What if human joy went on endlessly? Suppose, for example, that each human generation were followed by another, or that the Western religions are right when they teach that each human being lives eternally after death. If any such possibility is true in the actual world, then an agent might sometimes be so situated that more than one course of action would produce an infinite amount of utility. Deciding whether to have a child born this year rather than next is (...) a situation wherein an agent may face several alternatives whose effects could well ramify endlessly on such suppositions, for the child born this year would be a different person—one who preferred different things, performed different actions, and had different descendants—from a child born next year. It has recently been suggested that traditional utilitarianism stumbles on such cases of infinite utility. Specifically, utilitarianism seems to require, for its application, that all experience of pleasure and pain cease at some time in the future or asymptotically approach zero.2 If neither of these conditions holds, then the utility produced by each of two alternative actions may turn out to be infinite, and utilitarianism thus loses its ability to discriminate morally between them. (shrink)

The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers. Our experience suggests that the patient and family are rarely engaged in DNR discussions. This is acutely relevant considering that the Mental Capacity Act (MCA) now obliges these discussions to take place. The TEP is a form (...) that the doctor completes, ideally with the competent patient or close relative, documenting what treatment options would be appropriate if that patient were to become acutely unwell. Ventilation of the lungs, cardiac resuscitation, renal replacement therapy, intravenous fluids and antibiotics are all discussed. The study evaluated patient and relative experiences with the TEP. 55 patients or their relatives were interviewed regarding their experience of the TEP and thoughts regarding the process. 96% of patients and relatives evaluated thought that the TEP was a good idea. Free text comments were all positive and only 34% of patients claimed to feel anxious when completing the form. Following this study, the TEP has been expanded hospital wide and into the community within our trust. Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts. (shrink)

The author--a Danish philosopher influenced by Moore, the later Wittgenstein, and C. I. Lewis--lays bare three fundamental rules of "informal logic" implicit in any description of empirical reality. They are: psychological expressions cannot be applied independently of the personal pronouns, personal pronouns cannot be applied independently of names of ordinary things, and names of ordinary things cannot be applied independently of words expressing possibility of action. A number of important consequences are drawn: in particular, that certain traditional philosophical problems--such as (...) the existence of the external world and the future validity of physical laws--cannot be properly formulated; and that the description of nature cannot afford any argument for psychological determinism. A stimulating book. --T. L. M. (shrink)

This book is primarily a survey of commonly accepted theories of memory. In the course of the book Locke attempts to show that the traditional theories of memory, that is the Representative and the Realist theories are inadequate because of certain mistaken assumptions adopted by the advocates of these views. For example, both of these theories’ proponents mistakenly assume that remembering is an occurrence, that this occurrence consists in a mental experience in the form of having mental images, and that (...) memory-knowledge is knowledge based on or derived from the memory-experience or the memory-image. These notions are mistaken, Locke claims, because memory consists in immediate knowledge of the past, not in the immediate experience of the past; and memory is a form of knowledge, not a form of quasi-perceptual awareness. The notion that memory is a form of knowledge is considered by Locke to be the standard contemporary account of the nature of memory. It is in these terms that he analyzes the different forms of memory: factual memory, which is defined as retained factual knowledge or knowledge we have possessed before and still possess; practical memory, which is defined as retained practical knowledge or knowledge that consists in possessing certain acquired abilities and skills; and personal memory, which is defined as memory of items that one has experienced for himself. The true test of the contemporary account, as Locke sees it, is whether it allows one to answer affirmatively the question "Is memory reliable?". In the final analysis, however, this seems to be impossible. Generally speaking, one believes that he is entitled to rely on something insofar as it can be established that what is relied upon is normally an accurate guide to the facts of the matter. Nevertheless, if one can never tell when memory is correct, it cannot be established that memory is a reliable guide to anything; thus, one can never be entitled to rely on memories. One solution to this dilemma seems to lie in the suggestion that even if one cannot demonstrate that memory is reliable, this is the simplest and possibly the only plausible assumption to make to explain the plain facts of the human situation. Moreover, one who rejects this pragmatic use of the reliability of memory is committed to saying that knowledge is impossible in any case. If there is no avenue to the past, then there is no assurance that anyone or anything has a past history at all. Without a past history, one has never acquired any information nor any reason for knowing anything, not even about the present. Memory-knowledge, then, is not a matter of simple utility, rather it is a matter of what presuppositions or assumptions have to be made if knowledge is to be possible at all. In effect, Locke sees this as simply a "transcendental argument" for the reliability of memory; that is, an argument that shows that a certain principle has to be accepted as true if a certain form of inquiry is to be possible.—T. L. M. (shrink)

A concise, popular introduction to Buddhism, this book presents Buddha's teaching: avoid "desiring too much and avoid desiring too much stopping of such desiring." After a preliminary exposition, the author proceeds to examine the causes for various misinterpretations of Buddha's teaching and concludes with his own criticisms. Bahm's lack of sympathy, however, prevented him from seeing the relevance of Buddha's teaching to the problems confronting Western civilization. And in desiring too much to argue and to document, he interferes with the (...) natural persuasiveness of Buddhism. Nevertheless, the book is to be recommended as a useful introductory work on Buddhism.--T. L. M. (shrink)

SummaryHeterozygous 4.1 hereditary elliptocytosis results from the absence of one haploid set of protein 4.1, a major component of the red cell skeleton. Two successive epidemiological investigations revealed fifteen probands in the French Northern Alps. The frequency of this disease seems to be very high in four small villages isolated in the Aravis mountains. The genealogical study shows that eleven probands share common ancestors who lived eight or ten generations ago in these villages. Thus there was probably a founder effect (...) from one pair of ancestors, strengthened by endogamy. In contrast, four probands originate from another area and are not genealogically related. Recent results in molecular genetics support the present data. (shrink)

Even though the measurement of fear of crime in criminological research commenced a few decades ago, specific populations, such as social activists, remain undocumented. This article is an attempt to address this gap. A study was conducted among 153 social activists involved in exposing corruption and irregularities that take place in the government system in India. This article explores the gap between the fear of crime and actual victimization among the specific social activists in India. The results indicate activists expressed (...) moderate fear of any one form of victimization including verbal and emotional, physical, and sexual victimization. It was also found that one-third of them have reported facing some form of abuse. The research implications are discussed. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely (...) and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition ‘to return good in proportion to the good we receive, and to make reparations for the harm we have done’, as a mid-level principle in infectious disease screening policies. More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers’ participation and the benefits for the control of public health. The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases. (shrink)