This is a welcome reprint of a book that continues to grow in importance.

Two attitudes are possible: one, that the world is an absolute jungle and that the exercise of coercive power by rulers is only a manifestation of this; and the other, that it is both necessary and right that there should be this exercise of power, that through it the world is much less of a jungle than it could possibly be without it, so that one should in principle be glad of the existence of such power, and only take exception (...) to its unjust exercise. (shrink)

Objective: To evaluate one ethics rounds model by describing nurses’ and doctors’ experiences of the rounds. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly (...) fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses’ expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous. Conclusion: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

Research ethics committees are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.

An embedded automaton is introduced to monitor the whole glycolysis process in pancreatic β-cell and it is a hybridization of both non-deterministic finite automaton and push-down automaton. The set of irreversible and reversible reactions in the glycolysis process are related to non-deterministic finite automaton and push-down automaton respectively. The embedded automaton is used to observe the glucose metabolism with the states of acceptance and rejection. The acceptance state of the embedded automaton depicts the normal level of glycolysis and insulin secretion. (...) The rejection state of this machine shows inhibition of glycolysis which obstructs the secretion of insulin. The subsequent low level of insulin leads to the high blood glucose level also known as hyperglycemia. In this study, the designed machine can be used to regulate the process of glycolysis through a group of regulatory glycolytic enzymes for the treatment of Diabetes mellitus at molecular level. (shrink)

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

A problem in the text of Pindar, the interpretation of λαρετον, O. 2. 87, seems to be vanishing, swept away by a remarkable consensus of recent criticism, a consensus the more remarkable in that it accepts a false solution to a genuine difficulty. This article has two purposes, the first and more important of which is to argue that the currently prevailing answer is manifestly wrong, the second to offer evidence in support of a different approach. Simply read γαρυτων, recent (...) critics maintain, and all problems disappear. Since -ο- and -ω- were not yet distinguished in the orthography of Pindar's day, γαρυτων is as correct as the unanimous γαρύτον of the MSS, testimonia, and scholia. By this simple change, the argument proceeds, the troublesome dual of the MSS is purged and with it the ‘historicist hare’, as one critic has recently called it, which less enlightened Pindarists chased for so long. If there is no dual, there is no need to speculate as to the identity of the ‘pair’ likened to κρακς and contrasted with the ‘divine bird of Zeus’, the man who is wise φυ. We need no longer suppose that the μαθντς are Simonides and Bacchylides – the traditional answer – or any other specific rivals. Unfortunately for this view, there is no evidence to justify taking γαρυτων as a plural, which is of course precisely what critics have been doing. It is – if anything – a third dual imperative , and every bit as much a dual as the γαρύτον of the MSS. Mr Stoneman is not alone in his ready dismissal of the ‘historicist hare’. Here is the view of Professor Lloyd-Jones: ‘… the lightest possible alteration converts the dual to a plural imperative, so that the number two vanishes’. A year before, Professor C. A. P. Ruck had chided the scholiasts for ‘reading out of Pindar's ΓΑΡΥΕΤΟΝ the dual…rather than the plural’. Bowra had declared that γαρυτων ‘would be the plural of the imperative’. The belief is widespread and persistent; those who wish a full conspectus of earlier views on the matter may consult the massive compilation made by Dr J. van Leeuwen in 1964. Not all critics and editors have endorsed the change from the traditional reading. While it has been in the successive Teubner editions since Schröder adopted it in 1900, neither Turyn nor Bowra accepted it. But among those who have argued for γαρυτων, only one has expressed any doubt that it is a plural, and that one is Theodor Bergk, who first proposed it. Indeed Bergk expressed no doubt about its being a dual. (shrink)

Increased complexity of representations in development probably results from the differentiation of distributed neural circuits. Axonal differentiation plays a crucial role in this process. Axonal differentiation appears to be achieved in stages, each involving combinations of constructive and regressive events controlled by cell intrinsic and cell extrinsic information.

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Context: Josef Mitterer has become known for criticizing the main exponents of analytic and constructivist philosophy for their blind adoption of a dualistic epistemology based on an alleged ontological difference between world and words. Judith Butler, who has developed an influential model of (de)constructivist feminism and has been labeled a linguistic constructivist, has been criticized for sustaining exactly what, according to Mitterer, most modern philosophy fails to acknowledge: namely that there is no ontological difference between objective facts beyond language and (...) the discourse about these facts. Problem: In the scholarly discussion on non-dualism, two main questions have been raised: Where does Mitterer’s basic consensus, i.e., the starting-point description, come from? and: What does it mean, to say that further descriptions change their object? Method: Comparative analysis of the core concepts of Mitterer’s and Butler’s work in the context of the history of ideas. Results: Butler’s conception of a performative production of objectivity through discursive and non-discursive iterated practices can be interpreted as an illustration of Mitterer’s claim that descriptions change their object. The problem of where Mitterer’s starting-point descriptions come from can be solved by adopting Butler’s concept of culturally inherited practices. (shrink)

Modern medicine is increasingly aware of the significance of patient autonomy in making treatment choices. This would seem to be particularly important where the therapy requested was "voluntary" as in fertility treatment or cosmetic surgery. However, the Hippocratic doctrine "Primum non nocere", seems especially relevant where the treatment sought may have a low chance of a successful outcome or even be life-threatening. Mrs A's case demonstrates the difficulty faced by the physician who wants to maximise her patient's autonomy, but "Above (...) all, do no harm". (shrink)