Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Dictionary of terminology of Yoga philosophy.

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Concept of Avidyā in the Vedānta philosophy of Śaṅkarācārya; a study.

S. A. Lloyd - Liberty, Rationality, and Agency in Hobbes's Leviathan - Journal of the History of Philosophy 40:3 Journal of the History of Philosophy 40.3 397-398 Book Review Liberty, Rationality, and Agency in Hobbes's Leviathan David van Mill. Liberty, Rationality, and Agency in Hobbes's Leviathan. Albany: The State University of New York Press, 2001. Pp. xii + 253. Cloth, $59.50. Paper, $19.95. David van Mill's provocative book is an ambitious and thoughtful argument by an author well-versed in Hobbes's writings (...) and the secondary literature on them, intended to revolutionize our understanding of Hobbes's theory of rational agency. It is a shame that the text is marred by such egregious copy-editing that its unrelenting misprints, misquotes, inaccurate references, and grammatical infelicities so distract from van Mill's.. (shrink)

Text with commentary, work on Advaita Vedanta.

يقدم المؤلف لنا قانونا اجتماعيًا لعلماء النفس والاجتماع السياسي صاغه كالآتي: (إذا زاد عدد الأفراد الذين يمارسون تصرّفًا يعدّ خزيًا، وتساهل القانون في محاسبة مرتكبيه، وعجز الناس عن إيقافه أو وجدوا له تبريرًا، تحوّل إلى ظاهرة ولم يعد خزيًا كما كان). و من هذه العبارة التقديمية يمكن أن نؤكد أن هذا الكتاب لا يمكن إيفاءه حقه بنبذة موجزة، فهو سفر فكري ممتع، حيث يتناول المؤلف فيه بشكل تحليلي وعلمي مقنع أهم الموضوعات التي تشغل العقل العربي، ما بين شخصيات سياسية كصدام (...) وسليماني، وما بين فكرة الموت والانتحار، والبغاء والجريمة، والالحاد والإيمان، واللاوعي الجمعي العربي وما يحمله من أمراض وانحرافات، والتحرش والكبت، والفساد والسلطة، واللغة العربية والحضارة. (shrink)

Verse and prose commentaries, with text, on Nyāyāvatārasūtra, verse treatise on Jain logic, by Siddhasena Divākara.

Nietzsche, Friedrich Wilhelm, 1844-1900; criticism and interpretation; Human; Alienation; philosophical aspects; Philosophy, Modern; 19th century.

Ethics of scientific research in the field of sociology; proceedings of 1995 conference in Cairo.

A psychiatrist recounts a case of a man presenting with severe depression who claimed to have abused children and his pet dog.Clinical management of the case hinged on whether this claim was true, a lie or delusional. The uncertainty over this raised complex ethical dilemmas regarding confidentiality and protection of the public.

Lectures on Jaina logic according to Devasena, fl. 933-947 and Yaśovijaya, 1624-1688, Jaina philosophers.

Critical study of various commentaries on Bādarāyaṇa's Brahmasūtra, the aphoristic work on the fundamentals of the Vedanta school in Indian philosophy.

REVIEWS: This is a very helpful volume and a good addition to contemporary scholarship on the valuable and little-known Jaina contribution to philosophy. Prof.Nagin Shah has edited the book well, including clear introduction and a very complete index.