End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not ?futile.? Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, ?If this were not an attempted suicide, would a request to withdraw care be reasonable?? We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

From Soul to Self takes us on a fascinating journey through philosophy, theology, religious studies and physiological sciences. The contributors explore the relationship between a variety of ideas that have arisen in philosophy, religion and science, each idea seeking to explain why we think we are somehow unique and distinct.

We are grateful for the careful reading and insightful responses of the several peer commentaries to our proposed approach to requests to withhold or withdraw life support therapies among patients...

We are grateful for the careful reading and insightful responses of the several peer commentaries to our proposed approach to requests to withhold or withdraw life support therapies among patients...

More than 1.5 billion students experienced disruption to education as a result of COVID-19, representing the most substantial interruption to global education in modern history. Many educational institutions transitioned to emergency remote teaching (ERT) overnight, which has presented an array of distinct challenges for educators. Using virtual interviews and an experiential approach to thematic analysis, the study examined Scottish primary teachers’ (n = 10) lived experiences of adapting to ERT practice. Findings demonstrated three main themes; ‘Meeting Learners’ Needs,’ ‘Influencing Engagement’, (...) and ‘The Impact of ERT on Teachers’. Key findings suggested that differentiating learning, engaging, and communicating with learners is more difficult during ERT than face-to-face teaching. Parental engagement is vital, however, is influenced by several mitigating factors. Finally, ERT is likely to have substantial effects on the wellbeing of those involved. Implications of these findings are considered and discussed. (shrink)

Context: We are presently witnessing a revival of introspective methods, which implicitly challenges an impressive list of in-principle objections that were addressed to introspection by various philosophers and by behaviorists. Problem: How can one overcome those objections and provide introspection with a secure basis? Results: A renewed definition of introspection as “enlargement of the field of attention and contact with re-enacted experience,” rather than “looking-within,” is formulated. This entails (i) an alternative status of introspective phenomena, which are no longer taken (...) as revelations of some an sich slice of experience, but as full-fledged experiences; and (ii) an alternative view of the validity of first-person reports as “performative coherence” rather than correspondence. A preliminary empirical study of the self-assessed reliability of introspective data using the elicitation interview method is then carried out. It turns out that subjects make use of reproducible processual criteria in order to probe into the authenticity and completeness of their own introspective reports. Implications: Introspective inquiry is likely to have enough resources to “take care of itself.” Constructivist content: It is argued that the failure of the introspectionist wave of the turn of the 19th/20th centuries is mostly due to its unconditional acceptance of the representationalist theory of knowledge, and that alternative non-representationalist criteria of validity give new credibility to introspective knowledge. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

This study ascertained reports of assent (affirmative agreement) and permission (agreement by an adult fully capable of being informed) in 114 children's research articles in 1990 in Child Development (CD), Journal of Consulting and Clinical Psychology (JCCP), Journal of Pediatric Psychology, and Journal of Clinical Child Psychology. Of the research projects, 43% failed to specify permission, and 68.5% failed to specify assent. JCCP reported assent significantly more than CD. Assent was reported significantly more in research with older children than with (...) younger children. This lack of sensitivity to assent and permission suggests that many authors, reviewers, and editors consider reporting assent and permission unessential. We recommend specifying assent and permission in all manuscripts, highlighting children's research issues in graduate training, and using specific safeguards when conducting research with children. (shrink)

Power indices are commonly required to assign at least as much power to a player endowed with some given voting weight as to any player of the same game with smaller weight. This local monotonicity and a related global property however are frequently and for good reasons violated when indices take account of a priori unions amongst subsets of players (reflecting, e.g., ideological proximity). This paper introduces adaptations of the conventional monotonicity notions that are suitable for voting games with an (...) exogenous coalition structure. A taxonomy of old and new monotonicity concepts is provided, and different coalitional versions of the Banzhaf and Shapley–Shubik power indices are compared accordingly. (shrink)

We study the minimal enumeration degree problem in models of fragments of Peano arithmetic () and prove the following results: in any model M of Σ2 induction, there is a minimal enumeration degree if and only if M is a nonstandard model. Furthermore, any cut in such a model has minimal e-degree. By contrast, this phenomenon fails in the absence of Σ2 induction. In fact, whether every Σ2 cut has minimal e-degree is independent of the Σ2 bounding principle.

Retinoic acid is a good candidate for a morphogen in chick limb bud development. The challenge now is to determine how retinoic acid interacts with limb bud cells and how the retinoic acid signal is integrated with other signals to mould and pattern the developing limb.

In this article the Reformer Martin Luther is to be situated against the backdrop of his medieval theological context – considering especially Bernard of Clairvaux. It is well-known that he held in great esteem Bernard and the theology he represented. First of all, Luther's relationship to Bernard is to be investigated by way of a historiographic review of the research that was done in the past 150 years. How did one consider Luther’s attitude toward Bernard, and how did Luther research (...) specifically value this attitude? In this research, denominational positions appear to have played a important role. Secondly, the attempt is made here to sketch Bernard’s place in Luther’s own tradition. Next to the medieval scholastic theology, there were diverse other influences that became important for the young Luther. Bernard’s specific place within the complexity of medieval traditions is to be determined. This is being explained by presenting seven significant texts mainly from Luther’s works, which are added to this article. Finally, the attempt is made to determine more closely Bernard’s place in Luther’s theology between Scholasticism and Mysticism. If one wants to do justice to Bernard in Luther's works, one must take into consideration the way in which Luther has perceived him, namely as a theologian of the Scriptures, a theologian of experience and a preacher of Christ par excellence along the lines of monastic theology. (shrink)

Interest in and initiation of farm-to-school (FTS) programs have increased in recent years, spurred on by converging public concerns about child obesity trends and risks associated with industrialization and distancing in the modern food system. A civic agriculture framework that more specifically considers civic engagement and problem solving offers insights about variations in the development and prospects for FTS programs. Drawing on comparative case studies of two emerging FTS initiatives in Pennsylvania—one in a rural setting and one in an urban (...) setting—this article examines the role of internal and external “champions” in launching FTS programs and fostering civic engagement. Farm-to-school community stakeholders across the two cases framed FTS in broadly similar terms of (1) redressing poor food environments; (2) improving student nutrition, health and well-being; and (3) revitalizing rural community through support of local agriculture. However, specific concerns and emphases differed across the rural and urban cases, illustrating the significance of local context for such programs. The article concludes by discussing the importance of frame bridging and frame extension as strategies for expanding the FTS movement, and also ensuring programs that correspond to the specific circumstances and possibilities of their social and geographic settings. (shrink)

The dominant position in Philosophy of Science contends that downward causation is an illusion. Instead, we argue that downward causation doesn’t introduce vicious circles either in physics or in biology. We also question the metaphysical claim that “physical facts fix all the facts.” Downward causation does not imply any contradiction if we reject the assumption of the completeness and the causal closure of the physical world that this assertion contains. We provide an argument for rejecting this assumption. Furthermore, this allows (...) us to reconsider the concept of diachronic emergence. (shrink)