In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.3 (2003) 277-300 [Access article in PDF] Toward a Fragmatics, or Improvisionary Histories of Rhetoric, the Eternally Ad Hoc Cornelia Wells "Even historical truths are on the move, or truth is not the question." —my self "We don't / know much, and are / professors of it." —from Heather McHugh, "Professional Hazard," in McHugh (1987) In writing a history of rhetoric, we might want to (...) know before anything else both what rhetoric is and why we should care to be writing about it. Or we might begin with a notion of or motive for history or, more precisely, for doing or writing (a) history or histories (as opposed of course to History with a capital H, History proper, the "true whole" story and nothing else) of, specifically, rhetoric. 1 Or we might begin with a notion of subjectivity, of who this we is that concerns itself with this writing activity. Or we might focus on the writing itself, asking the question What is writing? or Who can do it? or What can it do? or What is it about? all of which may be much like answering or debating similar questions frequently asked about/of/through rhetoric. Indeed, rhetoric and writing, rhetoric and discourse, tend to be confused, or ecstatically intermingled, terms.Or fixating, as history so frequently does, on the oxymoronic notion of "final" origins, which function backward(ly) as destinations, we might begin with the question/justification of where or when rhetoric itself geographically/historically began and therefore establish the "proper" beginning place for our story of rhetoric to start. But as the contemporary poet Heather McHugh suggests, "where" may be "a narrow inquiry," and also when, for something always came before and generally from somewhere else, so that, ultimately, when and where never can be finally arrived at. 2 So we might, and probably will, follow the indirection or dereliction (as [End Page 277] opposed to direction) of the goddess Dike to Parmenides: "It is all one to me where I begin, for I shall return again." 3 Like Robert Frost, however, I doubt if I shall ever come back. Or not by the same road, believing with Heraclitus, "One cannot step twice into the same river" (or, perhaps less obviously, twice onto the same road) and that anyway it is "weariness to toil at the same tasks and be always beginning," at least beginning in the same place(s) (1979, Fragments LI and LIII). As they commonly say in Australia, a change is as good as a holiday. And anyway change arrives inevitably.So we may as well (as well as not) change our mind and change our route before it changes itself or us. We may as well turn away, before returning, pause from thinking about writing this particular history of rhetoric, about how or where or why to begin such a task in the "first" place (as if we have never previously occupied any other task or place), and consider instead some of the ways that histories of rhetoric have already been written or told or invented. But why should we make this turn? Well, for reconnaissance, I suppose. To get the lay of the land. To see the other side of the mountain. To show we've done our research. Or because a discipline demands continual recounting. To remain intact or stay in touch. Or for auld lang syne. Or so that improvisionarily, at least, "we shall have agreement on [']known['] premises, and the pursuit of further knowledge" (Rorty 1984, 67). Or to take stock. To see what's missing (as if we could say when the universe is full). Or to justify a point of departure. Or a point of entry into a conversation that preceded and therefore necessarily in some residual sense preempted or determined us. Or for just (only?) or unjust (not only?) cause. Or to establish ethos. Or just because. To show we "know." Auguring or augering (not arguing) a procedure Perhaps the best turn is to turn this essay, literally my attempted say, inside out... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Who was Socrates? CORNELIA DE VOGEL I CONSIDERIT TO BE quite a privilege to be invited to speak of Socrates,1 not only because of the wonderful picture drawn by Plato of his master in what we call the Socratic dialogues, but perhaps mostly because there is a real challenge in the difference of opinion among modern scholars on the question of "Who was Socrates?" I have solid grounds (...) for being convinced that we can answer that question in a positive manner; that is, I think I can explain, first, that it is not true (as some modern scholars hold) that we are unable to grasp the historical reality that stands behind the name of Socrates; second, that there are a few modern interpretations of Socrates which are suggestive but false; third, that one and only one interpretation is well founded and correct. I think it is worthwhile to spend an hour considering these points. Socrates is one of those four famous Greek philosophers who did not leave any written works. The other three are: Pythagoras, who in Aristotle's day already seemed to disappear in the haze of a remote past; Pyrrho, the founder of the Sceptic School, and Carneades, that famous dialectician who was the head of the New Academy in the second century. On none of these so much as on Socrates have modern critics endeavored to demonstrate that he never existed? The most refined representative of the nineteenth-century style of criticism is O. Gigon, who modified Dupr6el's thesis insofar as he does not deny explicitly that there existed an Athenian called Socrates, and even that he may have been an important personality. But he does hold that we cannot know of what importance was Socrates. To prove his thesis Gigon deals first with the tradition about the indictment, the litigation and condemnation of Socrates; next with the story about the Delphic oracle and Socrates' calling to philosophy; then with his marriage and family life, and last, with his relation to the city of Athens. It is not too difficult to cite divergent and even contradictory information on all these points. As to Plato's dialogues, in which the philosopher Socrates is pictured--to the life, as it might seem to us--according to Gigon the historical value of t Lecture at the University of California, Berkeley, May 25, 1962. ~E. Dupr6el, La ldgende de Socrate et les sources de Platon (Brux., 1921); O. Gigon, Sokrates (Bern, 1947; Samml. Dalp). (See my review in Mnemosyne [1950]; see also Phronesis [1955], I.) A. H. Chroust, Socrates, Man and Myth (London, 1957), adopts essentially Gigon's thesis. [14s] 144 HISTORY OF PHILOSOPHY these writings is by no means greater than that of any other of our sources. Why should they be more trustworthy? Because the image they present is beautiful? That would be a deceptive ground, for Plato may have invented freely, and we have good reason to believe he did. In fact, if anybody holds that we do not know anything for certain about Socrates, he must begin by disparaging Plato's testimony altogether. Next, he must deny that Aristotle said a word of truth about what was the proprium of Socrates as a philosopher, and in what Plato differed from him. Third, he must assert that there is a complete disagreement between Plato and Xenophon as to the personality of Socrates, not to mention the fifthcentury comedian Aristophanes (who, as a matter of fact, drew a fairly strange portrait of the philosopher). After having thus rejected the testimony of contemporaries and their direct successors, he may turn to the gossip of those later authors who have no authority at all: Aristoxenus, a furious anti-Socratic, who is cited by Plutarch as a classical instance of malignity; Diogenes Laertius, that late writer (3rd century A.D.) who tells us the strangest stories about all Greek philosophers; Athenaeus, Herodicus, Aelianus, and so on--and find there divergent and contradictory information about Socrates' life and behavior. Let us begin by stating that we must not follow this procedure. Moreover, let us state that it is not interesting to us that, while Plato and Xenophon say Socrates was married... (shrink)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Cornelia Dean draws on her 30 years as a science journalist with the New York Times to expose the flawed reasoning and knowledge gaps that handicap readers when they try to make sense of science. She calls attention to conflicts of interest in research and the price society pays when science journalism declines and funding dries up.--.

This paper explores one organisation’s journey into non-financial reporting, initially motivated by a crisis in public confidence that threatened the organisation’s legitimacy to the present with the organisation embracing integrated reporting. The organisation’s journey is framed through a legitimation lens and is illustrated by aligning internal reflections with external outputs guided by predominant paradigms of good practice, such as the GRI guidelines and more recently integrated reporting 〈IR〉. We find that the organisation’s relationship with external guidelines has evolved from pragmatic (...) adoption as a means of seeking external legitimation to the present position where those that prepare external reports are informed by the organisation’s strategic positioning and not constrained by the promulgation of voluntary guidelines. From the case study, we suggest that the International Integrated Reporting Council may face two hurdles: First, organisations may define social norms based on a broader definition of stakeholders than the definition currently published by the IIRC. The second hurdle is to convince report preparers that adopting integrated reporting 〈IR〉 will positively impact on capital flows. (shrink)

Powerful ultrastructural tools are providing new insights into neuronal circuits, revealing a wealth of anatomically‐defined synaptic connections. These wiring diagrams are incomplete, however, because functional connectivity is actively shaped by neuromodulators that modify neuronal dynamics, excitability, and synaptic function. Studies of defined neural circuits in crustaceans, C. elegans, Drosophila, and the vertebrate retina have revealed the ability of modulators and sensory context to reconfigure information processing by changing the composition and activity of functional circuits. Each ultrastructural connectivity map encodes multiple (...) circuits, some of which are active and some of which are latent at any given time. (shrink)

The goal of the article is to offer a framework against which relations between gesture and sign can be systematically explored beyond the current literature. It does so by a) reconstructing the history of the discussion in the field of gesture studies, focusing on three leading positions (Kendon, McNeill, Goldin-Meadow); and b) by formulating a position to illustrate how this can be achieved. The paper concludes by emphasizing the need for systematic cross-linguistic research on multimodal use of language in its (...) signed and spoken forms. (shrink)

From the discovery of distant galaxies and black holes to the tiny interstices of the atom, here is the very best on physics and astronomy from the New York Times! The newspaper of record has always prided itself on its award-winning science coverage, and these 125 articles from its archives are the very best, covering more than a century of breakthroughs, setbacks, and mysteries. Selected by former science editor Cornelia Dean, they feature such esteemed and Pulitzer Prize-winning writers as (...) Malcolm W. Browne on teleporting, antimatter atoms, and the physics of traffic jams; James Glanz on string theory; George Johnson on quantum physics; William L. Laurence on Bohr and Einstein; Dennis Overbye on the recent discovery of the Higgs Boson; Walter Sullivan on the colliding beam machine; and more. (shrink)

In the age of surveillance capitalism, the prevailing business model underlying the use of social media applications (“apps”) foresees the exchange of personal data for the allowance to use an online service. Such a data business model comes with many potential negative side effects ranging from violation of privacy issues to election manipulation. Therefore, it is of utmost importance to think of alternatives to the current data business model. The present study investigated how strong the support would be for a (...) monetary payment model among a sample of 210 participants. Participants were asked about their willingness to pay for social media, if in turn their data would be private and other problems concerning social media use would be tackled. Only one-fifth of participants (21.43%) supported such a model. From the Big Five Personality traits, Agreeableness was positively associated with support of such a model. Finally, data are also provided on how much participants would be willing to pay for social media on a monthly basis. The present study’s findings are of a preliminary nature and will contribute to the start of an important discussion. (shrink)

Dem Postmarxismus wird haufig ein mangelndes Verstandnis des Staats vorgeworfen. Dieser Band stellt sich dieser Lesart entgegen und zeichnet ein vielfaltiges Bild der Staatsverstandnisse von Abensour, Agamben, Badiou, Balibar, Bauman, Butler, Castoriadis, Deleuze und Guattari, Derrida, Hardt und Negri, Hall, Holloway, Lefort und Gauchet, Laclau und Mouffe, Nancy, Ranciere und zizek. Die Zugange dieser Autor_innen zum Staat werden anhand zentraler Konzepte in leicht zuganglicher Form dargestellt und von marxistischen und neomarxistischen Staatstheorien abgegrenzt. Im letzten Teil werden die gegenseitigen Beeinflussungen zwischen (...) postmarxistischen Staatsverstandnissen einerseits und feministischen und postkolonialen Zugangen andererseits beschrieben, wie auch die Verschrankung postmarxistischer Theorien mit zeitgenossischen politischen Bewegungen. Insgesamt bietet der Band damit einen erstmaligen Uberblick zu den Konzepten und der Bedeutung postmarxistischer Staatsverstandnisse. (shrink)

Serves as an essential reference for students, researchers, and academics in international relations.

While generally accepted as an interpretive theory, Bull’s emblematic text demonstrates strong structural characteristics. Subsequent attributions move between the interpretive or ‘reflexive’ and t...

In recent debates about inequality, many have pointed to the predominant position of the finance. This article highlights that structural power, not lobbying resources, are key to explaining variations across countries. It examines finance-government negotiations over national bank rescue schemes during the recent financial crisis. Given the structural power of finance, the variation in bank bailouts across countries cannot be explained by lobbying differences. Instead of observing organized interest intermediation, we can see that disorganization was crucial for the financial industry (...) to get off the hook and let the government carry the burden of stabilizing the economy. Put differently, structural power is strongest when finance remains collectively inactive. In contrast to traditional accounts of the lobbying influence of finance, the comparison highlights that the lack of organization can have crucial redistributive consequences. (shrink)

Der Band plädiert für eine Resymmetrisierung des Sprachlichen und des Bildlichen für das Verständnis der Gegenwartsgesellschaft. Bildlichkeit wird als eine vom Wahrnehmungsmodus unterschiedene genuin soziale Sinnform aufgefasst. Wir verlassen uns darauf, dass auch Andere ganz selbstverständlich dargestellte Welt von wahrgenommener Welt unterscheiden. Auf die Darstellungen von Darstellungsformen hat sich moderne Kunst spezialisiert. Am Beispiel der Gegenwartskunst wird die Vermehrung, Kombinatorik und wechselseitige Bezugnahme künstlerischer Formen als Katalysator für innerkünstlerische Transformationen identifizierbar.

Dieses Buch schreibt Theorie. Es entwirft am Beispiel von Wilhelm Raabes Erzähltexten zwischen 1856 und 1902 den Grundriss einer ontologischen Narratologie, der über seinen historischen Gegen-stand hinaus systematische Gültigkeit beansprucht. Den Ausgangspunkt bildet die Frage: Was ist Welt?

Perfect Harmony and Melting Strains assembles interdisciplinary essays investigating concepts of harmony during a transitional period, in which the Pythagorean notion of a harmoniously ordered cosmos competed with and was transformed by new theories about sound - and new ways of conceptualizing the world. From the perspectives of philosophy, literary scholarship, and musicology, the contributions consider music's ambivalent position between mathematical abstraction and sensibility, between the metaphysics of harmony and the physics of sound. Essays examine the late medieval and early (...) modern history of ideas concerning the nature of music and cosmic harmony, and trace their transformations in early modern musico-literary discourses. Within this framework, essays further offer original readings of important philosophical, literary, and musicological works. This interdisciplinary volume brings into focus the transformation of a predominant Renaissance worldview and of music's scientific, theological, literary, as well as cultural conceptions and functions in the early modern period, and will be of interest to scholars of the classics, philosophy, musicology, as well as literary and cultural studies. (shrink)

Inflammatory bowel disease is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient’s personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged (...) 16–76 years. An increase in the domain overvigilance and inhibition score had a significant effect, with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme and dependence/incompetence, vulnerability to harm and illness and subjugation schemas. The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme’s intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition. (shrink)

Learning in intelligent systems is a result of direct or indirect interaction with the environment. Humans can learn by way of different states of (inter-)action such as the execution or the imagery of an action, but their unique potential to induce brain-related as well as mind-related changes in the motor action system is still being debated. The systematic repetition of different states of action (e.g., execution and imagery in terms of physical and mental practice) and their contribution to the learning (...) of complex motor actions has traditionally been approached by way of performance improvements. More recently, approaches highlighting the role of action representation in the learning of complex motor actions have evolved. In the present perspective paper, we build on brain-related findings and sketch recent research on learning by way of imagery and execution from a hierarchical, perceptual-cognitive approach to the motor action system. These findings provide valuable insights into the learning of intelligent systems from a perceptual-cognitive, representation-based perspective and as such add to our current understanding of action representation in memory and its changes with practice. Future research should build bridges between approaches in order to more thoroughly understand functional changes throughout the learning process, and to jointly contribute to developing intelligent cognitive systems and their application in robotics, rehabilitation, or sports. (shrink)