Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

This study examined the relationship between individual differences in executive functions (EF; assessed by measures of working memory, Stroop, trail making, and verbal fluency) and ability to down-regulate and up-regulate responses to emotionally evocative film clips. To ensure a wide range of EF, 48 participants with diverse neurodegenerative disorders and 21 older neurologically normal ageing participants were included. Participants were exposed to three different movie clips that were designed to elicit a mix of disgust and amusement. While watching the films (...) they were either instructed to watch, down-regulate, and up-regulate their visible emotional responses. Heart rate and facial behaviours were monitored throughout. Emotion regulatory ability was operationalised as changes in heart rate and facial behaviour in the down- and up-regulation conditions, controlling for responses in the watch condition. Results indicated that higher verbal fluency scores were related to greater ability to regulate emotion in both the down-regulation and up-regulation conditions. This finding remained significant even after controlling for age and general cognitive functioning. No relationships were found between emotion regulation and the other EF measures. We believe these results derive from differences among EF measures, with verbal-fluency performance best capturing the complex sequence of controlled planning, activation, and monitoring required for successful emotion regulation. These findings contribute to our understanding of emotion–cognition interaction, suggesting a link between emotion-regulatory abilities and individual differences in complex executive functions. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Despite the supreme political and economic significance of boundaries--and ongoing challenges to existing national boundaries--scant attention has been paid to their ethics. This volume explores how diverse ethical traditions understand the political and property rights reflected in territorial and jurisdictional boundaries. It is the first book to bring together thinkers from a range of traditions, both religious and secular, to discuss the ethics of boundaries. Each contributor represents a tradition's views on questions surrounding the use of boundaries to delimit property (...) and political rights. What does it mean to own something? What resources should not be privately owned? What justifies the erection of political boundaries between one people and another? How ''hard'' should such boundaries be? What rights extend to minorities within a state? Should territorial boundaries coincide with social ones? Does national autonomy have an ethical basis, or is it an aspect of modern power politics? Should we aim for a more inclusive community than that afforded by modern nation-states? Cross-chapter dialogue and a substantive conclusion draw out similarities and differences among the traditions represented, traditions that include Christianity, classical liberalism, Confucianism, international law, Islam, Judaism, liberal egalitarianism, and natural law. In addition to the editors, the contributors are Nigel Biggar, Joseph Boyle, Joseph Chan, Russell Hardin, Will Kymlicka, Loren Lomasky, Robert McCorquodale, Richard B. Miller, David Novak, Sulayman Nyang, Michael Nylan, Raul C. Pangalangan, Daniel Philpott, Jeremy Rabkin, Hillel Steiner, M. Raquibuz Zaman, and Noam J. Zohar. (shrink)

Late in 1990, the Center for the Study of Ethics in the Professions at Illinois Institute of Technology (lIT) received a grant of more than $200,000 from the National Science Foundation to try a campus-wide approach to integrating professional ethics into its technical curriculum.! Enough has now been accomplished to draw some tentative conclusions. I am the grant's principal investigator. In this paper, I shall describe what we at lIT did, what we learned, and what others, especially philosophers, can learn (...) from us. We set out to develop an approach that others could profitably adopt. I believe that we succeeded. (shrink)

The essays in this book engage the original and controversial claims from Michael Boylan's A Just Society. Each essay discusses Boylan's claims from a particular chapter and offers a critical analysis of these claims. Boylan responds to the essays in his lengthy and philosophically rich reply.

Bioethicists function in an environment in which their peers - healthcare executives, lawyers, nurses, physicians - assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts (...) that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists. (shrink)

“April is the cruelest month, breeding Lilacs out of the dead land, mixing memory and desire… ” So, begins T.S. Eliot’s iconic poem, “The Wasteland,” challenging the memory of Chaucer’s April from Canterbury Tales, as being a delightful month to go on pilgrimage. Platonic teachings emphasize that you don’t create, you just remember. Might the inverse might also be true, “You don’t remember, you just create.” As the oneirocritic, Robert Bosnak, contends, you do not actually remember your dreams. You (...) remember your memory you recreate the dream in this time. Since the challenges of post-modernism, this is no longer a far-fetched idea. The eminent historian of immigration, Deborah Dash Moore, defines history in this regard, as “a search for a plausible narrative.” “History” is not a record of what happened, but rather, is a record of what we believe happened, or what we want to believe happened. This brings to the fore Foucault’s documenting the relationship of knowledge to power, as well as Freud’s assertion that material which is unacceptable to the ego, is disguised, in order to make them palatable. This places the notion of memory in a different light. There are incidents that occurred fifty years ago that seem as if they occurred five minutes ago. The depth psychologist and champion of the imagination, James Hillman, referred to this process as “soul-making.” Back to T.S. Eliot: when he studied Sanskrit at Harvard, he was certainly aware that the Sanskrit word for memory, smara (from which smrti “that which is remembered,” is derived) is also an epithet for Kama Deva, the Indian Cupid. Hence, the mixing of memory and desire. Perhaps, in this light, the study of history, which is a form of collective memory, is also a form of mass therapy, an effort to process the collective past. Hegel and Marx both believed classical India to be an inferior civilization because it had “no history,” but collections of mythologies. Maybe classical India, however, held an awareness that all memory is myth, a word which in its early Greek form literally translates as “plot.” Jesus declares (in the Gospel story) “Let the dead bury the dead.” As the Jesus narrative exemplifies, however, burying the dead is no easy task. Perhaps our ongoing, ever-morphing narratives, allow us an oblique opportunity to connect with and process our pain. And in this theatre of memory, the goal may not be to accumulate or catalogue what has been spoken (itihasa), but look a good miller, to process the grain into its essence: from what has passed, and is passing, and is to come, into what always is. Perhaps, the pilgrimage of the mind, on its endless perigination of story, is meant to ultimately take us to love, but that may be unspeakable. Keywords: memory, desire, narrative, history, myth, power. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)

In this book, I make use of an idea from economics to suggest how noble human tendencies might not only have survived the ruthless pressures of the material world, but actually have been nurtured by them.

Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)

Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...) of the functioning of the organism as a whole, we conclude that patients diagnosed as brain dead have not, in fact, lost this integrated functioning. We close with reflections on the implications of this conclusion generally and particularly with regard to organ transplantation, and briefly make reference to alternative approaches to justifying the procurement of transplantable organs that do not depend upon a flawed approach to the diagnosis of death. (shrink)

While deductive validity provides the limiting upper bound for evaluating the strength and quality of inferences, by itself it is an inadequate tool for evaluating arguments, arguing, and argumentation. Similar remarks can be made about rhetorical success and dialectical closure. Then what would count as ideal argumentation? In this paper we introduce the concept of cognitive compathy to point in the direction of one way to answer that question. It is a feature of our argumentation rather than my argument or (...) your argument. In that respect, compathy is like the harmonies achieved by an accomplished choir, the spontaneous coordination of athletic teamwork, or the experience of improvising jazz musicians when they are all in the flow together. It is a characteristic of arguments, not a virtue that can be attributed to individual arguers. It makes argumentation more than just the sum of its individual parts. The concept of cognitive compathy is brought into focus by locating it at the confluence of two lines of thought. First, we work up to the concept of compathy by contrasting it with empathy and sympathy in the context of emotions, which is then transplanted into epistemic, cognitive, and argumentative soil. Second, the concept is analytically linked to ideal argumentation by way of authenticity in communication. In the final section, we explore the extent to which argumentative virtues are conducive to producing compathetic argumentation, but reach the unhappy conclusion that the extra value of compathetic argumentation also transcends the evaluative reach of virtue argumentation theory. (shrink)

We are grateful to Jongsma et al 1 for their interest in our article analysing the case of ‘Mrs A’, a Dutch woman with Alzheimer’s disease who received euthanasia based on her advance euthanasia directive.2 Their commentary criticises two elements of our analysis. First, the authors believe our reasons for doubting that Mrs A had the capacity to write and revise an AED rely on ‘partial’ empirical data and rest on normative errors. Second, they use two of our statements to (...) suggest we must endorse some implausible claims, for example, that ‘… in all situations and for all people, current well-being should always take precedence over all other values’. Jongsma et al assert: ‘Miller et al argue that people with dementia are impaired to make decisions.’ This casts our probabilistic claim about Mrs A’s capacity as an absolute claim about persons with dementia in general. It also implies we are using an outdated diagnosis-based view of capacity. The accusation then becomes explicit : > … several empirical studies have shown that patients with dementia are able to actively participate in qualitative studies and can respond to open questions in a meaningful way,[2-8] as well that they are able to complete an advance directive in the early phases of dementia.[9, 10] One can therefore not simply conclude on the basis of the diagnosis of dementia …. (shrink)

Tocqueville pessimistically predicted that liberty and equality would be incompatible ideas. Robert Dahl, author of the classic _A Preface to Democratic Theory,_ explores this alleged conflict, particularly in modern American society where differences in ownership and control of corporate enterprises create inequalities in resources among Americans that in turn generate inequality among them as citizens. Arguing that Americans have misconceived the relation between democracy, private property, and the economic order, the author contends that we can achieve a society of (...) real democracy and political equality without sacrificing liberty by extending democratic principles into the economic order. Although enterprise control by workers violates many conventional political and ideological assumptions of corporate capitalism as well as of state socialism. Dahl presents an empirically informed and philosophically acute defense of "workplace democracy." He argues, in the light of experiences here and abroad, that an economic system of worker-owned and worker-controlled enterprises could provide a much better foundation for democracy, political equality, and liberty than does our present system of corporate capitalism. (shrink)

This essay offers a comprehensive vision for a higher education program incorporating critical thinking across the curriculum at hypothetical Alpha College, employing a rigorous detailed conception of critical thinking called “The Alpha Conception of Critical Thinking”. The program starts with a 1-year, required, freshman course, two-thirds of which focuses on a set of general critical thinking dispositions and abilities. The final third uses subject-matter issues to reinforce general critical thinking dispositions and abilities, teach samples of subject matter, and introduce subject-specific (...) critical thinking. Subject-matter departmental and other units will make long-range plans for incorporating critical thinking in varying amounts in subject-matter courses, culminating in a written Senior Thesis/Project involving investigating, taking, and defending a position, which reinforce critical thinking abilities and dispositions and increase subject-matter knowledge. Teaching approaches used in the program are involving and based on the principle, “We learn what we use.” Both summative and formative assessment are employed as appropriate. Coordination and support are extensive. Objections and concerns are discussed, and alternatives, including possible transitions, are considered. An extended review of research supports moving toward CTAC. (shrink)

According to many commentators, Davidson’s earlier work on philosophy of action and truth-theoretic semantics is the basis for his reputation, and his later forays into broader metaphysical and epistemological issues, and eventually into what became known as the triangulation argument, are much less successful. This book by two of his former students aims to change that perception. In Part One, Verheggen begins by providing an explanation and defense of the triangulation argument, then explores its implications for questions concerning semantic normativity (...) and reductionism, the social character of language and thought, and skepticism about the external world. In Part Two, Myers considers what the argument can tell us about reasons for action, and whether it can overcome skeptical worries based on claims about the nature of motivation, the sources of normativity and the demands of morality. The book reveals Davidson’s later writings to be full of innovative and important ideas that deserve much more attention than they are currently receiving. (shrink)

Disagreements over the meaning of the thermodynamic entropy and how it should be defined in statistical mechanics have endured for well over a century. In an earlier paper, I showed that there were at least nine essential properties of entropy that are still under dispute among experts. In this paper, I examine the consequences of differing definitions of the thermodynamic entropy of macroscopic systems.Two proposed definitions of entropy in classical statistical mechanics are (1) defining entropy on the basis of probability (...) theory (first suggested by Boltzmann in 1877), and (2) the traditional textbook definition in terms of a volume in phase space (also attributed to Boltzmann). The present paper demonstrates the consequences of each of these proposed definitions of entropy and argues in favor of a definition based on probabilities. (shrink)

How important is luck in economic success? No question more reliably divides conservatives from liberals. As conservatives correctly observe, people who amass great fortunes are almost always talented and hardworking. But liberals are also correct to note that countless others have those same qualities yet never earn much. In recent years, social scientists have discovered that chance plays a much larger role in important life outcomes than most people imagine. In Success and Luck, bestselling author and New York Times economics (...) columnist Robert Frank explores the surprising implications of those findings to show why the rich underestimate the importance of luck in success--and why that hurts everyone, even the wealthy. Frank describes how, in a world increasingly dominated by winner-take-all markets, chance opportunities and trivial initial advantages often translate into much larger ones--and enormous income differences--over time; how false beliefs about luck persist, despite compelling evidence against them; and how myths about personal success and luck shape individual and political choices in harmful ways. But, Frank argues, we could decrease the inequality driven by sheer luck by adopting simple, unintrusive policies that would free up trillions of dollars each year--more than enough to fix our crumbling infrastructure, expand healthcare coverage, fight global warming, and reduce poverty, all without requiring painful sacrifices from anyone. If this sounds implausible, you'll be surprised to discover that the solution requires only a few, uncontroversial steps. Compellingly readable, Success and Luck shows how a more accurate understanding of the role of chance in life could lead to better, richer, and fairer economies and societies. (shrink)

On November 8, 1994, Oregon became the first state in the nation to legalize assisted suicide. Passage of Proposition 16 was a milestone in the campaign to make assisted suicide a legal option. The culmination of years of effort, the Oregon vote followed on the heels of failed referenda in California and Washington, and other unsuccessful attempts to enact state laws guaranteeing the right to suicide assistance. Indeed, in 1993, four states passed laws strengthening or clarifying their ban against assisted (...) suicide. No doubt, Proposition 16 is likely to renew the effort to legalize assisted suicide at the state level.The battle over assisted suicide is also unfolding in the courts. Litigation challenging Proposition 16 on the grounds that it violates the equal protection clause is ongoing in Oregon. More significantly, three cases, two in federal courts and one in Michigan state court, have been brought to establish assisted suicide as a constitutionally protected right. (shrink)

The recent high-profile financial difficulties of Harvard Pilgrim Health Care, the largest HMO in Massachusetts and consistently rated as one of the top ten HMOs in the nation, shed light on many problems common to health insurers throughout the country. This article explores those difficulties in the context of the short but complicated history of Harvard Pilgrim, and its regulatory and competitive environments. The state legislation which made a receivership proceeding possible for Harvard Pilgrim offered some protection for subscribers, but (...) failed to provide the means for achieving a long term solution. The statute merely presented a method for staving off immediate collapse by temporarily protecting the plan from dissolution, and forcing the plan's contracting providers to continue delivering care even if owed money by the plan. The article concludes by drawing lessons for understanding and ideally avoiding similar managed care nearfatalities in the future. (shrink)

Assuming that critical thinking dispositions are at least as important as critical thinking abilities, Ennis examines the concept of critical thinking disposition and suggests some criteria for judging sets of them. He considers a leading approach to their analysis and offers as an alternative a simpler set, including the disposition to seek alternatives and be open to them. After examining some gender-bias and subject-specificity challenges to promoting critical thinking dispositions, he notes some difficulties involved in assessing critical thinking dispositions, and (...) suggests an exploratory attempt to assess them. (shrink)

The analysis of interacting relativistic many-particle systems provides a theoretical basis for further work in many diverse fields of physics. After a discussion of the nonrelativisticN-particle systems we describe two approaches for obtaining the canonical equations of the corresponding relativistic forms. A further aspect of our approach is the consideration of the constants of the motion.

(Part of a symposium on an OUP collection of Paul Russell's papers on free will and moral responsibility). Paul Russell’s The Limits of Free Will is more than the sum of its parts. Among other things, Limits offers readers a comprehensive look at Russell’s attack on the problematically idealized assumptions of the contemporary free will debate. This idealization, he argues, distorts the reality of our human predicament. Herein I pose a dilemma for Russell’s position, critical compatibilism. The dilemma illuminates the (...) tension between Russell’s critical and compatibilist commitments. The problem is not obviously insurmountable, and as a compatibilist who is sympathetic to the view, my aim is to spark further discussion. (shrink)