Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty (...) physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. (shrink)

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.4 (2001) 355-363 [Access article in PDF] Plato on Power, Moral Responsibility and the Alleged Neutrality of Gorgias' Art of Rhetoric (Gorgias 456c-457b) James Stuart Murray 1. Introduction You are sitting in your office on a quiet Thursday afternoon when an agitated university administrator enters with news that the students in your "Plato class" have just been interviewed on the city's largest radio station. According (...) to them, their professor claimed that the demise of their university is a direct result of the fact that senior administrative positions are held by a motley assortment of business-oriented, academically cynical, "renewal"-promoting "innovators" whose main preoccupation is "government funding opportunities" in areas of dubious academic importance.Your response might be: "That's not what I taught them." Or perhaps you might say, "That's not exactly what I taught them--I didn't say it was a 'motley' assortment." In either case, you would be relying on some form of what Robert Wardy (170, n.r 20) has dubbed the "blame students, not teachers defence." He asserts, perhaps correctly, that this defense gained the status of topos within the ancient rhetorical tradition. A version of it certainly does seem to show up in Isocrates' Antidosis (250-52) and perhaps in his Nicocles (3-4), and it is suggested by remarks in both Aristotle's Rhetoric (1355b) and Quintilian's Institutio Oratoria (II,16,5). On this occasion, however, I am concerned with only one rendition, probably its earliest extant instance in Greek literature. In Plato's Gorgias, the eponymous sophist argues as follows: Imagine someone who after attending wrestling school, 1 getting his body into good shape and becoming a boxer, went on to strike his father and mother or any other family member or friend. By Zeus, that's no reason to hate physical trainers... and to exile them from their cities! For while these people imparted their skills to be used justly against enemies and wrongdoers, and in [End Page 355] defense, not aggression, their pupils pervert their strength and skill and misuse them. So it's not their teachers who are wicked, nor is this a reason why the craft should be a cause of wickedness; the ones who misuse it are supposedly the wicked ones. And the same is true for oratory as well. The orator has the ability to speak against everyone on every subject, so as in gatherings to be more persuasive, in short, about anything he likes, but the fact that he has the ability to rob doctors or other craftsmen of their reputations doesn't give him any more of a reason to do it. He should use oratory justly, as he would any competitive skill. And I suppose that if a person who has become an orator goes on with this ability and this craft to commit wrongdoing, we shouldn't hate his teacher and exile him from our cities. For while the teacher imparted it to be used justly, the pupil is making the opposite use of it. So it's the misuser whom it's just to hate and exile or put to death, not the teacher. (Gorgias 456d, 457a-b) 2Change "exile from our cities" to "fire from our universities" and this makes a good passage to remember when confronted by that agitated administrator mentioned above. Blame the students, not the teachers.Not much comment has been provoked by this defense of Gorgianic rhetoric and its underlying rhetor/boxer analogy, except over the question of whether we should read the passage as an accurate reflection of the words of the historical Gorgias or as a Platonic invention. In a previous generation, E. R. Dodds (212) reckoned that this defense was "probably the standpoint of the historical Gorgias," while E. A. Havelock (195) cautioned that "there is little--very little--that he [i.e., Plato] lets Gorgias say in the Gorgias." In our own day, and on a more general level, Thomas Cole (151) states that "Plato's... (shrink)

Virtue epistemology is new in one sense but old in another. The new tradition starts with figures such as Code, Greco, Montmarquet, and Zagzebski. The old tradition has its pedigree in Plato, Aristotle, Aquinas, and their modern interpreters such as Anscombe and MacIntyre. Virtue epistemology recognizes that knowledge is something we value and that propositional knowledge requires intellectual virtues, that is to say, virtues as applied to the intellect. Although much pioneering work in the new tradition has been done on (...) propositional knowledge, comparatively little in it has been done on know-how. This is surprising, because one might naturally think of know-how as something to be refined into a skill, and virtues may be thought of as skills. In the modern epistemological tradition that does not take its direction from virtue ethics, propositional knowledge, as opposed to know-how, has received by far the bulk of the discussion, although since Ryle first argued that knowhow is not always propositional knowledge, there has been a fairly recent resurgence of interest in know-how.We value intellectual virtues because they are skills that promote our flourishing, both as individuals and as members of a community. The intellectual virtues are truth- seeking virtues and stem from a love of the truth. Since love is itself a virtue - indeed it was what Tyndale called the greatest Christian virtue before the King James translation renamed it as charity—it may be seen as the virtue that motivates all other intellectual virtues. A commitment to the truth is presupposed by any intellectual virtue. For example, logic is important to a community, and in particular to the intellectual community, not only because there are rules governing the activity of logic but also because there are those within the community who are trustworthy in following the activity and because there are publically accepted standards of accountability in the way the activity of logic is practiced. Here is how we will proceed. In section 2 we sketch a metaphysics of natural purposes that supports the claim that there are objective goods that beings need qua the kinds of being they are in order to flourish. In section 3 we argue that flourishing includes the acquisition of virtues. We give a general account of virtue, roughly as a stable disposition to act upon a habit elevated to a skill of putting one’s know-how into practice that springs from one’s motivation to pursue what one perceives as good. In section 4 we give a general sketch of intellectual virtues as truth-seeking virtues that stem from a love of the truth that are the skills to flourish intellectually. In section 5 we discuss connaturality, namely those specific metaphysical accidents readily acquired by beings due to their first nature. We make an original distinction between ontological connaturality, namely the connaturality that belongs to animals qua beings of a certain kind, and habitual connaturality, namely our first natures suffused with virtues—or vices, although we will concentrate only on virtues. Habitual connaturality is acquired through the practice of virtue and involves perceptiveness awakened by the possession of the virtue in question. The knowledge arising from this form of connaturality may be a form of know-how. In section 6 we give an account of connatural apprehension and connatural propositional knowledge. In section 7 we discuss connatural know-how and argue that it makes certain virtues possible. At this point we will have shown that intellectual and moral virtues are informed by know-how. In sections 8 and 9 we give analyses of know-how and skill in terms of counterfactual success. We show how skill is a refined form of know-how and how both know-how and skill are informed by moral and intellectual virtues. We conclude in section 10 that know-how informs intellectual and moral virtues in the sense that virtue is to be elucidated in terms of skill, which is in turn to be elucidated in terms of know-how. Moreover, virtues inform know-how in the sense that know-how is to be elucidated in terms of intellectual and moral virtues. No circularity arises because different virtues and different forms of know-how are involved. (shrink)

The study reports on the results of an empirical investigation of the education and recruitment processes used in HIV vaccine trials conducted in South Africa. Interviews were conducted with 21 key informants involved in HIV vaccine research in South Africa and three focus groups of community advisory board members. Data analysis identified seven major themes on the relationship between education and recruitment: the process of recruitment, the combined dual role of educators and recruiters, conflicts perceived by field staff, pressure to (...) achieve recruitment targets, problems in achieving comprehension, accountability and education as capacity building. The results raise ethical concerns about the adequacy of current informed consent processes in these settings. The study findings bear directly on current debates about issues of exploitation and the scope of moral responsibilities of researchers and funding agencies to assure that HIV clinical prevention research is conducted ethically. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Highly creative and interactive, this apologetics resource helps readers identify and evaluate 21 different worldviews through engaging yes-or-no questions and easy-to-understand descriptions. Appendices include answers to common questions and suggestions for further reading.

Natural ecosystems provide important services upon which humans depend. Unfortunately, some people tend to believe that these services are provided by nature for free; therefore, the services have little or no value. One nearly forgotten ecosystem service is ecotherapy – the ability of interaction with nature to enhance healing and growth. While we do not pay for this service, its loss can result in a cost to humans resulting in slower recovery times, greater distress and reduced well-being. Losses in these (...) images of nature can diminish our basic happiness. Little is understood or, at least, appreciated concerning the potential ecotherapy benefits of the natural environment and its ecosystem services. The complex and interactive relationship of ecosystems, their services and human well-being is poorly acknowledged in the broad social, philosophical, psychological and economic well-being literature. In this article, we examine the role of nature and its ecosystem services in ecotherapy and its associated enhancement of recovery from physical and mental illness through a review of studies evaluating this ecosystem service-recovery connection. (shrink)

A single protein molecule with one or more cysteine residues can occupy a plurality of unique residue and oxidation‐chemotype specified proteoforms that I term oxiforms. In binary reduced or oxidised terms, one molecule with three cysteines will adopt one of eight unique oxiforms. Residue‐defined sulfur chemistry endows specific oxiforms with distinct functionally‐relevant biophysical properties (e.g., steric effects). Their emergent complexity means a functionally‐relevant effect may only manifest when multiple cysteines are oxidised. Like how mixing colours makes new shades, combining discrete (...) redox chemistries—colours—can create a kaleidoscope of oxiform hues. The sheer diversity of oxiforms co‐existing within the human body provides a biological basis for redox heterogeneity. Of evolutionary significance, oxiforms may enable individual cells to mount a broad spectrum of responses to the same stimulus. Their biological significance, however plausible, is speculative because protein‐specific oxiforms remain essentially unexplored. Excitingly, pioneering new techniques can push the field into uncharted territory by quantifying oxiforms. The oxiform concept can advance our understanding of redox‐regulation in health and disease. (shrink)

No overarching hypotheses tie the basic mechanisms of mitochondrial reactive oxygen species (ROS) production to activity dependent synapse pruning—a fundamental biological process in health and disease. Neuronal activity divergently regulates mitochondrial ROS: activity decreases whereas inactivity increases their production, respectively. Placing mitochondrial ROS as innate synaptic activity sentinels informs the novel hypothesis that: (1) at an inactive synapse, increased mitochondrial ROS production initiates intrinsic apoptosis dependent pruning; and (2) at an active synapse, decreased mitochondrial ROS production masks intrinsic apoptosis dependent (...) pruning. Immature antioxidant defense may enable the developing brain to harness mitochondrial ROS to prune weak synapses. Beyond development, endogenous antioxidant defense constrains mitochondrial (ROS) to mask pruning. Unwanted age‐related synapse loss may arise when mitochondrial ROS aberrantly recapitulate developmental pruning. Placing mitochondrial ROS with their hands on the shears is beneficial in early but deleterious in later life. (shrink)

Ligand binding to cellular receptors initiates a series of signal transducing cascades that are essential to cellular responses. The Ras pathway is activated in response to a variety of ligands and has been extensively studied. More recently, a novel family of transcription factors (Stats) has been found to be activated in response to many ligands. Three recent publications(1–3) have presented evidence to suggest that these two pathways converge at the level of modulation of Stat function by phosphorylation by MAP kinases. (...) However, each proposes radically different models that are not easily reconciled but invite further experimentation. (shrink)

This festschrift collects a number of insightful essays by a group of accomplished Christian scholars, all of who have either worked with or studied under Hendrik Hart during his 35-year tenure as Senior Member in Systematic Philosophy at the Institute for Christian Studies, Toronto, Canada.

Rosenau writes that the history of the nineteenth and twentieth centuries is the story of convergence around political entities in order to preserve individual values in the context of collective needs and wants; but today the process of community building has been reversed.

After distinguishing professional ethic s from legal and aesthetic norms I argue that a version of rule-utilitarianism is best able to account for professional ethics. The alleged relativism of role-specific duties is a badly posed issue, I argue, since how morality comes to one critically depends upon one's occupation. Alternative theories of the foundations of professional ethics are criticized, both consent theories and the views of those who object to the legalism implicit in a rule-based theory. A mixed theory of (...) virtue is defended to include the most important aspects of an ethic of virtue in the overall rule-utilitarian framework. (shrink)

Mr. Bartley's remark that Goodman's puzzle is “an interesting variant of the possibility... that the next instance may be different” rather badly misrepresents matters. One might say that the “new riddle” arises just because no matter what the nature of the next instance, it will be as much like all previously examined cases as any other instance. Suppose “Hester” is the name of the first emerald examined after time t. If Hester is green, then Hester is like previously examined emeralds (...) with respect to their green-ness. But should Hester be blue, then Hester has its grue-ness in common with previously examined emeralds. The difficulty here is that likenesses abound; the evidence presents us with more likenesses than we could consistently expect of or project to subsequent cases. And the question that Goodman's puzzle poses is, by what criteria do we select one from among all of these likenesses to project to subsequent cases? (shrink)