Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.

The book "Philosophical Foundations of Neuroscience" is an engaging criticism of cognitive neuroscience from the perspective of a Wittgensteinian philosophy of ordinary language. The authors' main claim is that assertions like "the brain sees" and "the left hemisphere thinks" are integral to cognitive neuroscience but that they are meaningless because they commit the mereological fallacy—ascribing to parts of humans, properties that make sense to predicate only of whole humans. The authors claim that this fallacy is at the heart of Cartesian (...) dualism, implying that current cognitive neuroscientists are Cartesian dualists. Against this claim, we argue that the fallacy cannot be committed within Cartesian dualism either, for this doctrine does not allow for an intelligible way of asserting that a soul is part of a human being. Also, the authors' Aristotelian essentialistic outlook is at odds with their Wittgensteinian stance, and we were unconvinced by their case against explanatory reductionism. Finally, although their Wittgensteinian stance is congenial with radical behaviorism, their separation between philosophy and science seems less so because it is based on a view of philosophy as a priori. The authors' emphasis on the a priori, however, does not necessarily commit them to rationalism if it is restricted to conceptual or analytical truths. (shrink)

The solution of the outer multiplicity problem in the tensor product of U(3) irreducible representations (irreps) developed by Biedenharn et al.(1–7) and realized through the well-known Draayer-Akiyama (DA) computer code(8) is extended to the quantum algebra Uq(3). An analytic formula for special stretched Uq(3) Wigner coefficients, $$\left\langle {(\lambda _1 \mu _1 ) H_1 , (\lambda _2 \mu _2 ) \varepsilon _2 \Lambda _2 m_2 \left| { (\lambda _3 \mu _3 ) H_3 } \right.} \right\rangle _{\max }^q $$ is derived using (...) a projection operator method.(9–10) In this expression Hi denotes the highest weight vector of the (λiμi) irrep; the subscript “max” means coefficients corresponding to a unit tensor operator with a maximal characteristic null space; and q is the usual quantum label so the standard U(3) Wigner coefficient, which is required in the DA code, can be obtained in the q→1 limit of the theory. To illustrate the theory, some Uq(3) Wigner coefficients for the tensor product (22)×(22) are calculated. The procedure for evaluating nonhighest weight Wigner Uq(3) coefficients follow the DA prescription. (shrink)

John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.

Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

Ion channels are transport proteins present in the lipid bilayers of biological membranes. They are involved in many physiological processes, such as the generation of nerve impulses, hormonal secretion, and heartbeat. Conformational changes in the ion channel-forming protein allow the opening or closing of pores to control the ionic flux through the cell membranes. The opening and closing of the ion channel have been classically treated as a random kinetic process, known as a Markov process. Here the time the channel (...) remains in a given state is assumed to be independent of the condition it had in the previous state. More recently, however, several studies have shown that this process is not random but a deterministic one, where both the open and closed dwell-times and the ionic current flowing through the channel are history-dependent. This property is called long memory or long-range correlation. However, there is still much controversy regarding how this memory originates, which region of the channel is responsible for this property, and which models could best reproduce the memory effect. In this article, we provide a review of what is, where it is, its possible origin, and the mathematical methods used to analyze the long-term memory present in the kinetic process of ion channels. (shrink)

Traditionally, the consequences of employees' behavior (teleology) and the norms attributed to the behavior (deontology) have been two familiar determinants of ethical decision making (EDM). More recently, emotions have also gained considerable attention for their ability to affect EDM. Marketing ethics literature overlooks how emotions are related with norms and consequences. Hence, this study investigates how normative, consequentialist, and emotional factors interactively influence EDM in a sales ethics context. Using scenarios with a 2 × 2 between-groups factorial design, we collected (...) data online from 303 sales professionals. Then we used independent samples t tests and hierarchical regression models to analyze the hypothesized relationships. Results indicate that violation of and obedience to deontological norms stimulate negative and positive anticipated emotions, respectively, leading to stronger EDM. However, to a lesser extent, when violation of and obedience to deontological norms do not stimulate anticipated emotions, those emotions lead to weaker EDM. Moreover, consequences do not stimulate any anticipated emotions. Instead, consequences moderate the relationship between anticipated emotions and EDM. In addition, deontological and teleological evaluations mediate the relationship between anticipated emotions and EDM. These findings highlight the importance of considering the interplay between normative, consequentialist, and emotional factors in the formation of ethical judgments and intentions. The article discusses the implications of these results for sales professionals and organizations and suggests future research directions. (shrink)

ABSTRACT:Good science fiction can be a successful vehicle for portraying justice. Science fiction can stimulate moral imagination in much the same way as the most effective justice theories, connecting the world in which we live with a range of alternative futures deliberately and creatively made plausible. A selective examination of classic and recent science fiction stories and novels provides contextual framing for considering questions of climate justice, virtuous personal action in the face of structural injustice, and the problem of what (...) justice means when some people are regarded as “other.” By connecting compelling images of individual responsibility with the complex challenges posed by striving for social justice, science fiction can also help render justice work appealing and achievable—an essential step that is reinforced in closing by a brief set of maxims. (shrink)

Ray splitting is a universal phenomenon that occurs with appreciable amplitude in all wave systems when the properties of the system change on a scale smaller than the wave length. We study the quantum implications of ray splitting theoretically and experimentally with the help of ray-splitting billiards in one and two dimensions. We show that Gutzwiller's trace formula works even in the context of ray-splitting systems provided reflection and transmission of waves at ray-splitting boundaries is properly included.