In the UK, over 70% of AIDS, including new cases, is located in a few Districts in central London where the distribution of previously occurring and new cases is essentially confined to the original risk groups of homosexual/bisexual men, drug addicts of both sexes, and some of their sexual partners and consorts. But control policy is still based on the assumption that HIV has already spread from persons in these risk groups into the general population, and that it will spread (...) hereafter at an increased rate because of heterosexual transmission to cause a widespread epidemic of AIDS.The basis and implications of this policy were investigated in the South East region adjacent to London, Analysis of demographic and epidemiological data shows that, with one exception, there is very little extension of AIDS from affected Districts in London to the surrounding region or even to the suburban fringe. Where AIDS is prevalent, as in this exception, the distribution follows the same, original pattern which relates essentially to risks arising from life-styles. There is no significant association between the prevalence or spread of AIDS and conventional markers of deprivation, economic and social disadvantage.Allocations of personnel, services and expenditure, assessed from returns required under the AIDS Control Act of 1987 and official registration data, continue to follow the original policy assumptions. They are therefore unrelated to the numbers of existing and new cases, disproportionate and unrealistic. Claims that this widespread excess of effort is justified by the fact that AIDS has not spread to the general population are falsified by the continuation of cases almost exclusively in risk groups. There is nothing in the data required under the Act or in registrations in this main locus of AIDS in the UK to suggest any change in this or to justify continuation of current expenditure and redundant activities.There is no evidence in these data that ethnic variations in the resident populations of Districts are associated with variations in the prevalence of AIDS. However, the larger figures available in some of the national data do indicate a disproportionate increase in some minority ethnic groups. Further detail about risks factors in these groups are required and, meanwhile, effort and expenditure should be re-orientated toward treatment, contact tracing and other public health measures for more effective containment of the continuing spread of AIDS in all the high risk groups. (shrink)

Each contributor to this book has used personal experience as the basis from which to frame his individual sociological perspectives. Because they have personalized their work, their accounts are real, and recognizable as having come from 'real' persons, about 'real' experiences. There are no objectively-distanced disembodied third person entities in these accounts. These writers are actual people whose stories will make you laugh, cry, think, and want to know more.

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

I argue that Hobbes isn't really a materialist in the early 1640s (in, e.g., the Third Objections to Descartes's Meditations). That is, he doesn't assert that bodies are the only substances. However, he does think that bodies are the only substances we can think about using imagistic ideas.

In lieu of an abstract, here is a brief excerpt of the content:Studying Penguins to Understand BirdsJacinta O. A. Tan (bio), Anne Stewart (bio), Ray Fitzpatrick (bio), and Tony Hope (bio)Keywordsanorexia nervosa, treatment decision-making, competence, valuesWe are grateful to Grisso, Appelbaum, Charland, and Vollmann for their thoughtful commentaries on our paper. We would like to respond by picking up on some of the points they make, although we do not address all the issues raised.Our general aims in the paper (...) are less immediately pragmatic than are the central concerns of Grisso and Appelbaum. Our interest is primarily in a number of ethical, and related conceptual, issues that arise from empirical data. In the long run, of course, we believe that these ethical and conceptual issues are important to the care of people with mental disorders, but our focus is philosophical.Our central interest is what justifies overriding treatment refusal. We are unhappy with a "status" approach according to which, for example, the mere fact that a person suffers a mental disorder provides grounds for overriding her wishes. Such an approach, it seems to us, fails to identify reasons, and discriminates against those with mental disorder, a view shared by the Law Commission (The Law Commission 1995). We are, on the other hand, attracted by the approach that grounds any overriding of treatment refusal on lack of capacity (or competence) to make treatment decisions. The concept of capacity has been well developed through legal cases and conceptual analysis, not least by Grisso and Appelbaum themselves. We were struck, however, first through clinical experience, and subsequently from the pilot study reported in our paper, that many patients with anorexia nervosa who refuse treatment do not necessarily lack capacity, using the current criteria, and yet show features or give reasons that raise serious doubts as to whether it is right to respect their refusal of treatment.To avoid reliance on a "status" approach, the issue with which we are grappling is whether the concept of capacity (and therefore lack of capacity) can be developed to encompass some of our findings, and whether it is ethically right to do so. Charland makes the important point that the concept of competence, or capacity, has both a descriptive and a prescriptive component. It is for this reason that the question of whether, for example, we should extend the criteria for capacity is part of the question of when it is morally right to override treatment refusal.Grisso and Appelbaum suggest that our work advances "our thinking about appreciation, rather than requiring that we add new elements" (2006, 297). From our perspective, and at this stage, it is a secondary issue whether we are suggesting a development of appreciation, or a new element (e.g., "pathological values"). The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in [End Page 299] such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests.We chose to study anorexia nervosa for various reasons, but we expect that the issues raised have a more general relevance (such as to substance abuse and impulse control disorders as Grisso and Appelbaum and Charland suggest). We do not expect the results to be relevant to all, or even most, mental disorders. Our main interest is not the specific management of people with anorexia, but how the data challenge, and help to develop, the concept of capacity, and the ethical analysis of overriding patient refusal of treatment. Our paper aims to address what we understand Charland to be referring to by the "pretheoretical desiderata" (2006, 283) of the concept of capacity. One reason why we chose anorexia as the focus of this work is because it is different from many mental disorders in the issues that it raises. In this it is, perhaps, rather like studying penguins to better understand the concept of bird just because penguins, although clearly birds, have unusual features.We agree, therefore, with Grisso and Appelbaum's caution that it would be unwise to jump in and change the MacCAT-T on the basis of the results... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 697 however, that extreme caution is to be advised upon entering those waters? Fully respectful of this concern, Professor Stambaugh enjoins the reader to "reach his own conclusions about parallels and affinities" concerning "some strains of Nietzsche's thought that are most consonant with an Eastern temper of experience." DAVID B. ALLISON SUNY, Stony Brook W. J. Mander. An Introduction to Bradley's Metaphysics. New York: Oxford University Press, (...) 1994. Pp. viii + 175. Cloth, $39-95. T. L. S. Sprigge. James and Bradley: American Truth and British Reality. Chicago: Open Court, 1993. Pp. xiv + 63o. Cloth, $66.95. Paper, $29.95Until the appearance of Mander's book there had been no short general introduction to Bradley in print since Penguin dropped Wollheim's F. H. Bradley from their list. But in any case, as a result of the work of scholars since its last revision in 1969, Wollheim's account, despite its many virtues, is now known to be misleading in crucial places, for he remained to some extent in the grip of the dismissive caricature of Bradley bequeathed to analytic philosophers by Russell and Moore and stilloften just taken for granted. (See, e.g., almost any textbook which has a chapter on truth.) By drawing on this scholarship Mander offers us a philosopher strikingly different from this caricature. Mander's replacement portrayal is, in its broad outlines, accurate enough to be confidently recommended as giving a good general sketch of Bradley's views (excepting the ethics, which Woliheim managed to include), presenting them sympathetically but not completely uncritically in a way which should offer something of interest to both advanced undergraduates and their teachers. As Oxford has also recently published a selection from Bradley's works (Writings on Logic and Metaphysics, edited by James Allard and Guy Stock, with both general and topic-specific introductions), there is the added benefit that one who wishes to read him can now do so without being faced with wading through some intimidatingly large volumes of often meandering discussion in baffling prose. The two should make a good pair around which to structure classes concerning Bradley. I am not quite so confident about some of the detail of Mander's account, which is, moreover, sometimes explained in a way nearly as obscure as the original on which it is intended to cast light. This last is, of course, hard to avoid in expounding a writer whose whole cast of mind is opposed to the exact formulation of precise theses illustrated with clear examples, and is less misleading than artificial precisification; it also perhaps reduces the risk that students will use it as a substitute for, rather than a guide to, the primary texts themselves. And I want to stress that Mander's overall picture of Bradley's views seems to me reliable and as well situated historically as the book's ' G. M. C. Sprung, "Nietzsche's Interest in and Knowledge of Indian Thought," in The Great Yearof Zarathuara (188z-1981), ed. David Goicoechea (Lanham, MD.: University Press of America, x983), 166-8o. 698 JOURNAL OF THE HISTORY OF PHILOSOPHY 33:4 OCTOBER 1995 brevity allows. Its usefulness is enhanced by a very full bibliography which does include some coverage of the ethics. Sprigge's massive work is far more ambitious. His aim is "to provide a comparative exposition and personal evaluation of [Bradley's and James's] main views on truth and on the general nature of reality" (xiii). He gives several reasons for selecting these two philosophers for attention: they are the most important of their time; they are misunderstood and misrepresented; and their views have much in common that is largely correct while being the main alternative solutions to the problems they confront. Further, ajoint treatment makes sense because "it is toJames, rather than Russell, let alone Moore, that we must look for a serious critique of Bradley" (417). This is a labor of love, exhibiting reading of remarkable breadth and depth and the familiarity with its subject matter that is the product only of decades of exploration. Perhaps this very familiarity is part of the explanation of an occasional paucity of textual backup for the pictures Sprigge... (shrink)

This essay is an attempt to take stock of what has been done by those who have worked on the foundations of mathematics and to suggest, very inadequately in so short a space, what may be a satisfactory approach to this subject for one who is not an expert in it. The subject is one that neither mathematicians nor philosophers can any longer afford to ignore, but in the technicalities of which they may not be very interested.

This classic textbook focuses on medical law and its relationship with medical practice and modern ethics. It provides thorough coverage of all of the topics found on medical law courses, and in depth analysis of recent court decisions, encouraging students to think analytically about the subject.

Health care begins as an act of conscience, which urges a response to the sick and holds caregivers accountable to moral standards that public authorities ultimately do not define. Conscience nonetheless expresses itself as a type of dialogue within oneself that is influenced by dialogue with others, especially with society in the form of civil law and professional standards. A well-formed conscience for health care relates the foundations of morality to health care practices and contributes sound moral judgment about them (...) to the common good. Some current health care policies and medical education presume a distorted view of conscience as personal sentiment. These policies circumvent serious discussion and possible resolution of society's most vexing bioethics controversies. (shrink)