A “white coat” ceremony functions as a rite of passage for students entering medical school. This comment provides a second option in response to the earlier, more enthusiastic, discussion of the ceremony by Raanan Gillon. While these ceremonies may serve important sociological functions, they raise three serious problems: whether the professional oath or “affirmation of professional commitment” taken in this setting has any legitimacy, how a sponsor of such a ceremony would know which oath or affirmation to administer, and what (...) the moral implications of this “bonding process” are. I argue that the initiation oath is morally meanignless if students are not aware of its content in advance, that different students ought to commit to different oaths, and that bonding of students to the medical profession necessarily separates them from identification with lay people who will be their patients. (shrink)

The dynamics of populations of self-replicating, hierarchically structured individuals, exposedto accidents which destroy their sub-units, is analyzed mathematically, specifically with regardto the roles of redundancy and sexual repair. The following points emerge from this analysis:0 A population of individuals with redundant sub-structure has no intrinsic steady-statepoint; it tends to either zero or infinity depending on a critical accident rate α c . Increased redundancy renders populations less accident prone initially, but populationdecline is steeper if a is greater than a fixed (...) value α d . Periodic, sexual repair at system-specific intervals prevents continuous decline and stabilizesthe population insofar as it will now oscillate between two fixed population levels. The stabilizing sexual interval increases with increased complexity provided this is accom-panied by appropriate levels of redundancy. The model closely simulates the dynamics of heterosis effects. Repair fitness is a population fitness: the chance of an individual being repaired is a functionof the statistical make-up of the population as a whole at that particular period. Populationsliving at α > α c either engage in sexual repair at the appropriate time or they die out. The mathematical properties of the model illustrate mechanisms which possibly played arole in the evolution of a mortal soma in relation to sexual reproduction. (shrink)

Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea.Gasping respiration is also referred to (...) as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated.We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death. (shrink)

Normativism is the view that logic provides rules for correct reasoning. Some influential critics of normativism, such as Gilbert Harman, claim that logical rules provide reasoners with bad or misleading standards. Others, such as Gillian Russell, claim that logic is a descriptive subject and thus cannot, given Hume’s law, provide rules for reasoning. We think these critics are mistaken. Our aim in this paper is to defend normativism by sketching an alternative way of thinking about the normative force of logical (...) rules. On our view, logical rules are best characterized, in a broadly Rossian manner, as intellectual prima facie duties; i.e., they provide standards for evaluating reasoning and reasoners that are universal and authoritative, but not absolute. This position accommodates the inherent normativity of logic, contra Russell, while circumventing the challenges to normativism raised by Harman. (shrink)

Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)

Wittgenstein's Tractatus contains a wide range of profound insights into the nature of logic and language – insights which will survive the particular theories of the Tractatus and seem to me to mark definitive and unassailable landmarks in our understanding of some of the deepest questions of philosophy. And yet alongside these insights there is a theory of the nature of the relation between language and reality which appears both to be impossible to work out in detail in a way (...) which is completely satisfactory, and to be bizarre and incredible. I am referring to the so-called logical atomism of the Tractatus . The main outlines of this theory at least are clear and familiar: there are elementary propositions which gain their sense from being models of possible states of affairs; such propositions are configurations of names of simple objects, signifying that those simples are analogously configured; every proposition has its sense through being analysable as a truth-functional compound of elementary propositions, thus deriving its sense from the sense of the elementary propositions when this view is taken in conjunction with the idea that the sense of a proposition is completely specified by specifying its truth-conditions. In this way the Tractatus incorporates in its working out a philosophical system analogous to the classical philosophical systems of Leibniz or Spinoza which are regarded by many people, in a sense rightly, as the prehistoric monsters of philosophy which are not to be studied as living organisms, but studied as the curiosities of human thought. And we may here agree that in the end we must simply reject a philosophy which incorporates such features as its postulation of simple eternal objects, or of a possibility of an analysis of a proposition which was presented as a pre-condition for the propositions that we ordinarily utter to make sense, and yet the specific form of which we are unaware of, and so on. (shrink)

In this short paper, we respond to critics of our original paper, The agony of agonal respiration: is the last gasp necessary?. A common thread in both Hawryluck’s and Kuhse’s responses is the difficulties encountered when using the agent’s intentions to make moral distinctions between using neuromuscular blocking drugs to palliate versus using neuromuscular blocking drugs to kill. Although this difficulty does exist we maintain that the intentions of the physician must matter when providing end-of-life care.

This work is devoted to the testing, research and comparative analysis of the most well-known and widely used methods and algorithms for clustering numerical data sets. Multidimensional scaling was applied to evaluate the results of solving the clustering problem by visualizing datasets at all stages of the implementation of the studied algorithms. All algorithms were tested for artificial and real data sets. As a result, for each of the investigated algorithms, the main characteristics were formulated in the form of their (...) relative strengths and weaknesses. Based on the test results, conclusions and recommendations for using these algorithms are formulated. (shrink)