Here we describe how more important findings were obtained in a delirium study by using an informal assessment of mental capacity, and, in those who lacked capacity, obtaining consent later when or if capacity returned or a proxy was found. From a total of 233 patients 23 patients lacked capacity as judged by our informal capacity judgment and 210 did not. Of those who lacked capacity, 13 agreed to enter in the study. Six of them regained capacity later. When these (...) 13 participants were excluded from analysis, significant findings were no longer evident. These results show that by the inclusion of subjects who lacked capacity the results of analyses of the condition from whish they suffer are altered. We suggest that this approach to the study of delirium is more ethical than the usual system of strict exclusion of people who lack capacity to give consent and for whom assent is not available. (shrink)
This paper examines the debate around the headscarf in France with the view to critically examining two central arguments put forward by the Stasi Commission for the restriction of the headscarf in French public schools—that the headscarf imperiled public order and that it jeopardized neutrality in the public sphere. In the case of the first argument, this paper argues that France did not meet the threshold requirement necessary to curtail religious rights in public schools. In the case of the second (...) argument, this paper insists that neutrality in the pulic sphere has always involved some accommodation of religious groups in society and should include the headscarf in public schools. The paper argues that the decision to ban the headscarf is ultimately a controversy about French identity and the values on which the French community is built. (shrink)
Objectives: To investigate whether different methods of obtaining informed consent affected recruitment to a study of delirium in older, medically ill hospital inpatients.Design: Open randomised study.Setting: Acute medical service for older people in an inner city teaching hospital.Participants: Patients 70 years or older admitted to the unit within three days of hospital admission randomised into two groups.Intervention: Attempted recruitment of subjects to a study of the natural history of delirium. This was done by either a formal test of capacity, followed (...) by either a request for consent or an attempt at obtaining assent from a proxy, or a combined informal capacity/consent process.Main outcome measures: Prevalence and severity of delirium, and, as case mix measures, length of hospital stay and destination on discharge.Results: Recruitment of subjects through establishing formal capacity and then informed consent was less successful and, compared with those recruited through the usual combined capacity/consent approach, yielded a sample with less cognitive impairment, lower severity of delirium, lower probability of case note diagnosis of delirium and lower rate of entering a care home.Conclusions: Methods of obtaining informed consent may significantly influence the case mix of subjects recruited to a study of delirium. Stringent testing of capacity may exclude patients with delirium from studies, thus rendering findings less generalisable. A different method is necessary to achieve an ethical balance between respecting autonomy through obtaining adequate informed consent and avoiding sample bias. (shrink)
The present paper outlines the main points of Heidegger’s philosophical program starting from his early lectures of Freiburg. This program is founded in two fundamental questions. On the one hand, a thematic question: the phenomenon of life and its different forms of manifestation and apprehension. On the other hand, an eminently methodological question, namely the question of how it is possible to access in a correct manner to the primary sphere of life. This last issue conducts the young Heidegger to (...) a first and deep questioning of Husserl’s reflexive phenomenology that ends up in his hermeneutic turn of phenomenology. (shrink)
sirThe finding that Japanese physicians are reluctant to withdraw artificial nutrition from patients in persistent vegetative state is of note because, as the authors of a recent paper in the journal point out, Japanese physicians cannot be described as being strongly subject to the Judaeo-Christian influence.1 Despite this, the Japanese physicians show the same reluctance ….
During the latter part of his career, Kant proposes three different accounts of evil. In these accounts are found psychological, logical, and teleological elements intetwoven in such a way as to give a coherent reading of evil as a complex philosophical issue. Recent commentators have emphasized one or the other of these two elements and consequently have only given a partial picture of Kant’s struggle with evil. I argue that Kant’s use of scripture needs to be taken much more seriously (...) than it has been taken in order to unify these psychological, logical, and teleological aspects of his treatment. (shrink)
From the earliest days of philosophy, polemic has functioned as a common means of philosophical argumentation. Kant spends some time in the Critique of Pure Reason analyzing the place of polemic in rational argumentation. Even though it does not provide a legitimate approach to philosophical argument as employed by the dogmatists, Kant’s concern for the teaching of the young allows him to raise some issues concerning the ethics of philosophical argumentation also.