Objective To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years. Design and setting Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of (...) admission to the ICU and brain death were excluded. Intervention Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (κ=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann–Whitney U test, χ2 test and RR were used for data comparison. Measurements and main results 1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). A ‘do not resuscitate’ order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p<0.001). Conclusion Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation. (shrink)

No presente artigo, defendemos que uma constelação é formada por gêneros que se diferenciam em seus propósitos comunicativos específicos, mas que podem ser agrupados por razões diversas, como para a realização de uma tarefa para a qual seja necessária uma cadeia de gêneros. (SWALES, 2004). Com base na perspectiva teórica acima, objetivamos discutir as implicações pedagógicas do conceito de constelação de gêneros, tomando como referência o ensino da língua materna. Acreditamos que a compreensão do citado fenômeno, por parte dos professores, (...) pode ser útil para este ensino na medida em que a competência sociodiscursiva dos alunos pode ser ampliada em relação a um determinado elemento motivador da constelação. Isto se justifica porque os gêneros que se constelam se tornam distintos entre si graças à teia de propósitos comunicativos que eles formam dentro da constelação, a fim de atender às mais diversas funções sociais dentro da tarefa maior em função da qual eles se encadeiam. Portanto, o estudo de cadeia de gêneros dentro de uma tarefa escolar maior pode proporcionar aos estudantes uma visão mais ampla da função social dos gêneros, não limitando a compreensão acerca dos modos como a sociedade organiza seus processos comunicativos nos diversos tipos de constelação que podem existir. (shrink)

I am grateful to the commentators for their deep engagement with the issues raised in my paper. They raise a number of important challenges and questions about the use of frailty i...

Excluding only pure nominalists and "imagists" he includes in the classical theory "almost everyone who lived before the second decade of the twentieth century." This of course covers most of the other general types of theory found in the epistemology textbooks: that concepts are in the mind, that they are also in the thing, and finally that they are fundamentally prior to the thing. These types may be exemplified by Locke, Aristotle, and Plato, respectively. The controversy between these three schools (...) Price feels can for his purposes be regarded as a "domestic difference within the classical tradition." His subsidiary discussions of these differences he confines almost entirely to the first two. The Platonic theory he handles very lightly and gingerly; "it is a sufficiently difficult task in these days to convince people that there is any sense in talking of universals at all, even in the mild and moderate Aristotelian way". (shrink)

Rights have two properties which prima facie appear to be inconsistent. The first is that they are conditional in the sense that one some occasions it is always justifiable for someone to act in a way which appears to be inconsistent with someone else's rights, such as when the defence of necessity applies. The second is that rights are indefeasible in the sense that they are not subject to being defeated our outweighed by utilitarian or policy considerations. If we view (...) rules and the rights which they establish as being subject to a ceteris paribus clause, the form of which generates out the exceptions, the conditionality of rights becomes reconcilable with their nondefeasibility. Such a view of rules and rights would entail that the goals of the law and their orderings be considered as a part of the law. When so viewed, propositions about goals and their orderings become legitimate premises for legal reasoning, furnishing solutions to hard cases in the law of torts, without resort to balancing of interests or judicial discretion. (shrink)

ExcerptIn what follows, I would like to investigate the character of traditional Christian ritual, not as a full or comprehensive interpretation, but as a single step in that direction, inspired by recent archaeological excavations in southeastern Turkey and elsewhere that imply the primacy of ritual over material and economic factors in the development of society.1 The implications of these findings suggest that both anthropology and philosophy might focus on ritual as a key to the human. Yet if archaeological remains possess (...) the virtue of keys to the primordial, they also suffer from ineradicable obscurity that the absence of decipherable inscription…. (shrink)

Louis Frédéric Ancillon was a member of the Prussian Academy of Sciences and Belles Lettres whose imagined dialogue between Berkeley and Hume was read to the Academy in 1796 and published in 1799. It is important as an indicator of the reception of Hume and Berkeley in francophone philosophical circles in late eighteenth-century Prussia. Our introduction is followed by an English translation with notes.

In an increasingly global landscape, NFP initiatives including those addressing animal protection, are increasingly operating cross-borders. Doing so without respect, local engagement, and a thorough understanding of the issues of concern is fraught with danger, and potentially wasteful of resources. To this purpose, we sought to understand attitudes to the importance of 13 major world social issues in relation to animal protection by surveying 3433 students from at least 103 universities across 12 nations. The emergence of a ‘nature trifecta’ was (...) suggested, with animal and environmental protection and sustainable development recurring as the most highly rated in importance across all countries, with these issues also consistently rating amongst the highest in each individual country. It is concluded that significant differences exist between attributed importance of world issues by nation, pointing towards the benefit of tailoring NFP initiatives by country and region. It is also suggested that nation, or more specifically, sociopolitical and cultural region, is a vitally important demographic for consideration in social development. (shrink)

Some years ago, Lokhorst proposed an intuitionistic reformulation of Mally's deontic logic. This reformulation was unsatisfactory, because it provided a striking theorem that Mally himself did not mention. In this paper, we present an alternative reformulation of Mally's deontic logic that does not provide this theorem.