Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors JessicaRichmondMoeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)
Recent findings indicate that the constituting digits of multi-digit numbers are processed, decomposed into units, tens, and so on, rather than integrated into one entity. This is suggested by interfering effects of unit digit processing on two-digit number comparison. In the present study, we extended the computational model for two-digit number magnitude comparison of Moeller, Huber, Nuerk, and Willmes (2011a) to the case of three-digit number comparison (e.g., 371_826). In a second step, we evaluated how hundred-decade and hundred-unit compatibility (...) effects were moderated by varying the percentage of within-hundred (e.g., 539_582) and within-hundred-and-decade filler items (e.g., 483_489). From the results we predict that numerical distance as well as compatibility effects should indeed be modulated by the relevance of tens and units in three-digit number magnitude comparison: While in particular the hundred distance effect should decrease, we predict hundred-decade and hundred-unit compatibility effects to increase with the relevance of tens and units. (shrink)
Henri Bergson's philosophy, which Sartre studied as a student, had a profound but largely neglected influence on his thinking. In this paper I focus on the new light that recognition of this influence throws on Sartre's central argument about the relationship between negation and nothingness in his Being and Nothingness. Sartre's argument is in part a response to Bergson's dismissive, eliminativist account of nothingness in Creative Evolution (1907): the objections to the concept of nothingness with which Sartre engages are precisely (...) those raised by Bergson. Even if Sartre's account of nothingness in its entirety is found to be flawed, I argue that the points he makes specifically against Bergson are powerful. My discussion concludes with a brief examination of the wider philosophical background to Sartre's and Bergson's discussion of nothingness: here I point to some important aspects of Sartre's early philosophy, including some features of his conception of nothingness, that may testify to Bergson's positive influence on his thought. (shrink)
This paper attempts three tasks in relation to Carter and Leslie's Doomsday Argument. First, it criticises Timothy Chambers' 'Ussherian Corollary', a striking but unsuccessful objection to standard Doomsday arguments. Second, it reformulates the Ussherian Corollary as an objection to Bradley Monton's variant Doomsday and Nick Bostrom's Simulation Argument. Finally, it tries to diagnose the epistemic/metaphysical problems facing Doomsday-related arguments.1.
This paper discusses the different explanatory approaches taken by feminists and (Kleinian) psychoanalysts to women's psychological illness. In particular, anorexia nervosa (a condition that has attracted much feminist attention) is used as an example. Examination of some Kleinian accounts of work with anorexic patients reveals the great disparity between the terms and focus of psychoanalytical explanation and those invoked in feminist discussions. Can the two perspectives be combined? It is argued that, despite its individualist methodology, psychoanalysis stands to gain from (...) a broader understanding (that feminists might supply) of the cultural "provocation" of psychic conflict. This reconciliation of perspectives would require feminists to go beyond the "common sense" psychology that they often presuppose and to acknowledge the mediating influence of unconscious symbolic significance in experience. In connection with this issue, some work by feminists that has sought to accommodate psychoanalytical ideas is criticized for its "literalism." The lesson to be learned from this discussion applies more widely than to the feminist case. (shrink)
Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or (...) with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives. (shrink)
When asked by students taking Chinese Philosophy classes with me what I can recommend as reading material, I usually say, among other things, anything written by François Jullien. Thankfully, with Vital Nourishment: Departing from Happiness, there is now a new title available in English translation to add to this list. As with the works of most philosophically inclined writers whom I like, this book by Jullien does not really say much that has not already been said by him, at least (...) implicitly, in previous publications. More or less "creative" writers, paradoxically, tend to produce variations of one or more themes and thus repeat themselves to a certain degree. That is, so to speak, the price one has to pay if one .. (shrink)
This article discusses New Confucian views on individuality and related philosophical problems. Special emphasis is given to the position of Tu Wei-Ming (Du Weiming), a foremost living New Confucian thinker. It is pointed out that many New Confucian philosophers share a vision of a Confucian 'ideal' individuality or selfhood based on social integration - as opposed to a Western type of individuality sometimes portrayed as an individuality by isolation. These patterns of individuality are further examined on the basis of (...) Niklas Luhmann's historical analysis of the semantics of individuality and his categories of 'individuality by inclusion' and 'individuality by exclusion'. Finally, some parallels and differences between Confucian and the Luhmannian viewpoints are pointed out, and a suggestion on how a Luhmannian perspective might contribute to reformulations of New Confucian thought is attempted. (shrink)
Nelson Goodman has constructed two theories of simplicity: one of predicates; one of hypotheses. I offer a simpler theory by generalization and abstraction from his. Generalization comes by dropping special conditions Goodman imposes on which unexcluded extensions count as complicating and which excluded extensions count as simplifying. Abstraction is achieved by counting only nonisomorphic models and subinterpretations. The new theory takes into account all the hypotheses of a theory in assessing its complexity, whether they were projected prior to, or result (...) from, projection of a given hypothesis. It assigns simplicity post-projection priority over simplicity pre-projection. It better orders compound conditionals than does the theory of simplicity of hypotheses, and it does not inherit an anomaly of the theory of simplicity of predicates — its failure to order the ordering relations. Drop Goodman's special conditions, and the problems fall away with them. (shrink)
Preface This book, based on my doctoral dissertation, is a study in and of critical philosophy. Critical philosophy is committed to finding the limits of ...
This article uses Hans Kelsen's theory of a legal system to take a fresh look at European Community law, and the relationship between the European Community, its Member States, and international law. It argues that the basis of the Community's legal legitimacy is indeterminate, and offers a model to accommodate that indeterminacy. This model is founded on a constructivist approach suggested to be particularly useful in the EC context. Using this approach, it is argued that the concepts of system, autonomy (...) and sovereignty in the Community can only be understood through the recognition of a plurality of viewpoints, and that it is crucial, in describing the Community, to distinguish between a concept per se and the choice to adopt that concept. (shrink)
(2013). Germany's Media Coverage: Saluting Professional Journalism. Journal of Mass Media Ethics: Vol. 28, No. 1, pp. 61-63. doi: 10.1080/08900523.2013.755080.
Recently, an associative learning account of cognitive control has been suggested (Verguts & Notebaert, 2009). In this so-called adaptation by binding theory, Hebbian learning of stimulus–stimulus and stimulus–response associations is assumed to drive the adaptation of human behavior. In this study, we evaluated the validity of the adaptation-by-binding account for the case of implicit learning of regularities within a stimulus set (i.e., the frequency of specific unit digit combinations in a two-digit number magnitude comparison task) and their association with a (...) particular response. Our data indicated that participants indeed learned these regularities and adapted their behavior accordingly. In particular, influences of cognitive control were even able to override the numerical distance effect—one of the most robust effects in numerical cognition research. Thus, the general cognitive processes involved in two-digit number magnitude comparison seem much more complex than previously assumed. Multi-digit number magnitude comparison may not be automatic and inflexible but influenced by processes of cognitive control being highly adaptive to stimulus set properties and task demands on multiple levels. (shrink)
