The idea of personalized nutrition is to give tailored dietary advice based on personal health-related data, i.e. phenotoype, genotype, or lifestyle. PN may be seen as part of a general trend towards personalised health care and currently various types of business models are already offering such services in the market. This paper explores ethical issues of PN by examining how PN services within the contextual environment of four future scenarios about health and nutrition in Europe might affect (...) aspects of social justice according to Martha Nussbaum’s capability approach. The scenarios have been created by a mixed group of stakeholders and experts in three consecutive workshops. This resulted in the definition of four future scenarios within a scenario space consisting of two variables: the ‘logic of health care systems’ and ‘conception of health’. Within each scenario, PN is likely to play a more or less important role in improving health by influencing food consumption patterns in society. Nussbaum’s capability approach implies a concept of social justice as a function of a minimum standard of human dignity. This denotes an account for equality in terms of a minimum of entitlements. However, also the ability of achieving individual objectives is essential for social justice. Personalisation advice in health and food consumption patterns, as aimed for by PN, is therefore acceptable provided a minimum of entitlements is guaranteed to all members of a society, and at the same time freedom concerning personal preferences is respected. Potential variation of how different people might benefit from PN should therefore be consistent with the minimum required as defined by the list of capabilities. (shrink)

This cross sectional study was carried out among the workers of British American Tobacco Company, Dhaka with a view to explore their nutritional status, personal hygiene and health seeking behavior as because they are working on a tobacco processing company. The sample size was 179 which were selected purposively. The study showed that out of 179 respondents 89 (49.7%) were in the age groups of 30-39 years and the mean age of the respondents were 31.99 ± 6.01 years. A large (...) number of respondents (55.9%) had monthly family income of Taka 10001-20000 and the mean family income was Taka 12776.54 ± 5230.13. Maximum respondents (73.7%) were Muslim, more than half (54.2%) were shift in charge, 39.1% of the respondents consisted of 4 family members, 43.6% respondents were accustomed to other type of eating habit and 38.5% respondents knew that malnutrition was the effect of lack of proper nutrition, 59.8% of the respondents knew that night blindness was the disease due to malnutrition, most of the respondents (91.6%) performed duties to maintain health, majority (62.0%) respondents used to do nothing to maintain healthcare for their children and 35.9% visited doctor’s single time in a month, 40.2% of the respondents told regular tooth brushing as type of healthy habits. Majority (64.8%) respondents used to brush twice a day, majority (50.8%) respondents used to wash hand after toileting, majority (62.08%) respondents used to bath daily, 43.0% and 31.8% of the respondents told that dysentery and diarrhea was due to eating without proper hand washing respectively. Majority (53.6%) respondents informed that they learned about personal hygiene from television, 45.8% respondents understood that use of safe water in every work as sanitation. Majority (50.84%) came from nuclear family; most (84.92%) had exercise habit and 40.22% had education level of class VIII. Most (75.42%) of the respondents had semi pucca houses and majority (69.83%) of the respondents used only water as materials for hand washing. This study provided some important information which might help the concerned authority to take appropriate measures to improve the health status of the workers. (shrink)

In this article, Harvey notes the initial confusion about the statement made by the pope concerning artificial nutrition and hydration on patients suffering persistent vegetative states (PVS) due to misunderstanding through the translation of the pope's words. He clarifies and assesses what was meant by the statement. He also discusses the problems of terminology concerned with the subject of PVS. Harvey concludes that the papal allocution was in line with traditional Catholic bioethics, and that while maintaining the life of (...) a patient is favorable, in particular cases this presumption wanes when it is clear that this treatment modality would be futile or very burdensome. (shrink)

Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores whether one such tradition—halachic Judaism—in fact demands the use of artificial nutrition and hydration in this setting. Traditional arguments have been advanced holding that treatment can be withheld in persons who (...) are dying, in individuals whose condition causes great suffering, or in the event that the treatment would produce suffering. Individuals with advanced dementia can be considered to be dying, often suffer as a result of their dementia, and are likely to suffer from the use of a feeding tube. Given these observations and the absence of a compelling case for distinguishing between tube feeding and other forms of medical treatment, traditional Judaism appears compatible with withholding artificial nutrition for individuals with advanced dementia. (shrink)

Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, (...) challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries. (shrink)

This book offers a multidisciplinary look at the much-debated concept of “personalized medicine”. By combining a humanistic and a scientific approach, the book builds up a multidimensional way to understand the limits and potentialities of a personalized approach in medicine and healthcare. The book reflects on personalized medicine and complex diseases, the relationship between personalized medicine and the new bio-technologies, personalized medicine and personalized nutrition, and on some ethical, political, economic, and social implications (...) of personalized medicine. This volume is of interest to researchers from several disciplines including philosophy, bio-medicine, and the social sciences. (shrink)

At the present state of industrialized agriculture and specialized economy, achieving nutritional self-sufficiency on a personal level is widely considered a naïve goal, unsuited to the present technological era. Furthermore, nutritional self-sufficiency is considered overly demanding in terms of training, land, labor intensity, and time requirements. This study contests these common notions. Drawing on a study of a small (approximately 0.075 ha) low-input self-sufficient farm in an industrialized country, we show that achieving nutritional self-sufficiency on this farm required modest initial (...) agricultural training, a small parcel of land, and, perhaps most surprisingly, a single day of labor per month, on average. We offer these results as proof of concept that, when properly planned, nutritional self-sufficiency may be sustained over an extended period (more than a decade) and that doing so may be compatible with working full-time outside the farm, as well as engaging in regular leisure activities. We also propose that some upscaling is viable at the industrial, small-scale, and household levels. (shrink)

Withholding and withdrawing artificial nutrition and hydration from terminally ill patients poses many ethical challenges. The literature provides little information about the Islamic beliefs, attitudes, and laws related to these challenges. Artificial nutrition and hydration may be futile and reduce quality of life. They can also harm the terminally ill patient because of complications such as aspiration pneumonia, dyspnea, nausea, diarrhea, and hypervolemia. From the perspective of Islam, rules governing the care of terminally ill patients are derived from (...) the principle that injury and harm should be prevented or avoided. The hastening of death by the withdrawal of food and drink is forbidden, but Islamic law permits the withdrawal of futile, death-delaying treatment, including life support. Nutritional support is considered basic care and not medical treatment, and there is an obligation to provide nutrition and hydration for the dying person unless it shortens life, causes more harm than benefit, or is contrary to an advance directive that is consistent with Islamic law. The decision about withholding or withdrawing artificial nutrition and hydration from the terminally ill Muslim patient is made with informed consent, considering the clinical context of minimizing harm to the patient, with input from the patient, family members, health care providers, and religious scholars. (shrink)

Gypsy people are the most poorly considered minority in Spain. Their current circumstances in relation to growth rate and trend variation in this country are not well known. The main objective of this paper is to show what happens to a person's growth process in a transitional minority group affected by the process of globalisation. As target population and the articulation of social actions to have an implementation of quality of life is an additional objective. The research team, in collaboration (...) with “Apoyo”, an NGO, made contact with each Gypsy family. The sample comprised 189 boys aged 5 to 14 years. The boys and their families have been rehoused in two large buildings, named “Ruedo” and “Herradura”, in an attempt to accommodate the marginal Gypsy population following the disappearance of their shanties in Madrid. Morphological and physiological variables were considered as well as social situation and nutritional habits. Large family size (5–6 children), smoking and coffee- drinking habits and the intake of less than the internationally recommended number of calories after the age of 8 years endangers the healthy growth of these European Union citizens. (shrink)

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because patients in PDOC (...) can survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be (...) described as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision-making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. (shrink)

Personalised nutrition (PN) has emerged over the past twenty years as a promising area of research in the postgenomic era and has been popularized as the new big thing out of molecular biology. Advocates of PN claim that previous approaches to nutrition sought general and universal guidance that applied to all people. In contrast, they contend that PN operates with the principle that “one size does not fit all” when it comes to dietary guidance. While the molecular mechanisms (...) studied within PN are new, the notion of a personal dietary regime guided by medical advice has a much longer history that can be traced back to Galen’s “On Food and Diet” or Ibn Sina’s (westernized as Avicenna) “Canon of Medicine”. Yet this history is either wholly ignored or misleadingly appropriated by PN proponents. This (mis)use of history, we argue helps to sustain the hype of the novelty of the proposed field and potential commodification of molecular advice that undermines longer histories of food management in premodern and non-Western cultures. Moreover, it elides how the longer history of nutritional advice always happened in a heavily moralized, gendered, and racialized context deeply entwined with collective technologies of power, not just individual advice. This article aims at offering a wider appreciation of this longer history to nuance the hype and exceptionalism surrounding contemporary claims. (shrink)

In this essay, I discuss the role that vocation plays in assessing the proportion of burdens to benefits in end-of-life options. I then look at the case of patients in a persistent vegetative state. What vocational considerations are relevant for persons considering what care to accept should they ever be in a PVS or for those caring for patients in such a state? Ultimately, I argue that the vocational shape of a patient’s life ought not to be a consideration for (...) a caregiver in favor of removing artificial nutrition and hydration. (shrink)

Infant A was born at term with an antenatal diagnosis of gastroschisis. His parents were well informed about the condition and understood that he would require surgery. However, at delivery, his bowel was found to be severely compromised. Infant A returned from theatre with only four centimeters of small bowel. This is physiologically devastating and easily qualifies as ultrashort bowel syndrome. Whilst the prognosis from ultrashort bowel syndrome is greatly improving, the condition continues to carry a significant risk of mortality (...) and morbidity, in part attributable to treatment itself. The cornerstone of management of USBS is provision of intravenous parenteral nutrition. This is not a physiologically normal route of nutrition; it is a medical treatment. Infant A’s parents questioned whether continuation of active treatment was appropriate. If a treatment is not in the patient’s best interests, then it can be argued it is not justified to administer it. Decisions about quality of life are intensely personal. Where there is a significant burden of treatment, even when there is a potential for increased survival, whether the course of treatment is in the child’s best interests must be taken with huge emphasis on the parental perspective and their family values. For well-informed, realistic parents who are welcoming of the full picture of information and implications of their decision, I argue that parents are best placed to make the decision for their child. Long-term PN for USBS may well be a medically encouraged treatment. However, it should not be medically mandated. (shrink)

Due to the pandemic and the suspension of in-person school classes, there was an interruption in the meals served to approximately 40 million students who benefited from the Brazilian National School Feeding Program (PNAE). This article describes two case studies, comparing the strategies adopted by two municipalities for maintaining school feeding during the Covid-19 pandemic in the northern region of the state of Rio de Janeiro, Brazil, and discuss possible impacts of these strategies on food and nutrition security. These (...) municipalities together cover about 81% of the population in the region. In July 2020, we conducted interviews with PNAE municipal managers, following a qualitative approach. We discuss the results in relation to existing Brazilian guidance on food and nutrition security. The municipalities have developed distinct strategies to overcome operational obstacles and maintain PNAE goals, such as distributing food kits and making cash transfers to students’ families. The main determinants of these strategies are financial availability, the relationship between municipal teams and school communities, and the pre-pandemic PNAE logistics and management. Depending on the strategy and duration of the pandemic, the impacts on food and nutrition security can be wide-ranging, affecting food quality and local farmers who sell products to PNAE. It is necessary to acknowledge that this is not a short-term pandemic and find ways to perform school feeding in accordance with PNAE criteria. (shrink)

Modern parents, particularly in countries with highly developed public health systems, are not short of guidance about how to feed their children.1 Advice flows freely from many sources. State organs, particularly health departments and health care providers, offer advice with a reassuringly official provenance. Nutritional and pediatric societies, health-related charities, childcare manuals, parenting websites, and nutrition publications draw on scientific research in formulating their advice. Newspapers and magazines report the findings of the latest nutrition studies. Advice is also (...) relayed informally and personally, often with glosses drawn from personal experience.. (shrink)

Two hundred twenty eight experienced personal trainers responded to a survey of perceived role responsibilities, conflicts and boundary issues in this emerging profession. Data from a 53-item questionnaire were analyzed by sex, age, and trainers' levels of experience. Findings provide information about why clients are believed to hire personal trainers, degrees of responsibility trainers feel for different aspects of the relationship, common conflicts experienced in this profession, and relationship behaviors considered acceptable or unacceptable. From a number of perspectives, the results (...) suggest that trainers may engage in and take responsibility for behaviors that fall beyond their legitimate domains of competence and influence. These include such activities as giving advice to clients about nutrition, lifestyle, and psychological agendas. Significant differences were observed when results were analyzed by sex, age, and experience level. (shrink)

The bioethical issues confronting the Jewish chaplain in a long-term care facility are critical, particularly as life-support systems become more sophisticated and advance directives become more commonplace. May an elderly competent patient refuse CPR in advance if it is perceived as a life-prolonging measure? May a physician withhold CPR or artificial nutrition and hydration (which some view as basic care and not as therapeutic intervention) from terminal patients with irreversible illnesses? In this study of Jewish ethics relating to these (...) issues, the author carefully examines the moral implications and legal precedents in the literature. Jewish ethics, affirming a 'sanctity of life' position, suggest that while an elderly person may direct in advance that CPR not be administered in most instances, in the absence of a DNR (Do Not Resuscitate) order, CPR must be performed. In reference to 'tube-feeding', while there is some debate about whether elderly patients may refuse the initiation of 'tube-feeding', there is a consensus that once initiated, it may not be withdrawn. (shrink)

The issues involved in deciding whether to use artificial methods of delivering hydration and nutrition are often very difficult for patients, families, and health care providers. Once private and personal matters, these decisions now frequently involve the judicial system. Five years ago, Hospice of Washington recognized the need for a written policy and wrote the one published here. Its goal is to respect individual preferences and family concerns while addressing the nutrition and hydration needs of dying patients. The (...) policy sets parameters on the issue, provides basic information, and encourages crafting the most fitting resolution to each situation. (shrink)

When scientists consider the interaction of science and value judgments, debates often occur. When public policy grows out of science, disagreements between scientists can become even more spirited. This paper examines the case of nutrition policy in the United States, which has been both at the interface between agriculture and medicine and the object of serious discord concerned with the strength and validity of the scientific evidence and the responsibility for action. The development of indirect intervention policies, designed to (...) educate and inform the public on diet and health, is traced as a practical demonstration of the effects of involvements of nutritional scientists of different disciplines and philosophic bents. Controversies centered mainly on the issues of diet and coronary heart disease and of diet and cancer in nutritional guidelines for Americans and the recommended dietary allowances. But the arguments turned on a complex web of values and interests as well as scientific questions. A remarkable turnaround by animal agriculture and its scientific support occurred, changing from a defensive, rightist stance to one that appears to recognize a moral responsibility to the public health. The convincing point was likely the changing market. Nutritional scientists, however, remained divided on the issue of whether a public health strategy keyed to public education should replace a strategy to identify persons of high risk and modify the risk by treatment. Our analysis suggests that the tension between libertarian and utilitarian social values of scientists is at least as important as disagreements relative to validity and strengths of the scientific evidence. (shrink)

Infant A was born at term with an antenatal diagnosis of gastroschisis. His parents were well informed about the condition and understood that he would require surgery. However, at delivery, his bowel was found to be severely compromised. Infant A returned from theatre with only four centimeters of small bowel. This is physiologically devastating and easily qualifies as ultrashort bowel syndrome (USBS). Whilst the prognosis from ultrashort bowel syndrome is greatly improving, the condition continues to carry a significant risk of (...) mortality and morbidity, in part attributable to treatment itself. The cornerstone of management of USBS is provision of intravenous parenteral nutrition (PN). This is not a physiologically normal route of nutrition; it is a medical treatment. Infant A’s parents questioned whether continuation of active treatment was appropriate. If a treatment is not in the patient’s best interests, then it can be argued it is not justified to administer it. Decisions about quality of life are intensely personal. Where there is a significant burden of treatment, even when there is a potential for increased survival, whether the course of treatment is in the child’s best interests must be taken with huge emphasis on the parental perspective and their family values. For well-informed, realistic parents who are welcoming of the full picture of information and implications of their decision, I argue that parents are best placed to make the decision for their child. Long-term PN for USBS may well be a medically encouraged treatment. However, it should not be medically mandated. (shrink)

In postmodern society, many of the perceptions that people had about them, their lives, the values ​​that define them and the strategies that they can use to achieve their ideals have changed. Specifically, today we can talk about new paradigms, such as health, lifestyle focused on personal well-being, obtained through fitness and wellness, respectively wellbeing that adds the spiritual component, in an holistic interdependence. An important role in the changes we are talking about has been played by the media, which (...) promote living standards built on hedonistic principles, specific to the consumer society. The consequence is that more and more teenagers and young people want to look good and feel good, but only a small part of them reach the specialists, who are best able to provide individualized guidance, support, and programs to prevent any negative consequences of uninspired choices or poorly dosed enthusiasm The stakes of choice are high, because a healthy lifestyle, which should not be limited to body aesthetics, but also aims to develop the spiritual side, can support a more effective adaptation to the dynamics of changes in society. The last year, marked by a new challenge, the pandemic, has fully demonstrated the need to assume on a personal level a balanced and responsible lifestyle, which offers new values ​​of quality of life, as well as complementing proactive management with that managed by specialists. (shrink)

Multimodal prehabilitation is increasingly recognized as an important component of the pre-operative pathway in oncology. It aims to optimize physical and psychological health through delivery of a series of tailored interventions including exercise, nutrition, and psychological support. At the core of this prescription is a need for considerable health behavior change, to ensure that patients are engaged with and adhere to these interventions and experience the associated benefits. To date the prehabilitation literature has focused on testing the efficacy of (...) devised exercise and nutritional interventions with a primary focus on physiological and mechanistic outcomes with little consideration for the role of behavioral science, supporting individual behavior change or optimizing patient engagement. Changing health behavior is complex and to maximize success, prehabilitation programs should draw on latest insights from the field of behavioral science. Behavioral science offers extensive knowledge on theories and models of health behavior change to further advance intervention effectiveness. Similarly, interventions developed with a person-centered approach, taking into consideration individual needs and preferences will increase engagement. In this article, we will provide an overview of the extent to which the existing prehabilitation literature incorporates behavioral science, as well as studies that have explored patient's attitudes toward prehabilitation. We will go on to describe and critique ongoing trials in a variety of contexts within oncology prehabilitation and discuss how current scientific knowledge may be enhanced from a behavioral science perspective. We will also consider the role of “surgery schools” and detail practical recommendations that can be embedded in existing or emerging clinical settings. (shrink)

This study investigated the association between Big Five Personality Traits and nutrition-related variables. We used secondary data from the Indonesia Family Life Survey wave 5 involving a total of 14,473 men and 16,467 women aged 15−101 years in Indonesia that was selected by stratified random sampling conducted in the period 2014 to 2015. Data were collected through interviews with the Big Five Index 15 and a questionnaire similar to the Global Physical Activity Questionnaire which was translated into the Indonesian (...) language, and based on measurements of height and weight. Analyses used binary logistic regression test controlled by socio-demographic factors to determine the association between Big Five Personality Traits and eating habits, physical activity, and obesity. Results showed that openness and extraversion were positively associated with recommended and non-recommended foods, conscientiousness was positively associated with only recommended foods, agreeableness was positively associated with recommended foods, and negatively associated with only one non-recommended food. Whereas, neuroticism was positively associated with non-recommended foods and negatively associated with recommended foods. Openness and conscientiousness were associated with physical activity. Conscientiousness, extraversion, and neuroticism were associated with obesity. Although some results were different from previous studies, these associations can be used as strategies of behavioral change due to the adaptation of personality characteristics, which can be modified even though the personality tends to be persistent. Further studies are needed to understand other mechanisms that might underlie this association. (shrink)

Coping with a relative with a learning disability could be a stressful experience for family members. The present study is aimed at exploring the coping strategies adopted by families in trying to make meaning of their situation. A qualitative study design using focus group discussions was adopted. Ten FGD sessions were held with family members of persons with a learning disability. Findings revealed patterns of family coping to include problem-focused, emotion-focused, and spiritual/religious-focused. Also, coping responses to a learning disability varied (...) based on the level of information available to families about the condition of their relative. In some cases, interspousal relationship was strained due to stress. It was recommended that families of persons with a learning disability need social support and professional help from social workers to facilitate the adoption of more positive-oriented coping strategies by family members. (shrink)

Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt (...) to develop a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship. (shrink)

This paper focuses on experiences from a case study dealing with the Swiss type of a consensus conference called “PubliForum” concerning “Genetic Technology and Nutrition” (1999). Societal and ethical aspects of genetically modified food meanwhile can be seen as prototypes of topics depending on the involvement of the public through a participatory process. The important role of the lay perspective in this field seems to be accepted in practice. Nevertheless, there is still some theoretical controversy about the necessity and (...) democratic legitimacy of participatory processes in general, and especially about those dealing with technological or environmental problems (sustainable development) concerning society. From an ethical point of view, a lot of heterogeneous problems concerning contents and procedures of public participation can be pointed out, not only on the theoretical level but also in practice, e.g., concerning the communication process between laypersons and experts. The intention of our paper is to give hints and to clarify criteria that support the communication process leading to a dialog of autonomous citizens and which especially consider ethical aspects in the field. One important result is that there must be an orientation for all members of a consensus conference having clear rules and knowing their different roles that support transparency, credibility, and fairness of the whole procedure and a “good product”: a substantial final document or citizens’ report. (shrink)

This personal view draws attention to the lack of regard, given by the BMA in its new guidance, to the symptomatic benefit of clinically assisted nutrition and hydration in patients who are not imminently dying. This article aims to identify how ignoring symptomatic benefit is a serious oversight and cause for concern given that this document, endorsed by the General Medical Council and courts, is created with the purpose of providing a framework for best interests decision-making. The new BMA (...) guidance on CANH, which is endorsed by the GMC,1 follows up on the Supreme Court case of An NHS Trust v Y,2 that any removal of CANH from a patient in prolonged disorder of consciousness no longer requires the approval of the court unless there is disagreement or the decision is finely balanced. The decision in …. (shrink)

Alzheimer's disease remains the most common form of dementia. Dementia symptoms vary depending on individual personality, life experience, and social and cultural influences. As dementia progresses, involvement of multi-disciplinary health care professionals is needed to manage the disease. Alzheimer research is progressing rapidly. While 5% of all Alzheimer's disease may be genetically determined, the majority is not. Susceptibility genes can reveal the risk of contracting Alzheimer's disease. Early life risk factors such as education, nutrition, and vascular disease may increase (...) the likelihood of dementia in later life. In the United States, two acetylcholinesterase inhibitors have been approved as cognitive enhancers. Possible prevention and symptomatic treatment interventions have focused on estrogen replacement therapy, antioxidants, and anti-inflammatory medications. Research advances have improved the clinical management of dementia. Ethical implications to the patient, family, and society are multiple and remain challenging. (shrink)

This paper aims to establish that, for Aristotle, the state of the physical body is crucial to the human capacity for theoretical understanding. In recent years, scholars have begun to recognise the importance of Aristotle’s biological writings for understanding his psychology, after the relative neglect of these connections. The relevance in particular of the so-called Parva naturalia, small works on what is common to body and soul, and the De motu animalium, a work devoted to animal motion in broad terms, (...) has begun to fill in the picture of how the living body is involved in cognition. This paper will support this point of view by adding the De generatione animalium, a work which gives an account of the advent of soul capacities through the development of the body from the blood, under the control of the nutritive soul. An Aristotelian science of human physiology is a study of the “thinking body”, a person as a whole rather than disembodied nous. I will first set out factors that have made it difficult to integrate Aristotle’s biological treatises into our understanding of human thinking. Next, I will distinguish the thinking shared with other animals, from theoretical understanding, which is something only humans can achieve. I will then explain the aspects of the body that must facilitate and eventually bring about the capacity for thinking, before turning to Aristotle’s embryology where nutritive soul is ultimately responsible for the construction and maintenance of the thinking body. It will be concluded that only a human body leads to theoretical understanding and only a healthy human body can do so adequately. (shrink)

A competent person can avoid the onset of dementia by refusing life‐sustaining medical care and by voluntarily stopping eating and drinking, bringing life to an end well before any health crisis. A competent person can also try to limit the duration of dementia by drafting an advance directive that sets bounds on the life‐sustaining care, including artificial nutrition and hydration, that medical caregivers can provide when the person no longer has the capacity to make her own medical decisions. But (...) between these two strategies there can lie a significant gap. A person could live with moderate to severe dementia for a considerable time, no longer able to voluntarily stop eating and drinking yet also not yet requiring the life‐sustaining care forbidden by advance directive.This gap has been much discussed in recent years in the Hastings Center Report. Several years ago (in the May‐June 2014 issue), Paul Menzel and M. Colette Chandler‐Cramer argued for what they described as a moderate correction to the dominant view that food and water should always be offered to a patient with dementia if the patient expresses a desire to eat and drink. The problem is taken up again by the legal scholar Norman L. Cantor in this issue (July‐August 2018), and Cantor, too, tries to find a moderate alternative. (shrink)

I recently took issue with Kathryn George's contention that vegetarianism cannot be a moral obligation for most human beings, even assuming that Tom Regan's stringent thesis about the equal inherent value of humans and many sentient nonhumans is correct. I argued that both Regan and George are incorrect in claiming that his view would permit moral agents to kill and eat innocent, non-threatening rights holders. An unequal rights view, by contrast, would permit such actions if a moral agent's health or (...) life is at stake. I then argued that current nutritional research does not support Professor George's claim that some wealthy adult males (and many fewer wealthy women) are the only persons whose health does not require the consumption of nonhuman animals and their products. In her 1992 response to my critique, George did not address my moral argumentation. She concentrated her entire paper on a wholesale rejection of my discussion of nutrition. Although she now takes a somewhat more moderate position on who can safely contemplate strict vegetarianism, she still believes that most people are not in a position to follow such a diet. In my counter-reply, I argue that her rejection is based upon numerous distortions, omissions, and false charges of fallacy. She even devotes a substantial section of her paper to criticizing me for saying the opposite of what I actually wrote. As I did in my earlier paper, I cite current research, including George's own preferred source on the topic of vegetarianism, to support my view. I conclude that Professor George has still not shown that for most human beings it is dangerous to follow a diet that omits nonhuman animals and their products. Moral agents who take the rights of humansand nonhumans seriously will find vegetarianism well worth considering. (shrink)

The objective of this article is to gain an in-depth understanding of the eating lives of low-income single mothers in Japan. Semi-structured interviews were conducted with nine low-income single mothers living in the three largest urban areas (Tokyo, Hanshin [Osaka and Kobe] and Nagoya) in Japan. Framed by the capability approach and sociology of food, their dietary norms and practices, as well as underlying factors that impact the norm-practice gap were analysed across nine dimensions: meal frequency, place of eating, meal (...) timing, duration, persons to eat with, procurement method, food quality, meal content and pleasure of eating. These mothers were deprived of various types of capabilities, extending not only from the quantity and nutritional aspects of food, but also to spatial, temporal, qualitative and affective aspects. Aside from financial constraints, eight other factors (time, maternal health, parenting difficulties, children’s tastes, gendered norms, cooking abilities, food aid and local food environment) were identified as influencing their capabilities to eat well. The findings challenge the view that food poverty is the deprivation of economic resources required to ensure a sufficient amount of food. Social interventions that go beyond monetary aid and food provision need to be proposed. (shrink)

In Africa, the human person is the supreme force, the most powerful and dominant among all created beings. While this decreed power makes the lower beings subservient to humanity, it is only intended to be a source of harmony in the advancement of the hospitality and the joy of the human species. Today, however, the traditional lifestyles of Africans are threatened with virtual extinction by insensitive development over which the indigenous peoples have no participation. Africa has not only acquiesced a (...) scientific technology that has developed its own laws far removed from the known system of nature, it has no self-limiting principle in terms of size, speed and violence to nature and humanity. Consequent upon this incongruity, the machine has replaced the human person thus degrading the ecology and resources necessary for harmonious living. This chapter argues that, African endogenous knowledge is strategic heritage resource to salvage the technologically abused environment for sustainable agro-ecological living. The chapter argues further that African endogenous knowledge system encodes environmental management and policies for resource development in Africa’s complex and ageing ecological system. In doing this, we engage in conversation about current and potential land sovereignty work in African Indigenous communities. This will achieve food security and improved nutrition, promote sustainable agriculture and improved economic status of the African indigenous farmer. We conclude that, in seeking the whole from the units of the earth resources through cultivation of the soil, the African derives high credit balance of spiritual good, virtuous life, self-reliance, courage and moral integrity. (shrink)

Antallet sultne i verden har økt, selv om det kan diskuteres om det i dag er en høyere eller lavere andel som lider under sult enn for seks år siden – før matprisøkningen. Alle er uansett enige om at det samlet sett produseres nok mat i verden til at alle kan få dekket sine ernæringsbehov. Artikkelen viser at to hovedretninger i debatten om matproduksjon står mot hverandre. Den dominerende retningen fokuserer primært på matsikkerhet, forstått som økt matproduksjon og økt handel (...) med mat. Den andre retningen argumenterer for at interessene og rettighetene for de mest sårbare må ha forrang i politiske prioriteringer, og at de sårbare sikres best med en strategi basert på menneskerettigheter. Artikkelen drøfter landfordeling, økt bruk av genteknologi i landbruket og nedbygging av handelshindre for landbruksprodukter. Industrialisering av landbruket og liberalisering av handelen med landbruksvarer kan gi gode resultater på makronivå – på kort sikt. Dersom målet er å fremme situasjonen for de mest sårbare og samtidig møte klimautfordringene er løsningen en nedenfra-tilnærming, som til nå er blitt ignorert av de fleste stater.Nøkkelord: retten til mat, matsikkerhet, klima, Verdens handelsorganisasjon, FNs tusenårsmålEnglish summary: The struggle over food intake and food productionThe number of hungry persons in the world has increased – although it is debatable whether there is currently a higher or lower proportion of suffering from hunger than six years ago – before the food price increases. All agree that the overall production of food in the world is adequate for everyone's nutritional needs. The article demonstrates that there are two main approaches in the debate on food production. The dominant approach focuses primarily on food security, understood as increased food production and increased food trade. The other approach argues that the interests and rights of the most vulnerable must prevail, and that improvements for the vulnerable are best ensured with a strategy based on human rights. The article analyzes land distribution, increased use of genetic technology in agriculture and reduction of trade barriers for agricultural products. Industrialization of agriculture and the liberalization of trade in agricultural products can provide good results at the macro level – in the short term. If the goal is to promote the situation of the most vulnerable and at the same time addressing climate change, the solution is a bottom-up approach, which until now has been ignored by most states. (shrink)

In the last fifty years, average overall health status has increased more or less in parallel with a much celebrated decline in mortality, attributed mostly to poverty reduction, sanitation, nutrition, housing, immunization, and improved medical care. It is becoming increasingly clear, however, that these achievements were not equally distributed. In most countries, while some social groups have benefited significantly, the situation of others has stagnated or may even have worsened.If health is a prerequisite to a person functioning as an (...) agent, inequalities in health constitute inequalities in people's capability to function -- a denial of equality of opportunity. So why should a concern with health equity be singled out from the pursuit of social justice more generally? Can existing theories of justice provide an adequate account of health equity? And what ethical problems arise in evaluating health inequalities? These are some of the important questions that this book addresses in building an interdisciplinary understanding of health equity. With contributions from distinguished philosophers, anthropologists, economists, and public-health specialists, it centres on five major themes: what is health equity?; health equity and social justice; responsibilities for health; ethical issues in health evaluation; and anthropological perspectives. (shrink)

There are numerous ways people can improve their cognitive capacities: good nutrition and regular exercise can produce long-term improvements across many cognitive domains, whilst commonplace stimulants such as coffee temporarily boost levels of alertness and concentration. Effects like these have been well-documented in the medical literature and they raise few ethical issues. More recently, however, clinical research has shown that the off-label use of some pharmaceuticals can, under certain conditions, have modest cognition-improving effects. Substances such as methylphenidate and modafinil (...) can improve capacities such as working memory and concentration in some healthy individuals. Unlike their more mundane predecessors, these methods of “cognitive enhancement” are thought to raise a multitude of ethical issues. This paper presents the six principal ethical issues raised in relation to pharmacological cognitive enhancers —issues such as whether: the medical safety-profile of PCEs justifies restricting or permitting their elective or required use; the enhanced mind can be an “authentic” mind; individuals might be coerced into using PCEs;, there is a meaningful distinction to be made between the treatment vs. enhancement effect of the same PCE; unequal access to PCEs would have implications for distributive justice; and PCE use constitutes cheating in competitive contexts. In reviewing the six principal issues, the paper discusses how neuroscientific research might help advance the ethical debate. In particular, the paper presents new arguments about the contribution neuroscience could make to debates about justice, fairness, and cheating, ultimately concluding that neuroscientific research into “personalized enhancement” will be essential if policy is to be truly informed and ethical. We propose an “ethical agenda” for neuroscientific research into PCEs. (shrink)

Mounting evidence documents the extraordinary toll on human health resulting from the consumption of unhealthy food products and physical inactivity. Diseases related to poor nutrition – such as diabetes, heart disease, stroke, and some cancers – are among the leading causes of disability and death in the United States. Poor diet and lack of exercise come second only to tobacco use in actual causes of preventable death in this country. It is estimated that 6% of all adult health care, (...) 7% of Medicare, and 11% of Medicaid expenditures are attributable to obesity. According to the Centers for Disease Control and Prevention, the direct medical cost associated with physical inactivity was nearly $76.6 billion in 2000.In response to America's growing obesity problem, local policymakers have been looking for legal strategies to adopt in their communities to encourage healthful behaviors. Taking the lead from the successful tobacco control movement, nutrition advocates are seeking strategies to “denormalize” unhealthy behaviors, rather than pursuing education-based approaches that encourage individuals to change their own personal behavior. (shrink)

The Fourth Edition of this bestselling, highly regarded book has been fully revised to incorporate changes in law and clinical guidance making a vital impact on patient management, encompassing: The Equalities Act 2010 which provides a right of older people to treatment without discrimination ; Case law on withdrawing nutrition and hydration ; Updated guidance on resuscitation from the Resuscitation Council, the British Medical Association and the Royal College of Nursing ; The redefining of good medical practice by the (...) General Medical Council ; The abolition of the Liverpool Care Pathway with an updated guidance on end of life care and advance care planning. Expanded throughout, this new edition also integrates two entirely new chapters covering testamentary capacity and role of the physician, and religious beliefs and end of life issues. Its practical, reflective and informative approach continue to make it essential reading for all health professionals, particularly trainees, involved in making difficult decisions in the care of older persons. It is also highly recommended for undergraduate medical students. (shrink)

This article discusses a recent ruling by the German Federal Court concerning medical professional liability due to potentially unlawful clinically assisted nutrition and hydration at the end of life. This case raises important ethical and legal questions regarding a third person’s right to judge the value of another person’s life and the concept of ‘wrongful life’. In our brief report, we discuss the concepts of the ‘value of life’ and wrongful life, which were evoked by the court, and how (...) these concepts apply to the present case. We examine whether and to what extent value-of-life judgements can be avoided in medical decision-making. The wrongful-life concept is crucial to the understanding of this case. It deals with the question whether life, even when suffering is involved, could ever be worse than death. The effects of this ruling on medical and legal practice in Germany are to be seen. It seems likely that it will discourage claims for compensation following life-sustaining treatment. However, it is unclear to what extent physicians’ decisions will be affected, especially those concerning withdrawal of CANH. We conclude that there is a risk that LST may come to be seen as the ‘safe’ option for the physician, and hence, as always appropriate. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive listing of (...) those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

The Hebrew phrase tikkun olam means repairing, mending or healing the world. Today, the phrase tikkun olam, particularly in liberal Jewish American circles, has become a slogan for a diverse range of topics such as activism, political participation, call and pursuit of social justice, charities, environmental issues and healthy nutrition. Moreover, the presidents of the United States who attend Jewish religious days and Jewish ceremonies state the tikkun olam in its Hebrew origin, pointing out its origin embedded in the (...) Judaism and a religious rule and/or an obligation that is important in Jewish tradition and thought. Nevertheless, when we look at the context of religious literature in which the phrase is used, it is seen that, although it is difficult to make a clear definition, it does not reflect modern/widespread uses and their meanings. Furthermore, tikkun olam is an ignored and even rejected concept by the Rabbinic Judaism which claims to represent the tradition and its current representative Orthodox Judaism. This fact is also seen in the usage and prevalence of the term in the U.S. and Israel. Thus, in this article, especially with reference to the norms of Mishnah, the religious-juristicial contexts and possible meanings of the phrase of tikkun olam, the notion of tikkun olam in Jewish liturgy and its implied meaning and the Kabbalistic understanding of tikkun will be presented, the development, changing and conversion of the phrase in modern age and its contemporary usage areas and reinterpretations will be demonstrated.Summary: Recently and especially in the U.S., the Hebrew phrase tikkun olam are used as a slogan in a widespread manner such as for activism, political participation, social justice, all kinds of charities, environmental issues, counter terrorism and healthy nutrition. Such a common usage of the phrase is largely the result of its literal meaning and ambiguity. Hence, this article aims to explore the place of the concept of tikkun olam in Jewish religious literature and its variations and semantic changes. Tikkun olam, literally means the repairing, mending or healing the world. However, regarding its religious context, it is difficult to determine what it means accurately. In time, some has used the tikkun olam as a legislative justification for changing specific laws, some has attributed to it an eschatological meaning which indicates to the mesianic age, and some has dicussed it in the context of mystical sense. The first usage of the phrase of tikkun olam in the Jewish religious literature was simply in the form of “because of tikkun olam” in Gittin epistle, a tractate of Mishnah and Talmud. Here, the phrase was used as a reason of a judgment concerning to the subjects of marriage, divorcement, slavery, captivity etc. In the context of these subjects tikkun olam indicates to the similar meanings like “repairing, organizing, healing, changing the world; regulating and improving the society, maintaining the social order, and prioritizing the common good. In fact, the concept of tikkun olam as the reason of the judgements in these matters is likely related to a juridical reason that intends to ensure the personal and public welfare such as clarifying the marital status of woman, to prevent the capture and seizure from Jewish society, and to deal with economy and identification of juridical status of the slaves.The other reference to tikkun olam appears in the second part of the aleinu prayer. However, the notion of tikkun olam in the aleinu prayer refers to a situation that happens in God’s Kingdom if Torah and halakhah are followed carefully. Hence, the aleinu prayer’s tikkun olam points out eschatological expectation which desires a messianic age, but not the socio-political and ecological concerns of the world as in the current fields and meanings.The modern idea of tikkun olam is also associated with the Jewish mystical movement, Kabbalah. Nonetheless, the concept of tikkun in Kabbalah is not a concept related to the socio-political circumstances of the world where we live in, but it is related to the restoring of the divine world. In order to restoring the divine world, human should fulfill the commands by studying Torah and have a spiritual and moral rehabilitation process by engaging in ascetic practices.The use of the phrase of tikkun olam gradually progress in the socio-political life of the U.S. The first use of the expression of tikkun olam in the U.S. was in the 1950’s by Shlomo Bardin, the founder of the Brandeis Camp Institute in California. Bardin asserted that the Aleinu prayer was the most important expression of Jewish values, particularly the expression “le-taken olam be-malchut shaddai” that is typically translated as “when the world shall be perfected under the reign of the God.” Bardin suggested that these words referred to the obligation of Jews to work for a more perfect world. The concept of tikkun olam entered contemporary usage by the way of its being preferred as a name to those such as social justice and charity programmes which was launched by the Reformist and Conservative groups in the second half of the twentieth century. In 1970s, United Synagogue Youth which is the national youth foundation of the conservative movement adopted the expression of tikkun olam and changed the title of its social action programs from “Building Spiritual Bridges” to “Tikkun Olam.” Nowadays, United Synagogue Youth proceeds all of its social activities and tzedakah programs through the tikkun olam project.By the end of 1970’s, New Jewish Agenda, an organization devoted itself to the religious and social values, acknowledged the slogan of “Tikkun Olam” as the spirit of its ideology. In 1986, Michael Lerner entitled a left-oriented liberal publication with the concept of Tikkun by claiming that this concept represented the origin of Judaism, and he take an important role on making the concept have a prevalence.Pittsburgh Platform organized in 1999 by the Reformist Jewish Movement emphasized that people must perform the most significant moral principles in the relationships with all non-Jewish people and all other creatures. This platform also stated that making the world a better place with the help of God would quicken the upcoming the messianic age. The tikkun understanding of the Reformist movement evolved to more universal realm by embracing the non-Jewish people, as well. Over the last two decades, successive presidents of the U.S. who attended in the ceremonies of Jewish religious days and Jewish assemblages have contributed to the prevalence and usefulness of tikkun olam by mentioning the phrase of tikkun olam in Hebrew, expressing that this is an essential principle of Judaism and addressing that this has a central role in Jewish tradition and thought. On the other hand, this concept does not have an important or a central place in Rabbinic Judaism and even in Orthodox Jewish communities which are the current representatives of Rabbinic Judaism. Moreover, Reformist, Conservative, and Reconstructionist American Jews who are considered on the liberal side of the politics has put the concept on the current use and the world’s agenda. Thus, the phrase of the tikkun olam is more popular in non-Judaic milieux in the U.S. than the Jews in Israel. In Israel where the Orthodox doctrine is dominated and shaped the people, tikkun olam is regarded as a western value and is ignored. (shrink)

Research over the past few decades has shown the positive influence that cognitive, social, and physical activities have on older adults’ cognitive and affective health. Especially interventions in health-related behaviors, such as cognitive activation, physical activity, social activity, nutrition, mindfulness, and creativity, have shown to be particularly beneficial. Whereas most intervention studies apply unimodal interventions, such as cognitive training, this study investigates the potential to foster cognitive and affective health factors of older adults by means of an autonomy-supportive multimodal (...) intervention. The intervention integrates everyday life recommendations for six evidence-based areas combined with psychoeducational information. This randomized controlled trial study compares the effects of a MMI and CT on those of a waiting control group on cognitive and affective factors, everyday life memory performance, and activity in everyday life. Three groups, including a total of 119 adults aged 65–86 years, attended a 5- or 10-week intervention. Specifically, one group completed a 10-week MMI, the second group completed 5-week of computer-based CT followed by a 5-week MMI, whereas the third group paused before completing the MMI for the last 5 weeks. All participants completed online surveys and cognitive tests at three test points. The findings showed an increase in the number and variability of activities in the everyday lives of all participants. Post hoc analysis on cognitive performance of MMI to CT indicate similar or better effects. Furthermore, results on far transfer variables showed interesting trends in favor of the MMI, such as increased well-being and attitude toward the aging brain. Also, the MMI group showed the biggest perceived improvements out of all groups for all self-reported personal variables. The results implicate a positive trend toward MMI on cognitive and affective factors of older adults. These tendencies show the potential of a multimodal approach compared to training a specific cognitive function. Moreover, the findings suggest that information about MMI motivates participants to increase activity variability and frequency in everyday life. Finally, the results could also have implications for the primary prevention of neurocognitive deficits and degenerative diseases. (shrink)

Farm to School programs aim to connect school children with local foods, to promote a synergistic relationship between local farmers, child nutrition and education goals, and community development. Drawing from 18 months of ethnographic research with a regional FTS project and interviews with child nutrition program operators implementing FTS across Georgia, we identify perceptions of food safety as an emerging barrier in efforts to bring local foods into schools. Conducting a thematic analysis of data related to food safety, (...) we find that FTS participation may be hindered by discourses and perceptions of safety risks attributed to local foods—and to local produce in particular. We argue that this results, paradoxically, from a core tenant of FTS and other local food movements: forging personal relationships with farmers, through which POs confront the transparency of local food production, in contrast to the opacity of food procured through standard supply chains. Faced with unfamiliar production practices, and responsibilized to protect students as “at risk” subjects, POs may decide that buying local food is “not worth the risk.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comment on Hospice of Washington's PolicyJohn A. Robertson (bio)The recent history of medical ethics may accurately be described as a history of coming to terms with personal autonomy and informed consent across the range of medical practice. Nowhere has this recognition been more important than in decisions to withhold or withdraw life-sustaining medical procedures from terminal and chronically ill patients.Despite the widespread acceptance of autonomy in these decisions, many (...) people—physicians, families, and policymakers—have balked at extending it to the withdrawal of artificially supplied fluids and nutrition. The symbolic connotations of food and water have led some persons to perceive cessation of medically-supplied fluids and nutrition to be a cruel, barbarous act, rather than the merciful respect for the dying patient that such withdrawal usually represents.Two recent events might help resolve the controversy, and ensure that decisions about artificial fluid and nutrition are handled like any other medical intervention—according to patient and family choice and patient welfare. One event is the Supreme Court decision in Cruzan (Cruzan v. Director of Missouri Department of Health, 110 S.Ct. 2841, 1990). Although the Supreme Court upheld Missouri's constitutional power to require artificial nutrition for a patient in a persistent vegetative state, its decision was not based on the symbolic importance of artificial fluids and nutrition. No Supreme Court justice saw a significant difference between medically-supplied nutrition and hydration and other medical interventions, thus allowing them to be discontinued either directly or by advance directive on the same basis as other medical interventions.The second event is the publication of the statement of "Philosophy Regarding Medical Intervention to Supply Fluids and Nutrition" by Hospice of Washington (or similar statements by other organizations). This statement is useful and important because it removes the issue of food and water from its symbolic overlay [End Page 139] and places it in the real context of dying hospice patients. It makes clear that the overriding consideration should be benefit to the patient "in accord with the patient's wishes or those of the appropriate surrogate(s) for the patient." Depending on those wishes and their impact on the patient, this position may or may not involve medically-supplied fluids and nutrition.This statement is also helpful in showing the medical complexity of such decisions in terms of their actual effect on dying patients. Rather than an either/or position, it recognizes that fluids may harm a dying patient by increasing discomfort, and that "persons near death do not ordinarily tolerate substantial volumes of enteral feedings." Thus rather than adhere to a symbolically-based position about the meaning of food and water to a dying patient, the important thing is to look to that patient's needs and give fluids or not, as the patient's wishes and situation demand.Fortunately, the law in most jurisdictions will recognize such a position. In those few jurisdictions that have made a fetish of artificial fluids and nutrition, the law should be changed, for the HOW statement makes clear that such a position may actually end up harming dying patients. Patient welfare should be privileged above all else, and patient welfare may often entail that fluids and nutrition not be medically supplied. Even then, however, caregivers will look to patient comfort and remedy dry mouths and lips with lubricants and ice chips.The HOW statement is, in my view, a very useful guideline not only for hospices but for hospitals, too—for any situation in which a patient is terminally ill and soon to die. A somewhat different set of issues arises, however, when the patient is chronically ill and incompetent, and will survive for long periods with medically-supplied fluids and nutrition. Recognition of patient rights in those situation should also permit cessation of fluids and nutrition on the same basis that respirators, antibiotics, and other life-sustaining measures may be withheld. But the withholding of medically-supplied fluids and nutrition from a patient who no longer has interests in surviving in an extremely debilitated condition raises different issues from withholding fluids that could cause such discomfort and nutrition when the patient is imminently dying. In either case, patient... (shrink)

Food waste comprises a significant portion of the waste stream in industrialized countries, contributing to ecological damages and nutritional losses. Guided by a systems approach, this study quantified food waste in one U.S. County in 1998–1999. Publications and personal interviews were used to quantify waste from food production, processing, distribution, and consumption. Approximately 10,205 tons of food waste was generated annually in this community food system. Of all food waste, production waste comprised 20%, processing 1%, distribution 19%, and 60% of (...) food waste was generated by consumers. Less than one-third (28%) of total food waste was recovered via composting (25%) and food donations (3%), and over 7,000 tons (72%) were landfilled. More than 8.8 billion kilocalories of food were wasted, enough to feed county residents for 1.5 months. This case study offers an example of procedures to quantify and compare food waste across a whole community food system. (shrink)

Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

Theological basis -- Religion and health care -- The dignity of human life -- The integrity of the human person -- Implications for health care -- Theological principles in health care ethics -- Method -- The levels and questions of ethics -- Freedom and the moral agent -- Right and wrong -- Metaethics -- Method in Catholic bioethics -- Catholic method and birth control -- The principle of double effect -- Application -- Forgoing treatment, pillar one: ordinary and extraordinary means (...) -- Forgoing treatment, pillar two: killing and allowing to die -- Forgoing treatment, pillar three: decisions by competent patients -- Forgoing treatment, pillar three: decisions for incompetent patients -- Forgoing treatment, pillar three: advance directives -- Hydration and nutrition -- Physician-assisted suicide and euthanasia -- Medical futility -- Pain and pain management -- Ethics committees -- Embryonic stem cells and the beginning of human personhood -- Genetic engineering -- Allocating health care resources -- The use and misuse of the allocation argument. (shrink)