Developing residents’ communication skills has been a goal of residency training programmes since the Accreditation Council for Graduate Medical Education codified it as a core competency. In this article, a case that features problematic communication between a generalist and specialist physician is drawn upon, and it is suggested how their communication might become open and effective through a practice of reason exchange. This is a practice of giving reasons, listening to reasons given by others, evaluating reasons and deciding which particulars (...) of situations constitute reasons to act and reasons how to act. Drawing on recent literature in teaching communication to radiology residents, it is proposed that practices of reason exchange are part of the skill set generally referred to as “negotiation skills” that should be cultivated in all residents. Particularly, in cases in which generalist and specialist physicians disagree about the reasons to do something, not do something or do something this way or that way, how well physicians are trained to practice reason exchange depends on whether they can communicate effectively and negotiate disagreement collegially. (shrink)

Background: Physicians sometimes are asked by co-workers for prescriptions to deal with their medical problems. These “hallway” requests typically occur outside a formal doctor-patient relationship. There are professional guidelines on serving as physician for family members and friends, but no guidelines address writing prescriptions for co-workers. The frequency of these requests and the factors physicians consider in responding to them have not been examined.Objectives: To obtain data on the frequency of these requests and physicians’ attitudes and practices in responding to (...) them, and to explore the ethical considerations in writing prescriptions for co-workers.Design: A survey was administered to all physician faculty and residents in an academic department of internal medicine. The questions included whether the respondent had ever been asked for a prescription by a co-worker and how often the respondent had received such requests and written such prescriptions in the previous three months. Respondents also were asked to rate how likely they would be to write such a prescription in 15 hypothetical scenarios.Results: Of the 113 respondents who completed surveys, 68 percent reported having been asked for a prescription by a co-worker. Among those who had ever been asked, 59 percent had been asked one or more times during the previous three months and 88 percent had ever written such a prescription. Also, 88 percent of all respondents stated they were “very likely” or “likely” to write the prescription in one or more of the hypothetical scenarios.Conclusions: Most physicians in our sample had been asked for prescriptions by co-workers, and most had written such prescriptions. Many respondents indicated a willingness to write such prescriptions in a variety of scenarios, despite the absence of a formal doctor-patient relationship. Further discussion of the ethical considerations in writing prescriptions for co-workers is needed. (shrink)

ObjectiveTo evaluate the relationship between recently trained paediatricians' ethics knowledge and exposure to a formal ethics or professionalism curriculum during residency.MethodsWe conducted a cross-sectional survey of recently trained paediatricians which included a validated 23-item instrument called the Test of Residents' Ethics Knowledge for Pediatrics. The sample included paediatricians who completed medical school in 2006–2008, whose primary specialty was paediatrics or a paediatric subspecialty, and who completed paediatric residency training in 2010–2011. This sample was stratified based on residency programme variables: presence (...) of a formal curriculum in ethics or professionalism, programme size and American Board of Pediatrics certifying exam passage rate. Paediatricians were randomly selected from each stratum for survey participation.ResultsAmong the 370 responding paediatricians (55%), the mean knowledge score was 17.3 (SD 2.2) out of a possible 23. Presence of a formal curriculum in ethics and/or professionalism was not significantly associated with knowledge. Knowledge was lowest on items about parental requests for a child to undergo genetic testing (2 items, 44% and 85% incorrect), preserving patient confidentiality over email (55% incorrect), decision-making regarding life-sustaining technologies (61% incorrect), and decision-making principles such as assent and parental permission (2 items, 47% and 49% incorrect).ConclusionsThis study highlights several areas in which paediatricians' knowledge may be low and that are amenable to targeted educational interventions. These findings should prompt discussion and research among ethicists and educators about how ethics and professionalism curricula can more consistently influence paediatricians' knowledge. (shrink)

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

Objective: To analyse the process of end of life decisions in a neurosurgical environment.Methods: All 113 neurosurgical patients, who were subject to so called end of life decisions within a one year period were prospectively enrolled in a computerised data bank. Decision pathways according to patient and physician related parameters were assessed.Results: Leading primary diagnoses of the patients were traumatic brain injury and intracranial haemorrhage. Forty-five patients had undergone an emergency neurosurgical operation prior to end of life decision, N = (...) 69 were conservatively treated, which included intracranial pressure recording, or they were not offered neurosurgical care because of futile prognosis. N = 111 died after a median of two days. Two, in whom the end of life decisions were revised, survived. Clear decisions to terminate further treatment were made by a senior staff member on call being informed by the senior resident on call , difficult decisions on the basis of extensive round discussions , and very difficult decision by an interdisciplinary ethical consult . Decisions were further substantiated by electrophysiological examinations in N = 59.Conclusion: End of life decisions are to be considered standard situations for neurosurgeons. These decisions may reach a high rate of “positive” prediction, if substantiated by electrophysiological examinations as well as on the grounds of clinical experience and respect for the assumed will of the patient. The fact that patients may survive following revision of an end of life decision underlines the necessity for repeated reassessment of these decisions. Ethical training for neurosurgeons is to be encouraged. (shrink)

In his popular first book, The Spell of the Sensuous, David Abram (1996) calls on us to recognize the encompassing earth "in all its power and its depth, as the very ground and horizon of all our knowing." By re-emphasizing the connection between knowing and the earth, Abram hopes to encourage a more engaged existence with the flora, fauna, and landscapes among which we reside. Given that the earth is literally the ground and horizon of all our knowing, it makes (...) sense—in fact, it is good for the senses—to consider for a while how the places in which we know come to exert their influence upon the constructions that we call knowledge. This paper is a sketch of a larger project to illustrate the epistemic significance of geography. (shrink)

A Dutch medical student has the potentially more virulent Panton-Valentine leukocidin form of MRSA colonization yet shows no signs or symptoms of infection. More than a year ago, a routine MRSA screening of health care personnel providing care for MRSA-positive patients detected the colonization. Since then, the student has been treated intensively but unsuccessfully in an attempt to decolonize her. During this decolonization period, the medical student was barred from performing patient-related interventions, temporarily interrupting her medical residency. After initial treatment (...) with mupirocin nasal ointment and antibiotics proved ineffective, a more stringent hygiene regime was added that included hand, nose, hair, and body scrubbing with disinfecting soap. Additional precautions included simultaneous treatment of household members and disinfection of the family home. Despite these efforts, her MRSA status has remained positive. WIP guideline s bar any health care worker diagnosed with MRSA from performing patient-related interventions. Unable to complete the residency requirement of at least 1 year of patient care, the medical student was advised to pursue a career in another profession. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Many people view humor and a serious religious life as antithetical. This paper attempts to elucidate Kierkegaard’s view of humor, and thereby to explain his claims that humor is essentially linked to a religious life, and that the capacity for humor resides in a deep structure of human existence. A distinction is drawn between humor as a general element in life, and a special sense of humor as a “boundary zone” of the religious life. The latter kind of “humorist” embodies (...) a religious perspective which is not Christian, but is closely related to Christianity. Humor itself is a fundamental aspect of Christian faith. (shrink)

Recent controversy over philosophical advocacy of infanticide (or the comically-styled euphemism ‘postnatal abortion’) reveals a surprisingly common premise uniting many of the opponents and supporters of the practice. This is the belief that the moral status of the early fetus or embryo with respect to a right to life is identical to that of a newly born or even very young baby. From this premise, infanticidists and strong anti-abortionists draw opposite conclusions, the former that the healthy newly born have no (...) inherent right to life and the latter that minute embryos and the very early fetus have the same right to life as young babies. (Indeed strong anti-abortionists tend to regard this right to life as identical to that possessed by adult humans.) This paper argues that these opposed conclusions are both deeply implausible and that the implausibility resides in the common premise. The argument requires some attention to the structure of the philosophical case underpinning the supposed vice of speciesism that has been given intellectual currency by many philosophers, most notably Peter Singer, and also to the reasoning behind the strong anti-abortionist adoption of the common premise. (shrink)

The term “Native Hawaiian” is often used to refer to the indigenous people of the Hawaiian islands; however, the term is itself non-Hawaiian, as is its pronunciation. The Kānaka Maoli, the “true or real persons,” are the indigenous people of Ka Pae ‘Āina O Hawai‘i (the Hawaiian archipelago). After living for centuries in these islands as a sovereign people, with a relationship to the land that is both familial and reciprocal, the last Hawaiian government was overthrown in 1893 with the (...) help of military personnel from the United States of America. Five years after the overthrow the USA annexed the islands, in spite of clear and overwhelming opposition by the Kānaka Maoli. In 1959 the majority of non-Hawaiian residents of Hawai‘i voted in the affirmative for statehood. The aim of this article is to show that the overthrow of the sovereign Hawaiian nation, the annexation of Hawai‘i by the USA, and the incorporation of these islands into the USA as its fiftieth state, are both illegal and unjust. Moreover, justice requires the restoration of a sovereign Hawaiian nation. (shrink)

From the acclaimed author and scholar James C. Scott, the compelling tale of Asian peoples who until recently have stemmed the vast tide of state-making to live at arm’s length from any organized state society For two thousand years the disparate groups that now reside in Zomia (a mountainous region the size of Europe that consists of portions of seven Asian countries) have fled the projects of the organized state societies that surround them—slavery, conscription, taxes, corvée labor, epidemics, and warfare. (...) This book, essentially an “anarchist history,” is the first-ever examination of the huge literature on state-making whose author evaluates why people would deliberately and reactively remain stateless. Among the strategies employed by the people of Zomia to remain stateless are physical dispersion in rugged terrain; agricultural practices that enhance mobility; pliable ethnic identities; devotion to prophetic, millenarian leaders; and maintenance of a largely oral culture that allows them to reinvent their histories and genealogies as they move between and around states. In accessible language, James Scott, recognized worldwide as an eminent authority in Southeast Asian, peasant, and agrarian studies, tells the story of the peoples of Zomia and their unlikely odyssey in search of self-determination. He redefines our views on Asian politics, history, demographics, and even our fundamental ideas about what constitutes civilization, and challenges us with a radically different approach to history that presents events from the perspective of stateless peoples and redefines state-making as a form of “internal colonialism.” This new perspective requires a radical reevaluation of the civilizational narratives of the lowland states. Scott’s work on Zomia represents a new way to think of area studies that will be applicable to other runaway, fugitive, and marooned communities, be they Gypsies, Cossacks, tribes fleeing slave raiders, Marsh Arabs, or San-Bushmen. (shrink)

_A renowned philosopher challenges long-held views on just wars, ethical conduct during war, why wars occur, how they alter people and societies, and more_ For residents of the twenty-first century, a vision of a future without warfare is almost inconceivable. Though wars are terrible and destructive, they also seem unavoidable. In this original and deeply considered book, A. C. Grayling examines, tests, and challenges the concept of war. He proposes that a deeper, more accurate understanding of war may enable us (...) to reduce its frequency, mitigate its horrors, and lessen the burden of its consequences. Grayling explores the long, tragic history of war and how warfare has changed in response to technological advances. He probes much-debated theories concerning the causes of war and considers positive changes that may result from war. How might these results be achieved without violence? In a profoundly wise conclusion, the author envisions “just war theory” in new moral terms, taking into account the lessons of World War II and the Holocaust and laying down ethical principles for going to war and for conduct during war. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Why are cities looking more and more alike? Why do hipster coffee shops and clothing boutiques all share that same vibe? One answer is that gentrification represents an invasive force that forcibly re-models cities, from the top-down, to meet the monotone eye of the gentrifier. Gentrification brings in external developers and designers, who create new businesses which all meet that one monotonous aesthetic mold. But I suggest, using work from Quill Kukla and Jane Jacobs, that this top-down model of gentrification (...) is incomplete. Gentrification also incentivizes local residents to remake their own businesses and properties to meet that monotone eye. Gentrification is a pressure which pushes cities to meet a universalized and therefore homogenized taste, rather than letting diverse tastes flourish. (This piece originally published as part of a symposium on Quill Kukla's City Living.). (shrink)

Plagiarism has been a long standing concern within higher education. Yet with the rapid rise in the use and availability of the Internet, both the research literature and media have raised the notion that the online environment is accelerating the decline in academic ethics. The majority of research that has been conducted to investigate such claims have involved self-report data from students. This study sought to collect empirical data to investigate the potential influence the prevalence of the Internet has had (...) on significant higher education artifacts by comparing dissertations written prior to widespread use of the Internet with those written in a period in ubiquitous Internet use. Due to the prestige associated with the doctoral degree and the fact that the majority of the effort necessary to achieve such a degree resides within the dissertation, this study utilized Doctor of Philosophy dissertations written in English and published by accredited universities in the U.S. and Canada. A sample of 384 dissertations were analyzed by Turnitin plagiarism detection software. The mean similarity indices for pre-Internet and post-Internet eras were 14.5 and 12.3 %, respectively. A Mann Whitney U test indicated that the differences between groups was significant, however opposite than has been purported within the exigent literature. When comparing the counts of dissertations for each time era considering those with plagiarism versus those that had little/no evidence thereof, there was no statistically significant difference. The findings of this study suggest that the Internet may not be significantly impacting the prevalence of plagiarism in advanced levels of higher education. (shrink)

This study explored the influence of the COVID-19 pandemic on perceived health behaviors; physical activity, sleep, and diet behaviors, alongside associations with wellbeing. Participants were 1,140 individuals residing in the United Kingdom, South Korea, Finland, Philippines, Latin America, Spain, North America, and Italy. They completed an online survey reporting possible changes in the targeted behaviors as well as perceived changes in their physical and mental health. Multivariate analyses of covariance on the final sample revealed significant mean differences regarding perceived physical (...) and mental health “over the last week,” as well as changes in health behaviors during the pandemic by levels of physical activity and country of residence. Follow up analyses indicated that individuals with highest decrease in physical activity reported significantly lower physical and mental health, while those with highest increase in physical activity reported significantly higher increase in sleep and lower weight gain. United Kingdom participants reported lowest levels of physical health and highest increase in weight while Latin American participants reported being most affected by emotional problems. Finnish participants reported significantly higher ratings for physical health. The physical activity by country interaction was significant for wellbeing. MANCOVA also revealed significant differences across physical activity levels and four established age categories. Participants in the oldest category reported being significantly least affected by personal and emotional problems; youngest participants reported significantly more sleep. The age by physical activity interaction was significant for eating. Discussed in light of Hobfoll conservation of resources theory, findings endorse the policy of advocating physical activity as a means of generating and maintaining resources combative of stress and protective of health. (shrink)

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

A Catholic physician practices in a world that condones the use of contraception. In the effort to be morally consistent, Catholic physicians are faced with questions about the extent to which their participation in providing contraceptives constitutes immoral cooperation in evil. Particular challenges face resident physicians, who practice under attending physicians and within the constraints of local and specialty-wide training requirements. The author examines the nature of the moral act of referring for contraception and argues that, in limited cases, there (...) is a moral distinction between a referral and an intra-residency patient transfer, and the latter may be morally licit according to the principle of material cooperation. National Catholic Bioethics Quarterly 12.2 (Summer 2012): 283–309. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

Objective—To report the ethical development of medical students across four years of education at one medical school.Design and setting—A questionnaire was distributed to all four classes at the Wake Forest University School of Medicine during the Spring of 1996. Participants—Three hundred and three students provided demographic information as well as information concerning their ethical development both as current medical students and future interns. Main measurements—Results were analyzed using cross-tabulations, correlations, and analysis of variance.Results—Results suggested that the observation of and participation (...) in unethical conduct1 may have disparaging effects on medical students' codes of ethics with 35% of the total sample (24% of first years rising to 55% of fourth years) stating that derogatory comments made by residents/attendings, either in the patient's presence or absence, were “sometimes” or “often” appropriate. However, approximately 70% of the sample contended that their personal code of ethics had not changed since beginning medical school and would not change as a resident. Conclusions—Results may represent an internal struggle that detracts from the medical school experience, both as a person and as a doctor. Our goal as educators is to alter the educational environment so that acceptance of such behaviour is not considered part of becoming a physician. (shrink)

Laurel Schneider takes the reader on a vivid journey from the origins of "the logic of the One" - only recently dubbed monotheism - through to the modern day, where monotheism has increasingly failed to adequately address spiritual, scientific, and ethical experiences in the changing world. In Part I, Schneider traces a trajectory from the ancient history of monotheism and multiplicity in Greece, Israel, and Africa through the Constantinian valorization of the logic of the One, to medieval and modern challenges (...) to that logic in poetry and science. She pursues an alternative and constructive approach in Part II: a "logic of multiplicity" already resident in Christian traditions in which the complexity of life and the presence of God may be better articulated. Part III takes up the open-ended question of ethics from within that multiplicity, exploring the implications of this radical and realistic new theology for the questions that lie underneath theological construction: questions of belonging and nationalism, of the possibility of love, and of unity. In this groundbreaking work of contemporary theology, Schneider shows that the One is not lost in divine multiplicity, and that in spite of its abstractions, divine multiplicity is realistic and worldly, impossible ultimately to abstract. (shrink)

What does the word clinic mean? The clinic is first a place to diagnose and treat sick persons. The clinic is also a way of thinking and speaking; it is a discursive practice that links health with knowledge. For Michel Foucault the clinic is a mode of perception and enunciation that allows us to see and name disease and to place statements about illness among statements about birth and death. Within the clinic resides understanding of disease visible on the surface, (...) yet hidden within the tissual depths, of an ailing patient. Foucault shows that by the dawn of the nineteenth-century medicine is no longer a two-dimensional reading of symptoms, but a three-dimensional probing from symptomatic surface into disease interior. The anatomical site of disorder hidden within tissual depths is visible to the scrutiny of pathologist, endoscopist or radiologist. The clinic, a discourse that enables us to think about disease when we make statements about health and death, operates not only in its familiar textual domain, the medical journal, but in pictures of the scene at the sickbed, and poetry about disease. The truth of disease and placement of that truth in a general plan of the world in Renaissance woodcuts and John Donne's poetry is different from the regime of truth after the birth of the clinic in Bichat'sTreatise on Membranes, the paintings of Laennec, Agnew and Gross, the modern lithographs and the verse of Walt Whitman and L. E. Sissman. Foucault's clinic is where knowledge and sickness some together in the modern period. (shrink)

Scientific inquiry possibly shares with people's ordinary understanding the same evolutionary determinants, and affect-laden intuitions that shape moral judgments also play a decisive role in decision-making, planning, and scientific reasoning. Therefore, if ordinary understanding does differ from scientific inquiry, the reason does not reside in the fact that the former (but not the latter) is endowed with moral considerations.

This article explores the ethical concept of neutrality through use of a psychiatric clinical vignette. In this case a psychiatry resident is faced with the treatment of a patient who was found by the FBI to be in possession of child pornography. Although not accused of any other crimes, the patient was a fugitive from the law and requesting treatment for pedophilia. Faced with the pressures of limited resources and anxiety about the patient's dangerousness to others, the resident and his (...) supervisor tried to strike a balance between the ethical principles of neutrality and beneficence. Through this vignette, the importance of neutrality, as well as how it can be compromised by other pressures such as expediency and anxiety, is explored. (shrink)

Although most people still behave like happy meat eaters, there are good reasons to think that many are in fact ambivalent about meat. Following up on earlier findings, in this paper we describe how, in focus groups, cultured meat triggered much discussion about meat, especially among older people. While young people wondered whether they would eat cultured meat products, older people thought about diet changes in a historical perspective and wondered if and how cultured meat might become a societal success. (...) Beneath the surface of everyday behavior, in which they followed mainstream norms, many of our research participants harbored moral concerns and in various ways expressed an interest in collective change. Reflecting on the focus group discussions, we suggest, first, that appreciating the important role of ambivalence in processes of moral change requires rethinking relations between ambivalence and morality. Second, the entanglement of ambivalence with ambiguity increases the “fluidity” of such processes of change: when it is no longer clear what exactly meat is, the meanings and experiences of eating it also become unsettled. This has implications for thinking about morality in times of change. Studying consumer choices cannot do justice to processes of ambivalence and ambiguity below the surface of behavior. More generally, the idea that morality resides in making up our minds about clear moral choices gives way to the need to become skilled, collectively as well as individually, in dealing imaginatively with ambivalence and ambiguity. (shrink)

Raw (pragmatic) and potential (theoretical) power is seen as the key to press freedom in various global settings. Because the locus of power determines the locus of freedom, the authors suggest a model to understand where the raw and potential power resides within a matrix consisting of the State, the Media Elite, the Journalists, or the People. Numerous questions concerning accountability and ethics are raised concerning the practical application of a model that purports to overcome cultural biases inherent in traditional (...) theories of press and society. (shrink)

It is argued that cultural attitudes of a speciesist nature are background to the current practice of animal use in teaching medical students and residents. The scope of this activity is estimated, and educational theory is enlisted to suggest that many assumptions about the effectiveness of the practice are not valid. An assessment of one course used for ob-gyn training is presented. Since it is clear that animal suffering should be avoided when possible, the case is made that alternatives to (...) animals may be used to replace animal use in much of current medical education. Medical educators should routinely question and offer adequate justification for any use of animals in medical education. (shrink)

The ability of the medical profession to sustain life, or more appropriately, to prolong dying, in patients with terminal illness, creates a most complex and controversial situation for all involved: the patient, if mentally alert; the patient's family; and the medical care team including physicians, nurses and attendants. This situation is especially complex in large acute care hospitals where medical and nursing students, residents and house officers receive advanced medical training. A major problem, prolonging the dying of the terminally ill, (...) with its medical, legal, ethical and economic complexities now confronts American society. The problem is particularly acute in teaching hospitals, in which one finds a disproportionate number of terminally ill patients. The ability to work at these questions as a community rather than as adversaries will determine much about the ability of the health care system to respect the dignity and autonomy of those who seek aid and comfort when faced with serious illness and impending death. Better communication between the physicians, health care providers, the lawyers and ethicists must be developed in order to solve these problems. Over the next ten years society and our elected representatives will be making very demanding decisions about the use of the health dollar. One possible way to prevent increasing costs is to reach significant agreement on the proper care of the dying. Proper care for the dying is being considered, discussed, and evaluated by very thoughtful people. It is not governments which should decide who is to live or who is to die. There is the serious problem of the 'slippery slope' to euthanasia by omission if cost containment becomes the major force in formulating policy on the proper care of the dying. (shrink)

Lack of access to health care coupled with a severe shortage of physicians is on the forefront of much debate nationally and internationally. Rural areas often suffer the most. Innovations in medical education, such as the creation of rural immersion rotations, are attempting to solve this health crisis. The purpose of this study was to investigate and analyze the narrative writings of 36 fourth–year medical students and primary care residents that participated in a rural immersion rotation in the Mississippi Delta. (...) A grounded theory data analysis led to the emergence of four central themes: Positive reflections of the experience, community health, limited access to health care, and alteration of prior perceptions. The findings of this research provide rich data from the perspective of the medical student and resident. This study concluded that the use of narrative inquiry was beneficial within the rural immersion experience, and the experience positively influenced and impacted medical students and residents. (shrink)

Objectives: To explore how subjects in a placebo-controlled vitamin A supplementation trial among Ghanaian women aged 15–45 years perceive the trial and whether they know that not all trial capsules are the same, and to identify factors associated with this knowledge.Methods: 60 semistructured interviews and 12 focus groups were conducted to explore subjects’ perceptions of the trial. Steps were taken to address areas of low comprehension, including retraining fieldworkers. 1971 trial subjects were randomly selected for a survey measuring their knowledge (...) that not all trial capsules are the same. The subjects’ fieldworkers were also interviewed about their characteristics and trial knowledge. Factors associated with knowledge were explored using multi-level modeling.Results: Although subjects knew they were taking part in research, most thought they were receiving an active and beneficial medication. Variables associated with knowledge were education and district of residence. Radio broadcasts benefited those with some schooling. Fieldworkers’ characteristics were not associated with subjects’ knowledge.Conclusions: Research and debate on new or improved consent procedures are urgently required, particularly for subjects with little education. (shrink)

Sociocultural norms against women can contribute to promoting intimate partner violence (IPV) and shape women's decision to disclose IPV. A cross‐cultural analysis of the existing literature is needed to present an overview of the influences of sociocultural norms on women's decisions regarding the disclosure of IPV across different cultural contexts. The purpose of the review was to synthesize published quantitative, qualitative, and mixed methods (MMs) studies to identify known sociocultural norms across different cultures that may influence women's decision to disclose (...) IPV. The Whittemore and Knafl framework, Rayyan software, and PRISMA flow diagram were used. Databases included APA PsycInfo, CINAHL, PubMed, SocINDEX, and Women's Studies International. The quality of studies was assessed by the MMs appraisal tool. A total of 15 research articles written in English and published in peer‐reviewed journals were included. Main categories emerged: (1) stigma surrounding IPV disclosure, victimization, and divorce; (2) gender roles; (3) preserving family honor; and (4) Children's well‐being and future. A one‐size‐fits‐all approach is not adequate for women who are considering disclosing IPV. Findings underscore that regardless of residing in individualistic countries, those sociocultural norms related to traditional gender roles and gender inequality are still important barriers to the disclosure of IPV among women with collectivist roots. (shrink)

Networks and the World Wide Web seem to provide an answer to efficiently creating and disseminating knowledge resources. Knowledge, however, is ambiguous in character, and contains both explicit (information) and tacit dimensions - the latter being difficult to value as well as to transfer. Participant identity, commitment and behaviour within the network also affect the sharing of knowledge. Hence, existing laws and norms (including property rights) which have been established on the basis of discrete transactions and monetary value-oriented exchange may (...) not be adequate to deal with the whole spectrum of knowledge transfer. A model is needed to address transfer across a large heterogeneous network. We introduce the concept of sub-networks where tacit knowledge resides and argue that considering social norms underlying trust and other informal mechanisms provides a more suitable basis for understanding the exchange of tacit knowledge. Norm establishment is complicated by the fact that values differ across cultures; however, the social norms that underpin sub-networks can sustain knowledge transfer within them. The purpose of this conceptual article is to introduce the concept of sub-networks and to identify the sub-network/network relationship as an area in which it is necessary to look beyond property rights and raise the issue of norms. We believe that an analysis of the role of social norms in knowledge sub-networks and their interaction with global networks points to a key element in understanding networks and any emerging theory of network ethics in the twenty-first century. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

Surgical expertise does not have a clear definition and is often culturally associated with power, authority, prestige, and case number rather than more objective proxies of excellence. Multiple models of expertise progression have been proposed including the Dreyfus model, however, they all currently require subjective evaluation of skill. Recently, efforts have been made to improve the ways in which surgical excellence is measured and expertise is defined using artificial intelligence, video recordings, and accelerometers. However, these aforementioned methods of assessment are (...) still subjective or indirect proxies of expertise, thus uncovering the neural mechanisms that differentiate expert surgeons from trainees may enhance the objectivity of surgical expertise validation. In fact, some researchers have already suggested that their neural imaging-based expertise classification methods outperform currently used methods of surgical skill certification such as the Fundamentals of Laparoscopic Surgery scores. Such imaging biomarkers would not only help better identify the highest performing surgeons, but could also improve residency programs by providing more objective, evidence-based feedback and developmental milestones for those in training and perhaps act as a marker of surgical potential in medical students. Despite the potential advantages of using neural imaging in the assessment of surgical expertise, this field of research remains in its infancy. This systematic review identifies studies that have applied neuromonitoring in assessing surgical skill across levels of expertise. The goals of this review are to identify the strongest neural indicators of surgical expertise, the limitations of the current literature on this subject, the most sensible future directions for further study. We found substantial evidence that surgical expertise can be delineated by differential activation and connectivity in the prefrontal cortex across multiple task and neuroimaging modalities. Specifically, novices tend to have greater PFC activation than experts under standard conditions in bimanual and decision-making tasks. However, under high temporal demand tasks, experts had increased PFC activation whereas novices had decreased PFC activation. Common limitations uncovered in this review were that task difficulty was often insufficient to delineate between residents and attending. Moreover, attending level involvement was also low in multiple studies which may also have contributed to this issue. Most studies did not analyze the ability of their neuromonitoring findings to accurately classify subjects by level of expertise. Finally, the predominance of fNIRS as the neuromonitoring modality limits our ability to uncover the neural correlates of surgical expertise in non-cortical brain regions. Future studies should first strive to address these limitations. In the longer term, longitudinal within-subjects design over the course of a residency or even a career will also advance the field. Although logistically arduous, such studies would likely be most beneficial in demonstrating effects of increasing surgical expertise on regional brain activation and inter-region connectivity. (shrink)

Despite governmental and private antismoking initiatives, tobacco smoking remains a significant public health and economic challenge. The Centers for Disease Control and Prevention estimates that for each year between 1997 and 2001, cigarette smoking and exposure to secondhand smoke caused approximately 438,000 U.S. residents to die prematurely, resulting in 5.5 million years of potential life lost, and in $92 billion dollars of lost productivity. Also, despite convincing scientific data that laws against indoor smoking protect people from the negative health effects (...) of cigarette smoke, not all states have afforded their residents this protection. As of July 2007, 16 states neither restricted nor banned indoor smoking in restaurants, private worksites, or government worksites, and many state statutes only required separate rooms for smokers rather than eliminating all smoking inside buildings. In several states, local governments have attempted to fill this gap by adopting their own antismoking measures. (shrink)

The concept of vulnerability has been the topic of considerable discussion in research bioethics, largely because of dissatisfaction with early constructions of the concept that were based on subpopulations of research subjects. These subpopulations have attributes likely to undermine their capacity to provide autonomous informed consent: persons who are relatively or absolutely incapable of protecting their own interests through negotiations for informed consent. Several subpopulations were seen as requiring special protections, including children, pregnant women, prisoners, racial minorities, the economically disadvantaged, (...) the very sick, and the institutionalized. Recent years have witnessed the identification of other subpopulations with attributes that could render them vulnerable, as well. For example, the Council for the International Organization of Medical Societies has named such potentially vulnerable groups as the homeless, nursing home residents, patients with incurable diseases, patients in the emergency department, employees, students, and members of communities who are unfamiliar with modern medicine. (shrink)

People regularly make decisions about how often and with whom to interact. During an epidemic of communicable disease, these decisions gain new weight, as individual choices exert more direct influence on collective health and wellbeing. While much attention has been paid to how people’s concerns about the health impact of the COVID-19 pandemic affect their engagement in behaviors that could curb the spread of the disease, less is understood about how people’s concerns about the pandemic’s impact on their social lives (...) affect these outcomes. Across three studies, we find that individuals’ estimates of the pandemic’s social impact are associated with an unwillingness to curtail social interaction and follow other Centers for Disease Control guidelines as the pandemic spreads. First, these associations are present in self-report data of participants’ own behaviors and behavior across hypothetical scenarios; second, participants’ estimates of the pandemic’s impact on social life in their location of residence are associated with movement data collected unobtrusively from mobile phones in those locations. We suggest that perceptions of social impact could be a potential mechanism underlying, and therefore potential intervention target for addressing, disease-preventing behavior during a pandemic. (shrink)

Background: Ethics consultants (ECs) are increasingly expected to possess core knowledge and skills. Few data address whether ECs actually possess recommended core knowledge. We aimed to measure pediatric ECs’ understanding of ethical principles, identify knowledge gaps, and explore associations between experience/training and knowledge in pediatric ethics consultations. Methods: We identified the 2 ECs most knowledgeable in pediatric ethics from each of 45 freestanding children's hospitals and an equal number of general teaching hospitals in the United States. This yielded a sample (...) of 159 eligible pediatric ECs. Pediatric ECs were sent a survey measuring ethics training, characteristics of the ethics consultation service, and EC knowledge, as assessed by a previously validated scale entitled the Test of Residents’ Ethics Knowledge for Pediatrics (TREK-P). Of 102 completed surveys received, 99 were used in the analysis. Results: Seventy-three percent of ECs had completed ≥1 formal training modality, most commonly bioethics mini-courses, master's degrees, or certificate programs (20–30% each). Respondents infrequently received salary support (32%) or had a budget (28%) to support ethics work. The median TREK-P score was 19 (interquartile range [IQR] 17–21). Forty percent of subjects scored ≥20, surpassing the threshold of adequate performance proposed in previous work. Median scores were significantly higher among ECs with formal training in ethics but did not differ significantly by other variables. In secondary analyses, high scores (≥20) were significantly more common among ECs receiving salary support (55% vs. 33%, p = 0.04) and who had formal ethics training (47% vs. 22%, p = 0.02). Items pertaining to privacy, genetic testing, and assent, were answered incorrectly by >33% of ECs. Conclusions: High scores on a validated ethics knowledge scale were more common among ECs with salary support or formal ethics training. The study highlights knowledge gaps that warrant consideration as EC becomes a professionalized endeavor. (shrink)

This article challenges the orthodox view of international law, according to which states have no legal duty to cooperate. It argues for this legal duty in the context of COVID-19, based on the ethical principles of solidarity, stewardship, and subsidiarity. More specifically, the article argues that states have a legal duty to cooperate during a pandemic (as solidarity requires); and while this duty entails an extraterritorial responsibility to care for and assist other nations (as stewardship requires), the legal duty to (...) cooperate still allows states to attend first to the basic needs of those under their own jurisdiction—namely, fellow nationals and residents (as subsidiarity requires). The article provides a definition and philosophical justifications for this legal duty that are lacking in the literature by examining its application to a current COVID-19 controversy: namely, states’ responsibility to assist other countries in greater need by, inter alia, exporting at a discount or donating scarce COVID-19 treatments (including vaccines). In providing a principled tripartite account of pandemic governance, this conceptual and normative article offers a new lens for debating the potential international treaty for pandemic prevention, preparedness, and response that has now been drafted and is under negotiation at the World Health Assembly, by responding to the recent backlash against multilateralism by substantiating global co-responsibilities in times of pandemics and beyond. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.3 (2003) 104-107 [Access article in PDF] Motivating Aesthetics Cynthia C. Rostankowski Humanities Department San Jose State University The territory of philosophical aesthetics remains a conceptual hinterland in the world of academic disciplines. It is not the only hinterland, but in comparison to other disciplines in arts and letters, few scholars engage in the subject professionally, and many people avoid the territory it occupies (...) as a place to visit, let alone to tarry or reside. Why is this? Usually people do not wish to visit places that are uncomfortable in some way. Frozen wastelands, blazing deserts, war zones, and places with nothing to do or see are usually avoided because they are perceived as unpleasant, dangerous, or boring,and the same is very likely true of their conceptual analogs. In what senses might some people perceive aesthetics as analogous to Siberia, Sudan, or central Kansas? I would like to investigate what it is about aesthetics that causes people to shy away from it more often than to flock to it. I have long been fascinated by the responses of students who express amazement or confusion when exposed to the field of aesthetics as a part of an introductory philosophy class, or of arts educators who do not know what to do with aesthetics since it does not seem quite to fit with the rest of what they do, or the responses of some artists or other arts practitioners who are occasionally disdainful of aesthetics. It would be easy to say that aesthetics has merely had bad press or inadequate exposure in the classroom, but I suspect there is more to it than that. I have experienced many of the situations I have just mentioned, and they have usually surprised and sometimes demoralized [End Page 104] me. They have always motivated me to think harder about my beloved field of interest, to try to reveal its attractions to those who do not find it as appealing and engaging as I do, or as you, my reader does. (I am presuming that one who is reading an essay in a journal about aesthetic education has already found his or her comfort zone in the field.) I will also presume to offer some thoughts about motivating an interest in aesthetics among the aesthetically uninterested — why one might want to do it, and what one might do. Please note, I am not speaking of the aesthetically disinterested 1 ; they too have already found their place in the discipline!It is likely that the problem of aesthetics has to do in part with misunderstandings, and those misunderstandings are multi-layered. If one looks up the word "aesthetic" in the Oxford English Dictionary, one finds the following: (F)rom the Greek for perception...and, being pre-occupied;...pertaining to things perceptible by the senses, things material;..."criticism of taste"...the science which treats of the conditions of sensuous perception...of or pertaining to the appreciation or criticism of the beautiful...Recent extravagances in the adoption of a sentimental archaism as the ideal of beauty have still further removed aesthetic and its derivatives from their etymological and purely philosophical meaning. There are varied suggestions about the use of the term, including the mention of its removal in contemporary parlance from its original meanings. If one looks up the keyword "aesthetic" on the Internet, one may find the following sites: skin care, plastic surgery, dentistry, exterior and interior design, tattoos, and some art, art theory, and philosophy among other things. An exemplification in practice of what is suggested in the OED. It is clear that the meaning of the word "aesthetic" has become at best imprecise, at worst confusing in common parlance.So, the first misunderstanding regarding aesthetics is the meaning of the term. What is philosophical aesthetics? It is not what some misconstrue as the imposition of value judgments on society. Unfortunately, some presume that because matters of taste or definitions of beauty are considered in the field, someone must be telling someone what they ought to think is pleasing or beautiful. This is not the focus... (shrink)

The Findlay & Walker target article emphasizes the role of the target-nonspecific “fixate” system while downplaying the role of the target-specific “move” system in determining saccade latency. We agree that disengagement of the fixate system is responsible for the target-nonspecific latency reduction associated with the gap effect. However, high target predictability and extensive training at a target location can also result in latency reductions, the culmination of this being express saccades. The target-specificity associated with the latter forms of latency reduction (...) implicate a mechanism involving the move system. Recently discovered neurophysiological correlates underlying these behavioural phenomena reside in the superior colliculus. (shrink)

America’s industries and families continue to forsake cities for suburban and rural environs, in the process leaving nonproductive lands (brownfields) and simultaneously removing greenfield land from agriculturally or biologically productive use. In spite of noteworthy exceptions, urban regions which once functioned as vital communities continue in economic and social decline. Discussion or debate about the problem (or, indeed, whether it is a problem at all) invokes systems of values which often are not articulated. Some attribute the urban exodus to departure (...) from personal ethical norms (e.g., substance abuse, violence, welfare addiction) by urban residents, as though ethical decline is driving the phenomenon. Others take the exact opposite stance, that social and economic decline follow the departure of the economic base. There is no consensus on what government should do about the problem, or whether government should be involved at all. I present elements of a land-use ethic which can accommodate the foregoing. I argue that government is already involved in the brownfields problem because urban flight is facilitated by public policies which de facto subsidize the process. I further argue that the debate invokes key—but unexamined—assumptions regarding limits. Where there are few substitutes for resources and the social cost of exploitation is high, government intervention in the market is necessary; “value-free” economic approaches need to be supplemented by values concerning what ought to be, i.e., what is desirable for society. (shrink)