The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource (...) allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

Clinician gate-keeping is the process whereby healthcare providers prevent access to eligible patients for research recruitment. This paper contends that clinician gate-keeping violates three principles that underpin international ethical guidelines: respect for persons or autonomy; beneficence or a favourable balance of risks and potential benefits; and justice or a fair distribution of the benefits and burdens of research. In order to stimulate further research and debate, three possible strategies are also presented to eliminate gate-keeping: partnership with professional researchers; collaborative research (...) design and clinician education. (shrink)

In this close analysis of Hume’s moral psychology, John Bricke treats Hume as a thoroughly systematic thinker who aims for a comprehensive theory of mind. Bricke seeks to reveal the systematic structure of Hume’s thought by a process he calls “regimenting” the text. Bricke also has the aim of placing Hume’s theory in the context of contemporary action theory, the terms of which are inspired in large part by Davidsonian analyses.

that Buddhism is best understood as a philosophy of practice-or a.

Erasmus was one of the most widely read and controversial authors of the early modern period, inspiring a broad range of reader reactions. The present volume addresses various aspects of Erasmus's reception, including how the author's name was sometimes used to bolster decidedly "un-Erasmian" ideals.

Die Teilhabe an der lateinischen res publica litterarum der frühneuzeitlichen Fakultäten und Universitäten wurde mittels gemeinsamer literarischer Ausdrucksformen reguliert - zuweilen in Gestalt feingeistiger philologischer Kontroverse, zuweilen als wüste Polemik oder tosender Jubel. In Fallstudien zu Humanisten aus drei Jahrhunderten geht der Band der Frage nach, wie kollegiale Beziehungen literarisch inszeniert und innerhalb der Gelehrtengemeinschaft instrumentalisiert wurden. Diskursregeln und Kommunikationsbedingungen kommen dabei ebenso zur Sprache wie die Anwendung literarischer Modelle aus antiker und nachantiker Invektive, Satire und Panegyrik.

This collection by a distinguished group of philosophers, psychologists, and physiologists reflects an interdisciplinary approach to the central question of cognitive science: how do we model the mind? Among the topics explored are the relationships (theoretical, reductive, and explanatory) between philosophy, psychology, computer science, and physiology; what should be asked of models in science generally, and in cognitive science in particular; whether theoretical models must make essential reference to objects in the environment; whether there are human competences that are resistant, (...) in principle, to modelling; whether simulated thinking and intentionality are really thinking and intentionality; how semantics can be generated from syntactics; the meaning of the terms "representations" and "modelling;" whether the nature of the "hardware" matters; and whether computer models of humans are "dehumanizing." Contributors include Donald Davidson, Daniel C. Dennett, Margaret A. Boden, Adam Morton, Dennis Noble, T. Poggio, Colin Blakemore, K.V. Wilkes, P.N. Johnson-Laird, and Jonathan St. B.T. Evans. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

In Sāṃkhya similes are an important means to communicate basic philosophical teachings. In the texts similes are frequently used, especially in the Sāṃkhya passages in the Mahābhārata, in the Sāṃkhyakārikā and in the Sāṃkhyasūtra. This paper compares the similes in these three texts and analyses changes in the philosophy as revealed in the similes. A comparison of the similes of Sāṃkhya texts produced over more than one thousand years reveals changes in the emphasis in this philosophical system. The purpose of (...) the similes in the Sāṃkhya passages of the Mahābhārata is to produce an intuitive understanding of the separateness of puruṣa and prakṛti. The similes are designed to lead the listener to understand this basic dualism. In the Sāṃkhyakārikā the most difficult issues are the relationship between prakṛti and puruṣa and the idea of prakṛti working for the salvation of puruṣa. One whole chapter of the Sāṃkhyasūtra is devoted to similes. (shrink)

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)

Изложено понимание рассуждения как метода рационального познания, рассмотрены его разновидности: аргументативные, интерпретативные, прогностические, квалификационные и вычислительные. Для аспирантов и соискателей.

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)