Background: Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan-European study was conducted to determine the frequency and types of end of life practices in European intensive care units , including those in Israel. Several results of the Israeli subsample were different to those of the overall sample.Objective: The objective of this article was to explore these differences and provide a possible explanation based (...) on the impact of culture on end of life decision making.Method: All adult patients admitted consecutively to three Israeli ICUs who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively . These patients were compared with a similar sample taken from the larger study carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation , brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process . The data also included patient characteristics , specific therapies limited, and the method of SDP.Results: The majority of patients had treatment withheld, none underwent SDP, 62 received CPR , 31 had brain death , and 18 underwent withdrawal of treatment . The primary reason given for limiting treatment was that the patient was unresponsive to therapy . End of life discussions were held with 132 families , the vast majority of which revolved around withholding treatment and the remainder concerned withdrawing treatment .There was a statistically significant association between the type of end of life decision and region—that is, the northern region of Europe, the central region, the southern region, and Israel.Conclusions: Regional culture plays an important part in end of life decision making. Differences relating to end of life decision making exist between regions and these differences can often be attributed to cultural factors. Such cultures not only affect patients and their families but also the health care workers who make and carry out such decisions. (shrink)

There is concern that human applications of modern genetic technologies may lead inexorably to eugenic abuse. To prevent such abuse, it is essential to have clear, formal principles as well as algorithms for distinguishing genetics from eugenics. This work identifies essential distinctions between eugenics and genetics in the implied nature of the social contract and the importance ascribed to individual welfare relative to society. Rawls's construction of 'justice as fairness' is used as a model for how a formal systems of (...) ethics can be used to proscribe eugenic practices. Rawls's synthesis can be applied to this problem if it is assumed that in the original condition all individuals are ignorant of their genetic constitution and unwilling to consent to social structures which may constrain their own potential. The principles of fairness applied to genetics requires that genetic interventions be directed at extending individual liberties and be applied to the greatest benefit of individuals with the least advantages. These principles are incompatible with negative eugenics which would further penalize those with genetic disadvantage. These principles limit positive eugenics to those practices which are designed to provide absolute benefit to those individuals with least advantage, are acceptable to its subjects, and further a system of basic equal liberties. This analysis also illustrates how simple deviations from first principles in Rawls's formulation could countenance eugenic applications of genetic technologies. (shrink)

An analytical investigation into compressible gas flow with slight rarefactions through the insect trachea and tracheoles during the closed spiracle phase is undertaken, and a complete set of asymptotic analytical solutions is presented. We first obtain estimates of the Reynolds and Mach numbers at the channel terminal ends where the tracheoles directly deliver respiratory gases to the cells, by comparing the magnitude of the different forces in the compressible gas flow. The 2D Navier–Stokes equations with a slip boundary condition are (...) used to investigate compressibility and rarefied effects in the trachea and tracheoles. Expressions for the velocity components, pressure gradients and net flow inside the trachea are then presented. Numerical simulations of the tracheal compressible flow are performed to validate the analytical results from this study. This work extends previous work of Arkilic et al. :167–178, 1997) on compressible flows through a microchannel. Novel devices for microfluidic compressible flow transport may be invented from results obtained in this study. (shrink)

Vleeskens, F. D. A. Spinoza en zijn tijd.--Klever, W. N. A. Ervaring en rede.--Petry, M. J. De Regenboog.--Bend, J. G. van der. Spinoza's liberale rechtsstaat.--Sperna Weiland, J. Vrijheid.

The author describes his work as "an attempt to systematically re-think philosophy out of its original beginning and most fundamental perspective: the primordial phenomenon of wonder." Relying heavily upon the existential and phenomenological traditions, Boelen focusses upon wonder as the locus for the "dialectical self-manifestation of Being"; with this as his foundation, Boelen establishes the necessarily circular character of philosophical reflection, as rooted in wonder and recurring back upon its original data. The theory involved is further specified in analyses of (...) the aesthetic phenomenon, ethical existence, and existential loving. Throughout is evidenced a concern that philosophy and psychology work together in the reflective approach the primordial phenomena of human existence. Militantly anti-"scientistic." Although stylistically weak at times, Existential Thinking is nonetheless a useful and suggestive work; it is, to use one of the highest praises in Boelen's terminology, a beginning--and that in the two-fold sense of exploring the origins of philosophical reflection, and of indicating directions for fuller, more detailed reflection.--D. F. D. (shrink)

The Unifying Moment provides a fine comparative study of Whitehead and James. Eisendrath expresses the presupposition of his effort in noting "a fruitful complementarity" between his subjects: "Whitehead is highly abstract and needs the exemplification which reference to James can provide. Conversely, Whitehead can be used to show the full sweep of general application implicit in James’s ideas." The core of Eisendrath’s analysis lies in creativity and in the ‘aesthetic’ bias shared by Whitehead and James; experience is feeling, appetition and (...) advance into novelty. There are indeed problems in the analogy between personality and atomic concrescence, since from a Whiteheadian perspective personality is a complex ’society', not a simple concrescence. Yet the analogy works, because Eisendrath is aware of the disparity, and because it serves to illuminate the anthropomorphic tendency in Whitehead. The book is at its strongest in dealing directly with issues of epistemology and psychology, where Eisendrath also displays a firm grasp of the early history of psychology. Less satisfying are some of the approaches to larger issues, such as the discussions of God and civilization. Throughout, there is the stylistic flaw, perhaps inevitable in a comparative study, of lengthy textual citation and explication; while thus documenting his position, Eisendrath at times lets the documentation obscure his argument. The notes and index are both extensive and helpful.—D. F. D. (shrink)

Wernham's critical edition includes the complete text of the Tractatus Politicus and all the portions of the Tractatus Theologico-Politicus having to do with politics and ethics, with Latin and English texts conveniently printed face-à-face. The introduction and notes are balanced and substantial; they conclude from a detailed comparison of Spinoza's political thought with Hobbes' that Spinoza, while less "modern" in outlook than his English contemporary, may nevertheless possess greater relevance for current political philosophy.--J. F. D.

As the gap between the need for and supply of human organs continues to widen, the aim of securing additional sources of these “gifts of the body” has become a seemingly overriding moral imperative, one that could—and some argue, should—override the widespread ban on organ markets. As a medical practice, organ transplantation entails the inherent risk that one human being, a donor, will become little more than a means to the end of healing for another human being and that he (...) or she will come to have a purely instrumental value. With the establishment of organ markets, not only will the harms of instrumentalization be a reality—the ends of medicine will be further compromised and confused. (shrink)

A desultory caricature, ostensibly socialist in tenor, of a well-known theory of justice.--J. F. D.

A collection of essays by a British master of Marxism, this book ranges over a wide variety of related topics--ethics, human rights, social theory, ideology, religion, and philosophy. The essays are reprints or adaptations of previous articles and addresses, and are unified by the author's sympathetic interpretation of Marxist thought. Especially instructive and timely is a chapter on Sartre and Marxism.--J. F. D.

Contemporary problems associated with the notion of determinism are focused by this symposium in three major areas of inquiry--philosophy, physical science, and law and moral responsibility. Determinism in modern physics is capably analyzed by a number of eminent contributors; but with respect to its significance for a philosophy of nature, little that is new or suggestive emerges from this analysis. The distinction between "hard" and "soft" determinism and its implications in legal and moral contexts provoke the most valuable part of (...) the discussion.--J. F. D. (shrink)

My discussion addresses the differences between analytic and continental philosophy concerning the use of logic and exact reasoning in philosophical practice. These differences are mainly examined in the light of the controversial dominance of Hegel's concept of logic (and theory of concept) in twentieth-century continental philosophy. The inquiry is developed in two parts. In the first (Sections 1-2), I indicate some aspects of the analytic-continental divide, pointing to the role that the topic 'logic and philosophy' plays in it. In the (...) second part (Sections 3-6), I give a short account of the views of logic which are typical of the three main trends of continental philosophy (see Table 1). I also suggest how, with the aid of some typical analytical devices, some continental 'anti-logical' attitudes may be corrected, on their own terms. (shrink)

A paperbound edition of an excellent interpretative study, originally published in 1950. Though the bibliography and index are considerably abridged in the present edition, the text is complete and has been improved by numerous minor revisions prepared by the author.--J. F. D.