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 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)

Quite rightly, philosophers of physics examine the theories of physics, theories like Quantum Mechanics, Quantum Field Theory, the Special and General Theories of Relativity, and Statistical Mechanics. Far fewer, however, examine how these theories are put to use; that is to say, little attention is paid to the practices of theoretical physicists. In the early 1950s David Bohm and David Pines published a sequence of four papers, collectively entitled, ‘A Collective Description of Electron Interaction.’ This essay uses that quartet as (...) a case study in theoretical practice. In Part One of the essay, each of the Bohm-Pines papers is summarized, and within each summary an overview is given, framing a more detailed account. In Part Two theoretical practice is broken into six elements: (a) the use of models, (b) the use of theory, (c) modes of description and narrative, (d) the use of approximations, (e) experiment and theory, (f) the varied steps employed in a deduction. The last element is the largest, drawing as it does from the earlier ones. Part Three enlarges on the concept of ‘theoretical practice,’ and briefly outlines the subsequent theoretical advances which rendered the practices of Bohm and Pines obsolete, if still respected. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. Dr (...) Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: D.Hughes@wye.ac.uk), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (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)

In Classical Quarterly N.S. ix , 80 ff. Professor Hugh Lloyd-Jones published an article on the closing scenes of Seven Against Thebes. In it he directed an assault on the orthodox belief that these scenes are, in whole or in part, not authentic. The movement in favour of authenticity seemed all the stronger when independently, and in the same year, Walter Potscher put forward arguments in Eranos in defence of some parts of the disputed passages.

Uncoupling proteins (UCPs) regulate mitochondrial function, and thus cellular metabolism. Angiotensin‐converting enzyme (ACE) is the central component of endocrine and local tissue renin–angiotensin systems (RAS), which also regulate diverse aspects of whole‐body metabolism and mitochondrial function (partly through altering mitochondrial UCP expression). We show that ACE expression also appears to be regulated by mitochondrial UCPs. In genetic analysis of two unrelated populations (healthy young UK men and Scandinavian diabetic patients) serum ACE (sACE) activity was significantly higher amongst UCP3‐55C (rather than (...) T) and UCP2 I (rather than D) allele carriers. RNA interference against UCP2 in human umbilical vein endothelial cells reduced UCP2 mRNA sixfold (P < 0·01) whilst increasing ACE expression within a physiological range (<1·8‐fold at 48 h; P < 0·01). Our findings suggest novel hypotheses. Firstly, cellular feedback regulation may occur between UCPs and ACE. Secondly, cellular UCP regulation of sACE suggests a novel means of crosstalk between (and mutual regulation of) cellular and endocrine metabolism. This might partly explain the reduced risk of developing diabetes and metabolic syndrome with RAS antagonists and offer insight into the origins of cardiovascular disease in which UCPs and ACE both play a role. (shrink)

Catalogue of the Hugh Nevill Collection of Sinhalese Manuscripts in the British Library. K. D. Somadasa. Pali Text Society and the British Library. Vol. 1, 1987. xi, 440 pp. £22.00. Vol. 2, 1989. vii, 316 pp. £24.95.

In this paper we investigate some families of decision problems associated with a restricted class of Post canonical forms, specifically, those defined over one-letter alphabets whose productions have single premises and contain only one variable. For brevity sake, we call any such form an RPCF (Restricted Post Canonical Form). Constructive proofs are given which show, for any prescribed nonrecursive r.e. many-one degree of unsolvability D, the existence of an RPCF whose word problem is of degree D and an RPCF with (...) axiom whose decision problem is also of degree D. Finally, we show that both of these results are best possible in that they do not hold for one-one degrees. (shrink)

Book reviewed in this article: The Philosophical Assessment of Theology: Essays in Honour of Frederick C. Copleston. Edited by Gerard J. Hughes. Language, Meaning and God: Essays in Honour of Herbert McCabe OP. Edited by Brian Davies. God Matters. By Herbert McCabe. Philosophies of History: A Critical Essay. By Rolf Gruner. The ‘Phaedo’: A Platonic Labyrinth. By Ronna Burger. Lessing's ‘Ugly Ditch’: A Study of Theology and History. By Gordon E. Michalson, Jr. Peirce. By Christopher Hookway. Frege: Tradition and (...) Influence. Edited by Crispin Wright. The Private World. Selections from the Diario Íntimo and Selected Letters 1890–1936. By Miguel de Unamuno, translated by Anthony Kerrigan, Allen Lacy, Martin Nozick. A Third Collection: Papers by Bernard J.F. Lonergan, S.J. Edited by Frederick E. Crowe. Philosophical Papers. By Charles Taylor. 2 vols. Principles of Language and the Mind. By T.P. Waldron. The Principle of Double Effect: A Critical Appraisal of its Traditional Understanding and its Modern Reinterpretation. By L.I. Ugorji. Human Rights: Fact or Fancy By Henry B. Veatch. Enlightenment and Alienation: An Essay towards a Trinitarian Theology. By Colin Gunton. Only Human. By Don Cupitt. The Roots of the Modern Christian Tradition. Edited by E. Rpzanne Elder. ‘Africanische Theologie’: Darstellung und Dialog.. By Heribert Rücker. African Religions in Western Conceptual Schemes. By Emefie Ikenga Metuh. The Destiny of Man: Dagaare Beliefs in Dialogue with Christian Eschatology. By Edward Kuukure. The World in Between: Christian Healing and the Struggle for Spiritual Survival. By E. Milingo. Theology in Africa. By Kwesi A. Dickson. The Future of Anglican Theology. Edited by M. Darrol Bryant. Reconciling. By John Coventry. The Genesis of Faith: The Depth Theology of Abraham Joshua Heschel. By John C. Merkle. Anthropology in Theological Perspective. By Wolfhart Pannenberg. Contemporary Approaches to the Study of Religion. Volume II: The Social Sciences. Edited by Frank Whaling. American Sociology: Worldly Rejections of Religion and Their Directions. By Arthur J. Vidich and Stanford M. Lyman. A Critical Theory of Religion: The Frankfurt School. By Rudolf J. Siebert. The Anthropology of Evil. Edited by David Parkin. The Wealth of Christians. By Redmond Mullin. Biblical Interpretation in Ancient Israel. By Michael Fishbane. Reading the Old Testament: An Introduction. By Lawrence Boadt. Old Testament Theology: Its History and Development. By John H. Hayes and Frederick C. Prussner. God's Conflict with the Dragon and the Sea: Echoes of a Canaanite Myth in the Old Testament. By John Day. Law and Wisdom from Ben Sira to Paul. By Eckhard J. Schnabel. The Order of the Synoptics: Why Three Synoptic Gospels? By Bernard Orchard and Harold Riley. The Making of Mark. By J. Duncan M. Derrett. Argumentation bei Paulus. By Folker Siegert. Christians and the Military: The Early Experience. Edited by Robert J. Daly. Origienes' Eucharistielehre im Streit der Konfessionen; Die Auslegungsgeschichte seit der Reformation. By Lothar Lies. L'église de Cappadoce au IVe siècle d'après la correspondance de Basile de Césarée. By Benpit Gain Cave Monasteries of Byzantine Cappadocia. By Lyn Rodley. Augustine of Hippo, Selected Writings. Translated with an Introduction by Mary T. Clark. Wisdom from St Augustine. By Vernon J. Bourke. A History of Religious Ideas, Vol. 3: From Muhammad to the Age of Reforms. By Mircea Eliade. Les Lectionnaires Copies Annuels: Basse‐Egypte. By Ugo Zanetti. Humanism and Scholasticism in Late Medieval Germany. By James H. Overfield. Wyclif. By Anthony Kenny. The Lady and the Virgin: Image, Attitude and Experience in Twelfth Century France. By Penny Shine Gold. Unquiet Souls: Fourteenth‐Century Saints and Their Religious Milieu. By Richard Kieckhefer. Luther: Theologian for Catholics and Protestants. Edited by George Yule. La Réforme Catholique: Le Combat de Maldonat. By Paul Schmitt. Roman Catholicism in England: From the Elizabethan Settlement to the Second Vatican Council. By Edward Norman. The Life of David Brainerd. Edited by Norman Pettit. Nineteenth Century Religious Thought in the West. Edited by Ninian Smart, John Clayton, Patrick Sherry and Steven T. Katz The Significance of Jesus Christ in Asia. By Hans Staffner. Is the Virgin Mary Appearing at Medjugorje? By René Laurentin and Ljudevit Rupčić. Mary Queen of Peace: Is the Mother of God Appearing in Medjugorje? By Lucy Rooney and Robert Fancy. (shrink)

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)

One of the arguments against conducting human subject trials in the Third World adopts a distributive justice principle found in a commentary of the CIOM'S Eighth Guideline for international research on human subjects. Critics argue that non-participant members of the community in which the trials are conducted are exploited because sponsoring agencies do not ensure that the products developed have been made reasonably available to these individuals. I argue that the distributive principle's wording is too vague and ambiguous to be (...) used to criticize any trial. Furthermore, the mere fact that an experiment does not fulfill this particular distributive justice principle does not entail that it is unethical. (shrink)

In Bester’s article (2018) challenging the use of the harm principle and advocating sole reliance on the use of a best interest standard (BIS) in pediatric decision-making, we believe that the auth...

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.

A number of authors have drawn attention to the contributions to geology of Robert Hooke, and it has been pointed out that in several ways his ideas were more advanced than those of Steno, who is sometimes taken to be the founder of geology as a scientific discipline. Moreover, it has been argued that in a number of instances Hooke should receive the credit for ideas which are usually believed to have originated in the work of James Hutton. This recognition (...) of the significance of Hooke's work is regarded by the present writer as being well founded. But, by contrast, the relationship between Hooke's geological ideas and his views on the proper methods for conducting scientific enquiries has been largely overlooked, and his views on the methodology of science, as revealed in his Posthumous works, have received little discussion. Moreover, on one of the few occasions on which they were discussed, by William Whewell, they were belittled. Whewell regarded Hooke's methodological contribution as merely ‘an attempt to adapt the Novum organon to the age which succeeded its publication’, 5 and he implied that the ‘same imperfections’ were to be found in the writings of both Hooke and Bacon. The influence of Bacon is, to be sure, most obvious in Hooke's general philosophy. Nevertheless, it will be argued that Hooke had a much clearer idea than did Bacon of the importance of so-called ‘hypothetico-deductive’ methods in science, and that in many ways his methodological views represent a significant advance on those of Bacon. (shrink)

Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is (...) concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions. (shrink)

B. R. Frieden uses a single procedure, called extreme physical information, with the aim of deriving 'most known physics, from statistical mechanics and thermodynamics to quantum mechanics, the Einstein field equations and quantum gravity'. His method, which is based on Fisher information, is given a detailed exposition in this book, and we attempt to assess the extent to which he succeeds in his task.

The following article is a response to the position paper of the Hastings Center, “Ethical Challenges of Chronic Illness”, a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. (shrink)

Two rotational bands have been identified and characterized in the proton-magic N = Z + 1 nucleus Ni-57. These bands complete the systematics of well-and superdeformed rotational bands in the light nickel isotopes starting from doubly magic Ni-56 to Ni-60. High-spin states in Ni-57 have been produced in the fusion-evaporation reaction Si-28(S-32, 2p1n)Ni-57 and studied with the gamma-ray detection array GAMMASPHERE operated in conjunction with detectors for evaporated light charged particles and neutrons. The features of the rotational bands in Ni-57 (...) are compared to those of neighbouring isotopes and interpreted by means of configuration-dependent cranked Nilsson-Strutinsky calculations. The two observed high-spin bands are considered signature partners and assigned to configurations with one 1g(9/2) proton and one 1g(9/2) neutron, resulting in an unambiguous understanding of the energetically favoured signature alpha = -1/2 band but a somewhat less satisfactory description of the signature alpha = +1/2 band. (shrink)

Currently, an emphasis is being placed on the integration of ethical issues into the business curriculum. This paper investigates the viability of using student group interaction to induce an upward movement in the stages of moral development as advanced by Kohlberg. The results of a classroom experiment using graduate business law students suggest that formulating groups that mix stages of moral development can provide a robust environment for upward movement. In addition, the results suggest strategies for formulating effective groups, based (...) upon entry levels as measured by the Defining Issues Test. (shrink)