In the target article, Cramer et al. suggest that diagnostic classification is improved by modeling the relationship between manifest variables (i.e., symptoms) rather than modeling unobservable latent variables (i.e., diagnostic categories such as Generalized Anxiety Disorder). This commentary discusses whether symptoms represent manifest or latent variables and the implications of this distinction for diagnosis and treatment.

Edmund Pellegrino and David Thomasma’s writings have had a worldwide impact on discourse about the philosophy of medicine, professionalism, bioethics, healthcare ethics, and patients’ rights. Given their works’ importance, it is surprising that commentators have ignored their admission of an unresolved and troubling dilemma and inconsistency in their theory. The purpose of this article is to identify and state what problems worried them and to consider possible solutions. It is argued that their dilemma stems from their concerns about how to (...) justify professional rules restricting colleagues from performing acts they view as direct, active, and formal killings, such as physician-assisted suicide, mercy killing, and abortion. It is further argued that their inconsistency is that they both assert and deny that professional colleagues should not use their moral or theological values to impose professional restrictions on other colleagues without adequate philosophical grounds. At risk are their arguments about the nature of an internal morality for medicine, a secular and multicultural basis for medical ethics, and a nonarbitrary way to determine what acts fall outside the ends of medicine. These are arguments they claim also apply to other healthcare professions. The article begins with a brief overview of their key positions to provide the context in which they make their admission. (shrink)

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic, and in this issue of the Journal, seven authors discuss the moral, social and medical implications of having 70% of those stricken living in this area. Anton A. van Niekerk considers complexities of plague in this region (poverty, denial, poor leadership, illiteracy, women's vulnerability, and disenchantment of intimacy) and the importance of finding responses that empower its people. Solomon Benatar reinforces these issues, but also discusses the role of global politics in (...) sub-Saharan Africa, especially discrimination, imperialism and its exploitation by first world countries. Given the public health crisis, Udo Schüklenk and Richard E. Ashcroft defend compulsory licensing of essential HIV/AIDS medications on consequentialist grounds. Keymanthri Moodley discusses the importance of conducting research and the need to understand a moderate form of communitarianism, also referred to as "ubuntu" or "communalism", to help some Africans understand research as an altruistic endeavour. Godfrey B. Tangwa also defends traditional African values of empathy and ubuntu, discussing how they should be enlisted to fight this pandemic. Loretta M. Kopelman criticizes the tendency among those outside Africa to dismiss the HIV/AIDS pandemic, attributing one source to the ubiquitous and misguided punishment theory of disease. The authors conclude that good solutions must be cooperative ventures among countries within and outside of sub-Saharan Africa with far more support from wealthy countries. (shrink)

Consider an object or property a and the predicate F. Then a is vague if there are questions of the form: Is a F? that have no yes-or-no answers. In brief, vague properties and kinds have borderline instances and composite objects have borderline constituents. I'll use the expression "borderline cases" as a covering term for both. ;Having borderline cases is compatible with precision so long as every case is either borderline F, determinately F or determinately not F. Thus, in addition (...) to borderline cases, vagueness requires "fuzzy borders". A has fuzzy borders if there is no sharp line between a's borderline cases, a's determinate cases and a's determinate non-cases. To illustrate, loudness is vague because in a continuum of gradually increasing volume, there is no fact about where the last definite loud noise is and where the first borderline noise is. ;Actual borderline cases are not required for vagueness. Suppose actual noises are either ear-shatteringly loud or silent. Even so, loudness is vague since it could have borderline instances. Just so for objects. Suppose a table is cleanly bounded such that there is a sharp break between the table and its surroundings. Still, that table is vague since there are worlds at which it is indeterminate whether some wood molecule a is, or is not, part of that table. ;There are three views about which things can be vague. On the linguistic view, vagueness is solely a feature of expressions. On the nihilistic view, nothing is vague because vagueness is incoherent. Pitted against these views is the ontological conception of vagueness according to which borderline instances and constituents arise due to genuine indeterminacy in nature. ;My dissertation defends the ontological conception. I argue against the adequacy of the theory's rivals, disarm a damaging objection and demonstrate the causal superiority of vague events. Anyone familiar with the literature on vagueness will notice that only a subset of issues are discussed. What I offer is preliminary--I hope only to make the theory of ontological vagueness attractive enough to merit future work. (shrink)

Many pediatric research regulations, including those of the United States, the Council for International Organizations of Medical Science, and South Africa, offer similar rules for review board approval of higher hazard studies holding out no therapeutic or direct benefit to children with disorders or conditions. Authorization requires gaining parental permissions and the children’s assent, if that is possible, and showing that these studies are intended to gain vitally important and generalizable information about children’s conditions; it also requires limiting the risks (...) of harm to no more than a “minor increase over minimal risk” and showing the study is commensurable with the children’s experiences. For convenience, these investigations will be called “no benefit, higher hazard” studies.Despite the existence of these policies for decades, studies show that review boards’ judgments vary about what “no benefit, higher hazard” studies should be approved. (shrink)

Classifying research proposals by risk of harm is fundamental to the approval process and the most pivotal risk category in most regulations is that of “minimal risk.” If studies have no more than a minimal risk, for example, a nearly worldwide consensus exists that review boards may sometimes: (1) expedite review, (2) waive or modify some or all elements of informed consent, or (3) enroll vulnerable subjects including healthy children, incapacitated persons and prisoners even if studies do not hold out (...) direct benefits to them. The moral and social purposes behind this threshold are discussed along with relevant views from the National Commission, NBAC, NHRPAC, Grimes v. Kennedy Krieger Institute, The Nuremberg Code, and The WMA's Declaration of Helsinki. Representative policies from Australia, Canada, South Africa, the U.S., and CIOMS are reviewed revealing different understandings of this sorting threshold. Six of nine frequently cited interpretations of “minimal risk” are untenable. The “absolute” interpretation of the “routine examination” standard is defended as best. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the power to commit pregnant women (...) involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

A series of cases have crystallized disputes about when medical treatments are useful or futile, and consequently about the doctor-patient relationship, resource allocation, communication, empathy, relief of suffering, autonomy, undertreatment, overtreatment, paternalism and palliative care. It is helpful to understand that utility and futility are complimentary concepts and that judgments about whether treatments are useful or futile in the contested cases have common features. They are: (1) grounded in medical science, (2) value laden, (3) at or near the threshold of (...) utility, and (4) burdensome. No schema for linedrawing escapes borderline cases and we should focus upon justification of the empirical, ethical and evaluative components underlying these judgments, rather than make an arbitrary decision about whether doctors, patients or societal consensus should be the final arbiter. Keywords: futility, ethics, physician authority, consent CiteULike Connotea Del.icio.us What's this? (shrink)

"Applied" is a technical term describing a variety of new philosophical enterprises. The author examines and rejects the view that these fields are derivative. Whatever principles, judgments, or background theories that are employed to solve problems in these areas are either changed by how they are used, or at least the possibility exists of their being changed. Hence we ought to stop calling these endeavors "applied", or agree that the meaning of "apply" will have to include the possibility that what (...) is applied may be changed. The socalled applied fields of philosophy, therefore, are not derivative. The strongest cases to the contrary are the foundationalist views that what we apply is epistemically privileged. Different foundationalist views take different principles, judgments, or background theories to be epistemically privileged. Strong and weak versions of each of these foundationalist views are considered but none establish these fields as derivative. Keywords: applied ethics, background theories, casuistry, epistemic privilige, foundationalism, principles, reflective equilibrium CiteULike Connotea Del.icio.us What's this? (shrink)

ABSTRACT A complex problem exists about how to promote the best interests of children as a group through research while protecting the rights and welfare of individual research subjects. The Nuremberg Code forbids studies without consent, eliminating most children as subjects, and the Declaration of Helsinki disallows non-therapeutic research on non-consenting subjects. Both codes are unreasonably restrictive. Another approach is represented by the Council for the International Organizations of Medical Science, the U.S. Federal Research Guidelines, and many other national policies. (...) They allow research ethics committees or institutional review boards to authorize studies with acceptable balances of likely benefits and harms, but neither clarify how to balance them nor explain the meaning of pivotal concepts, like “minimal risk.” Paths to the improvement of balancing or consequentialist approaches include improving standardizing of risk assessment, rejecting crude utilitarianism, identifying and justifying normative or moral judg-ments, and acknowledging extra-regulatory thresholds and deontological or non-negotiable duties to children. (shrink)

A new analysis of the Best Interests Standard is given and applied to the controversy about testing children for untreatable, severe late-onset genetic diseases, such as Huntington's disease or Alzheimer's disease. A professional consensus recommends against such predictive testing, because it is not in children's best interest. Critics disagree. The Best Interests Standard can be a powerful way to resolve such disputes. This paper begins by analyzing its meaning into three necessary and jointly sufficient conditions showing it: is an "umbrella" (...) standard, used differently in different contexts, has objective and subjective features, is more than people's intuitions about how to rank potential benefits and risks in deciding for others but also includes evidence, established rights, duties and thresholds of acceptable care, and can have different professional, medical, moral and legal uses, as in this dispute. Using this standard, support is given for the professional consensus based on concerns about discrimination, analogies to adult choices, consistency with clinical judgments for adults, and desires to preserve of an open future for children. Support is also given for parents' legal authority to decide what genetic tests to do. (shrink)

The purpose of this paper is to examine whether randomized clinical trial (RCT) methods are necessarily morally problematic. If they are intrinsically problematic, then there may be a dilemma such that tragic choices might have to be made between this socially very useful method for making medical progress on the one hand, and patients' rights and welfare, or physicans' duties on the other. It is argued that the dilemma may be avoided if RCTs can sometimes be viewed as an honorable (...) and cooperative venture between investigators and subjects. Another dilemma may take shape, however, if too few people are willing to cooperate to maintain the structural integrity of many important RCTs. Given their importance, does this method justify easing some of the consent requirements? It is argued that RCT methods are not so ideal that special consideration should be given to them regarding consent requirements. To examine the compatibility of current consent requirements and frequently used RCT schemas, seven RCT designs are discussed. It is found that some, but not all, RCTs, are intrinsically problematic but that sufficient reason has not been found to hold all RCT schemas as intrinsically morally troubling. Keywords: randomized clinical trials, informed consent, randomization CiteULike Connotea Del.icio.us What's this? (shrink)

This book offers both the theoretical background behind the minority effect, teachers' personal experiences as they experienced being a minority, and their analyses and insights for teaching diverse learners. This book uses real-life experiences of diverse people to illustrate that, if not understood and addressed, situational minorities at school or work are unlikely to perform at their highest potentials.

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, (...) we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias. (shrink)

anonymous tissue samples obtained in hospitals and clinics without donor consent. This can be justified as a response to a public health emergency, but should not be seen as setting a precedent for waiving consent whenever samples are anonymous. The following recommendations grow out of this discussion: (1) Studies using anonymous tissue samples should not be automatically exempt from consent requirements, and consent should not be waived simply to avoid anticipated refusals, low participation rates or self selection bias. (2) The (...) consensus on informed consent favors fulfilling as many of the elements of informed consent as reasonably possible, so studies should be assessed individually to determine if any or all elements of informed consent should be modified or omitted. (3) There is a need for greater regulation of the research use of tissue samples. (4) Investigators seeking approval to waive consent or modify elements of informed consent should document the sort of new findings that they believe would effect their calculations about the benefits and burdens to subjects who are enrolled in the study, and institutional review boards should indicate whether they agree with the investigators' analysis. Keywords: AIDS, Consent, Ethics, HIV, Notification, Privacy, Research, Screening, Surveillance CiteULike Connotea Del.icio.us What's this? (shrink)

The Americans With Disabilities Act (ADA) promotes social justice by protecting disabled persons from discrimination and prejudice. It seeks equality of opportunity for them and protects their well being by giving them fair access to goods, services and benefits. These rights are circumscribed in the ADA, however, by constraints of cost, efficiency, utility, and certain social mores. The ADA offers little direction about how to set priorities when these values come into conflict, or about whether equality of opportunity favors equivalent (...) or preferential treatment for disadvantaged people. Until these ambiguities and potential value conflicts are resolved, a central moral and social problem remains unresolved: How can we demonstrate commitment to the rights and welfare of those with severe disabilities while placing fair limits upon their claims? Five special concerns are discussed: (1) eligibility and the allocation of health care; (2) the meaning of ‘qualified but disabled’ in employing people with mental disabilities; (3) equal opportunity and problems of envy and malingering; (4) ADA accommodation and public protection through testing and licensure; and (5) ADA protection and problems of backlash. Rather than simply wait to see what courts and administrative agencies decide, we should evaluate the moral conflicts, articulate criteria, and help make some difficult choices on morally defensible grounds. Keywords: disabled, health benefit plans, health care rationing, health care reform, health priorities, health services accessibility, Oregon, Rawls, selection bias, social justice CiteULike Connotea Del.icio.us What's this? (shrink)

Health care systems are widely criticized for limiting doctors' roles as patient-advocates. Yet unrestricted advocacy can be unfairly partial, costly, and prejudicial. This essay considers three solutions to the problem of how to reconcile the demands of a just health care system for all patients, with the value of advocacy for some. Two views are considered and rejected, one supporting unlimited advocacy and another defending strict impartiality. A third view suggested by Hume's moral theory seeks to square the moral demands (...) of professional advocacy and just health care systems. A moral basis for limited advocacy exists when it can be justified from a general or moral vantage. Consequently, ethical aspects of professionalism are not necessarily on a collision course with health care systems incorporating managed care. This solution is compatible with goals regarding the importance of humanistic education and professionalism to build patients' trust. (shrink)

Our cultural disagreements can often be anticipated, negotiated and resolved using shared methods of moral reasoning. This claim is incompatible with any extreme version of communitarianism or strong ethical relativism, which hold that one's culture is the final arbiter of good, bad, right and wrong, or that the rights of the community should trump individual rights within that community. This view is discussed and found to be implausible using the example of common grounds for responding to different cultural views about (...) being truthful in medical practice. Its implausibility stems from difficulties individuating cultures, and accounting for intercultural goals, values and methods. Given our increasingly diverse populations, problems arise as clinicians from one culture try to care respectfully and compassionately for people from other groups. Yet working from shared values and goals, we can use some bridging methods such as discussing grim news in the third person. Claims that something is a cultural belief or attitude, moreover, cannot always be taken at face value. Various meanings of ‘multiculturalism’ are distinguished. (shrink)

The U.S. Supreme Court's seminal 1978 Bakke decision, now 25 years old, has an ambiguous and endangered legacy. Justice Lewis Powell's opinion provided a justification that allowed leaders in medical education to pursue some affirmative action policies while at the same time undermining many other potential defenses. Powell asserted that medical schools might have a "compelling interest" in the creation of a diverse student body. But Powell's compromise jeopardized affirmative action since it blocked many justifications for responding to increases in (...) political opposition and legal challenges. The Bakke decision and itsmoral background and legal legacy are traced and analyzed. Despite recent legal setbacks, the framework sketched by Powell can be used to defend diversity inmedical education bothmorally and legally as a "compelling state interest." Because trust is a central component of the physician-patient relationship and a prerequisite to the profession's ability to provide effectivemedical care, the state has a compelling interest in training physicians with whom patients can feel comfortable and safe if the population is distrustful; underserved; faces significant discrimination in the allocation of benefits, goods and services and affirmative action programs would be likely to promote their trust in the system. Similar narrowly-tailored arguments could be used in other professions and for other groups. Bakke is an important background for the pending Grutter case. (shrink)

Within the popular consciousness, Emma Goldman has become something of an icon, a symbol for rebellion and women’s rights. But there has been surprisingly little substantive analysis of her influence on social, political, and feminist theory. In _Feminist Interpretations of Emma Goldman,_ Weiss and Kensinger present essays that resist a simplistic understanding of Goldman and instead attempt to examine her thinking in its proper social, historical, and philosophical context. Only by considering the sources, influences, and specific significance of Goldman’s ideas (...) can her proper place in feminist theory be truly understood. In addition to the editors, the contributors are Martha A. Ackelsberg, Kathryn Pyne Addelson, Lynne M. Adrian, Berenice A. Carroll, Voltairine de Cleyre, Janet E. Day, Candace Falk, Kathy E. Ferguson, Marsha Aileen Hewitt, Lori Jo Marso, Jonathan McKenzie, Alix Kates Shulman, Craig Stalbaum, Jason Wehling, and Alice Wexler. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the power to commit pregnant women (...) involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

The aim of this article is to investigate and discuss the notions of difference and representation in Emmanuel Levinas and Gilles Deleuze, articulating such notions through the example of a university extension project involving the formation of a musical ensemble composed of autistic children. Our research involved a review of four major philosophical works—Emmanuel Levinas’ Totality and Infinity; Among Us: Essays On Alterity; and “The Concept Of Difference In Bergson”; and Gilles Deleuze’s Difference and Repetition--in addition to secondary references. The (...) main articulations of the investigation carried out in the project consist of aspects such as: taking responsibility for the autistic child through cultivating asymmetrical relationships, a process that takes place through sensibility, below any representation; and not totalizing the alterity involved while maintaining, at the same time, its radical difference. In addition, there is an emphasis in the work on the difference of each child, beyond his or her diagnostic identity, understanding that all participants are undergoing unique processes of differentiation, and that some differences are not more privileged than others, in that that such hierarchies are determined by power relations. Another contribution of this research is the emphasis on the intensive affective flows of children, and the construction of relationships of mutual affection, which increases the circulation of vital energy in each one. Finally, the results of the project are offered as guidelines for clinical practice, and for the cultivation of a politics of difference, as an alternative to hegemonic practices in autism studies in contemporary times. (shrink)

Sounds play crucial roles in a poem’s meaning (re)construction. Grasping the content of a literary work such as poetry often requires a profound interpretation of the underlying linguistic cum phonetic codes of its discourse. Extant studies on Nigerian children’s poetry have paid little attention to this aspect of meaning conception, thereby concentrating mainly on the surface lexical constructs. Hence, this study aims to examine imagic iconicity in children’s poems in order to demonstrate how a poem’s thematic realization is inferred through (...) the interpretation of the phonic and acoustic nature of the sounds employed. The study involves five poems: three from Ossie Enekwe’s Gentle Birds Come to me and two from Ikeogu Oke’s Song of Success and Other Poems for Children. The analysis is anchored to insights from Charles Sanders Peirce’s concept of the iconic sign, and exploits the action of acoustic and phonetic articulation of sounds to determine their functions and effects in the poems. The study reveals how specialized lexemic choices and onomatopoeia (kinaesthemes, phonaestheme or sound symbolism) in children’s poems make each poem functional and purposeful. Thus, children’s poetry contains language structures and configurations that transmit sense and embody what the poem is asserting in a way that interestingly engages the reader. (shrink)

Este artigo tem como objetivo realizar uma compreensão daseinsanalítica do ser-nomundo do adolescente Christopher, protagonista do romance O Estranho Caso do Cachorro Morto, explicitando as relações do personagem com as pessoas de seu mundo. Partindo do diagnóstico de Transtorno de Asperger, demonst..

Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient’s participation in research compatible with her rights and interests. First, we defend the need for (...) traditional proxy consent against two alternative approaches. Second, we examine the impact of the intensive care unit environment on the informed consent process. Third, we discuss the therapeutic misconception and its potential influence on informed consent. Finally, we deal with issues of timing in recruiting participants and related factors which may affect the risks of participation. (shrink)

We give an example in which it is possible to understand quantum statistics using classical concepts. This is done by studying the interaction of chargedmatter oscillators with the thermal and zeropoint electromagnetic fields characteristic of quantum electrodynamics and classical stochastic electrodynamics. Planck's formula for the spectral distribution and the elements of energy hw are interpreted without resorting to discontinuities. We also show the aspects in which our model calculation complement other derivations of blackbody radiation spectrum without quantum assumptions.

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury patients. Nonetheless, (...) research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

We sometimes forget that medical ethics has a history, and that many of the issues we discuss today have already been discussed many times previously. As the field grows older, and the pioneers retire, we are, however, given some opportunity to recognise that there is in fact such a history, and that we could learn much from paying attention to it. A number of histories of bioethics have been published, and collections centred around the work of major figures are also (...) starting to appear.Journal of Medical Ethics 2001;27:206–214 The present volume is a collection of papers centred around a critical discussion …. (shrink)

In 2016, the National Book Council, the ISBN agency for Malta, released its ISBN database online. A few months later, the ISBN database was enhanced with an open-data feature that enables users to download the search results in a single file with read and write access. The database includes all the ISBN data of Malta except for some records and data that were lost during the period before 2013 when paper data storage of ISBN records was the common (...) practice. The implementation of an ISBN electronic database now ensures that no data go missing and facilitates the preservation of metadata. As added value, the open-data system provides access to all of the ISBN records as listed in the database, which means that virtually all of the ISBN data elements can be downloaded from the database. Researchers, publishers, authors, and booksellers all stand to benefit from this open ISBN data system. (shrink)

This paper concerns the issue of the continual arrival of irregular immigrants in Malta and the problems that ensue. The view generally held is that we need to respond to the needs of irregular immigrants by providing services. However, with reference to some of Jacques Derrida's ideas, I argue in this paper that the other /immigrant is not there for us to respond to by creating services to cater for her needs. Through the presence of the irregular immigrant, we (...) are made to question who we are, and are faced with our own vulnerability. We become 'other' to ourselves. This paper uses Derrida's ideas of tensions, trembling, borders and limited and unlimited hospitality, to lay the way for some suggestions of how the education of children can be influenced. In a time when educational discourse rotates around performativity, this paper suggests that space should be made in education for astonishment, surprise and enigmatic experience. (shrink)

The article questions the assumption that conjoined twins are necessarily two people or persons by employing arguments based on different points of view: non-personal vitalism, the person as a sentient being, the person as an agent, the person as a locus of narrative and valuation, and the person as an embodied mind. Analogies employed from the cases of amputation, multiple personality disorder, abortion, split-brain patients and cloning. The article further questions the assumption that a conjoined twin's natural interest and wish (...) is separation. I first contend that separation is such a radical procedure as to render the post-separation person different from the pre-separation one. Therefore, it is not possible to benefit the pre-separation twin by the act of separation. The article concludes with a critical evaluation of the tendency in bioethics to regard ethical challenges as rivalry between individuals competing for scarce resources. (shrink)

An inter-disciplinary enquiry concerning Europe, Europeans and Europeanity across time, based on proceedings of the 10th world congress of the International Society for the Study of European Ideas convened at the University of Malta. -/- Originally published in: Frendo, Henry (2010): The European Mind: Narrative and Identity : Proceedings of the X World Congress of the International Society for the Study of European Ideas, University of Malta, 24th-29th July 2006. International Society for the Study of European Ideas. (...) class='Hi'>Malta University Press. (shrink)

Antonino Saliba, a sixteenth century cartographer hailing from the Maltese island of Gozo, published a map in 1582 espousing his cosmology. Its popularity at the time is attested via the multiple editions and copies that were produced in Europe. Numerous sky phenomena, amongst them comets, are portrayed in the map. This study presents a detailed analysis of Saliba's treatment of these phenomena, following the first comprehensive translation of the map's text to English. It elucidates the sources that Saliba used, clarifying (...) and shedding further light on the views he held. Where possible, the comets mentioned by Saliba are identified and explained. Besides showing how Saliba wholly conformed to the Aristotelian and Ptolemaic representation of the world, in which respect he was quite orthodox, it is also shown for the first time that his work is significantly derived from previous and contemporary sources. (shrink)

Nevertheless, Marx's essay ["On the Jewish Question"] has a profound bearing upon The Jew of Malta; their conjunction enriches our understanding of the authors; relation to ideology and, more generally, raises fruitful questions about a Marxist reading of literature. The fact that both works use the figure of the perfidious Jew provides a powerful link between Renaissance and modern thought, for despite the great differences to which I have just pointed, this shared reference is not an accident or a (...) mirage. "On the Jewish Question" represents the nineteenth-century development of a late sixteenth-century idea or, more accurately, a late sixteenth-century trope. Marlowe and Marx seize upon the Jew as a kind of powerful rhetorical device, a way of marshalling deep popular hatred and clarifying its object. The Jew is charged not with racial deviance or religious impiety but with economic and social crime, crime that is committed not only against the dominant Christian society but, in less "pure" form, by that society. Both writers hope to focus attention upon activity that is seen as at once alien and yet central to the life of the community and to direct against that activity the anti-Semitic feeling of the audience. The Jews themselves in their real historical situation are finally incidental in these works, Marx's as well as Marlowe's, except insofar as they excite the fear and loathing of the great mass of Christians. It is this privileged access to mass psychology by means of a semimythical figure linked in the popular imagination with usury, sharp dealing, and ruthless cunning that attracts both the sixteenth-century playwright and the nineteenth-century polemicist.1 · 1. Anti-Semitism, it should be emphasized, is never merely a trope to be adopted or discarded by an author as he might choose to employ zeugma or eschew personification. It is charged from the start with irrationality and bad faith and only partly rationalized as a rhetorical strategy. Marlowe depicts his Jew with the compulsive cruelty that characterizes virtually all his work, while Marx's essay obviously has elements of a sharp, even hysterical, denial of his religious background. It is particularly tempting to reduce the latter work to a dark chapter in its author's personal history. The links I am attempting to establish with Marlowe or the more direct link with Feuerbach, however, locate the essay in a far wider context. Still, the extreme violence of the latter half of Marx's work and his utter separation of himself from the people he excoriates undoubtedly owe much to his personal situation. It is interesting that the tone of the attack on the Jews rises to an almost ecstatic disgust at the moment when Marx seems to be locating the Jews most clearly as a product of bourgeois culture; it is as if Marx were eager to prove that he is in no way excusing or forgiving the Jews. Stephen J. Greenblatt is the Class of 1932 Professor of English Literature at the University of California at Berkeley. He is the author of Sir Walter Raleigh: The Renaissance Man and His Roles, Renaissance Self-Fashioning: From More to Shakespeare, Marvelous Possessions: The Wonder of the New World, and the editor of a collection of essays, New World Encounters. (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been dedicated to (...) showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

Can state sovereignty justify privileged receiving countries exercising authority over non‐members in a third country to safeguard their own interests? Under the current migration governance of the EU, state sovereignty is manifested in migrant interdiction, interception and detention policies employed to prevent unauthorized migrants from reaching the EU, and even from attempting to embark on cross‐Mediterranean journeys. While reinforcement of the Schengen region's external borders is a key aim of the EU's internal migration politics, collaboration with third countries regarding migration (...) control has, in the last decade, become a key feature of its external migration policy. In close collaboration with third countries, the EU has managed to curb the outflux of migrants from transit and sending countries. In effect, irregular migrants are prevented from exiting as well as from entering. This article explores the justifiability of such practices, by questioning commonly invoked models of justification such as the sovereignty “model”, with a special focus on partnership agreements regarding migration control between the EU and Libya. (shrink)

BackgroundDecision-making in end-stage dementia is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems.AimThis study aimed to understand the decision-making processes of clinical teams and relatives in addressing life-threatening swallowing (...) difficulties in ESD in long-term care in Malta.MethodThe study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis.ResultsFour themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient’s dignity.ConclusionDecision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life. (shrink)

The aim of the article is to present selected relationships between social trust and the development of a territorial unit. Social trust affects the level of cooperation in society and decides about the competitiveness of a territorial unit [12, p. 7]. The main thesis of the article is the author’s conviction that there is a significant correlation between social trust and the activity of citizens, the consequence of which is the development of territorial units. This relationship applies to different categories (...) of units, the article mainly focuses on municipal units. The conclusions presented are a consequence of the analysis of information sources and surveys carried out in three cities: Cracow, Helsinki and Valletta. The socio-economic situation of Poland, Finland and Malta is varied, also due to historical and political conditions. Social trust in these cities depends on different factors. Everywhere, however, significantly affects the direction of urban development, accelerating and stabilising it. Trust is a component of social capital, which translates into the ability to build an innovative and modern economy. In countries where citizens trust each other, a sense of security increases which significantly affects well-being. (shrink)