Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of 1502 (...) French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

El artículo revisa las aportaciones más trascendentes que Jordi Ferrer ha hecho a la tradición racionalista de la prueba jurídica y evalúa críticamente el limitado papel que, desde su óptica, le corresponde desempeñar a la epistemología en la discusión general sobre los estándares de prueba apropiados para las distintas ramas del derecho. Más específicamente, se analiza la irrelevancia que Ferrer parece atribuir a dicha disciplina –o el silencio que debe guardar–, respecto del establecimiento del estándar de prueba deseable en materia (...) penal. Se concede que, en efecto, le corresponde al pueblo tomar la decisión de qué estándar implementar. No obstante, se sostiene, ello no impide que la epistemología incida en el proceso de formación de dicha decisión mediante la realización de observaciones, el ofrecimiento de argumentos y la propuesta de metodologías adecuadas, con miras a que aquella se tome en un contexto mejor informado y sea lo más racional posible. Se ilustra esta posición haciendo referencia al proyecto de epistemología jurídica de Larry Laudan. (shrink)

Scholarly work in the area of the wisdom movement and its literature has opened up, in the last half-century, new vistas in Old Testament religion and theology. The research has progressed on such different fronts and intensified so rapidly that a survey charting its movement and achievement is necessary to appreciate the achievement and sense its implications.

Pain is not a primitive sensory event but rather a complexperception and a process by which a person interacts with theinternal and external environments, constructs meaning, andengages in action. Because folk beliefs are central to meaning,folk concepts of pain play multiple causal roles in a painpatient's interaction with health care providers and others.In every case, the notion of pain is linked to a goal-directedbehavior that is useful to the person. The wide variation inconcepts of pain across individuals suffering with painunderscores (...) the richness and complexity of the pain experience.In some cases involving chronic pain, the patient may form amaladaptive cluster of behaviors around the concept of pain.Patient beliefs and expectations are an important part of manychronic pain syndromes, and patients can benefit fromintervention directed at revising the individual's folk model of pain. Memetics offers a framework for identifying the memesthat patients hold and determining whether patient memes fitor clash with provider memes. (shrink)

Shoemaker (1996) presenteda prioriarguments against the possibility of ‘self‐blindness’, or the inability of someone, otherwise intelligent and possessed of mental concepts, to introspect any of her concurrent attitude states. Ironically enough, this seems to be a position that Gopnik (1993) and Carruthers (2006, 2008, 2009a,b) have proposed as not only possible, but as the actual human condition generally! According to this ‘Objectivist’ view, supposed introspection of one's attitudes is not ‘direct’, but an ‘inference’ of precisely the sort we make about (...) the attitudes of others, an inference that has the advantage in our own case ofonlyour own sensory data and memories, our behavior, and of the context we are in; i.e. we are all substantially self‐ blind. After sorting out a number of methodological and verbal issues, I argue, first, that thea prioriarguments against Objectivism don't succeed, and that Gopnik and Carruthers are right to regard the issue as an empirical one. On the other hand, I think they seriously underestimate the difficulty of establishing Objectivism. It is unlikely there is an inferential procedure from the data of pure sensation, behavior and context to the relevant self‐attributions that would be as spectacularly reliable as people manifestly seem to be. Moreover, there is a simpler model: the mind very likely consists of a panoply of sub‐routines some of whose outputs are ‘tagged’ for their having been so processed, rather in the way that software ‘documents’ are on standard computers. Introspection plausibly consists in a person's simply attending to distinctive constellations of these tags, even though they may lack phenomenal feels. This draws attention to an important independent fact: that much of phenomenology (or ‘what it's like’ to be in a certain state) may be constituted by facts that are not phenomenal. (shrink)

In March 1996, the General Accounting Office issued the report Scientific Research: Continued Vigilance Critical to Protecting Human Subjects. It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always clear (...) to clinicians. Controversy exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

Freely falling point-like objects converge toward the center of the Earth. Hence the gravitational field of the Earth is inhomogeneous, and possesses a tidal component. The free fall of an extended quantum mechanical object such as a hydrogen atom prepared in a high principal-quantum-number state, i.e. a circular Rydberg atom, is predicted to fall more slowly than a classical point-like object, when both objects are dropped from the same height above the Earth’s surface. This indicates that, apart from transitions between (...) quantum states, the atom exhibits a kind of quantum mechanical incompressibility during free fall in inhomogeneous, tidal gravitational fields like those of the Earth.A superconducting ring-like system with a persistent current circulating around it behaves like the circular Rydberg atom during free fall. Like the electronic wavefunction of the freely falling atom, the Cooper-pair wavefunction is quantum mechanically incompressible. The ions in the lattice of the superconductor, however, are not incompressible, since they do not possess a globally coherent quantum phase. The resulting difference during free fall in the response of the nonlocalizable Cooper pairs of electrons and the localizable ions to inhomogeneous gravitational fields is predicted to lead to a charge separation effect, which in turn leads to a large Coulomb force that opposes the convergence caused by the tidal gravitational force on the superconducting system.A “Cavendish-like” experiment is proposed for observing the charge separation effect induced by inhomogeneous gravitational fields in a superconducting circuit. The charge separation effect is determined to be limited by a pair-breaking process that occurs when low frequency gravitational perturbations are present. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

Objectives The objectives of the study are to understand the current practice of informed consent in medical research in public hospitals in Shanghai, and to share our views with other countries, especially developing countries. Methods In the study, 145 consent forms (CFs) of the selected research projects in eight public hospitals with ethics committees in Shanghai were audited, and the principle investigators (PIs) of these research projects and 40 student subjects who had participated in clinical drug tests were surveyed by (...) questionnaires. Results The CFs of medical researches in public hospitals with ethics committees in Shanghai were generally acceptable. However, there were some defects in the CFs. Although most of the surveyed PIs had correct recognition of informed consent, some processes of informed consent were not in accordance with generally accepted requirements. A large number of the PIs considered the greatest difficulty with informal consent was lack of correct recognition of subjects or legally authorised representatives on medical research. Discussion Informed consent in medical research should consider the research ethics, the background of potential subjects, the local resources and culture of medical research. In addition, special protection is needed for student subjects in informed consent as well as efforts for building and restoring the public's trust in biomedical research. Conclusion The informed consent in Shanghai's public hospitals with ethics committees was generally acceptable and the achievement of adequate informed consent is influenced by many factors. (shrink)

Muhammed Kâsım Nânotevî başkanlığında kurulan Diyobendîlerin ta-savvuf ile irtibatını konu edinen bu çalışmanın temel amacı, Hint alt kıtasının dinî yaşantısında etkin olan Diyobendîlerin tasavvufa olan yaklaşımlarını analiz etmektir. Çalışmada öncelikle Diyobend’in kuruluşu, İngilizlere karşı mücadeleleri, Osmanlı Devleti ile temasları ve daha sonra Diyobendîlerin tasavvuf anlayışına dâir bilgilere yer verilmiştir. Onların tasavvuf ile ilişkileri araştırılırken literatür açısından Diyobendîler ile ilgili temel kaynaklara bakılmıştır. Bu kaynaklar geniş bir incelemeye tabi tutularak onların tasavvufa bakış açıları tespit edilmeye çalışılmıştır. Elde edilen sonuçlar kısaca şöyle (...) özetlenebilir: Sünnî olan Diyobendîler tasavvufu şerîatın bir parçası olarak görmektedirler. Onlar, mânevî hastalıklardan korunmak için tasavvufa sarılmaya, mürşidlerin sünnete ittibasına ve bid’atlardan uzak durmaya önem vermiş, ayrıca nübüvvetin velâyetten üstün olduğunu, kerâmetin hak olduğunu ve vahdet-i vücûdun tasavvufun esaslarından biri olmayıp bunun bir hâl olduğunu ifade etmişlerdir. Eğitim müfredatlarında tasavvuf klasiklerinin yanı sıra kendi mürşidlerinin yazdığı eserleri de okutan Diyobendîlerin tasavvufun birçok konusunda söz sahibi oldukları tespit edilmiştir. (shrink)

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

In the last number of C.Q. Mr. A. D. Knox has drawn up a list of Theocriteans who, he suggests, ‘have all of them made the most elementary mistake’ of failing to consider the possibility at least that it is the Boy, and not the Fox, who is the subject of καθξ in Id. I. 51. From that list he will have to with-draw two names, Gow and Campbell. This construction, which Mr. Knox propounds as a novelty, had been suggested (...) by Mr. Gow in C.R. XLIV., pp. 9–10. For my part, I am not ingenious, and that syntactical possibility would no more have occurred to me independently than would Mr. Gow's three renderings of it, two of which are ‘until he sets her vinous breakfast upon a more solid basis’ and ‘until he sets her grapes on toast’; as little could I ever have thought, with Mr. Knox, of ‘the obvious necessity’ for this fox ‘of rest after a heavy meal’; still less of those further inevitable eventualities1 at which he hints with such delicacy in his quotation of Aelian V. 39. In regard to these and all such matters, to my mind ‘it were to consider too curiously to consider so.’ For even in Greek which represented for my ears some such English as ‘until she set him a-breakfastant upon the dries,’ if there was one thing with which I was completely satisfied it was with the Fox as subject; that seemed so perfectly in keeping both with the happy playfulness of the passage and with the richly idiomatic φατ as applied to a graven image of an animal. But from the fact that I criticized Mr. Gow's note it is obvious that I was familiar with his idea. (shrink)

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who (...) were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence. Des interviews structurés ont eu lieu avec 149 infirmiers/ères dans sept pays en Amérique, Asie, Australie et Europe concernant l'alimentation des malades gravement dément qui refusent de manger. La raison la plus générale pour des infirmiers/ères d'être prêt à changer leures décisions de donner à manger ou non sont: un ordre du médecin, la demande du mari de la malade ou de la réunion du personnel. Il y avait un lien entre la volonté de nourir et le rang des principes éthiques. Les infirmiers/ères les plus enclins de nourir la malade le plus souvent donnaient un rang supérieur au principe éthique de la sainteté de vie, pendant que ceux et celles qui choisissaient de ne pas nourrir la malade donnaient un rang supérieur au principe éthique de l'autonomie. Tous insistaient sur l'importance du principe éthique de la bienfaisance. Konstruktive Interviews wurden mit 149 ausgebildeten Krankenschwestern und Pfleger in sieben Ländern in Amerika, Asien, Australien und Europa gehalten über die Ernährung von schwer von Dementia praecox leidenden Patienten, die das Essen verweigern. Die gewöhnlichsten Gründe des Pflegepersonals für die Bereitwilligkeit, ihre Entscheidung, zu ernähren oder nicht, zu ändern, waren Anordnungen vom medizinischen Chef, Anfragen vom Ehemann der Patientin und/oder einer Personalsitzung. Es bestand ein Zusammenhang zwischen der Bereitwilligkeit zur Ernährung und dem Rang der ethischen Prinzipien. Die Pflegenden, die sich am meisten neigten, die Patientin zu ernähren, gaben dem ethischen Prinzip der Heiligkeit des Lebens einen hohen Rang, während die, die meistens vorzogen, die Patientin nicht zu ernähren, gaben dem ethischen Prinzip der Autonomie einen hohen Rang. Alle Pflegenden legten grossen Wert auf das ethische Prinzip der Wohltätigkeit. (shrink)

Bu çalışmada din görevlilerinin mesleki doyumu ile örgütsel adalet algısı arasındaki ilişki incelenmiştir. Çeşitli kurum çalışanları örnekleminde, yapılan çalışmalar örgütsel adalet ile mesleki doyum arasında bir ilişkinin olduğunu göstermektedir. Fakat din görevlileri ile ilgili olarak örgütsel adalet ile mesleki doyum arasındaki bir ilişkiyi konu edinen bir çalışmaya rastlanmamıştır. Yapılan işten memnuniyet duymak anlamına gelen mesleki doyum çalışanın iş verimini artırmaktadır. Bununla ilişkili olarak da çalışanın, kurumu tarafından çalışanlara adil davranıldığına ilişkin algısı mesleki doyumunu etkilemektedir. Bu çalışmada din görevlilerinin örgütsel adalet (...) algısı ve mesleki doyumu arasındaki ilişkiyi belirlemek için, ilişkisel tarama modeli kullanılmıştır. Veriler ise örgütsel adalet ölçeği, mesleki doyum ölçeği ve demografik değişkenlerin de bulunduğu bir form ile Antalya’da görev yapan 380 din görevlisinden elde edilmiştir. Söz konusu iki değişken arasındaki ilişkinin analizinde korelasyon ve yapısal eşitlik modeli kullanılmıştır. Çalışma sonucunda din görevlilerinin örgütsel adalet algısının, mesleki doyum ile orta düzeyde, pozitif yönde ve anlamlı ilişkisinin olduğu tespit edilmiştir. Açıklanan varyans açısından ise örgütsel adalet algısının, mesleki doyuma ilişkin toplam varyansın %17’sini açıkladığı belirlenmiştir. (shrink)

Marco Aurelio. Pensamientos.--Kant, E. Fundamentación de la metafísica de las costumbres.--Mill, J. S. De que clase de prueba es susceptible el principio de utilidad.--Lefebre, H. La moral marxista.--Dostoievski, F. Crimen y castigo.--Nietzsche, F. Más allá del bien y del mal.--Bergson, H. La obligación moral.--Camus, A. El extraño.--Hare, R. M. Etica y política.

Possible measurement and testability weaknesses in Sperry's mind-supervenient emergent interactionism "argument by analogy" model are described. An alternative brain-supervenient interactionism that addresses the weaknesses of Sperry's mind-brain model is presented. The alternative model, Neurological Positivism - a systems-theoretical evolutionary epistemology - proposes that the measurable energy quality of the algorithmic organization of the Darwinian brain supervenes that of cultural mental models and thus downwardly influences the brain circuitry patterns that underlie them. Brain and mind are defined in interrelated energy terms (...) within the context of the self-referential maximum-power principle. The equivalence of maximum-power principle energy hierarchies to chaotic/fractal dynamical designs is described. The production of mental models through reflective thinking is defined as an emergent dimension of energetic self-referencing by the brain operating in accordance with the maximum-power principle. It is concluded that within the context of NP the brain-mind relationship constitutes an "uneven" central state energy identity, with brain supervenient, when brain-mind relative energy qualities are taken into account. (shrink)

Images of the future are usually only caricatures of the present. Perhaps this picture of the future of medical care will also prove to be a caricature. Whether it does depends on choices that Americans have still to make. —Paul Starr The Social Transformation of American Medicine.