Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Objective:To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design:Prospective clinical interventional study.Setting:Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland.Participants:Nine junior physicians in postgraduate training.Intervention:Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results:Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients’ involvement in the (...) decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion:An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Cet article présente un service de consultation conjugale situé en Suisse romande, non médicalisé, dont l’orientation psychodynamique et le travail auprès des couples n’est pas sans rappeler la pratique française des conseillers conjugaux-thérapeutes de couple « ancien modèle ». Si l’appellation de consultation conjugale a été retenue, malgré ses inconvénients, c’est qu’elle permet de toucher un très large public, en particulier de nombreuses personnes insuffisamment individuées pour qui l’appartenance au « Nous-couple » est constitutive. Par rapport aux objectifs de travail, (...) l’auteure explore deux voies, illustrées par deux vignettes cliniques : l’une vise à recouvrir une problématique sous-jacente en rétablissant un équilibre antérieur, l’autre à découvrir l’arrangement défensif du couple en introduisant une dynamique de changement. (shrink)

Standard accounts of civil disobedience include nonviolence as a necessary condition. Here I argue that such accounts are mistaken and that civil disobedience can include violence in many aspects, primarily excepting violence directed at other persons. I base this argument on a novel understanding of civil disobedience: the special character of the practice comes from its combination of condemnation of a political practice with an expressed commitment to the political. The commitment to the political is a commitment to engaging with (...) others as co-members in the on-going political project of living together. I show how such an understanding of civil disobedience is superior to the Rawlsian strain of thought, which focuses on fidelity to law. Rawls was concerned with civil disobedience solely in the context of overriding political obligation. The project of characterizing a contestatory political practice that can be distinguished and used in a wider variety of contexts than Rawls is concerned with, including under illegitimate regimes, beyond the nation-state, or on behalf of anarchism, requires a different understanding of civil disobedience. (shrink)

This is a new edition, revised and expanded, of a seminal work in the logic and philosophy of time, originally published in 1968. Arthur N. Prior was the founding father of temporal logic. His work has attracted increased attention in the decades since his death: its influence stretches beyond philosophy and logic to computer science and formal linguistics. Prior's fundamental ideas about the logic of time are presented here along with his investigations into the formal properties of time and tense. (...) Already in 1969 Prior had been planning a new edition of Papers on Time and Tense, to incorporate his more recent work. Because of his untimely death this plan was never followed through--till now. Seven important papers have been added to the original selection, as well as a comprehensive bibliography of his work and an illuminating interview with his widow, Mary Prior, about his life and work. In addition, the Polish logic which made the original book difficult for many readers has been replaced by standard logical notation. This new edition will secure the classic status of the book. (shrink)

Ravelingien et al1 argue that, given the restrictions that must be imposed on recipients of xenotransplanted organs, we should conduct clinical trials of xenotransplantation only on patients in a persistent vegetative state. I argue that there is no ethical barrier to using terminally ill patients instead. Such patients can choose to waive their rights to the liberties that xenotransplantation would probably restrict; it is surely rational to prefer to waive your rights rather than to die, and permissible to allow patients (...) to make this choice.Perhaps the single most important advance in the history of moral thought occurred when it came to be generally recognised that all people are protected by rights that are inviolable, at least without their consent. The precise nature and content of these rights is controversial, but there is a consensus among reasonable people over their core. We all have a right to life, to liberty, to security of person and to equality before the law. Other rights—so-called positive rights, such as the right to economic security, or cultural rights, for instance—may be controversial, but we all agree at least on these.Ravelingien et al1 therefore seem to be on solid ground when they conclude that it would not be permissible to use living persons as subjects in clinical trials of xenotransplantation, as such trials, potentially or actually, result in the violation of the core human rights of the subjects. Their argument is as follows:" Xenotransplantation carries with it a currently unquantifiable risk of the transmission of viruses, from the animal that is the source of the organ transplanted, to the human recipient. Such viruses could have potentially catastrophic consequences, up to and including triggering a global and devastating pandemic. Therefore, it would be necessary to monitor the health status of recipients of … ". (shrink)

This is the compelling story of one of the most fascinating thinkers of the twentieth century- a richly toned portrait of a modern-day Thoreau.

Avicenna holds that since God has existed from all eternity and is immutable and impassible, he cannot come to have an attribute or feature that he has not had from all eternity. He also claims for the simultaneous causation. A puzzle arises when we consider God’s creating this world. If God is immutable and impassible, then his attributes associated with his creating this world are unchanging. So, God must have been creating the world from all eternity. But then God’s creative (...) act, one might object, seems to be no different from a matter of natural necessity. This is a threat to divine freedom, for God would then have no choice concerning his creative action. Anthony Ruffus and Jon McGinnis argue that this puzzle can be solved in such a way that Avicenna can consistently affirm divine freedom along with divine simplicity. They suggest that Naṣīr al-Dīn Ṭūsī’s interpretation might help to show that it is false that Avicenna’s God cannot choose absolutely. For it is still open to him to choose either to create eternally or to refrain from creating anything at all. Ruffus and McGinnis argue that since creating or not creating anything at all do not correspond to two distinct concepts, Avicenna’s account of divine simplicity, which denies any multiplicity in divine mind, is safeguarded along with divine freedom. I claim that God’s omnirationality requiring that he always acts for reasons is a serious threat to such an interpretation. (shrink)

Auf Grund aller oben erörterten Betrachtungen und Tatsachen können wir jetzt die folgenden allgemeinen Gesetze der organischen Evolution erwähnen, die bzw. sich an die unmittelbaren Ursachen, Mechanismen und Tendenzen der Evolution beziehen: Unmittelbare Ursachen: das Gesetz der Mutation; Mechanismen: das Gesetz der natürlichen Auswahl : Tendenzen: das Gesetz der funktionellen Differenzierung; das Gesetz der Koordinierung der sich differenzierenden Funktionen; das Gesetz der Integrierung der funktionellen Systemen; das Gesetz der funktionellen Verbesserung des Lebens; das Gesetz der Beschleunigung der Evolution.Alle diese Gesetze (...) bilden zusammen ein einheitliches Ganzes und sind eher als Teilaus drücke eines einzelnen allgemeinen Gesetzes der organischen Evolution aufzufassen. Ob der Verfasser eine richtige Interpretation der Tatsachen gefunden hat, darüber darf man diskutieren; — das ist nur die Fragestellung.Das Problem selbst ist sowohl theoretisch wie auch praktisch sehr wichtig, so dass wir kein menschliches Recht haben um seine Lösung den künftigen Generationen zu überlassen.Life is considered as a functional whole, but not in the holistic sense of the word, because of an essentially different interpretation of the role of the individual element in the evolution of the functional system at various levels of the organisation of the life. This paper contains the following chapters: a) introduction, b) the unity of the life, c) the main questions of the theory of evolution, d) some regularities of organic evolution, and e) the general laws of organic evolution.The following general laws, referring to the immediate causes, mechanisms and tendences of evolution are formulated. the law of mutation , the law of selection , the law of functional differentiation, the law of coordination of the differentiating functions, the law of integration of the functional systems, the law of functional perfection of the life, the law of acceleration of the evolution.All this laws form together an internally coherent system, which may be considered as the unitary law of evolution. (shrink)

Auf Grund aller oben erörterten Betrachtungen und Tatsachen können wir jetzt die folgenden allgemeinen Gesetze der organischen Evolution erwähnen, die bzw. sich an die unmittelbaren Ursachen, Mechanismen und Tendenzen der Evolution beziehen: Alle diese Gesetze bilden zusammen ein einheitliches Ganzes und sind eher als Teilaus drücke eines einzelnen allgemeinen Gesetzes der organischen Evolution aufzufassen. Ob der Verfasser eine richtige Interpretation der Tatsachen gefunden hat, darüber darf man diskutieren; — das ist nur die Fragestellung. Das Problem selbst ist sowohl theoretisch wie (...) auch praktisch sehr wichtig, so dass wir kein menschliches Recht haben um seine Lösung den künftigen Generationen zu überlassen. (shrink)

This article discusses the 2005 OUP biography of Michael Polanyi by William T. Scott and Martin X. Moleski S.J., Michael Polanyi, Scientist and Philosopher . The discussants are N. E. Wetherick, Brian G Gowenlock, and John Puddefoot; Martin X. Moleski, S. J. briefly responds, providing a previously unpulished letter from Polanyi to Reverend Dr. Knox, a Presbyterian mininster.

Comprehensive work on history and philosophy of Nātha sect in India.

On Yoga; based on various texts on yoga philosophy.

Censurado durante la última década, sale finalmente a la luz Biografía de las ideas, de Isaiah Berlin. El libro pone de relieve el modo en que el sector liberal-conservador más poderoso, con sede en Oxford, ha construido la ficción en torno a la figura de Isaiah Berlin. Sir Isaiah Berlin es conocido como una lumbrera del pensamiento político del siglo XX, uno de los máximos exponentes intelectuales del liberalismo democrático, un pensador moralmente comprometido con la causa de la libertad y (...) la lucha contra el totalitarismo. El lector podrá comprobar que la imagen que se atribuye a Isaiah Berlin es una mitificación, una ficción forjada con el propósito de defender una serie de intereses académicos (y reforzar así la marca Oxford), políticos (en torno al sector liberal-conservador anglosajón) y nacionales (al objeto de cantar la leyenda de una Corona británica comprometida –así dicen– por la defensa de la democracia Occidental). Como Research Fellow en la Universidad de Oxford, el autor ha tenido oportunidad de examinar esta realidad y ver con sus propios ojos cómo los liberal-conservadores fabrican sus mitos. Las conclusiones de este estudio no dejarán indiferentes ni a académicos –principalmente, del área de Historia de las Ideas, y Teoría Política y Moral–, ni a escritores y políticos como el Premio Nobel Mario Vargas Llosa o la marquesa Cayetana Álvarez de Toledo, auto-denominados liberal-conservadores, porque derrumba un pilar de su religión. (shrink)