Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

We discuss five kinds of representations of rationales and provide a formal account of how they can alter disputation. The formal model of disputation is derived from recent work in argument. The five kinds of rationales are compilation rationales, which can be represented without assuming domain-knowledge (such as utilities) beyond that normally required for argument. The principal thesis is that such rationales can be analyzed in a framework of argument not too different from what AI already has. The result is (...) a formal understanding of rationales, a partial taxonomy, and a foundation for computer programs that represent and reason with rationales.The five kinds of rationales are as follows: (c)ompression and (s)pecialization, which yield rules, and (d)isputation, which yields a decision. These are modeled as potentially changing the focus of the dispute. Then there are (f)it, a rationale for rules, and (r)esolution, a rationale for decisions. These cannot be modeled as simply; they force disputation to a meta-level, at least temporarily. (shrink)

Human societies are extraordinarily cooperative compared to those of most other animals. In the vast majority of species, individuals live solitary lives, meeting to only to mate and, sometimes, raise their young. In social species, cooperation is limited to relatives and (maybe) small groups of reciprocators. After a brief period of maternal support, individuals acquire virtually all of the food that they eat. There is little division of labor, no trade, and no large scale conflict. Communication is limited to a (...) small repertoire of self-verifying signals. No one cares for the sick, or feeds the hungry or disabled. The strong take from the weak without fear of sanctions by third parties. Amend Hobbes to account for nepotism, and his picture of the state of nature is not so far off for most other animals. In contrast, people in even the simplest human societies regularly cooperate with many unrelated individuals. Human language allows low-cost honest communication of virtually unlimited complexity. The sick are cared for, and sharing leads to substantial flows of food from the middle aged to the young and old. Division of labor and trade are prominent features of every historically known human society, and archaeology indicates that they have a long history. Violent conflict among sizable groups is common. In every human society, social life is regulated by commonly held moral systems that specify the rights and duties of individuals enforced, albeit imperfectly, by third party sanctions. (shrink)

The disappearance of the imperial biographies written by Marius Maximus is one of the more frustrating losses of Latin literature, for various reasons: the well-known testimony of Ammianus, the interest of Marius Maximus' attested contribution to the Historia Augusta, his importance, much in dispute, to the writer of that work, the lack of information on much of the period he covered, and, not least, the fascinating role assigned to him by modern scholars, remodelling a previous duality of sources, of bad (...) biographer in contrast to the good Ignotus. It has recently become common practice for the evidence of Ausonius' Caesares to be used in the search for this biographer. The suggestion goes back to a dissertation of F. della Corte in 1956/7, and was taken up in his edition of Ausonius' works by Pastorino, and discussed in the following year by Cazzaniga who, though uncertain about the dependence of Ausonius on Marius Maximus, does misleadingly assert ‘e certo che l'ultima epigramma tocca Elagabalo, che chiude la silloge’. More recently, della Corte has returned to the question and sketched a possible model for the growth of the whole extant collection of Ausonius' Caesares, on the basis of the manuscript tradition. The same volume contains a contribution to the question by S. d'Elia and includes, by a felicitous piece of editing, an extended footnote in which d'Elia is able to comment on the relevant part of della Corte's paper. Meanwhile, outside Italy, there have been parallel and independent developments. (shrink)

Perhaps the most remarkable feature of the works in which Ausonius of Bordeaux and Libanius of Antioch, writing within a few years of each other, recall their long and varied careers is that there is so little resemblance between them; the impressions given by these experienced and successful teachers could hardly be more disparate. The reader of Ausonius finds in his Protrepticus a familiar enough picture of the terrors of the schoolroom; his Professores offer at first sight a series of (...) bland commemorations apparently deficient in the interesting information which might be expected from such an archive. Libanius' many volumes, on the other hand, compared where appropriate with the Vitae Sophistarum of Eunapius, present a situation which is well summarised by the following sentences from Walden's work The Universities of Ancient Greece : ‘There was, among the sophists of the fourth century…little, if any, of that spirit of brotherhood… that usually exists in a community of scholars at the present day. Instead there were jealousy, spite and often unrelenting hatred’. This striking divergence between Ausonius and his Eastern counterparts is unlikely to reflect a basic difference between East and West, or between Latin- and Greek-speaking milieux; the complaints of Augustine about his problems in Africa and Rome warn against such a simple answer. When one adds the evidence provided seven centuries later by the Frenchman Peter Abelard, whose plaintive Historia Calamitatum — an account of the disasters he suffered, not those which he caused — is remarkably similar to the prickly self-justification of Libanius in its account of bitter scheming and almost military manoeuvres in the educational world, one is forced to consider whether the evidence of Ausonius is not a serious anomaly, and to seek an explanation. (shrink)

A new installment in the series that blew readers' minds with Biocentrism and Beyond Biocentrism, The Grand Biocentric Design offers an even deeper dive in to the nature of reality and our universe based on the latest groundbreaking research.

Error is protean, ubiquitous and crucial in scientific process. In this paper it is argued that understanding scientific process requires what is currently absent: an adaptable, context-sensitive functional role for error in science that naturally harnesses error identification and avoidance to positive, success-driven, science. This paper develops a new account of scientific process of this sort, error and success driving Self-Directed Anticipative Learning (SDAL) cycling, using a recent re-analysis of ape-language research as test example. The example shows the limitations of (...) other accounts of error, in particular Mayo’s (Error and the growth of experimental knowledge, 1996) error-statistical approach, and SDAL cycling shows how they can be fruitfully contextualised. (shrink)

To whom do sperm and ova belong? Few tissues are produced by the human body with more waste than the germ cells. Yet dominion over the germ cells, and over the early embryo that results from their union in vitro, is behind much of the emotion that modern reproductive intervention can engender. The germ cells differ from other human tissues that can be donated or transplanted because they carry readily utilizable genetic information. Eventual expression of the germ cells' genetic potential (...) is the legitimate concern and responsibility of their donors, although in the right circumstances the responsibility can by agreement be entrusted to institutions administering gamete or embryo donor programmes; these institutions, in turn, may need to assume responsibility for decisions if, in the case of embryo storage, the wishes of the two donors conflict. The fact of sperm and ovum ownership (and the genetic potential that goes with it) before individuals part with these tissues is beyond dispute. Some contentious issues may be clarified if this area of human dominion, namely control over genetic expression among offspring, is acknowledged to be the legitimate persisting concern of those who have produced sperm and ova after storage commences. (shrink)

It may seem faintly absurd to claim or imply that a Vergilian cento has suffered unjustified neglect from scholars. These works—of which there are sixteen, covering a period of over three centuries within Late Antiquity—are usually treated at best with amused tolerance, and at worst with angry disdain. Though always ingenious, sometimes funny, and occasionally informative about the reception of Vergil, they are seldom admired. Even among Italian scholars, some of whom have paid much attention to centos, a recession has (...) set in since the annus mirabilis of 1981, which saw two editions of the Medea of Hosidius Geta. Proba has, deservedly, attracted more attention than most; her aims and methods as a Christian poetess were carefully and illuminatingly studied twenty years ago by Reinhard Herzog, and her interest as a female Roman aristocrat has brought her further attention, especially in recent years. The main aim of the present article is to suggest a particular context and a serious purpose for her cento. A postscript will show that it went on to enjoy considerable popularity until the end of the century, and an introductory section will discuss its date, but very briefly, since Matthews has convincingly said most of what needs to be said about a recent attempt to redate it. Proba's preface, much of it not in cento form, calls for detailed treatment from various angles—textual, literary, historical—and will be explored in a separate article. (shrink)

Many physicists regard the flow of time as an illusion. There is an upper level flow of time, the phenomenon of past/present/future; and there is a lower level flow of time which is really a flow of events. Perceptual completion accounts for the lower level flow of time in a few ways: apparent movement; amodal completion; and dynamic change as exemplified by a newly described modal completion that we called happening. It acts like an illusory percept connecting discrete stimuli in (...) all sensory modalities. The past/present/future distinction cannot exist unless an object is perceived to be the same now as it is then. This cognition requires object persistence. Experiments with object persistence suggest the circumstances when that, too, is an illusory percept. The illusory percepts of object persistence and perceptual completion can account for the entire flow of time. Our findings and conclusions are congruent with a few time theories and cosmologies that suggest that the flow of time is an illusion. (shrink)

Ventricular Fibrillation is responsible for a majority of sudden cardiac death, but little is known about how ventricular tachycardia (VT) degenerates into ventricular fibrillation. Several clinical studies focused only on preventing VT with a class III antiarrhythmic drug resulted in many deaths. Our simulations investigate the interactions between an antiarrhythmic drug likely to suppress a VT and a Figure 8 reentry. A parameter AAR is introduced to increase the action potential duration and therefore simulate various Class III drugs. Simulations are (...) ran under several conditions (phases of the reentry, values of AAR, durations). They show that a VT can be suppressed whatever the phase of the reentry but it strongly depends on the duration of the effect. It confirms that a drug which can suppress a reentry can also worsen it. It also shows a great variety of activation patterns and thus the complexity of antiarrhythmic drugs effects. Simulations also demonstrate that suppressing VT is an increasing function of AAR. (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)

This paper reconsiders certain questions about Ausonius’ two incomplete works on historical themes, Fasti and Caesares, with particular attention to points raised in a recent article by R. W. Burgess. Of the Fasti we have only a few tantalizing snippets, the packaging and not the core: what did the work look like when it left Ausonius? What was its coverage? was it in verse or prose? The Caesares as we have it breaks off in mid-quatrain, at line 139: did it (...) go beyond Elagabalus? What of the evidence in Giovanni Mansionario that Ausonius treated certain imperatores from Decius to Diocletian? (shrink)

Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. Objective: To identify and describe family caregivers’ experiences regarding care decisions for situations (...) that can lead to involuntary treatment use in persons living with dementia at home. Research design: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. Participants and research context: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. Ethical consideration: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. Findings: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. Discussion and conclusion: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations. (shrink)

We often think about the alternatives to a decision that has been made. Thinking in this way is known as counterfactual thinking, that is, thinking about what could have been had an alternative dec...

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four (...) principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy—one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline. (shrink)