Rationale Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines.Aims and objectives To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines.Methods Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast (...) cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression.Results The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P < 0.001) and from 31.1% to 52.2% across these periods for stage II (P < 0.001). Adjuvant radiotherapy also became more common (P < 0.001), with 20.6% of patients receiving this treatment in 1977–1990 compared with 60.7% in 1997–2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P < 0.001), from 19.6% in 1977–1990 to 36.9% in 1997–2003, and the proportion having hormone therapy also increased (P < 0.001), from 34.3% to 59.4% between these periods.Conclusions Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based. (shrink)

Plato famously promised to complement the Sophist and the Statesman with another work on a third sort of expert, the philosopher--but we do not have this final dialogue. Mary Louise Gill argues that Plato promised the Philosopher, but did not write it, in order to stimulate his audience and encourage his readers to work out, for themselves, the portrait it would have contained. The Sophist and Statesman are themselves members of a larger series starting with the Theaetetus, Plato's investigation (...) of knowledge, and the whole series relies on the Parmenides, the second part of which presents a philosophical exercise, introduced as the first step in a larger philosophical program. Gill contends that the dialogues leading up to the missing Philosopher, though they reach some substantive conclusions, are philosophical exercises of various sorts designed to train students in dialectic, the philosopher's method; and that a second version of the Parmenides exercise, closely patterned on it, spans parts of the Theaetetus and Sophist and brings the philosopher into view. This is the exercise about being, the subject-matter studied by Plato's philosopher. Plato hides the pieces of the puzzle and its solution in plain sight, forcing his students (and modern readers) to dig out the pieces and reconstruct the project. Gill reveals how, in finding the philosopher through the exercise, the student becomes a philosopher by mastering his methods. She shows that the target of Plato's exercise is internally related to its pedagogical purpose. (shrink)

The concept of self-motion is not only fundamental in Aristotle's argument for the Prime Mover and in ancient and medieval theories of nature, but it is also central to many theories of human agency and moral responsibility. In this collection of mostly new essays, scholars of classical, Hellenistic, medieval, and early modern philosophy and science explore the question of whether or not there are such things as self-movers, and if so, what their self-motion consists in. They trace the development of (...) the concept of self-motion from its formulation in Aristotle's metaphysics, cosmology, and philosophy of nature through two millennia of philosophical, religious, and scientific thought. This volume contains "Self-Movers" (David Furley), "Aristotle on Self-Motion" (Mary Louise Gill), "Aristotle on Perception, Appetition, and Self-Motion" (Cynthia Freeland), "Self-Movement and External Causation" (Susan Sauvé Meyer), "Aristotle on the Mind's Self-Motion" (Michael Wedin), "Mind and Motion in Aristotle" (Christopher Shields), "Aristotle's Prime Mover" (Aryeh Kosman), "The Transcendence of the Prime Mover" (Lindsay Judson), "Self-Motion in Stoic Philosophy" (David Hahm), "Duns Scotus on the Reality of Self-Change" (Peter King), "Ockham, Self-Motion, and the Will" (Calvin Normore), and "Natural Motion and Its Causes: Newton on the 'Vis Insita' of Bodies" (J. E. McGuire). Originally published in 1994. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

This book explores a fundamental tension in Aristotle's metaphysics: how can an entity such as a living organisma composite generated through the imposition of form on preexisting matterhave the conceptual unity that Aristotle demands of ...

This article focuses on service provision for women who are involuntarily referred under the UK Mental Health Act (1983) into medium and high security care in England and Wales. We explore how physical and procedural security in such settings is prioritized over relational care (see also Fallon Report, Department of Health, 1999a and NHS Executive, 2000 – Tilt Report). We are not arguing against the importance of protecting the public from the acts of dangerous members of our society. However, we (...) are arguing that many of the women in our secure services are inappropriately placed and receive inappropriate forms of treatment and care. Rather than physical security, it is high relational care, which the women require. Further, we argue that current service provision often re-produces forms of violence and violation which have marked many of women's lives prior to their entry into the secure system. (shrink)

Shaftesbury believed that the height of virtue was impartial love for all of humanity. But Shaftesbury also harboured grave doubts about our ability to develop such an expansive love. In The Moralists, Shaftesbury addressed this problem. I show that while it may appear on the surface that The Moralists solves the difficulty, it in fact remains unresolved. Shaftesbury may not have been able to reconcile his view of the content of virtue with his view of our motivational psychology.

This book casts new light on the application of the principle of proportionality in international law. Proportionality is claimed to play a central role governing the exercise of public power in international law and has been presented as the 'ultimate rule of law'.

This volume brings together twenty original essays on the changes and continuities in gender relations and intersecting politics of sexuality, race, class and location. The book is located in debates about contemporary culture at a moment of rapid technological change, global interconnectedness and the growing cultural dominance of neoliberalism and postfeminism. The collection traverses disciplines, spaces and approaches. It is marked by an extraordinarily wide focus, ranging from analyses of celebrity magazines and makeover shows to examinations of the experiences of (...) young female migrants, 'mail order brides' and young women who repudiate feminism. The contributions are united by their attempts to think through the ways in which experiences and representations of femininity are changing in the twenty-first century. Are we seeing new femininities? Are neoliberalism and postfeminism constructing new identities and subjectivities? What kinds of analytic tools and cultural politics are needed to critically engage with the current moment? This book will be of interest to everyone studying gender, media or cultural studies. (shrink)

In the mid-20th century, descriptive meta-ethics addressed a number of central questions, such as whether there is a necessary connection between moral judgment and motivation, whether moral reasons are absolute or relative, and whether moral judgments express attitudes or describe states of affairs. I maintain that much of this work in mid-20th century meta-ethics proceeded on an assumption that there is good reason to question. The assumption was that our ordinary discourse is uniform and determinate enough to vindicate one side (...) or the other of these meta-ethical debates. I suggest that ordinary moral discourse may be much less uniform and determinate than 20th century meta-ethics assumed. (shrink)

This groundbreaking collection on global leadership features innovative and critical perspectives by scholars from international relations, political economy, medicine, law and philosophy, from North and South. The book's novel theorization of global leadership is situated historically within the classics of modern political theory and sociology, relating it to the crisis of global capitalism today. Contributors reflect on the multiple political, economic, social, ecological and ethical crises that constitute our current global predicament. The book suggests that there is an overarching condition (...) of global organic crisis, which shapes the political and organizational responses of the dominant global leadership and of various subaltern forces. Contributors argue that to meaningfully address the challenges of the global crisis will require far more effective, inclusive and legitimate forms of global leadership and global governance than have characterized the neoliberal era. (shrink)

In theMetaphysics, Aristotle pointed out that some activities are engaged in for their own sake, while others are directed at some end. The test for distinguishing between them is to ask, ‘At any time during a period in which someone is Xing, is it also true that they have Xed?’ If both are true, the activity is being done for its own sake. If not, it is being done for the sake of some end other than itself. For example, if (...) I am thinking, it is true that I have thought. But if I’m making a blouse, it is not true that I have made a blouse, at least not this particular blouse. That’s not true until I have completed the project.There have been a number of attempts to deepen our understanding of this distinction. Anthony Kenny devoted a chapter of Action, Emotion, and Will to this issue, exploring the effect tense has on implication relations, and using that as a basis for dividing verbs of action into state-verbs, activity-verbs and performance-verbs. In more recent years the trend has been to generalize these categories so as to include occurrences other than actions, i.e., occurrences which do not involve intentions. While interest in this area tends to focus primarily on linguistic issues, such as the categorization of verbs, or on the logical analysis of sentences, there has been some interest in related metaphysical issues. In 1978 Alexander Mourelatos published ‘Events, Processes, and States,’ a paper which has turned out to be quite influential, in which he proposes an ontological trichotomy of occurrences. In his view, processes and events form distinct categories within the general category of occurrences. In this paper I will examine the reasoning underlying Mourelatos’s claim, arguing that the differences between processes and events cannot provide the basis for an ontological subcategorization of occurrences. (shrink)

This paper presents a model for the structure of universal frameworks in logic, mathematics, and physics that are closed to logical conclusion by the mechanism of paradox across a dualism of elements. The prohibition takes different forms defined by the framework of observation inherent to the structure. Forms include either prohibition to conclusion on the logical relationship of internal elements or prohibition to conclusion based on the existence of an element not included in the framework of a first element. The (...) model is applied to logical arguments in philosophy, mathematics, and physics and is initially a geometrical analysis of quantum theory and its application in experiment. Conclusion from the analysis is extended to give insight into the complexity of infinities above the two-dimensional boundary of the model. (shrink)

I argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral improvement over the current American system, which assumes that people do not want to donate their organs. I address what I take to be the most important objection to presumed consent. The objection is that if we implement presumed consent we will end up removing organs from the bodies of (...) people who did not want their organs removed, and that this situation is morally unacceptable because it violates the principle of respect for autonomy that underlies our concept of informed consent. I argue that while removing organs from the bodies of people who did not want them removed is unfortunate, it is morally no worse that not removing organs from the bodies of people who did want them removed, and that a policy of presumed consent will produce fewer of these unfortunate results than the current system. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Christopher Gill PLATO'S ATLANTIS STORY AND THE BIRTH OF FICTION There is a sense in which Plato's Atlantis story is the earliest example of narrative fiction in Greek literature; which is also to say it is the earliest example in Western literature. This may seem a surprising claim. Plato's story is introduced in the Timaeus as the record of a factual event and as one which is "absolutely (...) true." If the story is conceded, nonetheless, to be an invention, one might suppose that earlier works of literature, such as Homer's epics, have an equal claim to be considered fictional. On the other hand, it might be objected that the genre of narrative fiction (what we call the romance or novel) did not emerge in Greece until considerably later, in or around the first century B.C. A better understanding both of fiction and of the Atlantis story will, however, show my claim to be justified. If we describe a narrative as a fiction, we usually mean that it is an account of events which did not actually take place as they are described but which have been invented by the author. This, however, does not distinguish between falsehood and fiction. And, indeed, fiction is distinguishable from falsehood only by the presumptions of author and audience: the author of fiction does not intend to deceive (nor is the audience generally deceived) about the status of the narrative. It is also true (though in a different sense) that it is the presumptions of author and audience that distinguish fictional from factual accounts. For a fictional narrative in the past tense is not formally distinguishable from a narrative of past factual events; and it is only certain conventional and extrinsic signals (like the title of a book) which denote the class of the narrative. Moreover, an audience follows a fictional narrative with much the same kind of mental attention and emotional involvement as it does a factual narrative: fictional events may seem, in a sense, as real as, or more real than, factual events. Yet, at some level, the audience is aware that the fictional events are not real in the ordinary sense of the word but invented by the author; this awareness underlies 64 Christopher Gill65 and characterizes the kind of attention, and involvement, elicited by fictional narrative. Fiction, one may say, is a kind of game, in which both participants share in a willed pretense, treating what is unreal as real, and what is invented as actual. The rules of the game of fiction are not intuitively obvious, but presuppose a degree of cultural sophistication in a society or individual: in particular, the capacity to draw a clear distinction between fact and fiction. This capacity cannot be reasonably attributed to the composers of Homeric epic, nor can the poems (which are a chemical fusion of legends about the past and creative invention) accurately be classified by either term. The genre of deliberately fictional narrative (that is, the romance) did not emerge until historiography, factual recording of the past, was an established technique. Indeed, the romance seems to have grown up as an imitation of history, in which the author played the game of recounting a sequence of past events. Xenophon's Education of Cyrus (c. 360 b.c.), the first self-consciously semi-fictional history, served as a suggestive prototype for later, more completely fictional narratives. It is perhaps not accidental that Thucydides' attempt in the fifth century to lay down criteria for wholly factual historiography (with none of the romantic elaborations of the Homeric epics, 1.3, 1.10, 1.22) was succeeded in the fourth century by the first philosophical accounts ofthe truth-status of literature; Aristotle, in fact, defines literary truth through a contrast with historical truth (Poetics, 9). The clearer delineation of fact promoted the desire to define fiction (or, at least, literary invention), as well as creating the preconditions for the self-conscious production of fiction. Plato may seem to be an enemy rather than an analyst of literature; and his discussions undeniably have a polemical tone. But, closely examined, his treatment of literature in the Republic, and of the kinds of... (shrink)

This collection of essays explores analogous issues in classical and modern philosophy that relate to the concepts of person and human being. A primary focus is whether there are such analogous issues, and whether we can find in ancient philosophy a notion that is comparable to "person" as understood in modern philosophy. Essays on modern philosophy reappraise the validity of the notion of person, while essays on classical philosophy take up the related questions of what being "human" entails in ancient (...) ethics and psychology, and whether we should regard ourselves as, essentially, human or rational beings. (shrink)

The notion that management knowledge is universal, culture-neutral, readily transferable to any country or situation, has come under mounting challenge. The Politics of Management Knowledge goes beyond such `broad-brush' assertions to explore in detail the relations between management knowledge, power and practice in a world where globalization highlights, rather than obscures, the locally specific character of many management recipes. The book recognizes the political nature of management knowledge as a discourse produced from, and reproducing, power processes within and between organizations. (...) This theme underpins discussion of the ways in which management ideas and practices `produce' managers of a particular kind. (shrink)

This article addresses the precarious place of transgender and gender non-cis persons in relation to their discrimination-protections in recent legal, medical, and ethical policies in the United States. At present, there exists a contradiction such that trans persons are considered "pathological" enough that they are included in the latest iteration of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) as "gender dysphoric," but they are not included in the category of "disabled" under the Americans with Disabilities Act (ADA). As (...) such, trans persons in America are subject to the stigma of pathology (albeit with medical treatment) without the full protections of the ADA. By contrast, transgender and non-cis-gender Americans find their queer cohorts who are HIV-positive to be fully protected by the ADA. We ask whether transgender and non-cis-gender persons should embrace their (already pathologized) personhood as a disability. Sometimes "choosing disability" affords more rights than it deploys stigma. (shrink)

One of the most significant disputes in early modern philosophy was between the moral rationalists and the moral sentimentalists. The moral rationalists — such as Ralph Cudworth, Samuel Clarke and John Balguy — held that morality originated in reason alone. The moral sentimentalists — such as Anthony Ashley Cooper, the third Earl of Shaftesbury, Francis Hutcheson and David Hume — held that morality originated at least partly in sentiment. In addition to arguments, the rationalists and sentimentalists developed rich analogies. The (...) most significant analogy the rationalists developed was between morality and mathematics. The most significant analogy the sentimentalists developed was between morality and beauty. These two analogies illustrate well the main ideas, underlying insights, and accounts of moral phenomenology the two positions have to offer. An examination of the two analogies will thus serve as a useful introduction to the debate between moral rationalism and moral sentimentalism as a whole. (shrink)

In Hellenistic-Roman debate about psychology, thinkers such as Plutarch and Galen saw themselves as maintaining Platonic ideas about psychology that the Stoics rejected. This chapter suggests that the relationship between Plato and these Hellenistic and Roman thinkers is more complex than initially appears. It suggests that both sides in the debate may have been influenced by key features of Platonic psychology. This suggestion is illustrated by accounts of competing ways of reading two important Platonic treatments of psychology: in the Timaeus (...) and the Republic. The account of Galen’s reading is based on Galen’s own statements; the reconstruction of Chrysippus’ reading is more speculative. These competing readings are used to show how Platonic material could be seen as lending support both to part-based and to holistic ideas about embodied psychology and psychological functions. (shrink)

This chapter charts links between the Stoic and Epicurean conception of self that is discussed in Chapters 1 and 2, and their ideas about ethical development. Human beings, while seen as psychophysical and psychological wholes, are also seen as constitutively capable of achieving a fully structured and coherent ethical character. This set of ideas is illustrated especially by reference to the Stoic theory of development as ‘appropriation’. The Stoic theory is seen as embodying a holistic approach both to human psychology (...) and to ideals of ethical character. Stoic and Epicurean ideas about development are also linked with their use of the ‘whole-person’ model of causation and with ‘rich naturalism’, that is, the systematic integration of logic, ethics, and physics. Stoic-Epicurean thinking about development is contrasted with the Platonic-Aristotelian approach, especially as found in Antiochus and Arius Didymus. (shrink)

Impressed by morality's internal accessibility and motivational force, philosophers from the Greeks to the present day have advanced the view that moral distinctions originate in human nature. Every incarnation of this view, however, has had to face one central question: what is it about human nature that justifies some moral judgments and not others? This dissertation charts the rise and fall of one approach to that question, that contained in the works of the British moralists of the late seventeenth and (...) early eighteenth centuries. ;I argue, in the first four chapters, that in this period rationalists and sentimentalists alike collapsed justificatory questions into explanatory ones. I show how this collapse followed naturally from a widely-held theological conception of human nature, according to which it was possible to establish an immediate explanatory link between our original God-given constitution and some of our moral judgments. ;Against this background I turn, in chapters five and six, to David Hume, who shared his predecessors' commitment to founding moral distinctions in human nature but whose associative account severed the link between the explanation and justification of moral judgments. I maintain that Hume's work not only exposed the untenability of the theologically-based justificatory commitments of his predecessors but also casts serious doubt on contemporary efforts to ground normativity on reflexivity. Hume himself, I argue, makes plausible the suggestion that moral justification should be grounded not on the origins of judgments but on human ends that cannot and need not be justified in terms of anything else. (shrink)

This essay focuses on the applicaation of the notions of tacit knowing and embodied interaction to the college classroom. Topics ranging from classroom arrangement and discussion techniques, through curriculum and textbook choices, to attitudes and values are address.

Open peer commentary on the article “Second-Order Cybernetics as a Fundamental Revolution in Science” by Stuart A. Umpleby. Upshot: The process of writing a discussion case study requires that a researcher become embedded in the domain being studied; it entails constructing a reality as it is perceived by the participants; it demands a high level of humility, since complex environments have a tendency to thwart rational reasoning processes. Unfortunately, these very characteristics lead conventional researchers to disparage case writing, even questioning (...) whether it warrants the label of “research.” The propositions of second-order cybernetics offer a glimmer of hope to those of us who continue to write cases, as they inform us that what we are doing is science, just a different flavor of science. (shrink)

To understand the role of expert systems as a medium for transferring knowledge and skills within organisations requires an understanding of the nature of expertise within working life contexts. Central to this issue of transfer is the debate on the nature of tacit/implicit knowledge and the problem of formalising it in explicit form. This paper considers the British approach to the development of knowledge-based systems, which is regarded as being predominantly rationalistic, and compares it with the Scandinavian approach, which is (...) regarded as being predominantly humanistic. The paper proposes that crucial to the debate on the transfer of knowledge and skills is the development of expert systems as communications media which aims at enhancing and sharing the knowledge and skills of users. A human-centred approach for the future is proposed which brings the above two traditions together thereby providing a developmental framework for knowledge based systems. (shrink)

Galen is well known as a critic of Stoicism, mainly for his massive attack on Stoic (or at least, Chrysippean) psychology in "On the Doctrines of Hippocrates and Plato" (PHP) 2-5. Galen attacks both Chrysippus' location of the ruling part of the psyche in the heart and his unified or monistic picture of human psychology. However, if we consider Galen's thought more broadly, this has a good deal in common with Stoicism, including a (largely) physicalist conception of psychology and a (...) strongly teleological view of natural entities, shared features which are acknowledged in several treatises outside "PHP." Why, then, is Galen such a remorseless and negative critic of Stoicism in "PHP"? Various factors are relevant, including the shaping influence on Galen of the Platonic-Aristotelian (part-based) psychological framework. But, it is suggested here, an important underlying factor is the contrast between two ways of thinking about the part-whole relationship, a 'composition' and a 'structure' approach or an atomistic and holistic approach. This contrast is most evident and explicit in one section of "PHP" 5, where Galen, criticising Chrysippus' holistic psychology, denies that the Stoic thinker is entitled to use the concept of part at all. But the contrast is also seen as pervading Galen's response to Stoic thought more generally, in "PHP" and elsewhere, in ways that inform his explicit disagreements with Stoic theory. Stoicism is presented here as having a consistently 'structure' (or holistic) approach. Galen's approach is seen as more mixed, sometimes sharing, or aspiring towards, a holistic picture, and yet sometimes (especially in "PHP" 5), adopting a strongly 'composition' or atomistic standpoint. This (partial) contrast in conceptual frameworks is presented as offering a new perspective on Galen's critique of Stoic psychology in "PHP" and on his relationship to Stoic thought more generally. (shrink)