When we climb in the high places of the earth, plodding slowly at mountaineer's pace with crampons on our boots, that we may keep foothold on the blue ice, we should stop from time to time and, steadying ourselves with our ice-axe for a moment, raise our downbent eyes, weary with guiding our steps between crevasses, to the great peaks we would conquer, and see, too, the foot hills we have left behind. Only by gazing thus can the Alpine climber (...) find values, and often he catches too, just then, a glimpse of beauty. So it is profitable to turn from our work in laboratories and among the sick, to survey the general state of our knowledge in larger sweep. We cannot hope to have added by our deliberations to-day anything of solving value in this ultimate problem. But we clarify to ourselves the state of our small knowledge and the extent of our nescience, and, though we may throw on these matters no more light than that which Milton tells us shines in Hell, “enough to make darkness visible,” yet it were well done. (shrink)

Developing students’ skills to pose and respond to questions and actively engage in inquiry behaviours enables students to problem solve and critically engage with learning and society. The aim of this study was to analyse the impact of providing teachers with an intervention in inquiry pedagogy alongside inquiry science curriculum in comparison to an intervention in non-inquiry pedagogy alongside inquiry science curriculum on student questioning and other inquiry behaviours. Teacher participants in the comparison condition received training in four inquiry-based science (...) units and in collaborative strategic reading. The experimental group, the community of inquiry (COI) condition, received training in facilitating a COI in addition to training in the same four inquiry-based science units. This study involved 227 students and 18 teachers in 9 primary schools across Brisbane, Australia. The teachers were randomly allocated by school to one of the two conditions. The study followed the students across years 6 and 7 and students’ discourse during small group activities was recorded, transcribed and coded for verbal inquiry behaviours. In the second year of the study, students in the COI condition demonstrated a significantly higher frequency of procedural and substantive higher-order thinking questions and other inquiry behaviours than those in the comparison condition. Implementing a COI within an inquiry science curriculum develops students’ questioning and science inquiry behaviours and allows teachers to foster inquiry skills predicated by the Australian Science Curriculum. Provision of inquiry science curriculum resources alone is not sufficient to promote the questioning and other verbal inquiry behaviours predicated by the Australian Science Curriculum. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

In _The Politics of Toleration in Modern Life _Susan Mendus gathers a group of distinguished public figures—philosophers, historians, lawyers, and religious leaders—to reflect on a core issue within contemporary political debate. At the close of a century that will be remembered for its two world wars and its eruptions of genocide, the contributors examine the importance of an insistence on tolerance and the dangers of its lack, both historically and in the present day. How can toleration be fostered in a (...) contentious and tightly populated world? What situations and fears have historically fed attitudes of intolerance? When and how should states intervene? The authors of these essays seek answers to such questions and examine topics such as why certain national groups are especially vulnerable to intolerance and narcissistic fantasies and how the colonial view of intolerant exploitation as an acceptable norm of behavior has been replaced by a drive toward international solidarity. The essays address religious tolerance, the role of toleration in legal contexts, the philosophical justification of tolerance, and the concept of solidarity. Ethnic identity, nationalism, the “goods of conflict,” and the treatment of refugees seeking asylum are discussed as well. While one contributor argues that a moment of genuine tolerance is achieved only when there is a cost involved in the act of tolerating another person’s way of living, another stresses that rational, communal dialogue can only take place if the state is excluded from the discussion, if conflict is recognized as valuable, and if local communities come to consensus about what behavior and discourse is intolerable. Offering an accessible and engaging commentary on the concept of tolerance, _The Politics of Toleration in Modern Life_ will interest a wide range of readers of philosophy, political science, religion, sociology, and history. _Contributors_. George Carey, Christopher Hill, Michael Ignatieff, Helena Kennedy, Alasdair MacIntyre, Susan Mendus, Julia Neuberger, Bernard Williams. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 53-64 [Access article in PDF] Incentives for Providing Organs Patricia Milmoe McCarrick and Martina Darragh After a contentious debate at its 2002 annual meeting, the American Medical Association's House of Delegates voted to endorse the opinion of its Council on Ethical and Judicial Affairs that the impact of financial incentives on organ donation should be studied (Josefson 2002). The shortage of (...) organs for transplantation has been an ongoing problem for more than 20 years. In June1981, Representative Philip Crane (R-IL) introduced legislation in the U.S. House of Representatives proposing a $25,000 income tax deduction and a $25,000 estate tax exclusion for donating an organ (Tax Incentives 1981). Still the National Organ Transplant Act enacted in October 1984 prohibited the offering of any "valuable consideration" in return for organs (United States 1984).The developments of a legal market for tissues in the United States and a black market for organs around the world have raised the question of whether donation without compensation is the only ethically viable option. Some critics of the current system claim reliance on donation actually promotes a black market in organs (Kaserman and Barnett 2002, p. 38; Palmer 1999, p. 36). In addition, a new set of compensation issues has arisen as living kidney donor transplantations begin to rival those performed with cadaveric organs (United States 2001).As a result, current suggestions for incentives go far beyond the traditional death benefit payment to include such ideas as medals of honor for donors, reimbursement for funeral expenses, exchange programs for organ donation, and special medical insurance for living organ donors. Numerous bills introduced into the 107th Congress have proposed such incentives (Delmonico et al. 2002.) In October 2002, the U.S. Department of Health and Human Services awarded $5.2 million in grants to study both clinical and behavioral interventions for increasing organ donations that do not involve incentives. The inspiration for some of the funded proposals comes from the successes of Spain's social services and the United Kingdom's clinical administration of organ procurement programs (Robeznieks 2002). [End Page 53]With a nod to evidence-based medicine, the underlying concern expressed in much of the current literature is that no idea for increasing the supply of organs should be discounted before it is studied. This bibliography provides a short introduction to the range of opinions expressed on the issue of incentives for providing organs.al-Mousawi, M.; Samhan, M.; al-Mezairee I.; Razzak, M.A.; and Khawari, F. Cadaver Organ Procurement in Kuwait. Transplantation Proceedings 31 (8): 3375-76, 1999.The authors describe a protocol that significantly increased cadaveric organ donation and credit it with fostering the expansion of an organ sharing program among the Arab Gulf states. Developed by Kuwaiti neurologists and anesthetists after a continuing education course on transplantation, the protocol places a special emphasis on the role of local transplant coordinators who facilitate the investigation of brain death cases by neurologists.Arnold, Robert; Bartlett, Steven; Bernat, James; et al. [Ethics Committee of the American Society of Transplant Surgeons] Financial Incentives for Cadaver Organ Donation: an Ethical Reappraisal. Transplantation 73 (8): 1361-67, 27 April 2002.To prepare for proposed studies of financial incentives for organ donation, the American Society of Transplant Surgeons convened a panel to develop a methodology for evaluating the ethics of such research. Comprised of organ procurement organization executives, physicians, surgeons, and ethicists, the panel generated a list of nine criteria for use in judging any incentives proposal. While opposed to direct payment or tax incentives for organ donation, a majority of the members support funeral expense reimbursement or charitable contributions as incentives that would not violate or undermine the ideal of altruism.Cameron, J. Stewart, and Hoffenberg, Raymond. The Ethics of Organ Transplantation Reconsidered: Paid Organ Donation and the Use of Executed Prisoners as Donors. Kidney International 55 (2): 724-32, February 1999.After reviewing arguments for and against payment for organ procurement, the authors apply these arguments to the specific case of obtaining organs from executed... (shrink)

On June 11, 1963, in a dramatic gesture that caught the nation's attention, Governor George Wallace physically blocked the entrance to Foster Auditorium on the University of Alabama's campus. His intent was to defy Attorney General Nicholas Katzenbach, sent on behalf of the Kennedy administration to force Alabama to accept court-ordered desegregation. After a tense confrontation, President Kennedy federalized the Alabama National Guard and Wallace backed down, allowing Vivian Malone and James Hood to become the first African (...) Americans to enroll successfully at their state's flagship university. That night, John F. Kennedy went on television to declare civil rights a "moral issue" and to commit his administration to this cause. That same night, Medgar Evers was shot dead. In The Schoolhouse Door, E. Culpepper Clark provides a riveting account of the events that led to Wallace's historic stand, tracing a tangle of intrigue and resistance that stretched from the 1940s, when the university rejected black applicants outright, to the post-Brown v. Board of Education era. We are there in July 1955 when Thurgood Marshall and lawyers at the NAACP Legal Defense Fund win for Autherine Lucy and "all similarly situated" the right to enroll at the university. We are in the car with Lucy in February 1956 as university officials escort her to class, shielding her from a mob jeering "Lynch the nigger," "Keep 'Bama white," and "hit the nigger whore." Clark exposes the many means, including threats and intimidation, used by university and state officials to discourage black applicants following the Lucy episode. And he explains how University of Alabama president Frank Anthony Rose eventually cooperated with the Kennedy administration to ensure a smooth transition toward desegregation. We also witness Robert Kennedy's remarkable face-to-face plea for Wallace's cooperation and the governor's adamant refusal: "I will never submit voluntarily to any integration in a school system in Alabama." As Clark writes, Wallace's carefully orchestrated surrender would leave the forces of white supremacy free to fight another day. And the Kennedys' public embrace of the civil rights movement would set in motion a political transformation that changed the presidential base of the Democratic party for the next thirty years. In these pages, full of courageous black applicants, fist-shaking demonstrators, and powerful politicians, Clark captures the dramatic confrontations that transformed the University of Alabama into a proving ground for the civil rights movement and gave the nation unforgettable symbols for its struggle to achieve racial justice. (shrink)

The paper begins with the concept of voice and questions its different meanings, especially in educational settings, to propose a philosophical framing of people-of-young-age’s material voices. It then proposes to understand those voices as disruptive differences or opportunities to (re)think about our roles as educators and, most of all, to return to the question of what a philosophical approach to childhood might disrupt. In doing so, it outlines some ideas about “voice” as sound and materiality (Cavarero, 2005) and also about (...) “listening” as a permanent attention to what might emerge (Nancy, 2002; Davies, 2014), to then extend particular meanings of these concepts to the practice of thinking philosophically with people of different ages in the community of philosophical inquiry educational setting (Kennedy & Kennedy, 2012). It also builds on the concept of “event” by Gilles Deleuze (Deleuze, 2013), as a potential immanent within a confluence of forces, to then ask how we can foster a philosophical way of living (in) education that takes people-of-young-age’s material voices as something we cannot afford to lose. Finally, the paper proposes to frame the community of philosophical inquiry as a philosophical community of voices, in the sense of an opportunity to experience the materiality of all the voices as something that matters in the shared thought of its participants. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.4 (2002) 389-390 [Access article in PDF] IOM Report on the System for Protecting Human Research Participants Tom L. Beauchamp* In response to society's concerns about the use of human subjects in research, the Department of Health and Human Services commissioned the Institute of Medicine to perform a comprehensive assessment of current systems of research participant protection in the U.S., including recommendations for (...) reform (Committee 2002). Although the committee declared its frustration over the lack of data, it found ample evidence to indicate that there are pivotal weaknesses in the current system. First, it discovered dissatisfaction with the current system from virtually every quarter and at virtually every level. Second, it found evidence that IRBs are under severe strain and performing inadequately. Third, it found that the existing regulatory framework—the IRB system and the Common Rule—has not and probably now cannot react adequately to the constantly evolving research environment. Some of these problems might be handled through federal agencies, but the committee holds that the problems are more extensive and will require additional institutional support and professional attention.The committee found that federal protection requirements should be extended to every research project—private, public, or otherwise. Subjects should be, in this respect, equally protected in privately sponsored research.The committee found that the IRB system is in important respects a failure, especially when it alone is relied upon for ethics reviews in institutions. One set of problems concerns the proper education of IRB members. The committee recommends that all members henceforth be given a specialized knowledge of human research ethics. It finds that IRB deliberations commonly have been dominated by scientists, who often marginalize the perspectives of nonscientist members. It therefore recommends that unaffiliated members, nonscientists, local community representatives, and those representing the participant-perspective comprise at least 25 percent of the membership. It also recommends that no protocol be approved without three-quarters of the voting members concurring. [End Page 389]The committee recommends that institutions distinguish review aimed at (1) scientific merit, (2) conflict of interest, and (3) general Ethics Review. The distinction should more evenly distribute the work of institutional ethics review. The IRB should not conduct the initial scientific review nor should it be spending the bulk of its time purely in examining either scientific merit—as many IRBs now do—or conflict of interest. Instead, the conclusions of the scientific review should be submitted to the IRB for ethics-focused deliberations. Problems of both financial and nonfinancial conflicts of interest should be handled similarly, preferably by a committee properly distanced from the institution's interests.The committee underscores that consent must be understood on the model of an interactive dialogue between research staff and participants and not merely as a signed form or single-disclosure event. Conversations between the participant and the research staff should begin even prior to the point of enrollment and should be reinforced during each stage of the research. The committee finds that informed consent conversations and documents too often are being conceived as risk management tasks gauged to protect the institution from liability.The committee also believes that the system of protections established by a research program should be open to the public in order to foster and maintain the community's trust. Open communication should occur among all relevant stakeholders. The committee notes that currently no centralized system exists for the dissemination of information about clinical trials and other research activities.It urges reconsideration of present policies regarding compensation, finding that many research organizations provide at least short-term medical care for those who are injured, but that few organizations cover all potential risks and that many organizations have no effective policy of compensation. The report holds that providing reasonable compensation for bona fide instances of research harm is the only just system and is necessary to avoid diminished public trust.The committee holds that establishing the appropriate culture in research institutions will require sustained efforts to educate researchers, research administrators, IRB members, and... (shrink)

I want to examine a possible solution to the problem of induction-one which, as far as I know, has not been discussed elsewhere. The solution makes crucial use of the notion of objective natural necessity. For the purposes of this discussion, I shall assume that this notion is coherent. I am aware that this assumption is controversial, but I do not have space to examine the issue here.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.3 (2002) 305-323 [Access article in PDF] Scope Note 41 Bioethics and Cloning, Part I Susan Cartier Poland and Laura Jane Bishop This is Part One of a two part Scope Note on Bioethics and Cloning. Part Two will be published in the December 2002 issue of the Kennedy Institute of Ethics Journal and as a separate reprint. Contents For Parts 1 (...) And 2 Part 1Part 2I.History of the ScienceI.Ethical PerspectivesII.Historical CommentaryII.Religious PerspectivesIII.Animal WelfareIII.Fiction and FilmIV.Laws and Legal Literature"Clone" is a collective noun (I, Stewart 1997, p. 771). A collective noun names a group and is composed of individual members, such as "herd" or "flock." Derived from the Greek kl¯on for twig or slip, "clone" was first used in biology to describe the aggregate of asexually produced progeny of an individual, either naturally occurring or man-made; the definition later expanded to mean a group of genetically identical members who originate from a single ancestor. Thus, a clone is a group that results from the process of asexual reproduction.In nature, cloning occurs either by parthenogenesis (reproduction without fertilization) or by fission (embryo splitting). In a pioneering experiment in 1952, Robert Briggs and Thomas J. King (I, 1952), cancer researchers at the Institute for Cancer Research (today part of the Fox Chase Cancer Center) in Philadelphia, demonstrated on frogs another method of cloning by transplanting nuclei into enucleated cells, a technique called "nuclear transplantation," which John B. Gurdon and colleagues (I, 1958, 1975) used to create clones of frogs.Then, in the late 1970s and early 1980s, two back-to-back frauds in cloning occurred. First, the cloning of a human described by American science journalist David Rorvik in the 1978 book In His Image was called a hoax by a court in [End Page 305] 1982. Second, the cloning of three mice, announced by German wunderkind Karl Illmensee to scientific circles in 1979 (and to the public in 1981), could not be proven to be true, according to convincing evidence by McGrath and Solter (I) published in 1984.With their pronouncement that mammalian cloning was impossible, McGrath and Solter essentially stopped cloning research and funding for such biological research. So by the mid-1980s, instead of further investigating cloning, developmental biologists studied embryology related to in vitro fertilization, while molecular biologists studied recombinant DNA under the newly relaxed NIH guidelines. These two strands of scientific investigation came together in the work of Ian Wilmut, who created in vitro embryos using nuclear transplantation to reproduce genetically engineered cattle. Wilmut was seeking a way to increase the successful birth rate when, in the 1990s, he produced identical twin sheep, Megan and Morag, cloned from an embryonic cell, followed by another sheep, Dolly, cloned from an adult cell. The birth of a mammal from an embryo whose genetic material came from an adult cell firmly re-established the possibility of cloning from adults. Prior to Dolly's birth, scientists believed that adult cells lost the ability to dedifferentiate—i.e., to become unspecialized—and so could not direct the development of an embryo through to birth.The 1997 announcement of Dolly's birth initiated the present widespread discussion of cloning. Because of its potentially vast applications across human health, medicine, agriculture, and business/economics, cloning raises a host of issues including those concerning: genetics and genetic engineering, patenting, animal rights and/or animal welfare (especially for transgenic, research, or cloned animals), organ transplantation, reproduction, eugenics, pharmacology (drug production using transgenic animals), research practices, informed consent, stem cell research, women's rights, children's rights, parental rights and responsibilities, and theology and philosophy. It fosters questions about the meaning and purpose of life, the limits of human powers to intervene in research and therapy, and what it means to be human or animal. In addition, environmentalists and organic farmers raise concerns about the effect of novel animals and plants on the environment, while nutritionists and the lay public wonder... (shrink)

The aim of this study was to test red - green dichromats' ability to discriminate between illuminant and surface-reflectance changes in natural scenes. Stimuli were simulations of natural scenes presented on a colour monitor with 10-bit resolution per gun. The natural scenes were obtained with a fast hyperspectral imaging system. Six different scenes (including rocks, foliage, and buildings) were tested. In each trial, two images were presented in sequence, each for 1 s, with no interval. The images differed in the (...) phase of daylight on the scene: first with correlated colour temperature 25 000 K, then 6 700 K. The spectral reflectance of a region in the second image was changed randomly, consistent with a local change in daylight. The observer's task was to decide whether a particular surface in the successive images was the same (pure illuminant change) or different (illuminant change with a surface-reflectance change). The performance of four deuteranopes and five protanopes varied considerably across the scenes tested, with mean colour constancy indices (± 1 SEM) of 0.48 (± 0.13) and 0.19 (± 0.10), respectively (1.0 representing ideal performance). Deuteranopes seemed less disadvantaged than protanopes, performing close to normal with some scenes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 103-113 [Access article in PDF] Scope Note Update Searching Across Boundaries: National Information Resource on Ethics and Human Genetics* While indeed an historical moment, the announcement of the mapping of the human genome has been treated in the literature as a beginning—a new way to think about biology and the ways in which biological concepts are applied to medicine. Issues of (...) both Science and Nature magazines celebrated the event by establishing interdisciplinary websites where readers can access essays on aspects of genome mapping and directly link to databases to search for more information on the topics (IV. Genome Gateway 2001; The Human Genome 2001). Since 1994, the National Information Resource on Ethics and Human Genetics (NIREHG), a special project of the National Reference Center for Bioethics Literature (NRC), has been providing such an integrated information service on ethics and genetics. Designed to enable a wide range of users to go from annotated bibliographies (Scope Notes) and brief essays (called "enotes") to database searching, NIREHG fosters an interdisciplinary approach to research on ethics and genetics. Links are provided between and among Scope Notes and enotes to information maintained on the NIREHG site as well as to sources found throughout the Internet. In providing the following annotations added to NIREHG materials since 1997, the Kennedy Institute of Ethics Journal (in its online presence through Project Muse) becomes an additional forum for NIREHG links. "It is a rare and wonderful moment when success teaches us humility, and this, I argue, is precisely the moment at which we find ourselves at the end of the twentieth century" (IV. Keller 2000, p. 7). It is with both joy and humility that we celebrate the mapping of the human genome. [End Page 103] I. Genetic Testing Andrews, Lori B. Future Perfect: Confronting Decisions About Genetics. New York: Columbia University Press, 2001. 264 p.Noting the wide impact of genetic testing, Andrews discusses patient self concept, reproduction decisions, confidentiality, discriminations in health insurance and employment, the need for competent counseling, and the legal, ethical, and social regulations she deems important to help solve dilemmas arising from the tests and their ensuing ramifications. She describes three models, pointing out both advantages and problems: a medical model with physician gatekeepers, a public health model that could provide education as well some testing for those unable to afford tests, and a fundamental rights model that could give greater weight to individuals decisions about the use of health care services. The book has 85 pages of footnotes.American Society of Human Genetics. Social Issues Subcommittee on Familial Disclosure. Professional Disclosure of Familial Genetic Information. American Journal of Human Genetics 62 (2): 474-83, February 1998.The ASHG statement outlines points to consider: the general rule of confidentiality, exceptional circumstances that permit disclosure, and the ethical duty to inform patients about familial implications. Background discussion includes: ethical frameworks for disclosure of otherwise confidential information, the duty to warn under law, and international trends and positions.Boetzkes, Elisabeth. Genetic Knowledge and Third-Party Interests. Cambridge Quarterly of Healthcare Ethics 8 (4): 386-92, Summer 1999.Protection from the interests of insurers or prospective employers are discussed from the point of view of the ethical basis of the professional obligation to confidentiality as well as the right to privacy of those tested. However, the author supports family members, saying that "first-party resistance to disclosure may be overcome by weighty third-party claims."Chadwick, Ruth; Shickle, Darren; ten Have, Henk; and Wiesing, Urban, eds. The Ethics of Genetic Screening. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1999. 255 p.Twenty-one chapters and 23 authors provide views of genetic testing/screening in different European countries and offer brief discussions of sociological perspectives, moral and philosophical issues, privacy, reconciling liberty and the common good, and questions raised in genetic testing of children.Clayton, Ellen Wright. Genetic Testing in Children. Journal of Medicine and Philosophy 22 (3): 233-51, June 1997.Clayton argues that there is room for... (shrink)

Desire, Love, and Identity: Philosophy of Sex and Love combines classical readings with contemporary articles exploring love and sex as defining features of our identity. This volume includes readings from a wide variety of perspectives, addressing topics such as sexual objectification, sexual identity, the ethics of sex work, love and sex online, friendship, polyamory, and BDSM. Alongside ancient, modern, and contemporary selections are sixteen original contributions written by emerging voices in the field. A wide-ranging, engaging, accessible introduction to the subject, (...) the text includes further readings and discussion questions to promote thought, discussion, and composition on subjects deeply intertwined with students' identities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 165-168 [Access article in PDF] UPMC Presbyterian Policy and Procedure Manual Guidelines for Disclosure and Discussion of Conditions and Events with Patients, Families and Guardians* I. Introduction and Background In the course of hospital care, an extensive amount of clinical information is generated. It includes diagnostic findings, treatment options, responses to interventions, and professional opinions. The information can be positive or (...) negative. Clinical events may or may not be caused by clinicians and consequently may be iatrogenic (caused by medical treatment), nosocomial (occurring in the hospital) or natural events.In accordance with the informed consent policy (#4011), Patients' Bill of Rights (# 0154, Section II H), and the Guidelines on Forgoing Life Sustaining Treatment (#4007), patients have the right to information regarding their condition and care. Physicians and other caregivers are obligated to provide accurate information as expeditiously as possible. While it is usually easy to provide positive information, negative information is more difficult to disclose, especially when the cause is iatrogenic."Therapeutic privilege" has been invoked to explain why certain negative information might be withheld. By invoking therapeutic privilege, the physician refrains from full disclosure to protect the patient from the effects of receiving the information itself. The use of therapeutic privilege is increasingly being called into question because it decreases patient autonomy and reduces trust.The following recommendations are provided to clinicians to help guide delivery of sensitive information, positive and negative. Specific recommendations [End Page 165] are provided for situations where the information is about an unfavorable or adverse event, or where the information might best be characterized as "bad news." II. Definitions Unfavorable event or unfavorable condition. For the purposes of these guidelines, an unfavorable condition is an occurrence or diagnosis that results in or is likely to result in a significant negative outcome, and/or a significant alteration in the care plan.An unfavorable event in this context is not the same as a sentinel event, which in policy #4025 is defined as, "a serious, unexpected, adverse patient event which has resulted in, or if repeated would have a significant probability of resulting in, loss of life or serious physical or psychological injury, that is judged to be a warning of an underlying problem involving hospital facilities, policies, procedures, systems or personnel."Adverse Event. An unfavorable event for the purposes of these guidelines is also distinguished from the FDA definition of the term "adverse event", which is a reportable negative effect of a drug or device potentially resulting in death, hospitalization, or medical or surgical intervention. (See policy #4022 Safe Medical Device Act.)Examples of unfavorable events or conditions for the purpose of these guidelines include a new diagnosis of cancer, a perioperative myocardial infarction, or unintended delivery of an incorrect medication that results in clinical change.Examples of events not covered by these guidelines are intravenous saline infiltration and medication dosing errors that have no clinical impact on care.Iatrogenic. Event caused by the treatment of a healthcare provider. III. Guidelines and Principles It is appropriate that UPMC Presbyterian support basic principles for patient and family notification regarding all clinical events and conditions, including unfavorable ones. Physicians must be honest because that is a cornerstone of the patient-physician relationship, and because it fosters patient autonomy.UPMC Presbyterian supports the following AMA position regarding patient information: [End Page 166] It is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients. Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions. Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician's mistake or judgement. In these situations, the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred. Only through full disclosure is a patient able to make informed decisions regarding future medical care. Ethical responsibility includes informing patients of changes in their diagnoses... (shrink)

I argue that the reflections on language in Adorno and Heidegger have their common root in a modernist problematic that dissected experience into ordinary experience, and transfiguring experiences that are beyond the capacity for expression of our language. I argue that Adorno’s solution to this problem is the more resolutely “modernist” one, in that Adorno is more rigorous about preserving the distinction between what can be said, and what strives for expression in language. After outlining the definitive statement of this (...) problematic in Nietzsche’s early epistemological writings, I outline Heidegger’s solution and subsequently Adorno’s critique of Heidegger. Finally, I argue that situating Adorno within the modernist problem of language and expression is crucial for making sense of his philosophy as a form of critical theory. (shrink)

This article reflects on the problem of false belief produced by the integrated psychological and algorithmic landscape humans now inhabit. Following the work of scholars such as Lee McIntyre (Post-Truth, MIT Press, 2018) or Cailin O’Connor and James Weatherall (The Misinformation Age: How False Beliefs Spread, Yale University Press, 2019) it combines recent discussions of fake news, post-truth, and science denialism across the disciplines of political science, computer science, sociology, psychology, and the history and philosophy of science that variously address (...) the ineffectiveness, in a digital era, of countering individual falsehoods with facts. Truth and falsehood, it argues, rather than being seen as properties or conditions attached to individual instances of content, should now be seen as collective, performative, and above all persuasive phenomena. They should be practically evaluated as networked systems and mechanisms of sharing in which individually targeted actions are combining with structural tendencies (both human and mechanical) in unprecedented ways. For example, the persuasive agency of apparent consensus (clicks, likes, bots, trolls) is newly important in a fractured environment that only appears to be, but is no longer ‘public’; the control of narratives, labels, and associations is a live, time-sensitive issue, a continuous contest, or ongoing cusp. Taking a social approach to truth yields observations of new relevance; from how current strategies of negative cohesion, blame, and enemy-creation depend crucially on binary ways of constructing the world, to how the offer of identity/community powerfully cooperates with the structural tendencies of algorithm-driven advertiser platforms towards polarisation. Remedies for these machine-learned and psychological tendencies lie in end-user education. So the Arts and Humanities, whether via comparisons with previous historical periods, or via principles of critical thinking and active reading, offer crucial resources to help counter what since 1997 silicon valley executives and scholars have called ‘persuasive technology’ (Fogg in Persuasive Technology: Using Computers to Change What we Think and Do, Morgan Kaufmann, 2003; Hamari et al. (eds) in Persuasive Technology, Springer International Publishing, 2014; Harris in How a Handful of Tech Companies Control Billions of Minds Every Day, 2017; Lanier in Who Owns the Future? Simon & Schuster, 2014 and Ten Arguments for Deleting your Social Media Accounts Right Now, Picador, 2019). The article proposes a paradigm shift in public understandings of this new social environment: from a culture of discovery, where what matters is what exists or is in fact the case, to a culture of iteration, where what matters is what gets repeated. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The Confidentiality Advisory Group is a specialised body that advises the Health Research Authority and the Secretary of State for Health on requests for access to confidential information, in the absence of informed consent from its owners. Its primary role is to oversee the safe use of such information and to counsel the governing bodies mentioned above as to whether such use is appropriate or inappropriate. Researchers who seek access to England or Wales-based confidential data, for medical purposes that are (...) in the interest of the public, are typically required to submit an application to this body. However, it is not always clear to researchers whether requests for access to patient data fit within the remit of the CAG or a Trust’s local information governance team. This commentary will, therefore, explore the role of the CAG and reflect on how best to support researchers with this question. (shrink)

We are very grateful to Richard Ashcroft 1 and Andrew McGee 2 for their thoughtful and articulate criticisms of our views. 3 Ashcroft has disappointingly low aspirations for the law. Of course he is right to say that the law is not a ‘self-sufficient, integrated and self-interpreting system of doctrine’. The law is often philosophically incoherent and internally contradictory. But it does not follow from this that all areas of the law are philosophically unsatisfactory. And if that were true, the (...) response should not be Ashcroft’s contemptuous despair, but a determination to make it better. Ashcroft would say that such idealism is unrealistic in the light of the very nature of ‘the Law’: ‘...a complex assemblage of institutions, rules, accredited persons, practices and systems’. That isa radically ‘legal realist’ position and is plainly unsustainable. We can demonstrate its unsustainability while demonstrating both that he is wrong... (shrink)

The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient’s best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge’s job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.The presumption is best (...) regarded as a presumption of law. It has long been recognised as part of the way in which the English law discharges its obligations under Article 2 of the European Convention on Human Rights (the right to life). But even if it is a ‘mere’ evidential presumption it cannot, on the facts of most cases involving applications for the withdrawal of life-sustaining treatment from patients in prolonged disorders of consciousness, be rebutted. (shrink)

When the terms ‘control’ and ‘experiment’ are used in reference to the methodological procedures of the social sciences, frequently the question is raised as to whether or not the investigator uses the terms in the same sense as the natural scientist. The purpose of this paper is to show that the social scientist has good reason to use them in the same sense and that in fact this usage is consistent with a long tradition of social research. This will be (...) shown by an investigation of some common assumptions in the social sciences, such as, the claim that the social sciences are younger than the natural sciences and that the former have depended upon the latter for methodological cues, that human behavior is ultimately inexplicable and unpredictable, and that the social scientist is unable to observe human behavior under controlled, experimental conditions except in trivial instances. Of course, not all social scientists make these assumptions but they occur in the literature and their significance is considerable when the scientific status of the social sciences is being discussed. (shrink)

In his Res Gestae, the historian Ammianus Marcellinus describes the Egyptian city of Thebes and the obelisks that can be found there. There is an unusual passage in which he describes hieroglyphic writings. He goes on to show, through two examples, how hieroglyphs might seem bizarre, but in fact contain their own logic which can be explained : non enim ut nunc litterarum numerus praestitutus et facilis exprimit quicquid humana mens concipere potest, ita prisci quoque scriptitarunt Aegyptii, sed singulae litterae (...) singulis nominibus seruiebant et uerbis; non numquam significabant integros sensus. cuius rei scientiam his inseram duobus exemplis. per uulturem naturae uocabulum pandunt, quia mares nullos posse inter has alites inueniri rationes memorant physicae, perque speciem apis mella conficientis indicant regem moderatori cum iucunditate aculeos quoque innasci debere his signis ostendentes. et similia plurima.For the ancient Egyptians did not write as nowadays, when a prescribed and easy series of letters expresses whatever the human mind can imagine; but individual characters served as individual nouns and verbs; and sometimes they signified whole ideas. I will show the knowledge of this with these two examples. They represent the word for ‘nature’ by a vulture, because no males can be found among these birds, as natural history records; and by the figure of the bee making honey they indicate ‘a king’, showing by these signs that in a ruler stings also ought to arise from sweetness. And there are many similar instances. (shrink)

Volume 19, Issue 10, October 2019, Page 50-51.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. IOM speculated (...) that more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

At least two recent collections of essays – Postmodernism and the Enlightenment and What’s Left of Enlightenment?: A Postmodern Question – have responded to postmodern critiques of Enlightenment by arguing that Enlightenment philosophes themselves embraced a number of post-modern themes. This essay situates Kant’s essay Was ist Aufklärung in the context of this recent literature about the appropriate characterization of modernity and the Enlightenment. Adopting an internalist reading of Kant’s Aufklärung essay, this paper observes that Kant is surprisingly ambivalent about (...) who might be Enlightened and unspecific about when Enlightenment might be achieved. The paper argues that this is because Kant is concerned less with elucidating his concept of Enlightenment and more with characterizing a political condition that might provide the conditions for the possibility of Enlightenment. This paper calls this political condition modernity and it is achieved when civil order can be maintained alongside fractious and possibly insoluble public disagreement about matters of conscience, including the nature and possibility of Enlightenment. Thus, the audience for the Aufklärung essay is not the tax collector, soldier or clergyman, but rather the sovereign. Kant enjoins and advises the prince that discord and debate about matters of conscience need not entail any political unrest or upheaval. It is in this restricted sense that the Enlightenment essay is Kant’s Machiavellian moment. (shrink)

Romanmagistriandgrammaticitaught their students a wide range of subjects, primarily through the medium of Latin and Greek literary texts. A well-educated Roman in the Imperial era was expected to have a good knowledge of the literary language of Cicero and Virgil, as well as a competent command of Greek. By the late fourth and early fifth centuries, this knowledge had to be taught actively, as everyday Latin usage had changed during the intervening four centuries. After the reign of Theodosius the division (...) between the Eastern and the Western Empires meant that knowledge of Greek was no longer as common as it had once been in the West. At the same time, by Late Antiquity, migration increased and foreigners as well as provincials moved within the empire, for example, in search of military promotion. There is evidence that recruitment to official or public careers was based less on birth than on education. These ambitious newcomers sent their children to Roman schools, which would facilitate their access to public office. Receipt of this education provided a means by which men from less privileged backgrounds could achieve promotion to such office and become prominent and influential individuals. At the same time a late Roman education also produced a high level of cultural homogeneity among those who had experienced it. So what might we learn about how language was taught—and what kinds of language were valued—in a late-antique Roman school? How might this contribute to our understanding of late-antique Roman elite society? (shrink)

This paper contends that the conventional ethical and legal ways of analysing the wrong involved in the misuse of human body parts are inadequate, and should be replaced with an analysis based on human dignity. It examines the various ways in which dignity has been understood, outlines many of the criticisms made of those ways , and proposes a new way of seeing dignity which is exegetically consonant with the way in which dignity has been historically understood, and yet avoids (...) the pitfalls which have led to dignity being dismissed by many as hopelessly amorphous or incurably theological. The account of dignity proposed is broadly Aristotelian. It defines dignity in terms of human thriving, and presupposes that it is possible, at least in principle, to determine empirically what makes humans thrive. It contends that humans are quintessentially relational animals, and that it is not possible to define humans as atomistic entities. One important corollary of this is that when using dignity/thriving as a criterion for determining the ethical acceptability of a proposed action or inaction, one should ask not merely how the dignity interests of the patient would be affected, but how the dignity interests of all stakeholders would be affected. The business of ethics is then the business of auditing all those interests, and determining the course of action which would maximise the amount of thriving in the world. (shrink)

Read Rati Mekvabishvili's 'On the Importance of Altruism, Prosocial Behavior and Christian Love in Behavioral Economics research' here...

The relation between education and sustainability cannot be an external, still less an instrumental one. Sustainability means humans, as individuals and societies, consciously trying to go with the grain of nature. Learning to understand the natural world and the human place in it can only be an active process through which our sense of what counts as going with the grain of nature is continuously constituted and recreated. This process cannot have its agenda set to subserve sustainability criteria which it (...) actually makes meaningful. The policy discourse, parameters and indices of operational sustainability are heuristics, and the conditions for deploying them intelligently are at one and the same time the conditions for a genuinely learning and for a deeply sustainable society. This suggests, too, a basis for reclaiming education in general from the instrumentalising approaches that currently beset it. (shrink)

Translated and reprinted by permission of Monthly Review magazine. (c) Monthly Review. All rights reserved. The New Irrationalism by John Bellamy Foster (February 2023, Volume 74, Number 9). Tradução por Lara Nora Portugal Penna. Revisão por Elcemir Paço Cunha.