Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account of (...) the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

The view that organized social communities or associations differ from unorganized communities by having a kind of government or management exerting authority over the community appears almost obvious. Nevertheless it contradicts Dooyeweerd’s view, distinguishing organized communities from natural communities because of their being founded in the technical relation frame respectively the biotic one. This paper discusses the dual character of associations, requiring the introduction of a new relation frame. Determined by authority and discipline, the political relation frame succeeds the frames (...) of social intercourse and economic relations, and precedes the frames of justice and loving care. It qualifies the generic character of any association, founded in that of social intercourse. Besides, each association has a specific character, distinguishing various types of associations. These insights shed new light upon the dual character of a state as the guardian of the public domain. Constituting various networks of human relations, the public domain does not have the character of a community. (shrink)

The literary legacy of Aramaic-speaking Christianity consists predominantly of ecclesiastical works—theological treatises , sermons, hymns, and the like; it is for the most part, one must admit, rather dull stuff. Distinguished from the rest, and of peculiar interest to classical students, are secular works, translated from the Greek, which include, apart from medical and scientific treatises, a handful of writings by Plutarch, Lucian, and Themistius. Baumstark suggests that the translator of these three Greek writers be identified as Sargis , a (...) learned priest and ρχιατρός in Theodosiopolis, with a somewhat chequered ecclesiastical career , who is known as the translator of a number of philosophical and medical treatises. Sargis has his place in the history of thought, for it was in the first place through his Syriac translations that the Arabs became acquainted with Galen, whose works eventually assumed almost canonical status with them. (shrink)

Based on two workshops held February 1990 in New York and March 1990 in San Francisco. Following the presentation and discussion of three clinical case histories, psychotherapists James F. Masterson, Marian Tolpin, and Peter E. Sifneos compare and contrast developmental, self, and object relations.

Upshot: We respond to three main challenges that the commentaries have raised. First, we argue that to deal successfully with the hard problem of consciousness, it is not enough to posit a remedy by which to move beyond the hard problem. Second, we argue that it makes no sense to explain identity. Yet this does not commit us to definitions by fiat. The strategy we pursue here, and in the target article, is not to explain identity but to explain away (...) the appearance of non-identity. Finally, while we are sympathetic to Varela’s call for a paradigm shift in consciousness studies, we argue here, and in the target article, that this call can only be properly successful if the hard problem is dismantled. (shrink)

Background: Publications and discussions of survey research in empirical bioethics have steadily increased over the past two decades. However, findings often differ among studies with similar research questions. As a consequence, ethical reasoning that considers only parts of the existing literature and does not apply systematic reviews tends to be biased. To date, we lack a systematic review (SR) methodology that takes into account the specific conceptual and practical challenges of empirical bioethics. Methods: The steps of systematically reviewing empirical findings (...) in bioethics are presented and critically discussed. In particular, (a) the limitations of traditional SR methodologies in the field of empirical bioethics are critically discussed, and (b) conceptual and practical recommendations for SRs in empirical bioethics that are (c) based on the authors’ review experiences in healthcare ethics are presented. Results: A 7-step approach for SRs of empirical bioethics is proposed: (1) careful definition of review question; (2) selection of relevant databases; (3) application of ancillary search strategies; (4) development of search algorithms; (5) relevance assessment of the retrieved references; (6) quality assessment of included studies; and (7) data analysis and presentation. Conceptual and practical challenges arise because of various peculiarities in reviewing empirical bioethics literature and can lead to biased results if they are not taken into account. Conclusions: If suitably adapted to the peculiarities of the field, SRs of empirical bioethics provide transparent information for ethical reasoning and decision-making that is less biased than single studies. (shrink)

While much has been written on the cultural and intellectual antecedents that gave rise to Carolus Linnaeus?s herbarium and his Systema Naturae, the tools that he used to transform his raw observations into nomenclatural terms and categories have been neglected. Focusing on the Philosophia Botanica, the popular classification handbook that he published in 1751, it can be shown that Linnaeus cleverly ordered and reordered the work by employing commonplacing techniques that had been part of print culture since the Renaissance. Indeed, (...) the functional adaptability of commonplace heads allowed him to split and combine the book?s chapters and tables and played a notable conceptual role in the way in which he spatialized words and, to a certain extent, specimens. (shrink)

Citizens today are increasingly expected to be knowledgeable about and prepared to engage with biomedical knowledge. In this article, I wish to reframe this ‘public understanding of science’ project, and place fresh emphasis on public understandings of research: an engagement with the everyday laboratory practices of biomedicine and its associated ethics, rather than with specific scientific facts. This is not based on an assumption that non-scientists are ‘ignorant’ and are thus unable to ‘appropriately’ use or debate science; rather, it is (...) underpinned by an empirically-grounded observation that some individuals may be unfamiliar with certain specificities of particular modes of research and ethical frameworks, and, as a consequence, have their autonomy compromised when invited to participate in biomedical investigations. Drawing on the perspectives of participants in my own sociological research on the social and ethical dimensions of neuroscience, I argue that public understanding of biomedical research and its ethics should be developed both at the community level and within the research moment itself in order to enhance autonomy and promote more socially robust science. Public bioethics will have to play a key role in such an endeavour, and indeed will contribute in important ways to the opening up of new spaces of symmetrical engagement between bioethicists, scientists and wider publics—and hence to the democratisation of the bioethical enterprise. (shrink)

The author reconstructs the theory of F. Varela with relevance to the hard problem of consciousness. This problem was touched by Varela in relatively late period of his work. However, the implications for dissolution of this problem can be found in his earlier works with H. Maturana. Theory of autopoietic systems ties life and cognition together, resulting in natural historical comprehension of consciousness and its functioning. Autopoiesis, understood as network of processes of production of components used as resources for maintaining (...) these processes, sets organizational invariances, distinguishing living system from its milieu. The main criterion of living system is an ability to maintain autopoietic organization while undergoing structural transformations with environment. Structural plasticity leads to multiple realizability of autopoietic organizations, which, in turn, leads to radical conclusion on nature of knowledge. One can distinguish the knower and the known only contingently, as the structure of knowledge reflects cognitive structure of the knower. This intertwinement permits Varela to introduce the enactivist program, which presupposes not simply reform in the scientific research of consciousness but also rethinking the implications of scientific knowledge itself. Cognition is a sensorimotor constitution of the world. Therefore, consciousness is not an object of material nature among other objects but provides our cognitive access to nature. Varela intended to abandon the theoretical approach to the problem of consciousness. His aim was not to provide a new argument. This is a consequence of the enactivist position which, according to theory of autopoiesis, must be applicable to the knower himself. (shrink)

The following questions arising in connection with the géométrisation of modern physics are discussed: is the physical theory a bicomponent one or everything can be reduced to space? Whether the hypothesis of the macroscopic nature of space and time deals with the theoretical or empirical structure of physical theory? Is there géométrisation of quanta or quantisation of geometry?

Discusses the metaphysics of the iterative conception of set.

The role of the environment in producing the correct classical limit in the Bohm interpretation of quantum mechanics is investigated, in the context of a model of quantum Brownian motion. One of the effects of the interaction is to produce a rapid approximate diagonalisation of the reduced density matrix in the position representation. This effect is, by itself, insufficient to produce generically quasi-classical behaviour of the Bohmian trajectory. However, it is shown that, if the system particle is initially in an (...) approximate energy eigenstate, then there is a tendency for the Bohmian trajectory to become approximately classical on a longer time-scale. The relationship between this phenomenon and the behaviour of the Wigner function post-decoherence is discussed. (shrink)

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

Meyer, Kent and Clifton (MKC) claim to have nullified the Bell-Kochen-Specker (Bell-KS) theorem. It is true that they invalidate KS's account of the theorem's physical implications. However, they do not invalidate Bell's point, that quantum mechanics is inconsistent with the classical assumption, that a measurement tells us about a property previously possessed by the system. This failure of classical ideas about measurement is, perhaps, the single most important implication of quantum mechanics. In a conventional colouring there are some remaining patches (...) of white. MKC fill in these patches, but only at the price of introducing patches where the colouring becomes ``pathologically'' discontinuous. The discontinuities mean that the colours in these patches are empirically unknowable. We prove a general theorem which shows that their extent is at least as great as the patches of white in a conventional approach. The theorem applies, not only to the MKC colourings, but also to any other such attempt to circumvent the Bell-KS theorem (Pitowsky's colourings, for example). We go on to discuss the implications. MKC do not nullify the Bell-KS theorem. They do, however, show that we did not, hitherto, properly understand the theorem. For that reason their results (and Pitowsky's earlier results) are of major importance. (shrink)

In this paper, we examine how organizations’ impression management evolves in response to rising stakeholder pressures regarding organizations’ corporate responsibility initiatives. We conducted a comparative case study analysis over a period of 13 years for two organizations—Exxon and BP—that took extreme initial stances on climate change. We found that as stakeholder pressures rose, their IM tactics unfolded in four phases: advocating the initial stance, sensegiving to clarify the initial stance, image repairing, and adjusting the stance. Taken together, our analysis of (...) IM over these four phases provides three key insights about the evolution of IM in the face of rising pressures. First, when faced with stakeholder pressures, it seems that organizations do not immediately resort to conforming but tend to give in gradually when pressures increase and start to come from relatively powerful stakeholders. Second, evolution of IM seems to be characterized by path dependence, i.e., even as organizations’ positions evolve, they continue to show their conviction in their initial positions and try to convey that their subsequent positions flow logically from the previous ones. Finally, IM involves navigation between symbolism and substance, and companies tend to strive toward harmonizing their symbolic and substantive actions as stakeholder pressure increases. (shrink)