Organic crosstalk or intercommunication among different organs is an interesting medical concept based on the biosemiotic perspective which considers the organism as a process maintained by the vital information flow between structural plane and biosemiotic plane, both with their different layers of biological complexity. From this point of view the organ is not merely the structure which produces crosstalk but just as much its product. The crosstalk perspective seeks two main goals: to investigate the characteristic serum biosemiotic patterns of pathogenic (...) organic crosstalk in order to achieve early diseases diagnosis, and to learn how to correct it. These achievements could allow physicians to evolve from a medical practice that focuses on misbiosemiotic effects, diagnosing and treating damaged organs, to a medical practice that focuses on misbiosemiotic processes, in this way diagnosing and treating pathogenic organ crosstalk before it culminates in organ damage. (shrink)

MUC1 and MUC4 are the two membrane mucins that have been best characterized. Although they have superficially similar structures and have both been shown to provide steric protection of epithelial surfaces, recent studies have also implicated them in cellular signaling. They act by substantially different mechanisms, MUC4 as a receptor ligand and MUC1 as a docking protein for signaling molecules. MUC4 is a novel intramembrane ligand for the receptor tyrosine kinase ErbB2/HER2/Neu, triggering a specific phosphorylation of the ErbB2 in the (...) absence of other ErbB ligands and potentiating phosphorylation and signaling through the ErbB2/ErbB3 heterodimeric receptor complex formed in the presence of neuregulin. In contrast, MUC1 has a highly conserved cytoplasmic tail, which binds β‐catenin, a key component of adherens junctions and a regulator of transcription, in a process that is tightly regulated by MUC1 phosphorylation. The specific localization of these membrane mucins to the apical surfaces of epithelial cells suggests that their signaling functions may be important as sensor mechanisms in response to invasion or damage of epithelia. BioEssays 25:66–71, 2003. © 2002 Wiley Periodicals, Inc. (shrink)

This paper presents a new theory of modal reasoning, i.e. reasoning about what may or may not be the case, and what must or must not be the case. It postulates that individuals construct models of the premises in which they make explicit only what is true. A conclusion is possible if it holds in at least one model, whereas it is necessary if it holds in all the models. The theory makes three predictions, which are corroborated experimentally. First, conclusions (...) correspond to the true, but not the false, components of possibilities. Second, there is a key interaction: it is easier to infer that a situation is possible as opposed to impossible, whereas it is easier to infer that a situation is not necessary as opposed to necessary. Third, individuals make systematic errors of omission and of commission. We contrast the theory with theories based on formal rules. (shrink)

Dissipative systems are described by a Hamiltonian, combined with a “dynamical matrix” which generalizes the simplectic form of the equations of motion. Criteria for dissipation are given and the examples of a particle with friction and of the Lotka-Volterra model are presented. Quantization is first introduced by translating generalized Poisson brackets into commutators and anticommutators. Then a generalized Schrödinger equation expressed by a dynamical matrix is constructed and discussed.

This ground-breaking book brings together researchers from a wide range of disciplines to discuss the control and coordination of processes involved in perceptually guided actions. The research area of motor control has become an increasingly multidisciplinary undertaking. Understanding the acquisition and performance of voluntary movements in biological and artificial systems requires the integration of knowledge from a variety of disciplines from neurophysiology to biomechanics.

As in other countries, the traditional doctor-patient relationship in the Japanese healthcare system has often been characterised as being of a paternalistic nature. However, in recent years there has been a gradual shift towards a more participatory-patient model in Japan. With advances in technology, the possibility to use digital technologies to improve patient interactions is growing and is in line with changing attitudes in the medical profession and society within Japan and elsewhere. The implementation of an online patient engagement platform (...) is being considered by the Myotonic Dystrophy Registry of Japan. The aim of this exploratory study was to understand patients’ views and attitudes to using digital tools in patient registries and engagement with medical research in Japan, prior to implementation of the digital platform. We conducted an exploratory, cross-sectional, self-completed questionnaire with a sample of myotonic dystrophy patients attending an Open Day at Osaka University, Japan. Patients were eligible for inclusion if they were 18 years or older, and were diagnosed with MD. A total of 68 patients and family members attended the Open Day and were invited to participate in the survey. Of those, 59 % submitted a completed questionnaire. The survey showed that the majority of patients felt that they were not receiving the information they wanted from their clinicians, which included recent medical research findings and opportunities to participate in clinical trials, and 88 % of patients indicated they would be willing to engage with digital technologies to receive relevant medical information. Patients also expressed an interest in having control over when and how they received this information, as well as being informed of how their data is used and shared with other researchers. Overall, the findings from this study suggest that there is scope to develop a digital platform to engage with patients so that they can receive information about medical care and research opportunities. While this study group is a small, self-selecting population, who suffer from a particular condition, the results suggest that there are interested populations within Japan that would appreciate enhanced communication and interaction with healthcare teams. (shrink)

Many organisms face a dilemma rooted in the unequal numbers of X chromosomes carried by the two sexes and the need to maintain equivalent expression of X‐linked genes. Several strategies have arisen to cope with this problem. All rely on accurately targeting epigenetic modifications to entire chromosomes. Targeting results from the action of recognition elements that attract modification and may rely on spreading of modification in cis along the affected chromosome. A recent report describing the first X chromosome recognition element (...) from C. elegans opens the way to defining the relative contributions of these factors to the compensation of X‐linked gene expression in worms.1 Extrachromosomal arrays composed of a C. elegans recognition element attract proteins that modify the C. elegans X chromosomes and interact genetically with mutations disrupting compensation. Moreover, examination of X:A translocations provides the first evidence for spreading of modification along C. elegans X chromosomes. BioEssays 26:707–710, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

Cognitive reflection, or the ability to inhibit intuitive and incorrect responses in favour of correct responses, predicts performance on a variety of cognitive tasks. The present study examined interventions to improve cognitive reflection. In two experiments, college students (N = 491) were assigned to one of three conditions, completed two versions of a cognitive reflection test (CRT), and then completed transfer tasks. Between the two CRTs, some participants were provided with elaborative feedback, others were instructed to consider additional responses for (...) their initial responses and the final group was a control. In both experiments, CRT performance increased between the first and second CRT in the feedback and instruction groups, but not in the control group. There was little evidence, however, for transfer to other tasks. These results suggest that cognitive reflection performance can be improved with brief interventions but that this improvement may not transfer to related tasks. (shrink)

In 1932, Wolfgang Pauli was a world-renowned physicist and had already done the work that would win him the 1945 Nobel Prize. He was also in pain. His mother had poisoned herself after his father's involvement in an affair. Emerging from a brief marriage with a cabaret performer, Pauli drank heavily, quarreled frequently and sometimes publicly, and was disturbed by powerful dreams. He turned for help to C. G. Jung, setting a standing appointment for Mondays at noon. Thus bloomed an (...) extraordinary intellectual conjunction not just between a physicist and a psychologist but between physics and psychology. Eighty letters, written over twenty-six years, record that friendship. This artful translation presents them in English for the first time. Though Jung never analyzed Pauli formally, he interpreted more than 400 of his dreams--work that bore fruit later in Psychology and Alchemy and The Analysis of Dreams. As their acquaintance developed, Jung and Pauli exchanged views on the content of their work and the ideas of the day. They discussed the nature of dreams and their relation to reality, finding surprising common ground between depth psychology and quantum physics. Their collaboration resulted in the combined publication of Jung's treatise on synchronicity and Pauli's essay on archetypal ideas influencing Kepler's writings in The Interpretation of Nature and the Psyche. Over time, their correspondence shaped and reshaped their understanding of the principle they called synchronicity, a term Jung had suggested earlier. Through the association of these two pioneering thinkers, developments in physics profoundly influenced the evolution of Jungian psychology. And many of Jung's abiding themes shaped how Pauli--and, through him, other physicists--understood the physical world. Of clear appeal to historians of science and anyone investigating the life and work of Pauli or Jung, this portrait of an incredible friendship will also draw readers interested in human creativity as well as those who merely like to be present when great minds meet. (shrink)

This paper examines the methodological claim made famous by P.F. Strawson: that we understand what features are required for responsible agency by exploring our attitudes and practices of holding responsible. What is the presumed metaphysical connection between holding responsible and being fit to be held responsible that makes this claim credible? I propose a non-standard answer to this question, arguing for a view of responsible agency that is neither anti-realist (i.e. purely 'conventionalist') nor straightforwardly realist. It is instead ‘constructivist’. On (...) the ‘Scaffolding View’ I defend, reactive attitudes play an essential role in developing, supporting, and thereby maintaining the capacities that make for responsible agency. While this view has relatively novel implications for a metaphysical understanding of capacities, its chief virtue, in contrast with more standard views, is providing a plausibly defensible account of how so-called responsible agents genuinely deserve to be treated as such. (shrink)

Hackles have been raised in biosemiotic circles by T. L. Short’s assertion that semiosis, as defined by Peirce, entails “acting for purposes” and therefore is not found below the level of the organism (2007a:174–177). This paper examines Short’s teleology and theory of purposeful behavior and offers a remedy to the disagreement. Remediation becomes possible when the issue is reframed in the terms of the complexity sciences, which allows intentionality to be understood as the interplay between local and global aspects of (...) a system within a system. What is called “acting for purposes” is not itself a type of behavior so much as a relationship between a dynamic system that “exists for a purpose” and its microprocesses that “serve purposes.” The “intentional object” of philosophy is recast here as the holistic self-organized dynamics of a system, which exists for the purpose of self-maintenance, and that constrains the parts’ behaviors, which serve the purpose of forming the system. (A “system” can be any emergent, e.g. an abiotic form, an adapted species, a self, a conditioned response, thought, or a set of ideas.) The self-organized whole, which is represented to the parts in their own constrained behaviors, assumes the guiding function so long attributed to the mysterious “intentional object.” If emergent self-causation is not disallowed, creative originality, as well as directionality, becomes part of the definition of purposeful behavior. Thus, key tools used here, required for understanding emergence, come from poetics rather than semoitics. In the microprocesses of self-organization, I find what I call “accidental” indices and icons — which are poetic in the sense that they involve mere metonymic contiguity and metaphoric similarity — and which are preferentially selected under constrained conditions allowing radically new connections to habituate into an “intentional” self-organized system that, not coincidentally, has some of the emergent characteristics of a conventional symbolic system. (shrink)

It was, until recently, accepted that the two classes of acetylcholine (ACh) receptors are distinct in an important sense: muscarinic ACh receptors signal via heterotrimeric GTP binding proteins (G proteins), whereas nicotinic ACh receptors (nAChRs) open to allow flux of Na+, Ca2+, and K+ ions into the cell after activation. Here we present evidence of direct coupling between G proteins and nAChRs in neurons. Based on proteomic, biophysical, and functional evidence, we hypothesize that binding to G proteins modulates the activity (...) and signaling of nAChRs in cells. It is important to note that while this hypothesis is new for the nAChR, it is consistent with known interactions between G proteins and structurally related ligand‐gated ion channels. Therefore, it underscores an evolutionarily conserved metabotropic mechanism of G protein signaling via nAChR channels.Also watch the Video Abstract. (shrink)

It was, until recently, accepted that the two classes of acetylcholine (ACh) receptors are distinct in an important sense: muscarinic ACh receptors signal via heterotrimeric GTP binding proteins (G proteins), whereas nicotinic ACh receptors (nAChRs) open to allow flux of Na+, Ca2+, and K+ ions into the cell after activation. Here we present evidence of direct coupling between G proteins and nAChRs in neurons. Based on proteomic, biophysical, and functional evidence, we hypothesize that binding to G proteins modulates the activity (...) and signaling of nAChRs in cells. It is important to note that while this hypothesis is new for the nAChR, it is consistent with known interactions between G proteins and structurally related ligand‐gated ion channels. Therefore, it underscores an evolutionarily conserved metabotropic mechanism of G protein signaling via nAChR channels.Also watch the Video Abstract. (shrink)

The class forcing theorem, which asserts that every class forcing notion ${\mathbb {P}}$ admits a forcing relation $\Vdash _{\mathbb {P}}$, that is, a relation satisfying the forcing relation recursion—it follows that statements true in the corresponding forcing extensions are forced and forced statements are true—is equivalent over Gödel–Bernays set theory $\text {GBC}$ to the principle of elementary transfinite recursion $\text {ETR}_{\text {Ord}}$ for class recursions of length $\text {Ord}$. It is also equivalent to the existence of truth predicates for the (...) infinitary languages $\mathcal {L}_{\text {Ord},\omega }$, allowing any class parameter A; to the existence of truth predicates for the language $\mathcal {L}_{\text {Ord},\text {Ord}}$ ; to the existence of $\text {Ord}$ -iterated truth predicates for first-order set theory $\mathcal {L}_{\omega,\omega }$ ; to the assertion that every separative class partial order ${\mathbb {P}}$ has a set-complete class Boolean completion; to a class-join separation principle; and to the principle of determinacy for clopen class games of rank at most $\text {Ord}+1$. Unlike set forcing, if every class forcing notion ${\mathbb {P}}$ has a forcing relation merely for atomic formulas, then every such ${\mathbb {P}}$ has a uniform forcing relation applicable simultaneously to all formulas. Our results situate the class forcing theorem in the rich hierarchy of theories between $\text {GBC}$ and Kelley–Morse set theory $\text {KM}$. (shrink)

Katherine Sarah Moody and Steven Shakespeare begin this collection of essays, produced from the inaugural conference of the Association for Continental Philosophy of Religion (Liverpool Hope University, 2009), by reflecting on life’s ‘haunting’ of philosophy. Life’s dynamism—constantly shifting, fluctuating, hesitating and pushing forward, stretching between birth and death in anything but a safely predictable manner—has always been problematic for philosophy, resisting categorisation and explanation. They present life as an ongoing hermeneutical negotiation, wherein ‘lies the possibility of affirmation’ (p. 1). However, (...) from which standpoint should we affirm life? Immanence or transcendence? Or, with Derrida, should we foster a notion of survival that confounds this dualistic separation (p. 2)?Starting with Kant and Hegel, the editors provide a contextual background and discuss the problems of separating organic life from inorganic nature and the organic human body from unifying super. (shrink)

This article applies Hilary Putnam’s theory of internal realism to the issue of religious plurality. The result of this application – ‘internalist pluralism’ – constitutes a paradigm shift within the Philosophy of Religion. Moreover, internalist pluralism succeeds in avoiding the major difficulties faced by John Hick’s famous theory of religious pluralism, which views God, or ‘the Real,’ as the noumenon lying behind diverse religious phenomena. In side-stepping the difficulties besetting Hick’s revolutionary Kantian approach, without succumbing to William Alston’s critique of (...) conceptual-scheme dependence, internalist pluralism provides a solution to significant theoretical problems, while doing so in a manner that is respectful of cultural diversity and religious sensitivities. (shrink)

Focusing on the new theories of human motivation that emerged during the transition from feudalism to the modern period, this is the first book of new essays on the relationship between politics and the passions from Machiavelli to Bentham. Contributors address the crisis of moral and philosophical discourse in the early modern period; the necessity of inventing a new way of describing the relation between reflection and action, and private and public selves; the disciplinary regulation of the body; and the (...) ideological constitution of identity. The collection as a whole asks whether a discourse of the passions might provide a critical perspective on the politics of subjectivity. Whatever their specific approach to the question of ideology, all the essays reconsider the legacy of the passions in modern political theory and the importance of the history of politics and the passions for modern political debates. Contributors, in addition to the editors, are Nancy Armstrong, Judith Butler, Riccardo Caporali, Howard Caygill, Patrick Coleman, Frances Ferguson, John Guillory, Timothy Hampton, John P. McCormick, and Leonard Tennenhouse. (shrink)

Ehrenfeucht’s lemma asserts that whenever one element of a model of Peano arithmetic is definable from another, they satisfy different types. We consider here the analogue of Ehrenfeucht’s lemma for models of set theory. The original argument applies directly to the ordinal-definable elements of any model of set theory, and, in particular, Ehrenfeucht’s lemma holds fully for models of set theory satisfying V=HOD. We show that the lemma fails in the forcing extension of the universe by adding a Cohen real. (...) We go on to formulate a scheme of natural parametric generalizations of Ehrenfeucht’s lemma, namely, the principles of the form EL, which asserts that P-definability from A implies Q-discernibility. We also consider various analogues of Ehrenfeucht’s lemma obtained by using algebraicity in place of definability, where a set b is algebraic in a if it is a member of a finite set definable from a. Ehrenfeucht’s lemma holds for the ordinal-algebraic sets, we prove, if and only if the ordinal-algebraic and ordinal-definable sets coincide. Using a similar analysis, we answer two open questions posed earlier by the third author and C. Leahy, showing that algebraicity and definability need not coincide in models of set theory and the internal and external notions of being ordinal algebraic need not coincide. (shrink)

Tras su consagración como filósofa de referencia en cuestiones de ética, epistemología social, filosofía feminista y filosofía política, la obra cumbre de Miranda Fricker, _Injusticia epistémica, _ha sido traducida al castellano y publicada por Herder. Doctora en Filosofía por la Universidad de Oxford, Fricker ya había publicado anteriormente, junto con Jennifer Hornsby, _The Cambridge Companion to Feminism in Philosophy _, así como recientemente _The Epistemic Life of Groups: Essays in the Epistemology of Collectives _junto con Michael S. Brady. En la (...) obra que aquí nos ocupa, la autora explora dos tipos de injusticias específicamente epistémicas: la testimonial y la hermenéutica. Mientras que la primera se produce cuando los prejuicios llevan a un oyente a disminuir la credibilidad de los juicios de un emisor, no en un instante de exclusión accidental sino de forma estructural-sistemática, la segunda se corresponde con una fase anterior en la que una falta en los recursos de interpretación colectivos dificulta a un sujeto la comprensión de sus propias experiencias. (shrink)

The article carries out a comprehensive comparative analysis of the understanding of "practice" in the context of thinkers of two directions of Marxism – Ukrainian-Soviet and Chinese philosophers. When examining the concept of "practice" in Ukrainian Soviet Marxism, the work of the following domestic thinkers is studied: P. Kopnin, V. Shynkaruk, V. Tabachkovskyi, V. Ivanov, O. Yatsenko. It is substantiated that domestic thinkers in the 60s and 80s of the XX century. focused their attention on practice not so much in (...) the epistemological or socio-philosophical content, but in the anthropological and existential one. According to most of them, practice is not so much the opposite of theory, but a fundamental principle of consideration of all scientific and theoretical problems through the prism of their humanistic content, which allows us to realize the connection of theoretical knowledge with all the variety of ways of mastering a person. being, reveals the essence of knowledge as a cultural phenomenon. The work "On Practice" by Mao Zedong is analyzed, which reveals the prospect of further understanding of the researched concept within the framework of Chinese Marxism. In particular, he singles out two key aspects of the explanation of "practice": epistemological and political-philosophical. Therefore, Marxism in China is used to solve its problems and transform the rich practical experience of the state into theory, as well as in combination with Chinese history and unique Chinese traditional culture. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The median DUP across the (...) entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)

In recent years, there has been increasing discontent with feminism’s understanding of its own history and, more specifically, the place of the feminist 1970s. Feminist scholars – most prominently, Elizabeth Freeman, Victoria Hesford, Kate Eichhorn and Kathi Weeks – have sought to move beyond the feelings of progress and nostalgia that the feminist 1970s often inspires. There is a need to mediate between the urge to leave the past behind and the desire to return to it, with feminists adopting (...) positions that ricochet between progress and nostalgia. In this article, I argue that the feminist literary utopia offers a particularly productive means by which to represent this ambivalent, paradoxical temporal understanding. The classic feminist utopias of the 1970s have become the object of critical contention in more recent speculative texts, which destabilise both progress and nostalgia in their evocation of second-wave separatism. To elaborate this claim, I turn to Sarah Hall’s The Carhullan Army, which critically assesses the feminist 1970s via an account of a separatist feminist enclave in a near-future Britain. The community of women is a homage to the feminist 1970s, displaying both the potentialities of the movements of this time as well as their sometimes violent limitations. The dreams of the 1970s emerge in the text as an unsettling presence in the world, a force that can neither be left behind nor fully embraced. (shrink)

Background Voluntary assisted dying became lawful in Victoria, the first Australian state to permit this practice, in 2019 via the Voluntary Assisted Dying Act 2017 (Vic). While conscientious objection by individual health professionals is protected by the Victorian legislation, objections by institutions are governed by policy. No research has been conducted in Victoria, and very little research conducted internationally, on how institutional objection is experienced by patients seeking assisted dying. Methods 28 semi-structured interviews were conducted with 32 family (...) caregivers and one patient about the experience of 28 patients who sought assisted dying. Participants were interviewed during August-November 2021. Data from the 17 interviews (all with family caregivers) which reported institutional objection were analysed thematically. Results Participants reported institutional objection affecting eligibility assessments, medication access, and taking the medication or having it administered. Institutional objection occurred across health settings and was sometimes communicated obliquely. These objections resulted in delays, transfers, and choices between progressing an assisted dying application and receiving palliative or other care. Participants also reported objections causing adverse emotional experiences and distrust of objecting institutions. Six mediating influences on institutional objections were identified: staff views within objecting institutions; support of external medical practitioners and pharmacists providing assisted dying services; nature of a patient’s illness; progression or state of a patient’s illness; patient’s geographical location; and the capability and assertiveness of a patient and/or caregiver. Conclusions Institutional objection to assisted dying is much-debated yet empirically understudied. This research found that in Victoria, objections were regularly reported by participants and adversely affected access to assisted dying and the wider end-of-life experience for patients and caregivers. This barrier arises in an assisted dying system that is already procedurally challenging, particularly given the limited window patients have to apply. Better regulation may be needed as Victoria’s existing policy approach appears to preference institutional positions over patient’s choice given existing power dynamics. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection (...) were thematically analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed (...) to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed. (shrink)