Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

This chapter suggests that Sellars' account of subjectivity as socially constructed, and hence conceptual at its illusory roots, presents a crisp and compelling perspective on cognitive life that captures Buddhist conceptions of transformative non-duality.

Based on newly discovered texts, this book explores the barely known but tremendously influential thought of the Tibetan Buddhist teacher, Mabja Jangchub Tsöndrü.This Tibetan Buddhist master exercised significant influence on the interpretation of Madhyamaka thinking in Tibet during the formative phase of Tibetan Buddhism and plays a key role in the religious thought of his day and beyond. The book studies the framework of Mabja’s philosophical project, holding it up against the works of both his own Madhyamaka teachers as well (...) as those of central authors of the later "classical period". The emerging account of the evolution of Madhyamaka in Tibet reveals a striking pattern of transformative appropriations. This, in turn, affords us insights into the nature and function of tradition in Tibetan religious culture and Mahāyāna Buddhism at large. Innovation is demanded for both the advancement and consolidation of tradition. This ground-breaking book is an invaluable contribution to the study of Tibetan philosophy. It is of great interest to Buddhist practitioners, specialists in Buddhist philosophy and Tibetan Buddhism. (shrink)

Star Wars Episode VII: The Force Awakens is not the hero’s journey as George Lucas previously conceptualized it. Instead, the story line of The Force Awakens leads me to believe that it creates a new iteration of the hero myth. It follows the contemporary heroine’s journey while conforming to the essential construct of the hero monomyth. First, the contemporary heroine’s journey focuses primarily on the greater good and secondarily on her own personal journey, which is the converse of the traditional (...) hero’s journey. Second, the contemporary heroine’s self is awakened and called to adventure in a different way than the traditional hero. Third, the traditional hero receives guidance on his journey, while the contemporary heroine pushes ahead alone, striving to save her society from despair. (shrink)

Best known for his contributions to the development of contemporary intersubjectivity theory, Bernard Brandchaft has dedicated a career to the advancement of psychoanalytic theory and practice. Continually searching for a theoretical viewpoint that would satisfactorily explain the clinical phenomena he was encountering, his curiosity eventually led him to the work of Heinz Kohut and the then-emerging school of self psychology. However, seemingly always one step ahead of the crowd, Brandchaft constantly reformulated his ideas about and investigations into the intersubjective nature (...) of human experiences. Many of the chapters in this volume have never before been published. Together, they articulate the evolution of Brandchaft's thinking along the road toward an emancipatory psychoanalysis. Moreover, commentary from Shelley Doctors and Dorienne Sorter – in addition to Bernard Brandchaft himself – examines the clinical implications of the theoretical shifts that he advocated and provides a contemporary context for the case material and conclusions each paper presents. These theoretical shifts, both clear and subtle, are thereby elucidated to form the grand narrative of a truly visionary psychoanalytic thinker. (shrink)

In the Nyāya school of Classical Indian Philosophy, the concept of word meaning is described in detail; however, the theory of metaphor seems to clash with the theory of word meaning. This paper explores the theory of meaning in the early Nyāya theory and whether metaphor is compatible with it. The Nyāya theory of meaning is a 'basis for application' (pravrttinimitta) model: words pick out references because of the conventions and practices of use. Yet, these words can come to refer (...) to something completely different by pushing off its conventional usage and taking on a metaphorical meaning. If the referent is determined on the basis of the properties it possesses, how it is possible that only some properties are applied to a referent in metaphorical cases when, conventionally, a referent must possess all of the properties before the word is applied to it? This paper will investigate three main questions: 1) what is the nature of a referent according to the Nyāya?; 2) what is the mechanism for metaphorical transfer that allow some properties to transfer and not others?; and 3) what are the philosophical implications of the Naiyāyikas understanding of meaning? (shrink)

As a Madhyamaka philosopher, Taktsang Lotsawa Sherab Rinchen 1 is perhaps most widely known for his claim to have identified eighteen major contradictions in the thought of Tsongkhapa Losang Drakpa, a polemic discussion that appears in the Madhyamaka chapter of his encyclopedic Freedom from Extremes through Comprehensive Knowledge of Philosophy.2 In this article we will not pursue this critique, both renowned and infamous, but instead focus on Taktsang Lotsawa's own pragmatic hermeneutics of emptiness in context. Taktsang Lotsawa argues that *Svātantrika (...) 3 Mādhyamikas, in their drive to furnish the two... (shrink)

In this case-study, I examine examples which fall within the five categories of the re-use of texts in the Nyāya Sūtra, Nyāya Bhāṣya, and Nyāya Vārttika and note the form of quoting and embedment. It is found that the re-use of texts is prominent and that the category and method of embedding the re-used passages varies from author to author. Gautama embeds the most interlanguage quotations without acknowledging his sources and Uddyotakara re-uses the most quotations and paraphrases while acknowledging his (...) sources. Vātsyāyana re-uses the most direct quotations but only acknowledges his sources about half the time. Each author re-uses textual material for two reasons: to demonstrate his authority in this field; and to support his own arguments and to critique objections and opposing theories. Differences crop up in the methodologies of Gautama, Vātsyāyana, and Uddyotakara as the concept of an authority shifts over time, as the body of literature grows, and as new objections and opponents arise. (shrink)

In the acquisition of verbal knowledge, the Nyāya school outlines four conditions of a linguistic utterance that must be met: āsatti (temporal proximity), ākāṅkṣā (syntactic expectancy), tātparya (speaker intention), and yogyatā (semantic fitness). I will follow the traditional Nyāya view that is it one of the four necessary conditions that enable a hearer to gain verbal knowledge. The reasoning behind retaining tātparya as a condition (or cause) of verbal knowledge, is that it provides a resource with which to clarify ambiguity (...) when contextual factors cannot. It also provides a context for a hearer so that the primary (abhidhā) or secondary (lakṣaṇā) meaning of the word, or sentence is understood. In this sense, tātparya imparts the meaning of a work. Examples such as “Bring saindhava” or “Hari” make the case for the importance of tātparya in that the meanings of these terms are ambiguous unless the context is provided or the speaker intends to mean one referent rather than another. In this paper, I present the case that tātparya is the most important component of an accurate paraphrase, and it must be retained in order to preserve the original intention of the work. In other words, tātparya should be the primary constraint of an acceptable paraphrase. As a side comment to my aim, I discuss the notion of why paraphrase only needs to be sufficiently similar to the original work. (shrink)

This important new work surveys the source and ramifications of the famed Nuremburg Code -- recognized around the world as one of the cornerstones of modern bioethics.

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common (...) in clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

Background The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. Methods A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a (...) tertiary care teaching hospital) during April and May 2003. Results The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) Conclusion The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent (...) ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Background: Current practice relies on patient-designated and next-of-kin surrogates, in consultation with clinicians, to make treatment decisions for patients who lose the ability to make their own decisions. Yet there is a paucity of data on whether this approach is consistent with patients' preferences regarding who they want to make treatment decisions for them in the event of decisional incapacity. Methods: Self-administered survey of patients at a tertiary care center. Results: Overall, 1169 respondents completed the survey (response rate = 59.8%). (...) Of the 229 respondents who had previously designated a surrogate, 78.2% wanted their surrogate to make treatment decisions in the event of decisional incapacity, whereas 21.8% wanted their doctors to make treatment decisions. Of the 822 respondents who had not designated a surrogate, 66.1% wanted their family to make treatment decisions, whereas 33.9% wanted their doctors to make treatment decisions. The most common explanation provided for why respondents wanted their surrogate or family to make treatment decisions for them in the event of decisional incapacity was the belief that loved ones knew the patient's treatment preferences. Conclusions: Contrary to current practice, 33.9% of respondents who had not designated a surrogate and 21.8% of those who had designated a surrogate indicated that they wanted their doctors to make treatment decisions for them in the event of decisional incapacity. Moreover, many of those who wanted their surrogates or family members to make treatment decisions explained this preference by citing a belief that loved ones knew the patient's treatment preferences. This belief is undermined by prior research that suggests that surrogates and family members frequently are unable to predict which treatments their charges would want. Future research should assess these two concerns with current practice and, where necessary, identify approaches to address them. (shrink)

There is increasing recognition among bioethicists that health-care practitioners' everyday ethical challenges ought to be the focus of ethical analysis. Interviews were conducted with Australian junior doctors to identify some of the kinds of situations that they found ethically challenging, as a basis for this type of grounded philosophical analysis and for further empirical research into junior doctors' ethical issues. Fourteen doctors in their first to fourth year of work from six hospitals in Melbourne participated. Issues discussed (...) included involvement in treatment perceived as inappropriate, seniors discouraging disclosure of errors, coping when requested help was not forthcoming, observing behaviour perceived as unethical, truth-telling and informed consent. The difficulties described often focused on interactions with colleagues and position in the health-care team. Although the results cannot be generalized to junior doctors as a population, these junior doctors' stories point to various issues warranting further investigation, both philosophical and empirical. (shrink)

The interaction between evidence-based medicineand doctors' duty of care to patients iscomplex. One the one hand, there is surely anobligation to take account of the bestavailable evidence when offering health care topatients. On the other hand, it is equallyimportant to be aware of important shortcomingsin the processes and practices ofevidence-based medicine. There are tensionsbetween the population focus of evidence-basedmedicine and the duties that doctors have toindividual patients. Implementingevidence-based medicine may have unpredictableconsequences upon the overall quality of healthcare. Patients (...) may have a range of reasons forpreferring one form of treatment over another,not all of which are captured by currentformulations of evidence. This paper examinesthese issues, using relevant examples fromevidence-based medicine. (shrink)

The use of informed consent for surgery or research has been widely studied; however, its use in other areas of clinical practice has received less attention. This study investigates how doctors and nurses understand informed consent in relation to the prescription and administration of medicines in secondary care. It uses a qualitative analysis of semi-structured in-depth interviews with 19 doctors and 6 nurses recruited from various specialties in a teaching hospital. The results indicate a striking gap between official (...) and actual standards of practice. Providing information, assuring adherence and communication about potential treatment harms were raised as key issues instead of the principal goals of informed consent. Rather than simply treating these findings as support for a 'deficit' account of professionalism, the paper concludes that we need a richer and more grounded account of exactly when hospital medication decisions need to be subjected to the highest standards of informed consent. (shrink)

This paper supports the need for health professionals to be trained in argumentation theory, by illustrating the challenges that they face in interacting with patients and according to the different models of consultation that patients prefer. While there is no ideal model of consultation that can be promoted universally, the ability to construct arguments in support of health professionals’ points of view, as well as the ability to engage in critical discussion with patients, translate in essential skills for reaching patients’ (...) agreement when communication develops through the interpretative model or the informed decision model or, eventually, shared decision-making. Keywords: models of consultation, argumentation skills, medical training, patient-centeredness, informed consent. (shrink)

This paper discusses the key role medical regulators have in setting standards for doctors who use artificial intelligence (AI) in patient care. Given their mandate to protect public health and safety, it is incumbent on regulators to guide the profession on emerging and vexed areas of practice such as AI. However, formulating effective and robust guidance in a novel field is challenging particularly as regulators are navigating unfamiliar territory. As such, regulators themselves will need to understand what AI is (...) and to grapple with its ethical and practical challenges when doctors use AI in their care of patients. This paper will also argue that effective regulation of AI extends beyond devising guidance for the profession. It includes keeping abreast of developments in AI-based technology and considering the implications for regulation and the practice of medicine. On that note, medical regulators should encourage the profession to evaluate how AI may exacerbate existing issues in medicine and create unintended consequences so that doctors (and patients) are realistic about AI’s potential and pitfalls when it is used in health care delivery. (shrink)

The public often believes that parents have a right to make medical decisions about their child. The idea that, in respect of children, doctors should do what parents tell them to do is problematic on the face of it. The effect of such a claim would be that a doctor who acted deliberately to harm a child would be making a morally correct decision, providing only that it is what the child’s parents said they wanted. That is so obviously (...) nonsense that it cannot be what people who claim it actually mean. In this paper, I suggest that the claim actually represents either or both of two misunderstandings. It can be a result of wrongly appealing to the principle of respect for autonomy, or a belief that doctors are not committed to acting in the interests of the child. In this paper, I show that, while neither belief is entirely justified, there are elements of truth in both. I argue that if ethically correct decisions are those that are directed to improving the quality of a child’s existence, then neither parents nor doctors are in a position to make ethically correct decisions about a child except in discussion with one another. Where such discussion is not possible, I suggest there should be a national Children’s Interests Panel to agree on the child’s interests. The panel should include, but not be limited to, paediatricians and lawyers and its decisions should be legally binding on all parties. (shrink)

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any (...) given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Is it time to leave the non-professional aspects of personal life at the door and face patients as medical professionals and no more?Ever wondered about the appropriateness of Christian doctors displaying pictures of Pope Benedict, Muslim doctors displaying pictures of Osama son of Laden or former PLO leader Yassir Arafat, or gay doctors proudly flying the rainbow flag in their rooms? I suggest that we should be concerned about such display of religious, political, or other allegiance to (...) non-professional causes in loci of health care delivery.Let us take a step back, however, and ask why we seek health care professionals’ help or assistance. Our reasons have, of course, primarily to do with doing our fair share by way of enabling health care delivery services to achieve their primary objectives for being in existence, namely to ensure that we live as long as is feasible at as high a quality of life as is possible. While legitimate questions may be asked about acceptable trade-offs between length and quality of life, broadly speaking, that is what we expect health care providers to do for us. Importantly, we expect them to do so in a professional manner. This is very much in line with the historical roots of the idea of professionalism, meaning essentially to profess publicly to serve the public good.1 The public …. (shrink)

Defensive medicine is defined as a doctor’s deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it.

Elisabeth Kübler-Ross’ seminal 1969 work, On Death and Dying, opened the door to understanding individuals’ emotional experiences with serious illness and dying. Patient’s emotions, however, are on...

Although some doctors celebrated when the Court of Appeal overturned Hadiza Bawa-Garba’s erasure from the medical register, it is argued here that in many ways the ruling is by no means good news for the medical profession. Doctors’ interests are served by transparent professional tribunals but the Court of Appeal’s approach to the GMC Sanctions Guidance risks increasing opacity in decision-making. Close attention to systemic factors in the criminal trial protects doctors yet the Court of Appeal states (...) that the structural circumstances surrounding Bawa-Garba’s failings were only of peripheral relevance to her conviction. Public confidence in the profession is undermined when convicted doctors return to work because the public de facto do not understand the nuance of gross negligence manslaughter law. Rather than changing the law to make the regulator more lenient towards doctors, it would be better to ensure that doctors are only convicted of gross negligence manslaughter when their conduct is so serious that they ought to be struck off. (shrink)

Justice at Nuremberg traces the history of the Nuremberg Doctors' Trial held in 1946-47, as seen through the eyes of the Austrian bliogemigrbliogé psychiatrist Leo Alexander. His investigations helped the United States to prosecute twenty German doctors and three administrators for war crimes and crimes against humanity. The legacy of Nuremberg was profound. In the Nuremberg code--a landmark in the history of modern medical ethics--the judges laid down, for the first time, international guidelines for permissible experiments on humans. (...) One of those who helped to formulate the code was Alexander. Justice at Nuremberg provides a detailed insight into the origins of human rights in medical science and into the changing role of international law, ethics and politics. (shrink)

The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown.

Raymond Chandler, the creator of legendary detective Philip Marlowe and the recipient of increasing literary admiration over the past 40 years, used numerous physicians as minor characters in his novels and short stories. The presence of physicians as minor characters in Chandler's work, though unnoticed by previous critics, is illustrative both of the writer's personal antipathy towards medical doctors and larger societal forces which left medical charlatans free to open clinics. Chandler's own chronic health problems and those of his (...) wife Cissy may have contributed to the writer's negative attitude toward medicine and heath care, though little is known of Chandler's personal interactions with physicians prior to his death in 1959. (shrink)

Humor styles and psychosocial working conditions in relation to occupational burnout among doctors Medical professionals are an occupational group at a particularly high risk for job burnout. The aim of the study was to determine relationships between humor styles and psychosocial working conditions on the one hand and occupational burnout in the medical profession on the other. Participants in the study were 82 professionally active doctors, interviewed and examined using questionnaire methods: the Maslach Burnout Inventory, Humor Styles Questionnaire, (...) and the Psychosocial Working Conditions instrument. The results show that occupational burnout is a serious problem among medical doctors, even those with a short work history. Difficult psychosocial working conditions enhance the occupational burnout symptoms. Moreover, higher severity of burnout symptoms correlates with lower support from superiors and with less frequent utilization of adaptive humor styles: self-enhancing and affiliative. Therefore, it is worthwhile to develop programs of burnout prevention for medical professionals, with an emphasis on social skills training, and to enlarge such resources as support at workplace and humor utilization skills. (shrink)

Ghostwriting for medical journals has become a major, but largely invisible, factor contributing to the problem of credibility in academic medicine. In this paper I argue that the pharmaceutical marketing objectives and use of medical communication firms in the production of ghostwritten articles constitute a new form of sophistry. After identifying three distinct types of medical ghostwriting, I survey the known cases of ghostwriting in the literature and explain the harm done to academic medicine and to patients. Finally, I outline (...) steps to address the problem and restore the integrity of the medical literature. (shrink)