OBJECTIVES: In treating critically ill neonates, situations occasionally arise in which aggressive medical treatment prolongs the inevitable death rather than prolonging life. Decisions as to limitation of neonatal medical intervention remain controversial and the primary responsibility of the generally unprepared family. This research was designed to study response patterns of expectant mothers towards treatment of critically ill and/or malformed infants. DESIGN/SETTING: Attitudes were studied via comprehensive questionnaires divided into three sections: 1-Sociodemographic data and prior personal experience with perinatal problems; 2-Theoretical (...) philosophical principles used in making medical ethical decisions; and 3-Hypothetical case scenarios with choices of treatment options. SUBJECTS AND RESULTS: Six hundred and fifty pregnant women were studied. Maternal birthplace (p = 0.005) and level of religious observance (p = 0.02) were strongly associated with the desire for maximally aggressive medical intervention in the hypothetical case scenario. Specific personal experiences such as infertility problems, previous children with serious mental or physical problems were not correlated with the selection of different treatment choices. Of the theoretical principles studied, only the desire to preserve life at all costs was significantly associated with the choice for maximal medical treatment (p = 0.003). CONCLUSIONS: Maternal ethnocultural background and philosophical principles more profoundly influenced medical ethical decision-making than did specific personal life experiences. (shrink)

This major study examines the most fundamental categories in terms of which we conceive of ourselves, critically surveying the concepts of substance, causation, agency, teleology, rationality, mind, body and person, and elaborating the conceptual fields in which they are embedded. The culmination of 40 years of thought on the philosophy of mind and the nature of the mankind Written by one of the world’s leading philosophers, the co-author of the monumental 4 volume _Analytical Commentary on the Philosophical Investigations_ Uses broad (...) categories, such as substance, causation, agency and power to examine how we think about ourselves and our nature Platonic and Aristotelian conceptions of human nature are sketched and contrasted Individual chapters clarify and provide an historical overview of a specific concept, then link the concept to ideas contained in other chapters. (shrink)

A relative value of life dependent on age has been produced from a survey of 721 randomly selected individuals together with other observations of professional practice. The results are presented in diagrammatic form. If two identical people, except for age, present for medical treatment for a life-threatening condition and only one can be treated then the diagram indicates what the choice should be.

In vitro fertilisation is now an established technique for treating some forms of infertility, yet it remains ethically controversial. New developments, such as embryo donation and embryo freezing, have led to further discussion. We briefly discuss the ethical aspects of IVF, focusing on the issues of resource allocation, the 'unnaturalness' of the procedure, the moral status of the embryo, surrogate motherhood, and restrictions on access to IVF. We argue that, on the whole, IVF is an ethically justifiable method of assisting (...) infertile couples. (shrink)

Clinicians are required to act in the best interest of neonates.However, it is not obvious that entry into a randomised controlled trial (RCT) is in a neonate’s best interest because such trials often involve additional onerous procedures (such as intramuscular injections) in return for which the neonate receives unproven treatment or a placebo.On the other hand, neonatology needs to develop its evidence base, and RCTs are central to this task. The solution posited here is based on two points. First, “best (...) interest” is not equivalent to “the best possible interest” only to “best interest within a certain realm”. The realm of deliberation when asking the title question is the neonate’s health. Deliberating in this realm may involve the exclusion from consideration of some factors that might be thought relevant (such as parental wealth). Furthermore, circumstances may dictate the need to deliberate on other factors that might be thought irrelevant (such as health care resources). Second, deciding on a neonate’s best interest does not involve “putting oneself in its shoes”. Rather, it involves asking in what it has an interest, or stake. These will include some things in which we all, as human beings, have a stake, such as medical progress. Putting these two points together, in the realm of health the answer to whether RCT entry is in a neonate’s best interest is usually very finely balanced. Where this is the case, it is reasonable to invoke a broader notion of best interest and include a broader range of elements in which the neonate has a stake, including medical progress. In this way RCT entry can, usually, be said to be in a neonate’s best interest. (Journal of Medical Ethics 2001;27:110–113) Keywords: Neonates; randomised controlled trials; best interest; ethics. (shrink)

A questionnaire on the attitudes towards the functions of research ethical committees was sent to members of selected research ethical committees in Wessex and some controls. Almost all respondents felt there was a need for ethical review of research projects; 42 per cent thought there was a need for some training before joining a committee; 67 per cent thought the system could be improved and 47 per cent thought that monitoring or follow-up procedures should be adopted. Ethical committees were thought (...) to be purely advisory, as opposed to mandatory, by 33 per cent, and 63 per cent thought they should restrict their review to ethical problems as opposed to scientific or design problems. Views about the function of non-medical members ranged from 'none at all' to 'very important'. Of the 10 controls who were asked whether they would become a member of an ethical committee if asked, seven said that on balance they would and the reasons stated varied from the view that it was a 'very important committee' to the feeling that it was 'a necessary but irksome job'. (shrink)

United States of America demographic profiles illustrate a nation rich in cultural and racial diversity. Approximately 29% of the population are minorities and demographic projections indicate an increase to 50% by the year 2050. This creates a highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. (...) During times of stress, such as when injury strikes, problems associated with lack of cultural sensitivity are intensified. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients. (shrink)

The Australian bioethicist Peter Singer has presented an intriguing argument for the opinion that it is quite proper (morally) to deem the lives of certain individuals not worth living and so to kill them. The argument is based on the alleged analogy between the ordinary clinical judgement that a life with a broken leg is worse than a life with an intact leg (other things being equal), and that the broken leg therefore ought to be mended, on the one hand, (...) and the judgement that the lives of some individuals, for example, severely disabled infants, are not worth living and therefore ought to be terminated, on the other. In the present article it is argued that Singer's argument is flawed, intellectually and/or ethically. (shrink)

The difficulties of undertaking good quality effectiveness research in palliative medicine are well documented. Much of the ethical literature in this area focuses on the vulnerability of the palliative care population. It is clear that a wider ethical approach will need to be used to justify research in the terminally ill. Some themes of ethical thought are underutilised in considering the ethics of palliative care research. Three arguments to justify the need for effectiveness research in palliative care should be highlighted: (...) there is evidence of an untapped altruism amongst the population of palliative care patients who would be keen to be involved in such research; traditional Aristotelean and Thomistic virtue ethics would point to the need to gain knowledge in and of itself, but especially in palliative medicine for the benefit of patients: virtue also accrues in the acquisition of a stock of research experience which in turn makes further research feasible; most compellingly, justice would dictate that palliative treatments are effective, that futile or useless treatments are avoided and that patients are not party to “n of 1” trials by default. The current state of the evidence base of effectiveness in palliative care leads us to the uncomfortable position where patients are in precisely the position of being unwitting participants in “n of 1” clinical trials by default, without their explicit consent. (shrink)

Contrary to chimpanzees and bonobos, humans display long-term exclusive relationships between males and females. Probably all human cultures have some kind of marriage system, apparently designed to protect these exclusive relationships and the resulting offspring in a potentially sexual competitive environment. Different hypotheses about the origin of human pair-bonds are compared and it is shown how they may refer to different phases of human evolution.

This article, written by a former justice of the Supreme Court of India and chairman of the Press Council of India, describes the media accountability system in India and argues for the global necessity for such systems. It declares the need for free press systems for the survival of democratic institutions and claims that society has an obligation to monitor media systems so they remain free. The alternative will be government regulation, which will suspend the vital characteristics of a free (...) press. A press council, on the other hand, can work more cooperatively with the press to assure responsibility. Global forces make it important for the mass media to explore the virtues inherent in media accountability systems, such as press councils. This article suggests why those systems are increasingly important, proposes structures and functions for such councils, and uses the Press Council of India as an example of a working organization. (shrink)

Discussions of the constitution of the Principate are usually focused on the powers of the emperor, and relatively little attention is given to the role of the senate; by exception much has been written on its jurisdiction, with which I shall not be concerned. Despite his theory of a dyarchy of emperor and senate, which I do not wish to revive, Mommsen, partly because he devoted separate volumes to each, did I not exhibit the extent to which Augustus and Tiberius (...) at least worked through the senate, and on occasions attributed to them legal powers to act by their own authority, when in reality they caused the senate to take action as the only proper means of effecting their wishes. More recently, F. de Martino in his admirable account of the Principate dedicates only one out of twenty-seven chapters to the composition, functions and procedure of the senate. For Syme it was simply an ‘organ that advertised or confirmed the decisions of the government’. This description does not bring out the truth that it was performing a role essential to Augustus' design. For though in effect he founded a monarchy, he commonly thought it expedient on necessary obtain for his measures senatorial approval. That this was the practice of Tiberius in his early years is clearly attested, and some suppose that he behaved in an entirely different manner from Augustus. This view seems to be mistaken, and the mistake is of some consequence. (shrink)

Entertainments and celebrations are meant to give audiences and participants pleasure. Pleasure and enjoyment are an integral part of flourishing human life, and the desire for pleasure and enjoyment is a distinctive aspect of human nature. Psychological hedonism is a descriptive doctrine concerned with giving an account of actual human motivation. Ethical hedonism is a prescriptive doctrine that advances the view that human beings ought to pursue pleasure and avoid pain, that prospective pleasure and pain are severally the only good (...) reasons for action. ‘Pleasure’, ‘enjoyment’, and ‘being pleased’ are three graces that stand at the intersection of psychology, axiology, and practical reasoning. The relation between pleasure and awareness or consciousness of pleasure is subtle and unlike the corresponding relation to having a pain. To live the life of a practical hedonist is to live a life guided by the pursuit of pleasure. (shrink)

In dealing with patients the doctor is very often paternalistic. No more so than when the patient is unable to help him--or herself. Modern technology allows people to be kept alive in "intensive care" where they often become an "object" at the centre of proceedings. Fortunately for them, most patients who survive intensive care cannot remember the experience though this does not mean that they were not suffering at the time. There is a strong case for explaining things as much (...) as possible and for making practical procedures as tolerable as possible. The relatives and families of the seriously ill often have great difficulty in understanding what is happening to their loved ones and, in these situations, suffer a great deal of stress and foreboding regarding the ultimate outcome of their illness. The stress on the staff who may become "attached" to their patients often shows through as an indifferent attitude. Peter remembers three out of fourteen days in intensive care and Jane, his wife, remembers the whole experience. Here we tell our stories in the hope that they may help our medical and nursing colleagues to manage better the patients under their care in this situation. (shrink)

Striving to find a simple characterization of the essence of the imagination, philosophers have argued that it consists in the power to call up before the mind mental images, either in recollection and recognition or in fancy. Wittgenstein's interest in the imagination focused upon six interrelated themes. First, the concept of imagination is associated with the concept of a mental image. Second, imagination is connected in various ways with perception. Third, the faculty of imagination is associated with artistic creativity and (...) no less so with intellectual creativity, with originality, insight and deviation from stock solutions to problems. Fourth, 'to imagine' is connected not only with intellectual creativity, but also more generally with thought, conception or supposition. Fifth, 'to imagine' is associated with false belief, mistaken memory and misperception. Finally, the imagination is connected with make‐believe, pretence, play‐acting or idle fancy. The multitude of grammatical similarities between the visual imagination and visual perception is deceptive. (shrink)

In this paper, I argue that Thomson's famous attempt to reconcile the fetus's putative right to life with robust abortion rights is not tenable. Given her view, whether or not an abortion violates the fetus's right to life depends on the abortion procedure utilised. And I argue that Thomson's view implies that any late term abortion that involves feticide is impermissible. In particular, this would rule out the partial birth abortion technique which has been so controversial of late.

The “family rule” paper by Dr Foreman proposes a way of resolving the present uncertainty about medical law on children's consent and refusal. This commentary reviews how doctors' decisions are already well protected by English law and respected by the courts. The “family rule” appears to be likely only to complicate the already diffuse law on parental consent, and to weaken further the competent minor's position in cases of uncertainty and disagreement. It leaves the difficult questions about defining and assessing (...) children's competence unanswered. This commentary suggests that these questions would be better resolved through professionally determined standards of good practice that respect children and parents, rather than through rules or laws. (shrink)

The fact that psychic life is not merely given externally and as mutual externality, but is given in its nexus, given by self-knowledge, by internal experience, constitutes the basic difference between psychological knowledge and knowledge of nature.

Upshot: Time constraints, locked curriculums, strict management, and possible anarchy in the classroom are some of the themes that originated from the commentaries. I argue that these challenges should be viewed holistically in the broader picture. I also question the educator’s role in mitigating these obstacles. My advice: Do it anyway.

This chapter contains sections titled: Background The Tractatus The role of the Tractatus in the history of analytic philosophy The collapse of the Tractatus vision The Philosophical Investigations Philosophy of language Philosophy of mind The critique of metaphysics and nature of philosophy Wittgenstein's place in postwar analytic philosophy Notes Bibliography.

The physical world consists of relatively enduring objects that exist in an objective spatiotemporal framework, that consist of matter of one kind or another, and that interact with each other in physical processes and events. In the course of his reflections on the idea of a private language, and more generally in his ruminations on psychology and the philosophy of psychology, Wittgenstein subjected the traditional philosophical picture to critical scrutiny. In every respect he found it a distortion of grammar in (...) the flawed mirror of metaphysics. The concept of pain‐location is parasitic on the concept of the sufferer from pain, for the location of a pain is where the sufferer points and where he avows it is. Frege presented the idea that pains (experiences in general) are inalienably owned by the person whose pains or experiences they are as a metaphysical insight into the essential nature of things. (shrink)

In reviewing Ellis' OCT of Catullus, Housman scorned the ‘diction and metre’ of Carm. 64.37, ‘Pharsaliam coeunt, Pharsalia tecta frequentant’. Yet several subsequent editors have agreed with Ellis and have also refrained from emending Pharsaliam. Even if there has not been enough discomfort with the MS reading to put some editors off retaining it, they might yet welcome a piece of positive evidence to support this decision. I will make the case that a passage in Statius' Achilleid may indicate that (...) the later poet was familiar with the line as the MSS have it. (shrink)