This study examined why intensive care unit (ICU) nurses experience difficulties in respecting the wishes of patients in end-of-life care in Japan. A questionnaire survey was conducted with ICU nurses working in Japanese university hospitals. The content of their narratives was analyzed concerning the reasons why the nurses believed that patients' wishes were not respected. The most commonly stated reason was that patients' wishes were impossible to realize, followed by the fact that decision making was performed by others, regardless of (...) whether the patients' wishes were known, if the death was sudden, and time constraints. Many nurses wanted to respect the wishes of dying patients, but they questioned how patients die in ICUs and were therefore faced with ethical dilemmas. However, at the same time, many of the nurses realized that respecting patients' wishes about end-of-life care in an ICU would be difficult and that being unable to respect these wishes would often be unavoidable. The results thus suggest that there has been insufficient discussion about respecting the wishes of patients undergoing intensive care. (shrink)

Dienes & Perner's analysis provides a clear theoretical justification for using a demonstration of volitional control as a criterion for conscious awareness. However, in memory tasks, the converse does not hold: A phenomenological awareness of a memory episode can arise involuntarily, even when the task does not require retrieval of the episode. The varying amounts of volitional retrieval required by different memory tasks need to be recognized.

We agree with Frost that the variety of orthographies in the world's languages complicates the task of Frost suggests that orthographic processing must therefore differ between orthographies. We suggest that the same basic orthographic processes are applied to all languages. Where languages differ is in what the reader must do with the results of orthographic processing.