By virtue of their professional ethics as healers and because of their specialized technical knowledge and clinical experience in assessing and reacting to real and potential emergencies, physicians have an obligation to offer an unsolicited medical opinion when the following conditions are met: (1) physicians assess a high probability of potentially serious disease in a stranger because of information presented to them, either in the form of a communication or physical signs; (2) physicians judge this information to be latent (not (...) readily interpretable as potentially dangerous by the stranger) and likely to remain latent prior to the onset of symptoms; (3) the physicians possess the medical knowledge appropriate to the professional interpretation of this information. Although not a morally risk-free endeavor (invasion of privacy and the potential creation of a ‘sick role’ whether or not the diagnosis is correct), offering an unsolicited medical opinion under the above conditions can prevent suffering and save lives in unsuspecting strangers. Keywords: bystander, professional duty, patient-physician relationship, privacy, altruism * I would like to dedicate this essay to my father, Martyn C. Ratzan, M.D., who taught me never to listen to whispers too close to the window. CiteULike Connotea Del.icio.us What's this? (shrink)

Like most EM physicians presented with a wide assortment of patients I've never seen before, will probably never see again, and cannot schedule for a more convenient return visit when there are not three ambulances pulling up to the door, I sometimes get a bit cranky when I interview a patient who has registered for a less‐than‐valid “emergency.” As a resident in Mel Konner's Becoming a Doctor put it, “Low back pain? Low fucking back pain? You're waking me up for (...) low fucking back pain?” Although I ceased a long time ago to ask, “Why now?”—you almost never get an answer that is satisfying—I still think it. Often, I am sad to say. Perhaps it is a result of the obvious forces of callousness born of distance born of training and of stress. Again, Konner captures it well: “It is obvious … that the stress of clinical training alienates the doctor from the patient, that in a real sense the patient becomes the enemy. … At first I believed that this was an inadvertent and unfortunate concomitant of medical training, but I now think that it is intrinsic. Not only stress and sleeplessness but the sense of the patient as the cause of one's distress contributes to the doctor's detachment.” Such detachment can blinker our eyes from seeing why patients come to the emergency room and prevent our ears from hearing. (shrink)

Richard M Weaver, a thinker and writer celebrated for his unsparing diagnoses and realistic remedies for the ills of our age, is known largely through a few of his works that remain in print. This new collection of Weaver's shorter writings, assembled by Ted J Smith III, Weaver's leading biographer, presents many long-out-of-print and never-before-published works that give new range and depth to Weaver's sweeping thought. Included are eleven previously unpublished essays and speeches that were left in near-final form (...) at the time of Weaver's death in 1963. In all, there are some one hundred and twenty-six essays, speeches, book reviews, and editorials. (shrink)

In this volume, fourteen scholars, many of them contemporaries of Professor Frank, engage with his legacy with important and seminal works which take some of ...

This honest, forthright, and beautifully-written book introduces readers to the human variations on medical topics spoken of in abstract in the daily news--euthanasia, assisted suicide, abortion, "extreme procedures", genetic testing, experimental surgeries--and to the people who must agonize over those decisions regarding themselves and their loved ones.

Quilts with "a black-and-white checked" pattern "for the NASCAR market" are stitched together by an Amish woman whose family uses an outdoor privy because church rules stipulate "no indoor plumbing"; an Amish man delivers cans of his milk to an Amish-owned neighborhood collection tank cooled by electricity because state laws require the refrigeration of milk. These are just a few of the images Karen Johnson-Weiner presents of the New York State Amish and their continuing effort to maintain a life disconnected (...) from the surrounding society upon which they are, to varying degrees, economically dependent. The Amish's struggle to preserve separate-from-the world communities and the diversity among the various Amish... (shrink)

The measurement of sensory intensity has had a long history, attracting the attention of investigators from many disciplines including physiology, psychology, physics, mathematics, philosophy, and even chemistry. While there has been a continuing doubt by some that sensation has the properties necessary for measurement, experiments designed to obtain estimates of sensory intensity have found that a general rule applies: Equal stimulus ratios produce equal sensory ratios. Theories concerning the basis for this simple psychophysical rule are discussed, with emphasis given to (...) the physical correlate theory, which considers judgments of subjective magnitudes to be based upon estimates of physical dimensions that vary regularly with changes in degree of stimulation. For the most thoroughly investigated sensory scales, brightness and loudness, the physical correlate is considered to be distance. Our “tacit knowledge” of the sensory effects of changing distance plays an essential role in matching motor activities to environmental conditions and in ensuring accurate perceptual evaluations through brightness and loudness constancies. In psychophysical experiments, subjects apparently use this same tacit knowledge when required to estimate relative subjective magnitudes. The evidence related to the physical correlate theory is summarized, and it is concluded that, while under appropriate conditions we demonstrate considerable skill in evaluating environmental relationships, we are quite unable to estimate the neurophysiological nature or quantity of sensory response. A psychophysics devoted to studying conditions required for accuracy and conditions producing errors in the perception of environmental relationships would seem to be more valuable than one devoted to subjective magnitudes. (shrink)

After writing my response to the commentaries, I sat back and reflected on the fascination and frustration of work on this topic. There is the ancient fascination of trying to understand the nature of the sensory bridge linking us to the external world. Also, discussing the measurability of sensation brings to the surface concepts we use and take for granted when we are working in other areas of psychology; and it holds them before us for critical examination. The frustration lies (...) chiefly in the difficulty of formulating concepts clearly, in a way understood by all. At least when constructing the original Tower of Babel, workers hearing strange words knew that communication was not occurring. The psychophysical Tower of Babel sometimes has workers using the same words, but with different meanings. Much of my response is based on attempts to clarify concepts and clear up confusions. (shrink)

In my book, The Language of Time, it was argued that the distinctions of past, present and future are objective. The over-all structure of the argument was as follows: ‘now’, as well as other temporal demonstratives, although not designating a sensible property, has an informative role in our language, and for this reason temporal demonstratives cannot be eliminated without loss of information; ‘now’ is “semantically” objective but “pragmatically” subjective, i.e. a sentence containing a word such as ‘now’ is not used (...) to refer to any mental event or linguistic tokening of itself, but the rules controlling the use of such a sentence for making a true statement do specify that a specific kind of temporal relation must obtain between the tokening event and the event reported by the statement made through this tokening event; the use of ‘now’ is not selective, picking out some moment of time or class of simultaneous events from amongst others that might have been designated in its place; and, the realistic commitments of ordinary language or common-sense concerning ‘now’ are not, and could not be, inconsistent with any empirical fact or physical theory. Points -, taken in conjunction, go a long way toward establishing that there is nothing mind-dependent or linguocentric about now, that events could be past, present and future and change in respect to these distinctions even in a world devoid of perceivers or language-users. (shrink)

A neurally plausible model of how the process of visually perceiving a letter in the context of a word is learned, and how such processing occurs in adults is proposed. The model consists of a collection of abstract letter feature detector neurons and their interconnections. The model also includes a learning rule that specifies how these interconnections evolve with experience. The interconnections between neurons can be interpreted as representing the spatially redundant, sequentially redundant, and transgraphemic information in letter string displays. (...) Anderson, Silverstein, Ritz, and Jones's (1977) “Brain‐State‐in‐a‐Box” (BSB) neural mechanism is then used to implement the proposed model. The resulting system makes explicit qualitative predictions using both letter recognition accuracy and reaction time as dependent measures. In particular, the model offers an integrated explanation of some experiments involving manipulations of orthographic regularity, masking, case alternations, and experience with words. The similarities and differences between the model and models proposed by Adams (1979) and McClelland and Rumelhart (1981) are also discussed. (shrink)

This article reviews the historical and current controversies about the nature of clinical ethics consultation, as a way to focus on the place and responsibility of ethics consultants within the context of clinical conversation — interpreted as a form of dialogue. These matters are approached through a particularly compelling instance of the controversy that involves several major figures in the field. The analysis serves to highlight very significant questions of the nature and constraints of clinical situations, and the moral responsibility (...) and legal accountability that are especially important for clinical ethics consultants. (shrink)

Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms. Here's what the experts had to say: Professor Zaner has provided us with a remarkably (...) lucid and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. Dokecki Richard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee (1985), he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

This book offers students a philosophical introduction to the ethical foundations of business management. It combines lessons from Kant with virtue ethics and also touches upon additional approaches such as utilitarianism. At the core of the book lies the concept of the nexus of imperfect managerial duty: building and reinforcing the virtuous managerial team, engaging in reasoned discourse among all stakeholders, and diligently pursuing business responsibilities, including the creative efforts necessary for modern organizations. Case illustrations of these applications are presented (...) throughout the book, including chapter appendices. Ancillary videos, test and answer banks and sample syllabi are available online via the author’s website. (shrink)

Many of the errors that occur in children' subtraction are due to the use of incorrect strategies rather than to the incorrect recall of number facts. A production system is presented for performing written subtraction which is consistent with an earlier analysis of the nature of such a cognitive skill. Most of the incorrect strategies used by schoolchildren can be accounted for in a principled way by simple changes in the production system, such as the omission of individual rules or (...) the inclusion of rules appropriate to other arithmetical tasks. The production system model is evaluated against a corpus of over 1500 subtraction problems done by 10‐year olds and is shown to account for about two‐thirds of the (nonnumber fact) errors. It also provides an alternative, simpler interpretation of the subtraction errors analysed by Brown and Burton (1978). Some implications for teaching are discussed. (shrink)