Many writers in various fields--philosophy, religion, literature, and psychology--believe that the question of the meaning of life is one of the most significant problems that an individual faces. In The Meaning of Life, Second Edition, E.D. Klemke collects some of the best writings on this topic, primarily works by philosophers but also selections from literary figures and religious thinkers. The twenty-seven cogent, readable essays are organized around three different perspectives on the meaning of life. In Part I, the readings assert (...) and defend the theistic view that without the existence of God--or faith in God--life has no significance or purpose. In Part II the selections deny this thesis, defending instead the humanistic alternative--that life has or can have meaning and worth without any theistic beliefs or commitment. In the final group of readings, contributors ask if the question of the meaning of life is in itself legitimate and significant. The volume also includes an introduction by the editor and a selected bibliography. This new edition adds essays by A. J. Ayer, Hazel Barnes, William Lane Craig, Owen Flanagan, Antony Flew, Thomas Nagel, Kai Nielsen, Philip L. Quinn, Arthur Schopenhauer, and Walter T. Stace.The only anthology of its kind, The Meaning of Life, Second Edition, is ideal for courses in introduction to philosophy and human nature. It also provides an accessible and stimulating introduction to the subject for general readers. (shrink)

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics (...) of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care. (shrink)

In this volume, I have given attention to what I consider to be some of the central problems and topics in the philosophical thought of SJ2jren Kierkegaard. Some of the chapters have been previously publish ed but were revised for their appearance here. Others were written expressly for this book. I have tried to focus on issues which have not been customarily dealt with or emphasized in the scholarship on Kierkegaard with the exception of the writings of David Swenson and (...) Paul L. Holmer to which (and to whom) I am greatly indebted. Some of the positions for which I have argued in this volume (especially in Chapters IV and V) may be controversial. I am grateful to all those who enabled me to carry out or influenced me in my studies of Kierkegaard or who assisted with regard to the research for or preparation of this volume. Among these are: Professors Paul L. Holmer, F. Arthur Jacobson, and Dennis A. Rohatyn; Dean Wallace A. Russell and Vice President Daniel J. Zaffarano of Iowa State University. (shrink)

A phenomenalist philosophy which employs the Principle of Acquaintance (PA) plus the Principle that what exists are the referents of certain meaningful terms, defined by PA, cannot include either universals or particulars in its ontology, but is limited to instances of universals as constituting the range of ontological existents. Universals must be omitted since they are repeatable and, hence, never wholly presented or contained, whereas the objects of direct acquaintance are wholly and exhaustively presented. Furthermore, no entities beyond characters (qualities (...) and relations) are given in direct acquaintance; hence, particulars, too, must be omitted for the phenomenalist who relies on PA. (shrink)

Originally published in 1928, this book contains a general introduction to the science of map reading. Laborde builds on the materials he used to teach the subject at Harrow School to create a thoroughly illustrated and practical guide to maps, their creation and their decipherment. This book will be of value to anyone with an interest in the history of cartography or the history of education.

No one doubts that Kierkegaard's Concluding Unscientific Postscript is one of the most important, one of the most artistically contrived, and certainly one of the wittiest works in the history of philosophy. Further, the Postscript has often been accorded a kind of centrality in the Kierkegaardian corpus. Kierkegaard himself seems to have assigned it some such role. He informs the reader in the ‘First and Last Declaration’ that he originally intended the Postscript to be his last word before retiring from (...) his authorship . In The Point of View for My Work as an Author he himself calls it both ‘the turning-point’ and ‘the middle point’ in the sense that ‘this work concerns itself with and sets “the Problem”, which is the problem of the whole authorship: how to become a Christian’. Aside from the way in which Kierkegaard may have conceived the Postscript as being central or pivotal to his whole enterprise, certainly scholars have sometimes treated the Postscript as, at least in some ways, his magnum opus and summum verbum – as I would also. But our concern here is not with the centrality of the Postscript but with the centrality within the Postscript. Most everyone would, I think, acknowledge that a central section of the Postscript may be identified, though I would go farther and claim that within this a central, pivotal, solitary statement may be identified. (shrink)

This paper looks into the contents of the Tractatus suppositionum terminorum by Master Franquera, in the context of the teaching of logic in Salamanca in the fifteenth century. Franquera’s work is characterised by its explicit realist bias and its rejection of Ockhamist theses, i.e., by its recognition of the existence of a natura communis or a universale in re, which is evident in all discussions related to suppositio simplex and the theory of significatio. But, apart from this, Franquera’s discussion of (...) the theory of suppositio stands out as a strange mixture of different doctrines: some of them are derived from thirteenth-century analyses, others from fourteenth-century developments; realist goals are reached by means of instruments that, while not being nominalist, are definitely inspired by terminism. While upholding the theses of realist schools, Franquera adopts the definitions and rules of nominalist authors. (shrink)

Richard Rorty’s conception of literature has been criticised more than acclaimed. While Rorty certainly has impacted literary studies, a comprehensive account of his understanding of literature is still lacking. Moreover, while literature is seen as significant to his later work, the philosophical role this plays in Rortyan thought is underexamined and underappreciated. This paper aims to provide an account of the role of literature and the “literary” in Rorty’s philosophy and the functions he assigns to literature and poetry – in (...) a broad and narrow sense – in democratic cultures. Beginning with an account of Rorty’s conceptions of metaphor and “unfamiliar” language, it draws on this to explain Rorty’s parallel view of literature in the “narrower sense” as playing the same role in culture as metaphors do in language. “Stimulating” literature unsettles settled selves and beliefs and expands human imagination. Using Rorty’s readings of Lolita and 1984 as examples, it shows that to him, literature not only plays a part in increasing empathy and solidarity but has a distinct therapeutic epistemological task: it helps individuals and societies adopt a more pluralist, ironist, post-metaphysical outlook. Both are important democratic functions. For these reasons, Rorty recommends that we work to realise a “literary” culture that rejects any ontologically inflected distinctions between kinds of texts, where philosophy becomes comparative “literary” criticism, and we see literature in the “narrower sense” as equally necessary material for making selves, communities and just institutions as any philosophical or political treatise. (shrink)

This volume is a revival and updating of the rationalism initiated by the Cartesian cogito. Even the four main divisions of the work give evidence of this: Perception, the Real World, Real Mind, and the Suprarational. The order of treatment is not identical in every respect with that of Descartes, but the four main themes are indubitably Cartesian. While the protagonist is Descartes, the antagonist to whom this volume is consciously addressed is the empiricist and the positivist. Professor Robinson seems (...) intent on convincing the contemporary positivist that science is primarily an affair of reason and secondarily one of experience. He enlists two formidable allies of Descartes to elucidate and solidify his position. One he finds in the same century as Descartes, the redoubtable Leibniz; the other he takes from the twentieth century, Bertrand Russell. The problem of perception is resolved by the joint solution of Leibniz and Russell, a solution which rejects a naive realism in favor of a metarealism. The singular attraction of this volume is the personal dedication and expertise which Professor Robinson brings to this subject. His exploration and defense of his rationalistic premise brings him to examine epistemic issues and paradoxes which have cast long shadows over the history of modern and contemporary philosophy in Western civilization. These are the issues with which the inheritors of the Cartesian cogito have been wrestling: Spinoza, Leibniz, Locke, Berkeley, Hume, and Kant. Another very attractive aspect of this volume is that whereas Professor Robinson’s thesis has its protagonist and antagonist, it does not explicitly address itself to these. They remain more in the background as the audience to whom the book is addressed. They are not called on explicitly to engage in the exposition. In this sense, the book is not presented as a professorial treatise with copious footnotes and an extensive bibliography. It is presented as a personal exposition engaging in the act of philosophizing within the letter and spirit of a rationalistic revival. In spite of this personal and personalized renewal of rationalism on the part of Professor Robinson, it should not be construed that the book is written either for the layman or by a layman. It is a methodical and technical exposition replete with the coinage of new terms befitting the spirit of a philosophy operating within the parameters of a self-enclosed and self-contained scientism. Professor Robinson presents his book as a viable alternative to the monopoly which the empiricist and positivist have exercised within the domain of the philosophy of science.—R.E.D. (shrink)

This book appears in the International Library of Psychology, Philosophy and Scientific Method, along with the Platonic studies of Cornford, but it can hardly satisfy the public that reads those. There are chapters on various aspects of Plato’s thought such as Ethics, Aesthetics, Philosophy of Religion, Philosophy of Education, and included in the last is the perennial topic of Plato’s relation to Socrates, so that most subjects of importance are touched on in some way. But the treatment will not satisfy (...) a philosopher or a Hellenist, for it seems everywhere too superficial; there is much in summary, but problems are not properly indicated. Indeed, in spite of its length and inclusiveness, the book still has the feel of journalism, of something addressed to the readers of a literary digest who wish to know what broad line Plato took on various matters of human interest, or at any rate of lectures intended for those who need some philosophy in a rapid course on liberal arts, or on the background of modern literature, or educational theory which has been influenced by Plato. This impression is strengthened by the style, which is deliberately chatty and repetitive, and uses such expressions as ‘the Veritable Above’ and ‘biosocial living’. It is also most misleading to call such a person as Heraclitus a ‘factual scientist’. (shrink)

A comprehensive anthology of selections for the Introductory Philosophy of Religion course, this text surveys more than 50 responses to the question, "Is religious belief a viable option in today's world?" Organizes selections around central theistic positions and attacks on those positions. Pro-con format encourages lively discussions.

Professors Battersby and Phelan have presented a lively challenge. They urge readers to reject the later, fuzzy Hirsch, in favor of an earlier, truer Hirsch.Their first objection is that Hirsch 2 has mistaken the nature of literary meaning. Battersby and Phelan reject the view that a literary work carries a general meaning analogous to the concept of “bicycle” that can be exemplified by all bicycles. They propose that a literary work is “more appropriately conceived as … a Schwinn or even (...) a red Schwinn three-speed with a blue seat and two flat tires”. They object to my adoption of Sir Philip Sidney’s claim that literature provides both the general concept and the particular example simultaneously. By saying that literature does both things at once I conflate and confuse, they say, two different intentions, because, as they aver, an exemplified concept cannot be further exemplified”.This claim reinstates the familiar New Critical doctrine that a literary concept is unique among concepts in that it can never be dissevered from its particular embodiment. E. D. Hirsch, Jr., professor of English at the University of Virginia, is the author of numerous works including Validity in Interpretation and The Aims of Interpretation. His previous contributions to Critical Inquiry include “Against Interpretation?” and “The Politics of Theories of Interpretation”. His most recent contributions is “Meaning and Significance Reinterpreted”. (shrink)

Background: Since the passage of the Patient Self-Determination Act, numerous policy mandates and institutional measures have been implemented. It is unknown to what extent those measures have affected end-of-life care, particularly with regard to the do-not-resuscitate order.Methods: Retrospective cohort study to assess associations of the frequency and timing of DNR orders with advance directive status, patient demographics, physician’s specialty and extent of documentation of discussion on end-of-life care.Results: DNR orders were more frequent for patients on a medical service than on (...) a surgical service and were made earlier in the hospital stay for medicine than for surgical patients . 22.18% of all patients had some form of an advance directive in their chart, yet this variable had no impact on the frequency or timing of DNR ordering. Documentation of DNR discussion was significantly associated with the frequency of DNR orders and the time from DNR to death .Conclusions: The physician’s specialty continues to have a significant impact on the frequency and timing of DNR orders, while advance directive status still has no measurable impact. Additionally, documentation of end-of-life discussions is significantly associated with varying DNR ordering rates and timing. (shrink)

The combination of breeding for increased production and the intensification of housing conditions have resulted in increased occurrence of behavioral, physiological, and immunological disorders. These disorders affect health and welfare of production animals negatively. For future livestock systems, it is important to consider how to manage and breed production animals. In this paper, we will focus on selective breeding of laying hens. Selective breeding should not only be defined in terms of production, but should also include traits related to animal (...) health and welfare. For this we like to introduce the concept of robustness. The concept of robustness includes individual traits of an animal that are relevant for health and welfare. Improving robustness by selective breeding will increase (or restore) the ability of animals to interact successfully with the environment and thereby to make them more able to adapt to an appropriate husbandry system. Application of robustness into a breeding goal will result in animals with improved health and welfare without affecting their integrity. Therefore, in order to be ethically acceptable, selective breeding in animal production should accept robustness as a breeding goal. (shrink)

Some people have found my distinction between meaning and significance useful. In the following revision of that distinction, I hope to improve its accuracy and perhaps, therefore, its utility as well. My impulse for making the revision has been my realization, very gradually achieved, that meaning is not simply an affair of consciousness and unconsciousness. In 1967, in Validity in Interpretation, I roundly asserted that “there is no magic land of meanings outside human consciousness.” 1 That assertion would be true (...) if, godlike, we could oversee the whole of human consciousness, past, present, and future. But we language users, being limited creatures, intend our verbal meanings to go beyond what we can pay attention to at any moment. We intend our meanings to transcend our momentary limitations of attention and knowledge. Hence there is a land of meanings beyond past and present human consciousness—the land of the future. What I should have said originally is that there is no magic lance of meanings beyond the whole extent of human consciousness, past, present, and future. This correction of my original statements leads to a deepening of the concept of meaning.In 1960 I first proposed the analytical distinction between two aspects of textual interpretation. One of them, meaning, was fixed and immutable; the other, significance, was open to change.2 I acknowledged that significance, changeable or not, is the more valuable object of interpretation, because it typically embraces the present use of texts, and present use is present value. But I argued that, in academic criticism, the significance and use of a text ought to be rooted in its fixed meaning, since otherwise criticism would lack a stable object of inquiry and would merely float on tides of preference. The claim that one reader’s opinion is as valid as another’s would then be right, despite any indignant protest to the contrary. I did not wish to dissuade people from floating on the tides of preference if that was what they wished to do. I intended to provide a firm justification for those who wished to pursue historical scholarship. 3 I also assumed that even those who did not pursue historical scholarship might sometimes wish to exploit the possibility of historically fixed meaning. In my experience, even antiauthorial theorists sometimes with to regard their own texts as having a historically fixed meaning and will complain if someone misunderstands that meaning. 1. E. D. Hirsch, Jr., Validity in Interpretation, p. 4.2. See my “Objective Interpretation,” PMLA 75 : 463-79.3. See, for instance, W. K. Wimsatt, Jr., and Monroe C. Beardsley, “The Intentional Fallacy,” in Wimsatt, The Verbal Icon: Studies in the Meaning of Poetry, which ends:We submit that this is the true and objective way of criticism, as contrasted to what the very uncertainty of exegesis might tempt a second kind of critic to undertake: the way of biographical or genetic inquiry …. Our point is that such an answer to such an inquiry would have nothing to do with the poem “Prufrock”; it would not be a critical inquiry. Critical inquiries, unlike bets, are not settled in this way. Critical inquiries are not settled by consulting the oracle. [P. 18] E. D. Hirsch, Jr., professor of English at the University of Virginia, is the author of numerous works, including Validity in Interpretation and The Aims of Interpretation. His previous contributions to Critical Inquiry are “Against Interpretation?”, “The Politics of Theories of Interpretation, and “Stylistics and Synonymity”. (shrink)

Welfare-friendly outdoor poultry husbandry systems are associated with potentially higher public health risks for certain hazards, which results in a dilemma: whether to choose a system that improves chicken welfare or a system that reduces these public health risks. We studied the views of citizens and poultry farmers on judging the dilemma, relevant moral convictions and moral arguments in a practical context. By means of an online questionnaire, citizens and poultry farmers judged three practical cases, which illustrate the dilemma of (...) improving chicken welfare or reducing public health risks for Campylobacter, avian influenza and dioxin. Furthermore, they scored the importance of moral arguments and to what extend they agreed with moral convictions related to humans and chickens. Citizens were more likely than farmers to choose a system that benefits chicken welfare at the expense of public health. These different judgments could be explained by differing moral convictions and valuations of moral arguments. Judgments of citizens and farmers were associated with moral arguments and convictions, predominantly with those regarding the value of chickens and naturalness. Citizens agreed stronger with moral convictions regarding the intrinsic value of chickens and regarding naturalness than farmers did, while farmers agreed stronger with conviction regarding fairness. We argue that opinions of citizens and farmers are context-dependent, which may explain the differences between these groups. It implies that opinions of different stakeholder groups should be considered in order to achieve successful innovations in poultry husbandry, which are supported by society. (shrink)

In Reason and Analysis, Prof. Brand Blanshard criticises the logical empiricist view regarding necessary statements, including the laws of logic. He distinguishes four component these of this view: (I) Necessary statements--here, the laws of logic--are resolutions or reports of linguistic usage. (II) They are conventions. (III) They are analytic (tautologies). (IV) They say nothing about the world. In this paper I first show that Prof. Blanshard is essentially right in his criticisms of (I), (II), and (IV); but that he has (...) done nothing to show that (III) is incorrect with regard to the laws of logic. Then, second, I attempt to show that even though (I), (II), and (more importantly) (IV) are false, (III) is true. That is, the laws of logic are tautologies, and yet, in a sense to be distinguished, they say something about the world. (shrink)

Doctors who entered the National Health Service to practice medicine now find themselves forced to practise selection. It seems that patients are being lost at GP level. Surely the basis of a good relationship between doctor and patient relies on trust and trust is based on truth which should not be concealed from patients. And should any one dare decide the quality of life for another human being?

Background Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders’ perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), (...) deep brain stimulation (DBS), and adaptive brain implants (ABI). Methods We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs. Results Participants’ ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies. Conclusions To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs. (shrink)

When, in Telos #55, we sought to evaluate the meaning and impact of French socialism in power, the verdict turned out to be peculiarly disappointing. The rhetorical question in the Introduction: “Beyond Reform or Revolution?” had already been effectively answered. As early as 1982 French socialism had revealed itself to be a “Gaullism with a Human Face” which did not have much to do either widi reform or revolution, and could provide nothing more -above and beyond the usual cliches—than a (...) continuation of the same berated but unsurpassed technocratic management of the given. Socialism had turned out to be a bad idea whose time had past. (shrink)

Recent work has shown that memory for various types of information associated with social targets (impressions based on behaviours and political ideology) influences decisions to approach or avoid those same targets. The current study was intended to better understand the extent that memory for other types of details associated with targets (beliefs and behaviours) affects subsequent approach/avoidance decisions. In this investigation, participants formed impressions of social targets represented by a picture and a sentence (a belief in Experiment 1; either a (...) belief or behaviour in Experiment 2). Later, memory for the impressions and sentences associated with each target was tested. Finally, participants decided whether they would want to approach or avoid each target. Results demonstrated that accurate memory strongly influenced approach/avoidance decisions for targets associated with different types of information (beliefs; behaviours), although there was no difference in the effect of memory between beliefs and behaviours. Overall, results suggest an important role of memory in decisions to approach or avoid others. (shrink)

During the last few years forgiveness has been seen as an important element in psychological health. The development of forgiveness therapy and its application by psychotherapists to areas like family therapy attests to its growing significance. As a consequence it is important to investigate what people understand by forgiveness and in what circumstances this knowledge structure is retrieved. The present study forms part of ongoing research to access and measure a person's construct of forgiveness. Two studies are compared across three (...) dimensions: semantics, questionnaire instructions and five methods of accessing a forgiveness knowledge structure. In the first study, 49 students from the University of Glasgow were presented with descriptions or videoed scenarios of an act of infidelity. After each presentation they completed the Scobie Forgiveness Scale . In the second study, 315 students from the University of Glasgow completed four measures, only the SFS is used in the current study. A comparison of the studies suggests that minor word changes and questionnaire instructions may not exert a significant influence on participants' responses. However, different methods of accessing knowledge structures may have an effect on an individual's construct of forgiveness. The results suggest that different methodologies , affect participants' responses in both the forgiver and the forgiven mode. The findings may have implications for the general accessing of knowledge systems and for the measurement of forgiveness. (shrink)

The construct of the self is important in the domain of memory research. Recent work has shown that person memory is influenced by similarity of social targets to the self. The current experiments investigate self-similarity as defined by traits and political ideology to better understand how memory for social targets is organised. Across three experiments, participants formed positive or negative impressions based on each target’s picture, a trait-implying behavior (Experiments 1 & 2), and/or political ideology (conservative/liberal label in Experiment 2; (...) political-ideological belief statements in Experiment 3) followed by a memory test. Results showed a self-similarity effect dependent on valence in Experiment 1, but not in Experiments 2 or 3 when participants processed ideological information associated with targets. These results suggest that self-similarity has an effect on memory for social targets, but that ideological information disrupts self-focused processing of others, suggesting that ideological information also has a powerful influence on what people remember about others (i.e. social targets). (shrink)

Cette étude reconstitue le «modèle musical» des principaux écrivains et philosophes mélomanes européens depuis le xviie siècle. Elle met également en lumière la rémanence d'un schème qui parcourt tout l'imaginaire européen: la succession d'un âge d'or, d'une décadence, et d'une régénération.

A key question about the value of truth in epistemology is whether the truthfulness of some proposition is a factor in our evaluation of beliefs. The traditional view—evidenced in introductory texts and academic journals :349–369, 2002, p. 350)—is that the truth of a belief should not impact our evaluations of it. Recent work has raised empirical objections to this default position of truth-insensitivity by suggesting that our ordinary belief evaluations assign considerable weight to the truth value of the believed proposition. (...) If correct, this work grants truth a larger role in our epistemology—suggesting that it serves both as an element of our ordinary epistemic evaluations and as an intuitive norm for belief evaluation :4009–4030, 2015. https://doi.org/10.1007/s11229-015-0727-z, Philos Phenomenol Res 93:348–367, 2016. https://doi.org/10.1111/phpr.12218). However, this position is not convincing. In this paper, I argue that this empirical work, while revelatory of some interesting features of belief evaluation, falls far short of demonstrating that belief evaluation is truth-sensitive, or that truth-sensitivity is intuitive. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Developmental systems theory (DST) is a general theoretical perspective on development, heredity and evolution. It is intended to facilitate the study of interactions between the many factors that influence development without reviving `dichotomous' debates over nature or nurture, gene or environment, biology or culture. Several recent papers have addressed the relationship between DST and the thriving new discipline of evolutionary developmental biology (EDB). The contributions to this literature by evolutionary developmental biologists contain three important misunderstandings of DST.

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

Continuous recordings of brain electrical activity were obtained from a group of 176 patients throughout surgical procedures using general anesthesia. Artifact-free data from the 19 electrodes of the International 10/20 System were subjected to quantitative analysis of the electroencephalogram (QEEG). Induction was variously accomplished with etomidate, propofol or thiopental. Anesthesia was maintained throughout the procedures by isoflurane, desflurane or sevoflurane (N = 68), total intravenous anesthesia using propofol (N = 49), or nitrous oxide plus narcotics (N = 59). A set (...) of QEEG measures were found which reversibly displayed high heterogeneity of variance between four states as follows: (1) during induction; (2) just after loss of consciousness (LOC); (3) just before return of consciousness (ROC); (4) just after ROC. Homogeneity of variance across all agents within states was found. Topographic statistical probability images were compared between states. At LOC, power increased in all frequency bands in the power spectrum with the exception of a decrease in gamma activity, and there was a marked anteriorization of power. Additionally, a significant change occurred in hemispheric relationships, with prefrontal and frontal regions of each hemisphere becoming more closely coupled, and anterior and posterior regions on each hemisphere, as well as homologous regions between the two hemispheres, uncoupling. All of these changes reversed upon ROC. Variable resolution electromagnetic tomography (VARETA) was performed to localize salient features of power anteriorization in three dimensions. A common set of neuroanatomical regions appeared to be the locus of the most probable generators of the observed EEG changes. (shrink)

The most debated status of the wave function of Quantum Mechanics is discussed in the light of the epistemological vs ontological opposition.

The right to refuse medical intervention is well established, but it remains unclear how best to respect and exercise this right in life support. Contemporary ethical guidelines for critical care give ambiguous advice, largely because they focus on the moral equivalence of withdrawing and withholding care without confronting the very real differences regarding who is aware and informed of intervention options and how patient values are communicated and enacted. In withholding care, doctors typically withhold information about interventions judged too futile (...) to offer. They thus retain greater decision-making burden and face weaker obligations to secure consent from patients or proxies. In withdrawing care, there is a clearer imperative for the doctor to include patients in decisions, share information and secure consent, even when continued life support is deemed futile. How decisions to withhold and withdraw life support differ ethically in their implications for positive versus negative interpretations of patient autonomy, imperatives for consent, definitions of futility and the subjective evaluation of benefits and burdens of life support in critical care settings are explored. Professional reflection is required to respond to trends favouring a more positive interpretation of patient autonomy in the context of life support decisions in critical care. Both the bioethics and critical care communities should investigate the possibilities and limits of growing pressure for doctors to disclose their reasoning or seek patient consent when decisions to withhold life support are made. (shrink)

Children, because of age-related reasons, are a vulnerable population, and protecting their health is a social, scientific and emotional priority. The increased susceptibility of children and fetuses to environmental agents has been widely discussed by the scientific community. Children may experience different levels of chemical exposure than adults, and their sensitivity to chemical toxicities may be increased or decreased in comparison with adults. Such considerations also apply to unborn and newborn children. Therefore, research on children is necessary in both clinical (...) and environmental fields, to provide age-specific relevant data regarding the efficacy and safety of medical treatments, and regarding the assessment of risk from unintended environmental exposure. In this context, the stakeholders are many, including children and their parents, physicians and public health researchers, and the society as a whole, with its ethical, regulatory, administrative and political components. The important ethical issues are information of participants and consent to participate. Follow-up and protection of data should be discussed in the context of biobanks, where children obtain individual rights when they become adults. It is important to realise that there are highly variable practices within European countries, which may have, in the past, led to differences in practical aspects of research in children. A number of recommendations are provided for research with children and environmental health. Environmental research with children should be scientifically justified, with sound research questions and valid study protocols of sufficient statistical power, ensuring the autonomy of the child and his/her family at the time of the study and later in life, if data and samples are used for follow-up studies. When children are enrolled, we recommend a consent dyad, including parental informed consent and the child’s assent and/or informed consent from older minors. For evaluation of the studies including children, a paediatrician should always be involved in the research ethics committee. (shrink)

Traditionally, philosophical writings on personal identity have taken the form of attempts to discover the dominant criterion for deciding when a person at one time is identical with a person at some other time. Among the candidates for the role of dominant criterion have been bodily continuity and memory . In the normal case, where a person P is identical with a person P′ at an earlier time, it is true that P and P′ share a continuous body, that P (...) can remember experiences of P′, and that many other relationships hold between P and P′. Consequently, the debate as to which of the normal criteria is the dominant one has usually taken the form of imagining strange cases in which one or more of the normal criteria are lacking, and attempting to say, in such cases, who is identical with who. The scene was set, at least for modern times, by Locke's prince/pauper example, in which, according to Locke, the ability to remember experiences of a person having a different body guarantees, nevertheless, that one is that person—and hence that the memory criterion is dominant over the bodily identity one. (shrink)

In September 1998 the Dutch Ministry of Health together with the Dutch Society of General Practitioners , the Royal Dutch Society of Pharmacists , and the Dutch Patient and Consumer Federation published a pamphlet entitled: The same medicine in a different coat. Drugs without a trademark, equally effective, but cheaper. Patients could obtain a copy at the local pharmacy or in the waiting room of their general practitioner. It deals with the question whether the name of the patent drug should (...) be written on the prescription or only the active component. This is important because, according to the authors, the costs of health care can be reduced without reducing the quality of the care if the doctor prescribes the generic form. It is also mentioned that another advantage of prescribing the generic form is that, contrary to the …. (shrink)

Kenneth C. Schaffner's paper is an important contribution to the literature on behavioral genetics and on genetics in general. Schaffner has a long record of injecting real molecular biology into philosophical discussions of genetics. His treatments of the reduction of Mendelian to molecular genetics first drew philosophical attention to the problems of detail that have fuelled both anti-reductionism and more sophisticated models of theory reduction. An injection of molecular detail into discussions of genetics is particularly necessary at the present time, (...) when so many philosophers seem happy to discuss the philosophical and ethical implications of molecular biology using gene concepts derived from evolutionary biology ). Schaffner has long advocated the view that the philosophy of biology should be more than the philosophy of evolution. This paper shows how radically a picture of gene action derived from molecular biology undercuts the popular picture associated with a more evolutionary view of genes as units of heredity or as ‘difference-makers’ mediated by the ‘black box’ of development. (shrink)

This issue of Mélusine pursues the research initiated in 1982 on the surrealist book, without giving the last word on such a complex subject. Demonstrating erudition worthy of La Revue d'histoire littéraire de la France, the contributors propose new ideas and points of view. By the sheer abundance of technical terms, the articles would have astonished the avant-garde poets and artists in question, who were so very fond of entertainment. Some contributors examine the illustrated book, the artist's book and the (...) book-object in general as surrealist publications, while others focus on a single book or even on the non-book imagined by André Breton.In her introduction, editor Andrea Oberhuber describes the evolution of .. (shrink)

Featuring nine new articles chosen by coeditor, Steven M. Cahn, the third edition of E. D. Klemke's The Meaning of Life offers twenty-two insightful selections that explore this fascinating topic. The essays are primarily by philosophers but also include materials from literary figures and religious thinkers. As in previous editions, the readings are organized around three themes. In Part I the articles defend the view that without faith in God, life has no meaning or purpose. In Part II the selections (...) oppose this claim, defending instead a nontheistic, humanistic alternative--that life can have meaning even in the absence of theistic commitment. In Part III the contributors ask whether the question of the meaning of life is itself meaningful. The third edition adds substantial essays by Moritz Schlick, Joel Feinberg, and John Kekes as well as selections from the writings of Louis P. Pojman, Emil L. Fackenheim, Robert Nozick, Susan Wolf, and Steven M. Cahn. The only anthology of its kind, The Meaning of Life: A Reader, Third Edition, is ideal for courses in introduction to philosophy, human nature, and the meaning of life. It also offers general readers an accessible and stimulating introduction to the subject. (shrink)

Although it is frequently overlooked, J.S. Mill's political philosophy has a significant civic component; he is a committed believer in the value of active and disinterested participation in public affairs by the citizens of liberal democracies, and he advocates a programme of civic education intended to cultivate public spirit. In the first half of this essay I present a brief but systematic exploration of his thought's civic dimension. In the second half I defend Mill's civic liberalism against various critics who (...) have explicitly or implicitly charged that the civic and liberal components of his political philosophy are inconsistent. (shrink)

Scientific developments of the last 20 years have made the transplantation of cadaveric solid organs a viable and expected treatment alternative for patients suffering from various forms of End Stage Organ Disease. Of the number of organs that could be utilized for this, only a small percentage of them are actually made available. North American legislation explicitly categorizes the transfer of cadaveric organs as an anatomical or tissue “gift”. The concept of the gift is mediated by transculturally consistent unwritten, but (...) powerfully felt, rules of conduct. Among the most profound elements of the concept is the obligatory gift-exchange which is central to the gift-relationship. Obviously, neither of these are permitted by the organ transplant scenario. As a result, dissonance is created within the thought process of the individual which cannot be easily resolved, paralyzing many into inaction. We maintain that the present legal framework, designed to facilitate the transfer of organs, clashes with the human phenomenon of giving, and may actually prevent organs from being made available. In a search for a solution to this gift-relationship dilemma, giving organs is contrasted with taking organs as a basis upon which to ground ethically sound public policy. Liberty-limiting principles and the concept of harm are considered within this context. (shrink)

Many observers have argued that the US health care system could be more efficient, and achieve better outcomes if providers focused more on improving the community's health, not just the welfare of individual patients. The passage of the Affordable Care Act in 2010 seemed to herald the promise of such reforms, and greater integration of the health care and public systems. In this article, we reassess the quest for integration, a quest we call the “integration project.” After examining the modest (...) steps taken so far toward integration, we consider some conceptual barriers to integration as well as some of the risks it might portend for the public health system. Our assessment contributes to wide-ranging debates among public health advocates, practitioners, and policymakers as to the health care system's role in protecting public health, and how the public health system can best be organized to meet expected population health challenges. (shrink)

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)