Objectives: This study investigated Finnish physicians’ experiences of decisions concerning living wills and do not resuscitate orders and also their views on the role of patients and family members in these decisions.Design: A questionnaire was sent to 800 physicians representing the following specialties: general practice ; internal medicine ; neurology , and oncology .Results: The response rate was 56%. Most of the respondents had a positive attitude toward , and respect for living wills, and 72% reported situations in which such (...) a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden or only palliative care required . The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed.Conclusions: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind. (shrink)

Objectives: This study investigated Finnish physicians’ experiences of decisions concerning living wills and do not resuscitate orders and also their views on the role of patients and family members in these decisions.Design: A questionnaire was sent to 800 physicians representing the following specialties: general practice ; internal medicine ; neurology , and oncology .Results: The response rate was 56%. Most of the respondents had a positive attitude toward , and respect for living wills, and 72% reported situations in which such (...) a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden or only palliative care required . The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed.Conclusions: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind. (shrink)

This study investigated Finnish nurses’ experiences and views on end-of-life decision making and compared them with physicians’ views. For this purpose, a questionnaire was sent to 800 nurses, of which 51% responded. Most of the nurses had a positive attitude towards and respect for living wills, more often than physicians. Most also believed that a will had an effect on decision making. Almost all of the nurses considered it their responsibility to talk to physicians about respecting living wills. Do-not-resuscitate (DNR) (...) orders were often interpreted to imply partial or complete palliative (symptom-orientated) care, which may cause confusion. Half of the nurses reported that a DNR decision was discussed always or often with a patient who was able to communicate; physicians were more positive in this respect. Surprisingly, many nurses (44%) stated that active treatment continued too long. Two-thirds thought that their opinions were taken into account sufficiently, even though only half believed that, in general, they had some impact. (shrink)

Using Carnap’s concept explication, we propose a theory of concept formation in mathematics. This theory is then applied to the problem of how to understand the relation between the concepts formal proof and informal, mathematical proof.

Recently Carrie S. Jenkins formulated an epistemology of mathematics, or rather arithmetic, respecting apriorism, empiricism, and realism. Central is an idea of concept grounding. The adequacy of this idea has been questioned e.g. concerning the grounding of the mathematically central concept of set (or class), and of composite concepts. In this paper we present a view of concept formation in mathematics, based on ideas from Carnap, leading to modifications of Jenkins’s epistemology that may solve some problematic issues with her ideas. (...) But we also present some further problems with her view, concerning the role of proof for mathematical knowledge. (shrink)

St. Thomas’s commentary on the Book of Psalms, known as the Postilla super Psalmos, gives us a privileged insight into the mind and heart of a Dominican friar and theologian at work and at prayer. In this contribution I will elucidate these claims on the basis of elements found in his commentary and in particular in the areas of prayer and the liturgy, Christ, Mary and the Church, Sin and Mercy and Contemplation and Preaching.

Clinical trials give rise to ethical dilemmas, especially in the acutely ill, but we take issue with two points raised in a recent comment on a specific acute myocardial infarction (AMI) trial. The commentators judged that the trial most likely could, and therefore should, have been terminated much earlier. By analysing the problem statistically we arrive at results that go against their intuitive judgment—they also see it as mandatory to update the patient Information sheet as trial results accrue and trends (...) begin to emerge. In our view, interpreting subtle trends and borderline p-values must rest with data monitoring boards, not patients. Moreover, patients with AMI or in other medical emergencies need very simple instructions. Empirical studies of the consent process confirm that the idea of a genuinely informed consent is problematic in such cases. (shrink)

The medical concept of prognosis is analysed into its basic constituents: patient data, medical intervention, outcome, utilities and probabilities; and sources of utility and probability values are discussed. Prognosis cannot be divorced from contemplated medical action, nor from action to be taken by the patient in response to prognostication. Regrettably, the usual decision-theoretic approach ignores this latter aspect. Elicitation of utilities, decision contemplation and prognostic counselling interweave, diagnostics playing a subsidiary role in decision-oriented clinical practice. At times the doctor has (...) grounds for withholding information. As this is known to the patient, prognostic counselling becomes a conflict-prone and rationality-thwarting activity. The meaning of standard phrases such as prognosis of a disease, the prognosis of this patient, the prognosis is unknown, is examined. (shrink)

Patient autonomy is a fundamental principle in end of life decision making. However, its realisation may take a variety of forms. Discourse analysis was conducted in a qualitative interview study of 19 physicians. The physicians made use of three different discourses, each of which contained a specific understanding of patient autonomy and a physician’s proper activities in the context of end of life decision making.

Neurobiologically inspired theories of speech perception such as that proposed by Sussman et al. are useful to the extent that they are able to constrain such theories. If they are simply intended as suggestive analogies, their usefulness is questionable. In such cases it is better to stick with the Gibsonian approach of attempting to isolate invariants in speech and to demonstrate their role for the perceiver in perceptual experiments.

Mathematical concepts are explications, in Carnap's sense, of vague or otherwise non-clear concepts; mathematical theories have an empirical and a deductive component. From this perspective, I argue that the empirical component of a mathematical theory may be tested together with the fruitfulness of its explications. Using these ideas, I furthermore give an argument for mathematical realism, based on the indispensability argument combined with a weakened version of confirmational holism.

In this paper I discuss possible ways of measuring the power of arithmetical theories, and the possiblity of making an explication in Carnap's sense of this concept. Chaitin formulates several suggestions how to construct measures, and these suggestions are reviewed together with some new and old critical arguments. I also briefly review a measure I have designed together with some shortcomings of this measure. The conclusion of the paper is that it is not possible to formulate an explication of the (...) concept. (shrink)

Global climate change is likely to become a major cause of future migration. Small Island States are particularly vulnerable since territorial destruction caused by sea level rise poses a threat to their entire existence. This raises important issues concerning state sovereignty and self-determination. Is it possible for a state to remain self-determining even if it lacks a stable population residing on a specific territory? It has been suggested that migrants from disappearing Small Island States could continue to exercise sovereign control (...) over their abandoned territory. Such an arrangement would allow them to retain a measure of self-determination. The question posed in this paper is whether this ?deterritorialized state proposal? is conceptually plausible and normatively acceptable. It is argued that the proposal is conceptually plausible if we adopt a gradual understanding of ?self-determination?, but that its normative acceptability is weak even if it is supplemented with compensatory measures. (shrink)

Our aim was to study how nurses interpret patient autonomy in end-of-life decision making. This study built on our previous quantitative study, which evaluated the experiences of and views on end-of-life decision making of a representative sample of Finnish nurses taken from the whole country. We performed qualitative interviews with 17 nurses and analysed these using discourse analysis. In their talk, the nurses demonstrated three different discourses, namely, the ‘supporter’, the ‘analyst’ and the ‘practical’ discourses, each of which outlined a (...) certain position for patients and relatives, and a certain identity for the nurses in end-of-life decision making. The nurses’ talk showed notable differences when compared with that of physicians, highlighting the differences that take place in respect of the image of a person’s work, professional culture, professional identification and responsibilities. An important finding was that the nurses often described their participation in end-of-life decision making in terms of indirect influence. (shrink)

Tekster til Buddhismen. Selected and translated by Frede Möller-Kristensen. Gyldendal, Copenhagen 1980. 104 pp. Illustrated. D.Kr.68.50.

In this article I will claim that from a Thomist perspective the question “Soul or Brain: What makes us human?” presents us with a false dilemma and hence must as such remain an unanswerable question. In order to corroborate this claim I will do two things. First, I present the framework of a Thomistic anthropology in so far as it relates to the unity of soul and body in the human person. Next, I deal with the question that immediately results (...) from this unity, i.e. the subsistence of the soul. From a Thomist perspective this question can be answered apart from any findings from neuroscience. (shrink)

Herausgegeben von Walter Senner OP (Federf hrender Herausgeber), Kaspar Elm, Thomas Eggensperger OP, Isnard W. Frank OP, Ulrich Horst OP Mit neuen Methoden und Fragestellungen ist in den letzten Jahrzehnten die Erforschung der Geschichte der Bettelorden vorangetrieben und ihre ber die engere Ordens- und Kirchengeschichte hinausgehende Bedeutung f r Politik-, Wirtschafts- und Sozial-, f r Bildungs- und Geistesgeschichte herausgearbeitet worden. Zur Intensivierung und Koordinierung der sie ber hrenden Forschungen gibt die deutsche Dominikanerprovinz Teutonia die Reihe "Quellen und Forschungen zur Geschichte (...) des Dominikanerordens. Neue Folge" heraus. Auch in der Neuen Folge wird die Geschichte der Dominikaner im deutschen Sprachraum den Schwerpunkt bilden. Es werden auch wichtige Untersuchungen zur Ordensverfassung und Fr mmigkeit, zur Philosophie und Theologie aufgenommen, die f r den Dominikanerorden im Untersuchungsraum Verbindlichkeit oder Bedeutsamkeit hatten, selbst wenn die untersuchte Thematik ihrer Entstehung nach nicht speziell mit den deutschen Dominikanern und Dominikanerinnen zu tun hatte. Der Begriff Dominikanerorden wird in einem weiten Sinn verstanden. Alle Gemeinschaften, die nach rechtlicher Verfassung oder geistlicher Ausrichtung mit den Dominikanern zu tun hatten, werden ihm subsumiert: der Predigerorden, die dominikanischen Frauenkl ster und -gemeinschaften, die losen Verb nde der Dritten Orden sowie die verschiedenen Bruderschaften. Dem Zeitraum nach ist Forschungsgegenstand die Geschichte des Dominikanerordens von den Anf ngen bis in die unmittelbare Vergangenheit. Dabei ist auch gedacht an die Aufarbeitung von Entstehen und Geschichte der verschiedenen dominikanischen Frauengemeinschaften des 19. Jahrhunderts, die mit ihren religi sen und sozialen Aktivit ten in der sich rasch wandelnden Gesellschaft eine bedeutende, bisher meist untersch tzte Rolle spielten. Zum Lehrstuhl von P. Prof. Walter Senner OP: http: //philo.pust.op.org/prof/senner/index.html Zur Seite von Dr. theol. Thomas Eggensperger OP, M.A. http: //www.institut-chenu.eu. (shrink)

On the basis of a chronological approach of the decision-making process with regard to the recognition of the PRC we concluded in an analytical part that the decision-making process was merely of the "hypo-institutional" type. Afterwards, we examined the effectivity of the Belgian policy in comparison with the international scientific literature on recognition and with the practice of other small European states. We concluded the non-recognition policy had been ineffective. The relation between "hypo-institutional" decision-making on the one hand and ineffective (...) public policy on the other hand is just one element within a broader research-project : "The effectivity of public policy according to type of decisionmaking". (shrink)

One questioned premiss in the indispensability argument of Quine and Putnam is confirmational holism. In this paper I argue for a weakened form of holism, and thus a strengthened version of the ind ..

Attempts have been made to analyse features in mathematics within a social constructivist context. In this paper we critically examine some of those attempts recently made with focus on problems of the objectivity, ontology, necessity, and atemporality of mathematics. Our conclusion is that these attempts fare no better than traditional alternatives, and that they, furthermore, create new problems of their own.

It is not unusual in real-life that one has to choose among finitely many alternatives when the merit of each alternative is not perfectly known. Instead of observing the actual utilities of the alternatives at hand, one typically observes more or less precise signals that are positively correlated with these utilities. In addition, the decision-maker may, at some cost or disutility of effort, choose to increase the precision of these signals, for example by way of a careful study or the (...) hiring of expertise. We here develop a model of such decision problems. We begin by showing that a version of the monotone likelihood-ratio property is sufficient, and also essentially necessary, for the optimality of the heuristic decision rule to always choose the alternative with the highest signal. Second, we show that it is not always advantageous to face alternatives with higher utilities, a non-monotonicity result that holds even if the decision-maker optimally chooses the signal precision. We finally establish an operational first-order condition for the optimal precision level in a canonical class of decision-problems, and we show that the optimal precision level may be discontinuous in the precision cost. (shrink)