Substituted judgment assumes adequate knowledge of patient’s mind-set. However, surrogates’ prediction of individual healthcare decisions is often inadequate and may be based on shared background rather than patient-specific knowledge. It is not known whether surrogate’s prediction of patient’s integrative life-story narrative is better. Respondents in 90 family pairs rank-ordered 47 end-of-life statements as life-story narrative measure and completed instruments on decision-control preference and healthcare-outcomes acceptability as control measures, from respondent’s view and predicted pair’s view. They also scored their confidence in (...) surrogate’s decision-making and familiarity with pair’s healthcare-preferences. Life-story narratives’ prediction was examined by calculating correlation of statements’ ranking scores between respondent-personal and respondent-surrogate Q-sorts and between respondent-surrogate and pair-personal Q-sorts before and after controlling for correlation with respondent-personal scores, and by comparing percentages of respondent-surrogate Q-sorts co-loading with pair-personal vs. respondent-personal Q-sorts. Accuracy in predicting decision-control preference and healthcare-outcomes acceptability was determined by percent concordance. Results were compared among subgroups defined by intra-pair relationship, surrogate’s decision-making confidence, and healthcare-preferences familiarity. Mean age was 35.4 years, 69% were females, and 73 and 80% reported ≥ very good health and life-quality, respectively. Mean surrogate’s decision-making confidence score was 3.35 and 75% were ≥ familiar with pair’s healthcare-preferences. Mean projection, simulation, and adjusted-simulation correlations were 0.68, 0.42, and 0.26, respectively. Out of 180 respondent-surrogate Q-sorts, 24, 9, and 32% co-loaded with respondent-personal, pair-personal, or both Q-sorts, respectively. Accuracy in predicting decision-control preference and healthcare-outcomes acceptability was 47 and 52%, respectively. Surrogate’s decision-making confidence score correlated with adjusted-simulation’s correlation score. There were significant differences among the husband-wife, parent-child, and sibling-sibling subgroups in percentage of respondent-surrogate Q-sorts co-loading with pair-personal Q-sorts and percent agreement on healthcare-outcomes acceptability. Despite high self-reported surrogate’s decision-making confidence and healthcare-preferences familiarity, family surrogates are variably inadequate in simulating life-story narratives. Simulation accuracy may not follow the next-of-kin concept and is 38% based on shared background. (shrink)

Although informed consent is an integral part of clinical practice, its current doctrine remains mostly a matter of law and mainstream ethics rather than empirical research. There are scarce empirical data on patients’ perceived purpose of informed consent, which may include administrative routine/courtesy gesture, simple honest permission, informed permission, patient-clinician shared decision-making, and enabling patient’s self decision-making. Different purposes require different processes.

The current doctrine of informed consent for clinical care has been developed in cultures characterized by low-context communication and monitoring-style coping. There are scarce empirical data on patients' norm perception of information disclosure in other cultures.

ABSTRACT BackgroundIt isn’t clear how lay people balance the various ethical interests when addressing medical issues. We explored lay people’s ethical resolution models in relation to abortion. MethodsIn a tertiary healthcare setting, 196 respondents rank-ordered 42 opinion-statements on abortion following a 9-category symmetrical distribution. Statements’ scores were analyzed by averaging-analysis and Q-methodology. ResultsRespondents’ mean (SD) age was 34.5(10.5) years, 53% were women, 68% Muslims (31% Christians), 28% Saudis (26% Filipinos), and 38% healthcare-related. The most-agreeable statements were “Acceptable if health-benefit to (...) woman large,” “Acceptable if congenital disease risk large,” and “Woman’s right if fetus has congenital disease.” The most-disagreeable statements were “State’s right even if woman disagrees,” “Acceptable even with no congenital disease risk,” and “Father’s right even if woman disagrees.” Q-methodology identified several resolution models that were multi-principled, consequentialism-dominated, and associated with respondents’ demographics. The majority of Christian women and men identified with and supported a relatively “fetus rights plus State authority-oriented” model. The majority of Muslim women and men identified with and supported a “conception-oriented” model and “consequentialism plus virtue-oriented” model, respectively. One or more of three motives-related statements received extreme ranks on averaging-analysis and in 33% of the models. Conclusions1) On average, consequentialism, focusing on a woman’s health-benefit and congenital disease risk, was the predominant approach. This was followed by the rights approach, favoring a woman’s interest but taking context into account. 2) Q-methodology identified various ethical resolution models that were multi-principled and partially associated with respondents’ demographics. 3) Motives were important to some respondents, providing empirical evidence against adequacy of principlism. (shrink)

Disclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known.

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (shrink)

BackgroundConsenting for retrospective medical records-based research (MR) and leftover tissue-based research (TR) continues to be controversial. Our objective was to survey Saudis attending outpatient clinics at a tertiary care hospital on their personal preference and perceptions of norm and current practice in relation to consenting for MR and TR.MethodsWe surveyed 528 Saudis attending clinics at a tertiary care hospital in Saudi Arabia to explore their preferences and perceptions of norm and current practice. The respondents selected one of 7 options from (...) each of 6 questionnaires.ResultsRespondents' mean (SD) age was 33 (11) years, 42% were males, 56% were patients, 84% had ≥ secondary school education, and 10% had previously volunteered for research. Respectively, 40% and 49% perceived that the norm is to conduct MR and TR without consent and 38% and 37% with general or proposal-specific consent; the rest objected to such research. There was significant difference in the distribution of choices according to health status (patients vs. companions) for MR (adjusted Kruskal-Wallis test P = 0.03) but not to age group, gender, education level, or previous participation in research (unadjusted P = 0.02 - 0.59). The distributions of perceptions of current practice and norm were similar (unadjusted Marginal Homogeneity test P = 0.44 for MR and P = 0.89 for TR), whereas the distributions of preferences and perceptions of norm were different (adjusted P = 0.09 for MR and P = 0.02 for TR). The distributions of perceptions of norm, preferences, and perceptions of current practice for MR were significantly different from those of TR (adjusted P < 0.009 for all).ConclusionsWe conclude that: 1) there is a considerable diversity among Saudi views regarding consenting for retrospective research which may be related to health status, 2) the distribution of perceptions of norm was similar to the distribution of perceptions of current practice but different from that of preferences, and 3) MR and TR are perceived differently in regard to consenting. (shrink)

Background The consistency of codes governing disclosure of terminal illness to patients and families in Islamic countries has not been studied until now. Objectives To review available codes on disclosure of terminal illness in Islamic countries. Data source and extraction Data were extracted through searches on Google and PubMed. Codes related to disclosure of terminal illness to patients or families were abstracted, and then classified independently by the three authors. Data synthesis Codes for 14 Islamic countries were located. Five codes (...) were silent regarding informing the patient, seven allowed concealment, one mandated disclosure and one prohibited disclosure. Five codes were silent regarding informing the family, four allowed disclosure and five mandated/recommended disclosure. The Islamic Organization for Medical Sciences code was silent on both issues. Conclusion Codes regarding disclosure of terminal illness to patients and families differed markedly among Islamic countries. They were silent in one-third of the codes, and tended to favour a paternalistic/utilitarian, family-centred approach over an autonomous, patient-centred approach. (shrink)

Background: Medical chaperones (MC) are underutilised. The influence of Islamic culture on the use of MC is not known. Aim: To examine physicians’ use and perception of MC in Islamic culture. Setting: A major tertiary care hospital in Saudi Arabia. Methods: 315 self-administered questionnaires were distributed to attendees of grand rounds of 13 departments. Results: 186 (59%) questionnaires were completed. 64.5% of the respondents were 30–49 years old, 75.8% were men and 31.2% were in training; 79% had a clinic load (...) of under 50 patients per week and 47.8% had postgraduate training (PGT) in an Islamic country. MC were reported to be infrequently (⩽25% of the time) used by 44.1% (69.2% female vs 39% male physicians, p = 0.001; 58.6% in training vs 36.8% attending, p = 0.007; 52.1% PGT in Islamic vs 35.6% in western countries, p = 0.027), offered by 52.7% (78.9% female vs 46.8% male physicians, p<0.001) and requested by 79% of patients. MC were reported to be commonly (>75% of the time) used, offered by physicians and requested by patients by 38.2%, 29% and 7.5% of respondents, respectively. The most frequently cited reasons for not using MC were privacy/confidentiality (36.6%) and understaffing (30.5%). Equal numbers of respondents perceived MC use as a protection for physicians or patients (67.7% and 65.6%, respectively). Conclusions: MC are underutilised even in Islamic culture, especially among female physicians. Training in western countries is favourably associated with MC use. Underutilisation appears to be related to privacy/confidentiality, understaffing and failure of patients to request a MC. (shrink)

Fractional calculus is nowadays an efficient tool in modelling many interesting nonlinear phenomena. This study investigates, in a novel way, the Ulam–Hyers and Ulam–Hyers–Rassias stability of differential equations with general conformable derivative. In our analysis, we employ some version of Banach fixed-point theory. In this way, we generalize several earlier interesting results. Two examples are given at the end to illustrate our results.

Involving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world.

Vulnerability and resistance have often been seen as opposites, with the assumption that vulnerability requires protection and the strengthening of paternalistic power at the expense of collective resistance. Focusing on political movements and cultural practices in different global locations, including Turkey, Palestine, France, and the former Yugoslavia, the contributors to Vulnerability in Resistance articulate an understanding of the role of vulnerability in practices of resistance. They consider how vulnerability is constructed, invoked, and mobilized within neoliberal discourse, the politics of war, (...) resistance to authoritarian and securitarian power, in LGBTQI struggles, and in the resistance to occupation and colonial violence. The essays offer a feminist account of political agency by exploring occupy movements and street politics, informal groups at checkpoints and barricades, practices of self-defense, hunger strikes, transgressive enactments of solidarity and mourning, infrastructural mobilizations, and aesthetic and erotic interventions into public space that mobilize memory and expose forms of power. Pointing to possible strategies for a feminist politics of transversal engagements and suggesting a politics of bodily resistance that does not disavow forms of vulnerability, the contributors develop a new conception of embodiment and sociality within fields of contemporary power. -/- Contributors. Meltem Ahiska, Athena Athanasiou, Sarah Bracke, Judith Butler, Elsa Dorlin, Basak Ertür, Zeynep Gambetti, Rema Hammami, Marianne Hirsch, Elena Loizidou, Leticia Sabsay, Nükhet Sirman, Elena Tzelepis. (shrink)

Biofilms can be viewed as tissue‐like structures in which microorganisms are organized in a spatial and functional sophisticated manner. Biofilm formation requires the orchestration of a highly integrated network of regulatory proteins to establish cell differentiation and production of a complex extracellular matrix. Here, we discuss the role of the essential Bacillus subtilis biofilm activator RemA. Despite intense research on biofilms, RemA is a largely underappreciated regulatory protein. RemA forms donut‐shaped octamers with the potential to assemble into (...) dimeric superstructures. The presumed DNA‐binding mode suggests that RemA organizes its target DNA into nucleosome‐like structures, which are the basis for its role as transcriptional activator. We discuss how RemA affects gene expression in the context of biofilm formation, and its regulatory interplay with established components of the biofilm regulatory network, such as SinR, SinI, SlrR, and SlrA. We emphasize the additional role of RemA played in nitrogen metabolism and osmotic‐stress adjustment. (shrink)

BackgroundMoral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. However, moral courage rema...

The 19th century constitutes the most unsteady period of the Ottoman Empire on the basis of military, political and scientific senses. Although not as much as in previous centuries, respected scholars and mystics continued to be upbrought in this century. Muhammed Tevfîk Bosnevî Efendi (1866) is one of the leading scholar mystics who upbrought in the Ottoman science and wisdom climate in the aforementioned period. After he was promoted to the caliphate post in eleven sects carrying out active guidance activities (...) in Istanbul, he consented to become a devout disciple of the famous Halwati-Shabani Sheikh of the time, Kuşadalı İbrahim Efendi, and received his ijazah by completing the entire course of mystical training under his supervision. Upon the death of his sheikh, he took the position of guidance and assumed the duty of guidance for twenty years. He also adopted the understanding of ignoring the cult rituals such as the crown, cardigan, and fleece, which were the most distinctive qualities of his sheikh, and disregarded such images throughout his life. He has a deep knowledge of Islamic sciences such as fiqh, tafsir, hadith and kalam, as can be understood from the works that were written by his students in the lesson circles called Council [Majlis]. In this study, which examines the work named "Tefsîru ve'd-Duhâ li'l-Hammâmî", his hermeneutics method is discussed. At the end of the study, it is understood that he explained the Qur'an in the light of the Qur'an, hadith-i sharifs, and the words of the Companions. It is also clear that in order to consolidate the subjects, he included legends from the life of our Prophet Muhammed, Companions and Saints (Awliya). Although he interprets words, it is observed that his main priority is not words but their meaning, he focuses on verses’ messages and aimed to deliver them to the addressee. It has been determined that he preferred the explanations of the past scholars rather than interpreting the verses personally, and he referred to both the first period hermeneutics works written in Arabic and the ones written by the Ottoman scholars. (shrink)

Arianne Shahvisi has argued that a doctor’s conscientious objection to abortion is a misuse of their authority which unduly burdens patients and, moreover, does not succeed in its aim of exculpating objectors from participating in perceived evil. We examine these claims in this response. First, we ask what the ‘conscience clause’ really requires of doctors and whether Shahvisi has interpreted it correctly. Second, we explore the notions of vulnerability and power in the doctor–patient relationship and cast doubt on Shahvisi’s claims (...) about these. Third, we tackle Shahvisi’s claim that conscientious objection is self-defeating because it entails remaing causally implicated in a chain of events leading to abortion. We show that this claim entails absurdity, then revisit the classical framework for the ethics ethics of co-operation to show that conscientious objection can suceed in exculpating objectors from perceived wrongdoing. We briefly critically evaluate the General Medical Council’s guidance on conscie... (shrink)

The logos question, one of the most important among the subjects that traverse the Plato's Sophist, has in fact some different aspects: the criticism of father Parmenides' logos, that is unable to speak about the not-being, but also about the being; the relations between logos and its cognates, phantasia, doxa and dianoia; the logos’ complex structure, that is a compound with onoma and rema; the difference between naming and saying, two distinct but inseparable actions; the logical and ontological conditions (...) that make possible to say the truth, or to lie or simply to joke; the necessity of a most flexible logos that allows us to speak about the not-being, and about the being, but at the same time is a logos dangerously similar to the sophist’ one; finally, the identity between the power to produce “spoken images” and the very power to speak. The aim of the present article is giving a systematical view of the matter that grasps all these faces. (shrink)

ḥeleḳ 1. Hadrakhah le-shalom bayit : sefer hadrakhah meforaṭ be-ʻinyene shidukhim ṿe-shelom bayit be-niśuʼin ʻa. p. maʼamre Ḥazal -- ḥeleḳ 2. Hadrakhah le-ṭaharat ha-bayit : ʻiḳre ha-halakhot ha-ḥiyuniyot : ʻa. p. pisḳe maran ha-Shu. ʻa. ṿeha-Rema uve-tsiruf hakhraʻot aḥarone zemanenu.

In lieu of an abstract, here is a brief excerpt of the content:The Irreplaceable Cannot Be ReplacedEllen HarveyThe Irreplaceable Cannot Be Replaced, Ellen Harvey, 2008. Photographs: Jan Baracz.People in New Orleans were invited to submit images or descriptions of irreplaceable places, people, or things lost to Hurricane Katrina. Eleven submissions were chosen at random and the artist painted 16” x 20” oil paintings based on those submissions. All thirty texts that were submitted were framed and exhibited along with the paintings (...) at the Contemporary Arts Center/New Orleans as part of the exhibition Something from Nothing, curated by Dan Cameron. Texts without a painting were accompanied by a framed black panel. At the end of the exhibition, all of the paintings and the framed texts were given away to the participants.Ellen Harvey was born in the United Kingdom and lives and works in Brooklyn, NY. She has exhibited extensively in the US and internationally and was most recently included in the 2008 Whitney Biennial. Recent solo exhibitions include Private Collections at Locks Gallery, Philadelphia, The Museum of Failure at Luxe Gallery, New York, Beautiful/Ugly at Magnus Müller in Berlin, Bad Mirror at Galerie Gebruder Lehmann in Dresden, Mirror at the Pennsylvania Academy, and A Whitney for the Whitney at Philip Morris at the Whitney Museum at Altria. She took part in the Whitney Independent Study Program and the PS1 Studio Program. Recent awards include a Pennies from Heaven Grant, a Philadelphia Exhibitions Initiative Grant, a Rema Hort Mann Foundation Grant, a Palm Beach County Cultural Council Grant, and a New York Foundation for the Arts Fellowship. She has completed projects for both the New York and Chicago Transit Authorities, most recently including a mosaic for the new Metro-North Yankee Stadium Station. The New York Beautification Project was published by Gregory Miller in 2005, and Ellen Harvey: Mirror was published by the Pennsylvania Academy in 2006. Click for larger view View full resolutionI am 87 years old living in a trailer on our property in New Orleans.We had 5 ft of water, which remained in the house 6 weeks creating mold to the ceiling.We lost everything. When I read Chris Rose’s column (he’s my favorite columnist in the whole world) it brought to mind my mother’s two dining room chairs that had been around as long as I can remember. I had them restored in about 1976 by Senior Citizens in classes of the “Peoples Program” sponsored by the nuns on Mirabean Ave. The wood was polished and varnished with a light brown stain and the seats were re-caned. I was born in 1920 so the chairs could be 75 years old. Anyway I can imagine you will have many interesting subjects to choose from but I’m submitting mine hoping I’ll be one of the very fortunate ones selected.I am terrible at drawing but will give you as complete a description as I can.I loved those chairs and enjoyed them for extra seating on holidays and at parties and they were conversation pieces.Alice Delaney[End Page 2] Click for larger view View full resolutionThere are so many “washed away” treasures, that the memorialization of even just one will be everlastingly meaningful to the community.I am submitting photographs of porcelain dolls, which I had crafted prior to the disaster. The dolls shown were created from commercial molds and were ready to go to a “new home.” Needless to say these dolls were submerged under water for at least two weeks. I call them my “children of the flood” but have not had the courage to disassemble them. I was able to rescue some doll parts and am in the process of cleaning, sorting and sanitizing them for future assembly.If I am ever able to get back to my very rewarding hobby, which was helpful in supplementing my retirement income, I will have to replace my electronic kiln and most of my doll making supplies. Many of the molds that were destroyed are no longer available. However, I will keep the memories dear, I have been fortunate enough to replace my sewing machines and some of the fabric used for clothing and doll... (shrink)

The logos’ question, one of the most important among the subjects that traverse the Plato’s Sophist, has in fact some different aspects: the criticism of father Parmenides’ logos, that is unable to speak about the not-being, but also about the being; the relations between logos and its cognates, phantasia, doxa and dianoia; the logos’ complex structure, that is a compound with onoma and rema; the difference between naming and saying, two distinct but inseparable actions; the logical and ontological conditions (...) that make possible to say the truth, or to lie or simply to joke; the necessity of a most flexible logos that allows us to speak about the not-being, and about the being, but at the same time is a logos dangerously similar to the sophist’s one; finally, the identity between the power to produce “spoken images” and the very power to speak. The aim of the present article is giving a systematical view of the matter that grasps all these faces. (shrink)