Self-understanding is to a great extent defined by narrative: who we are as human beings is determined by the stories we, and others, tell about ourselves. Yet many are unable to compose coherent personal narratives, as their experiences do not fall within the scope of an accepted conceptual framework. Survivors of trauma are particularly apt to fall into this “narrative rift,” where there can be no words to describe, and hence can be no assimilation of, their experiences. Using the example (...) of child sexual abuse, and drawing on the work of Bass, Spence, Schafer, and Guignon, I propose an examination of the nature of narrative fragmentation itself. Philosophical counselling may succeed where psychoanalysis might not: for where the latter has theoretical commitments to specific narratives, the former, through its reluctance to force epistemological or metaphysical assumptions on the narrator, may well facilitate a more comprehensive self-understanding. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

Abstract25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with (...) LEP. We define a framework to tease out public health responsibilities given some populations’ limited proficiency in a society’s predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP. (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.

At the beginning of the study of physical phenomena, the idea of "force" was widely used to explain the non-stationarity of observed phenomena, such as the movement of bodies. However, as mechanics and physical theories developed, the force notions gained own formal definitions and names, without the use of the term "force". So, the concept of kinetic energy arose instead of "vis viva", and "current" instead of "current strength" ets. Additionally, a number of new physical theories have been formulated without (...) the use of force concept. As a result, different types of forces have gradually been replaced by other more important concepts, such as energy and action, which are closely linked to fundamental physical principles. It is interesting to note that the general trend in the development of civilizations has been a shift from unrestricted power (expressed in the thesis "might makes right") to its subordination and incorporation into a legal framework. This is similar to the evolution of physics, which has seen the notion of force become eliminated or subordinated to more general principles and laws. (shrink)

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (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)

Background: The Declaration of Helsinki prohibits the publication of articles that do not meet defined ethical standards for reporting of research ethics board approval and informed consent. Despite this prohibition and a call to highlight the deficiency for the reader, articles with potential ethical shortcomings continue to be published.Objective: To determine what proportion of articles in major medical journals lack statements confirming REB approval and informed consent, and whether accompanying commentary alerts readers to this deficiency.Design: Retrospective, observational study.Setting: Online review (...) of five major medical journals.Population: All clinical research articles published online between 1 January 2005 and 31 December 2006 in the BMJ, Lancet, Annals of Internal Medicine, JAMA and the New England Journal of Medicine.Measurements: Statement of REB approval and informed consent.Results: Of 1780 articles reviewed, 1133 met inclusion criteria , 36 articles lacked a statement of REB approval, 62 lacked disclosure of informed consent and 15 articles lacked both. Articles that did not state REB approval were associated with not stating informed consent . There were no editorial comments to alert readers to the lack of either REB approval or informed consent statements associated with any of the deficient articles.Conclusions: Articles that lack explicit statements of REB approval and informed consent are infrequent but continue to be published in major medical journals without editorial statements to alert the reader to this deficiency. (shrink)

Les fouilles effectuées au cours de ces dernières dizaines d’années, ont modifié profondément le tableau qu’on se faisait de la préhistoire chinoise. Au début du xxe siècle, les savants les plus connus pouvaient encore mettre en doute l’existence d’une époque néolithique chinoise — mais depuis lors, l’activité de l’archéologie a mis à jour un vaste matériel et paléolithique et néolithique. Le présent article, extrait du premier volume d’une histoire économique et sociale de la Chine, donne une vue d’ensemble du matériel (...) nouvellement acquis et cherche à le mettre en valeur pour une considération sociologique.L’homo pekinensis, l’ancien habitant de la Chine paléolithique du Nord connaissait le feu ; il se servait d’instruments et d’armes en pierre travaillée. Aux deux degrés de son évolution de chasseur primitif et de chasseur évolué, correspondent deux degrés de perfection de ces instruments. Il semble bien que les prisonniers aient été tués (et mangés?) sans distinction d’âge et de sexe. Les chasseurs ne sauraient que faire du travail d’esclave.Vers la fin de l’époque néolithique chinoise se produisit un épanouissement que la rare perfection de la céramique „rouge“ et „noire“ indique assez bien. La filiation somatique de l’homo pekinensis et du Chinois des époques ultérieures est probable ; il semble hors de doute que l’homme de l’époque néolithique soit du même type que celui de la Chine historique. Primitivement, l’agriculture (à la houe) était faite par les femmes, qui en même temps confectionnaient à la main — par la suite au moyen d'une plaque très simple — la céramique,,rouge“ ; les hommes continuaient à s'occuper de la chasse et de la pêche. Dès lors apparaît, encore qu'assez vaguement, une civilisation démocratique et paysanne, caractérisée probablement par des éléments matriarchaux. Vers l'époque de la céramique „noire“ se produit la transition vers l'élevage et à la céramique qui connaît alors le tour de potier — ces deux sortes de travaux incombent aux hommes. L'agriculture se fait plus intense, c'est peut-être ici qu'il convient de supposer les premiers débuts de la construction de terrasses et de l'irrigation. Les esclaves trouvent un emploi, une différenciation sociale se produit, c'est l'origine des villes. La société agraire primitive fait place à un ordre nouveau. Celui-ci s'exprime socialement parlant par une noblesse de clan primitive, politiquement par l'État.Les découvertes les plus récentes de l'archéologie chinoise apportent de nombreuses preuves pour l'évolution telle qu'elle vient d'être esquissée. L'analyse des mythes archaïques et des contes populaires de la Chine confirme, par la suite, au moyen de l'anthropologie ce que l'étude avait jusqu'ici rendu hautement probable par les méthodes de l'archéologie.Die Ausgrabungen der letzten Jahrzehnte haben das Bild der chinesischen Frühgeschichte grundlegend geändert. Während noch zu Anfang des 20. Jahrhunderts führende Gelehrte die Existenz eines chinesischen Neolithikums bezweifelten, hat seither die Tätigkeit der Archäologie sowohl paläolithische wie neolithische Funde in grosser Reichhaltigkeit zutage gefördert. Der vorliegende Aufsatz — Sektion I des ersten Bandes einer Wirtschafts-und Sozialgeschichte Chinas — gibt einen Überblick über das neu gewonnene Material und sucht es sozialwissenschaftlich auszuwerten.Homo pekinensis, der (früh) altsteinzeitliche Bewohner Nordchinas kannte das Feuer ; er benutzte Werkzeuge und Waffen aus behauenem Stein. Zwei Stufen der Bearbeitung seiner Geräte deuten zwei Stufen seiner ökonomischen Entwicklung an, die des „niederen“ und des „höheren“ Jägertums. Gefangene scheinen ohne Unterschied von Alter und Geschlecht getötet (und verzehrt?) worden zu sein. Jäger haben für Sklavenarbeit keine Verwendung.Reich entwickelt ist Chinas (spätes) Neolithikum, dessen „rote“ und „schwarze“ Töpferei von seltener Vollkommenheit ist. Der Zusammenhang des homo pekinensis mit den späteren Chinesen ist somatisch wahrscheinlich, die Zugehörigkeit der Bewohner des chinesischen Neolithikums zu dem geschichtlichen Chinesentum scheint ausser Zweifel. Ursprünglich wurde offenbar der Ackerbau (Hackbau) von Frauen betrieben, die zugleich mit der Hand — und später mit einem einfachen Drehrad — die „rote“ Töpferei herstellten, während die Männer fortfuhren zu jagen und zu fischen. Das Bild einer primitiven demokratischen Dorfkultur mit vermutlich mutterrechtlichen Zügen wird andeutungsweise sichtbar. Es folgt zur Zeit der „schwarzen“ Töpferei der Übergang zur von Männern betriebenen Viehzucht und zu einer mit der Töpferscheibe von Männern durchgeführten Töpferei. Der Ackerbau wird intensiver, die ersten Anfänge von Terrassenbau und Bewässerung liegen vielleicht hier. Sklaven werden verwendbar, soziale Differenzierung tritt ein. Städte entstehen. Die primitive Agrargesellschaft verwandelt sich in eine Ordnung neuer Art, deren sozialer Ausdruck ein primitiver Clan-Adel, deren politischer Ausdruck der Staat ist.Die jüngsten Entdeckungen auf dem Gebiete der chinesischen Archäologie erbringen zahlreiche Beweise für einen derartigen Entwicklungsgang. Die Analyse von Chinas archaischen Mythen und Volkserzählungen bestätigt im Fortgang der Untersuchung mit den Mitteln der Anthropologie, was die hier gebotene Darstellung mit den Methoden der Archäologie bereits in hohem Grad wahrscheinlich gemacht hat. (shrink)

This is a review of the biographic drama Love and Mercy. More than a story of the evolution of The Beach Boys, it is the story of the lead Beach Boy, Brian Wilson, and his struggle with substance abuse, mental illness, family stress, emerging love, and a controlling psychologist. Interwoven are many bioethics themes, including the doctor–patient relationship, conflict of interest, autonomy, and patient welfare. For those unaware of the sadness and torment running directly alongside the sunny, bubbly life of (...) The Beach Boys, this film is an eye-opener. It is also a great reminder of the importance of boundaries between clinicians and their patients. (shrink)

This collection by a distinguished group of philosophers, psychologists, and physiologists reflects an interdisciplinary approach to the central question of cognitive science: how do we model the mind? Among the topics explored are the relationships (theoretical, reductive, and explanatory) between philosophy, psychology, computer science, and physiology; what should be asked of models in science generally, and in cognitive science in particular; whether theoretical models must make essential reference to objects in the environment; whether there are human competences that are resistant, (...) in principle, to modelling; whether simulated thinking and intentionality are really thinking and intentionality; how semantics can be generated from syntactics; the meaning of the terms "representations" and "modelling;" whether the nature of the "hardware" matters; and whether computer models of humans are "dehumanizing." Contributors include Donald Davidson, Daniel C. Dennett, Margaret A. Boden, Adam Morton, Dennis Noble, T. Poggio, Colin Blakemore, K.V. Wilkes, P.N. Johnson-Laird, and Jonathan St. B.T. Evans. (shrink)

In 1918, Emmy Noether published a (now famous) theorem establishing a general connection between continuous 'global' symmetries and conserved quantities. In fact, Noether's paper contains two theorems, and the second of these deals with 'local' symmetries; prima facie, this second theorem has nothing to do with conserved quantities. In the same year, Hermann Weyl independently made the first attempt to derive conservation of electric charge from a postulated gauge symmetry. In the light of Noether's work, it is puzzling that Weyl's (...) argument uses local gauge symmetry. This paper explores the relationships between Weyl's work, Noether's two theorems, and the modern connection between gauge symmetry and conservation of electric charge. This includes showing that Weyl's connection is essentially an application of Noether's second theorem, with a novel twist. (shrink)