Professionalism, like common sense, remains a timeless ingredient in the ethically successful practice of medicine in the twenty-first century. Professional ideals are particularly relevant in times of economic and social upheaval, medicolegal crises, provider shortages, and global threats to the public health. The American Board of Internal Medicine specifies professionalism as “constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest.” Because of its transcendent nature, professionalism, like ethics, is also considered “a structurally stabilizing, morally protective (...) force in society.” Professions enjoy tremendous deference and autonomy in exchange for three unwritten but prerequisite promises: expert knowledge, self-regulation, and a fiduciary responsibility to place the needs of the client ahead of self-interest. Many educators suggest that professionalism includes additional characteristics such as honesty, altruism, temperance, commitment, integrity, and suspension of self-interest. However, there are large gaps in providing more user-friendly and operational models of professionalism to learners and evaluators at all levels of the academic hierarchy. (shrink)

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents (...) were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians. (shrink)

Death is the destiny we all share, and this will not change. Yet the way we die, which had remained the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and (...) fade into death. Most likely, they would have seen their parents and grandparents die the same way, and so this manner of dying would be familiar: it was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, having reached much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements, however we also face new problems as a result of the new way in which we die. We can no longer anticipate a peaceful waning at home with family. We know our lives will likely end in hospitals likely after we have endured grueling treatments to prolong life. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our own lives, and when faced with the deaths of our loved ones. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language, enhanced by real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches. (shrink)

Five experiments investigated how people use categories to make inductions about objects whose categorisation is uncertain. Normatively, they should consider all the categories the object might be in and use a weighted combination of information from all the categories: bet-hedging. The experiments presented people with simple, artificial categories and asked them to make an induction about a new object that was most likely in one category but possibly in another. The results showed that the majority of people focused on the (...) most likely category in making inductions, although there was a group of consistently normative responders who used information from both categories (about 25% of our college population). Across experiments the overall pattern of results suggests that performance in the task is improved not by understanding the underlying principles of bet-hedging but by increasing the likelihood that multiple categories are in working memory at the time of the induction. We discuss implications for improving everyday inductions. (shrink)

Six experiments investigated variables predicted to influence subjects’ tendency to classify items by a single property instead of overall similarity, following the paradigm of Norenzayan et al., who found that European Americans tended to give more “logical” rule-based responses. However, in five experiments with Mechanical Turk subjects and undergraduates at an American university, we found a consistent preference for similarity-based responding. A sixth experiment with Korean undergraduates revealed an effect of instructions, also reported by Norenzayan et al., in which classification (...) instructions led to majority rule-based responding but similarity instructions led to overall similarity grouping. Our American subjects showed no such difference and used similarity more overall. We conclude that Americans do not have a preference for rule responding in classification and discuss the differences between tasks that reliably show strong rule or unidimensional preferences in contrast to this classification paradigm. (shrink)

Leave No Trace (LNT) has become the official education and outreach policy for managing recreational use in parks and wilderness areas throughout the United States. It is based on seven core principles that seek to minimize impacts from backcountry recreational activities such as hiking, climbing, and camping. In this paper, we review the history and current practice of Leave No Trace in the United States, including its complex role in the global political economy of outdoor recreation. We conclude by suggesting (...) a new framework for building on the successes of Leave No Trace, while moving beyond its self-imposed limitations, and recapturing wilderness recreation as a more collaborative, participatory, productive, democratic, and radical form of political action. (shrink)

This paper explores the scriptural and theological reasons given by Jehovah's Witnesses (JWs) to refuse blood transfusions. Julian Savulescu and Richard W Momeyer argue that informed consent should be based on rational beliefs and that the refusal of blood transfusions by JWs is irrational, but after examining the reasons given by JWs, I challenge the claim that JW beliefs are irrational. I also question whether we should give up the traditional notion of informed consent.

The problems that Millikan addresses in theories of concepts arise from an extensional view of concepts and word meaning. If instead one assumes that concepts are psychological entities intended to explain human behavior and thought, many of these problems dissolve.

Research on children's and adults' concepts embodies very different assumptions of how concepts are structured, as reflected in their experimental designs. Developmental studies seem to assume that categories contain highly similar objects that can all be identified from one or two examples. If concepts are more like those tested in adult experiments, research on word learning may be misleading.

In his enormously influential The Modularity of Mind, Jerry Fodor (1983) proposed that the mind was divided into input modules and central processes. Much subsequent research focused on the modules and whether processes like speech perception or spatial vision are truly modular. Much less attention has been given to Fodor's writing on the central processes, what would today be called higher‐level cognition. In “Fodor's First Law of the Nonexistence of Cognitive Science,” he argued that central processes are “bad candidates for (...) scientific study” and would resist attempts at empirical analysis. This essay evaluates his argument for this remarkable claim, concluding that although central processes may well be “messier” than input modules, this does not mean that they cannot be studied and understood. The article briefly reviews the scientific progress made in understanding central processes in the 35 years since the book was published, showing that Fodor's prediction is clearly falsified by massive advances in topics like decision making and analogy. The essay concludes that Fodor's Law was not based on a clear argument for why the complexities of central systems could not be studied but was likely based on intuitions and preferences that were common in psychology at the time. (shrink)

Volume 1 -- Unit 1: Tragedy as an independent art of musical drama. Chapter 1: Plato's well-educated men, the dancers: Harmonia kai rhuthmos as "music and dance" -- Chapter 2: Tragedy as a necessarily performed "musical" art in the Poetics -- Chapter 3: The irreducibility of tragedy to literature -- Chapter 4: Harmonia kai rhuthmos as "music and dance" in Politics VIII.

When a structure or class of structures admits an unbounded induction, we can do arithmetic on the stages of that induction: if only bounded inductions are admitted, then clearly each inductively definable relation can be defined using a finite explicit expression. Is the converse true? We examine evidence that the converse is true, in positive elementary induction . We present a stronger conjecture involving the language L consisting of all L∞ω formulas with a finite number of variables, and examine a (...) combinatorial property equivalent to “all L-definable relations are elementary”. (shrink)

Jacques Derrida's Politics of Friendship is adopted as a theoretical guide to the mutation of metaphysical categories under way in the shift from literacy to electracy. The politics is embodied in the design of a digital “memory palace,” created by the Florida Research Ensemble, whose setting is the city of Miami, Florida. Listening with an ear attuned by Derrida, through Freud and Heidegger, one hears in “Miami” a creole phrase “my friend” resonating with the aphorism by Aristotle—“O my friend, there (...) is no friend”—whose “event” Derrida traces to the “other” beginning. His alternative politics of hospitality is articulated with the history of prudence and the possibility of an image category supporting digital deliberative reason in an Internet public sphere. (shrink)

We present game-theoretic characterizations of the complexity/expressibility measures “dimension” and “the number of variables” as Least Fixed Point queries. As an example, we use these characterizations to compute the dimension and number of variables of Connectivity and Connectivity.

The tetratricopeptide repeat (TPR) motif is a protein-protein interaction module found in multiple copies in a number of functionally different proteins that facilitates specific interactions with a partner protein(s). Three-dimensional structural data have shown that a TPR motif contains two antiparallel α-helices such that tandem arrays of TPR motifs generate a right-handed helical structure with an amphipathic channel that might accommodate the complementary region of a target protein. Most TPR-containing proteins are associated with multiprotein complexes, and there is extensive evidence (...) indicating that TPR motifs are important to the functioning of chaperone, cell-cycle, transcription, and protein transport complexes. The TPR motif may represent an ancient protein-protein interaction module that has been recruited by different proteins and adapted for specific functions. BioEssays 1999;21:932–939. © 1999 John Wiley & Sons, Inc. (shrink)

The tetratricopeptide repeat (TPR) motif is a protein-protein interaction module found in multiple copies in a number of functionally different proteins that facilitates specific interactions with a partner protein(s). Three-dimensional structural data have shown that a TPR motif contains two antiparallel α-helices such that tandem arrays of TPR motifs generate a right-handed helical structure with an amphipathic channel that might accommodate the complementary region of a target protein. Most TPR-containing proteins are associated with multiprotein complexes, and there is extensive evidence (...) indicating that TPR motifs are important to the functioning of chaperone, cell-cycle, transcription, and protein transport complexes. The TPR motif may represent an ancient protein-protein interaction module that has been recruited by different proteins and adapted for specific functions. BioEssays 1999;21:932–939. © 1999 John Wiley & Sons, Inc. (shrink)

This chapter focuses on one of the common fallacies in Western philosophy, appeal to ridicule. An appeal to ridicule is closely related to an ad hominem argument because both attack the person. There is a similarity between an appeal to ridicule and an appeal to emotion in that both attempt to bypass rational assessment of a point of view and elicit an emotional reaction from the audience. An appeal to ridicule may be an attempt to elicit humor at another's expense, (...) or it may be an attempt to elicit enmity, playing on the fears and prejudices of the group. The difference between a reductio ad absurdum and an appeal to ridicule is that the former uses good evidence while the latter does not. Perhaps the best way to avoid this fallacy is to cultivate an attitude of respect for other points of view. (shrink)

In Black Museum, a young woman is out to take revenge on the man who imprisoned her father's digital self in a museum exhibit that allows sadistic visitors to reenact his execution. While the exhibit is morally detestable and some may think that the museum's curator gets what he deserves in the end, the woman's act of vengeance is morally disturbing. This chapter explores Martha Nussbaum's account of anger and forgiveness and considers Christian and Buddhist teachings. An argument by David (...) Kyle Johnson for the moral permissibility of revenge under certain circumstances is considered and rejected. The authors conclude that the act of revenge in Black Museum is not morally justified. (shrink)

In a recent Journal of Medical Ethics article, ‘Should Religious Beliefs Be Allowed to Stonewall a Secular Approach to Withdrawing and Withholding Treatment in Children?’, Joe Brierley, Jim Linthicum and Andy Petros argue for rapid intervention in cases of futile life-sustaining treatment. In their experience, when discussions of futility are initiated with parents, parents often appeal to religion to ‘stonewall’ attempts to disconnect their children from life support. However, I will argue that the intervention that the authors propose is culturally (...) insensitive. (shrink)

Robert Larmer critiques my view that the correct interpretation of David Hume’s argument against miracles in “Of Miracles” is that no testimony of a miracle can serve as the foundation of a religion. Larmer thinks that there is no unified argument in the section but says that Hume’s essential argument is that there can never be a justification for believing that a miracle has occurred on the basis of testimony. I raise a number of problems with Larmer’s interpretation, not the (...) least of which is the fact that Hume explicitly contradicts such a reading. (shrink)

Christine Korsgaard argues for the moral status of animals and our obligations to them. She grounds this obligation on the notion that we share a common identity, our animal nature, with them and that animal pain represents a public reason that binds us; nevertheless, her distinctive attempt to enlist Kantian arguments to account for our obligations to animals has a startling implication that she fails to adequately consider: that we have direct duties to plants as well.

Righteous Indignation explores the philosophy of Christian anger—for example what anger is, what it means for God to be angry, and when anger is morally appropriate. The contributors examine several dimensions of the topic, including divine wrath, imprecatory psalms, and the proper place of anger in the life of Christians today.

Patients can be harmed by a religiously motivated surrogate decision maker whose decisions are contrary to the standard of care; therefore, surrogate decision making should be held to a high standard. Stewart Eskew and Christopher Meyers proposed a two-part rule for deciding which religiously based decisions to honor: (1) a secular reason condition and (2) a rationality condition. The second condition is based on a coherence theory of rationality, which they claim is accessible, generous, and culturally sensitive. In this article, (...) I will propose strengthening the rationality condition by grounding it in a theory of intellectual virtue, which is both rigorous and culturally sensitive. (shrink)

The purpose of this paper is to propose a middle ground in the debate over religious exemptions from measles vaccination requirements. It attempts to strike a balance between public health concerns on the one hand and religious objections on the other that avoids two equally serious errors: making religious liberty an absolute and disregarding religious beliefs altogether. Some think that the issue is straightforward: science has spoken and the benefits to public health outweigh any other concerns. The safety of the (...) community, they say, demands that everybody be vaccinated so that measles outbreaks can be prevented, but such voices often ignore the freedom of religion, which is a mistake. Using Martha Nussbaum’s work on religious liberty, this paper claims that the exemptions should be preserved if a certain level of vaccination rates can be maintained. (shrink)