Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)

ObjectivesTo investigate which of two sources of information about an older adult’s wishes—choices made in an advance directive or proxy’s opinion—provides better insight into the older adult’s preferences measured in hypothetical clinical situations involving decisional incapacity.MethodsSecondary analyses of data collected from 157 community-dwelling, decisionally competent adults aged 70 years and over who attended a group information session on advance directives with their proxy. Older adults were invited to complete a directive introduced during the session, designed to express healthcare preferences. An (...) average of 3 months later, older adults were asked during an interview whether they would want to receive each of four medical interventions and what their goals of care would be should they develop one of three sudden health events, assuming that they had severe dementia. Proxies were asked to guess the older adult’s answers in each of the seven scenarios.ResultsEighty per cent of the older adults completed the directive. Choices they made in the directive were more in line with the preferences they stated during the interview than were their proxies’ guesses at their answers. However, concordance was relatively low, with percentages of agreement ranging from 43% to 83% across scenarios.ConclusionsFindings suggest that a directive might provide better insight into a person’s wishes than the person’s proxy, although neither source is perfect. A multifaceted decision-making model that includes both sources of information might better serve the interests of older adults who have lost the capacity to make decisions on their own.Trial registration numberISRCTN89993391; Post-results. (shrink)

BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including (...) support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered. (shrink)

Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

L’acceptabilité sociale est devenue un élément incontournable pour la réalisation de projets de mise en valeur du territoire et des ressources naturelles. Elle constitue bien souvent le cœur des préoccupations des investisseurs, des communautés, des instances régionales et gouvernementales, des citoyens, du milieu des affaires et des groupes environnementaux. Le ministère de l’Énergie et des Ressources naturelles, par sa mission de gardien du territoire public et de soutien au développement de projets de mise en valeur des ressources énergétiques et minières, (...) est directement concerné par ces préoccupations. À l’automne 2014, le Ministère a lancé le chantier sur l’acceptabilité sociale. Les pistes de réflexion qui se sont dégagées de cet exercice ont permis d’élaborer des orientations visant à améliorer ses pratiques en la matière. Le Ministère a fait connaître ces orientations en février 2016 dans son Livre vert et prévoit la tenue de consultations particulières en commission parlementaire. (shrink)

This edition of Marcel's inspiring Homo Viator has been updated to includle fifty-seven pages of new material available for the first time in English, making this the first English-language edition to conform to the standard French edition. Here, Christianity's foremost existentialist of the twentieth century gives us a prodigious personal insight on `man on the way' that will reinforce and commend our own pilgrimages in hope. "Homo Viator - "Homo Viator - or as Marcel calls him, `itinerate man' (...) - is an outstanding example of the philosophy concerned, not with technical problems, but with the urgent problems of man. Marcel talks to our condition, emphasizing our urgent need of hope, thus discovering beyond the lack of stability the values on which we may depend. "A subtle mind, a dramatist as well as a philosopher, close to the texture of human experience, he goes far beyond current platitudes to show that our Western tradition contains living truths that are as essential to our contemporary life as they were to our ancestors when they discovered them." - Eliseo Vivas "The theme of Marcel's Homo Viator is close to the center of all preoccupations: man in his pilgrim condition. With great virtuosity in the use of his own philosophical method, he probes into interpersonal relations and the threat to ethical values. Marcel excels here in his concrete analyses of the attitude of hope, the family community in its temporal and supratemporal aspects, and the forgotten virtue of personal fidelity." - James Collins. (shrink)

The central theme of this important book is that we are paying the price of an arrogance that refuses to recognize mystery. The author invites the reader to enter into the argument that he holds with himself on a great number of problems. Written in the early 1950s, Marcel's discussion of these topics are remarkably contemporary, e.g.: * Our crisis is a metaphysical, not merely social, one. * What a man is depends partly on what he thinks he is, (...) and a materialistic philosophy turns men into things. * Can a man be free except in a free country? * Stoicism is no longer a workable philosophy because today pressure can be put on the mind as well as on the body. * Technical progress is not evil in itself, but a technique is a means that, regarded as an end, can become either an idol or an excuse for self-idolatry. State control of scientific research, leading to a concentration on new means of destruction, is a calamity. * Fanaticism is an opinion that refuses to argue, and so the fanatic is an enemy of truth. * The kind of unification that science is bringing about today is really an ironing out of differences, but the only valuable kind of unity is one that implies a respect for differences. * We must beware of thinking in terms of great numbers and so blinding ourselves to the reality of individual suffering. Our philosophical approach to being is made possible only by our practical approach to our neighbor. * We must encourage the spirit of fraternity and distrust the kind of egalitarianism that is based on envy and resentment. * No man however humble should feel that he cannot spread the light among his friends. No easy solution is offered, but the author conveys his own faith that ultimately love and intelligence will triumph. (shrink)

This edition of Marcel's inspiring Homo Viator has been updated to includle fifty-seven pages of new material available for the first time in English, making this the first English-language edition to conform to the standard French edition. Here, Christianity's foremost existentialist of the twentieth century gives us a prodigious personal insight on 'man on the way' that will reinforce and commend our own pilgrimages in hope. Book jacket.

Libertarian paternalism involves the idea that it is justified to shape the context in which people make important choices in a way that they are nudged to options that would be better for them, wh...

In this chapter, we discuss a specific kind of progress in economics, namely, progress that is pushed by the repeated use of mathematical models in most sub-branches of economics today. We adopt a functional account of progress to argue that progress in economics occurs via the use of what we call ‘common recipes’ and the use of model templates to define and solve problems of relevance for economists. We support our argument by discussing the case of twentieth-century business cycle research. (...) By presenting this case study in detail, we show how model templates are not only re-applied to different phenomena. We also show how scientists come up with them in the first place and how – once they are considered less useful – they are replaced with new ones. Finally, our case also illustrates that it is not only the mathematical structure that is re-used but that such a re-use also requires a shared conceptual vision of core properties of the phenomenon. If that vision is not shared anymore among economists, a model template can become useless and has to be replaced – sometimes through overcoming resistance – with a different one. (shrink)

Essays in this volume honor Marcel Senn on the occasion of his retirement from the law department of Universität Zürich. The contributors of the essays are colleagues and friends.

Peut-on dire qu'une philosophie est vraie?" [et la réponse négative de Canguilhem], "La réalité des philosophies" [et l'idéalisme radical de Gueroult], "Les deux systèmes de métaphysique" [et la place de Spinoza], "Comment je vois la Nature", "Les points cardinaux de ma philosophie", "Comment philosopher", "Faire son devoir" [ce qui compte est 1'k-te] sont parmi les chapitres principaux de cet ouvrage. Ceux-ci sont secondaires : "Bergson et Eucken", "Palmyre", "Kant contre Spinoza" [sur la place des définitions]."--Page 4 of cover.

Decision outcomes sometimes result in negative emotions. This can occur when a decision appears to be wrong in retrospect, and/or when the obtained decision outcome does not live up to expectations. Regret and disappointment are the two emotions that are of central interest in the present article. Although these emotions have a lot in common, they also differ in ways that are relevant to decision making. In this article we review theories and empirical findings concerning regret and disappointment. We first (...) discuss how regret and disappointment differ with respect to their antecedent conditions, appraisals, and phenomenology. We also discuss possible behavioural consequences of experiencing these emotions. Next, we consider how the anticipation of regret and disappointment may influence decision making. We use regret and disappointment theory, developed by the economists Bell (1982, 1985), and Loomes and Sugden (1982, 1986, 1987), as a framework for our discussion. Finally, we argue that combining the theoretical approaches and research paradigms of behavioural decision theory with emotion theories will significantly increase our knowledge of antecedents and consequences of emotions. (shrink)

In Kreative Gegensätze Marcel Bubert analyses the debates among medieval scholastics on the social usefulness of learned knowledge in their specific social and cultural contexts. In particular, he shows how the skepticism towards the scholars as well as the tensions between the University of Paris, the French royal court, and the citizens of Paris had profound effects on the scientific community, and led to very different views on the utility of philosophy. Some Masters responded to the expectations of society (...) by emphasizing the autonomy of philosophical cognition. Others departed radically from this notion of science "for its own sake", and created decidedly "practical" concepts of knowledge. The examination of these contentious relations shows how the dynamics of mutual demarcation within this "constellation" became intellectually prolific by way of generating highly original and innovative responses to the question of the utility of philosophy. (shrink)

The Routledge Companion to Sounding Art presents an overview of the issues, methods, and approaches crucial for the study of sound in artistic practice. Thirty-six essays cover a variety of interdisciplinary approaches to studying sounding art from the fields of musicology, cultural studies, sound design, auditory culture, art history, and philosophy. The companion website hosts sound examples and links to further resources. The collection is organized around six main themes: Sounding Art: The notion of sounding art, its relation to sound (...) studies, and its evolution and possibilities. Acoustic Knowledge and Communication: How we approach, study, and analyze sound and the challenges of writing about sound. Listening and Memory: Listening from different perspectives, from the psychology of listening to embodied and technologically mediated listening. Acoustic Spaces, Identities and Communities: How humans arrange their sonic environments, how this relates to sonic identity, how music contributes to our environment, and the ethical and political implications of sound. Sonic Histories: How studying sounding art can contribute methodologically and epistemologically to historiography. Sound Technologies and Media: The impact of sonic technologies on contemporary culture, electroacoustic innovation, and how the way we make and access music has changed. With contributions from leading scholars and cutting-edge researchers, The Routledge Companion to Sounding Art is an essential resource for anyone studying the intersection of sound and art. (shrink)

-- -- ḥeleḳ 2. Sofisṭim. Soḳraṭes. Aflaṭon.

L'ouvrage présente, à partir d'une thèse empruntée à chacun, quinze auteurs qui ont contribué - et pour la plupart contribuent encore - au débat ...

Perhaps the most animated debate in green political thought-the subdiscipline of political theory devoted to the relations between humanity, politics and environment-addresses the question of the compatibility of ecologism and liberal democracy, more particularly the liberal aspects of the latter. The present article affirms and further elaborates earlier suggestions that existing approaches to this matter are either flawed or, when defensible, prone to produce trivial conclusions. Incompatibility of the two theories is always to be expected, in one form or another. (...) It is argued that a characterization of political theories as families growing and changing over time, a notion partly derived from Wittgenstein’s family concept, allows us to understand ecologism and liberalism as evolving theories, and to anticipate the development of both-which may lead to far more surprising conclusions. (shrink)

Regret and disappointment have in common the fact that they are experienced when the outcome of a decision is unfavourable: They both concern “what might have been”, had things been different. However, some regret and disappointment theorists regard the differences between these emotions as important, arguing that they differ with respect to the conditions under which they are felt, and how they affect decision making. The goal of the present research was to examine whether and how these emotions also differ (...) with respect to the way in which they are experienced. Participants were asked torecall aninstance of intense regret or disappointment andto indicate what they felt, thought, felt like doing, did, and were motivated to do during this experience (cf. Roseman, Wiest, & Swartz, 1994). Significant differences between regret and disappointment were found in every category. These differences were most pronounced for “action tendencies” (what participants felt like doing) and “emotivations” (what they were motivated to do). These results suggest that the two emotions have differential implications for future behaviour. (shrink)

Tous les textes publiés dans l'ouvrage parlent directement de l'œuvre de Jean-Michel Berthelot. La première partie, " Sociologie de Jean-Michel Berthelot ", rassemble les contributions restituant des traits de son œuvre à l'aide d'études de cas précis ou de panoramas plus larges, et balise des domaines de recherche dans lesquels il s'est illustré : sociologie de l'éducation, du corps, des sciences, épistémologie des sciences sociales. La deuxième partie rend compte des perspectives ouvertes par ses travaux et de la manière dont (...) des chercheurs ont mis en œuvre ses réflexions pour leurs propres recherches. Il s'agit donc de restituer la façon dont on peut faire de la sociologie " avec " Jean-Michel Berthelot - à l'aide de ses travaux et des jalons qu'ils posent. La troisième partie est biographique en restituant l'itinéraire académique, intellectuel et humain de Berthelot, que ce soit son parcours universitaire et social, notamment à l'ENS durant mai 68, ou encore sa période " toulousaine " où sa carrière universitaire a débuté et qui en constitue une partie essentielle. Dirigé par Jean-Christophe Marcel et Olivier Martin, cet ouvrage rassemble les contributions de collaborateurs, d'anciens étudiants ou de proches collègues de Jean-Michel Berthelot. (shrink)

This anthology is a unique compilation of scientific contributions on the topic of measurement and understanding, showing how terms such as number, measurement, understanding, model, pattern are used in a wide variety of disciplines. Based on the results and experiences from their own projects, 23 researchers comment on the potentials and limitations of individual methodological approaches and success factors of interdisciplinary collaboration. In doing so, they sound out the different significance of quantification and empirical evidence for their own disciplines and (...) examine the influence of methodological approaches on existing models and images. The common goal is to want to understand the world; the methods, however, are highly diverse. (shrink)

This chapter contains section titled: The Diversity of Experimental Practices in Biology Model Organisms Experimental Systems and the “New Experimentalism” in Biology The Nature of Evidence Objectivity and Realism Acknowledgment References Further Reading.