As a patient approaches death, family members often are asked about their loved one’s preferences regarding treatment at the end of life. Advance care directives may provide information for families and surrogate decision makers; however, less than one-third of Americans have completed such documents. As the U.S. population continues to age, many surrogate decision makers likely will rely on other means to discern or interpret a loved one’s preferences. While many surrogates indicate that they have some knowledge of their loved (...) one’s preferences, how surrogates obtain such knowledge is not well understood. Additionally, although research indicates that the emotional burden of end-of-life decision making is diminished when surrogates have knowledge that a loved one’s preferences are honored, it remains unclear how surrogates come to know these preferences were carried out. The current study examined the ways that next of kin knew veterans’ end-of-life preferences, and their ways of knowing whether those preferences were honored in Veteran Affairs Medical Center inpatient settings. (shrink)

How democratic is contemporary Indonesia? While analysts differ, Indonesian citizens, when asked in systematic public opinion surveys conducted regularly by the authors since 1999, consistently express strong support for democratic principles and also believe that their country's democratic performance is high. Support for democratic performance is highly correlated with support for government performance, as measured by perceptions of the condition of the national economy and political system. At the same time, higher levels of education and income, in Indonesia as in (...) other countries, have created a considerable number of critical citizens, that is, citizens who value democracy but are critical of its performance. On our evidence for Indonesia, it is members of this group who are the most motivated and best prepared to demand a higher level of democratic performance from their elected officials. (shrink)

This is a description of an avian-shaped feature that rests below a network of cellular structures found on a mound within the Argyre Basin of Mars in Mars Global Surveyor image M14-02185, acquired on April 30, 2000, and released to the public on April 4, 2001. The area examined is located near 48.0° South, 55.1° West. The formation is approximately 2,400 meters long from the tip of its beak to the tip of its farthest tail feather. There is a minimum (...) of six different variations in appearance of the surface material over this small area. Utilizing the public targeting request form provided on the Mars Global Surveyor (MGS) website, co-author Miller secured a second image of the area that was obtained on July 3, 2006, showing this feature under different conditions S20-00165. The new image was then released to the public on August 11, 2006. A third image of the formation identified as MGS S13-01480 was acquired on December 15, 2005, and although officially processed on June 20, 2006, it was not made available to the public until August 22, 2009, on NASA’s Planetary Data System (PDS) website. All three of the MGS images reveal defining aspects of this avian feature, including a head, beak, body, eye, leg, foot, toes, wing, and feathers. When taken together, these components induce the visual impression of an avian-shaped formation that exhibits a unique set of proportional features. Adjoining this formation is a composite of complex cellular features that form a compartmentalized infrastructure. The three authors who are veterinarians provide a critical analysis of the avian features, and the geologist and geoscientist authors examine natural mechanisms that could contribute to the formation of this feature. An extensive search of comparable regions within and beyond the area of the Argyre Basin was conducted. A list of these sites is provided, and terrestrial comparisons are also offered. (shrink)

This book assesses how Vatican II opened up the Catholic Church to encounter, dialogue, and engagement with other world religions. Opening with a contribution from the President of the Pontifical Council for Interreligious Dialogue, Cardinal Jean-Louis Tauran, it next explores the impact, relevance, and promise of the Declaration Nostra Aetate before turning to consider how Vatican II in general has influenced interfaith dialogue and the intellectual and comparative study of world religions in the postconciliar decades, as well as the contribution (...) of particular past and present thinkers to the formation of current interreligious and comparative theological methods. Additionally, chapters consider interreligious dialogue vis-à-vis theological anthropology in conciliar documents; openness to the spiritual practices of other faith traditions as a way of encouraging positive interreligious encounter; the role of lay and new ecclesial movements in interreligious dialogue; and the development of Monastic Interreligious Dialogue. Finally, it includes a range of perspectives on the fruits and future of Vatican’s II’s opening to particular faiths such as Judaism, Islam, Hinduism, and Buddhism. (shrink)

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

Primary research on HIV/AIDS in India has predominantly focused on known risk groups such as sex workers, STI clinic attendees and long-distance truck drivers, and has largely been undertaken in urban areas. There is evidence of HIV spreading to rural areas but very little is known about the context of the infection or about issues relating to health and social impact on people living with HIV/AIDS. In-depth interviews with nineteen men and women infected with HIV who live in rural areas (...) were used to collect experiences of testing and treatment, the social impacts of living with HIV and differential impacts on women and men. Eight focus group discussions with groups drawn from the general population in the four villages were used to provide an analysis of community level views about HIV/AIDS. While men reported contracting HIV from sex workers in the cities, women considered their husbands to be the source of their infection. Correct knowledge about HIV transmission co-existed with misconceptions. Men and women tested for HIV reported inadequate counselling and sought treatment from traditional healers as well as professionals. Owing to the general pattern of husbands being the first to contract HIV women faced a substantial burden, with few resources remaining for their own or their children’s care after meeting the needs of sick husbands. Stigma and social isolation following widowhood were common, with an enforced return to the natal home. Implications for potential educational and service interventions are discussed within the context of gender and social relations. (shrink)

Imprinted genes are monoallelically expressed in a parent‐of‐origin‐dependent manner and can affect brain and behavioural phenotypes. The X chromosome is enriched for genes affecting neurodevelopment and is donated asymmetrically to male and female progeny. Hence, X‐linked imprinted genes could potentially influence sexually dimorphic neurobiology. Consequently, investigations into such loci may provide new insights into the biological basis of behavioural differences between the sexes and into why men and women show different vulnerabilities to certain mental disorders. In this review, we summarise (...) recent advances in our knowledge of X‐linked imprinted genes and the brain substrates that they may act upon. In addition, we suggest strategies for identifying novel X‐linked imprinted genes and their downstream effects and discuss evolutionary theories regarding the origin and maintenance of X‐linked imprinting. BioEssays 28:35–44, 2006. © 2005 Wiley Periodicals, Inc. (shrink)

Here we present what we believe is a novel account of what languages are, along with an axiomatically rich representation of languages and language-related data that is based on this account. We propose an account of languages as aggregates of dispositions distributed across aggregates of persons, and in doing so we address linguistic competences and the processes that realize them. This paves the way for representing additional types of language-related entities. Like demographic data of other sorts, data about languages may (...) be of use to researchers in a number of areas, including biomedical research. Data on the languages used in clinical encounters are typically included in medical records, and capture an important factor in patient-provider interactions. Like many types of patient and demographic data, data on a person’s preferred and primary languages are organized in different ways by different systems. This can be a barrier to data integration. We believe that a robust framework for representing language in general and preferred and primary language in particular – which has been lacking in ontologies thus far – can promote more successful integration of language-related data from disparate data sources. (shrink)

Bernard Suits’ groundbreaking work, The Grasshopper: Games, Life, and Utopia, has profoundly shaped the philosophy of sport. Its sequel, Return of the Grasshopper: Games, Leisure, and the Good Life in the Third Millennium, released in October 2022, enriches scholarly understandings of Suits’ views on games, emphasizing the normative aspects of gameplay and its impact on people’s pursuit of the good life. In this book symposium, world-leading Suits scholars analyze the Suitsian conception of gameplay and its relevance to his views on (...) Utopia outlined in the sequel, covering a wide range of topics. Filip Kobiela explores counterfactual situations in Suits’ oeuvre. Christopher Bartel and Gwen Bradford scrutinize the ethical nature and ramifications of Suits’ claim that life is an unconscious game. R. Scott Kretchmar and John S. Russell present thoughtful critiques of Suits’ musings on Utopia. William J. Morgan’s contribution integrates contemporary work studies to illuminate Suits’ utopia. The symposium concludes with the editors, Francisco Javier Lopez Frias and Christopher Yorke, offering their perspectives on Suitsian Utopia, ethics, and metaethics. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of (...) life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

Ca. 40 published papers from a summer institute in the German Democratic Republic in 1988.

These last words are titled “Conclusion,” but they should be “Inception.” Professor Jacob Needleman encourages a vigorous conversation about commercialism in medicine. An honest conversation, he maintains, will spur understanding, indignation, and reformation. We do sincerely hope that such a conversation begins and is carried on to meaningful change. However, as the essays in this collection show, that conversation must take place in many different places and about many different things. All of our authors acknowledge that the problem of commercialism (...) is extremely complex. It cannot be understood as a simple fact or a single feature of modern healthcare. Thus, the conversation that discusses it must be varied and diverse. (shrink)

This book taps the best American thinkers to answer the essential American question: How do we sustain our experiment in government of, by, and for the people? Authored by an extraordinary and politically diverse roster of public officials, scholars, and educators, these chapters describe our nation's civic education problem, assess its causes, offer an agenda for reform, and explain the high stakes at risk if we fail.

We investigated the properties of the sustained attention to response task . In the SART, participants respond to frequent neutral signals and are required to withhold response to rare critical signals. We examined whether SART performance shows characteristics of speed–accuracy tradeoffs and in addition, we examined whether SART performance is influenced by prior exposure to emotional picture stimuli. Thirty-six participants in this study performed SARTs after being exposed to neutral and negative picture stimuli. Performance in the SART changed rapidly over (...) time and there was a high correlation between participants errors of commission rate and their reaction time to the neutral targets . Regardless of exposure self-reported thoughts significantly correlated with both errors of commission and reaction times. Overall, the results support the view that the SART is a better measure of impulsive responding than sustained attention. (shrink)

In this significant contribution to Hegel scholarship, Robert Williams develops the most comprehensive account to date of Hegel's concept of recognition. Fichte introduced the concept of recognition as a presupposition of both Rousseau's social contract and Kant's ethics. Williams shows that Hegel appropriated the concept of recognition as the general pattern of his concept of ethical life, breaking with natural law theory yet incorporating the Aristotelian view that rights and virtues are possible only within a certain kind of (...) community. He explores Hegel's intersubjective concept of spirit as the product of affirmative mutual recognition and his conception of recognition as the right to have rights. Examining Hegel's Jena manuscripts, his _Philosophy of Right_, the _Phenomenology of Spirit_, and other works, Williams shows how the concept of recognition shapes and illumines Hegel's understandings of crime and punishment, morality, the family, the state, sovereignty, international relations, and war. A concluding chapter on the reception and reworking of the concept of recognition by contemporary thinkers including Derrida, Levinas, and Deleuze demonstrates Hegel's continuing centrality to the philosophical concerns of our age. (shrink)

The present article presents Wang Fuzhi 王夫之 (1619-1692 C.E.)’s reading of the eighteenth chapter of the Zhuang-Zi 莊子 (ZZ) by looking at his entry from Zhuang-Zi-Tong 莊子通 and other key glosses from Zhuang-Zi-Jie 莊子解. The philosophical upshot, I aim to show, is that Wang takes ZZ as presenting the consummation of “the greatest joyousness” (zhi-le 至樂) as requiring getting rid of joyousness as one’s desideratum. Using Derek Parfit’s work as a point of reference, I aim to show that this is (...) not paradoxical or even inconsistent or even (directly or indirectly) self-defeating but is instead an interesting instance of a self-effacing theory. (shrink)

Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering ‘deep’ reality or God. In addition to symptom relief, (...) psychedelic experiences often lead to significant changes in a patient’s personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process–one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

The wave function of quantum mechanics can be understood in terms of the dispositional role it plays in the dynamics of a distribution of matter in three-dimensional space (or four-dimensional spacetime). There is more than one way, however, of specifying its dispositional role. This paper considers Suárez’s theory of ‘Bohmian dispositionalism’, in which the particles are endowed with their own ‘Bohmian dispositions’, and Simpson’s theory of ‘Cosmic Hylomorphism’, in which the particle configuration comprises a hylomorphic substance which has an intrinsic (...) power. I argue that Bohmian dispositionalism fails to capture intuitively correct counterfactuals about what would happen in Small Worlds which have only a small number of particles, but that this problem is avoided by Cosmic Hylomorphism, in which the cosmic power manifests a teleological process. (shrink)

Why would a country strongly influenced by Buddhism's reverence for life allow legalized, widely used abortion? Equally puzzling to many Westerners is the Japanese practice of mizuko rites, in which the parents of aborted fetuses pray for the well-being of these rejected "lives." In this provocative investigation, William LaFleur examines abortion as a window on the culture and ethics of Japan. At the same time he contributes to the Western debate on abortion, exploring how the Japanese resolve their conflicting emotions (...) privately and avoid the pro-life/pro-choice politics that sharply divide Americans on the issue. (shrink)