This review emphasizes the worldwide and U.S. evolving population demographics and the need for the dental profession to exercise its professional and ethical duty to expand its traditional patient base to provide needed services.

In lieu of an abstract, here is a brief excerpt of the content:R. D. Ackerman BELIEVING IN A FICTION: WALLACE STEVENS AT THE LIMITS OF PHENOMENOLOGY The "ring of men" of "Sunday Morning" will chant their "devotion to the sun, / Not as a god, but as a god might be, / Naked among them, like a savage source" (CP, pp. 69-70).' Solar nakedness is deferred even as it is named. The problem for belief is the question of appearance (...) and representation. Things appear as and like.... The phenomenological return to things is also a turn to fiction, as Husserl understood: "If anyone loves a paradox, he can really say... that the element which makes up the life of phenomenology... is fiction. ' " The sun is divine, and it is not; it is both naked and clothed, savage and civilized, source (or end) and means. But such paradox is ultimately unsatisfying, and as we will see with Stevens, the need for belief—for an image or idea of totality—forces the issue of fiction and reality. The Stevens we will have in view is not the Stevens—as if there were such a creature. Our Stevens is the one most persuaded by promises such as those of phenomenology, the one most concerned with decreation (reduction) and fresh beginnings, with discovery and recognition, with imagination, the body, and the earth. This is the Stevens for whom the barrier of language presages at last not absence and difference but fictive recovery of presence and identity, the one for whom poetry represents a way of belief beyond mysticism even as it bodes mythic proximity. Finally, this is the Stevens who predominates throughout the prose (as well as in much of the poetry), who tries mightily to secure a belief while disencumbering himself of metaphysics—but alas, I think, with small success. Although Stevens's association of the problem of belief with the idea of fiction occurs in early poems such as "A High-Toned Old Christian 79 80Philosophy and Literature Woman" and "To the One of Fictive Music," his most intensive involvement with fiction as belief dates from the early 1940s and spans the period of his major essays and his last four volumes of poems. He recounts, for instance, a 1942 conversation with a student: "I said that I thought that we had reached a point at which we could no longer really believe in anything unless we recognized that it was a fiction. The student said that that was an impossibility, that there was no such thing as believing in something that one knew was not true. It is obvious, however, that we are doing that all the time" (L, p. 430). What does it mean to believe in a fiction? That is my main subject here, as we seek out the limits of the phenomenological Stevens. His letters of this period are preoccupied with the problem of fictive belief: "If one no longer believes in God (as truth), it is not possible merely to disbelieve; it becomes necessary to believe in something else.... A good deal of my poetry recently has concerned an identity for that thing.... In one of the short poems that I have just sent to the harvard advocate, I say that one's final belief must be in a fiction. I think that the history of belief will show that it has always been in a fiction" (L, p. 370). The poem referred to, "Asides on the Oboe," begins: The prologues are over. It is a question now, Of final belief. So, say that final belief Must be in a fiction. It is time to choose. (CP, p. 250) Acknowledging that "in the long run, poetry would be the supreme fiction" (L, pp. 430-31), Stevens nonetheless singles out the nominative function of poetry as the essence of its claim to supremacy: "Poetry means not the language of poetry but the thing itself.... The subject matter is what comes to mind when one says of the month of August... 'Thou art not August, unless I make thee so'" (L, p. 377). The quoted line (also from "Asides") underscores the paradox that for Stevens the essence of fiction (the nontrue) is its capacity to nominate the true or the real. This... (shrink)

Basson's commentary on my proposals regarding the structure and function of research in bioethics provides a welcome opportunity for extended comparison of standard approaches with the suggestions made in ‘What Bioethics Should Be.’ I begin by noting a common assumption underlying our respective views. I then address points of fundamental difference, indicating why the experimental method proposed in my original essay presents a potentially more productive strategy for examining moral issues in biomedicine. In the latter respect, I certainly disagree with (...) Basson's contention that "we are unable to test" metaethical hypotheses "against reality" (Basson, p. 185) – a proposition which seems no more defensible than the equally untenable claim that we cannot refine methods of natural science research through examination of their usefulness in advancing our understanding of the correlation of events in nature. (shrink)

History, Prophecy, and the Stars: The Christian Astrology of Pierre d'Ailly. By Laura Ackerman Smoller (Princeton: Princeton University Press, 1994), xii + 233 pp., $35.00 cloth. The Jewish Alchemists: A History and Sourcebook. By Raphael Patai (Princeton: Princeton University Press, 1994), xv + 617 pp., $35.00/£29.95 cloth. Access to Western Esotericism. By Antoine Faivre (Albany: State University of New York Press, 1994), x + 369 pp., $19.95 cloth.

Fiction can help make students better thinkers about some philosophical issues, but this does not mean it will make them morally better people.

Reflection Principles are commonly thought to produce only strong axioms of infinity consistent with V = L. It would be desirable to have some notion of strong reflection to remedy this, and we have proposed Global Reflection Principles based on a somewhat Cantorian view of the universe. Such principles justify the kind of cardinals needed for, inter alia , Woodin’s Ω-Logic.

Should a brain-dead woman be artificially maintained for the sake of her fetus? Does a physician have the right to administer a life-saving transfusion despite the patient's religious beliefs? Can a family request a hysterectomy for their retarded daughter? Physicians are facing moral dilemmas with increasing frequency. But how should these delicate questions be resolved and by whom? A Casebook of Medical Ethics offers a real-life view of the central issue involved in clinical medical ethics. Since the analysis of cases (...) plays a critical role in this study, the authors have assembled a broad collection of histories encountered in their work as medical ethics educators and consultants. The cases are developed in substantial detail to reflect the rich medical and psychosocial complexity involved, and each is brought to a decision point at which a course of action must be chosen. Among the issues examined are conflicts between patients' wishes and respect for their well-being, tensions concerning duties to patients unable to care for themselves and obligations to family members, and clashes between patient care obligations and the interests of other persons, including physicians, third parties, and the general public. The book also includes commentaries that combine general discussion of ethical principles with specific analysis of the cases examined in the text, as well as various options for resolving conflicts. Readers are invited to assess the comparative merits and liabilities of these approaches. An ideal text for undergraduate and medical school courses, A Casebook of Medical Ethics brings readers to the forefront of medicine, where they share in the determination of crucial ethical decisions. (shrink)

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Consider these three positions about physician-assisted suicide:Physician-assisted suicide should be illegal for everyone.Physician-assisted suicide should be legal for only the terminally ill.Physician-assisted suicide should be legal for all competent adults.So far, the debate in America has been primarily between positions 1 and 2. I think it should be between positions 1 and 3. Both those positions embody reasonable viewpoints, and I will not try to decide between them in this chapter. But I will argue that the double standard embodied in (...) position 2 is morally untenable. (shrink)

The relationship between metacognition and mindreading was investigated by comparing the monitoring of one’s own learning and another person’s learning . Previous studies indicated that in self-paced study judgments of learning for oneself are inversely related to the amount of study time invested in each item. This suggested reliance on the memorizing-effort heuristic that shorter ST is diagnostic of better recall. In this study although an inverse ST–JOL relationship was observed for Self, it was found for Other only when the (...) Other condition followed the Self condition. The results were interpreted in terms of the proposal that the processes underlying experience-based metacognitive judgments are largely unconscious. However, participants can derive insight from observing themselves as they monitor their own learning, and transfer that insight to Other, thus exhibiting a shift from experience-based to theory-based judgments. Although different processes mediate metacognition and mindreading, metacognition can inform mindreading. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

Anyone who thinks contemporary American society is hopelessly contentious and lacking in shared values has probably not been paying attention to the way the popular media portray the hospice movement. Over and over, we are told such things as that “Humane care costs less than high-tech care and is what patients want and need,” that hospices are “the most effective and least expensive route to a dignified death,” that hospice personnel are “heroic,” that their “compassion and dedication seem inexhaustible,” and (...) that “few could argue with the powerful message that it is better [for dying patients] to leave wrapped in the love of family and care givers than locked in the cold, metallic embrace of a machine.“. (shrink)

There have been essentially two types of theoretical approaches to account for the grammatical relations associated with the causee argument of causative constructions. Ignoring the specifics of particular theories, there are transitivity based approaches in which the causee is a direct object when the embedded clause is intransitive, and an indirect object or oblique when the embedded clause is transitive. This pattern finds considerable cross-linguistic support. On the other hand, there are languages in which the causee exhibits alternative grammatical relations (...) irrespective of transitivity: the causee direct object correlates with direct causation, while indirect object or oblique causees are associated with indirect causation. Such phenomena have motivated a semantic approach.Focusing primarily on data from Spanish, we account for both sorts of phenomena by proposing a novel extension of Dowty's [(1991) Language 67, 547–619] proto-property proposal, thereby rendering it a comprehensive model of argument selection for both simple and complex predicates. According to Dowty's original Argument Selection Principle, the most proto-patientive argument in a single argument structure tends to be encoded as a direct object. In the case of causatives with intransitive base predicates, the most proto-patientive argument will be the causee. However, if the embedded clause is transitive, the causee will be less proto-patientive that the embedded patient, and will not be encoded as a direct object. Thus, the Argument Selection Principle, operating in a syntagmatic fashion over co-arguments, effectively derives the transitivity-determined causee encodings. In order to address the effects associated with the semantic approach, we develop paradigmatic interpretation of the Argument Selection Principle. That is, when the causee argument varies in degree of proto-patientivity, the most proto-patientive alternant is encoded as a direct object, and any decrease in proto-patientivity is reflected by relational encodings that are sequentially lower than direct object on the relational hierarchy. Thus, the transitivity and semantic effects of causee encoding are accounted for by the interaction of the syntagmatic and paradigmatic argument selection strategies. We propose that these two strategies represent organizing principles for argument selection information associated with lexical entries. (shrink)

My little girl has leukemia; she has had it for over a year, and now she needs at least five pints of blood a day. Not the whole blood, just the platelets. Most of our relatives and friends have given at least a few times. But we need more. Now I have to go to strangers.So begins Roberta Silman's short story, “Giving Blood,” a story about illness and charity. When the narrator's husband solicited blood donations at his workplace, “he thought (...) everyone would help…He must have asked a hundred people. Thirty gave. His officemate…turned green and said, ‘Oh, no, anything but that. I'm scared of needles.'”. (shrink)

Offers a compelling vision of how to achieve and conduct a liberal but democratic society through the ideal of Neutrality--between people and ideas of the good--and using the tool of Neutral dialogue.

In 2003, South African writer J. M. Coetzee was awarded the Nobel Prize in Literature for his riveting portrayals of racial repression, sexual politics, the guises of reason, and the hypocrisy of human beings toward animals and nature. Coetzee was credited with being "a scrupulous doubter, ruthless in his criticism of the cruel rationalism and cosmetic morality of western civilization." The film of his novel _Disgrace_, starring John Malkovich, brought his challenging ideas to a new audience. Anton Leist and (...) Peter Singer have assembled an outstanding group of contributors who probe deeply into Coetzee's extensive and extraordinary corpus. They explore his approach to ethical theory and philosophy and pay particular attention to his representation of the human-animal relationship. They also confront Coetzee's depiction of the elementary conditions of life, the origins of morality, the recognition of value in others, the sexual dynamics between men and women, the normality of suppression, and the possibility of equality in postcolonial society. With its wide-ranging consideration of philosophical issues, especially in relation to fiction, this volume stands alone in its extraordinary exchange of ethical and literary inquiry. (shrink)

The book illustrates the concept of action in three different contexts - the justification of actions, people's life history, and pragmatism.Because of ...