OBJECTIVES: To compare the practices of local research ethics committees and the time they take to obtain ethical approval for a multi-centre study. DESIGN: A retrospective analysis of outcome of applications for a multi-centre study to local research ethics committees. SETTING: Thirty-six local research ethics committees covering 38 district health authorities in England. MAIN MEASURES: Response of chairmen and women, the time required to obtain approval, and questions asked in application forms. RESULTS: We received replies from all 36 chairmen contacted: (...) four (11%) granted their approval, and 32 (89%) required our proposal to be considered by their local research ethics committee. Three committees asked us to attend their meetings. The application was approved by all 36 local research ethics committees but the time to obtain ethical approval varied between six to 208 days. One third of the committees did not approve the project within three months, and three took longer than six months. There was considerable variation in the issues raised by local research ethics committees and none conformed exactly to the Royal College of Physicians' guidelines. CONCLUSION: Obtaining ethical approval for a multi-centre study is time-consuming. There is much diversity in the practice of local research ethics committees. Our data support the recommendation for a central or regional review body of multi-centre studies which will be acceptable to all local research ethics committees. (shrink)

Objectives: to assess physicians’ and patients’ views in Saudi Arabia towards involving the patient versus the family in the process of diagnosis disclosure and decision-making, and to compare them with views from the USA and Japan.Design: A self-completion questionnaire was translated to Arabic and validated.Participants: Physicians from different specialties and ranks and patients in a hospital or attending outpatient clinics from 6 different regions in KSA.Results: In the case of a patient with incurable cancer, 67% of doctors and 51% of (...) patients indicated that they would inform the patient in preference to the family of the diagnosis . Assuming the family already knew, 56% of doctors and 49% of patients would tell the patient even if family objected . However, in the case of HIV infection, 59% of physicians and 81% of patients would inform the family about HIV status without the patient’s consent . With regards to withholding ventilatory support, about 50% of doctors and over 60% of patients supported the use of mechanical ventilation in a patient with advanced cancer, regardless of the wishes of the patient or the family. Finally, the majority of doctors and patients were against assisted suicide.Conclusions: Although there was more recognition for a patient’s autonomy amongst physicians, most patients preferred a family centred model of care. Views towards information disclosure were midway between those of the USA and Japan. Distinctively, however, decisions regarding life prolonging therapy and assisted suicide were not influenced to a great extent by wishes of the patient or family, but more likely by religious beliefs. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

В монографии представлены взгляды авторов на возникновение и развитие либеральной и консервативной идеологий в политической истории российского государства.

Our fascination with artificial intelligence (AI), robots and sentient machines has a long history, and references to such humanoids are present even in ancient myths and folklore. The advancements in digital and computational technology have turned this fascination into apprehension, with the machines often being depicted as a binary to the human. However, the recent domains of academic enquiry such as transhumanism and posthumanism have produced many a literature in the genre of science fiction (SF) that endeavours to alter this (...) antagonistic notion of AI. In his novel Klara and the Sun, Kazuo Ishiguro explores this notion of AI as a caring machine capable of nursing an ailing young girl back to health. Through this portrayal of AI as a sentient being capable of empathy and cognition, Ishiguro is attempting to usher in a new perception of AI: a posthuman perception that challenges the conventional notions of AI as a machine devoid of emotions. The novel further expands on the idea of self, soul and human consciousness and ponders on the question, what makes humans human, and if it is possible to imbibe these qualities onto an AI. Owing to the novelty of this notion, an unexplored avenue that deserves further exploration, this paper examines the plausibility of this new notion of AI through a careful exegesis of the novel. The paper also attempts to chart the impact of SF in society and culture. The study reveals a positive shift in perception towards AI, and there seems to be much scope for interdisciplinary and transdisciplinary research. (shrink)

In the setting of transplant medicine, decision making needs to take into account the multiple clinical and psychosocial case variables, rather than turn to arbitrary rules that cannot be scientifically supportedThe yearly demand for liver transplants far exceeds the supply of available organs .1 Additionally, alcoholic cirrhosis has been a controversial indication for transplant as these recipients can be viewed as having caused their own illness—an illness that is preventable by abstaining from alcohol . While not categorically denying liver transplantation (...) to those with alcoholic cirrhosis, many hospitals have incorporated a six month alcohol abstinence criterion 2 in an effort to select optimal candidates. The six month rule has two purposes; namely, allowing the liver a chance to recover in the absence of alcohol , and also observation of the patient to verify that he/she remains alcohol free, with the hope of reducing the risk of relapse. Everhart et al,3 determined that 85% of US liver transplant programmes and 43% of third party payers require a defined period of abstinence—for example, three or six months—as part of the waiting list process.Liver transplantation does not cure alcoholism, as evidenced by the fact that roughly 20% of these patients use alcohol following transplant, with one third exhibiting “repetitive or heavy drinking”.4 Arguments abound as to the scientific merit of a six month abstinence criterion in reducing the risk of alcohol relapse following transplant. Some propose that a minimum of six months abstinence itself predicts a lower relapse rate,5 while others argue that six months is not predictive or that other factors—for example, illicit drug use—in combination with a minimum number of months abstinent is predictive.6,7 Even the United …. (shrink)

“Wherever there is smoke there must be fire.” In 1957, Aram M. Frenkian noticed that both ancient Greek and Indian philosophy makes use of the smoke-fire analogy as a model for inferential reasoning. He postulated that Greek use of the example reflected Indian influence on Greek philosophy which was mediated through the works of Pyrrho, the founder of Sceptisicm, who had accompanied Alexander the Great on his Indian campaign (327-5 BCE) and learnt from Indian sages (‘gymnosophists’ as the Greeks called (...) them). More recent scholarship mainly shares his views. In the present paper, I argue that the smoke-fire example formed part of a complex theory of sign inference, and that not only the isolated analogy, but the theory as a whole which it illustrates is present in both cultures. Furthermore, the variants of this theory comprise such close and extended similarities that they must be the result of direct contact between Indian and Greek thinkers, although it is impossible to decide whether they stem from a common origin, or are the result of influence from one culture to the other. (shrink)

The article is devoted to almost unknown monastery of the Russian Orthodox Church, a Holy Trinity Zosimo-Savvatievskaya Novo-Solovetskaya Krasnokholmskaya poustinia that was one of the important pilgrimage places of the royal family in the 17th century. Despite the fact that the monastery was founded in the reign of Tsar Alexei Mikhailovich, it is an important link in the historical and cultural development of our Fatherland, primarily because the extant architectural monuments of outstanding artistic qualities. That is why the architectural ensemble (...) of the monastery occupies a prominent place in the history of Russian culture. In addition, Novo-Solovetskaya poustinia is an important historical object providing data on the development of Russian spiritual and artistic culture of the late seventeenth century. The question of cultural-historical and social roles that Orthodox monasteries played in the history of Russia is still not sufficiently studied is. The modern development of the Russian state cannot be complete without the restoration of the positive legacy that has been lost in our culture and morality. In this regard, the study of development and formation of the Orthodox monastic culture may fill this gap. Historical development of the Zosimo-Savvatievskaya Novo-Solovetskaya Krasnokholmskaya poustinia, its architecture can contribute to the restoration of our historical memory, which is an important factor in the revival of our national identity. The author of the article also tells about the history of monastery in tough years of godless power and about the people, who died for their faith and who are called now the new martyrs. (shrink)

The founders of reformational philosophy, H. Dooyeweerd and D.H.Th. Vollenhoven, each published in short succession, viz. 1949 and 1950, a voluminous study in the history of philosophy. Whoever reads both works is struck by the remarkable differences in treatment. In this contribution these differences are analysed, but there is also indication of agreement. The article ends with a number of conclusions based on the analysis.

The age of a structure M is the set of all isomorphism types of finite substructures of M. We study ages of generic expansions of ω-stable ω-categorical structures.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Interpreting a Classic: Demosthenes and His Ancient CommentatorsK. KapparisCraig A. Gibson. Interpreting a Classic: Demosthenes and His Ancient Commentators. Berkeley and Los Angeles: University of California Press, 2002. xii + 261 pp. Cloth, $55.This book aims to provide a comprehensive account of the ancient scholarship on Demosthenes. Gibson points out that Demosthenes was widely read in later antiquity, and this created the need for linguistic and historical commentaries (...) on his speeches. Of these, some have partially survived on papyrus, while excerpts have also been preserved in later lexicographers and the Byzantine scholia found in the margins of Demosthenic manuscripts. The purpose of Gibson's study is to clarify some confusing and difficult issues related to the ancient scholarship on Demosthenes and to provide the text and commentary on the main sources. [End Page 481]Gibson's introduction includes an informative outline of key parameters in the debate, such as the accuracy of excerption from an ancient commentary, the significance of date and place, and the intended readership of these commentaries. The first chapter discusses the form and transmission of ancient commentaries, their relation with lexicographic works, and their impact on the Byzantine scholia. Gibson convincingly argues that the scholia do not reveal direct dependency upon the surviving ancient commentaries but were compiled from lexicographic works such as Harpocration or the Suda, and possibly other works lost for us. The second chapter deals with the sources, critical agenda, and readership of the ancient commentaries. Here, Gibson provides a clear account of the purposes and guiding principles behind the composition of these works. He concludes that ancient commentators were familiar with interpretative problems of the Demosthenic text and tried to explain allusions and references to specific events, people, and places and also provide semantic, etymological and textual explanations of difficult or unusual terms. In this and the third chapter, Gibson discusses in considerable detail the scholarship on Didymus. He rejects the view that Didymus was merely a filter for a "golden era" of Alexandrian scholarship and argues that his prominent position as a commentator is due to the vast quantity of his work and its impact on later scholars. In sum, the first part of the study offers an informative account of ancient Demosthenic scholarship written in a clear and accessible style.The second part of the book contains the texts of ancient commentators of Demosthenes, with English translations, and also linguistic and historical commentary. In the translation, Gibson chooses to leave out many lines from the papyrus texts where only single words or fragments of words are legible; he translates only the most extant sections of the text. This is a valid choice, but readers should be aware of the fact that many important details may be hiding in the leftovers and fragments that have been omitted. Gibson does not provide the readily available text of P.Berol.inv. 9780, the most extensive surviving work of Didymus, while he cites the rest of the texts from reliable modern editions. In the commentary there are interesting discussions on the Spartan mora, the building of the Parthenon, the Helliastic courts, and many other topics noted by the ancient commentators on Demosthenes. An appendix presents and discusses P.Lond.Lit. 179, a prologue and commentary on Dem. 21. The reader will probably find useful the indexes and rich bibliography provided in the last part of this study.Gibson's commentary is certainly thorough but contains a number of errors in detail, and important bibliography is missing on individual topics. For example:Page 113: Gibson adopts the text of Pearson-Stephens. The adjective is, or, as here (later Greek),. Therefore the text should be (see LSJ s.v.).Page 120: Gibson has missed several important contributions to the issue of the theoric fund in recent years (M. H. Hansen, GRBS 17 [1976] 235-46; E. M. [End Page 482] Harris in E. M. Harris and R. Wallace, eds., Transitions to Empire: Essays in Greco-Roman History 360-146 B.C., in Honor of E. Badian [Norman, Okla., 1996]; C. Carey, Apollodoros Against Neaira [Warminster, 1992] 152-57). As a result, his note on P.Berol. 9780, Col. 8.32-44 is... (shrink)

Изложено понимание рассуждения как метода рационального познания, рассмотрены его разновидности: аргументативные, интерпретативные, прогностические, квалификационные и вычислительные. Для аспирантов и соискателей.

We study the structure of algebraic -closed subsets of an algebraic lattice L, where is some Browerian binary relation on L, in the special case when the lattice of such subsets is an atomistic lattice. This gives an approach to investigate the atomistic lattices of congruence-Noetherian quasivarieties.

This article contributes to the current debate on human embryonic stem cell researchers’ possible complicity in the destruction of human embryos and the relevance of such complicity for the issue of commodification of human embryos. I will discuss if, and to what extent, researchers who destroy human embryos, and researchers who merely use human embryos destroyed by others, have moral use rights, and/or moral property rights, in these embryos. I argue that the moral status of the human embryo, however justified, (...) places few restrictions on the latter researchers’ use of it, and property rights in it, once it is destroyed. I argue that the former researchers have no property rights in the destroyed embryo but use rights in it to the extent allowed by the legitimate owners of the destroyed embryo. I discuss the implications of this account for previous and current US federal law regulating human embryonic stem cell research. (shrink)

In Japan, few studies and ethical debates have addressed medical futility, but articles suggesting the practice of such treatment exist. The present study aimed to explore attitudes about this by examining personal practical experiences of those who have been involved in judging treatments as futile. We employed a qualitative descriptive design with content analysis of semi-structured and focus group interviews with 11 Japanese physicians and 9 nurses of a university hospital in Japan. The interviews mined their practical experience to identify (...) why they provided treatment that was regarded futile, factors for determining futility, and attitudes toward foregoing futile treatments. All participants had provided treatments judged as futile for various reasons, such as patient request, inadequate decision-making processes, request from another physician, and the lack of standards with which to judge futility, among others. In addition to medical science factors , participants also considered non-medical science factors to determine if a treatment was futile. Almost all participants agreed that futility should be defined and that such treatments should be foregone, but they did not take a proactive stance towards this due to factors related to the healthcare worker‟s situation or the patient. Although the implications of the present study are somewhat limited, our results indicate that futile treatments are provided at multiple treatment departments. Health-care workers employ a variety of factors to determine futility, including non-medical science factors. As provision of such treatment is not always performed for reasons of patient autonomy, diverse approaches should be employed to cope with situations regarding futile treatments. (shrink)

Mind uploading speculation and debate often concludes that a procedure described as gradual in-place replacement preserves personal identity while a procedure described as destructive scan-and-copy produces some other identity in the target substrate such that personal identity is lost along with the biological brain. This paper demonstrates a chain of reasoning that establishes metaphysical equivalence between these two methods in terms of preserving personal identity.

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert’s) suggests that there is no reform of morality , but (...) of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured. (shrink)