Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or “hidden rationing”, into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives of (...) individual and political autonomy and conclude that local hidden rationing and unsophisticated global hidden rationing clearly violate patients’ individual autonomy, that is, their right to participate in medical decision-making. While sophisticated global hidden rationing avoids this charge, the authors point out that it nonetheless violates the political autonomy of patients, that is, their right to engage in public affairs as citizens. A defence of any of the forms of hidden rationing is therefore considered to be incompatible with a defence of autonomy. (shrink)

Aim: To examine how physicians’ life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large (...) life-stance groups in each country.Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient’s death , physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics and Protestants reported ever having made such a decision.Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. (shrink)

Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient’s life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics.

Objectives: To investigate the extent to which family physicians in Lithuania inform their patients about possible side-effects when a common treatment is proposed. To examine the relation between physicians’ estimation of the severity and frequency of these side-effects and their willingness to inform patients. To identify the reasons for informing or not informing the patients.Methods: A questionnaire, presenting three hypothetical cases involving decisions about ordinary medical treatments and a series of general questions about information about side-effects, was distributed to 500 (...) Lithuanian GPs. The response rate was 42%.Results: The respondents differed considerably with regard to their willingness to inform patients about side-effects, but they informed their patients significantly more if the side effect was considered to be common and serious, than in cases when it was considered to be rare and trivial. The majority of the respondents informed their patients primarily to enable them to react appropriately to the side-effects in question. The major reason for not informing was that the side-effects were considered too rare to be relevant to the patient’s decision-making.Conclusion: Information, given to patients about side-effects by Lithuanian GPs, is not in accordance with the principle of respect for patients’ autonomy and requirements of Lithuanian legislation. (shrink)

Among Plato's works, the Statesman is usually seen as transitional between the Republic and the Laws. This book argues that the dialogue deserves a special place of its own. Whereas Plato is usually thought of as defending unchanging knowledge, Dr Lane demonstrates how, by placing change at the heart of political affairs, Plato reconceives the link between knowledge and authority. The statesman is shown to master the timing of affairs of state, and to use this expertise in managing the conflict (...) of opposed civic factions. To this political argument corresponds a methodological approach which is seen to rely not only on the familiar method of 'division', but equally on the unfamiliar centrality of the use of 'example'. The demonstration that method and politics are interrelated transforms our understanding of the Statesman and its fellow dialogues. (shrink)

‘It is supposed’, declared the poet Wordsworth in 1802, ‘that by the act of writing in verse an author makes a formal engagement that he will gratify certain known habits of association; that he not only thus apprizes the reader that certain classes of ideas and expressions will be found in his book, but that others will be carefully excluded. This exponent or symbol held forth by metrical language must in different eras of literature have excited very different expectations.’ For (...) his own era of literature Wordsworth proposed a language derived from the ‘simple and unelaborated expressions’ of the ‘language really spoken by men’, at the expense of ‘devices to elevate the style’ and ‘what is usually called poetic diction’. (shrink)

Abstract:The present paper focuses on the linkage between two academic paradigms in the enquiry into business ethics: normative philosophy and empirical social sciences. The paper first reviews existing research pertaining to a normative-empirical dialogue. Further empirical data on the relationship between various standards of morality are discussed in relation to the normative frameworks of ethics. Lastly, future directions for such a dialogue in business ethics are suggested.

The first comprehensive study of Nietzsche's earliest book, The Birth of Tragedy, this important volume by M. S. Silk and J. P. Stern examines the work in detail: its place in Nietzsche's philosophical career; its value as an account of ancient Greek culture; its place in the history of German ideas, and its value as a theory of tragedy and music. Presented in a fresh twenty-first-century series livery, and including a specially commissioned preface written by Lesley Chamberlain, illuminating its enduring (...) importance and relevance to philosophical enquiry, this accessible study has been revived for a new generation of readers. (shrink)

The practice of evidence based medicine has changed the role of the physician from information dispenser to gatherer and analyser. Studies and controlled trials that may contain unknown errors, or uncertainties, are the primary sources for evidence based decisions in medicine. These sources may be corrupted by a number of means, such as inaccurate statistical analysis, statistical manipulation, population bias, or relevance to the patient in question. Regardless of whether any of these inaccuracies are apparent, the uncertainty of their presence (...) in physician information should be disclosed to the patient. These uncertainties are not, however, shared by physicians with patients, and have caused a direct increase in patient responsibilities and mistrust. Only when disclosure of uncertainty becomes commonplace in medical practice will the physician/patient relationship evolve to a level of greater understanding and satisfaction for both the physician and patient. (shrink)

The study ascertained (1) whether an observer's scope of justice with reference to either the moral agent or the target person of a moral act, would affect his/her judgements of the ethicality of the act, and (2) whether observer judgements of ethicality parallel the moral agent's decision processes in systematically evaluating the intensity of the moral issue. A scenario approach was used. Results affirmed both research questions. Discussions covered the implications of the findings for the underlying cognitive processes of moral (...) judgements, for the link between judgements of fairness and ethicality, as well as for the debate of ethical absolutism versus relativism. (shrink)

M. S. Ronald Commers is Professor of Moral Philosophy and head of the department of Philosophy and Moral Science at Ghent University. He is the director of the Center for Ethics & Value Inquiry at...

Zhizneopisanie -- Kniga znanii︠a︡ -- Ukazanii︠a︡ i nastavlenii︠a︡ -- Kniga o dushe.

Business is a representative institution of our times; it represents the spirit of our age. Modern business in general has displaced a remarkable ability to change. But the change yet to come will be something unprecedented. What is the nature of this change? What is the type of vision and sirategy that will help business as a social institution, and the organizations that are part of it, to navigate this evolutionary transition successfully? Or, in other words, what is the nature (...) of the paradigm shift needed to manage future change? These are the main questions business leaders and managers will be facing in the future. This article examines these questions in the light of Sri Aurobindo's vision. (shrink)

t. 1. A-D -- t. 2. E-M -- t. 3. N-S -- t.4. T-I︠A︡.

Consider orthodox motivational judgment internalism: necessarily, A’s sincere moral judgment that he or she ought to φ motivates A to φ. Such principles fail because they cannot accommodate the amoralist, or one who renders moral judgments without any corresponding motivation. The orthodox alternative, externalism, posits only contingent relations between moral judgment and motivation. In response I first revive conceptual internalism by offering some modifications on the amoralist case to show that certain community-wide motivational failures are not conceptually possible. Second, I (...) introduce a theory of moral motivation that supplements the intuitive responses to different amoralist cases. According to moral judgment purposivism (MJP), in rough approximation, a purpose of moral judgments is to motivate corresponding behaviors such that a mental state without this purpose is not a moral judgment. MJP is consistent with conceptual desiderata, provides an illuminating analysis of amoralist cases, and offers a step forward in the internalist-externalist debates. (shrink)

Motivation holds the key for harnessing the human potential in an organization. However, in modern management, motivation is used mainly as a strategy for enhancing the efficiency, productivity and performance of the employee. But for a more integral and effective realization of the human potential in an organization, motivation has to be used as a lever for human evolution and development, with enhanced performance as a spontaneous result. This article provides a comprehensive framework for evolving a motivational strategy, which will (...) lead to the progressive evolution of human potential in an organization. The article tries to integrate modern theories of motivation with ancient Indian perspectives, based on an integral psychology. (shrink)

The term ‘organizational development’ is defined in management textbooks as a ‘collection of planned change interventions built on democratic–humanistic values that seek to improve organizational effectiveness and well–being’. But we use the term in a simpler and broader sense as the evolution and development of an organization towards its highest potential. In this article we present the broad outlines of a strategic vision of organizational development based on the aims and principles of yoga. The word ‘yoga’ has now become well (...) known all over the world. But the popular conceptions of yoga conjure up images of a hatha–yogi standing upside down or a hermit in the Himalayas. The deeper psychological and pragmatic significance of yoga is not fully understood. ‘Yoga,’ says Sri Aurobindo, ‘is nothing but practical psychology’ (Sri Aurobindo 1972b: 39). It contributes to the psychological and spiritual development of the human organism. Yoga is the scientific, psychological process or discipline by which the inner development of the human being is triggered and can be accelerated. (shrink)

Although it is common in liberal and progressive circles to scoff at the idea that the Unites States is “exceptional”—a derision driven by an admirable suspicion of the chauvinistic connotations of the exceptionalist view—doing so obscures a significant reality. The United States is different, or at least rather unusual, in its social, cultural, and geo-strategic circumstances, especially when compared to the nations of Europe from which it draws the core of its intellectual traditions. What's more, the critique of American exceptionalism (...) has acquired its own troublesome politics. “It is extremely dangerous to encourage people to see themselves as exceptional, whatever…. (shrink)

The community representative plays a very important role in an institutional review board but there is sparse data about their understanding of their role in an IRB. This study was conducted to assess perceptions of community members serving on IRBs of one region in India. A validated questionnaire was administered to community members of IRBs in a prospective cross-sectional study. The questions related to demography, perceptions of their role in the IRB, experiences while serving on the IRBs, difficulties faced by (...) them, and suggestions to improve their contributions. Of the 56 IRBs contacted, all 15 of the public institutions shared details of their community members, while only 26 of the 41 IRBs of private institutions responded. When questioned about why they joined the IRB, one third of the respondents said either that there was “no specific reason” for joining or that they accepted the invitation to serve on the insistence of other members of the IRBs or the head of their institution. All except one felt that community members were needed for optimal functioning. Six participants said that they did not review informed consent documents, and 10 were unaware that their presence was vital for quorum to be met. Twenty-eight said they participated actively in meetings and did not feel intimidated by the presence of clinicians. Twelve reported difficulties in understanding medical terminologies in ICDs. Although the majority of participants were aware about their role in an IRB, some did not review important documents such as ICDs. Restricted participation by private hospital IRBs was a striking observation in our study. There is a need to define eligibility criteria and develop targeted training modules for community members to ensure their effective contribution to effective oversight of clinical research. (shrink)

Spirituality is now a much talked about subject. All over the world, after a long reign of heavy and soul- stifling materialism, people are seeking for a higher meaning in work and life, beyond the mundane and material aims. So religion and spirituality are coming back with the message of hope and peace. Business, which is a leading institution of our age and employs a large chunk of humanity, cannot escape from this new worldwide trend. Thus, the meeting of business (...) and spirituality is already happening. This article examines the evolutionary significance of this meeting in the light of Sri Aurobindo's spiritual vision. (shrink)

s This paper reports studies designed to examine perceptions of preferential selection. Subjects evaluated the fairness of hypothetical cases of selection decisions based on either candidate sex or ethnic origin. A within-subjects design and a between-subjects design yielded convergent results showing that (1) preferential selection was perceived as unfair, irrespective of respondent sex or the basis for the preferential treatment (i.e., candidate sex or ethnic origin), (2) the level of perceived injustice was directly related to the discrepancy in merits between (...) the successful minority candidate and the more qualified yet unsuccessful majority candidate, and (3) the provision of either an ethical or legislative justification for the selection decisions further exacerbated feelings of injustice. Possible interpretations for the findings and practical implications of the study were then discussed. (shrink)