Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

Transplantation research on samples and organs from deceased donors in England, Wales and Northern Ireland is under threat. The key problems relate to difficulties encountered in gaining consent for research projects, as distinct from consent to donation for clinical transplantation. They are due partly to the terms of the Human Tissue Act 2004 (the 2004 Act), and partly to its interpretation by the Human Tissue Authority (HTA). They include excessive interaction with donor representatives regarding ‘informed consent’ to research projects, uncertainty (...) as to the scope and duration of a donor's ‘authority’ over an organ, and restrictions caused by the apparent need for licensing of transplantation research under the 2004 Act, combined with lack of certainty, or guidance, as to the distinction between ‘research’, which requires a licence, and ‘service development’, which does not. In our view this confusion hinders and deters Specialist Nurses for Organ Donation in approaching donor representatives and discussing possible research projects with them. It has also, as we have reported elsewhere, led to abandonment of research projects for fear of liability, despite both Research Ethics Committee (REC) approval and donor consent. Such problems do not seem to occur under the transplant laws of most other comparable jurisdictions. The Transplantation Ethics Symposium, ‘The ethics of organ retrieval: goals, rights and responsibilities’, hosted by the MRC Centre for Transplantation at King's College London in December 2010, revealed that many senior clinicians and researchers, administrators, and lawyers are both unclear and in disagreement concerning the effects of the 2004 Act and the extent to which it is adhered to or ignored in practice. In this paper we examine the difficulties encountered and suggest solutions based on a less restrictive interpretation of the 2004 Act, or, more probably, a regulatory change under its authority. We propose that, in the long term, a law which includes consent for REC-approved research within the general consent for organ donation and transplantation seems preferable to the present system, both ethically and in practical terms. (shrink)

What causes adolescents to develop consumer’ ethical beliefs? Prior research has largely focused on the negative influence of peers and negative patterns of parent–child interactions to explain risky and unethical consumer behaviors. We take a different perspective by focusing on the positive support of parents and peers in adolescent social development. An integrative model is developed that links parental and peer support with adolescents’ self-worth motives, their materialistic tendencies, and their consumer ethical beliefs. In a study of 984 adolescents, we (...) demonstrate support for a sequential mediation model in which peer and parental support is positively related to adolescents’ self-esteem and feelings of power, which are each associated with decreased materialism as a means of compensating for low self-worth. This reduced materialism is, in turn, associated with more ethical consumer beliefs. (shrink)

Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much (...) more likely to influence a decision to pursue or reject aggressive life‐extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor—particularly in the context of an inadequate social safety net—robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision‐making, the irrational distinction between PAD and withdrawal of life‐sustaining care, and the more appropriate focus on the great flaws in the American health care system. (shrink)

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

_Purpose:_ In order to develop an evidence-based, sport-specific minimum impairment criteria (MIC) for the sport of vision-impaired (VI) shooting, this study aimed to determine the relative influence of losses in visual acuity (VA) and contrast sensitivity (CS) on shooting performance. Presently, VA but not CS is used to determine eligibility to compete in VI shooting. _Methods:_ Elite able-sighted athletes ( n = 27) shot under standard conditions with their habitual vision, and with their vision impaired by the use of simulation (...) spectacles (filters which reduce both VA and CS) and refractive blur (lenses which reduce VA with less effect on CS). Habitual shooting scores were used to establish a cut-off in order to determine when shooting performance was ‘below expected’ in the presence of vision impairment. Logistic regression and decision tree analyses were then used to assess the relationship between visual function and shooting performance. _Results:_ Mild reductions in VA and/or CS did not alter shooting performance, with greater reductions required for shooting performance to fall below habitual levels (below 87% of normalized performance). Stepwise logistic regression selected CS as the most significant predictor of shooting performance, with VA subsequently improving the validity of the model. In an unconstrained decision tree analysis, CS was selected as the sole criterion (80%) for predicting ‘below expected’ shooting score. _Conclusion:_ Shooting performance is better predicted by losses in CS than by VA. Given that it is not presently tested during classification, the results suggest that CS is an important measure to include in testing for the classification of vision impairment for athletes competing in VI shooting. (shrink)

(2006). Screed or Scholarship: The Days of Whine and Roses: The Destruction of Young Lawyers: Beyond One L by Douglas Litowitz. Legal Ethics: Vol. 9, No. 2, pp. 233-243.

Alzheimer's disease is characterized by plaques of amyloid-beta peptide, cleaved from amyloid-beta protein precursor . Our hypothesis is that lifespan profiles of AD-associated mRNA and protein levels in monkeys would differ from mice and that differential lifespan expression profiles would be useful to understand human AD pathogenesis. We compared profiles of AbetaPP mRNA, AbetaPP protein, and Abeta levels in rodents and primates. We also tracked a transcriptional regulator of the AbetaPP gene, specificity protein 1 , and the beta amyloid precursor (...) cleaving enzyme . In mice, AbetaPP and SP1 mRNA and their protein products were elevated late in life; Abeta levels declined in old age. In monkeys, SP1, AbetaPP, and BACE1 mRNA declined in old age, while protein products and Abeta levels rose. Proteolytic processing in both species did not match production of Abeta. In primates, AbetaPP and SP1 mRNA levels coordinate, but an inverse relationship exists with corresponding protein products as well as Abeta levels. Comparison of human DNA and mRNA sequences to monkey and mouse counterparts revealed structural features that may explain differences in transcriptional and translational processing. These findings are important for selecting appropriate models for AD and other age-related diseases. (shrink)

Dans ce texte, Walter D. Mignolo, l’un des membres-fondateurs du groupe modernité/colonialité aux côtés d’Aníbal Quijano, revient sur la définition de la colonialité comme « face sombre de la modernité » et sur les formes non seulement politiques et économiques mais encore épistémiques et esthéSiques que doivent prendre les enquêtes et les luttes décoloniales. Renommant les ancêtres de ces luttes et dénonçant le « management colonial du savoir » qui a tenté de les faire disparaître, le texte de Mignolo célèbre (...) les travaux de Ottobah Cuogano, Felipe Guamán Poma et M. K. Gandhi comme autant d’appuis pour une pensée décoloniale et pluriverselle de la frontière. (shrink)

Orthodox game theory and social preference models cannot explain why people cooperate in many experimental games or how they manage to coordinate their choices. The theory of evidential decision making provides a solution, based on the idea that people tend to project their own choices onto others, whatever these choices might be. Evidential decision making preserves methodological individualism, and it works without recourse to social preferences. Rejecting methodological individualism, team reasoning is a thinly disguised resurgence of the group mind fallacy, (...) and the experiments reported by Colman et al. Colman, A. M., Pulford, B. D., & Rose, J. (this issue). Collective rationality in interactive decisions: Evidence for team reasoning. Acta Psychologica, do not offer evidence that uniquely supports team reasoning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 42.3 (2004) 297-326 [Access article in PDF] Wittgenstein, German Organicism, Chaos, and the Center of Life Richard Mcdonough No supposition seems to me more natural than that there is no process in the brain correlated with associating or with thinking; so that it would be impossible to read off thought processes from brain processes. I mean this: if I talk or write, there (...) is, I assume, a system of impulses going out from my brain and correlated with my spoken or written thoughts. But why should the system continue further in the direction of the center. Why should this order not proceed, so to speak, out of chaos? The case would be like the following-certain kinds of plants multiply by seed, so that a seed always produces a plant of the same kind as that from which it was produced—but nothing in the seed corresponds to the plant which comes out of it—this can only be done from the history of the seed. So an organism might come into being out of something quite amorphous, as it were, causelessly; and there is no reason why this should not really hold for our thoughts, and hence for our talking and writing. L. Wittgenstein, Zettel §608 Paragraph 608 of Zettel is one of the most remarkable passages in Wittgenstein, for it presents a more metaphysical view than one would associate with his later philosophy.1 [End Page 297] Despite Wittgenstein's well known opposition to metaphysics,2 Z §608 clearly endorses a doctrine of emergence, the view, that the order in our language and thought "arises" out of "chaos" or "nothing." The general idea in emergentism is that certain kinds of wholes, notably, organisms, are "greater than the sum of their parts."3 Although emergentism has suffered from neglect and abuse for a half century, it has recently become a live issue.4Klee, Kim, and McLaughlin emphasize the kind of emergence which involves "downward causation," the view that the emergent whole causally influences the behavior of its own parts.5 Such emergentism asserts that there is an "explanatory gap" between an organism's characteristics and its mechanical structure,6 where this gap is a matter of ontology rather than mere ignorance of the causes. The present paper argues that Wittgenstein's doctrine of emergence is central to his later philosophies of language and mind. The common view that Wittgenstein's later philosophy is primarily negative has proved a liability for Wittgenstein.7 Cognitive scientists respond that even if there are serious problems with their views, [End Page 298] "Remotely plausible theories are better than no theories at all."8 But Wittgenstein's remark at PI §109 that philosophy should not offer theories has been misunderstood. For Wittgenstein, the paradigm of a theory is mechanics (LAC28-29), and it is not the job of philosophy to explain the phenomena by adverting to hidden mechanisms (PI §435). But philosophy may offer a different kind of positive account, the kind of descriptive account appropriate to emergent organic phenomena.9 According to Z §608, this is a description of the phenomena as it emerges in a history. In order to appreciate Wittgenstein's emergentism, it is necessary to have the correct interpretation of the words "center" and "chaos" in Z §608. Many commentators take it as obvious that by "the center," Wittgenstein means the neural center.10 For in modern neuroscience, it is natural to view the brain as the control center of the organism. Wooldridge, Armstrong, Popper, Rose, Fodor, Dennett, Gillett, Greenfield, and Clark, all use "center" in this way.11Given the modern view, called "central state materialism" as background,12 Z §608 seems to claim, first, that the order of our thought and language cannot be [End Page 299] traced to the neural center, and, second, that intelligence must arise out of neural "chaos." Thus, McGinn thinks Wittgenstein is suggesting that the brain might turn out to be oatmeal.13 But careful attention to... (shrink)

The work of many scholars in the last hundred years has helped us to understand the nature and origins of the treatise which we know for short as the Contest of Homer and Hesiod. The present state of knowledge may be summed up as follows. The work in its extant form dates from the Antonine period, but much of it was taken over bodily from an earlier source, thought to be the Movaelov of Alcidamas. Some of the verses exchanged in (...) the contest were current even earlier, and some scholars have supposed that the story of a contest went back to the fifth, sixth, or even eighth century; but this is now much doubted. (shrink)

Cet article s’intéresse à l’évolution non seulement quantitative mais aussi qualitative du phénomène du divorce. Dans le divorce, d’un cas à l’autre, on observe de grandes différences suivant le degré d’accomplissement du travail psychique de deuil des ex-partenaires. Mais son extrême banalisation entraîne aussi un important changement d’état d’esprit général, avec des problèmes nouveaux, voire des mutations d’ordre psycho-culturel concernant la vie de couple. La puissante médiatisation contemporaine contribue à amplifier les transformations en cours, modifiant considérablement non seulement les comportements (...) et les mœurs, mais aussi certaines représentations, y compris dans leurs dimensions inconscientes. On voit poindre, entre autres, la représentation d’un « destin » inéluctable qui condamnerait à l’avance tout projet de vie amoureuse durable. Certaines conséquences cliniques en sont perceptibles dans le choix amoureux des couples actuels, où s’atténue parfois la distinction entre couple projeté à long terme et aventure passagère. (shrink)

In teaching introductory ethics courses it is a struggle to find ways to ground the theoretical approach in a context accessible to students. Two way to provide this context are to use feature films and service learning. Each approach has advantages and disadvantages. Feature films provide students with a consistentnarrative, the filmmaker’s intentions, and identical experiences. Service learning provides students with an open encounter with uncertain meaning, concrete human problems, and at best similar experiences. The benefits and weaknesses of each (...) approach depend upon the objectives of the course. Films allow for greater clarity in interpretation of ethical theory, while service makes possible an appreciation of the ambiguities of ethical actions. (shrink)

This study, the third in a series of three, draws on a broader Norwegian research project exploring the phenomenon of support for young persons with mental health issues. The aim was to explore and explicate the sense of “nourishing communion”, as a somewhat neglected aspect of support. Fourteen Norwegian young adults, aged 18-25, were interviewed about their experiences of support. Data was analyzed using van Manen’s hermeneutic-phenomenological approach to open up possible meanings of how nourishing communion is concretely lived. Analysis (...) was supplemented by in-depth reflexive dialogues between the first and second author, which fostered a nourishing communion akin to the processes and dimensions of our phenomenon of interest. Findings highlight five intertwined existential themes: a) trusting the other to hold vulnerability safely; b) flourishing in mutual participation; c) acceptance in a felt togetherness; d) feeling found and received; and e) feeling an attuned resonance. The notion of “nourishing communion” as a significant but neglected element of support challenges current practice, suggesting the need for a different approach to collaboration with young persons and their networks. From the perspectives both of individual professional engagement and of policy making, there is a need for further exploration of how young persons might be supported to create and maintain a broader range of nourishing relationships. (shrink)

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

A Papyrus commentary on Alcman published in 19571 brings us news of a poem in which Alcman “physiologized”. The lemmata and commentary together witness to a semi-philosophical cosmogony unlike any other hitherto known from Greece. The evidence is meagre, but it seems worth while to see what can be made of it; for it is perhaps possible to go a little farther than has so far been done.