Name der Zeitschrift: Das Mittelalter Jahrgang: 19 Heft: 2 Seiten: 302-325.

On September 1, 2023, Texas made important revisions to it its decades‐old statute granting legal safe harbor immunity to physicians who withhold or withdraw life‐sustaining treatment over the objection of critically ill patients’ surrogate decision‐makers. However, lawmakers left untouched glaring flaws in a key safeguard for patients—the transfer option. The transfer option is ethically important because, when no hospital is willing to accept the patient in transfer, that fact is taken as strong evidence that the surrogates’ treatment requests fall outside (...) accepted medical practice. But there are serious shortcomings in how the transfer option is carried out in Texas and many other states, which undermines the ethical usefulness of the process. We identify these shortcomings and recommend revisions to state statutes and professional guidelines to overcome them. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

In recent years, the genetic testing and selection of IVF embryos, known as preimplantation genetic testing (PGT), has gained much traction in clinical assisted reproduction for preventing transmission of genetic defects. However, a more recent ethically and morally controversial development in PGT is its possible use in selecting IVF embryos for optimal intelligence quotient (IQ) and other non–disease-related socially desirable traits, such as tallness, fair complexion, athletic ability, and eye and hair colour, based on polygenic risk scores (PRS), in what (...) is referred to as PGT-P. Artificial intelligence (AI) and machine learning–based analysis of big data sets collated from genome sequencing of specific human ethnic populations can be used to estimate an individual embryo’s likelihood of developing such multifactorial traits by analysing the combination of specific genetic variants within its genome. Superficially, this technique appears compliant with Islamic principles and ethics. Because there is no modification of the human genome, there is no tampering with Allah’s creation (_taghyīr khalq Allah_). Nevertheless, a more critical analysis based on the five maxims of Islamic jurisprudence (_qawa'id fiqhiyyah_) that are often utilized in discourses on Islamic bioethics, namely _qaṣd_ (intention), _yaqın̄_ (certainty), _ḍarar_ (injury), _ḍarūra_ (necessity), and _`urf_ (custom), would instead reveal some major ethical and moral flaws of this new medical technology in the selection of non–disease-related socially desirable traits, and its non-compliance with the spirit and essence of Islamic law (shariah). Muslim scholars, jurists, doctors, and biomedical scientists should debate this further and issue a fatwa on this new medical technology platform. (shrink)

In this article, we present results from a literature review of intrinsic, instrumental, and relational values of nature conducted for the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, as part of the Methodological Assessment of the Diverse Values and Valuations of Nature. We identify the most frequently recurring meanings in the heterogeneous use of different value types and their association with worldviews and other key concepts. From frequent uses, we determine a core meaning for each value type, which is (...) sufficiently inclusive to serve as an umbrella over different understandings in the literature and specific enough to help highlight its difference from the other types of values. Finally, we discuss convergences, overlapping areas, and fuzzy boundaries between different value types to facilitate dialogue, reduce misunderstandings, and improve the methods for valuation of nature's contributions to people, including ecosystem services, to inform policy and direct future research. © 2023 The Author(s). Published by Oxford University Press on behalf of the American Institute of Biological Sciences. (shrink)

This research explores the contextual approach within Christian-Jewish religious education, addressing a notable gap in existing literature and offering fresh insights into the application of the Contextual Teaching and Learning (CTL) model within Christian contexts. Through a qualitative literature study employing a three-step methodology, including an in-depth analysis of Deuteronomy 11:19–20, this study reveals that this biblical text provides both educational guidance and theological significance, serving as a foundational support for the CTL model in Christian-Jewish religious education. The integration of (...) digital media into biblical sources holds promise for future research, while the central challenge lies in harmonising life experiences and empirical phenomena with biblical reflections to seamlessly integrate inquiry processes and pedagogical phases, with potential avenues for further exploration in scripture models endorsing CTL. This research provides valuable insights for educators, parents and policymakers in Indonesia and beyond, advancing educational research in contextualised teaching models within religious education.Contribution: This article demonstrates that the CTL model in the digital era has the potential to revolutionise religious education and profoundly impact learners, making it a significant scientific contribution in the context of Christian-Jewish religious education. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

_The purpose_ of the article is to comprehend the Husserlian model of constituting temporal modes through the ability of intentional "retentional-protentional" consciousness, as well as to clarify the possibility of interpreting its positions in the reconstruction of the concept of anthropic time. _Theoretical basis._ The theoretical framework of the research includes: 1) the interpretation of the phenomenological reflection of "time-consciousness" by E. Husserl in the context of solving the problem of phased-differentiation of this form of temporality; 2) the concept of (...) anthropic time (V. Khanzhy). _Originality._ For the first time in research literature, the possibilities of applying the ideas of Husserl to the reconstruction of the concept of anthropic time are considered through the interpretation of the phenomenological solution to the problem of temporality, proposed and specified in Husserl’s "time-consciousness" concept. _Conclusions._ The comprehension of the Husserlian model of intentionality of consciousness through the "grasping-from-now" and the constitution of phases of phenomenological time through the component of "exiting-from-now" showed that solving the problem of phased-differentiation of phenomenological time leads to the observation of the impossibility of isolating the modes of past, present, and future as self-sufficient and unconditional. More accurate indications, based on the constitutive intentionality of consciousness on the "grasping-from-now" phases of time (as conventional), are as follows: a) the abilities of retention and recollection are the foundation for the constitution of the past and its connections to the present; b) the perception establishes the basis for the phase of the present itself; c) the possibilities of protention and anticipation (as forms of imagination) constitute the future and its connections to the present. By the concept of retention, Husserl fixes a certain primary memory (the present "now" of a past interval), which enables retaining the past in the present. The category of recollection or secondary memory is used by the philosopher to refer to the self-sufficient reproduction of past experiences (without being joined to present perception). The fundamental difference between recollection and retention is that the former _re-_presents a temporal interval, grasping its content and reproducing it as it was in the past, while in the latter, the perceived duration is presented as a fragment of time that has just passed. According to the German philosopher, the "grasping" of the present phase is performed by perception. Through the constitutive intentionality of consciousness, perception synthesizes the results of primary-actual activity and retentional holding of duration. The second part of the article will present solutions to the following research tasks: 1) analysis of the possibilities of protention and anticipation in constituting the future and its connections with the present; 2) understanding the possibility of using interpreted forms of Husser’s ideas in reconstructing the concept of anthropic time. (shrink)

ABSTRACTMajor depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy with treatment-as-usual on cognitive reactivity in recurrently depressed patients. Depressive symptoms, cognitive reactivity, and mindfulness skills were assessed pre and post treatment. Patients (...) in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group. The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminar... (shrink)

One of the processes that Zaydism, as a sect that has survived to the present day, went through in the Yemen region is the period that began with Mansûr-Billâh Qasim b. Muhammad, who declared his imamate in the 16th century and continued by the descendants of the ruling class until the declaration of the Republic. However, there is not enough information in the literature about this period, which is known as the Kasimi’s era. Mansûr-Billâh Qasim b. Muhammad has many works (...) on akaid, tafsir, method, islamic law, and in addition, there is a small pamphlet (risalah) written by him. This study aims to introduce the translation of the will written by Mansûr-Billâh Qasim b. Muhammad, who is known as the founder of the Kasimi dynasty, for his son Muayyad-Billâh Muhammad b. Kasım into the literature. (shrink)

Ch. 1. Antropogenez -- ch. 2. Problema t︠s︡elesoobraznosti -- ch. 3. Dialektika kak geneticheskai︠a︡ logika.

An alternative notion of an existential quantifier on four-valued Łukasiewicz algebras is introduced. The class of four-valued Łukasiewicz algebras endowed with this existential quantifier determines a variety which is denoted by \. It is shown that the alternative existential quantifier is interdefinable with the standard existential quantifier on a four-valued Łukasiewicz algebra. Some connections between the new existential quantifier and the existential quantifiers defined on bounded distributive lattices and Boolean algebras are given. Finally, a completeness theorem for the monadic four-valued (...) Łukasiewicz predicate calculus corresponding to the dual of the alternative existential quantifier is proven. (shrink)

Background: Pulsed dye laser is the gold standard for treatment of port-wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. Objective: We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. Methods: Healthy individuals with PWS were treated with PDL and then randomized to (...) apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements for 57 PWS sites were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa and ΔE were measured to quantify treatment outcome. Results: Two patients developed minor skin irritation. Other adverse effects were not noted. Average a was 0.43 for PDL + placebo sites and 1.27 for PDL + imiquimod sites indicating a greater reduction in erythema with imiquimod. Average E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod, again indicating a greater color improvement with imiquimod. Limitations: Effects were evaluated after a single treatment and duration of effect is unknown. Conclusion: Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy. © 2011 by the American Academy of Dermatology, Inc. (shrink)

The spatial organization of the genome is intimately linked to its biological function, yet our understanding of higher order genomic structure is coarse, fragmented and incomplete. In the nucleus of eukaryotic cells, interphase chromosomes occupy distinct.