En los Países Bajos, tanto los pacientes psiquiátricos involuntarios como los voluntarios tienen derecho a recibir apoyo individual de un abogado del paciente. Desde 1982, el apoyo de los defensores de los pacientes ha sido organizado y facilitado por la Fundación Nacional Holandesa para los Defensores de los Pacientes en la Atención de la Salud Mental. La forma en que los defensores tienen que llevar a cabo sus tareas jurídicas se ha traducido en normas de conducta elaboradas por la mencionada (...) Fundación. Algunas piedras angulares del modelo holandés son la independencia del hospital psiquiátrico, la buena accesibilidad, la confidencialidad, la receptividad a las preguntas y quejas del paciente, la orientación sobre la posición jurídica del paciente individual, la parcialidad, la representación de los intereses de atención del paciente según su experiencia y el requisito del consentimiento a las acciones del defensor. La combinación de estas piedras angulares resulta en un papel muy específico para el defensor del paciente. El modelo holandés asume que este papel encaja bien con el de otros actores de la salud y que las leyes de salud son justas. El valor de esa defensa del paciente depende de la medida en que se cumplan esos dos supuestos. Se pueden hacer preguntas críticas sobre el ajuste en cuestión y la calidad de la justicia positiva. (shrink)

The principle of autonomy presupposes Patient Decision Making Competence (PDMC). For a few decades a considerable amount of empirical research has been done into PDMC. In this contribution that research is explored. After a short exposition on four qualities involved in PDMC, different approaches to assess PDMC are distinguished, namely a negative and a positive one. In the negative approach the focus is on identifying psychopathologic conditions that impair sound decision making; the positive one attempts to assess whether a patient (...) actually has the required abilities and qualities. Characteristic of the latter approach is the use of (or development of) test-like instruments for PDMC assessment. Some of these tests are discussed and commented on. Although they may be useful in investigating aspects of PDMC, none of the described approaches and tests offers a reliable and valid method for PDMC assessment. In response to a potential misuse of tests, the concept of a supportive situation is briefly introduced in order to draw attention to the risk of prematurely deeming patients incompetent on the basis of low test scores, whereas their insufficient performance may be (partly) attributable to alack of situational support. Also, the need for and possibility of an emotionalist concept of PDMC are suggested, as an alternative to the more common rationalist one. In this regard,the legitimacy of competence being conceived as a presumption or fiction of law, deserves further investigation. (shrink)

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate, and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of best interest judgments entails a risk that health care providers withdraw (...) from the decision-making process, abandoning patients to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)

In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)

This volume presents a study edition of the lectures delivered by Charles Peirce to the Lowell Institute in Boston in the Fall of 1903. These previously unpublished lectures present a comprehensive and revised statement of his work on the methods of science. Offering mature reflection on a lifetime's thought and work, they represent the culmination of Peirce's research on scientific objectivity. Alongside the Cambridge Conferences Lectures (1898, edited by K. L. Ketner), the Harvard Lectures on Pragmatism (1903, edited by P. (...) A. Turrisi), and the The Logic of Interdisciplinarity (the project of Peirce's Monist Series 1891-1909, edited by E. Bisanz), the Lowell Lectures of 1903 presented here offer significant insights into Peirce's mature phase as an explorer of objective methods in interdisciplinary science. This collection will appeal to anyone interested in the work of this great thinker, the history of science, and the history of American intellectual life. (shrink)

Differential scanning calorimetry (DSC) has been employed to investigate the glass transition activation energy E g, thermal stability and glass-forming ability (GFA) of Se90In10− x Sb x (x = 0, 2, 4, 6, 8, 10) chalcogenide glasses. DSC runs were performed at six different heating rates. Well-defined endothermic and exothermic peaks were obtained at glass transition and crystallization temperature. The dependence of glass transition temperature T g on heating rate (α), as well as composition of Sb, has been studied. From (...) the dependence of glass transition temperature on heating rate, the E g has been calculated on the basis of the Kissinger [Anal. Chem. 29 (1957) p.1702] and Moynihan [J. Phys. Chem. 78 (1974) p.267] models. Thermal stability has been monitored through the calculation of temperature differences T c–T g, the stability parameter S, and the enthalpy released during crystallization H c. The GFA has been investigated on the basis of the Hruby parameter H r, which is strong indicator of GFA. Results for GFA are in good agreement with fragility index F i calculations, indicating that Se90In6Sb4 is an excellent glass-former. (shrink)

Материалы сборника предназначены для специалистов.

Treatise on the Advaita school in Hindu philosophy.

The mathematical works of the French philosopher Charles de Bovelles have received little attention from historians of scientific thought. At the University of Paris, Bovelles studied under Jacques Lefèvre d'Étaples, sharing with him a high regard for the Christian Neoplatonic philosophy of Nicholas of Cusa. One aspect of Cusanus's philosophy was particularly favoured by Lefèvre and Bovelles: the use of geometrical symbolism to provide mathematical guidance to the divine. While Lefèvre was preparing an edition of Cusanus's works , Bovelles wrote (...) a treatise of his own, in which the geometry of the five polyhedra was used to provide an approach to the mystery of the Trinity. Seen in the context of Renaissance syncretism of Platonism and Christianity, Bovelles's treatise adds a theological layer of interpretation to the literal meaning of the polyhedral physics described by Plato in the Timaeus. In so doing, it contributes to the discussion of a problem that was later to concern several Renaissance philosophers and cosmologists, including, at the end of the century, Johannes Kepler. (shrink)

The purpose of this article is to comprehensively review studies that have examined the relation between diet and childhood obesity. The review specifically considers the roles of total energy intake and energy density; dietary composition; individual foods, food groups, and dietary patterns; beverage consumption; and eating behaviors. The paper also discusses methodological considerations and future research directions and concludes by summarizing the evidence presented and highlighting the ethical issues surrounding providing dietary advice.

An epistemic logic is built up on the basis of an analysis of two skeptical arguments. the method used is to first construct an inference relation appropriate to epistemic contexts and introduce "a knows that..." as an operator giving rise to sentences closed with respect to this new concept of inference. soundness and completeness proofs are provided using auxiliary three-valued valuations.

This paper attempts to argue for the theory-ladenness of evidence. It does so by employing and analysing an episode from the history of eighteenth century chemistry. It delineates attempts by Joseph Priestley and Antoine Lavoisier to construct entirely different kinds of evidence for and against a particular hypothesis from a set of agreed upon observations or (raw) data. Based on an augmented version of a distinction, drawn by J. Bogen and J. Woodward, between data and phenomena it is shown that (...) the role of theoretical auxiliary assumptions is very important in constructing evidence for (or against) a theory from observation or (raw) data. In revolutionary situations, rival groups hold radically different theories and theoretical auxiliary assumptions. These are employed to construct very different evidence from the agreed upon set of observations or (raw) data. Hence, theory resolution becomes difficult. It is argued that evidence construction is a multi-layered exercise and can be disputed at any level. What counts as unproblematic observation or (raw) data at one level may become problematic at another level. The contingency of these constructions and the (un)problematic nature of evidence are shown to be partially dependent upon the scientific knowledge that the scientific community possesses. (shrink)

Childhood obesity is a serious problem for increasing numbers of children around the world. According to the International Obesity Task Force, 1 of 10 schoolaged children worldwide is overweight or obese, a number totaling 155 million; of these, 2-3% are obese. Prevalence is highest in the Americas and Europe, followed by the Near/Middle East, with smaller but growing numbers in the Asia-Pacific and Sub-Saharan regions of the world.In the United States, which provides the data for much of this report, prevalence (...) continues to rise. The most recent nationally representative data indicate that 33.6% of individuals aged 2-19 years were overweight and 17.1% were at risk for overweight in 2003-2004, compared to 28.2% and 13.9% in 1999-2000, respectively. In this age group, the prevalence of overweight or at risk for overweight was highest among Mexican Americans, followed by Non-Hispanic blacks and Non-Hispanic whites, and a higher percentage of males were overweight compared to females. (shrink)

Objective: To study the preferences of patients for information related to elective procedures.Methods: A survey was carried out using a sample of 187 women. The majority of whom were on a low-income, who obtained obstetric or gynaecological services at St Joseph Regional Medical Center in Milwaukee, Wisconsin, while they were in a waiting room.Results: Many of the complications, including those that are uncommon and less serious, were considered to be relevant to the medical decisions of most patients. Average seriousness ratings (...) associated with complications of various elective procedures were in the range of moderate to high. A frequency of complications of 1:100 or higher would factor into most women’s elective treatment decisions. Women indicated a preference for receiving as much or more information pertaining to complications associated with particular elective obstetric or gynaecological procedures as other elective procedures.Conclusion: Most women wish to be informed of risks and treatment alternatives, rate many complications as serious, and are likely to use information provided to make elective treatment decisions. (shrink)

Uneasy times such as the present are distinguished by the extreme indeterminacy and fuzziness of the language they use. But as a rule this is veiled over, not unsuccessfully, if often unconsciously and with self-deception. The concrete examples or "figures" of linguistic expression are quite diverse: they include the reduction of the conceptual structures of language to purely verbal constructions and schemata, the uncommonly frequent use of certain words and expressions, which creates the illusion that they are clear and well (...) defined, and much, much else. (shrink)

Pluralism is on everyone's lips these days. Only lazy people do not refer to it. Politicians and authorities on political affairs are particularly eager to talk about it. Not to be left behind are scholars who broaden pluralism to a philosophical methodological position that fits best the spirit of the times and the present historical situation. Some writers view pluralism as the most important discovery of the twentieth century, a further development of the Copernican revolution in philosophy.