The essay focuses on the concept of mimesis Theodor W. Adorno developed in his Aesthetic Theory. After outlining key motifs of Adorno’s critical theory so as to provide the overall intellectual context, it explains why for Adorno mimesis enacts an ethical relation to the (non-identical) other. Mimesis for Adorno, the paper suggests, counters the violence that reason inflicts on the objects of its cognition by reconstituting the latter in terms of reason’s concepts. The essay discusses mimesis also in relation to (...) other aesthetic concepts that dialectically interanimate in Adorno’s explication. It ends with very provisional thoughts on the possibilities, or lack thereof, Adorno’s Aesthetic Theory offers for the aesthetic practices of historically marginalized constituencies. (shrink)

While a national health care system may be greeted with enthusiasm on many grounds, it poses substantial moral problems – not the least of which would be the clash between the ‘standardization’ of care for the sake of efficiency and the needs of individual patients. Such problems are best seen in the treatment of dying patients. Keywords: best buy, cost-saving, dying, efficiency, practice guidelines, Rilke, standards of practice, two tier CiteULike Connotea Del.icio.us What's this?

The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making (...) and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward. In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised. (shrink)

The study area was a small lowland river valley within a range of 4750 m length and approx. 150 m width (about 62 ha), situated in the south-east of Poland, in the middle of Sandomierz Basin (Fig. 1). Flora and the chosen most valuable plant communities of the river bed with adjacent ecotone zone were investigated in 2007. During the study 291 species of vascular plants were found. Among them 10 are protected: Batrachium peltatum, Convallaria majalis, Dactylorhiza majalis, Daphne mezereum, (...) Frangula alnus, Hedera helix, Lycopodium annotium, Nuphar lutea, Utricularia vulgaris, and Viburnum opulus. Other species were considered to be value-raising, e.g. Achillea ptarmica, Batrachium circinatum, Calla palustris, Crepis paludosa, Hottonia palustris, Hypochoeris glabra, Senecio ovatus or Valeriana dioica. The number of antropophytes with the amount of 10% is relatively low. Most valuable plant communities represent 3 types of Nature 2000 habitats: natural eutrophic lakes with Magnopotamion or Hydrocharition – code 3150, transition and quaking bogs – code 7140-1, and alluvial forests with Alnus glutinosa and Fraxinus excelsior – code 91E0-3. Human activities brought about the emergence of 3 different areas within the valley: channeled river site (K), natural river bed site (N) and agricultural field site (P). Those areas differ significantly in terms of the composition of flora, vegetation and biological diversity. Most valuable is (P) and the least is (K). The greatest potential source of danger for biodiversity is the wrong forester’s management, especially interference in the natural processes (the planned building of the extra pond) and preventing wooden biomass accumulation. (shrink)

In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread (...) of the virus, both of which have seen decreases in the number of intensive care beds and have been marked by financial cuts during the last ten years. It is a fact that a greater number of people, especially those over 70 years of age, have been left without respiratory support treatment, and therefore, there have been a greater number of deaths. It is also a fact that there has been a higher infection rate among healthcare professionals due to the delay in the management of protective measures and the inability to provide adequate care for those in nursing homes, as recognised by WHO. In the context of this health emergency, healthcare professionals have suffered a real ‘moral distress’ because, knowing first-hand the causes of the limitation of resources, they have had to put triage protocols into practice. Finally, we set forth a series of concrete ethical proposals with which to face the successive waves of COVID-19 infection, as well as other future pandemics. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Looking Death Straight in the Eye:The Wisdom and Witness of the SaintsPaul Murray O.P.At the Basilica of San Clemente here in Rome, the tomb which lies directly under the high altar contains, according to received tradition, the relics of both St. Clement of Rome and St. Ignatius of Antioch. Elsewhere, in the San Clemente complex, there is another tomb or sarcophagus, unknown to the public, whose original place may (...) well have been in the atrium of the Basilica. It now finds its place in the garden of the Irish Dominican Collegio adjoining the Basilica.This tomb, an ancient Roman sarcophagus of grey marble, was re-used in medieval times, around the year 1300, in order to house the remains of a certain Nicolaus Boniseniore.1 Nicolaus, a lawyer by profession, belonged to a prominent Sienese family which, in the late thirteenth century, were bankers to the papacy. Why I have chosen to make reference to this particular tomb is because, inscribed across its front in bold letters, is an unusually striking statement concerning death. Nicolaus who was, we are told in the inscription, "distinguished" during his life "by the glory of his knowledge of the law,"2 now speaks from the tomb, as it were, stripped of all prestige and glory, his haunting, ghostly words a warning to all those coming after him of the vanity of earthly endeavor. [End Page 923]Recognise in me, you who read this how limited are the possibilities of mankind. As I was, what you are, I was Lord of my possibilities. Now I am no more because I am dust and bones. So will you too no longer be the master of your own potential when you will be interred. The fame of the world, honours, prominent position, rank and influence, nobility, strength, pleasure, celebrity, delights and laments, high birth and wisdom, … vigour, boldness and intimidation, bruised pride, illness and everything passes except for the love of God. … Finally, I was abandoned to wretched death. Then according to the will of Christ I was shut up in this grave. Naked was enough for me, who once could not do without a big house, a wide bed, fine clothes and tableware. Without a bed I am laid naked in this marble tomb. I have no pillow, sheets, mattress or linen. I have no overgarment, not even an undershirt. To die is the destiny of all. Death admits no respect for honour; it spares neither the greatest nor the smallest. There are three things which you should know in order to live correctly: be thankful for death, pious and disdainful of worldly goods.3Few texts written in the Christian era, or indeed in any era, evoke with such compelling force the sharp, devastating impact of death, the utter and complete loss of so many treasured earthly goods and pleasures, earthly honors, powers, and privileges. But the statement itself, although composed in the Christian era and by a Christian believer—is it in any real sense Christian in spirit? Yes, we do hear sounded, it is true, a few notes of Christian piety, but these are decidedly faint and seem almost to lack conviction. What we don't hear sounded anywhere in the text is the clear note of Christian hope. Although the sarcophagus has obviously been made to serve as a Christian tomb, there survives in the statement of Niccolò an almost pagan perspective on death, a grim and unhappy sense of doom, a stark melancholy. Pagan stone, pagan marble, entombs the Christian voice.But what is it, we need to ask, that constitutes an authentic Christian understanding of death? My aim in the present paper is, while offering a few general comments on the question, to explore how, over the centuries, death has been viewed and approached by the Christian saints. Three sections comprise the work: (1) Facing Death: The Distinctive Christian Vision; (2) Scandal or Blessing: Christian Grief in the Face of Death; (3) Imagining the Unimaginable: Visions of the Afterlife. [End Page 924]Facing Death: The Distinctive Christian VisionFour centuries before Christ, around the year 441 BC, the Greek chorus in one of the plays by... (shrink)

The setting is a garden in Elysium. The sun is shining. A rich verdant lawn is surrounded by flower beds and flowering bushes, with a grove of magnificent trees behind. Beyond, a large lake and in the distance high mountains. Five comfortable garden chairs are placed in the shade of some trees. There is a low table on which are placed a wine decanter and glasses, three of which are half full. Richard, Jill and Frank are deep in discussion.

The DRM paradigm produces robust false memories of non-presented critical words. After studying a thematic word list participants falsely remember the critical item “sleep.” We report two false memory experiments. Study One introduces a novel use of the lexical decision task to prime critical words. Participants see two letter-strings and make timed responses indicating whether they are both words. The word pairs Night-Bed and Dream-Thweeb both prime “sleep” but only one pair contains two words. Our primary purpose is to introduce (...) this new methodology via two pilot experiments. The results, considered preliminary, are promising as they indicate that participants were as likely to recognize critical words and presented words just as when studying thematic lists. Study Two actually employs the standard DRM lists so that semantic priming is in play there as well. The second study, however, uses functional near-infrared spectroscopy to measure activity in the prefrontal cortex during a DRM task which includes a deception phase where participants intentionally lie about critical lures. False and true memories occurred at high levels and activated many of the same brain regions but, compared to true memories, cortical activity was higher for false memories and lies. Accuracy findings are accompanied by confidence and reaction time results. Both investigations suggest that it is difficult to distinguish accurate from inaccurate memories. We explain results in terms of activation-monitoring theory and Fuzzy Trace Theory. We provide real world implications and suggest extending the present research to varying age groups and special populations. A nagging question has not been satisfactorily answered: Could neural pathways exist that signal the presence of false memories and lies? Answering this question will require imaging experiments that focus on regions of distinction such as the anterior prefrontal cortex. (shrink)

Objectives: This study attempts to analyse the ethical dilemmas arising from the microallocation of scarce health care resources, in terms of deontology and utilitarianism.Methods: A group of 395 people were interviewed in the region of Diadema, greater San Paulo, Brazil, while visiting patients in the only state hospital in town. Each interviewee was given a list of eight simulated emergencies . In each of the eight cases the interviewee had to choose which of the two patients described, both of whom (...) suffered from exactly the same problem, should receive the only hospital bed currently available. The differences between the hypothetical patients were as follows: age, gender, family dependency, and lifestyle. Each interviewee was asked to justify one of their responses. These responses were then analysed.Results: The results pointed to the co-existence of deontological and utilitarian orientations among the people interviewed. A tendency to give priority to the destitute was revealed throughout the research, contradicting the idea that society, valuing only productive people, wishes only such people to receive the most resources, thus maximising the benefits to be gained from resources. The results showed that people’s disapproval of the alcoholic was stronger than that of the nicotine abuser. (shrink)

Objectives: To quantify the use of do-not-resuscitate orders in a tertiary-care children’s hospital and to characterise the circumstances in which such orders are written.Design: Retrospective study conducted in a 500-bed children’s hospital in Taiwan.Patients: The course of 101 patients who died between January 2002 and December 2005 was reviewed. The following data were collected: age at death, gender, disease and its status, place of death and survival. There were 59 males and 42 females with a median age of 103 months (...) . 50 children had leukaemias, and 51 had malignancies other than leukaemia. The t test and the χ2 test were applied as appropriate.Results: The study found that 44% of patient deaths occurred in the paediatric oncology ward; 29% of patient deaths occurred in the intensive care unit; and 28% of patients died in their home or at another hospital. Other findings included the following: 46 of 101 patients died after attempted cardiopulmonary resuscitation and 55 died with a DNR order in effect. The mean age at death was 9.8 years in both groups with or without DNR orders.Conclusions: From the study of patient deaths in this tertiary-care children’s hospital, it was concluded that an explicit DNR order is now the rule rather than the exception, with more DNR orders being written for patients who have been ill longer, who have solid tumours, who are not in remission and who are in the ward. (shrink)

Sympathetic interpretations of Kant’s frequently stressed characterizations of his "architectonic" approach to philosophy are rare. As much as such an approach seemed to gratify Kant, it has embarrassed commentators, who have complained for generations about the "Procrustean bed" or ad hoc quality of Kant’s meta-philosophical principles. The author of this book proposes to take quite seriously the idea of a "unity in Kant’s thinking," but his approach to such an issue is historical and, for the most part, unsystematic. That is, (...) rather than discuss the philosophical importance of a claim for architectonic unity, he instead announces that he will demonstrate that the "unity" of Kant’s entire corpus is the "unity of a problem-determined development in his thinking, not that of a pre-conceived or static system." The result of this approach is a well-informed, but only incidentally thematic summary of Kant’s occasionally continuous, occasionally radically altered views of various Hauptprobleme. (shrink)

Human sleeping arrangements have evolved over time and differ across cultures. The majority of adults share their bed at one time or another with a partner or child, and many also sleep with pets. In fact, around half of dog and cat owners report sharing a bed or bedroom with their pet. However, interspecies co-sleeping has been trivialized in the literature relative to interpersonal or human-human co-sleeping, receiving little attention from an interdisciplinary psychological perspective. In this paper, we provide a (...) historical outline of the “civilizing process” that has led to current sociocultural conceptions of sleep as an individual, private function crucial for the functioning of society and the health of individuals. We identify similar historical processes at work in the formation of contemporary constructions of socially normative sleeping arrangements for humans and animals. Importantly, since previous examinations of co-sleeping practices have anthropocentrically framed this topic, the result is an incomplete understanding of co-sleeping practices. By using dogs as an exemplar of human-animal co-sleeping, and comparing human-canine sleeping with adult-child co-sleeping, we determine that both forms of co-sleeping share common factors for establishment and maintenance, and often result in similar benefits and drawbacks. We propose that human-animal and adult-child co-sleeping should be approached as legitimate and socially relevant forms of co-sleeping, and we recommend that co-sleeping be approached broadly as a social practice involving relations with humans and other animals. Because our proposition is speculative and derived from canine-centric data, we recommend ongoing theoretical refinement grounded in empirical research addressing co-sleeping between humans and multiple animal species. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system was significantly faster than the manual system for lung function evaluation, loan of equipment, and checking for overdue equipment. The production of correspondence was slightly slower with the computer. b. All outpatient episodes, but only 43 of 65 of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high. Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice. After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

BackgroundOther Specified Feeding and Eating Disorders are characterized by less frequent symptoms or symptoms that do not meet full criteria for another eating disorder. Despite its high prevalence, limited research has examined differences in severity and treatment outcome among patients with OSFED compared to threshold EDs [Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder ]. The purpose of the current study was to examine differences in clinical presentation and treatment outcome between a heterogenous group of patients with OSFED or threshold (...) EDs.MethodPatients with threshold EDs or OSFED presenting for eating disorder treatment completed self-report questionnaires at intake and discharge to assess eating disorder symptoms, depression symptoms, impairment, and self-esteem.ResultsAt intake, OSFED patients showed lower eating concerns compared to patients with BN, but similar levels compared to AN and BED. The OSFED group showed higher restraint symptoms compared to BED, and similar restraint to AN and BN. Global symptoms as well as shape and weight concerns were similar between OSFED and threshold ED groups. There were no differences between diagnostic groups in self-esteem, depression scores, or symptom change from intake to discharge.DiscussionOur findings suggest that individuals with OSFED showed largely similar ED psychopathology and similar decreases in symptoms across treatment as individuals diagnosed with threshold EDs. Taken together, findings challenge the idea that OSFED is less severe and more resistant to treatment than threshold EDs. (shrink)

Methods Young healthy heterosexual couples underwent sleep-lab-based polysomnography of two sleeping arrangements: individual sleep and co-sleep. Individual and dyadic sleep parameters (i.e., synchronization of sleep stages) were collected. The latter were assessed using cross-recurrence quantification analysis. Additionally, subjective sleep quality, relationship characteristics, and chronotype were monitored. Data were analyzed comparing co-sleep vs. individual sleep. Interaction effects of the sleeping arrangement with gender, chronotype, or relationship characteristics were moreover tested. Results As compared to sleeping individually, co-sleeping was associated with about 10% (...) more REM sleep, less fragmented REM sleep (p = 0.008), longer undisturbed REM fragments (p = 0.0006), and more limb movements (p = 0.007). None of the other sleep stages was significantly altered. Social support interacted with sleeping arrangement in a way that individuals with suboptimal social support showed the biggest impact of the sleeping arrangement on REM sleep. Sleep architectures were more synchronized between partners during co-sleep (p = 0.005) even if wake phases were excluded (p = 0.022). Moreover, sleep architectures are significantly coupled across a lag of ± 5min. Depth of relationship represented an additional significant main effect regarding synchronization, reflecting a positive association between the two. Neither REM sleep nor synchronization was influenced by gender, chronotype, or other relationship characteristics. Conclusion Depending on the sleeping arrangement, couple's sleep architecture and synchronization show alterations that are modified by relationship characteristics. We discuss that these alterations could be part of a self-enhancing feedback loop of REM sleep and sociality and a mechanism through which sociality prevents mental illness. (shrink)

Have invisible barriers for women been broken in 2007, or do we still have to break through medicine's glass ceiling? Data from two of the most prestigious university hospitals in Barcelona with 700-800 beds, Hospital Clínic (HC) and Hospital de la Santa Creu i Sant Pau (HSCSP) address this issue. In the HSCSP, 87% of the department chairs are men and 85% of the department unit chiefs are also men. With respect to women, only 5 (13%) are in the top (...) position (department chair) and 4 (15%) are department unit chiefs. Similar statistics are also found at the HC: 87% of the department chairs and 89% of the department unit chiefs are men. Currently, only 6 women (13%) are in the top position and 6 (11%) are department unit chiefs. Analysis of the 2002 data of internal promotions in HC showed that for the first level (senior specialist) sex distribution was similar. Nevertheless, for the second level (consultant) only 25% were women, and for the top level (senior consultant) only 8% were women. These proportions have not changed in 2007 in spite of a 10% increase in leadership positions during this period. Similar proportions were found in HSCSP where 68% of the top promotions were held by men. The data obtained from these two different medical institutions in Barcelona are probably representative of other hospitals in Spain. It would be ethically desirable to have males and females in leadership positions in the medical profession. (shrink)

Richard, a sixty‐seven‐year‐old man, has been admitted to Midtown University Center for difficulty breathing. He has a significant medical history that includes pulmonary fibrosis and subsequent heart failure, and he depends on supplemental oxygen to breathe. Upon admission and after discussing his prognosis with his family and doctors, Richard decided to sign a do‐not‐resuscitate order stating that if his heart stops or he stops breathing, he does not want to undergo cardiopulmonary resuscitation or other life‐sustaining measures. On his third day (...) in the hospital, the nurse practitioner who is caring for Richard notices that his breathing is becoming more labored and that his blood pressure is steadily dropping. She thinks he requires closer observation and treatment in the cardiac intensive care unit. Dr. P, the physician in the intensive care unit at the time, Dr. P does not want to accept Richard into the CICU because of his prognosis and his DNR order. He believes that Richard should be cared for on a regular hospital floor, and that the last bed in the CICU should be held for its intended user—a patient suffering a life‐threatening heart attack who requires intensive care. Should Richard be admitted to the CICU? (shrink)

Richard, a sixty‐seven‐year‐old man, has been admitted to Midtown University Center for difficulty breathing. He has a significant medical history that includes pulmonary fibrosis and subsequent heart failure, and he depends on supplemental oxygen to breathe. Upon admission and after discussing his prognosis with his family and doctors, Richard decided to sign a do‐not‐resuscitate order stating that if his heart stops or he stops breathing, he does not want to undergo cardiopulmonary resuscitation or other life‐sustaining measures. On his third day (...) in the hospital, the nurse practitioner who is caring for Richard notices that his breathing is becoming more labored and that his blood pressure is steadily dropping. She thinks he requires closer observation and treatment in the cardiac intensive care unit. Dr. P, the physician in the intensive care unit at the time, Dr. P does not want to accept Richard into the CICU because of his prognosis and his DNR order. He believes that Richard should be cared for on a regular hospital floor, and that the last bed in the CICU should be held for its intended user—a patient suffering a life‐threatening heart attack who requires intensive care. Should Richard be admitted to the CICU? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Plotinus by Lloyd P. GersonGary M. Gurtler S.J.Lloyd P. Gerson. Plotinus. The Arguments of the Philosophers. London: Routledge, 1994. Pp. xviii + 338. Cloth, $59.95.This challenging account of Plotinus’ philosophy is appropriately published in a series called The Arguments of the Philosophers. Professor Gerson confronts Plotinus’ position on some major issues in the history of philosophy with an array of counterarguments, ancient, medieval, and modern. More often than (...) not, Plotinus’ position is presented cogently and sympathetically, refuting the notion that Plotinus is merely a philosophical lightweight. The book is rigorous, demanding more than passing knowledge of the history of philosophy and its current trends, especially the Anglo-American. It will thus serve to establish Plotinus as a reputable philosopher among analytic philosophers. Students of Plotinus will find it controversial. Both results will enhance the scholarly work on Plotinus that has flourished recently, indicated in Gerson’s extensive bibliography, although less apparently utilized in establishing his account of Plotinus’ philosophy.The author himself admits that the book is difficult and he indicates where he thinks Plotinus is to blame (225). It thus falls to the reviewer to indicate difficulties traceable to the author. The symptoms are easily seen in the portrait of Plotinus that emerges from these pages. It is a strange one indeed: a Plotinus who is scholastic in organization, Thomist in holding the real distinction and post-Cartesian in epistemology. The Platonic character of Plotinus’ Neoplatonism is not merely absent, but positively excluded by Gerson’s insistence on fitting Plotinus to the Procrustean bed of modern logic, eliminating experience as of dubious philosophical worth. This is most noticeable in his treatment of mysticism, but occurs also when he considers the social or intersubjective dimension of human life and, more crucially, the methodological starting point of Plotinus’ philosophy. Gerson’s method proceeds, in scholastic fashion, from the First Principle to those ontological and logical principles that are deduced from it, coming finally to consider the soul and its capacities. This inversion of Plotinus’ [End Page 128] position entails constant difficulties as Gerson drives his logical engine to make deductions where none are necessary.Attention to Plotinus’ Platonism entails two interlocking assumptions excluded in the above portrait. One concerns the nature and limits of language itself. Language and discursive thought in general are essentially images of what in some way is and they are thus subordinate to the more direct contact of experience, whether sensible or intelligible. The other concerns the nature of experience itself as the starting point of Plotinus’ reflection, moving from the immediate awareness of the empirical self (Gerson’s “endowed self”) to those conditions that make such awareness possible in the dependence both of the soul and the sensible world on the intelligible world, and ultimately on the One. That Plotinus begins with the human situation can be seen in V 3[49] 6,1–11, where he contrasts precisely the necessity of Intellect with the persuasion possible for the soul. He recognizes that whatever the allure of logical thought it is not sufficient to convince the soul. It does not take into account the status of language as an image and the experience of the soul as essentially embodied. It is characteristic of post-Cartesian philosophy, on the contrary, to read necessity into the soul and to assume that propositional thought is identical with the real and brings certitude with it. This denies the analogous character that human knowledge has for someone like Plotinus. Similar problems arise about the nature of intellect.Within the logical parameters that Gerson has set for his interpretation, the influence of Plotinus on and the claims made about him with regard to religion (203–12) and mysticism (218–24) fall by the way. This may please those who would otherwise ignore Plotinus’ philosophy, but it will not persuade people on either side of the religious divide. The issue, however, is less about a specific kind of experience than about any kind of experience that cannot be reduced to logical categories. Ultimately, the claim being made is that what cannot be captured in logical categories is no more than an empty surd. Gerson, in fact, reverses... (shrink)

In this article, we will consider how the regulation of populations is not just a feature of prisons, but of all institutions and organisations that control members though hierarchies, divisions and norms. While nurses and other allied health professionals are considered to be predominantly self‐regulatory, practice is guided by a code of conduct and codes of ethics that act as rules that serve to uphold the safety of the patient, whether they are a sick person in a hospital bed or (...) an inmate in a prison. The codes of conduct espouse a number of rules that to a certain extent govern the behaviour of individual and groups of practitioners through reciprocal rewards and punishments. Supervision is one method of monitoring the effectiveness of the codes of conduct and ethics while regulating both the minimum standard of individual practice and of training organisations. It is posited that one of the possible effects of clinical supervision is to make the person effectively self‐regulatory as, an autonomous practitioner. We take the view that professional autonomy is a highly problematic concept requiring closer examination. (shrink)

Na busca da cura do corpo, a oração opera milagres: uma discussão sobre eficácia simbólica, perspectivismo, cura e religião (In the search for the healing of the body, prayer works miracles: a discussion on symbolic efficacy, perspectivism) - DOI: 10.5752/P.2175-5841.2013v11n31p965 O artigo busca descrever, compreender e interpretar o caso observado de uma jovem portadora de teratoma ovariano maligno, internada em hospital do câncer na cidade de Belém, estado do Pará. A jovem foi desenganada diante do diagnóstico da doença, mas sua (...) mãe agarrou-se na “fé em Deus”, pois “Ele opera milagres”, dizendo que dela retiraram “coisa feia”, cheia de dentes, cabelos e gorduras, que não sabia inteiramente explicar, mas que “Jesus cura”. A mãe, evangélica, mantinha a Bíblia na enfermaria, orando em voz alta diante do leito da menina. Aos poucos, amenizou-se a gravidade do caso, deixando perplexo o saber biomédico, diante do reconhecimento de outras buscas de cura, como através da oração, que levou aquela jovem a sair de alta hospitalar. Esse episódio, observado atentamente pela coautora deste artigo, permite uma discussão que transcende o âmbito da biomedicina, do ponto de vista antropológico, especialmente no campo da chamada “eficácia simbólica”, em que xamanismo e psicanálise podem ser chamados para conferir sentido a esse drama, cujo desfecho mostrou-se favorável para a jovem e sua mãe, até o ponto que foi possível observar. Palavras-chave : Cura. Religião. Eficácia Simbólica.This article aims to describe, understand and interpret the observed case of a young woman with ovarian malignant teratoma, hospitalized in the cancer hospital in the city of Belém, State of Pará, Brazil. The young woman was thought as incurable on the diagnosis of the disease, but her mother clung in “faith in God”, because “He works miracles”, saying that “ugly things”, full of teeth, hair and grease, were removed from her; she also said that she could not understand it all, or full explain it, but she is convinced that “Jesus heals”. The mother, an Evangelical woman, held the Bible in the infirmary, praying out loud in front of the girl’s bed. Gradually it was alleviated the severity of the case, leaving bewildered the biomedical knowledge, on the recognition of other results, such as healing through prayer, which led that young woman to leave the hospital. This episode, closely observed by one of the authors of this article, allows a discussion that transcends the scope of biomedicine, from the anthropological point of view, especially in the field of the so-called “symbolic efficacy” (Lévi-Strauss), in which shamanism and psychoanalysis can be called to give meaning to this drama, whose outcome was favorable to the young woman and to her mother, until the point that it was possible to observe. Keywords : Healing. Religion. Symbolic efficacy. (shrink)

A 68-year-old gentleman is brought into a New York City ER at 2:30 P.M. by the squad in response to a 911 call from his neighbor, who found him unconscious in his bed. The cause of his condition is not known, but the man is unresponsive and requires immediate life support, including intubation, IV fluids, and pressors. Within minutes, his son arrives and attempts to deny permission for the LSMTx, claiming that his father is in end-stage ALS and has an (...) advance directive stipulating that he should not be invaded with LSMTx at this last moment in his life. The copy of the directive he produces is nonspecific in this context, because it qualifies refusal of LSMTx for “ … irreversible conditions …” and no one is sure if this situation is reversible. The advance directive names a daughter as proxy, and she is on her way from Maine, a 10-hour drive. (shrink)

When knowledge is being doubted one way to express this doubt is by a counterfactual. Typically this counterfactual quotes some elements of the actual case or a case considered as actual and dodges the connection between proposition believed and what makes that proposition true. For example, when Descartes states his dreaming skepticism case, he gives us instances where he has previously been lying in his bed fast asleep while dreaming that he is awake. What triggers the loss of knowledge in (...) Descartes’ case is that if he were asleep, he would still believe that he is sitting by the fire, holding a paper in his hand etc. The fact that he cannot distinguish between his dream-state and awake-state entails that he doesn’t know in the awake-state, considered as actual, either. So, a description of counterfactual possibilities that can be used to doubt knowledge in a possibility considered as actual has to make the truth of p indistinguishable from the falsity of p. Any possibility that falls under this description will be called transparent. Here is a definition: For any possibility W and any proposition believed p, W is transparent iff, in W the truth of p is indistinguishable from the falsity of p. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Not the End We Planned ForAnonymous FourIn 1997, my four–year–old daughter was diagnosed with a high–risk medulablastoma. She underwent the current treatment program at that time. She suffered multiple complications from the treatment and developed seizures, which caused her to lose her sight and 80% of her hearing. These all contributed to her manifesting many behavioral issues, making her a danger to herself and others. Also during this time, (...) she developed large amounts of brain atrophy from the maximum radiation dose she had been given. In August of 2010, Emily was still deteriorating, her seizures were uncontrollable, and her quality of life was extremely poor. A meeting to discuss how to care for my child if an acute crisis presented was held. The meeting included her parents, oncologist, endocrinologist, pediatric neurologist, social worker and the head of medical ethics. We discussed what course of action would be best for her nothing could be done to reverse her condition or prevent further deterioration. A POLST is a physician order for life sustaining treatment and is appropriate if the doctor feel that the patient has a good chance of death in the next year. The purpose of this document is to have a plan in place in case the patient has a life threatening crises. We chose to put a POLST in place with specific instructions not to intubate. This was a hard decision to make for a parent, but we all felt it was the best choice for her.A few months after the POLST was entered, in November, 2010, I came home from the store and my daughter’s caregivers told me she had complained of a headache different from her usual headaches. They gave her Tylenol with codeine and she went to bed about 4 p.m. When I checked her later she seemed fi ne, merely sleeping her headache off. We [End Page 30] decided to let her sleep some more. Around 8 p.m the caregivers came and got me because they could not wake her up to go to the bathroom, which was her normal routine. I immediately went to try and wake her up but could not. I ran my thumb up the bottom of her foot and there was no reflex response. I yelled for her father that we needed to immediately go to the hospital.We took her to the ER at the local hospital that treated her close to the house. We told them we did know what was happening with her but that there was a POLST in place in her chart. They started lines, a nasogastric tube, and sent her for a CT, which showed massive amounts of blood in her brain. I repeated again to the ER staff and physician that there was a POLST in place but no one acknowledged my statement. I asked for a different physician, one that would respect the POLST, and was told there was no one else nor was there a neurosurgeon available. The attending physician insisted she be intubated in order to be transferred to a partner hospital (more than 20 minutes away) where there was a neurosurgeon on duty. I asked him to please call her oncologist at which point he yelled at me that, “he was not calling anyone else and that she needed to be intubated and transferred to the other hospital.” By this time, four hours had passed and I knew she had not gotten any medication for pain, so I told the physician to go ahead and transfer her since I knew the hospital we were at would not admit her for palliative care. She was then intubated, in violation of the POLST, and transferred to the other hospital where the neurosurgeon there told us what we already feared: That she had experienced a massive bleed in her brain. We requested she be extubated and be given palliative care to make her comfortable until she passed away.It is tragic that our daughter’s last hours involved aggressive medical treatment. As parents we hoped to avoid any additional suffering for our child, we did everything we knew to do to insure aggressive... (shrink)

BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, and (...) patient care among ICU nurses.Sample and SettingThe sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period.MethodsAlvita K. Nathaniel’s Theory of Moral Reckoning guided development of the nursing ethics huddle process.1 The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects’ level of MD.2 Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects’ perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions.ResultsOverall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant (p < 0.0001). (shrink)

PurposeScarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.Materials and methodsA prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire.Results8 (25%) physicians and 24 (75%) nurses participated in (...) the study by providing their ‘treatment decisions’ for 14 patients at several time points. EOLD was ‘made’ 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment.ConclusionsOur findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals. (shrink)

Respect for human dignity is a basic and crucial component of nursing care. Illness with restricted physical ability and being confined to bed can compromise the dignity of patients. The views of adolescents regarding dignity in care have not previously been researched. This article details a descriptive-analytic study in which survey data was collected from all nurses and compared with a convenience sample of 180 hospitalized adolescents in two hospitals in Iran. The data was analyzed with SPSS software. A significant (...) difference between nurses and hospitalized ill adolescents’ perceptions was identified in relation to: understanding the importance of privacy (p < 0.001); observance of privacy (p < 0.001); importance of interaction between nurses and patients (p = 0.019); and the observance of interaction between nurses and patients (p < 0.001). Attention to adolescents’ views about dignity can help nurses to improve quality of care for this group. (shrink)

Self-applied portable polysomnography is considered a promising tool to assess sleep architecture in field studies. However, no findings have been published regarding the appearance of a first-night effect within a sport-specific setting. Its absence, however, would allow for a single night sleep monitoring and hence minimize the burden on athletes while still obtaining the most important variables. For this reason, the aim of the study was to assess whether the effect appears in home-based sleep monitoring of elite athletes.The study sample (...) included eight male and 12 female German elite athletes from five different sports. Participants slept with a portable polysomnography for two nights, which they self-applied at night before going to bed. Time in bed and wake-up time in the morning were freely chosen by each individual athlete without any restrictions regarding time or sleeping environment. Participants were asked to keep the same location and time frame during the two days of monitoring and stick to their usual sleeping schedules. Sleep stages were manually scored using 30-s epochs. Sleep parameters and stages were later compared with the help of linear mixed models to investigate the factor time.Significant differences between the two nights were found for percentage of Non-REM sleep [T = −2,10, p < 0.05, d = −0.47, 95%-CI ] with small effect size, Total Wake Time [T = 2.30, p = 0.03, d = 0.51, 95%-CI ], Sleep Efficiency [T = −2.48, p = 0.02, d = −0.55, 95%-CI ], and Wake percentage [T = 2.47, p = 0.02, d = 0.55, 95%-CI ] with moderate effect sizes, and N3 Sleep Onset Latency [T = 3.37, p < 0.01, d = 0.75, 95%-CI ] with large effect size. Confidence Intervals for all other indices range from negative to positive values and hence specify, that parameters were not systematically negatively affected in the first night.Findings suggest that some individuals are more affected by the first-night effect than others. Yet, in order to keep the measurement uncertainties to a minimum, a more conservative approach with at least two monitoring nights should be used whenever possible, if no other supporting information on the athletes says otherwise. (shrink)

Engineering is 'the people-serving profession'. The work of engineers involves interaction with clients, other engineers, and the public at large. More than any other profession, their work also directly involves and affects the environment. This book makes the case that engineers have special professional obligations to protect and enhance the environment, and the authors - one, an engineer and the other, a philosopher - seek to provide an ethical basis for these obligations. In exploring these ethical issues, the authors aim (...) to show that engineers make a difference. The text opens with a series of case studies in which engineers face complex and challenging decisions about the environment. Succeeding chapters examine different ideas about environmental ethics for engineers, including professional codes and both modern and historical discussions of environmental responsibility. The book concludes with a collection of readings that complement the text. Students, as well as practising engineers, will find much of interest in this well-argued and thought-provoking book. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sighs and Tears:Biological Signals and John Donne's "Whining Poetry"Michael A. WinkelmanPhebe: Good shepherd, tell this youth what 'tis to love. Silvius: It is to be all made of sighs and tears...—Shakespeare, As You Like It (5.2.83–84)ISighs and tears permeate John Donne's poetry, as well they should. Crying in particular functions as a costly signal in biological terms: a blatant, physiologically-demanding, involuntary indicator of hurt feelings. "Tears dim mine eyes," (...) laments Donne's Sappho ("Sappho to Philaenis," l. 56); they are "Fruits of much grief" in "A Valediction of Weeping" (l. 7).1 The theory of costly signaling, related to the handicap principle, was developed fairly recently by Israeli zoologists Amotz and Avishag Zahavi. As the Zahavis explain: "in order to be effective, signals have to be reliable; in order to be reliable, signals have to be costly."2 Initially their idea was resisted, but it has since become widely accepted and it has proven very helpful in making sense of both animal and human behavior. Wasteful conspicuous consumption among upper-class Americans, as noted a century ago by sociologist Thorstein Veblen, exemplifies this handicap principle in action. Like gazelles jumping in place or stotting rather than running away when wolves appear, it indicates fitness by flaunting excess resources.Shedding tears when feeling sad is an evolved human adaptation that broadcasts unhappiness. The wailing of infants demands attention, and crying does something similar for grown-ups: among other things, it tests the commitment of hearers to appease the distressed. For instance, in Chaucer's tragic medieval romance Troilus and Criseyde, Pandarus advises [End Page 329] Troilus to provoke a suitable reaction from Criseyde by embellishing his billet-doux: "Towchyng thi lettre... Biblotte it with thi teris ek a lite" (touching thy letter... Be-blot it with thy tears a little).3 Early modern authors also knew their importance. In the words of Robert Herrick, "tears are tongues," while Claudius suspects that "There's matter in these sighs, these profound heaves" (Hamlet, 4.1.1).4As a case in point, Donne was overwhelmed by the death of his dear wife Anne in 1617. As his contemporaneous biographer Izaak Walton reported: "his very soul was elemented of nothing but sadness; now, grief took so full a possession of his heart, as to leave no place for joy."5 Donne even hoped to be literally entombed with her soon: "as the grave is become her house, so I would hasten to make it mine also; that we two might there make our beds together in the dark" (Walton, p. 51). His miserable mood was revealed in his initial sermon after her demise:His first motion from his house was to preach, where his beloved wife lay buried (in St. Clement's Church, near Temple-Bar, London) and his text was a part of the Prophet Jeremiah's Lamentation: "Lo, I am the man that have seen affliction."And indeed, his very words and looks testified him to be truly such a man; and they, with the addition of his sighs and tears expressed in his Sermon, did so work upon the affections of his hearers as melted and molded them into a companionable sadness; and so they left the Congregation.(Walton, p. 52)Listeners responded in kind to his honest confessions, a textbook illustration of the empathy generated by crying. (A related issue—how and why literature affects audiences so strongly—is currently generating some very interesting work from New Humanists investigating the question from an evolutionary perspective.)These qualities make sighs and tears fundamental to love poetry. In other words, writers deploy them because they reflect universal states of mind, rather than originating as some arbitrary, socially-constructed literary device. The copious opening sonnet of Petrarch's magnificent Rime sparse codifies the theme:6You who can hear in scattered rhymes the soundof all that sighing which once fed my heartin my first youthful error, when in partI was a person of a different kind—my changing manner as I weep and reason, [End Page 330] between vain aspirations and vain grief,leads everyone who has known... (shrink)

We agree with Pickering & Garrod's (P&G's) proposal that dialogue is an important empirical and theoretical test bed for models of language processing. However, we offer two cautionary notes. First, the enterprise will require explicit computational models. Second, such models will need to incorporate both joint and separate speaker and hearer commitments in ways that go beyond priming and alignment.

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Sometimes I think: I'm flying. And why am I flying? Because of the dress. The flesh, I think, is multiplying itself. Here are the children, I think, going away from me and coming to me. If all is one, I think, why this split?My body of thought is likewise made of a womb of wombs. Whatever it begets begets its own body [in this sense I may be said to be multiparous].I am beautiful like a snip of ivory. My face (...) is like the negative of another woman's face. Whatever she does I do moving backward.I spread a hundred fingers up against the wind and the wind dries the lacquer. At these parties I have no given name. I may be called Flora and I may be called Rosamund. The images of color that I set up in space redeem me.In the morning. After the dreams. I see the white body stitched in bed. My corporal body. The veins that store the precious fluid. What I think have they hauled up there from the deep?I get up as in the miracle that Our Teacher Rabbi Loew worked upon a lump of clay and turn on the stove.Sometimes the light bounces off of forks and knives into the eyes. The light of the fork into the eye of the fork and the light of the knife into the eye of the knife.What am I what am I I am thinking flattening out knives and forks on those wooden headstones they call a table?The bread is the showbread and the butter is the clot of my blood. What are they looking for in these blue thighs?The kitchen windows [as in the ancient Icelandic language] are the wind's eye. This is the house and these are the children's table-napkins.... Now. When everything is in place. I am waterboiling. Water pours out of the mouth of the tap into the mouth of the kettle and I am thinking about these hairs that I have. About the hundreds of thousands of fine threads that rise at night in utter silence from the skin. The walls close in on me but my head. As in the Book of Creation. Extracts from nothingness black streams.Through the drinking glasses I see a great field of ice. A white antelope eating a fish.... What am I with a round shoulder and milk muttering prices of chemicals. The cash registers cut the boundaries of my skin.In supermarkets with thousands of tins of canned peas ought to ambulate people covered with hair. Let them block one another's cart like they once did in the hippodromes of Byzantium.Let them speak—with those colorful rags that they tie around their necks—into mouthpieces of telephones. Let their voices run crisscross like stifled crow calls between wires inside the earth. Why have they enclosed me—I, who can cover entire fields like Bermuda grass—within the confines of an electric bell?At 7:20. As if down the ladder of angels painted by Raphael. The child descends the wooden staircase. His toes are depressed precisely according to the divine image of grief. Each toe and its mirror reflection in the other foot.The forest creatures on the pajama fabric with their mouths gaping open as in the sudden vision seen by our primogenitor when they spread the coat of many colors before him and said: Surely he has been torn to pieces.... When the child turned inside me and stood in the placental fluid with his head to the ground, the two of us were the complete converse figure. One head toward the outer boundary, the other head toward the middle point.It was unnatural how the head emerged. Why did it pierce the membrane in which it was enfolded and discharge the water?Windows previously shut were torn apart. Lids of cookware dropped to the floor. This rupture [Michael. Michael.] gave birth to unreason.The child [in my imaginations he is chasing gadflies] is sitting at the table waiting for his cornflakes. He is eating them flake by flake and inside every flake are little crystals of sugar.This game [being able to hold shreds of sugar inside tiny dents] fills his heart.... The light that radiates in every thing is the light of late autumn. I play with it the age-old game. Ask for its name and it replies.The kitchenware too bear their names [just as they bear the form].... I can write an inner play about The Non-Intervention of Time in Kitchenware. Time will get the leading role.In Act One it will set out [like Ulysses] on a journey. The kitchenware will stay put, each ware in its respective place, within daily life.In Acts Two and Three time will travel so far that one or two wares should drop out of place.Act Four will be called Fatal Incidence and Act Five, The Return of Time.... I shout [an inner shout] Dolores Dolores as if I had a friend whose name were like that.How do you do Dolores [I say in my heart] and exchange recipes for dresses with her.Then Dolores sets out in both directions at once. The direction of the great bird in the sky and the direction of Nachlat Binyamin St.... I can see [by means of two mirrors] my silk dressing gown.The silk dressing gown enfolds me and prepares me for verbal exchange. It enables me to communicate information. If it slides down I kneel down until it slides up [and then I kneel down].... When I think of recollection I wonder how the image of myself gets duplicated.The bathtub gets duplicated and the light above the bathtub. Time sends a facsimile of itself.In the black margins outside the sheet of paper hides my mother. Come out come out she is calling to me like you would to a snail.At that time were created the archetypes of things.The complete washbasin. The complete mirror. Next to every sound was inscribed the right clef.Every movement was a perfectum mobile: I jump and by force of this jump I jump again.... Through the window I see the crow called Salpeter.Good morning Old Salpeter. Did you get your black robe back from the dry cleaner?Sometimes you see me obliquely from the right and sometimes obliquely from the left. What am I? A very strange female crow?I adore your rich language. This single word of yours that has in it all the verb stems.... What is so logical about the sky? The window frame.The window frame is like the twelve apostles. Three in each lintel and in their midst [behind the nebula] is sitting the child Michael.The motion of a doll turned over and the motion of the trains sent by him flying in the air are the divine edict. Get'p get'p he tells me all of you and go'ver there.... See Dolores how simple everything is: There is the kitchen. There is the child. There is the wooden staircase.Whom are we to thank for this grace. The colors are so right Dolores and the shapes precise. Every thing I spell out is cut with utmost perfection for the space allotted to it and for the sequence of time.... My biography may easily be canceled.First cancel the alienation. Then cancel the kneeling in the dark. The joy of the assigned date. The bridal veil and the porcelainware.If a medical ground is required I can say I have edema.... I like the words earth quake.Sometimes I think the earth is quaking and the words are not and sometimes the words are quaking and the earth is not.The great catfish know the earth is about to quake and the Chinese who paint the words with a fine paintbrush six lines for the earth and fifteen for this quake set guards to watch the great catfish who knows what is about to take place.... As if after a very severe accident I have to practice life anew.My physiotherapist tells me: Now a slight movement with the right hand. Now a shake of the head.I learn to press handles. To turn sharply in this or that direction.Lately when they ask me anything I pretend that the reply answers the question.Look Dolores how I refute the theory about the formation of species:I take a bubble of soap from the sink and elevate it to the sun.... There is a thing Dolores and it is infinitely good and I shall not tell you what it is.You can hear it in the first hours of the night when darkness is gaping. It has the property of withdrawing into a point tiny as a tittle.Or you can search for it in places where there appears to be something and there is not. (shrink)

Medical informed consent stands as an ethical and legal requisite preceding any medical intervention. Hospitalized patients face functional health literacy (FHL) challenges when dealing with informed consent forms (ICFs). The legitimacy of ICFs and informed consent procedures in China remains substantially undisclosed. The study’s aim was to investigate if Chinese patients have adequate FHL to be truly informed before providing medical consent. In this cross-sectional, structured interview-based study, FHL was assessed within the context of the informed consent scenarios in two (...) teaching hospitals (a 1500-bed general tertiary hospital and a 700-bed cancer hospital) affiliated with Shantou University Medical College. Twenty-seven patients admitted across clinical departments, along with their relatives (n = 59), were enrolled in the study after obtaining informed consent. The participants underwent a three-step assessment with two selected ICFs —teach-back skills, perceived understanding (perception), and informed knowledge (cognizance), with each component carrying a maximum score of 10. Data were analyzed with SPSS (version 22.0) for descriptive and inferential statistics, with consideration of significant P values as < 0.05. The median age (IQR and range) of participants was 35.5 (28 – 49 and 13 – 74) years. Most participants had only high school education (24.4%, 21/86) or below high school education (47.7%, 41/86). The median score (IQR) of FHL assessments—teach-back, perception, and cognizance—was 4.0 (2.5, 5.8), 8.0 (6.8, 8.8), and 6.5 (5.5, 8.0) out of 10, respectively. A moderate correlation was observed between the scores of cognizance and teach-back (r = 0.359, P = 0.002) or perception (r = 0.437, P < 0.001). Multivariate linear regression analysis predicted being a patient and having lower education levels as independent risk factors of inadequate FHL (Ps = 0.001). Lack of patient-centeredness in ICFs, time constraints, and poor clinical communication were identified as barriers impeding informed consent. This study demonstrates inadequacy in personal FHL and impaired organizational HL, resulting in compromised informed consent in Chinese teaching hospitals. As a remedy, we propose improving the quality of ICFs and institutionally mandated outcome-focused training on informed consent for all concerned clinicians to enhance medical ethics, ensure quality health care, address patient values, and mitigate potential medical conflicts. (shrink)

Objective:To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design:Prospective clinical interventional study.Setting:Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland.Participants:Nine junior physicians in postgraduate training.Intervention:Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results:Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients’ involvement in the (...) decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion:An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Suppose you come to my house and I invite you in. ‘I’m just heading out’, I say, ‘but make yourself at home’. I have consented to you remaining in my house, but what else? In your home, you put your feet up on the coffee table, so may you now do that in mine? If I complain that you’ve left crumbs from eating biscuits in my bed, can you defend yourself on the grounds that I told you to make yourself (...) at home? These questions concern the scope of my consent. How we should ascertain the scope of someone's consent is the topic of Tom Dougherty's book.The book is divided into three main parts, each corresponding to a view about what fixes the scope of consent: the mental account, the successful communication account, and the evidential account, which Dougherty favours.Versions of the mental account have in common that they think consent can be granted without any behavioural signal. Provided that the person granting consent has the appropriate mental state, they can grant permission to the recipient of consent, even if they do nothing to communicate the consent. Proponents of these views, Dougherty argues, should adopt a principle according to which the scope of consent is fixed by what the consent-giver intends to permit. However, Dougherty rejects the mental account on the grounds that consent requires some sort of publicity so that we can hold each other accountable: ‘what you do in the privacy of your own mind is not enough to waive your rights in the public sphere’ (p. 60). (shrink)

There is a growing body of writing, for instance from the nursing profession, espousing an approach to ethics based on care. I suggest that this approach is hopelessly vague and that the vagueness is due to an inadequate analysis of the concept of care. An analysis of 'care' and related terms suggests that care is morally neutral. Caring is not good in itself, but only when it is for the right things and expressed in the right way. 'Caring' ethics assumes (...) wrongly that caring is good, thus it can tell us neither what constitutes those right things, nor what constitutes the right way. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics Committees in HospitalsPat Milmoe McCarrick (bio)(Literature about hospital ethics committees has grown enormously since Scope Note 3 first appeared. This update provides new information about resources and documents now available while continuing to include important earlier sources.)Hospital ethics committees increasingly have taken hold in the United States since 1983, when the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research encouraged their (...) creation in its report, Deciding to Forego Life-Sustaining Treatment (III, 1983, p. 5).The President's Commission report (pp. 160-64) suggested the following roles for ethics committees: 1) review of treatment decisions made on behalf of incompetent, terminally ill patients; 2) review of medical decisions having ethical implications with the option, in cases of disagreement, to refer cases to a court with proper jurisdiction; 3) provision of social, psychological, spiritual, or other counseling for patients, family members, physicians, or other hospital staff; 4) establishing guidelines regarding treatment or other medical decisions; and 5) sponsoring or conducting educational programs to inform all concerned, including the public, about ethical problems in medicine.No exact count of these committees is available. According to estimates cited by Donald F. Phillips, managing editor of Hospital Ethics, about two-thirds to three-fourths of hospitals with more than 200 beds have ethics committees, as do about one-third of hospitals under 200 beds. He thinks that about half of the 6,000 hospitals in the United States now have working ethics committees.Several journal articles and a court decision in the late 1970s influenced their formation. A 1975 journal article by pediatrician Karen Teel (VII A) urged the use of hospital ethics committees to provide for dialogue in individual care situations as an appropriate sharing of responsibility. Another early article suggested that beyond parents and treating physicians, a "disinterested," mixed lay and medical committee could consider cases about defective newborns to improve the ethical decisionmaking process (VII A, Robertson and Fost, 1976). Three 1977 discussions in the Hastings Center Report highlighted this new concept (VII A, Levine; Shannon; Veatch).Produced at the National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057. It is supported by funds provided under grant number LM04492 from the National Library of Medicine, National Institutes of Health. Literature available through June 1992 is represented in this Scope Note. [End Page 285]The court decision was the March 31, 1976 ruling by the New Jersey Supreme Court in the Karen Quinlan case. The parents of a young woman in a persistent vegetative state had requested that she be taken off a respirator. The court designated a "prognosis" role for the hospital ethics committee and stipulated that the committee must concur that the patient will never return to a "cognitive, sapient state" before the life-support system can be withdrawn (In the Matter of Karen Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976)). Shortly after the Quinlan decision, Massachusetts General Hospital's Clinical Care Committee created an ad hoc subcommittee (a psychiatrist, a legal counsel, an ICU nurse, an oncologist/internist, a surgeon, and a lay person who had recovered from serious cancer disease) which looked at 15 cases. Based on the subcommittee's success, establishment of a permanent committee to review treatment of the terminally ill was recommended by the critical care committee (VII A, Clinical Care Committee 1976).In its 1984 Baby Doe rules, the federal government recommended establishment of infant care review committees, which promoted the growth of hospital ethics committees (VII C, Povar 1991). In July 1987 Maryland became the first state to require by law that hospitals establish patient care advisory committees to offer advice about choices available in the care of life-threatening illnesses; this requirement was extended to nursing homes in 1990 [codified as amended at Md. Health-Gen. Code Ann. Sections 19-370 to -374 (1990)] (VII C, Hollinger 1991).Recently the role for these committees has been noted in the Accreditation Manual for Hospitals, 1992 Supplement (p. 10, Patient Rights, Section RI. 1.1.6.1) of the Joint Commission... (shrink)

A continuoxis t- norm is a continuous map * from [0, 1]² into [0,1] such that is a commutative totally ordered monoid. Since the natural ordering on [0,1] is a complete lattice ordering, each continuous t-norm induces naturally a residuation → and becomes a commutative naturally ordered residuated monoid, also called a hoop. The variety of basic hoops is precisely the variety generated by all algebras, where * is a continuous t-norm. In this paper we investigate the structure of the (...) variety of basic hoops and some of its subvarieties. In particular we provide a complete description of the finite subdirectly irreducible basic hoops, and we show that the variety of basic hoops is generated as a quasivariety by its finite algebras. We extend these results to Hájek's BL-algebras, and we give an alternative proof of the fact that the variety of BL-algebras is generated by all algebras arising from continuous t-norms on [ 0,1] and their residua. The last part of the paper is devoted to the investigation of the subreducts of BL- algebras, of Gödel algebras and of product algebras. (shrink)

Hospital ethics committees are common, but not universal, in small hospitals. A needs assessment was completed at a 155-bed community hospital in order to adapt an academic tertiary center model for a clinical ethics committee to fit the needs of the small hospital community. Of 678 questionnaires distributed, 209 were completed. Data suggested that clinical staff frequently experienced ethical dilemmas. Significantly more nonphysicians indicated that they would utilize a consultation service, if available, compared to physicians (p = 0.0067). The data (...) also indicated that the majority of staff (>80 percent) desired more education in clinical ethics. Physicians preferred annual or bi-annual hospital-wide grand rounds, compared to nonphysicians, who preferred more frequent department-based teaching (p < 0.001). The data presented in this article were used to subsequently develop a clinical ethics support committee, the process of which is also described. (shrink)