This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Extending a normal 24 hours day by four hours is unexpectedly highly disruptive to daily rhythms in gene expression in the blood. Using a paradigm in which human subjects were exposed to a 28 hours day, Archer and colleagues show how this sleep‐altering forced desynchrony protocol caused complex disruption to daily rhythms in distinct groups of genes. Such perturbations in the temporal organisation of the blood transcriptome arise quickly, and point to the fragile nature of coordinated genomic activity. Chronic disruption (...) of the daily and circadian rhythms in sleep compromise health and well‐being and this study reveals potential new molecular targets to combat the disruptive effects of shift work and jetlag. (shrink)

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

This paper consists of commentaries about and the reprint of an autobiographical essay authored by Italian medium Eusapia Palladino and published in 1910. The details of the essay are discussed in terms of the writings of other individuals about the life and performances of the medium. The essay conveys a view of Palladino as a person who has suffered much in life and has a mission to help scientific research into mediumship. Typical of the positive emphasis in autobiographies in general, (...) the medium did not discuss negative aspects of her performances. Due to the fact that the essay appeared during Palladino's visit to New York City in which many authors branded her as a fraud, it may be speculated that the purpose of this autobiography was to elicit sympathy from the American public. While some of the statements that Palladino made about phenomena are consistent with the statements of other authors who have written about her, there are several statements that show alternate or incomplete versions of particular events in her life. The differences suggests that Palladino's essay and other discussions about the medium's life are not reliable when it comes to specific details and to biographical accuracy. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Michael A. PetersBeijing Normal UniversityMy deepest condolences to Pepe, Dom and Marcus and to Jim’s grandchildren. Tina and I spent a lot of time at the Marshall family home, often attending dinn...

Hugh V. Mclachlan Cet article est une réponse à la critique de Saunders de ma proposition de politique non conséquentialiste publiée précédemment concernant l’utilisation d’une loterie pour la distribution de vaccins rares par l’État face à une pandémie de grippe. J’y ai soutenu que, pour des raisons de justice, l’État devrait distribuer une partie du vaccin rare qu’il pourrait détenir à certains de ses employés de la santé et le reste aux citoyens de manière aléatoire et égale sur le (...) principe d’une loterie. Au coeur de la critique de Saunders se trouve l’affirmation selon laquelle j’ai omis à tort de prendre en compte les différences moralement pertinentes dans les besoins et la capacité de production entre les receveurs potentiels du vaccin. Le point central de ma réponse ici est que le fait que le besoin et la capacité de production soient ou non des facteurs moralement pertinents dépend de qui ou de quoi distribue le vaccin, à qui ils le distribuent et pourquoi ils le font. Par exemple, la discrimination entre les personnes dans la distribution de vaccins publics distribués à titre prophylactique sur la base de leur âge est injuste, qu’elle soit ou non moralement justifiable pour d’autres motifs. (shrink)

Les dépenses en médicaments augmentent plus rapidement que les ressources disponibles. Les facteurs qui jouent sur l’augmentation des dépenses en médicaments au Canada sont essentiellement associés au volume d’utilisation et à l’arrivée de nouveaux médicaments. Parmi ceux-ci, certains sont extrêmement onéreux et apportent peu de bénéfices par rapport à leur coût. Les évaluateurs sont amenés à s’interroger sur l’opportunité de les inscrire sur la liste des produits couverts par le régime public. L’un des problèmes les plus persistants pour les agences (...) d’évaluations est celui de justifier le refus de rembourser un médicament sur la base de son coût élevé. Nous croyons que le rationnement de médicaments très chers peut s’appuyer sur une justification transparente qui comprend, outre des données probantes, des principes et des valeurs éthiques. Dans cet article, nous entreprenons d’établir et d’analyser les critères et principes pharmaco-économiques et éthiques à considérer lorsqu’il s’agit de limiter équitablement l’accès à des médicaments onéreux. (shrink)

Le présent article propose une approche sémiotique du concept rhétorique d'éthos, et analyse de ce point de vue les portraits des candidats à l'élection présidentielle de 2002 en France, en première page de leurs prospectus électoraux.

Si la modernité consiste à trouver le nouveau radical, la fin de la postmodernité n’est pas la sortie de l’art, dans la culture de masse, le kitsch ou le silence mais bien le moment où la modernité trouve ses marges, repère la lisière de ses différences. La tâche de la pensée ne consiste pas à désespérer de l’art ou de la nouveauté mais à identifier les lieux et les fins de la différence dans ce que l’on peut nommer une « (...) en-différence » (in-difference) qui n’a rien de négatif. Ce que montre une série d’exemples artistiques tirés de la production contemporaine, y compris télévisée. (shrink)

Résumé: Cet article discute de façon générale les cas dans lesquels les symboles peuvent être utilisés de façon avantageuse dans le raisonnement logique et mathématique, et aspire, par un examen des symboles déjà existants, à déterminer quelques règles ou principes, d’abord, quant à l’opportunité d’introduire de nouveaux symboles, puis, quant au types de symboles qui doivent être sélectionnés. Cet article contient aussi une brève histoire du développement graduel de la méthode symbolique propre à l’auteur, telle qu’elle a été présentée et (...) expliquée par l’auteur dans ses articles publiés dans les Proceedings of the London Mathematical Society, le Educational Times, le Philosophical Magazine, et Mind. (shrink)

In his article ‘God and Probability’, 1 Hugh Mellor introduced the notion of the ‘bridge-hand fallacy’, allegedly committed by those who think they can appeal to probabilities in arguments for design. I should like to give this notion another airing, partly because of its recent criticism in two interesting books - R. G. Swinburne' The Existence of God and D. J. Bartholomew's God of Chance - and partly because it seems worth asking how it fares in relation to the (...) most recent examples of design argument, namely those which appeal to the so-called ‘anthropic principle’ in cosmology. (shrink)

Le visage est-il un phénomène simple ou complexe? Serait-il juste de le définir comme cet aspect de l’être humain qui dépasse tout effort de compréhension et de totalisation, ou bien y a-t-il d’autres caractéristiques de ce phénomène qu’il faut inclure dans toute définition ou description du visage? Le visage est un événement fondamental. Parmi les multiples manières d’approcher l’être, de se rapporter...

Under the careful editorship of R. A. Markus, this book appears to be one of the very finest anthologies of critical essays dedicated to the elucidation of the thought of St. Augustine. Those familiar with Markus’ contribution to The Cambridge History of Later Greek and Early Medieval Philosophy will readily attest to the depth as well as to the breadth of understanding which Markus brings to Augustine scholarship. Three of the essays appear for the first time: "Action and Contemplation," by (...) Robert J. O’Connell; "Si Fallor, Sum," by Gareth B. Matthews; "On Augustine’s Concept of a Person," by A. C. Boyd. The remaining articles have appeared either as separate pieces or as journal articles: "St. Augustine and Christian Platonism," by A. H. Armstrong; "St. Augustine on Signs," by R. A. Markus; "The Theory of Signs of St. Augustine’s De Doctrina Christiana," by B. Darrell Jackson; "Augustine on Speaking from Memory" and "The Inner Man," by Gareth B. Matthews; "Augustine on Foreknowledge and Free Will," by William L. Rowe; "Augustine on Free Will and Predestination," by John M. Rist; "Time and Contingency in St. Augustine," by Robert Jordan; "Empiricism and Augustine’s Problems about Time," by Hugh M. Lacey; "Political Society," by P. R. L. Brown; "The Development of Augustine’s Ideas on Society before the Donatist Controversy" and "De Civitate Dei, XV, 2, and Augustine’s Idea of the Christian Society," The essays display scholarly depth as well as concern for contemporary philosophical problems. It is an excellent addition to Augustine scholarship and to contemporary philosophizing. This book is part of the Doubleday Anchor Modern Studies in Philosophy Series, under the general editorship of Amelie O. Rorty.—D. A. C. (shrink)

No fruitful discussion of the logic of religious belief can afford to ignore George Mavrodes' classification of propositional concepts, i.e. concepts predicable of propositions singly or in sets , as an analytical tool for pinning down the ‘person-oriented’ and ‘content-oriented’ factors in such ‘epistemic activities’ as religious proving, experiencing, and verifying. Mavrodes shows in particular that the formal model of logical soundness, i.e. valid form and true premises, has but limited application to proving, experiencing, and verifying as ways of giving (...) good reasons for religious belief. In this essay, I will show how Mavrodes' analysis of the logic of religious belief can be extended by substituting a procedural model of logical soundness for the truth-functionally formal model that he adopts. I will show further why it is desirable and, in certain instances, vital to extend his analysis in this manner. Along the way, I will explain why the extension that I am advocating augments Mavrodes' original analysis without substantially altering it or sacrificing any of its original analytical virtues. (shrink)

Editors who profess to interpret these lines, while reaching agreement on some few points of detail, concur chiefly in a somewhat irritable half-confession of puzzlement and not unnatural tendency to avenge their smart on the poet's broader back. Hence the suggestions of historical misrepresentation and dramatic confusion, the hypothesis of a late recension, and other well-worn devices of commentatorial window-dressing. A task more likely to be of value to the study of the Georgics is to explore this short, compact poem (...) for that unifying principle among the multiplicity of details, in accordance with which the triumphator and the temple-builder, the Greek festival and the Italian venue, the lightness of allegory and the ponderous literalism of the Via Sacra, Virgil and Octavian each perform their different functions and move in harmony with the whole poetic plan. (shrink)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

The bioethical principle of autonomy is problematic regarding the future of the embryo who lacks the ability to self-advocate but will develop this defining human capacity in time. Recent experiments explore the use of clustered regularly interspaced short palindromic repeats /Cas9 for germline engineering in the embryo, which alters future generations. The embryo’s inability to express an autonomous decision is an obvious bioethical challenge of germline engineering. The philosopher Joel Feinberg acknowledged that autonomy is developing in children. He advocated that (...) to reserve this future autonomy, parents should be guided to make ethical decisions that provide children with open futures. Here, Feinberg’s 1980 open future theory is extended to the human embryo in the context of CRISPR germline engineering. Although the embryo does not possess the autonomous decision-making capacity at the time of germline engineering, the parental decision to permanently change the unique genetic fabric of the embryo and subsequent generations disregards future autonomy. Therefore, germline engineering in many instances is objectionable considering Feinberg’s open future theory. (shrink)