in the actual world since doing so will violate the right to physical security of future, created persons once those persons exist and have the right. First, we argue that procreators can be responsible for non-trivial harms that befall future persons even if they do not cause them and (...) if the harms are temporally delayed, provided the harms are reasonably foreseeable by procreators. For example, consider a case in which we can create a person in a room that is dangerously aflame. It would be wrong to do so since, once the person exists, they have a right that we avoid being morally responsible for unjust harms to them, and the fire in which we created them is one such unjust harm. Second, we argue that procreators are responsible for unjust harms that befall their children, since many non-trivial physical harms (e.g. broken bones, lower respiratory illnesses) are reasonably foreseeable by procreators. Thus, parents wrong their children by creating them. Third, we argue that procreators are also responsible for the unjust harms their children commit against others, since it is reasonably foreseeable that every person will inflict unjust, non-trivial physical harms on someone else. But this is worse since parents thereby share in their child’s future culpable intent. Finally, we consider a number of objections to anti-natalism and argue that none of them succeed against anti-natalism generally or against our argument grounded in the right to physical security. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of Medicine’s Report on Non-Heart-Beating Organ TransplantationRoger Herdman (bio), Tom L. Beauchamp (bio), and John T. Potts Jr. (bio)In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis of the IOM (...) report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.Transplantation BackgroundAs a first step, some background in the relevant aspects of organ transplantation will prove useful. For the purposes of this analysis, “transplantation” involves the transfer of cells, tissues, or solid organs from one human to another to replace the structure or function of comparable body components that, through injury or disease, are defective or of inadequate function. The IOM report deals with solid organs, primarily kidneys and livers, whose blood supply is reconnected in the organ recipient, in contrast to cells, like bone marrow, and tissues, like corneas. A variety of donor types exists for organ transplantation, each with particular medical and scientific conditions.Living donors are healthy (and usually genetically related) individuals who volunteer to provide either a whole, paired organ such as a kidney or a section of an organ such as a liver. Cadaver donors are individuals who have died and from whom a full array of organs can be taken. “Heart-beating” cadaver donors are individuals who have suffered “brain death,” that is, irreversible cessation of function of the whole brain including the brain stem; and “non-heart-beating” donors (NHBDs) are individuals who are ill or injured, but not “brain dead,” and who have suffered cardiopulmonary death, that is, irreversible cessation of cardiac and respiratory function. NHBDs can be “controlled,” which means that [End Page 83] they can be sustained by artificial life support systems until a medical and family decision is made to terminate futile life support. This can be done at a scheduled time and in a controlled manner, and organs can then be recovered for transplantation. NHBDs can also be “uncontrolled,” which means that their hearts and breathing have stopped through disease or injury at an unexpected time or in an uncontrolled manner, and they cannot be resuscitated; the organs of some individuals of this description can be recovered for transplantation. The IOM report focused on both controlled and uncontrolled NHBDs and on problems specific to them.The questions that were asked and addressed in the IOM report became current and salient beginning in 1992 with the establishment of the University of Pittsburgh “Policy for the Management of Terminally Ill Patients Who May Become Organ Donors After Death.” This policy addressed controlled NHBDs and the ethical questions raised by their use; much of the discussion was reported in the June 1993 special issue of the Kennedy Institute of Ethics Journal. Public notice and anxiety about some of these concerns were sharpened and refocused by national and local media allegations of improper treatment of donors at the Cleveland Clinic in 1997, specifically premature—i.e., antemortem—recovery of organs and administration of drugs that allegedly might hasten donor death.The DHHS Request for StudyIt is not surprising that several federal actions would be taken in response to these events. Some, such as the results of a transplantation task force, remain largely internal to DHHS at this writing. Others are public, such as the IOM study of the NHBD situation. In May 1997, the DHHS initiated contacts with the IOM with the goal of exploring federal concerns about the medical and ethical treatment of NHBDs, in particular the allegations directed at the Cleveland Clinic.The DHHS response should be understood in at least three contexts. First, living donors and uncontrolled NHBDs were essentially the only donor types in the early days of transplantation in the United States. The technologies, ethics, and social acceptance of controlling and terminating life support for... (shrink)

It is hypothesized that human faces judged to be attractive by people possess two features—averageness and symmetry—that promoted adaptive mate selection in human evolutionary history by way of production of offspring with parasite resistance. Facial composites made by combining individual faces are judged to be attractive, and more attractive than the majority of individual faces. The composites possess both symmetry and averageness of features. Facial averageness may reflect high individual protein heterozygosity and thus an array of proteins to which parasites (...) must adapt. Heterozygosity may be an important defense of long-lived hosts against parasites when it occurs in portions of the genome that do not code for the essential features of complex adaptations. In this case heterozygosity can create a hostile microenvironment for parasites without disrupting adaptation. Facial bilateral symmetry is hypothesized to affect positive beauty judgments because symmetry is a certification of overall phenotypic quality and developmental health, which may be importantly influenced by parasites. Certain secondary sexual traits are influenced by testosterone, a hormone that reduces immunocompetence. Symmetry and size of the secondary sexual traits of the face (e.g., cheek bones) are expected to correlate positively and advertise immunocompetence honestly and therefore to affect positive beauty judgments. Facial attractiveness is predicted to correlate with attractive, nonfacial secondary sexual traits; other predictions from the view that parasite-driven selection led to the evolution of psychological adaptations of human beauty perception are discussed. The view that human physical attractiveness and judgments about human physical attractiveness evolved in the context of parasite-driven selection leads to the hypothesis that both adults and children have a species-typical adaptation to the problem of identifying and favoring healthy individuals and avoiding parasite-susceptible individuals. It is proposed that this adaptation guides human decisions about nepotism and reciprocity in relation to physical attractiveness. (shrink)

Genetic testing can be used to determine if unexplained fractures in children could have resulted from a predisposition to bone fractures, e.g., osteogenesis imperfecta. However, uncertainty is introduced if a variant of unknown significance is identified. Proper interpretation of VUS in these situations is critical because of its influence on clinical care and in court rulings. This study sought to understand how VUS are interpreted and used by practitioners when there is a differential diagnosis including both osteogenesis imperfecta and non-accidental (...) injury.A 15-question survey was emailed to physicians who requested analysis of two genes, COL1A1 and COL1A2, from the University of Washington from 2005-2013 for patient cases involving suspicion of child abuse.Among the 89 participants, responses differed about when genetic testing should be ordered for osteogenesis imperfecta, who should be consulted about utilization of VUS test results, follow-up procedures, and who should receive the VUS results.There are no clear guidelines for how to interpret and follow up on VUS. In the legal setting, misinterpreted VUS could lead to unintended consequences and deleterious ramifications for family members. The need for better practice guidelines to help promote more equitable handling of these sensitive legal cases is clear. (shrink)

Word recognition is the Petri dish of the cognitive sciences. The processes hypothesized to govern naming, identifying and evaluating words have shaped this field since its origin in the 1970s. Techniques to measure lexical processing are not just the back-bone of the typical experimental psychology laboratory, but are now routinely used by cognitive neuroscientists to study brain processing and increasingly by social and clinical psychologists (Eder, Hommel, and De Houwer 2007). Models developed to explain lexical processing have also aspired to (...) be statements about the nature of human cognition (e.g., connectionist models, Plaut, McClelland, Seidenberg, and Patterson 1996). Words were convenient objects to study for cognitive psychologists because they are welldefined and their nature as alphabetic strings was a good fit to analysis with the computer programming languages of the 1970s and 1980s which excelled at string manipulation. But are words actually the privileged unit of mental representation and processing that all of this scientific attention makes them out to be? Like a growing number of other language researchers, our answer is no (see, e.g., (Bybee and Hopper 2001; Wray 2002). We propose that the mental representations for lexical structures form a continuum, from word combinations which have fossilized into single units (nightclub) to those that both exist as independent units and yet have bonds, varying in tightness, with the words with which they frequently co-occur (Harris 1998). The first line of support for this view is the simple observation that fluent speakers easily recognize the familiarity and cohesive quality of word combinations in their language. Examples in English include common noun compounds (last year, brand new), verb phrases (cut down, get a hold of, faced with) and other multi-word expressions such as common sayings and references to cultural concepts (saved by the bell, speed of light; Jackendoff 1995).. (shrink)

Acoustic speech output results from coordinated articulation of dozens of muscles, bones and cartilages of the vocal mechanism. While we commonly take the fluency and speed of our speech productions for granted, the neural mechanisms facilitating the requisite muscular control are not completely understood. Previous neuroimaging and electrophysiology studies of speech sensorimotor control has typically concentrated on speech sounds (i.e., phonemes, syllables and words) in isolation; sentence-length investigations have largely been used to inform coincident linguistic processing. In this study, we (...) examined the neural representations of segmental features (place and manner of articulation, and voicing status) in the context of fluent, continuous speech production. We used recordings from the cortical surface (electrocorticography (ECoG)) to simultaneously evaluate the spatial topography and temporal dynamics of the neural correlates of speech articulation that may mediate the generation of hypothesized gestural or articulatory scores. We found that the representation of place of articulation involved broad networks of brain regions during all phases of speech production: preparation, execution and monitoring. In contrast, manner of articulation and voicing status were dominated by auditory cortical responses after speech had been initiated. These results provide a new insight into the articulatory and auditory processes underlying speech production in terms of their motor requirements and acoustic correlates. (shrink)

Burns, C. R. Introduction.--Antiquity: Margalith, D. The ideal doctor as depicted in ancient Hebrew writings. Edelstein, L. The Hippocratic oath. Edelstein, L. The professional ethics of the Greek physician. Michler, M. Medical ethics in Hippocratic bone surgery. Maas, P. L., Oliver, J. H. An ancient poem on the duties of a physician.--The medieval era: Levey, M. Medical deontology in ninth century Islam. Bar-Sela, A., Hoff, H. E. Isaac Israeli's fifty admonitions of the physicians. Rosner, F. The physician's prayer attributed to (...) Moses Maimonides. MacKinney, L. C. Medical ethics and etiquette in the early middle ages, the persistence of Hippocratic ideals. Welborn, M. C. The long tradition, a study in fourteenth-century medical deontology.--The modern period: Larkey, S. V. The Hippocratic oath in Elizabethan England. Pleadwell, F. L. Samuel Sorbiere and his Advice to a young physician. Clark, G. Bernard Mandeville, M.D., and eighteenth-century ethics. Burns, C. R. Thomas Percival, medical ethics or medical jurisprudence? Burns, C. R. Reciprocity in the development of Anglo-American medical ethics, 1765-1865. Williams, T. F. Cabot, Peabody, and the care of the patient. (shrink)

Stoicism was one of the new philosophical movements of the Hellenistic period. The name derives from the porch (stoa poikilê) in the Agora at Athens decorated with mural paintings, where the members of the school congregated, and their lectures were held. Unlike ‘epicurean,’ the sense of the English adjective ‘stoical’ is not utterly misleading with regard to its philosophical origins. The Stoics did, in fact, hold that emotions like fear or envy (or impassioned sexual attachments, or passionate love of anything (...) whatsoever) either were, or arose from, false judgements and that the sage—a person who had attained moral and intellectual perfection—would not undergo them. The later Stoics of Roman Imperial times, Seneca and Epictetus, emphasise the doctrines (already central to the early Stoics' teachings) that the sage is utterly immune to misfortune and that virtue is sufficient for happiness. Our phrase ‘stoic calm’ perhaps encapsulates the general drift of these claims. It does not, however, hint at the even more radical ethical views which the Stoics defended, e.g. that only the sage is free while all others are slaves, or that all those who are morally vicious are equally so. Though it seems clear that some Stoics took a kind of perverse joy in advocating views which seem so at odds with common sense, they did not do so simply to shock. Stoic ethics achieves a certain plausibility within the context of their physical theory and psychology, and within the framework of Greek ethical theory as that was handed down to them from Plato and Aristotle. It seems that they were well aware of the mutually interdependent nature of their philosophical views, likening philosophy itself to a living animal in which logic is bones and sinews; ethics and physics, the flesh and the soul respectively (another version reverses this assignment, making ethics the.. (shrink)

Peter van Inwagen’s short piece on the possibility of resurrection via simulacrum from 1978 has been regularly condemned for its overall implausibility. However, this paper argues that van Inwagen’s thesis has been unfairly criticized and remains a live and salutary option. It begins by summarizing the metaphysics of the simulacrum theory of the resurrection alongside the motivation for such a theory. Next, it challenges the four main criticisms against the van Inwagen styled simulacrum model. First, it argues that while van (...) Inwagen’s model may appear unnecessary or irrelevant for those that reject his metaphysics of human persons, an account like his is necessary for those that desire to maintain the traditional metaphysics of resurrection (e.g., the resurrection of the “self-same” body). Second, it argues that his model does not implicate God in mass deception or irreverence for the dead. Third, it rejects the idea that van Inwagen’s model is analogous to the implausibility of young earth creationism and its required claims like dinosaur bones being given the appearance of age. Fourth, it argues that his model is not metaphysically impossible for scenarios where someone is simultaneously killed and destroyed, such as in nuclear blasts. (shrink)

1. There is a commonly held endoxon that idealism did not exist and could not exist before Plato, since the «Presocratics» did not yet distinguish between the material and the ideal etc. This preconception is based on the misleading conception of «Presocratics» as physicalists and the simplistic evolutionist scheme of Aristotle’s Metaph. A. In fact, religious and idealist metaphysics are attested in different archaic traditions before Plato, whereas «simple» physical theories of elements of the Milesian type did not exist before (...) the 6th century B.C. scientific revolution. 2. Those who deny the existence of idealism in Greek philosophy commonly refer to Myles F. Burnyeat. We will argue against this article on the following grounds: a) it is based on a selective and incomplete data from early Greek philosophy, b) Burnyeat understands by «idealism» subjective idealism and anti-realism. But Greek idealism as a rule is a form of objective idealism and has nothing to do with anti-realism. The two basic forms are: dualstic idealism and monistic idealism. 3. We will argue against modern naturalist interpretations of the Pythagorean first principles by Huffmann and others. Both in the table of opposites and in Philolaus πέρας καὶ ἄπειρον denote self-subsistent mathematical essences, ‘out of which’ physical bodies are composed. It is impossible to interpret “the limit and the unlimited” as physical bodies themselves or as properties of physical bodies. 4. We will argue for the Pythagorean origin of the 5th centu-ry graffiti on bones’ plates from Olbia. According to this early table of oppo-site, the body is ψεῦδος, i.e., an illusion. 5. The Zeller-Burnet interpretation of Parmenides B3 is grammatically impossible. The fragment states the identity of νοεῖν καὶ εἶναι, i.e., affirms mental nature of Being.6.The basic opposition of Parmenides’ Aletheia exactly corresponds to the basic opposition of doxa. Light is the active and thinking element, night is the «heavy», dense, corporeal substance. Sine light corresponds to Being, night corresponds to non-Being. The philosophy of Parmenides is a radical form of immaterialism and idealistic monism. (shrink)

Comprehending the messages of Qurʾān in terms of the relationship between occasions (sīra) and revelation has a profound influence on determining the contextual purpose and shades of meanings. Establishing such relationship necessitates dating sūras and verses. Although there are some oral transmissions (riwāya) that verses 12, 45, 47 and 77 were revealed in Madīnah, and some weak transmissions date this sūra as Medinan, this sūra is unanimously regarded as Meccan. Like many Meccan verses, not only the order of revelation and (...) causality of verses but also the content of the script do not provide concrete evidence about whether the whole sūra was sent down at once or revealed piece by piece or the date of the revelation. In this regard, in studies carried out on the dating of Sūrat Yāsīn, the dating of this sūra is established on the basis of the dates of the sūras coming before or after Yāsīn since they apparently have more definite datings. In recent studies done on the nuzūl order, Sūrat Yāsīn is dated on the basis of a time frame before the emigration to Abyssinia (615-616) in terms of Sūrat Maryam and Ṭāhā, or Muhammed’s return from Ṭāif and his Ascension (Isrāʾ) (620) in terms of Sūrat al-Jinn. The dating of the sūra covers a time span of 4 to 5 years and points out two discrete occasions of revelation. With this reason, there is a need for further studies to be carried out on dating Qurʾānic sūras, especially within the specific context of Sūrat Yāsīn. Traditional Islamic studies dispute the chronological order of the sūra, offering various chronological orderings for the sūra: 31, 36, 37, 39, 40 and 41. In the first part of this study, such variations and their causes are tentatively established and determining the precise chronology and listing of the sūra was attempted. Based on the analysis of the variations in the disputed ordering of the sūra, it has been found to be caused by five different reasons. When such discrepancies are accounted for and conflicts are resolved, the conclusion was reached that in almost all riwāyas, sūrat Yāsīn can be dated as the 41st chapter (sūra). In the second part of the study, on the basis of the discourse analysis of the sūra, new arguments to date the chronology of the sūra were put forward. These are; a- Because of their obstinacy, unbelievers will not heed the warnings directed at them (36/11), b- The speeches of unbelievers should not grieve Prophet Muhammad (36/76), c- The use of the word Rahmān the Most Gracious (36/11, 15, 23, 52), d- In return for conveying the message of Allah, prophets do not ask people for any wage (36/21), e- Regarding Qurʾān as book of poetry and calling Muhammad a poet (36/69), f- The possibility of recreation and reviving bones (36/78). Such arguments presented in a – f usually refer to events happening in Mecca and in particular the second part or the end of Meccan period, yet there is no exact date. g- Based on the phrase “al-Fulq al-Mashhūn”, the fact that sūrat Yāsīn should be dated after the emigration to Abyssinia (615-616) presents strong evidence that it was revealed after sūrat Maryam, though this is still not enough to give an exact date. h- In sūrat Yāsīn, in phenomenon of (a man coming from the farthest part of the City) (36/20), two names (Hazrat Abū Bakr and el-Hāris b. Abī Hāla) and two dates (month of Dhu al-Qiʿdah/April 5 – May 4, 615 and three days after Shawwal 15/February 27, 617) are mentioned in Sīra for the purpose of consolation and encouragement. In the third part of the study, in the chronological ordering of sūrat Yāsīn, information regarding the dating of sūras coming before and after Yāsīn are evaluated based on their similarity with Yāsīn in terms of discourse and diction. In nuzūl orderings, when riwāyas regarding dating sūrat al-Qamar, Ṣād and al-Jinn coming before Maryam and Ṭāhā are analysed, events happening during 7th or 10th year after emigration were observed. In addition, there were close connections between the discourse and diction of Yāsīn with those of Ḥavāmīm sūras. This brings to the mind the possibility that some sūras might be listed in the wrong place because of the vagueness of the piecemeal character of the Qurʾānic revelation and its effects on riwāyas. Based upon the findings and inferences in the first three sections of this study, sūrat Yāsīn was determined to be the 41st chapter (sūra) of Qurʾān. The dating of sūrat Yāsīn presented some difficulties especially while trying to date it according to the interrupted revelation order approach, and considering it together with Sūrat Maryam and Ṭāhā. However, listing sūrat Yāsīn on the basis of uninterrupted revelation order along with Sūrat al-Jinn, the previous sūra and Ḥāmīm sūras is found to be a more coherent strategy since it gives priority to the succession of two sūras. (shrink)

Contemporary biologists are not agreed on the question of whether there are any human races, despite the widespread scientific consensus on the underlying genetics. For most purposes, however, we can reasonably treat this issue as terminological. What most people in most cultures ordinarily believe about the significance of “racial” difference is quite remote, I think, from what the biologists are agreed on. Every reputable biologist will agree that human genetic variability between the populations of Africa or Europe or Asia is (...) not much greater than that within those populations; though how much greater depends, in part, on the measure of genetic variability the biologist chooses. If biologists want to make interracial difference seem relatively large, they can say that “the proportion of genic variation attributable to racial differences is … 9 – 11%.”1 If they want to make it seem small, they can say that, for two people who are both Caucasoid, the chances of difference in genetic constitution at one site on a given chromosome are currently estimated at about 14.3 percent, while for any two people taken at random from the human population, they are estimated at about 14.8 percent. The statistical facts about the distribution of variant characteristics in human populations and subpopulations are the same, whichever way the matter is expressed. Apart from the visible morphological characteristics of skin, hair, and bone, by which we are inclined to assign people to the broadest racial categories—black, white, yellow—there are few genetic characteristics to be found in the population of England that are not found in similar proportions in Zaire or in China; and few too which are found in Zaire but not in similar proportions in China or in England. All this, I repeat, is part of the consensus . A more familiar part of the consensus is that the differences between peoples in language, moral affections, aesthetic attitudes, or political ideology—those differences which most deeply affect us in our dealings with each other—are not biologically determined to any significant degree.[…]In this essay, I want to discuss the way in which W. E. B. Du Bois—who called his life story the “autobiography of a race concept”—came gradually, though never completely, to assimilate the unbiological nature of races. I have made these few prefatory remarks partly because it is my experience that the biological evidence about race is not sufficiently known and appreciated but also because they are important in discussing Du Bois. Throughout his life, Du Bois was concerned not just with the meaning of race but with the truth about it. We are more inclined at present, however, not to express our understanding of the intellectual development of people and cultures as a movement toward the truth; I shall sketch some of the reasons for this at the end of the essay. I will begin, therefore, by saying what I think the rough truth is about race, because, against the stream, I am disposed to argue that this struggle toward the truth is exactly what we find in the life of Du Bois, who can claim, in my view, to have thought longer, more engagedly, and more publicly about race than any other social theorist of our century. 1. Masatoshi Nei and Arun K. Roychoudhury, “Genetic Relationship and Evolution of Human Races,” Evolutionary Biology 14 : 11; all further references to this work, abbreviated “GR,” will be included in the text. Anthony Appiah is associate professor of philosophy, African studies, and Afro-American studies at Yale. He is the author of Assertion and Conditionals and For Truth in Semantics . In addition, he is at work on African Reflections: Essays in the Philosophy of Culture. (shrink)