" Dr. Cassell discusses the world of the sick, the healing connection and healer's battle, the role of omnipotence in the healer's art, illness and disease, and ...

Extracorporeal membrane oxygenation (ECMO) is currently reserved predominantly for bridging patients to a different destination therapy, but the use of ECMO as a destination therapy itself (ECMO-DT...

Let X be an infinite set and let and denote the propositions “every filter on X can be extended to an ultrafilter” and “X has a free ultrafilter”, respectively. We denote by the Stone space of the Boolean algebra of all subsets of X. We show: For every well‐ordered cardinal number ℵ, (ℵ) iff (2ℵ). iff “ is a continuous image of ” iff “ has a free open ultrafilter ” iff “every countably infinite subset of has a limit point”. (...) implies “every open filter on extends to an open ultrafilter” implies “has an open ultrafilter” implies It is relatively consistent with that (ω) holds, whereas (ω) fails. In particular, none of the statements given in (2) implies (ω). (shrink)

William Lawrence Tower’s work on the evolution of the Colorado Potato Beetle (_Leptinotarsa decemlineata_), documenting the environmental induction of mutation and speciation, made him a leading figure in experimental genetics during the first decade of the 20th century. His research program served as a model for other experimental evolution studies seeking to demonstrate the environmental modification of inheritance. Tower enjoyed the support of influential figures in the field, despite well-known problems that plagued Tower’s earlier academic career. The validity of his (...) genetic work, and other findings reported by Tower, were later challenged. The Tower affair illustrates how questionable and possibly fraudulent scientific practices can be tolerated to explore certain experimental directions and theoretical frameworks, particularly at the frontier of expanding disciplines. When needed, those explorations can be forestalled or extinguished by exploiting conspicuous vulnerabilities of rogue practitioners. In Tower’s case, both unrefuted allegations of scientific misconduct and personal problems dissolved his institutional support, leading to a swift ouster from academic science. Tower’s downfall discredited soft inheritance and neo-Lamarckian conceptions in the field of experimental genetics, facilitating the discipline’s embrace of a hard inheritance model that featured a hereditary material resistant to environmental modification. (shrink)

Like the broom in “The Sorcerer's Apprentice,” technologies take on a life of their own. To bring them under control, doctors must learn to tolerate ambiguity, resist the lure of the immediate, cease fearing uncertainty, and rechannel their response to wonder.

During his career, Ronald Dworkin wrote extensively on an impressive range of issues in moral, political, and legal philosophy, but, like many of his contemporaries, international law remained a topic of relative neglect. His most sustained work on international law is a posthumously published article, “A New Philosophy for International Law” (2013), which displays some familiar aspects of his views in general jurisprudence, in addition to some novel (though perhaps surprising) arguments as well. This paper argues that the moralized account (...) of international law we might have expected is conspicuously missing from this posthumous article; with Dworkin advancing an argument based on a form of political realism instead. (shrink)

The legal and ethical asymmetry between honoring positive claims of conscience versus negative claims of conscience was recently analyzed by several articles in this journal. The first author of this article (ALB) identified unique but defeasible reasons against honoring positive claims of conscience, such as the greater threat they post to institutional values and institutional resources than negative claims of conscience. However, ALB wrote, when these reasons can be overcome, positive claims of conscience should enjoy the same ethical and legal (...) respect as negative claims of conscience. This article argues that the prescription of birth control by non-Roman Catholic physicians in Roman Catholic institutions is an example of a positive claim of conscience that can overcome concerns of institutional values and resources, and therefore ought to receive the same ethical respect and legal protection as negative claims of conscience. In making this argument, this article also responds to several of the thoughtful comments raised by Alberto Giubilini and Dominic Wilkinson. (shrink)

Game of Thrones is a popular, award-winning television series with an eight-season run on Home Box Office, based on the Song of Fire and Ice series of books by George R.R. Martin. It depicts a morally complex political situation in a fantasy environment that has some similarities to medieval Europe. In the midst of this setting, the series advocates a cynical attitude towards politics, social structures, and religion. Most notably, the series suggests that there is no such thing as political (...) legitimacy. This chapter identifies a pattern of cynicism throughout Game of Thrones but points towards the thoughts of John Locke and Thomas Aquinas as possible alternatives to the story’s cynicism. (shrink)

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) (...) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life. (shrink)

Kant’s philosophy is often treated as a closed system, without reference to how it was written or how Kant arrived at its familiar form, the critique. In fact, the style of the critique seems so artless that readers think of it as an unfortunate by-product—a style of stylelessness. In _Constituting Critique_, Willi Goetschel shows how this apparent gracelessness was deliberately achieved by Kant through a series of writing experiments. By providing an account of the process that culminated in his three (...) _Critiques_, this book offers a new perspective on Kant’s philosophical thought and practice. _Constituting Critique_ traces the stages in Kant’s development to reveal how he redefined philosophy as a critical task. Following the philosopher through the experiments of his early essays, Goetschel demonstrates how Kant tests, challenges, and transforms the philosophical essay in his pursuit of a new self-reflective literary genre. From these experiments, critique emerges as the philosophical form for the critical project of the Enlightenment. The imperatives of its transcendental style, Goetschel contends, not only constitute and inform the critical moment of Kant’s philosophical praxis, but also have an enduring place in post-Kantian philosophy and literature. By situating the _Critiques_ within the context of Kant’s early essays, this work will redirect the attention of Kant scholars to the origins of their form. It will also encourage contemporary critical theorists to reconsider their own practice through an engagement with its source in Kant. (shrink)

The Supremacy of Love advocates an agape-centered vision of virtue ethics, combining traditional Aristotelian ethics with insights from Thomas Aquinas. It shows why virtue is good for the virtuous individual, reimagines impartiality so that it is compatible with close personal relationships, and has pluralistic cross-cultural applications.

It has become increasingly evident that gene content of the sex chromosomes is markedly different from that of the autosomes. Both sex chromosomes appear enriched for genes related to sexual differentiation and reproduction; but curiously, the human X chromosome also seems to bear a preponderance of genes linked to brain and muscle functions. In this review, we will synthesize several evolutionary theories that may account for this nonrandom assortment of genes on the sex chromosomes, including 1) asexual degeneration, 2) sexual (...) antagonism, 3) constant selection, and 4) hemizygous exposure. Additionally, we will speculate on how the evolution of sex‐chromosome gene content might have impacted on the phenotypic evolution of mammals and particularly humans. Our discussion will focus on the mammalian sex chromosomes, but will cross reference other species where appropriate. BioEssays 26:159–169, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

The cell division and differentiation events that occur during the development of the nematode Caenorhabditis elegans are nearly identical between different individuals, a feature that distinguishes this organism from larger and more complex metazoans, such as humans and Drosophila. In view of this discrepancy, it might be expected that the regulation of cell growth, division and differentiation in C. elegans would involve mechanisms separate from those utilized in larger animals. However, the results of recent genetic, molecular and cellular studies indicate (...) that C. elegans employs an arsenal of developmental regulatory mechanisms quite similar to those wielded by its arthropod and vertebrate relatives. Thus, the nematode system is providing both novel and complementary insights into the general problem of how growth and patterning events are integrated in development. This review offers a general perspective on the regulation of cell division and growth in C. elegans, emphasizing recent studies of these crucial aspects of development. BioEssays 24:38–53, 2002. © 2002 John Wiley & Sons, Inc. (shrink)

This chapter contains section titled: “You're Right. There's No Earth. It's All a Legend” “I'm Not a Cylon!…Maybe, But We Just Can't Take That Chance” “You Have to Have Something to Live For. Let it be Earth” Notes.

To the Editor: Daniel Callahan is correct when, in “Rationing: Theory, Politics, and Passions”, he tells us that the combination of ever-rising medical costs and ever-increasing demand for expensive resources by physicians and their patients will—in the absence of any workable, generally acceptable mode of official rationing—lead to covert rationing. Or, more precisely, it will encourage us to extend the covert rationing that already exists, where those with more get more. As things stand now, this is unavoidable. However..

Book reviewed in this article: Thinking Clearly About Death. By Jay F. Rosenberg.

The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick person: bodies do not suffer, people do. An exclusive concern with scientific knowledge of the body (...) and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years. (shrink)

Two papers on global morality and ethics—by David Loye and Solomon H. Katz—are hereby placed into an evolutionary context. Simply stated though no less true, ethical evolution will likely be the next great evolutionary leap forward into the future—if humankind is to have a future.

Much of the recent work on oncogenes has been interpreted as signifying that the cancerous phenotype is caused by the direct expression of ‘dominantly‐acting’ oncogenes. On the other hand, numerous somatic cell hybridization experiments suggest that there are potent tumour‐suppressor genes in the genome. The conflict between the observations and the possible nature of the relationships between oncogenes and tumour‐suppressor are discussed.

Individual-level research in behavioral science can have massive impact and create system-level changes, as several recent mandates and other policy actions have shown. Although not every nudge creates long-term behavior change, defaults and other forms of choice architecture can not only change individual behavior but also reduce inequities and lead to changes in public policy and norms.

Wittgenstein's Tractatus carefully distinguished the concept all from\nthe notion of a truth-function, and thereby from the quantifiers.\nI argue that Wittgenstein's rationale for this distinction is lost\nunless propositional functions are understood within the context\nof his picture theory of the proposition. Using a model Tractatus\nlanguage, I show how there are two distinct forms of generality implicit\nin quantified Tractatus propositions. Although the explanation given\nin the Tractatus for this distinction is ultimately flawed, the distinction\nitself is a genuine one, and the forms of generality that (...) Wittgenstein\nindicated can be seen in the quantified sentences of contemporary\nlogic. (shrink)

The way information and communication technology (ICT) develops can promote or hinder the democratic potential of this critical societal infrastructure. Concerns about the role standards development organizations (SDOs) play in this context predate the “digital age” but are reemerging amid substantial changes in the institutional landscape of standardization. This article explores the increasingly critical link between the institutional design of SDOs and the democratic design of ICT. We review some principles of democracy in terms of the design of technology, apply (...) these to standardization, and discuss the role public policy may play here, while distinguishing between input and output legitimacy. (shrink)