Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account of (...) the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

The Greeks and Romans have been charged with destroying the ecosystems within which they lived. In this book, however, M. D. Usher argues rather that we can find in their lives and thought the origin of modern ideas about systems and sustainability, important topics for humans today and in the future. With chapters running the gamut of Greek and Roman experience – from the Presocratics and Plato to Roman agronomy and the Benedictine Rule – Plato's Pigs brings together unlikely bedfellows, (...) both ancient and modern, to reveal surprising connections. Lively prose and liberal use of anecdotal detail, including an afterword about the author's own experiments with sustainable living on his sheep farm in Vermont, add a strong authorial voice. In short, this is a unique, first-of-its-kind book that is sure to be of interest to anyone working in Classics, environmental studies, philosophy, ecology, or the history of ideas. (shrink)

Citizens today are increasingly expected to be knowledgeable about and prepared to engage with biomedical knowledge. In this article, I wish to reframe this ‘public understanding of science’ project, and place fresh emphasis on public understandings of research: an engagement with the everyday laboratory practices of biomedicine and its associated ethics, rather than with specific scientific facts. This is not based on an assumption that non-scientists are ‘ignorant’ and are thus unable to ‘appropriately’ use or debate science; rather, it is (...) underpinned by an empirically-grounded observation that some individuals may be unfamiliar with certain specificities of particular modes of research and ethical frameworks, and, as a consequence, have their autonomy compromised when invited to participate in biomedical investigations. Drawing on the perspectives of participants in my own sociological research on the social and ethical dimensions of neuroscience, I argue that public understanding of biomedical research and its ethics should be developed both at the community level and within the research moment itself in order to enhance autonomy and promote more socially robust science. Public bioethics will have to play a key role in such an endeavour, and indeed will contribute in important ways to the opening up of new spaces of symmetrical engagement between bioethicists, scientists and wider publics—and hence to the democratisation of the bioethical enterprise. (shrink)

While much has been written on the cultural and intellectual antecedents that gave rise to Carolus Linnaeus?s herbarium and his Systema Naturae, the tools that he used to transform his raw observations into nomenclatural terms and categories have been neglected. Focusing on the Philosophia Botanica, the popular classification handbook that he published in 1751, it can be shown that Linnaeus cleverly ordered and reordered the work by employing commonplacing techniques that had been part of print culture since the Renaissance. Indeed, (...) the functional adaptability of commonplace heads allowed him to split and combine the book?s chapters and tables and played a notable conceptual role in the way in which he spatialized words and, to a certain extent, specimens. (shrink)

Disjunctivism about sensory experience is frequently put forward in defence of a particular conception of perception and perceptual experience known as naïve realism. In this paper, I present an argument against naïve realism that proceeds through a rejection of disjunctivism. If the naïve realist must also be a disjunctivist about the phenomenal nature of experience, then naïve realism should be abandoned.

To avoid misinterpretations one should substitute the ambiguous notion of 'new disease' with 'emerging disease'. A disease can be classified emergent in at least five dif férent historical situations; 1) it existed before it could be first identified but was overlooked from a médical point of view because it could not be conceptualized as a nosological entity; 2) it existed but was not noticed until a quantitative and/or qualitative change in its mani festations; 3) it did not exist in a (...) particular région of the world before its introduction from other régions; 4) it never existed in a human population but only in an animal population; 5) it is completely new - the triggering germ and/or necessary environmental conditions did not exist prior to the first clinical manifestations. A sériés of historical examples illustrate this classification. (shrink)

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

Discusses the metaphysics of the iterative conception of set.

The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number (...) of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: Classics and Complexity in Walden’s “Spring” M. D. USHER In 1843, two years before Henry Thoreau built his cabin at Walden Pond, the Fitchburg Railroad laid down tracks through the woods near the Pond for its line connecting Boston to Fitchburg. The original Fitchburg Line, at 54 miles long, was, until 2010, the longest run in the present -day MBTA Commuter Rail system. And it is one of (...) the oldest railways in New England. By 1900, fortunes swelled and the Fitchburg’s Hoosac Tunnel Line took passengers and goods westward toward Chicago. The Lake Champlain Route connected Boston to points north like Burlington, Vermont. (See Figure 1.) arion 27.1 spring/summer 2019 Figure 1 (left): Advertisement for the Hoosac Tunnel Route in The New England Magazine (Vol. 21, Issue 6, February, 1900). Figure 2 (right): Herbert Wendell Gleason. The Fitchburg Railroad and Walden Pond in winter, Concord, Mass., March 24, 1920. Courtesy Concord Free Public Library. The Railroad was literally a fixture in Thoreau’s landscape. Its tracks pass remarkably close to Walden Pond (Figure 2), and the Fitchburg Line—both its reality and the specter of it—is practically a character in his writing: “I usually go to the village along its causeway, and am, as it were, related to society by this link,” Thoreau writes in “Sounds,” a chapter of Walden that contains what must be one of the most picturesque odes (or laments) to rail travel and commerce in all of American literature: The engine’s whistle, Thoreau complains, pierces the still silence of his idyllic retreat like a screaming hawk circling a farmer’s field, its billows of steam an ominous harbinger of “this travelling demi-god, this cloud-compeller.”1 Thoreau’s frequent, customary walks into Concord along the railroad tracks took him through a heavily excavated stretch of the line known as the Deep Cut, to which he returned again and again each year in early spring, even after leaving the cabin, to observe and to record his observations. The leaf-shaped sand flows and trickling surface erosion caused by melting frost in the banks of the Deep Cut are elaborately described in Thoreau’s chapter in Walden entitled “Spring,” what Laurence Buell calls the “high point of Thoreau’s epic.”2 And yet, in spite of the universal acclaim of this passage as a literary tour de force, it has not received the full attention it deserves. What warrants fresh consideration first and foremost is “Spring”’s deep-rootedness in classical sources. Many classical influences, allusions, and a good deal of etymological word play have gone so far unnoticed. The chapter is also important because it describes, by intimation, what contemporary scientists now call emergence. Emergent phenomena are properties or behaviors that arise in systems as a result of complex, dynamic interactions amongst constituent parts, including changes to a system brought about by human interventions3—not only, e.g., climate change and wildfires, but also traffic patterns and terrorist networks; kidney function in the body; the rings of Saturn. As he tries to capture the essence of the 114 classics and complexity in WALDEN’s “spring” Deep Cut and interpret its significance, Thoreau adumbrates this concept, but also grapples ingeniously with broader issues of perennial concern—the relationship of Nature to Culture, for example, of Wilderness to Civilization, of Science to the Humanities—making “Spring” not only a probing work of eco-criticism and environmental philosophy, but of scientific reflection and poetic experiment as well. In short, Thoreau’s “Spring” is that rare work of classical reception that transmits both literary and scientific insight. Perhaps at this point, in lieu of accolades, it is best to let Thoreau start speaking for himself. What I offer in the following pages is a commentary on the Deep Cut passage from “Spring.” Classical references and aspects of systems theory will be explained and contextualized as they emerge, as it were, from Thoreau’s text. The whole chapter corresponds to pages 289–308 in Cramer’s edition of Walden—26 paragraphs all told, of which only the relevant ones are printed and annotated here. (Transitions and extraneous material are briefly summarized, as needed, in paraphrase... (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

Legislation that authorises controversial organ procurement strategies but ignores respect for autonomy is flawed in principle and predictably unworkable in practiceThe UK Human Tissue Act 2004,1 designed to regulate all activity involving human tissue, organs, or bodies, was introduced in the House of Commons in December 2003, received Royal Assent on 15 November 2004,2 and has been partially implemented by Commencement Orders from April 2005. The new act, which repeals and replaces the Human Tissue Act 1961, the Anatomy Act 1984, (...) and the Human Organ Transplants Act 1989, has its origins in events of serious public concern, namely the retained organs scandals at Bristol Royal Infirmary3 and the Royal Liverpool Childrens’ Hospital.4 The act is correspondingly dominated by regulation of postmortem examinations and retention of human tissue, with consistent emphasis on the need for fully informed consent. Compliance with these requirements is now mandatory with the threat of up to three years’ imprisonment and/or fines for any deviation.The impact of the original proposals within the bill on research and the clinical practice of pathology have been carefully considered and documented,5 with subsequent amendments to ameliorate professional concerns.6 The act, however, also carries significant implications for medical practice in areas where donor recruitment for transplantation can take place, and representations on these aspects during readings of the bill7 have produced neither clarification, justification, nor amendment within the final legislation.Section 43 will make it lawful for hospital authorities “to take steps for the purpose of preserving the part for use for transplantation and to retain the body for that purpose”. The original explanatory notes for the bill8 while it proceeded through parliament implied that such action, prior to consent to transplantation being sought, was then lawful, clause 44 as section 43 …. (shrink)

The idea that the mass m of an elementary particle is explained in the semi-classical approximation by quantum-mechanical zero-point vacuum fluctuations has been applied previously to spin-1/2 fermions to yield a real and positive constant value for m, expressed through the spinorial connection Γ i in the curved-space Dirac equation for the wave function ψ due to Fock. This conjecture is extended here to bosonic particles of spin 0 and spin 1, starting from the basic assumption that all fundamental fields (...) must be conformally invariant. As a result, in curved space-time there is an effective scalar mass-squared term $m_{0}^{2}=-R/6=2\varLambda_{\mathrm{b}}/3$ , where R is the Ricci scalar and Λ b is the cosmological constant, corresponding to the bosonic zero-point energy-density, which is positive, implying a real and positive constant value for m 0, through the positive-energy theorem. The Maxwell Lagrangian density $\mathcal{L} =- \sqrt{-g}F_{ij}F^{ij}/4$ for the Abelian vector field F ij ≡A j,i −A i,j is conformally invariant without modification, however, and the equation of motion for the four-vector potential A i contains no mass-like term in curved space. Therefore, according to our hypothesis, the free photon field A i must be massless, in agreement with both terrestrial experiment and the notion of gauge invariance. (shrink)

LIFE offers various amusements, and anyone these days who can choose among them will come late to the study of hiatus in Greek prose. Germany in the 1880s, so it seems, was less fortunate, and few greater excitements were known to young or old than the hunt for hiatus; but now that we no longer strait-waistcoat our classical authors and the austerity of those times is discredited, few collectors of hiatus are to be found, and there are people even in (...) Germany who have never identified a single specimen. Yet there is nothing to be said for underrating an author' stylistic pretensions, still less for encouraging others to do the same; and the textual critic, whose path is slippery enough at the best of times, can ill afford to dispense with footholds. There has been no broad study of hiatus in Greek prose since 1841, when Benseler in a long and original book De hiatu in oratoribus et historicis Graecis went through the text of 27 authors and attempted to determine their practice. (shrink)

In a brief article under the present title, Adam Parry raised a simple but profound question: were there certain things that the inherited vocabulary of oral poets did not allow them to sayF; The mere raising of this question, whatever his answer, is enough to make the article one of the more important contributions to Homeric studies in the last fifty years. As it happens, his answer was affirmative, and it has not been contested. Contested it will now be.

This article identifies two trends in Dooyeweerd’s conception of ‘cosmic time’, and elaborates their consequences for the philosophy of history. The first trend, connecting time to modal diversity and the order of the modal aspects, prevails in Dooyeweerd’s analysis. The application of the second trend, emphasizing that in each relation frame the temporal order governs subject-subject relations and subjectobject relations, sheds a new light on the interpretation of history conceived of as development of the culture and civilization of mankind. The (...) distinction of faith and religion and the position of the aspect of faith in the order of the modal aspects play important parts in this discussion, in particular with respect to the possibility of transcending time. (shrink)

At the law side of the creation, the Philosophy of the Cosmonomic Idea distinguishes between natural laws, values and norms. Natural laws are coercive both for human beings and for any other subject or object. Like natural laws, values or normative principles belong to the creation, being universal and invariable. Both people and associations are subject to values, which they can obey or disobey. Values characterize the relation frames following the natural ones. Norms are man-made realizations of values, historically and (...) culturally different. Philosophical ethics investigates the normativity of human acts. This paper argues that ethics cannot be related to a single relation frame and that the designation ‘ethical’ or ‘moral’ modal aspect is a misnomer. (shrink)

The Schrödinger equation for a particle of rest mass $m$ and electrical charge $ne$ interacting with a four-vector potential $A_i$ can be derived as the non-relativistic limit of the Klein–Gordon equation $\left( \Box '+m^2\right) \varPsi =0$ for the wave function $\varPsi $ , where $\Box '=\eta ^{jk}\partial '_j\partial '_k$ and $\partial '_j=\partial _j -\mathrm {i}n e A_j$ , or equivalently from the one-dimensional action $S_1=-\int m ds +\int neA_i dx^i$ for the corresponding point particle in the semi-classical approximation $\varPsi \sim (...) \exp {(\mathrm {i}S_1)}$ , both methods yielding the equation $\mathrm {i}\partial _0\varPsi \approx \left( \frac{1}{2m}\eta ^{\alpha \beta }\partial '_{\alpha }\partial '_{\beta } + m + n e\phi \right) \varPsi $ in Minkowski space–time , where $\alpha ,\beta =1,2,3$ and $\phi =-A_0$ . We show that these two methods generally yield equations that differ in a curved background space–time $g_{ij}$ , although they coincide when $g_{0\alpha }=0$ if $m$ is replaced by the effective mass $\mathcal{M}\equiv \sqrt{m^2-\xi R}$ in both the Klein–Gordon action $S$ and $S_1$ , allowing for non-minimal coupling to the gravitational field, where $R$ is the Ricci scalar and $\xi $ is a constant. In this case $\mathrm {i}\partial _0\varPsi \approx \left( \frac{1}{2\mathcal{M}'} g^{\alpha \beta }\partial '_{\alpha }\partial '_{\beta } + \mathcal{M}\phi ^{(\mathrm g)} + n e\phi \right) \varPsi $ , where $\phi ^{(\mathrm g)} =\sqrt{g_{00}}$ and $\mathcal{M}'=\mathcal{M}/\phi ^{(\mathrm g)} $ , the correctness of the gravitational contribution to the potential having been verified to linear order $m\phi ^{(\mathrm g)} $ in the thermal-neutron beam interferometry experiment due to Colella et al. Setting $n=2$ and regarding $\varPsi $ as the quasi-particle wave function, or order parameter, we obtain the generalization of the fundamental macroscopic Ginzburg-Landau equation of superconductivity to curved space–time. Conservation of probability and electrical current requires both electromagnetic gauge and space–time coordinate conditions to be imposed, which exemplifies the gravito-electromagnetic analogy, particularly in the stationary case, when div ${{\varvec{A}}}=\hbox {div}{{\varvec{A}}}^{(\mathrm g)}=0$ , where ${{\varvec{A}}}^{\alpha }=-A^{\alpha }$ and ${{\varvec{A}}}^{(\mathrm g)\alpha }=-\phi ^{(\mathrm g)}g^{0\alpha }$ . The quantum-cosmological Schrödinger (Wheeler–DeWitt) equation is also discussed in the $\mathcal{D}$ -dimensional mini-superspace idealization, with particular regard to the vacuum potential $\mathcal V$ and the characteristics of the ground state, assuming a gravitational Lagrangian $L_\mathcal{D}$ which contains higher-derivative terms up to order $\mathcal{R}^4$ . For the heterotic superstring theory , $L_\mathcal{D}$ consists of an infinite series in $\alpha '\mathcal{R}$ , where $\alpha '$ is the Regge slope parameter, and in the perturbative approximation $\alpha '|\mathcal{R}| \ll 1$ , $\mathcal V$ is positive semi-definite for $\mathcal{D} \ge 4$ . The maximally symmetric ground state satisfying the field equations is Minkowski space for $3\le {\mathcal {D}}\le 7$ and anti-de Sitter space for $8 \le \mathcal {D} \le 10$. (shrink)

M. I. Finley in his Politics in the Ancient World , 92–6 has recently cast doubt on the extent to which religious phenomena were taken seriously in ancient times. We believe that in stressing the reasons for scepticism he has overlooked much positive evidence for the impact of religious scruples on political behaviour and that in generalising he has undervalued the differences in this respect between ancient societies. The significance of some of this positive evidence is admittedly uncertain since in (...) civilian life scruples might be easy to observe without great suffering. The acid test is in time of war, so that is the concern of our present enquiry. That attitudes varied can be shown only by comparing societies. We have here limited our discussion to three for which the evidence is well preserved: the world of the Greek city before Alexander the Great, Rome before Constantine, and the Jews in the Hellenistic and Roman period. Elucidation of the reasons for their distinct attitudes would reveal much about each of these societies and its religious practices and conceptions, but there will be space here only to show that considerable variety did indeed exist. Most ancient peoples assumed that their gods approved of war; the pacifism of some pre-Constantinian Christians was exceptional. Nor did such rules in combat as were observed necessarily have a religious foundation. Ancient like modern scruples were often based on moral and humanitarian grounds, as in the treatment of corpses and civilians; the gods, as the guardians of general morality, might be involved in such matters, but only at a remove. (shrink)

No speech in Attic tragedy has made a stronger impression on later generations than Medea's farewell to her children. Four changes of mind and two displays of maternal affection lay bare the depths of a tortured soul; ‘there, in a short space, arelove and hatred, firmness and hesitation, fierce joy and unfathomable sorrow’.

Discussions about the aesthetic relation frame are often focused on subject-object relations, on objects of arts, their production and their perception.1 A Christian philosophical anthropology emphasizes human subject-subject relations and human acts, including more than the production of artefacts. According to the philosophy of the cosmonomic idea, any kind of human act has an aesthetic aspect. Yet, I shall restrict myself to types of characters that are aesthetically qualified. I shall discuss characters of acts, which objects are not typically aesthetic; (...) characters of acts, which objects are aesthetically qualified; characters of acts performed in subject-subject relations, and characters of aesthetically qualified associations. (shrink)