Objective: To assess the adequacy of the process of informed consent for surgical patients at the University Hospital of the West Indies. Method: The study is a prospective, cross-sectional, descriptive study. 210 patients at the University Hospital of the West Indies were interviewed using a standardised investigator-administered questionnaire, developed by the authors, after obtaining witnessed, informed consent for participation in the study. Data were analysed using SPSS V.12 for Windows. Results: Of the patients, 39.4% were male. Of the surgical procedures, (...) 68.6% were scheduled, 7.6% urgent and 23.8% emergency, 35.2% were minor and 64.8% major. Information imparted/received was acceptable in 40% of cases, good in 24% and inadequate (unacceptable) in 36% of cases. Almost all (97.6%) patients stated that they understood why an operation was planned and 93.3% thought that they had given informed consent. Most (95.2%) thought that they had free choice and made up their own mind. A quarter (25.2%) of all patients were told that it was mandatory for them to sign the form. There was a discussion of possible side effects and complications in 56.7% of patients. Conclusions: This study clearly indicates that surgical patients at the University Hospital of the West Indies feel that they have given informed consent. However, it also suggests that more information should be given to patients for consent to be truly informed. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development of (...) agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient’s decisions in relation to her identity. (shrink)

The article presents the main results of theoretical review on the study of the phenomenon of affect and definition, classification, legal aspects of affective states, as well as the results of statistical processing of data on crimes in the state of affect are provided in Kazakhstan for the last 5 years according to the provided statistical data from the database of the General Prosecutor's Office of the CLSaSA (Committee on Legal Statistics and Special Accounts) of the RK. The relevance of (...) this study is the study of the phenomenon of affect in Kazakhstan, as well as the processing of statistical data on affective suicide, as little-studied and not sufficiently developed phenomena. It is important to note the difference in approaches to understanding the term physiological affects (PA), which actually has no direct analogue in the English-language bibliography. In some respects, the concept of an "irresistible impulse" based on passion corresponds to it. Both conditions can significantly affect a person's behavior and their ability to control their actions, while both can serve as mitigating circumstances in law. At the same time, physiological affect is usually short-lived and characteristic of sane individuals, while an irresistible impulse can be a chronic condition associated with a mental disorder. Subsequent research may be devoted to the issues of comparing the two above concepts from a forensic perspective. (shrink)

Objective To assess parental permission for a neonate's research participation using the MacArthur competence assessment tool for clinical research (MacCAT-CR), specifically testing the components of understanding, appreciation, reasoning and choice. Study Design Quantitative interviews using study-specific MacCAT-CR tools. Hypothesis Parents of critically ill newborns would produce comparable MacCAT-CR scores to healthy adult controls despite the emotional stress of an infant with critical heart disease or the urgency of surgery. Parents of infants diagnosed prenatally would have higher MacCAT-CR scores than parents (...) of infants diagnosed postnatally. There would be no difference in MacCAT-CR scores between parents with respect to gender or whether they did or did not permit research participation. Participants Parents of neonates undergoing cardiac surgery who had made decisions about research participation before their neonate's surgery. Methods The MacCAT-CR. Results 35 parents (18 mothers; 17 fathers) of 24 neonates completed 55 interviews for one or more of three studies. Total scores: magnetic resonance imaging (mean 36.6, SD 7.71), genetics (mean 38.8, SD 3.44), heart rate variability (mean 37.7, SD 3.30). Parents generally scored higher than published subject populations and were comparable to published control populations with some exceptions. Conclusions The MacCAT-CR can be used to assess parental permission for neonatal research participation. Despite the stress of a critically ill neonate requiring surgery, parents were able to understand study-specific information and make informed decisions to permit their neonate's participation. (shrink)

The article examines wittgenstein's theory of quantification as it appears in the "tractatus". it is argued that wittgenstein advances a theory of quantification and a theory of generality where most contemporary writers on the subject hold a single theory of quantification incorporating both quantification proper and generality. having established this it is shown that wittgenstein theory of quantification is truth functional and not substitutional as recent authors have suggested.

On the controversial questions between al-Rāzī and al-Ṭūsī, Islamic philosophy; Islamic history to 1800; dissertation.

Platon n’est pas sérieux lorsqu’il conduit Socrate à déduire que la poésie doit être essentiellement narrative avec juste un peu de dialogue. Non seulement cette argumentation est-elle intentionnellement fautive, mais Platon crée aussi un Socrate qui obscurcit à dessein une distinction fondamentale. Le Socrate de Platon fait ensuite semblant d’être confus par son propre obscurcissement. En nous obligeant à nous frayer un passage à travers les broussailles de son argumentation erronée, Platon nous donne l’occasion d’avoir une participation plus profonde aux (...) véritables problèmes sous-jacents et de découvrir son thème : une bonne personne est stoïquement indifférente à la fois au malheur et au bonheur. (shrink)

ABSTRACT: Careful analysis of the details of the text allows us to refine Socrates objections to his definition of manliness as prudent perseverance. He does not appreciate that Socrates objections merely require that he make his definition more precise. Nicias refuses to consider objections to his understanding of manliness as avoiding actions that entail risk. The two sets of objections show that manliness entails first calculating that a risk is worth taking and then subsequently not rejecting that calculation without due (...) consideration. (shrink)

Current interpretations of Plato’s cave are obviously incorrect because they do not explain how what we hear does not come from what we see. I argue that Plato is saying that the colors we receive from our faculty of vision do not cause the sounds that we receive from our faculty of hearing. I also show how we do not see ourselves or one other, how the shadows on the wall of the cave are images of that which casts them (...) and therefore have less reality than them, and how the cave illustrates the divided line’s concern for the relationship between Forms and visible reality. The paper is structured around the two great riddles of the divided line: how Forms can be more real than everyday objects, and how one can know the unhypothesized beginning with complete certainty. I further argue that the puppets that cast shadows stand for the immanent Forms of the Phaedo and also for the moving Forms of the Timaeus. That of which these puppets are themselves images would thus stand for the Forms as they are in themselves of the Phaedo or the indestructible Forms of the Timaeus. ‘Plato used to ask whether the discussion was proceeding from or leading up to fundamental principles, just as in a race course there is a difference between running from the judges to the far end of the track and running back again.’ – Aristotle, Nicomachean Ethics 1095. (shrink)

Socrates contradicts himself when he claims that a good doctor must have the experience of having an unsound body and when he claims that a good judge must have a sound soul, for the unsound of body will not be treated and how a judge decides the case of a good person is a matter of indifference. These pages are really about the meaning of simplicity of soul, and arguing against Glaucon's claim, 'to be moved by self-advantage is the end (...) which it is natural to pursue as good, until forcibly turned aside by law and custom to respect equality'. (shrink)

The principles of ecological integration -- The landscape criterion -- The ecosystem criterion -- The community criterion -- The organism criterion -- The population criterion -- The biome and biosphere criteria -- Narratives for complexity -- Management of ecological systems -- A unified approach to basic research.

The PBR theorem is widely seen as one of the most important no-go theorems in the foundations of quantum mechanics. Recently, in Cabbolet (Found Phys 53(3):64, 2023), it has been argued that there is no reality to the PBR theorem using a pair of bolts as a counterexample. In this addendum we expand on the argument: we disprove the PBR theorem by a generic counterexample, and we put the finger on the precise spot where Pusey, Barrett, and Rudolph have made (...) a tacit assumption that is false. (shrink)

Spontaneous abortion is rarely addressed in moral evaluations of abortion. Indeed, 'abortion' is virtually always taken to mean only induced abortion. After a brief review of medical aspects of spontaneous abortion, I attempt to articulate the moral implications of spontaneous abortion for the two poles of the abortion debate, the strong pro-abortion and the strong anti-abortion positions. I claim that spontaneous abortion has no moral relevance for strict pro-abortion positions but that the high incidence of spontaneous abortion is not (as (...) some claim) eo ipso any sort of justification for voluntarily induced abortion. Secondly, I show that if the strict anti-abortionist position is to be taken seriously in its insistence that prenatal life has a right to be protected by virtue of its being conceived, then it seems necessary to take measures to prevent spontaneous abortion and its presumptive causes, and this as a matter of moral obligation. (shrink)

There are religious and philosophical versions of the thesis that AIDS is a punishment for homosexual behaviour. It is argued here that the religious version is seriously incomplete. Because of this incompleteness and because of the indeterminacies that ordinarily attend religious argumentation, it is concluded that the claim may be set aside as unconvincing. Homosexual behaviour is then judged for its morality against utilitarian, deontological, and natural law theories of ethics. It is argued that such behaviour involves no impediment to (...) important moral goals and is not therefore immoral. Where natural law might be used to condemn homosexual behaviour, it is argued that the theory itself is not well established. Consequently there is a prima facie reason for rejecting the philosophical version of the punishment thesis. This conclusion is further supported by noting the lack of proportion between the purported immorality of homosexuality and a punishment as devastating as AIDS. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom (a modification of the Aristotelian phronèsis) has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to (...) be insufficient. However, this solution is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

There are four problems to be faced in 710–12. Is πρσει correct? Who was Orestes? What is the construction of 'ρστ? What is the meaning of να μιλν ποδ? A brief review of the evidence collected on the subject of Orestes is the first essential.

This article shows that Plato is discussing Pauline predication and Pauline self-predication in the Phaedo. The key is the recognition that the “something else” of Phaedo 103e2-5 cannot be a sensible object because any such object which participates in Form ‘X’ can sometimes appear not to be x. It is argued that Plato has not written in a straightforward manner, but rather has written a series of riddles for the reader to solve. Thus this dialogue is an example of the (...) playful use of the written word discussed at Phaedrus 275ff. (shrink)

Theologies may be divided into two distinct types which, for the purpose of this essay, may be called ‘interactionist’ and ‘dualist’. By an interactionist theology I mean one in which God is thought of as interacting closely with the world of nature and history without being confused with it, and by a dualist theology I mean one in which God is thought of as separated from the world of nature and history by a measure of deistic distance. Obviously there are (...) degrees of closeness and distance, while their extremes tend to pass over into each other. Thus a theology in which God is thought of as so transcendentally other that he cannot be the ‘object’ of our knowledge, as in the thought of Schleiermacher, can only acquire content through constructions out of our immanent religious consciousness. Nevertheless a working distinction between interactionist and dualist theologies may serve a useful purpose in helping us to get into the heart of the problem. (shrink)

Karl Barth's homiletical viewsKarl Barth is well-known for his theology and dogmatics. His struggle as a young preacher to proclaim the word of God, inspired his theological views, especially his homiletics. This paper is an attempt to pay tribute to his homiletical views. In order to do this research it is necessary to evaluate his works against the background of the theological trends of his time. The conclusions of this paper are formed by putting Barth's homiletical principles to the test, (...) comparing them ith abstracts from his sermons. (shrink)