Background: Observance of the patients’ bill of rights is one of the main features of moral codes in hospitals. In this regard, nurses bear great responsibility because they spend a long time with patients. Therefore, the continuous evaluation of the nurses’ performance and assessing their knowledge about the patients’ bill of rights are a need. Objectives: We aimed to determine the nurses’ awareness of the patients’ rights and measure their performance in this regard. Research design (...) and participants: This cross-sectional study was carried out in 2013. To measure the nurses’ knowledge and performance, 250 nurses and 300 patients were surveyed. The participants were selected randomly from five teaching hospitals in Tehran, Iran. Two questionnaires, one for nurses (17 questions) and the other for patients (11 questions), were applied. The data were analyzed in SPSS software using descriptive and inferential statistics. Ethical consideration: The research protocol was submitted and approved by the research and ethics committees of the participating hospitals. Additionally, the consent of all of the participants was obtained before the study. Findings: The mean score of the nurses’ knowledge regarding the patients’ rights was acceptable (69.85 ± 11.7 of 85). Furthermore, the mean score of nurses’ performance in observing the patients’ rights was relatively acceptable (11.2 ± 4.6 of 22). More experienced and educated nurses had higher knowledge regarding the patients’ rights, and patients with higher education level or experience of being hospitalized were less satisfied with the nurses’ performance. Conclusion: Nurses’ knowledge of the patients’ bill of rights was acceptable; however, observance of the patients’ rights was not. It seems that notification of the patients’ bill of rights has increased the nurses’ awareness of the patients’ rights, although improvement of the nurses’ performance needs more extensive measures. (shrink)

The Patient's Charter has been in effect for nearly five years. This article considers the purpose and value of the document through a comparison with the New Jersey Patient Bill of Rights. Patient rights statements have been posted in American hospitals for more than twenty years. However, the New Jersey document and the patient rights programme it established seven years ago, have proven to be economically effective, successful in their representation of patients and enforceable, due to (...) the adoption of state legislation and regulation to oversee the process. Several examples of how the programme works are included in the comparison, with a similar review of The Patient's Charter. In the comparison the author argues that for the programme to succeed as it has done in New Jersey, the government will need to develop legislative backing to ensure enforcement, and an efficient system for monitoring compliance. The programme will need to become credible in the eyes of the health service user. The author suggests this may be best achieved by developing an efficient, accessible and user-friendly means of redress, should the patient consider his or her rights have been violated. A "mish-mash" of quality assurance standards and levels of care which patients can "expect" from the health service providers only serves to distract the health service user from the government's failure to commit the resources that would empower the patients rights portion of The Patient's Charter. (shrink)

The aim of this phenomenological research study carried out in Iran was to capture the meaning of patients' rights from the lived experiences of patients and their companions. To achieve this, 12 semistructured interviews were conducted during 2005 in a teaching hospital in Tehran with patients and/or their companions. In addition, extensive field notes were compiled during the interviews. The data were analyzed using Benner's thematic analysis. The themes captured were classified into three main categories, with certain themes identified (...) within each category. The categories were: (1) the concept of patients' rights; (2) barriers to patients' rights; and (3) facilitators of patients' rights. The distinctive themes within each of the categories were identified as: (1a) receiving real care, (1b) focus on the patient, and (1c) equality and accessibility; (2a) dissatisfaction with caregivers, and (2b) specific work environment limitations; (3a) the patient's companion, (3b) a responsible system, and (3c) the public's awareness of rights. Although certain themes identified closely resemble those identified in international patients' bills of rights, the current study focused on themes that are particularly relevant to the Iranian sociocultural context. (shrink)

This paper presents and discusses a recent Israeli proposal to legislate on the rights of the dying patient. A gap exists between elitist biases of the committee proposing the law, and popular values and sentiments. The proposed law divides the dying patients into two groups: “those who wish to go on living” and “those who wish to die”. The former will have a right to life prolonging extraordinary care. It is not clear who would foot the bill for (...) this care. Also it is hard to see how this munificence could fail to discriminate against all other patients. Both the secular ethicists and the rabbis involved in drawing up the proposal accepted the assumption that it is good for some terminal patients to die. The rabbis objected, however, to direct and active interventions that shorten life. The solution arrived at was to install timers in the ventilators so as to allow them to expire automatically unless the patient wishes for their resetting. (shrink)

In 2006, a WHO survey found evidence of a substantial increase in patient-led litigation against health authorities and funders over access to medicines around the world. New Zealanders have seldom litigated denials of access to health care. Part of the explanation lies in the fact that New Zealand has a legislated patients' "bill of rights", with enforcement through a complaints mechanism. Although the separate regime does not afford patients substantive legal protection in respect of complaints about lack of (...) access to care, this form of alternative, low-level resolution of health care disputes does condition disgruntled patients not to turn to the courts for legal redress in relation to their rights. But given the increasing need for prioritization arising from serious concern about the sustainability of the public health system, as well as a trend towards greater explicitness when it occurs, increased disappointment on behalf of patients and the public when care is denied or limited seems inevitable. This may well translate into increased patient-led litigation against health boards and funders. Part 1 provides an overview of the New Zealand health system, with a focus on the points at which resource allocation decisions are made, the identity of the decision-maker, and the methods by which priority-setting occurs. Part 1.1 describes inequalities between population groups in New Zealand, both in health outcomes and in access to health care. Part 2 describes the legal framework surrounding the health and disability sector, and discusses the lack of legislated rights to health and the limited right of access to health care in legislation, despite the existence of a legally enforceable Code of Health and Disability Services Consumers' Rights. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

In this paper, I argue that a well-known objection to subsistence rights developed by Onora O'Neill - namely, that such rights would generate obligations without an obligation-bearer, can be answered if we take such rights to impose an obligation on the world's population, taken collectively.

It is, perhaps, a propitious time to discuss the economic rights of disabled persons. In recent years, the media in the United States have re-ported on such notable events as: students at the nation's only college for the deaf stage a successful protest campaign to have a deaf individual ap-pointed president of their institution; a book by a disabled British physicist on the origins of the universe becomes a best seller; a pitcher with only one arm has a successful (...) rookie season in major league baseball; a motion-picture actor wins an Oscar for his portrayal of a wheelchair-bound person, beating out another nominee playing another wheelchair-bound person; a cancer patient wins an Olympic gold medal in wrestling; a paralyzed mother trains her children to accept discipline by inserting their hands in her mouth to be gently bitten when punishment is due; and a paraplegic rock climber scales the sheer four-thousand-foot wall of Yosemite Valley's El Capitan. Most significantly, in 1990, the United States Congress passed an important bill – the Americans with Disabili-ties Act – extending to disabled people employment and access-related protections afforded to members of other disadvantaged groups by the Civil Rights Act of 1964. (shrink)

Patients may show a more-or-less complete deviation of the head and eyes towards the right (ipsilesional) side [that is, to the same side of egocentric space as the brain lesion responsible for their disorder]. If addressed by the examiner from the left (contralesional) side [the opposite side to their lesion], patients with severe extrapersonal neglect may fail to respond or may look for the speaker in the right side of the room, turning head and eyes more and more to the (...) right. Frequently these patients will not pick up food from the left half of the plate. Given a crossword puzzle, they may complete only the squares to the right. If walking is not prevented by hemiparesis, neglect patients may lose their bearings, since they do not make use of left sided cues. (shrink)

Jessica Flanigan defends patients' rights of self-medication on the grounds that same moral reasons against medical paternalism in clinical contexts are also reasons against paternalistic pharmaceutical policies, including prohibitive approval processes and prescription requirements.

Background: Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day care of older people.Objectives: To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the (...) information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided.Method: A descriptive questionnaire given to 200 patients and 200 relatives during the patients’ stay in hospital.Results: Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives , despite the irregularities observed.Conclusions: The capacity of elderly patients to participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lisa’s StoryLisa P. (wife of patient) and Jeanne KerwinMy husband suffered from sudden onset of heart failure with a very low ejection fraction and was on IV Milrinone at the age of 47. One of the most powerful things he told me was that he was not afraid to die and therefore did not want to move forward with Milrinone. He eventually “did it for the kids.” After the (...) Milrinone drip was no longer working, he was offered an LVAD (left ventricular assist device) to keep him alive. He refused, but the doctor again convinced him to “do it for your kids” and said, “we put these devices in 80-year-olds.” He did not have time to explore any other options and reluctantly accepted the LVAD. It was implanted in May of 2014 in a very long and complicated surgery with a long and difficult recovery. He was in the hospital for a long time, and then he refused to go to rehab upon discharge, making it difficult for our family to manage, as he was extremely weak and needed care of his wound dressing. He worried about the financial [End Page 7] impact of a heart transplant and the medications required, as we were already struggling with the medical bills. He refused to have more surgery with the potential complications and never agreed to get on the transplant waiting list.After the implanted LVAD, my husband was not able to do most of what he loved in life. He couldn’t work (he was a truck driver), he couldn’t go fishing or swimming in the ocean, he couldn’t go hunting and fishing, and his overall physical condition was so poor that he couldn’t cook, garden and, most aggravating to him, he could not take a regular hot shower. The LVAD had to be covered with plastic in order to avoid getting the drive-line area wet, so bathing was a complicated process. He had trouble with stairs, had neuropathic pain in his legs from diabetes, and because of the pain medications, he felt cloudy and dizzy and slept most of the day in his recliner. I took care of him, even after I had to go back to work, and at the same time, I managed our two children (ages 9 and 12 at the time of LVAD).After almost two years of living with the LVAD, multiple hospitalizations for GI bleeds then seizures, more medications, and weekly blood draws for INR1, my husband requested that the LVAD be de-activated and that he be allowed to die of his heart failure. He described his life as “miserable.” He watched as his misery impacted his children and me. He suffered daily and had none of the joys that made life worth living for him. When we approached the cardiac team that implanted and monitored his LVAD with his request, they said “no.” They would not de-activate the LVAD because it was working. It was keeping him alive and he had no other terminal illness. His palliative doctor, who was treating his pain, also heard his request and told us to call for an “ethics consult” to determine if he would be “allowed” to have the LVAD de-activated. We got the number and called on March 31, 2016.At the time of the call to Ethics, we had no idea what “Ethics” was, other than a general definition of the word ethics as in professional behaviors and such. We did not know what to expect but we called. We would never have known to call “Ethics” if the palliative doctor had not advised us to do so, and my husband might have suffered a longer, more painful life both mentally and physically prolonged by the LVAD.We explained the request to the ethics consultant. She listened to my husband describe his daily living and his dissatisfaction with the quality of his life, his physical and emotional suffering, and his wish to rid himself of the LVAD and allow nature to take its course. There was actually no decision to be made on his part. He had already made up... (shrink)

In this paper I attempt to show how an appeal to a particular kind of collective obligation - a collective obligation falling on an unstructured collective consisting of the world’s population as a whole – can be used to undermine recently influential objections to the idea that there is a human right to health which have been put forward by Gopal Sreenivasan and Onora O’Neill. -/- I take this result to be significant both for its own sake and because it (...) helps to answer a challenge often put to Those who argue for the existence of collective obligations: namely, to explain why the question of whether there are any such obligations might matter from a practical point of view. One way of introducing the objection is to focus on questions of agency. Here I'll argue both that there can be obligations on groups that are not themselves collective agents, and that these can play an important explanatory and clarifcatory role in accounting for obligations which fall on individuals. (shrink)

This short article starts with Alasdair MacIntyre’s famous critical remarks on human rights in After Virtue, and proceeds to ask whether in fact MacIntyre can be read against himself, taking a range of his own texts. This provides the basis for a sketch of a substantive account of human rights, more historicised and political than those for which MacIntyre has so little time. The article engages with some leading English Aristotelians-James Griffin and John Tasioulas in particular. MacIntyre has (...) been a Marxist: this article suggests that perhaps he still is and that a consistent Aristotelian is a Marxist, especially where human rights are concerned. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be (...) discussed in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

The nurse asks the ethics consultant what can be done to stop the patient’s blogging. R.J.’s messages on the public forum are taking their toll on the care environment and the health care providers...

Respecting patients’ rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients’ rights was independent of gender, (...) socio-economic and educational status. Doctors were found to be the most common source of information for patient’s about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services. (shrink)

This article discusses the rights of patients who are attending hospital for the most common laboratory examinations and who may also be taking part in research studies. A distinction is made between five kinds of rights to: protection of privacy, physical integrity, mental integrity, information and self-determination. The data were collected ( n = 204) by means of a structured questionnaire specifically developed for this study in the clinical chemistry, haematological, physiological and neurophysiological laboratories of one randomly selected (...) university hospital in Finland. The analysis of the data was statistical. On the whole, patients’ rights were realized reasonably well. This was most particularly the case with protection of privacy, as well as with the rights of physical and mental integrity. The rights to information and self-determination were less well realized. There are various steps that health care professionals and organizations can take to make sure that patients can enjoy their full rights, by counselling the patient, by giving opportunities to plan the examinations in advance, and by arranging a sufficient number of small examination rooms. (shrink)

The aim of this project was to study the way in which patients’ rights are being exercised in everyday hospital practice in Greece. Data were collected by using questionnaires and structured interviews with 600 patients. These patients were found to ignore the fact that special regulations exist regarding their rights. They considered their right to information was being respected, albeit to different degrees. Many patients allowed their doctors to make decisions. The right to confidentiality was not considered as (...) a major priority by these patients because they doubted its applicability. They hesitated to protest when their rights were being violated. They thought that the most effective way of protecting their rights is either through the existence of someone with specialized knowledge or an internal hospital committee. These Greek patients appeared to be relatively satisfied with the way in which their rights were being exercised in hospital. However, a number of improvements could increase patient satisfaction regarding this issue. (shrink)

According to Wringe 2006 we have good reasons for accepting the existence of Global Collective Obligations - in other words, collective obligations which fall on the world’s population as a whole. One such reason is that the existence of such obligations provides a plausible solution a problem which is sometimes thought to arise if we think that individuals have a right to have their basic needs satisfied. However, obligations of this sort would be of little interest – either theoretical or (...) practical – if they did not give rise, either directly or indirectly, to any kinds of reasons for individuals to behave in certain ways. -/- In this paper, I shall argue that in many situations, forward-looking global obligations give rise to an obligation on individuals to work towards bringing into existence and support an institutional system which will enable their obligations to be met. My argument for this conclusion involves two steps. In the first step, I address a general question about how collective obligations can give rise to individual obligations without being reducible to them, and which obligations they give rise to. Here I give a Kant-inspired argument, based on the principles that ‘ought implies can’ and that the content of the moral law is given by reflecting on how agents should legislate in a kingdom of ends, which is designed to show that collective obligations can give rise to individual obligations. In the second step I apply this principle to the case of global forward-looking obligations. (shrink)

The standard paradigm for mental causation is a person’s acting for a reason. Something happens - she intentionally φ’s - the occurrence of which we explain by citing a relevant belief or desire. In the present context, I simply take for granted the following two conditions on the appropriateness of this explanation. First, the agent φ’s _because_ she believes/desires what we say she does, where this is expressive of a _causal_ dependence.1 Second, her believing/desiring this gives her a _reason_ for (...) φ-ing: recognizing that she has this belief/desire makes her φ-ing intelligible as rational in the light of her other attitudes and circumstances. A further condition must be met, though, if this is to be a genuine psychological explanation, a case of her acting _for_ the reason in question. Consider the following example of Davidson’s (1973, p. 79). An exhausted climber is desperate to rid herself of the weight and danger of holding her partner on a rope; and her sudden realization that simply letting go would achieve this so unnerves her that her grip loosens slightly and he falls. Her releasing him causally depends upon her having this belief and desire, which provide _a_ reason for doing what she does. But this is not _why_ she does it: it would be at best misleading to say that she dropped him, intentionally, because she was fed up with holding his weight, or because she thought that she might otherwise fall. Her letting go does not depend upon her having these reasons in the right way. The reason-giving relation is causally irrelevant. If we are to explain a person’s acting _for_ a reason, then her doing. (shrink)

The identification of human rights issues has become more prominent in statements from national and international nursing organisations such as the American Nurses Association and the United Kingdom’s Royal College of Nursing with the International Council of Nursing asserting that human rights are fundamental to and inherent in nursing and that nurses have an obligation to promote people’s health rights at all times in all places. However, concern has been expressed about this development. Human rights may (...) be seen as the imposition of legal considerations for nurses and other healthcare workers to bear in mind, as yet more responsibilities with the consequent fear of litigation. Although a more hopeful scenario is that consideration of human rights is something that is supportive of good practice. If this more hopeful scenario is to be realised, the role of education will be crucial. As with human rights generally, human rights education is a global phenomenon, a practice-orientated expression of the Universal Declaration of Human Rights, and the goal of human rights education is to build a culture of respect and action for human rights for all. However, the nature of human rights has long been contested. A ‘mapping exercise’ of the academic literature on human rights identified ‘four schools’ or ‘ideal types’ that have shaped thinking about human rights. This sets out the conceptual context in which human rights problems are defined and solutions are proposed, which is particularly important for human rights education. However, it also complicates the picture. The different approaches taken by the four ‘types’ would likely lead to different outcomes in terms of human rights education. It is timely to discuss the nature of human rights education and examine its potential for impact on patient care. This will involve identifying the challenges and potential benefits of this approach and analysing the implications for professional practice. (shrink)

This response to Robert Knox’s very kind and constructive review1 of my 2008 book The Degradation of the International Legal Order: The Rehabilitation of Law and the Possibility of Politics gives me the opportunity not only to answer some of his criticisms, but also, on the basis of my own reflections since 2008, to fill in some gaps. Indeed, to revise a number of my arguments. First, I restate my attempt at a materialist account of human rights. Next I (...) explain why, for me, the right of peoples to self-determination is absolutely central to a materialist understanding of human rights; and also fill a serious gap in my own account in the book. This leads me not only to a reply to Robert Knox on the question of ‘indeterminacy’ in international law, but also to a disagreement with him on the use or misuse of the language of self-determination. My fourth section returns to our very different evaluations of the significance and meaning of the work of Yevgeny Pashukanis, and what, for me, is Pashukanis’s misunderstanding, for reasons consistent with his general theoretical trajectory, of Marx and Lenin on the Irish question. Finally, I present an outline of a re-evaluation of Marx’s principled position on self-determination. (shrink)

We perceive things in the external world as spatially located both with respect to each other and to ourselves, such that they are in principle accessible from where we seem to be. I hear the door bang behind me; I feel the pen on the desk over to my right; and I see you walking beneath the line of pictures, from left to right in front of me. By displaying these spatial relations between its objects and us, the perceivers, perception (...) places us in the perceived world: our world and the world we perceive are one. Clearly this is not achieved by our continually perceiving ourselves along with the things around us, and thus recovering our position with respect to them. Indeed I shall argue that there are serious difficulties with the suggestion that this might be the basic mechanism for perceptual self- location. Furthermore, I shall argue that our existence as an element of the objective order cannot be inferred from the raw given in sense perception. Hence it cannot even be on the right lines as an answer to the question 'What is it for perception to represent its objects as environmental to the subject?', that it should present these objects, along with the perceiving subject himself, or along with something from which his existence in the perceived world could be deduced, in the very same frame so to speak. Nevertheless it yields him an awareness of himself as there in the wings of that scene, genuinely located with respect to the action, yet somehow not normally quite getting onto the stage. And I shall argue here, that perceptual contents succeed in being self-locating in this way in.. (shrink)

The rule of double effect is regularly invoked in ethical discussions about palliative sedation, terminal extubation and other clinical acts that may be viewed as hastening death for imminently dying patients. Unfortunately, the literature tends to employ this useful principle in a fashion suggesting that it offers the final word on the moral acceptability of such medical procedures. In fact, the rule cannot be applied appropriately without invoking moral theories that are not explicit in the rule itself. Four tenets of (...) the rule each require their own ethical justification. A variety of moral theories are relevant to making judgements in a pluralistic society. Much of the rich moral conversation germane to the rule has been reflected in arguments about physician-asssisted suicide and voluntary active euthanasia, but the rule itself has limited relevance to these debates, and requires its own moral justifications when applied to other practices that might hasten death. (shrink)

In his “Why be Moral? A Different Rationale for Managers,” , La Rue Tone Hosmer argues that managers should be moral because “acting in ways that can be considered to be ‘right’ and ‘just’ and ‘fair’ is absolutely essential to the long-term competitive success of the firm.” According to Hosmer, moral behavior generates trust among stakeholders, which leads to stakeholder commitment, which leads to increased stakeholder effort, which ultimately leads to corporate success. Though we agree with Hosmer’s causal reasoning, we (...) are concerned about an ancient loophole, namely, cases where the mere appearance of morality will generate the same trust, and commitment, and so on, and will thus enable managers to reap the material benefits of morality while nevertheless engaging in immoral practices. We conclude that a virtue ethics perspective will strengthen Hosmer’s model so as to cover such cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 114-116 [Access article in PDF] The Earth Charter: Buddhist and Christian Approaches Bill Aiken Soka Gakkai International Seattle, Washington, is well known as the home of the coffee renaissance that swept across America in the 1980s and 1990s. Its hometown favorite, The CoffeeBrand, first appeared in 1971 in an open-air farmers' market; the popular round, green logo now seems to appear on the streets (...) of every city and suburb of the world.But what really impresses the visitor to the Seattle-Tacoma area is not The Coffee; it's The Mountain. When you look to the southeast, it rises there, big and craggy and snow-covered, and alone. It dominates the horizon. Even when you're not looking at it, or when it's obscured by the morning haze, you feel its presence. The Mountain... that's what the locals call it, as if it were the only one in the world.Those of us from other parts of the country call it Mount Rainier, but it looms large just the same. And from August 5 through 12, it seemed to watch over us like an expectant teacher as we convened on the wooded campus of Pacific Lutheran University for the Sixth International Conference of the Society of Buddhist-Christian Studies (SBCS). More than 170 scholars, students, and practitioners (and scholar-practitioners and practitioner-students) joined in a week of dialogue, study, and reflection on the theme "Buddhism, Christianity, and Global Healing."The conference opened with blessings from both the Buddhist and Christian traditions and with musical performances representing the traditions of the West--the passionate resonance of the pipe organ; and East--the evocative sounds of the simple bamboo shakuhachi.Boston Research Center (BRC) founder and president of Soka Gakkai International, Daisaku Ikeda, sent a congratulatory message to the gathering praising their efforts and noting the key areas in which Christianity and Buddhism can make important complementary contributions to the issues facing the world.The theme of global healing provided an excellent opportunity to focus on the Earth Charter. Under the title "Spirituality and the Earth Charter: Buddhist and Christian Approaches," co-chairs Professor Jay McDaniel, of Hendrix College, and BRC Executive DirectorVirginia Straus assembled a rich program of presentation and dialogue, which included some of the most renowned scholars, activists, and scholar-activists of the Earth Charter movement. [End Page 114]Professor Mary Evelyn Tucker, of Bucknell University, began by introducing the Earth Charter not as a document but as a living movement, whose activities are inspired by the ideals and guidelines contained within the charter. Dr. Tucker, who played an active role in the shaping of the charter, spoke of how the input of various constituencies (indigenous peoples, developing economies, businessmen, political leaders, and yes, lawyers) was solicited, considered, and, where appropriate, given voice in the charter. She noted that we now have what will be--more or less--the final form of the charter. Our next step is to make it come alive in our behavior as individuals, communities, businesses, and nations.Virginia Straus spoke of the contributions of the global Buddhist community to the Earth Charter process. It began with Professor Steven Rockefeller's call for participation, which in turn led to contributions by prominent Buddhist leaders and scholars to the charter language, scholarly and grassroots consultations, publications by the Buddhist Peace Foundation (BPF) and the BRC, and the efforts of Buddhist organizations and engaged scholars to build grassroots support for the charter. Straus noted that the charter now reflects central Buddhist beliefs, with its clear recognition of interdependency and its emphasis on a change of mind or heart, and on "becoming more" rather than "acquiring more."Jay McDaniel rounded out the Earth Charter introduction by providing a very personal Christian perspective, giving special attention to those elements of the charter that speak to the human soul. As an example, he highlighted the broad spiritual and moral vision contained in Article 16(f) defining peace as "the wholeness created by right relationships with oneself, other persons, other cultures, other life, Earth, and the... (shrink)

In the New York Times bestseller Everything All at Once, Bill Nye shows you how thinking like a nerd is the key to changing yourself and the world around you. Everyone has an inner nerd just waiting to be awakened by the right passion. In Everything All at Once, Bill Nye will help you find yours. With his call to arms, he wants you to examine every detail of the most difficult problems that look unsolvable—that is, until you (...) find the solution. Bill shows you how to develop critical thinking skills and create change, using his “everything all at once” approach that leaves no stone unturned. Whether addressing climate change, the future of our society as a whole, or personal success, or stripping away the mystery of fire walking, there are certain strategies that get results: looking at the world with relentless curiosity, being driven by a desire for a better future, and being willing to take the actions needed to make change happen. He shares how he came to create this approach—starting with his Boy Scout training (it turns out that a practical understanding of science and engineering is immensely helpful in a capsizing canoe) and moving through the lessons he learned as a full-time engineer at Boeing, a stand-up comedian, CEO of The Planetary Society, and, of course, as Bill Nye The Science Guy. This is the story of how Bill Nye became Bill Nye and how he became a champion of change and an advocate of science. It’s how he became The Science Guy. Bill teaches us that we have the power to make real change. Join him in… dare we say it… changing the world. (shrink)

In Learner Agency: Building the Mindset and Skill Set of Hope in Our Classrooms, author Bill Zima clarifies what student agency looks and sounds like in the classroom. Zima introduces a framework that K-12 educators can use to organize their instructional practice to create opportunities and the right conditions that give learners control over their thinking. When teachers deliberately plan and structure lessons with the goal of developing student agency, they shift away from simply delivering content to encouraging students (...) to become active participants in their learning. By reading Learner Agency, teachers and leaders will discover research-based strategies for supporting and cultivating students' ability to build agency within themselves. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 35-37 [Access article in PDF] Seeking Emancipation through Engagement:One Nichiren Buddhist's Approach to Practice Bill Aiken SGI-USA I was born and raised Roman Catholic, which meant attending Catholic schools, first in the local parish schools and later at a private academy in suburban Philadelphia. As a child I was serious about my religion. I served as an altar boy and had serious thoughts about (...) becoming a priest.That was until the mid-1960s, when my hormones took over, my voice changed, and I converted to hedonism. I hadn't so much turned against my Catholic upbringing as I was temporarily distracted from it.It was when I went away to college that the religious questions began to resurface. Friends and classmates wanted to know what I believed in, and I really didn't know. The old form of Catholicism, with its stern, patriarchal vision of God, didn't seem to fit anymore. But the mystery remained as a palpable presence, and it seemed to require an answer. Was I an atheist? That seemed so negative. How about an agnostic? Possibly. They seemed to believe in something, even if they didn't know what it was. That seemed about right for the moment.My first encounter with Buddhism came during that freshman year at Penn State University in the fall of 1968. While attending a rather psychedelic party, a friend asked me if I knew anything about Buddhism. Replying that I didn't, I asked what Buddhism had to say for itself. My friend said that it spoke of the oneness and interrelatedness of everything. All I can say is that at that particular moment this made sense to me and started me on what would at first be a pretty casual exploration of Buddhism.But it would be in the bedridden summer of 1970, while recovering from a lifestyle-inflicted illness, that I started to reflect on my life in earnest and began to read as though Buddhism had something to say directly to me. More books by Alan Watts led to D. T. Suzuki, which in turn led to collections of sutras and finally to Phillip Kapleau and the Three Pillars of Zen. This would be my guide for the next year as I struggled to bring focus to my mind and my life.Being the poor and struggling student that I was, I could not afford the cost of a [End Page 35] retreat or sesshin training. So I struggled as well as I could with a combination of self-instruction and whatever I could learn from those who did attend these sessions.I should say at this point that while I may have had a highly developed religious sense, I never wanted to become a religious virtuoso or a renunciate. From the depths of my adolescent angst and confusion, I longed for an awakening, but I had conditions. And chief among them was that I would not be pried apart from my life as I knew it. The quietude of the monastery and hours of prayer or meditation held absolutely no appeal for me. If I were going to attain enlightenment it would have to be in Times Square (before Disney took it over). And so, through my daily stumbling efforts at zazen, I began struggling to bring about this awakening.So this is where I was spiritually when on a late summer day in 1971, a pleasant though somewhat scattered young woman approached me on the streets of downtown Philadelphia, invited me to a Buddhist meeting, and introduced me to the chanting of Nam-myoho-renge-kyo. The first meeting I attended was a rather large one on the campus of Columbia University in NewYork. Everyone seemed pleasant enough, but the meeting seemed more like a pep rally than a serious discussion about the profound teachings of the Buddha. When the main speaker finally took the stage, I found it nearly impossible to understand his broken English. So I'm afraid that I don't remember a single word he... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes and Fragments TO THE UGHTHOUSE AND THE FEMINIST PATH TO POSTMODERNITY by Bill Martin Postmodernity is in part the existence of an unprecedented space for feminism. Already in this formulation, however, we encounter two major terms that require explication. I will argue in this essay that Virginia Woolf's To the Lighthouse provides the basis for productively understanding postmodernism and feminism in relation to each other.1 The question (...) of placing feminism temporally has of course been raised before; I will simply mention two occasions. In Sexual/Textual Politics, Toril Moi argues for a kind of natural affinity of feminism with literary modernism's implicit critique of notions of the unified self.2 Here the comparison of Woolf with Joyce is appropriate. Moi moves from this perceived affinity toward the notion of écriturefeminine. Practitioners of the latter have been much more interested in Joyce than Woolf. Joyce, especially in Finnegans Wake, thoroughly shatters the self, reaching the highest expression of modernism. Woolf does something different. In To tL· Lighthouse, she not only decenters the subject, she also reconstitutes the subject. If Woolf had only reinstated the subject, as a matter of simply returning to the previous paradigm, then obviously her writing would have to be considered anachronistic. Though the affinity posited by Moi is real and useful (if made problematic by what seem to be real affinities that also exist between modernism and misogyny ), the force of another affinity can also be felt: in her deconstruction /reconstitution, Woolf achieves a writing that is both postmodern and feminist. The both/and relation here is itself a cultural creation, 307 308PHrLOSOPHY and Literature however, which points to the elective affinity involved in joining a particular politics with a particular artistic practice. The question is whether a political argument that does not avoid questions of artistic integrity can be marshaled to the task of showing that the affinity of feminism and postmodernism is more viable in the contemporary context than the affinity posited by Moi.3 Elaine Showalter, in her formulation of "women's time," raises the possibility ofanother kind of temporalized feminism. In "Feminist Criticism in the Wilderness," Showalter pursues the idea that there might be a time and space which women occupy without their location being known or knowable to men, and perhaps without women fully knowing it themselves.4 In short, this "time" is conditional and predicated upon a possible future in which people will remember and be more fully aware of their spatial/temporal context. I would propose that this same conditional and uncertain sense of time applies to postmodernism. For the very terms "postmodernism" and "postmodernity" connote a transitional period in which it is not certain how elements which are for the time being in flux will ultimately setde down and congeal. The "aftereffect of the "post" in postmodernity will be truly understood only in the longer run, if even then. Showalter takes it that there is a sense in which "women's time," the "Age of Feminism," is occurring right now, but in a concealed way. Again, something like this may be said of postmodernism. In either case there is the sense of creating artifacts for a future which may or may not exist. There is also the sense of permanent postponement or deferral which is integral to the very notion of "possibility." Add to these references the by now familiar postmodern and feminist criticisms of grand narratives that crush difference, and I think we are in possession of a set of basic issues common to both feminism and postmodernism: the nature of the self and its possible recreation, the question of periodization and our "time," problems of difference and questions of doing something different (in the latter case feminism is much more explicit about doing something different that is also emancipatory, though some forms ofpostmodernism stress this as well). Given these common concerns I simply want to set the new affinity as follows: postmodernism is a social and cultural atmosphere in which feminism and other emancipatory trends might flourish. In this context, To tL· Lighthouse is a trailblazing feminist-postmodern artifact. The project here is not to generate or force a postmodern reading (any more... (shrink)

Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of (...) brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry. (shrink)

The case outlined below will be the basis for the In That Case section in the next issue of the Journal of Bioethical Inquiry (JBI). We invite interested readers to provide responses to the case for possible publication. Responses should be 500–700 words, and should be submitted as soon as possible after publication of this issue. The editors will select the responses to be published in the next issue of the JBI, and reserve the right to edit contributions to avoid (...) repetition. Editorial changes will be cleared with authors before going to press. Responses should be submitted on Editorial Manager. (shrink)

It is natural to think of political philosophy as being concerned with reflection on some of the ways in which groups of human beings come together to confront together the problems that they face together: in other words, as the domain, par excellence, of collective action. From this point of view it might seem surprising that the notion of collective obligation rarely assumes centre-stage within the subject. If there are, or can be, collective obligations, then these must surely constrain the (...) ways in which we can act collectively. Indeed, one might even suspect that considerations about collective obligations ought to play a central role in demarcating the form that any legitimate form of political organization ought to take. -/- Elsewhere I have argued that we have good reasons for accepting the existence of global collective obligations - in other words, collective obligations which fall on the world’s population as a whole.(Wringe 2006, 2010, forthcoming, under review) For example, the existence of such obligations provides a plausible solution to a problem which is sometimes thought to arise if we think that individuals have a right to have their basic needs satisfied. In this paper, I shall argue that in many situations, forward-looking global obligations give rise to an obligation on individuals to work towards bringing into existence and support an institutional system which will enable their obligations to be met. Call such an obligation the ‘Obligation to Promote Satisfactory Global Institutions.’ I shall also examine a significant challenge to this line of argument, which I call the ‘Pluralist Challenge’ One might suppose that the ‘Obligation to Promote Satisfactory Global Institutions’ could be met by providing strategic support to attempts to modify and extend existing international institutions. After all, creating new institutions is a difficult matter: perhaps it would be better, especially where stringent obligations are concerned, to concentrate on those institutions which we already have. On the other hand, existing international institutions are subject to a range of significant moral and ethical criticisms. It would simply be naïve to suppose that their existence of such institutions is based on an international consensus about what justice requires; and it is not clear how we could motivate individuals who have severe ethical reservations about the existence of such institutions, or why we should wish to. This suggests that those who think that there are global collective obligations, and that such obligations should play an important role in shaping how we think of international distributive justice are faced with a significant dilemma: either support a program of extending and strengthening existing institutions in a way which risks entrenching some existing forms of injustice; or commit oneself to a program of attempting to build new institutions which will have to compete with those institutions we have already and which are unlikely to be in a position to meet help us to discharge our collective obligations at any point in the near future. Neither option seems satisfactory. I shall argue that our response should be to look for plausible ethical constraints on how international institutions should be developed, and suggest that these constraints are likely to take a cosmopolitan form. (shrink)