BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

The authors conducted a baseline survey of baccalaureate and graduate degree health humanities programs in the United States and Canada. The object of the survey was to formally assess the current state of the field, to gauge what kind of resources individual programs are receiving, and to assess their self-identified needs to become or remain programmatically sustainable, including their views on the potential benefits of program accreditation. A 56-question baseline survey was sent to 111 institutions with baccalaureate programs and 20 (...) institutions with graduate programs. Respondents were asked about three areas: (1) program administration (managing unit, paid director, faculty lines, paid staff, funding sources); (2) educational program (curricular structure, CIP code usage, completion rates); and (3) views on accreditation for the field. A clear majority of respondents agreed that some form of accreditation or consultation service could address resource and sustainability issues. Overall, the survey responses to staffing, curricular structure, and support suggest the need for developing a sustainable infrastructure for health humanities. (shrink)

The concept of a G‐quartet, a unique structural arrangement intrinsic to guanine‐rich DNA, was first introduced by Gellert and colleagues1 over 40 years ago. For decades, it has been uncertain whether the G‐quartet and the structure that it gives rise to, the G‐quadruplex, are purely in vitro phenomena. Nevertheless, the presence of signature G‐rich motifs in the eukaryotic genome, and the plethora of proteins that bind to, modify or resolve this nucleic acid structure in vitro have provided circumstantial evidence for (...) its physiological relevance. More recently, direct visualisation of G‐quadruplex DNA at native telomeres was achieved, bolstering the evidence for its existence in the cell. Furthermore, G‐quadruplex folded telomeric DNA has been found to perturb telomere function and to impede the action of telomerase, an enzyme overexpressed in >85% of human cancers, hence opening up a novel avenue for cancer therapy in the form of G‐quadruplex stabilising agents. BioEssays 29: 155–165, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Lack of guidance and regulation for authorizing medical cannabis for conditions involving the health and neurodevelopment of children is ethically problematic as it promulgates access inequities, risk-benefit inconsistencies, and inadequate consent mechanisms. In two virtual sessions using participatory action research and consensus-building methods, we obtained perspectives of stakeholders on ethics and medical cannabis for children and youth. The sessions focused on the scientific and regulatory landscape of medical cannabis, surrogate decision-making and assent, and the social and political culture of medical (...) cannabis. We found that evidence-gathering and data dissemination, pressures on clinical relationships, and the lack of integration of culturally diverse perspectives and Indigenous knowledges were key areas of concern. Participants emphasized the importance of utilizing adaptive study designs, highlighted the importance of trust-building between clinicians, patients and caregivers, and discussed barriers including historical and ongoing stigmatization of medical cannabis. We conclude that continued public consultation and strength-based research that integrate diverse perspectives are critical steps forward. (shrink)

Four studies explore the role of perceptual fluency in attenuating bullshit receptivity, or the tendency for individuals to rate otherwise meaningless statements as “profound”. Across four studies, we presented participants with a sample of pseudoprofound bullshit statements in either a fluent or disfluent font and found that overall, disfluency attenuated bullshit receptivity while also finding little evidence that this effect was moderated by cognitive thinking style. In all studies, we measured participants’ cognitive reflection, need for cognition, faith in intuition, and (...) superstitious beliefs. Superstition strongly predicted bullshit receptivity regardless of fluency. Inconclusive results were found for the remaining scales. Potential links for the role of perceptual disfluency in promoting analytic thinking are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:INDIRECT METHODS IN THEOLOGY: KARL RAHNER AS AN AD HOC APOLOGIST NICHOLAS M. HEALY St. John's University Staten Island, New York THE PURPOSE of this paper is to discuss Karl Rahner's emarks upon, and use of, what he called ' indirect methds ' in theology.1 To my knowledge there has been little analysis, beyond incidental treatment, of Rahner's scattered references to these methods.2 In the following pages I hope (...) to remedy this gap, and argue for two interdependent theses : First, by construing Rahner's own theological practice in the light of his remarks on the indirect methods, an apologetic method can be discerned which could prove useful for contemporary theology. Second, reading Rahner from this perspective indicates that his apologetic method is much more situation-relative and occasionalist than has generally been recognized hitherto. Two Kinds of Apologetics A quick sketch of some aspects of the present theological scene will help make these theses a little clearer and provide some cate1 My discussion of the indirect methods is based primarily upon the following sources: Theological Investigations (New York: Crossroad, 1961-1982) (cited in the text as TI), vol. 6, " A Small Question Regarding the Contemporary Pluralism in the Intellectual Situation of Catholic and the Church", pp. 21-30; vol. 11, "Reflections on Methodology in Theology", pp. 68-114; vol. 16, "A New Task for Theology". Foundations of Christian Faith (New York: Crossroad, 1978) (henceforth cited as FCF), introduction, pp. 1-23, et passim. 2 See e.g., Anne Carr, The Theological Method of Karl Rahner (Missoula: Scholars Press, 1977), pp. 267-9; Francis S. Fiorenza, Foundational Theology: Jesus and the Church (New York: Crossroad, 1984) (cited as Fiorenza), p. 93. Both these interpreters consider the indirect methods to be synonymous with the transcendental method. They then interpret the former in terms of the latter, misguidedly, I will argue. 613 614 NICHOLAS M. HEALY gories for the following discussion. According to William Placher,8 the contemporary situation in North American theology is often characterized as one in which two rival models of theology are dominant, the revisionist and the post-liberal (Placher, 17-19). Placher discusses many aspects of each model; here I want to look only at those features which bear upon their different conceptions of the nature of apologetics. According to David Tracy, a leading practitioner of the revisionist model, theology in all its forms must be " determined by a relentless drive to genuine publicness ".4 In order to maintain its public character, theology, like any discipline, must develop a preliminary systematic argument by which to ground its possibility and to ·establish its claims to truth and meaningfulness. This initial apologetics uses universal categories and proceeds in accordance with general criteria, functioning in terms, that is, which " all reasonable persons, whether ' religiously involved ' or not, can recognize as reasonable" (Tracy, 57). Usually it takes the form of a foundational explanatory theory of religious discourse which appeals to the universal nature of the deep structures of religious experience. This general theory of religion provides criteria for the subsequent theology, thereby maintaining the latter's relevance for the general, non-Christian public. The theological method considered appropriate is one which attempts systematically to correlate Christian-specific claims with the deep structures of human experience.5 The post-liberal model, by comparison, is more concerned to preserve Christian identity than to maintain the publicness of Christian discourse. The task of theology is not primarily the apologetic one of justifying Christianity to a non-Christian puba Unapologetic Theology: A Christian Voice in a Pluralistic Conversation (Louisville: Westminster/John Knox Press, 1989) (cited as Placher). 4 David Tracy, The Analogical Imagination: Christian Theology and the Culture of Pluralism (New York: Crossroad, 1981), p. 31 (cited as Tracy). 5 See the analyses in, e.g., George A. Lindbeck, The Nature of Doctrine: Religion and Theology in a Postliberal Age (Philadelphia: Westminster Press, 1984), chapter 2; and Ronald F. Thiemann, Revelation and Theology: The Gospel as Narrated Promise (Notre Dame: U. of N. D. Press, 1985), chapter 4. KARL RAHNER AS AN AD HOC APOLOGIST 615 lie. Instead the theologian should critically " describe and redescribe the character and relationship of Christian beliefs and... (shrink)

To our knowledge, this is one of the first studies to test different theoretical models of working memory in childhood based on a computerized assessment. We tested this across several countries: Argentina, Brazil, Canada, Italy, and UK. The present study addressed the wider macro-cultural context and how this impacts working memory. We used two economic indices to characterize the participating countries and ranked the countries based on the Global Index of Cognitive Skills and Educational Attainment. Children between 5 and 10 (...) years completed the same set of short-term and working memory tests. There were two main findings. First, there was a similar pattern in verbal working memory across countries, which suggests that this skill may be relatively consistent across different cultural groups. In contrast, the pattern for visuo-spatial working memory was different across countries, which may explained by cultural differences and educational rankings of the countries. The second main finding was that both a domain-general model and a domain-specific model provided a reasonably good fit with the data, there was the high relationship between the verbal and visuo-spatial working memory constructs across the countries in the latter model. Thus, it may be a more parsimonious choice to rely on a three-factor model. The data also suggest culture-similar patterns in a computerized assessment of working memory. (shrink)

In an item-method directed forgetting paradigm, participants were required to attend to one of two colored words presented on opposite sides of a central fixation stimulus; they were instructed to Remember or Forget the attended item. On a subsequent recognition test, the Attended words showed a typical directed forgetting effect with better recognition of Remember words than Forget words. Our interest was in the fate of the Unattended words. When the study display disappeared before the memory instruction, there was no (...) effect of that instruction on unattended words; when the study display remained visible during presentation of the memory instruction, there was a reverse directed forgetting effect with better recognition of unattended words from Forget trials than from Remember trials. Incidental encoding of task-irrelevant stimuli occurs following presentation of a Forget instruction – but only when those task-irrelevant stimuli are still visible in the external environment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:332 BOOK REVIEWS toral inventions (such as basic Christian communities), and the religious backgrounds of millions who help to make up the churches, Catholic and Protestant, of the United States. Providence College Providence, RI EDWARD L. CLEARY, O.P. Springs of Action: Understanding Intentional Behavior. By ALFRED R. MELE. New York and Oxford: Oxford University Press, 1992. Pp. 272 + ix. $39.95 (cloth). Alfred Mele's overarching aim in this book (...) is to offer an account of the role of intentions in the explanation of intentional action. He works within the familiar terms of causal theories of action, and is particularly indebted to Donald Davidson. In Part I, Mele borrows a set of theses from Davidson's desire/belief model of intentional action, and in the process of addressing problems associated with these theses, he progressively refines an account of action that understands an agent's reasons to have explanatory force by virtue of being among the causes of action. In Part II, Mele argues that desire/belief models are insufficient as they stand and need to be filled out by recognizing that intentions provide a crucial link between reasons and actions. The discussion begins with the vexed question of how the content of mental states can be relevant to the causal explanation of action. We constantly appeal to our desires, beliefs, plans, and so on (i.e., to various propositional, or intentional, attitudes) in explaining our behavior. But how does, say, my appetite for good wine and my belief that the house chardonnay is such a wine figure in the causal order that brings about my act of ordering a glass of it? Presumably, these intentional states supervene upon certain physical states of my body, and the latter do the causal work of producing wine-ordering behavior. However, there are good reasons to think that, with certain sorts of changes in my history and environment (viz., of the sort described in twin earth thought experiments), these physical states could be the realization of different intentional states. So can a causal theory of action actually accord my desires and beliefs any role in explaining my action? Mele argues that even if we hold (with externalists) that the agent's history and environment help to fix the content of her intentional states, we can nonetheless say that unless the agent had intended what she did, she would not have acted as she did. The behavior is intentional action by virtue of issuing (in the right way) from physical processes BOOK REVIEWS 333 that realize the agent's reasons for acting, and these processes realize these reasons only if the processes have an appropriate causal history. The result is that what we desire, believe, and intend does after all make a systematic difference in what we do. Mele makes some helpful refinements in the standard account of the causal role of desire in intentional action. It has typically been claimed that when an agent's wants compete, the "strongest" of them deter· mines the action; if an agent wants to do A more than anything else that she takes herself to be able to do, then if she acts intentionally she will do A. Mele points out that this general claim must be qualified so as to index desires to times, to accommodate both unsuccessful at· tempts and the agent's estimates of the likelihood of success, and to deal with the complex relations between desires. He explores the way in which agents are able to control the motivational strength of their desires, and he works out a definition of irresistible desire. One of the deepest challenges to the claim that action is caused by what we most desire arises in considering "motivational ties." How, on this account, is intentional action possible when we equally desire each of two incompatible alternatives? An arbitrary decision procedure can be adopted (e.g., a coin toss), but this alone does not en· hance the attractiveness of the randomly selected alternative. Here Mele introduces his thesis about intentions: viz., that intentions have an "executive quality that is not reducible to desire-strength" (p. 72), so that even when there is no preponderant motivation to do A... (shrink)

Electronic technologies, in general, and computer-oriented technologies specifically have had a tremendous impact on all aspects of business. One area of increased concern is the protection of intellectual properties -- notably copyrights -- within the boundaries of the broadly defined technology industry. While the ability to share copyrighted information has always existed at the most basic levels, the advent of the information age has allowed the sharing of this information to take place in potentially greater quantities and without a loss (...) of quality. As such, copying creates a major threat to industries dealing in the production and distribution of copyrightable creations. The focus of this paper is to better understand how the ethical judgments of employees regarding the opportunities to recreate copyrighted works via traditional and newer technologies impact assessments of copying behavior in the workplace. (shrink)

Morality – the subjective sense that humans discern between right and wrong – plays a ubiquitous role in everyday life. Deontological reasoning conceptualizes moral decision-making as rigid, such that many moral choices are forbidden or required. Not surprisingly, the language used in measures of deontological reasoning tends to be rigid, including phrases such as “always” and “never.” Two studies drawn from two different populations used commonly used measures of moral reasoning and measures of morality to examine the link between individual (...) differences in deontological reasoning and language on the endorsement of moral foundations. Participants low on deontological reasoning generally showed less endorsement for moral principles when extreme language was used in the measures. (shrink)

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast (...) clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

Using a sample of 652 college students, we examined several implications of the hypothesis that the shape of the human penis evolved to enable males to substitute their semen for those of their rivals. The incidence of double mating by females appears sufficient to make semen displacement adaptive (e.g., one in four females acknowledge infidelity, one in eight admit having sex with two or more males in a 24-hour period, and one in 12 report involvement in one or more sexual (...) threesomes with two males). We also document several changes in post-ejaculatory behavior (e.g., reduced thrusting, penis withdrawal, loss of an erection) which may have evolved to minimize displacement of the male’s own semen. Consistent with predictions derived from a theoretical model (Gallup and Burch 2006), we discovered that most females report waiting at least 48 hours following an instance of infidelity before resuming sex with their in-pair partners. (shrink)

Forenames serve as proxies for gender labels that activate gender stereotypes and gender socialization. Unlike rigid binary gender categories, they differ in the degree to which they are perceived as “masculine” or “feminine.” We examined the novel hypothesis that the ability of a forename to signal gender is associated with gender role behavior in women and men as part of a larger study evaluating forenames used in resume research. Compared to individuals endorsing a “gender-strong” forename, those perceiving their forename as (...) relatively “gender-weak” reported less gender-typical childhood social behavior and a weaker expression of gender-linked personality traits. Our findings suggest that forenames strengthen or weaken gender socialization, gender identification, and so contribute to the variable expression of gender role behavior within binary gender groups. (shrink)

In this article, we conceptualize the under investigated and under theorized relationship between intimate partner violence (IPV) and business responsibility. As an urgent social issue, IPV—understood as abuse of power within the context of an intimate partner relationship, mainly perpetrated by men and involving a pattern of behavior—has been studied for decades in many disciplines. A less common yet vital research perspective is to examine IPV as it relates to the business and to ask how organizations should engage with IPV. (...) In response to this question, we contribute a framework drawing from two distinctions in the business responsibility scholarship: the assumed role of the organization (responsibility to the firm/market; responsibility to the broader socio-political-economic environment); and the second focused on the approach to conceptualizing ethics (justice/fairness; ethics of care). Thus, we explicate four approaches to business responsibility and IPV, which serve the purposes of mapping three selected contributions, identifying limitations of these approaches, and opening up future research opportunities. (shrink)

Objectives: To test the range of beliefs regarding the ethics of testing, in resource poor settings, new therapies that are less efficacious but more affordable and feasible than the best current therapeutic standard. Design: Using a web-based survey, we presented a hypothetical scenario proposing to test a therapy for HIV disease ("therapeutic inoculation") known to be less efficacious than highly active antiretroviral therapy (HAART). Respondents evaluated various trial designs as ethical or unethical. Participants: 604 subscribers to two listservs for individuals (...) interested in international health research ethics. Main outcome measures: Proportion of respondents endorsing trials testing this "substandard" therapy, and proportion endorsing placebo-controlled trials. Results: There were 215 respondents from 47 countries. Forty-five percent of respondents were from low or middle income countries; 96% devoted at least some time to research activities; and 75% had "some" or "considerable" research experience in developing countries. Of respondents, 97% (95% CI 94.7 to 99.4) endorsed testing therapeutic inoculation, without HAART, in patients with HIV disease; 86% (95% CI 81.4% to 90.7%) endorsed testing against placebo. Sixty-eight percent explicitly endorsed principles where the standard of care for subjects in clinical trials is determined by local, not universal, standards. There were no differences in responses based on respondent education-level or the income-level of their country of citizenship. Conclusion: There was broad agreement that a therapy of potential local benefit may be tested, even when that therapy is known to be inferior to the standard of care in wealthy countries. Most agreed that a placebo control may be used in some circumstances. (shrink)

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

Although significant literature and jurisprudence has amassed on rights-based climate litigation over recent years, less research and case law has emerged on poverty-related court cases and the fulfilment of economic, social, and cultural rights (ESCR) in Canada. Fewer still are studies exploring the interlinkages between these areas of inquiry. The purpose of this paper is to explore, using Canada as a case study, rights-based developments in climate litigation cases and how these could impact the innovative advancement of ESCR (e.g. to (...) food, housing and water). Typically, issues of justiciability and standing emerge, impeding the realization of such rights. Given the grave threats we now face, climate cases and social movements must be brought together to better hold state actors accountable for their rights obligations. We implore the legal community to explore ways to traverse juridical obstacles to realize the interdependencies of human rights and protect the planet from calamitous climate change. (shrink)

Consumers are bombarded with labels and claims that are intended to address their concerns about how food products are produced, processed, and regulated. Among those are the natural or all-natural claims and the certified organic label. In this study, two focus groups were conducted to explore consumers’ attitudes toward all-natural and organic pork and to gather their reactions to the USDA organic standards for meat, and the policy for natural claims. Results indicated that participants had positive associations with the terms (...) “organic” and “all-natural” with exceptions regarding the trustworthiness of all-natural claims. Participants perceived the “no” labeling theme (no antibiotics, no hormones, no chemicals, etc.) often coupled with the all-natural label on pork products as identifying potential health and animal welfare risks. In response to the USDA standards and policies for labeling pork products as organic or all-natural, participants expressed confusion and had many unanswered questions. (shrink)

This research project defines the concept of an ethical incident pit and explores how qualitative and quantitative research into corporate ethical failurescan be conducted using this concept. Factors on an organizational, departmental and individual level are explored.

Legal codes, such as the Uniform Commercial Code (UCC) examined in this article, are good points of entry for AI and ontology work because of their more straightforward adaptability to relationship linking and rules-based encoding. However, approaches relying on encoding solely on formal code structure are incomplete, missing the rich experience of practitioner expertise that identifies key relationships and decision criteria often supplied by experienced practitioners and process experts from various disciplines (e.g., sociology, political economics, logistics, operations research). This research (...) focuses on the UCC because it transcends the limitations of a formal code, functioning essentially as a composite. AI work can benefit from real-world codes like the UCC, which are essentially formal codes enlightened from a more realistic experience-base from centuries of development in international commercial transactions settings. This paper then describes our initial work in converting an expert system on the U.S. law governing the sale of goods from Article II of the Uniform Commercial Code (UCC), into a knowledge-based system using the Web Ontology Language OWL. (shrink)

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

The purpose of this study was to compare working memory (WM), executive function, academic ability and problem classroom behaviors in children aged 8 to 11 years who were either identified via routine screening as having low WM, or had been diagnosed with ADHD. Standardised assessments of WM, executive function and reading and mathematics were administered to 83 children with ADHD, 50 children with low WM and 50 typically developing children. Teachers rated problem behaviors on checklists measuring attention, hyperactivity/impulsivity, oppositional behavior, (...) and difficulties associated with executive function in the classroom. The ADHD and low WM groups had highly similar WM and executive function profiles, but were distinguished in two key respects: children with ADHD had higher levels of rated and observed impulsive behavior, and children low WM had slower response times. Possible mechanisms for these common and distinct deficits are discussed. (shrink)

In _Violence and Civility_, Étienne Balibar boldly confronts the insidious causes of violence, racism, nationalism, and ethnic cleansing worldwide, as well as mass poverty and dispossession. Through a novel synthesis of theory and empirical studies of contemporary violence, the acclaimed thinker pushes past the limits of political philosophy to reconceive war, revolution, sovereignty, and class. Through the pathbreaking thought of Derrida, Balibar builds a topography of cruelty converted into extremism by ideology, juxtaposing its subjective forms and its objective manifestations. Engaging (...) with Marx, Hegel, Hobbes, Clausewitz, Schmitt, and Luxemburg, Balibar introduces a new, productive understanding of politics as antiviolence and a fresh approach to achieving and sustaining civility. Rooted in the principles of transformation and empowerment, this theory brings hope to a world increasingly divided even as it draws closer together. (shrink)

Contemporary Western societies are obsessed with the “obesity epidemic,” dieting, and fitness. Fat people violate the Western conscience by violating a thinness norm. In virtue of violating the thinness norm, fat people suffer many varied consequences. Is their suffering morally permissible, or even obligatory? In this paper, I argue that the answer is no. I examine contemporary philosophical accounts of oppression and draw largely on the work of Sally Haslanger to generate a set of conditions sufficient for some phenomena to (...) count as oppression, and I illustrate the account’s value using the example of gender oppression. I then apply the account to fat people, examine empirical evidence, and argue that the suffering of fat people counts as oppression. (shrink)

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

In this paper we consider an intuitionistic variant of the modal logic S4 (which we call IS4). The novelty of this paper is that we place particular importance on the natural deduction formulation of IS4— our formulation has several important metatheoretic properties. In addition, we study models of IS4— not in the framework of Kirpke semantics, but in the more general framework of category theory. This allows not only a more abstract definition of a whole class of models but also (...) a means of modelling proofs as well as provability. (shrink)

Graphical AbstractDriving patterns of coral bleaching over reefs are a suite of biophysical interactions where the physical environment modulates organism response through an interplay with intrinsic biological functioning. Flow conditions over reefs can mitigate the physiological impacts of thermal stress across multiple spatial scales. More details can be found in article number 1800226 by Charlotte E. Page et al., Seeking Resistance in Coral Reef Ecosystems: The Interplay of Biophysical Factors and Bleaching Resistance under a Changing Climate, DOI: 10.1002/bies.201800226.