The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he (...) argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper. (shrink)

The attitudes of women patients with cancer were explored when they were invited to participate in one of three randomised trials that included chemotherapy at two university centres and a satellite centre. Fourteen patients participating in and 15 patients declining trials were interviewed. Analysis was based on the constant comparative method. Most patients voiced positive attitudes towards clinical research, believing that trials are necessary for further medical development, and most spontaneously argued that participation is a moral obligation. Most trial decliners, (...) however, described a radical change in focus as they faced the actual personal choice. Almost no one got an impression of clinical equipoise between treatments in the trials, and most patients expressed discomfort with randomisation. A patient’s choice to participate was mainly determined by whether the primary focus was on treatment effect or on adverse effects. Both knowledge about and feelings towards trials originated mostly from the media, although paradoxically the media were largely seen as untrustworthy. Mistrust was shown towards the pharmaceutical industry, and although most patients originally trusted that doctors primarily pursued the interest of patients, they did not trust the adequacy of doctors or industry in maintaining self-regulation. Thus, public control measures were judged to be essential. (shrink)

Background: Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. Research objective: The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Research design: Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to (...) interpret the data. Participants and research context: Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. Ethical considerations: The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings: Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. Discussion: A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. Conclusion: The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. (shrink)

In this paper we define Martin-L¨of complexes to be algebras for monads on the category of (reflexive) globular sets which freely add cells in accordance with the rules of intensional Martin-L¨of type theory. We then study the resulting categories of algebras for several theories. Our principal result is that there exists a cofibrantly generated Quillen model structure on the category of 1-truncated Martin-L¨of complexes and that this category is Quillen equivalent to the category of groupoids. In particular, 1-truncated Martin-L¨of complexes (...) are a model of homotopy 1-types. In order to establish these facts we give a proof-theoretic analysis, using a modified version of Tait’s logical predicates argument, of the propositional equality classes of terms of identity type in the 1-truncated theory. (shrink)

This article compares James M. Buchanan's and John Rawls's theories of democratic governance. In particular it compares their positions on the characteristics of a legitimate social contract. Where Buchanan argues that additional police force can be used to quell political demonstrations, Rawls argues for a social contract that meets the difference principle.

Since 1994, when the first fetal imaging boutique appeared in Texas, many sites have been established around the country for parents to receive nonmedical fetal imaging using three- and four-dimensional ultrasound machines. These businesses boast the benefits they offer to parental-fetal bonding, but the medical community objects to the use of ultrasound machines for nonmedical purposes. In this article, I present the statements released by the medical community, highlighting the alarmist strategies used to paint boutique ultrasounds as bad science and (...) elevate the medical use of ultrasounds. Through a close reading of the statements, it is shown that the medical community's primary concern is not the health of the fetus or the woman but rather their place as the sole users of fetal ultrasounds. This detailed analysis reveals a medical community fearful that its authority is being usurped and is therefore responding with statements meant to denigrate boutique fetal ultrasounds. (shrink)

The practice of evidence based medicine has changed the role of the physician from information dispenser to gatherer and analyser. Studies and controlled trials that may contain unknown errors, or uncertainties, are the primary sources for evidence based decisions in medicine. These sources may be corrupted by a number of means, such as inaccurate statistical analysis, statistical manipulation, population bias, or relevance to the patient in question. Regardless of whether any of these inaccuracies are apparent, the uncertainty of their presence (...) in physician information should be disclosed to the patient. These uncertainties are not, however, shared by physicians with patients, and have caused a direct increase in patient responsibilities and mistrust. Only when disclosure of uncertainty becomes commonplace in medical practice will the physician/patient relationship evolve to a level of greater understanding and satisfaction for both the physician and patient. (shrink)

ch.1. Dialekh'ka esteticheskikh i︠a︡vleniĭ.--ch.2. Dialektika iskusstva.--ch.3. Dialektika Khudozhestvennogo razvitii︠a︡.

William Burnside was one of the three most important algebraists who were involved in the transformation of group theory from its nineteenth-century origins to a deeper twentieth-century subject. Building on work of earlier mathematicians, they were able to develop sophisticated tools for solving difficult problems. His works are of enormous historical importance; they remain also a source of inspiration and information. The works of his contemporaries, such as Klein, Frobenius, Schur, have been published as also have the works of his (...) immediate successors such as Phillip Hall. All of Burnside's papers are reproduced here, organized chronologically and with a detailed bibliography. Walter Feit has contributed a foreword, and a collection of introductory essays are included to provide a commentary on Burnside's work and set it in perspective along with a modern biography that draws on archive material. This is the first reference volume of Burnside's collected papers, enhanced by a series of critical essays on his work, and is important for group theorists and historians and philosophers of mathematics and fills the gap in this area of literature. (shrink)

The study ascertained (1) whether an observer's scope of justice with reference to either the moral agent or the target person of a moral act, would affect his/her judgements of the ethicality of the act, and (2) whether observer judgements of ethicality parallel the moral agent's decision processes in systematically evaluating the intensity of the moral issue. A scenario approach was used. Results affirmed both research questions. Discussions covered the implications of the findings for the underlying cognitive processes of moral (...) judgements, for the link between judgements of fairness and ethicality, as well as for the debate of ethical absolutism versus relativism. (shrink)

There was a deep continuity in Wollheim’s thought from his book on F. H. Bradley onward. His notion of the concept of art as deeply interiorized was inextricable from his sense of the psychological unity of the mind and the historical continuity of artistic tradition, seen on analogy with an inherited language. His study of pictorial representation pivoted on the innate psychological capacity of ‘seeing-in’, perceiving the represented subject in a surface from which it was seen as distinct but to (...) which it could be related. The expressiveness of depiction he explained through a psychoanalytic concept of projection in which we come to see a piece of the external world as corresponding to an inward state of mind. He reserved the use of the term ‘imagination’ for the artist’s elaboration of ‘seeing-in’. This he exemplified in accounts of painting by Manet, Friedrich, Titian, and Ingres among others. His critical stance has a close affinity with certain essays by Pater. (shrink)

The quantum probability flux of a particle integrated over time and a distant surface gives the probability for the particle crossing that surface at some time. We prove the free fluxacross-surfaces theorem, which was conjectured by Combes, Newton and Shtokhamer [1], and which relates the integrated quantum flux to the usual quantum mechanical formula for the cross section. The integrated quantum flux is equal to the probability of outward crossings of surfaces by Bohmian trajectories in the scattering regime.