It is often assumed that the central problem in a medical ethics issue is determining which course of action is morally correct. There are some aspects of ethical issues that will yield to such analysis. However, at the core of important medical moral problems is an irreducible dilemma in which all possible courses of action, including inaction, seem ethically unsatisfactory. When facing these issues ethical behaviour depends upon an individual's understanding and acceptance of this painful dilemma without recourse to external (...) moral authority. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

Editors’ note: These four interrelated discussions of the role of the cerebellum in coordinating emotional and higher cognitive functions developed out of a workshop presented by the four authors for the 2000 Conference of the Cognitive Science Society at the University of Pennsylvania. The four interrelated discussions explore the implications of the recent explosion of cerebellum research suggesting an expanded cerebellar role in higher cognitive functions as well as in the coordination of emotional functions with learning, logical thinking, perceptual consciousness, (...) and action planning. (shrink)

The phenomenon of contract cheating presents, potentially, a serious threat to the quality and standards of Higher Education around the world. There have been suggestions, cited below, to tackle the problem using legal means, but we find that current laws are not fit for this purpose. In this article we present a proposal for a specific new law to target contract cheating, which could be enacted in most jurisdictions.We test our proposed new law against a number of issues that would (...) need to be considered before any legal approach could be successful; would changing the legal status of contract cheating make it less likely to happen? Could this be achieved in a specific way? If so, who should actually be prosecuted and what offence are they committing? Would it actually address the causes of contract cheating? We suggest some answers to these questions, but then also identify a number of unintended potential consequences. We therefore additionally consider whether a legal approach is possible or even desirable.We conclude that a legal approach to contract cheating is possible, and, on balance, appropriate. Using UK law as an example, we offer a specific suggestion to lawmakers, around the world, for how this might be achieved, and conclude that the most successful approach would be to focus largely on a law targeting the providers of contract cheating, in particular commercial services. (shrink)

A four dimensional approach to Newtonian physics is used to distinguish between a number of different structures for Newtonian space-time and a number of different formulations of Newtonian gravitational theory. This in turn makes possible an in-depth study of the meaning and status of Newton's Law of Inertia and a detailed comparison of the Newtonian and Einsteinian versions of the Law of Inertia and the Newtonian and Einsteinian treatments of gravitational forces. Various claims about the status of Newton's (...) Law of Inertia are critically examined including these: the Law of Inertia is not an empirical law but a definition; it is not a law simpliciter but a family of schemata; it is a convention and gravitational forces exist only by convention; it is (or is not) redundant; the concepts it embodies can be dispensed with in favor of operationally defined entities; it is unique for a given theory. More generally, the paper demonstrates the importance of space-time structure for the philosophy of space and time and provides support for a realist interpretation of space-time theories. (shrink)

A quantum theory of the photon is developed in a natural manner. Newton-Wigner and Wightman demonstrated that the photon could not be strictly localized according to natural criteria. These investigations involved the identification of an elementary system with a uirrep of the Poincare group. We identify a particle with the localized measurement of the states satisfying the uirrep. In the case of zero mass and unit spin, the photon is identified with those components of the state that can be (...) localized. A c-number four-vector potential and Lorentz condition are derived from the relativistic wave equation. The Wightman localization is demonstrated for the three independent space components of the vector potential, and the photon is identified with these components. A position operator and probability density follow immediately from the localization. A consequence of the subjective definition of a photon is that the transformations of the vector potential are unitary, and hence the unitary scalar product can be obtained for the four-vector potential. A Hilbert space is defined for the three space components of the vector potential. A position operator and probability density are derived from the scalar product, which compare directly with those obtained from the localization and the non-relativistic theory. As the longitudinal and scalar polarizations do not contribute to the measured transition probability, they are considered virtual. Lastly, a conserved four-vector current is derived from the scalar product. The possibility of observing a strict localization of the photon in the laboratory is suggested. (shrink)

O presente ensaio apresenta como ponto de partida o conto "Cadeira", do escritor português José Saramago, para ilustrar a contínua atualidade do estudo "Amizade, recusa do servir" da professora e filósofa Marilena Chaui, publicado em 1982 pela editora Brasiliense como posfácio da obra "Discurso da servidão voluntária", de Étienne de La Boétie. Nossa intenção é partir da alegoria saramaguiana da queda da ditadura salazarista em Portugal para mostrar como o pensamento de La Boétie, especialmente quando analisado por Chaui, trespassa incólume (...) séculos inteiros chegando até a contemporaneidade europeia e brasileira e que possíveis caminhos alternativos a este sistema podem se apresentar. (shrink)

-/- Attempts to reduce irreversible processes to the scope of Newton’s mechanics are particularly challenging topics for both physical and philosophical research. Hollinger and Zenzen,1 for instance, claim that macroscopic irreversibility has a mechanical origin, and they explain this within the Newtonian framework. Newton’s Scientific and Philosophical Legacy Newton’s Scientific and Philosophical Legacy Look -/- .

Classical mechanics is presented so as to render the new formulation valid for an arbitrary temporal variable, as opposed to Newton’s Absolute Time only. Newton’s theory then becomes formally identical (in a precise sense) to relativity, albeit in a three-dimensional manifold. (The ultimate difference between the two dynamics is traced to the existence of the relativistic ‘mass-shell’ condition.) A classical Lagrangian is provided for our formulation of the equations of motion and it is related to one of the (...) known forms of the corresponding relativistic Lagrangian, which is the analogue of the Polyakov Lagrangian of string theory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS At the Origins of Modern Atheism. By MICHAEL J. BucKLEY, S.J. New Haven and London: Yale University Press, 1987. Pp. viii+ 445. Writing ostensibly a history of the philosophical origins of 18th century atheism in 17th century theism, Michael Buckley, S.J., has contributed a learned, subtle, and provocative hook whose length is significantly increased and whose focus is considerably enlarged by a running commentary about the metatheory (...) (Richard McKeon's philosophical semantics) that structures his reading of the chosen theists and atheists. Buckley provides the best summary of his own historical conclusion: "... theology generated apologetic philosophy and philosophy generated Universal Mechanics, and these in turn co-opted theology to become the foundations of theistic assertions... [But] when the contradictions between Cartesian and Newtonian mechanics were further negated... god became a deus otiosus" [pp. 358-359]. This conclusion rests on a philosophical principle whose elements are taken from Plato's Seventh Epistle: " The name, the definition, and the instance for the atheistic negations are all set by the current theism " [p. 15]. In turn, this principle is justified by a cluster of meta-theses that are not easily summarized, although one stands above the rest: " Much more may he involved in such a process of ideas [from 17th century theism to 18th century atheism] than their· own internal necessity, hut internal necessity remains and governs inherently " [p. 334]. The latter meta-thesis asserts that there is a dialectic of ideas and it is from this point of view that Buckley reads the conceptual history of modern atheism. Dialectical necessity is a bugbear for many contemporary philosophers, hut Buckley argues, convincingly I think, that some kind of conceptual necessity links theism and atheism. Atheism is, essentially, the negation of a particular form of theism. In Hegelian terms, atheism is a determinate negation which draws all of its conceptual content from what it negates. Buckley, however, puts an even greater Hegelian spin on the same point. If the theism carries within itself a contradiction, it negates itself and, thereby, dialectically generates its contradiction-atheism [cf. p. 17]. " Modern atheism took not only its meaning hut its existence from the self-alienation of religion " [p. 359]. A theism that believes in the existence of an intelligent, personal God, Who creates and orders the universe, but that attempts a rational 144 BOOK REVIEWS 145 justification of this belief apart from the religious experience that alone can embody such a faith contains exactly the kind of inner contradiction that generates the negation of itself. Buckley focuses on the poignant contradiction of a Christian theology abandoning " the religious figure of Jesus as the principal evidence for the reality of God" [p. 41] in favor of some philosophy (whether that of Descartes, Malebranche, or Newton) which provides a different and allegedly more certain kind of evidence for God's existence. This theology, or more precisely the theistic philosophies it spawned, are the sources of modern atheism because, if Descartes and Newton are consistently combined, philosophy can do quite well without God. Laplace's famous reply to Napoleon, although it was not originally an atheistic slogan, captures what Diderot and d'Holbach thought: God is an unnecessary hypothesis in a truly universal mechanics which needs to presuppose only matter and motion. The historical story, of course, is more complicated than this skeleton dialectic can suggest. Buckley richly details the story but I shall rehearse only its opening chapter. Buckley begins with the Jesuit theologian, Leonard Lays (1554-1623), usually known under his Latin name, Lessius, whose De providentia numinis et anima immortalitate (1613) set the pattern for subsequent Catholic theology. Lessius, who was convinced that atheism by eliminating the eternal judge destroys morals and sound politics, revived Stoic arguments, numerous variations on a theme, which show that the universe is everywhere imprinted with a divine design. Lessius's intent, although he referred only to ancient philosophers, was not to replay the classical battle between the Stoics and the Epicureans but to combat the atheism, silent and disguised in contemporary Europe, that Lessius thought to be the inevitable outcome of the wars of religion and theological fights. Lessius, however, paid scant attention to his own insight... (shrink)

The second volume in the Pittsburgh Series in the Philosophy of Science, this collection of papers covers a wide range of topics: the development of Newton's First Law comes under scrutiny in papers by Hanson and Ellis; Putnam attempts to clarify certain conceptual issues at the foundations of quantum theory; David Hawkins discusses the relation of teleology and thermodynamics from a neo-Aristotelian viewpoint; Morrison examines certain topics in astronomy; empiricism is studied by Feyerabend from a number of aspects, and (...) is found wanting; finally, Rescher looks at the connections of ethical principles and scientific research, with special reference to the goals, means, and standards of proof, and the dissemination of results of the latter. On the whole, a worthy successor to the first volume, just as certain to raise interest within diverse areas of philosophy.—P. J. M. (shrink)

Primordial emotions are the subjective element of the instincts which are the genetically programmed behaviour patterns which contrive homeostasis. They include thirst, hunger for air, hunger for food, pain and hunger for specific minerals etc.There are two constituents of a primordial emotion—the specific sensation which when severe may be imperious, and the compelling intention for gratification by a consummatory act. They may dominate the stream of consciousness, and can have plenipotentiary power over behaviour.It is hypothesized that early in animal evolution (...) complex reflex mechanisms in the basal brain subserving homeostatic responses, in concert with elements of the reticular activating system subserving arousal, melded functionally with regions embodied in the progressive rostral development of the telencephalon. This included the emergent limbic and paralimbic areas, and the insula. This phylogenetically ancient organization subserved the origin of consciousness as the primordial emotion, which signalled that the organisms existence was immediately threatened. Neuroimaging confirms major activations in regions of the basal brain during primordial emotions in humans. The behaviour of decorticate humans and animals is discussed in relation to the possible existence of primitive awareness.Neuroimaging of the primordial emotions reveals that rapid gratification of intention by a consummatory act such as ingestion causes precipitate decline of both the initiating sensation and the intention. There is contemporaneous rapid disappearance of particular regions of brain activation which suggests they may be part of the jointly sufficient and severally necessary activations and deactivations which correlate with consciousness [Crick, F. & Koch, C. . A framework for consciousness. NatureNeuroscience,6, 119–126]. (shrink)

Publication de deux poèmes byzantins du 12ème s. attribués à Théodore Prodomos, qui fournissent un certain nombre de renseignements sur les tentes des camps d'hiver des Comnène, et en particulier sur celle de la maison d'Irène la Sevastokratorissa. Cette étude mène l'auteur à un commentaire historico-artistique des éléments décrits: il compare d'abord ceux-ci avec l'art des 11ème et et 12ème s., et particulièrement avec l'art profane, puis il s'interroge sur l'authenticité des descriptions par rapport aux figures de rhétorique employées dans (...) ces textes. (shrink)

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

The author briskly gives the principles of criticism which he will follow in examining Kant's theory of time, and the distinctions between absolute time, psychological time, and the duration of events and processes which must be made in order to deal with the time theories of Kant and his great predecessors Newton and Leibniz and their defenders. Al-Azm then follows Kant's writings from 1747 through his brief conversion to the Newtonian "receptacle" theory, through the critical period. He considers the (...) Dissertation of 1770, at least in so far as it deals with space and time, to belong to the latter. The principles of criticism are especially relevant to Al-Azm's interpretation of Kant's time doctrine in the critical period. He holds that we must carefully bear in mind Kant's alternation of analytic and synthetic methods, and their dialectic interplay. If we do so, we can explain away the "patchwork" theory of Kemp Smith and others, as the obscurities and apparent inconsistencies and paradoxes which are resolvable in the light of the roles played for Kant by the approaches he employs. Within the first Critique, the teachings on time in the Aesthetic and the Analytic constitute a "genuine dialectic of a highly complex order." Thus, Kant's final position should be sought in the progressive modifications of the preliminary position. Al-Azm regards the Aesthetic as offering merely provisional statements on the subject of time, reached by a process of analysis, at an early dialectical stage, and offering a starting point for a fresh stage in analysis which aims "at the unveiling of the synthetic processes of the understanding." This is accomplished in the Analytic. In a last section, on the first Antinomy, the author considers Strawson's essay, The Bounds of Sense, published in 1966, and cites passages which he feels defend Kant's theory of time, seen in its relation to the critical philosophy, as successfully against Strawson's interpretation as against the claims of its Leibnizian and Newtonian rivals.--M. B. M. (shrink)