A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care (...) in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift be approached with caution. (shrink)

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)

An icy wind blows through your cotton shirt while you sit outside the hospital door, waiting for your wife to bring up the car. The warm August day, when you entered the emergency room, has transformed into a gray November one. Your mind returns to Dr. Snipe.

Don't you just know it. It's a relatively peaceful day and you are getting some quality work done when the phone rings. The caller requests help in the form of an ethics consult. When you first hear about it you think someone is pulling your leg, but no, this is the real world. A case like this exemplifies many of the twists and turns of fact, and belief, that accompany many clinical ethics consultations. Several of the facts of the case (...) generate an immediate emotional response that tempts the mind to run with them down enticing and confusing paths of thought. The age 19, is a minor in some states, but not in many. This introduces the whole notion of decisionmaking by parents or designated surrogates. Additional information suggests the comatose victim's mother is the prime motivator behind the request. The various motivations for the mother are revealed, primarily her desire to have a grandchild. The patient's own feelings are portrayed as ambivalent and the potential recipient, after the patient's sisters had been excluded because of consanguinity, is a 16-year-old girl who didn't even show up at the care conference. You are also told that the technical feasibility of the medical procedure under consideration is questionable and, of course, your legal department can't give you a straight answer—just hazard a guess. (shrink)

Libertarians such as J.R. Lucas have abandoned traditional Christian doctrines because they cannot reconcile them with the freedom of the will. Traditional Christian thinkers such as Augustine have repudiated libertarianism because they cannot reconcile it with the dogmas of the Faith. In Free Will and the Christian Faith, W.S. Anglin demonstrates that free will and traditional Christianity are ineed compatible. He examines, and solves, puzzles about the relationships between free will and omnipotence, omniscience, and God's goodness, using the idea of (...) free will to answer the question of why God allows evil, and presenting arguments that link free will to eternal life and to the nature of revelation. Topics covered include the meaning of life, the soul and Lesbegue measure, and strategies for discerning the voice of God. (shrink)

by W. S. F. Pickering Durkheim's sociological approach to morals and moral systems has always aroused considerable interest, be it by way of criticism or ...

A fundamental philosophical question that arises in connection with evolutionary theory is whether the fittest patterns of behavior are always the most rational. Are fitness and rationality fully compatible? When behavioral rationality is characterized formally as in classical decision theory, the question becomes mathematically meaningful and can be explored systematically by investigating whether the optimally fit behavior predicted by evolutionary process models is decision-theoretically coherent. Upon investigation, it appears that in nontrivial evolutionary models the expected behavior is not always in (...) accord with the norms of the standard theory of decision as ordinarily applied. Many classically irrational acts, e.g. betting on the occurrence of one event in the knowledge that the probabilities favor another, can under certain circumstances constitute adaptive behavior.One interesting interpretation of this clash is that the criterion of rationality offered by classical decision theory is simply incorrect (or at least incomplete) as it stands, and that evolutionary theory should be called upon to provide a more generally applicable theory of rationality. Such a program, should it prove feasible, would amount to the logical reduction of the theory of rational choice to evolutionary theory. (shrink)

By arguing that his use of representations at the core of Durkheim's sociological thought, this book makes a unique contribution to Durkheimian studies which have recently been dominated by postivist and functionalist interpretaions, and reveals a thinker very much in tune with contemporary developments in philosophy, linguistics and sociology.

'Thick neural event' is introduced to mean an event that requires firings of more than one neuron and a substantive (i.e. additional to merely temporal and spatial) relation among them. It is shown that some well regarded theories (e.g. by Lamme, Koch, etc.) strongly suggest that neural correlates of consciousness (NCCs) are thick neural events. It is then shown that thin (= not thick) neural events provide sufficient causation for neural events leading to behaviour, and that there are good reasons (...) to reject overdetermination by thick events. Thus, any physicalism that recognizes legitimacy of a search for NCCs must either reject theories that embrace thickness of NCCs, or accept the epiphenomenalistic view that the properties in virtue of which we are conscious are not properties in virtue of which events causally contribute to our behaviour. (shrink)

The most recent edition of these books is that of R. M. Ogilvie , which should be read in conjunction with his Commentary on these books . The other modern edition to which I have referred is that of W. Weissenborn and H. J. Müller = W.-M.

By far the best edition is that of L. D. Reynolds . Other modern editions referred to are those of W. C. Summers ; R. M. Gummere ; F. Préchac et H. Noblot.

The authors' novel approach to some interesting mathematical concepts - not normally taught in other courses - places them in a historical and philosophical setting. Although primarily intended for mathematics undergraduates, the book will also appeal to students in the sciences, humanities and education with a strong interest in this subject. The first part proceeds from about 1800 BC to 1800 AD, discussing, for example, the Renaissance method for solving cubic and quartic equations and providing rigorous elementary proof that certain (...) geometrical problems posed by the ancient Greeks cannot be solved by ruler and compass alone. The second part presents some fundamental topics of interest from the past two centuries, including proof of G del's incompleteness theorem, together with a discussion of its implications. (shrink)

The general significance of Ovid's Apollo-Dapbne within its immediate context seems plain enough. Ovid's technique, as Otis remarks, is to set epic pretensions beside elegiac behaviour and thus to show a struggle between incompatible styles of life and poetry. Yet the episode still poses certain problems. These mainly concern the significance of the story within the wider context of the opening of Ovid's poem. One difficulty is hinted at by Otis himself. He observes that with the Apollo-Dapbne and Jupiter-10 Ovid (...) has ‘deflated his divine prologue’. Yet elsewhere3 Otis remarks that in one sense the gap between the behaviour of the gods in the concilium deorum and their philandering in the Daphne and Io stories is very slight. (shrink)

As a method of oppositional reading, deconstruction argues that a text, and by extension any object of observation including the self, is characterized by disunity rather than unity. The present paper proposes that if we define the self as having a dimension that is not an object of observation, but is a pure witness, or what in Eastern cultures is known as ‘pure consciousness’, then deconstruction can be seen to undo in practice what it claims to do in theory. This (...) reversal has implications for the postmodernist self, which is thought to be fragmented by a multiplicity of social voices and the loss of a unifying depth of feeling. Through an analysis of the deconstructive notions of consciousness and language, this paper suggests that fragmentation can in effect take the postmodernist self toward a sense of wholeness. In theory deconstruction undermines the unity of language and consciousness, while in practice it invites a nonconceptual response similar to that of aesthetic experience. The deconstructive ‘freeplay’ of language empties out the meaning of a text and leads the reader toward a state of being anterior to thought, toward an experience of awareness itself as opposed to its phenomenal content. (shrink)

Delia is being carefully watched and the door is locked to keep her in and her lover out . It is hardly reasonable to suppose that she has in these circumstances been left in possession of the key; it is presumably in the custody of the ianitor. According to Ovid, what girls in this situation did was to have a duplicate key fabricated for use when occasion offered. The Delphin Ed. note ‘Par. pro fixo habet fcdso’ may, of course, record (...) what is merely a correction. Falso may, on the other hand, have arisen from a gloss on a reading ficto in a manuscript prior to those extant, which could easily have degenerated to fixo. This reading would sufficiently improve the sense of the passage to merit consideration, for lines 17 ff., while couched in general terms, clearly refer to the situation in which Tibullus and Delia are placed and describe the kind of behaviour by which they are to merit Venus' aid. (shrink)