Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Joseph T. O’Connell drew attention to the relative scarcity of academic work on religion in South Asia, and o ered as a plausible explanation for this state of a airs the tension between secular and religio‐political communal interests. This paper explores the potential role of phi‐ losophy as an established academic discipline within this situation, in the context of India. It argues that objective study, including evaluation, of the truth claims of various religious traditions is an important aspect (...) of academic as opposed to confessional engagement with religion, and that philosophy in India is especially well suited to undertake such re ection and to provide corresponding education. Unlike Western countries, philosophy and religion were never clearly separated in India and did not evolve in tension with one another. The history of Indian philosophy therefore includes and is included within the history of its ‘religions’, in a way that makes philosophical examination of the truth claims of Indian religions internal to those religions themselves. By tracing this history, the discipline of philosophy can help to unsettle the idea of religion as a matter of xed dogma. It can also continue the procedure of interpreting and evaluating metaphysical and epistemological theses that has been an intrinsic component of Indian religious thought for most of its history. (shrink)

The spatial dynamics of the optical emission from an array of 50 times 50 individual microcavity plasma devices is investigated. The array is operated in argon and argon-neon mixtures close to atmospheric pressure with an ac voltage. The optical emission is analysed with phase and space resolution. It has been found that the emission is not continuous over the entire ac period, but occurs once per half period. Each of the observed emission phases shows a self-pulsing of the discharge, with (...) several bursts of emission of fixed width and repetition rate. The number of emission bursts depends on applied voltage and frequency. Spatially resolved measurements prove that the emission bursts are formed by overlapping emission pulses from single discharge cavities. Intensity differences between positive and negative half-wave can be interpreted through spatially resolved measurements of single discharge cavities. (shrink)

“... it ain't likely to have a radius of exactly zero,” is the conclusion of H. G. Dehmelt(1) from his Nobel Prize (1989) winning observations on trapped electrons. There are small discrepancies between Dehmelt's observations and the theoretical predictions of quantum electrodynamics (QED), which assumes that the electron is a point particle. Here we present evidence in support of Dehmelt's contention that the electron has a structure. Essentially, we point out that the nonrelativistic limit of QED is at variance with (...) a fundamental principle underlying all of physics, viz. the second law of thermodynamics. (shrink)

PURPOSE:To report the localization of a gene causing drusen and macular degeneration in a previously undescribed North American family. METHODS:Genetic mapping studies were performed using linkage analysis in a single family with drusen and atrophic macular degeneration. RESULTS:The clinical manifestations in this family ranged from fine macular drusen in asymptomatic middle-aged individuals to atrophic macular lesions in two children and two elderly patients. We mapped the gene to chromosome 6q14 between markers D6S2258 and D6S1644. CONCLUSIONS:In a family with autosomal dominant (...) drusen and atrophic macular degeneration, the gene maps to a 3.2-cM region on chromosome 6q14. This locus appears to be distinct from, but adjacent to, the loci for cone-rod dystrophy 7 (CORD7) and North Carolina macular dystrophy (MCDR1). Future identification of the gene responsible for the disease in this family will provide a better understanding of macular degeneration. (shrink)

Most philosophical explorations of responsibility discuss the topic solely in terms of metaphysics and the "free will" problem. By contrast, these essays by leading philosophers view responsibility from a variety of perspectives -- metaphysics, ethics, action theory, and the philosophy of law. After a broad, framing introduction by the volume's editors, the contributors consider such subjects as responsibility as it relates to the "free will" problem; the relation between responsibility and knowledge or ignorance; the relation between causal and moral responsibility; (...) the difference, if any, between responsibility for actions and responsibility for omissions; the metaphysical requirements for making sense of "collective" responsibility; and the relation between moral and legal responsibility. The contributors include such distinguished authors as Alfred R. Mele, John Martin Fischer, George Sher, and Frances Kamm, as well as important rising scholars. Taken together, the essays in _Action, Ethics, and Responsibility_ offer a breadth of perspectives that is unmatched by other treatments of the topic. Contributors: Joseph Keim Campbell, David Chan, Randolph Clarke, E.J. Coffman, John Martin Fischer, Helen Frowe, Todd Jones, Frances Kamm, Antti Kauppinen, Alfred R. Mele, Michael O'Rourke, Paul Russell, Robert F. Schopp, George Sher, Harry S. Silverstein, Saul Smilansky, Donald Smith, Charles T. Wolfe The hardcover edition does not include a dust jacket. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 147-151 [Access article in PDF] Book Review Philosophical Meditations on Zen Buddhism Philosophical Meditations on Zen Buddhism. By DaleS.Wright. Cambridge, Great Britain: Cambridge University Press, 1998. xv +227 pp. In a work brimming with unobtrusive erudition and centered on the figure of Huang Po (d. 850), Dale Wright offers a seasoned account of a topic that is still very much in need of clarification, namely, (...) the roles of language, conceptuality, textuality, interpretation, and historical development in Zen Buddhism. Some recent critics tend to see Zen as incoherent or even hypocritical in that this "special transmission outside the sutras, not dependent on language and texts, pointing directly to mind" (quoted, p. 64) in reality developed complex and varied textual and ritual traditions from [End Page 147] which the supposedly pure enlightenment experience cannot be siphoned out. Wright argues that the critics themselves are often naive, giving an inverted reflection of the naiveté of earlier scholars such as John Blofeld, who saw Zen as centered on an ineffable Supreme Experience, quite independent of the language used to point to it. Nonetheless, Wright himself is in basic agreement with the critics and in radical opposition to Blofeld (and to D. T. Suzuki). But he points out that the early Chinese Zen masters speak in many voices, often anticipating the most sophisticated insights of their critics.Wright's style is very unlike that of Bernard Faure, being slow, serene, reflective, scrupulous, and imbued with the deepest respect for the Zen tradition. Yet his thought rejoins Faure's at many points.The thrust of Wright's argument is to demystify Zen enlightenment by reinserting it in its varied linguistic, social, institutional, and historical contexts. He gives a realistic and holistic account of what Zen experience must have been like for disciples of Huang Po (pp. 187-192). His stress on the linguisticality of all experience certainly illuminates the texture of Huang Po's world. But I am left wondering if there is not another aspect of Zen that is missed here. Modern philosophers have derived much insight from the realization that thought and perception are deeply embedded in language. But I do not know that anyone has proven that there can never be a thinking or perception that is independent of language. Even the supposedly pan-textualist Derrida states somewhere that he does not exclude the possibility of nonlinguistic thought. In most fields of inquiry this abstruse question makes no practical difference, but in the case of Zen it is of crucial import. The presupposition of universal linguisticality, especially if it hardens into a dogma, may block access to the core of Zen experience.Wright argues that though some Zen masters sought prelinguistic immediacy, the majority were deeply aware of the inseparability of experience and the language in which it is grasped. But could it not be that prelinguistic immediacy was so much taken for granted in Zen that the masters scarcely needed to insist on it? Wright says that enlightenment itself is a linguistic event, since it is often occasioned by a verbal statement and given immediate expression in another verbal statement. But to recognize the indispensability of language for conveying experience is not necessarily to imply that the experience itself is dependent on language. Although a certain poem of Huang Po "strives to make its anti-textual point, the master must enter into the textual world to do so, thus abandoning the position of 'no dependence on texts'" (p. 22). Is it really necessary to see a contradiction here, given that, as Wright himself points out, "no unanimity on the meaning of the mandate against 'words and letters' existed" (p. 26)? Let us suppose that the point is nonattachment to texts and a realization of the intrinsic independence of enlightenment from the limited perspectives of textuality, language, and conceptual thought. This is quite compatible with intensive use of texts in practice.Blofeld explains that texts were useful to the learner but cast aside when enlightenment was reached. Wright argues that the enlightened experience must "continue to hold within it, and... (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.

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

The contributors to The Moral of the Story, all preeminent political theorists, are unified by their concern with the instructive power of great literature. This thought-provoking combination of essays explores the polyvalent moral and political impact of classic world literatures on public ethics through the study of some of its major figures-including Shakespeare, Dante, Cervantes, Jane Austen, Henry James, Joseph Conrad, Robert Penn Warren, and Dostoevsky. Positing the uniqueness of literature's ability to promote dialogue on salient moral and intellectual (...) virtues, editor Henry T. Edmonson III has culled together a wide-ranging exploration of such fundamental concerns as the abuse of authority, the nature of good leadership, the significance of "middle class virtues" and the needs of adolescents. This collection reinvigorates the study of classic literature as an endeavor that is not only personally intellectually satisfying, but also an inimitable and unique way to enrich public discourse. (shrink)

La cuestión de si los lenguajes intensionalesson más expresivos que los lenguajes nointensionalessurge en el marco de unaperspect i va semánt i ca de l as t eorí as.Desde esta perspectiva, la cuestión esesta. ¿Hay clases modelo que se puedencaracterizar mediante teorías que usanconceptos intensionales que no se puedencaracterizar mediante teorías que no usanconceptos intensionales? Se sugiere unaformulación precisa de esta cuestión, perono se ofrece una respuesta.Para aproxi marse a est a cuest i ón, seresume la teoría de modelos de (...) primerorden [II] y se revisa el enfoque semánticode las teorías que emplea incrementost eóri cos, no i nt ensi onal es, de pri merorden [III].Los i nc r e me nt os t e ór i c os de pr i me rorden se bosquejan pero no se definenr i g u r o s a me n t e [ I V] . E s t e l e n g u a j ei n t e n s i o n a l pr o po r c i o n a e l a p a r a t op a r a a t r i b u i r u s o d e l l e n g u a j e yact i t udes i nt ens i onal es a i ndi vi duoscuyo comportami ento es el obj eto deinvestigación. También proporciona elaparato para habl ar sobre traducci óndel lenguaj e atribuido al lenguaj e delinvestigador.La cuestión inicial se convierte entoncesen si hay clases modelo que se puedanc a r a c t e r i z a r me d i a n t e i n c r e me n t o sintencionales de lógica de primer ordenq ue n o pue de n s e r c a pt ur a do s po rincrementos teóricos no-intensionales [V].The ques t i on of whet her i nt ens i onallanguages are more expressive than nonintensional languages is raised within the framework of a semantic view of theories. Fromthis perspective, the question isthis. Are there model classes that can becharacterized by theories using intensionalconcepts that cannot be characterizedby theories that do not use intensionalconcepts? A precise formulation of thisquestion is suggested, but no answer isgiven.To approach this question, model theory offirst order theories is summarized [II] andthe semantic approach to theories usingnon-intensional, theoretical augmentationsof first order theories is reviewed [III].I n t e n s i o n a l a u g me n t a t i o n s o f f i r s torder theories are sketched [IV] but notr i gor ous l y de f i ne d. Thi s i nt e ns i onall anguage provi des t he apparat us f orattributing language use and intensionalattitudes to individuals whose behavioris the object investigation. It also providesapparatus for talking about translationf r om t he at t r i but e d l anguage t o t heinvestigator’s language.T h e i n i t i a l q u e s t i o n t h e n b e c o me swhet her t here are model cl asses t hatc a n be c ha r a c t e r i z e d by i nt e ns i ona laugmentations of first order logic thatcannot be captured by non-intensionaltheoretical augmentations [V]. (shrink)

In “Reliabilism Leveled” Jonathan Vogel (2000) provides a strong case against epistemic theories that stress the importance of tracking/sensitivity conditions. A tracking/sensitivity condition is to be understood as some version of the following counterfactual: (T) ~p oÆ ~Bp (T) says that s would not believe p, if p were false. Among other things, tracking is supposed to express the external relation that explains why some justified true beliefs are not knowledge. Champions of the condition include Robert Nozick (1981) and, more (...) recently, Keith DeRose (1995). To my knowledge, the earliest formulation of the counterfactual condition is found in Fred Dretske’s conclusive reasons condition (1971), which says, s would not have had the reason that she does for believing p, if p were false. Vogel contends that any such counterfactual condition on knowledge will render the theory of knowledge too strong. He believes that there is at least some possible reflective knowledge that cannot satisfy the counterfactual--viz., the possible knowledge that one does not believe falsely that p. The alleged impossibility of such reflective knowledge is taken by Vogel to be a decisive objection to the tracking theories advocated by Dretske, Nozick, DeRose1 and others. The criticism finds its roots in Vogel’s earlier work (1987), and recurs in papers by Ernest Sosa (2002, 1996). Sosa suggests that the externalist idea behind tracking is on target, but that Nozick’s counterfactual is a misbegotten regimentation of the idea. In its place Sosa offers his own counterfactual “safety” condition, which he feels properly captures the externalist idea. Sosa’s counterfactual is not the topic of this paper. I mention it only to point out that the criticism that constitutes the subject of my investigation is meant to do a lot of work. In Sosa’s 1 case the criticism is meant to motivate his own counterfactual analysis, and in Vogel’s case the criticism promises to be a silver bullet against a theory that has recently found renewed life in the work of Keith DeRose.. (shrink)

Spiritualist ethics: The problem of evil, by L. Lavelle. On conscience, or On the pain of having-done-it, by V. Jankélévitch. Value and immortality; and, Dangerous situation of ethical values, by G. Marcel. The concept of fallibility, by P. Ricoeur.--Axiological ethics: Ethics and metaphysics, by R. Le Senne. Good and evil, by H. Reiner. Values and truths, by R. Polin. Values as principles of action, by G. Gusdorf.--Three contemporary conceptions of humanism: Jean-Paul Sartre: Sartre on humanism, by J. J. Kockelmans. Moral (...) perspectives in Sartre's thought, by F. Jeanson. Ambiguity, by S. de Beauvoir. Albert Camus: Albert Camus and the ethic of absurdity, by H. Hochberg. On humanism, by M. Heidegger. Existentialism's basic ethical position, by O. Bollnow.--Situation ethics: Systematic essentialist ethics and existential situation ethics, by T. Steinbüchel. The question of the Single One, by M. Buber. What is a Christian ethic? By D. Bonhoeffer. Meaning and analysis of the borderline situation, by H. Thielicke. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The "Thinking of Thinking" in MetaphysicsA.9 JOSEPH G. DE FILIPPO a+~6v &Qa voE[, e~eQ ~o~t ~6 XQ&~O~OV, xetl. I~o~tv ~1VdOloLgvo1]o~t0g v6"qotg. (A.9, 1o74b33-34) Therefore it thinks itself, if indeed it is most powerful, and its thinking is the thinking of thinking. Thus culminates Aristotle's treatment of God's activity in the twelfth book of the Metaphysics. The conclusion seems transparent. God is an intellect (vo~Sg); since he is also (...) the best thing, and it is absurd that he should think anything worse than himself, he therefore thinks himself. And since he is nothing other than a thinking (v6"qotg), what he thinks of is thinking (vo~loEe0g). "Thinking of thinking," however, is a notion that is as ambiguous in ancient Greek as it is in English. It is just not clear what sort of thing such a reflexively self-thinking mind would be, though it might seem natural to construe the activity of Aristotle's God as somehow an act of pure self-awareness, self-consciousness or self-knowledge. On such an understanding God would be a separately existing consciousness, with himself or his activity as the only object of that consciousness. In 196 9 R. Norman published a paper which disputed this sort of interpretation.' He argued that when one considers Aristotle's theory of, R. Norman, "Aristotle's Philosopher-God," Phronesis 14 (1969): 63-74 (reprinted in Articles on Aristotle, vol. 4, ed. J. Barnes, M. Schofield and R. Sorabji [London, 1979], 93-1o2). While I a-m indebted to Norman's basic approach, my treatment of God's self-thought differs substantially from his in two respects. First, although it isessential to recognize that in Aristotle human thought too thinks itself, this does not justify the conclusion that God's thinking is "of the same kind as our own normal abstract thought" (73). As 1shall argue below in section 4, the characterization of the Prime Mover as v6"qoLgvo~o~t0g is meant specifically to differentiate its activity from the selfthinking of human volSg;human thought could never be characterized as v6"qotgvofioEt0g.Secondly, Norman does not isolate the real source of A.9's argument, which, as l shall argue, is the potential conflict between Aristotle's own physical and psychological theories. M. Wedin, Mind and Imagination in Aristotle (New Haven, 1988), 229-45, also argues against Norman's thesis that human and divine thought are the same in kind. [543] 544 JOURNAL OF THE HISTORY OF PHILOSOPHY 33:4 OCTOBER 1995 volSg from De Anima III.4-8, it is clear that the conception of God as a selfthinking mind does not entail that he engages in self-contemplation in the normal sense of the term. On Norman's interpretation, God thinks himself because he thinks a definite content with which he is numerically identical, according to the well-known Aristotelian doctrine of the unity of vo~g with its object of thought (vo~lx6v). To describe this act simply as self-contemplation belies the fact that its object must have an intelligible content, which in the case of God is not adequately described as his "self," for this self would indeed be nothing more than an act of self-contemplation. While many commentators have followed Norman in recognizing that the description of God as "thinking himself" is drawn from the De Anima's characterization of self-thinking, there has persisted a tendency to interpret Aristotle 's God as engaged in an act of pure self-awareness or under some similar description.' The reason for this persistence is due, I believe, to a crucial difference between chapters 7 and 9 of book A. Whereas both chapters characterize the Prime Mover (PM) as a self-thinker, in chapter 9 he is also said to be ~1 v61]otg vo~loec0g V6tlOtg (the thinking of thinking), which understandably appears to be a much more specific delineation of his thought content. A. 7 tells us that the PM is a vofJg that thinks itself (to72b18-3o); according to De Anima III. 4 that simply is what voa)g does at the highest level of actuality, since it... (shrink)

Maʼamarim she-hevi ha-Ḥo. ha-l. be-shem aḥerim -- Maʼamarim she-katav ha-Ḥo. ha-l. be-ʻatsmo.

In lieu of an abstract, here is a brief excerpt of the content:248 HISTORY OF PHILOSOPHY be taken from a philosophical point of view. Since it is not certain whether the author of the Prolegomena was or was not a Christian (p. xlix), "god" should not be capitalized, and the translation of T&~ia 5~l~ttovo'f~l~taTa as "God's creation" at IV. 15. 6 is actually misleading. Moreover, for no apparent reason, 0~oX07tz6gis translated as "metaphysical" in the first four chapters, but as "theological" (...) thereafter. Inaccuracies are very few indeed. "Ungrateful" is peculiar for o~5~5t• at I. 2. 25, and so is "adapted state" for ~to~tTe[a~ ~no~ae0g at I. 5.35; X. 26. 38, 40, and 44; at II. 10. 11, there is no need to translate o~Te&0t~6)g bu~yovxctL as "they do not aim at accurate expression," and on p. 32, line 1, "as yet" is not in the Greek of the Prolegomena, although it should have been, if the Anonymous had quoted correctly from Plato, Phaedrus 229 E. But this is trifling criticism of a work which leaves nothing to be desired in any other respect, and which displays the same high qualities of scholarship which we have come to expect of the author on the basis of his earlier achievements. MARTIN OSTWALI) Swarthmore College The Fountain of Life (Fons Vitae). By Solomon ibn Gabirol (Avicebron). Specially abridged edition, translated from the Latin by Harry E. Wedeck, with an Introduction by Theodore E. James. (New York: Philosophical Library, 1962. Unpaged introduction, 133 pp. $4.75.) The romance of the nineteenth-century discovery, by Salomon Munk, that "Avicebron's" Fons Vitae, a major source of neoplatonic thought in the thirteenth and fourteenth centuries, was actually the work of the eleventhcentury Hispano-Jewish poet, Solomon ibn Gabirol, and has often been retold. It is, indeed, a remarkable story. Perhaps its most noteworthy feature is that it reveals how closely alike Muslim, Jewish, and Christian philosophers were; by implication, then, it indicates that theological considerations were of less importance in medieval philosophy than is suggested by most historical accounts. Although the story of The Fountain of Lqe has now become an oft-told tale, the work itself has never been available in English dress. The present edition remedies this situation in part. It presents Tract III of the original text, a section dealing with the existence of simple spiritual substances. Harry Wedeck's translation is lucid and readable. Theodore E. James's introduction is useful for the beginning student but too elementary to be of much use to a more advanced reader. It is good that there is now this much to recommend to our students; we may hope that the day will come when BOOK REVIEWS 249 larger sections of the work will be translated-preferably not from the Latin, but from the Arabic original. JOSEPHL. B~u Columbia University Commentary on the Metaphysics of Aristotle. By St. Thomas Aquinas. Trans. by John P. Rowan. (Chicago, Illinois: Henry Regnery Company, 1961. Pp. xxiii + 955.2 vols., boxed, $25.00.) Generally speaking, the two Summae of St. Thomas, long available in English translation, contain all that is most personal and most profound in his philosophical thought. Nonetheless, it is quite impossible to get a fully adequate conception of St. Thomas' place in the history of western thought from a consideration of his theological writings alone. Hence, by translating St. Thomas' Commentary on the Metaphysics of Aristotle into English, Professor J. P. Rowan has provided the non-Latin reading student of the history of philosophy an invaluable service. For it is in his r61e as Aristotelian commentator that we see St. Thomas creating for the Schoolmen a version of Aristotle which served to render the Stagirite's thought into terms which became fundamental to the philosophical defense of Christianity. Further, by keeping in mind the fully-developed notions of St. Thomas on the existence of God and the nature of being as these are given us to understand in the Summae, the reader becomes better enabled, by a critical reading of Thomas' Commentary, to grasp the sense in which the Saint's theological writings are said by his enthusiasts to represent a "completing" and "perfecting" of... (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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This paper offers an experimental test of a version of Rubinstein’s bargaining model in which the players’ discount factors are unequal. We find that learning, rationality, and fairness are all significant in determining the outcome. In particular, we find that a model of myopic optimization over time predicts the sign of deviations in the opening proposal from the final undiscounted agreement in the previous period rather well. To explain the amplitude of the deviations, we then successfully fit a perturbed version (...) of the model of myopic adjustment to the data that allows for a bias toward refusing inequitable offers. (shrink)

This work is intended as an introduction to the study of Soviet psy chology. In it we have tried to present the main lines of Soviet psycho logical theory, in particular, the philosophical principles on which that theory is founded. There are surprisingly few books in English on Soviet psychology, or, indeed, in any Western European language. The works that exist usually take the form of symposia or are collections of articles translated from Soviet periodicals. The most important of these (...) are Psychology in the Soviet Union (ed. by Brian Simon), Recent Soviet Psychology (ed. by Neil O'Connor) and Soviet Psychology, A Symposium (ed. by Ralf Winn). Raymond Bauer has also edited an interesting symposium entitled Some Views on Soviet Psychology. Only two systematic studies of Soviet psychology have been published to date: Joseph Wortis' Soviet Psychiatry and Raymond Bauer's The New Man in Soviet Psychology. Both are valuable introductions to Soviet psychology; Bauer's book, in particular, gives a good account of the debates on psychological theory in the Soviet Union in the nineteen twenties and -thirties. Both, however, are somewhat out of date. There are also a number of interesting articles written by Ivan D. London and Gregory Razran, which give general surveys of particular periods or aspects of Soviet psychology. These have been listed in the bibliography. (shrink)

Memory sometimes yields knowledge and sometimes does not. It is, however, natural to suppose that i f a man remembers that p, then he knows that p and formerly knew that p. Remembering something is plausibly construed as a f o rm of knowing something which one has not forgotten and which one knew previously. We argue, to the contrary, that this thesis is false. We present four counterexamples to the thesis that support a different analysis of remembering. We propose (...) that a person remembers that p (at t) if and only if the thought or conviction that p comes from memory (at t) when, in fact, it is true that p. (shrink)

From the Preface: "The majority of the papers contained in this volume was delivered in the fall of 1978 at The Catholic University of America as part of the Machette series of lectures on Aristotle. Although collections of essays on Aristotle are hardly lacking at present, this volume presents new studies which, it is hoped, give some idea of the variety of philosophical perspectives in which Aristotle has held and continues to hold great interest and of the scholarly analysis needed (...) in order to reach a better understanding of a difficult author." • CONTENTS: 1. Categories in Aristotle, Michael Frede • 2. Definitions in Aristotle's Posterior Analytics, Alfonso Gomez-Lobo • 3. Aristotle and Galileo: The Uses of ΥΠΟΘΕΣΙΣ (suppositio) in Scientific Reasoning, William A. Wallace • 4. Aristotle and the History of Greek Scepticism, A. A Long • 5. Aristotle's Metaphysics Viewed by the Ancient Greek Commentators, Gérard Verbeke • 6. ΕΙΔΗ in Aristotle's Earlier and Later Theories of Substance, John A. Driscol • 7. Averroes as Commentator on Aristotle's Theory of the Intellect, Arthur Hyman • 8. Aristotle's Method of Ethics, Terence Irwin • 9. Goodness and Human Aims in Aristotle's Ethics, Nicholas P. White • 10. Aristotle on the Essence of Happiness, Daniel T Devereux • 11. The ΚΑΛΟΝ in Aristotelian Ethics, Joseph Owens • 12. Telos and Teleology in Aristotelian Ethics, Henry B Veatch. (shrink)