OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)
The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a (...) do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)
There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, we argue that (...) the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. (shrink)
The apolipoprotein E gene plays an important role in the pathogenesis of Alzheimer's disease , and amyloid plaque comprised mostly of the amyloid-beta peptide ) is one of the major hallmarks of AD. However, the relationship between these two important molecules is poorly understood. We examined how A treatment affects APOE expression in cultured cells and tested the role of the transcription factor NF-B in APOE gene regulation. To delineate NF-B's role, we have characterized a 1098 nucleotide segment containing the (...) 5'-flanking region of the human APOE gene . Sequence analysis of this region suggests the presence of two potential NF-B elements. To demonstrate promoter activity, the region was cloned upstream of a promoterless luciferase gene. This segment was able to drive expression of luciferase in transient transfections of human fetal glial cells. Promoter activity was stimulated twofold by A treatment. Pretreatment with double-stranded DNA decoy oligonucleotides against NF-B reduced A stimulation. Deletion and mutagenetic analyses demonstrated that the distal NF-B element was functional and showed a strong DNA-protein complex band in gel shift analysis, similar to that from control NF-B consensus element. An anti-inflammatory and anti-NF-B drug, sodium salicylate, significantly blocked A-induced APOE promoter function. Our data provide evidence that upregulation of APOE by A in astroglial cells is mediated by an NF-B-element present in the 5'-flanking region of the APOE gene. (shrink)
The purpose of this study was to develop a Physician's Spiritual Well-Being Scale (PSpWBS). The significance of a physician's spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physician's characteristics; medical practice challenges; response to changes; and overall well-being. The explainable (...) total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician. (shrink)
This study investigated the differences between past and future temporal discounting in terms of neural activity in relation to temporal distance. Results show that brain regions are engaged differently in past and future temporal discounting. This is likely because past temporal discounting requires memory reconstruction, whereas future temporal discounting requires the processing of uncertainty about the future. In past temporal discounting, neural activity differed only when preferences were made between rewards received one hour prior and rewards received further in the (...) past. The peak amplitudes of P2 and P3 varied as the temporal distance increased from 2 weeks to 50 years. In future temporal discounting, neural activity differed only when preferences were evaluated between two delayed rewards. The delay conditions and had a significant influence on P2 and N2. Findings indicate the existence of different decision-making systems operating in past and future temporal discounting. (shrink)
In _Animacies_, Mel Y. Chen draws on recent debates about sexuality, race, and affect to examine how matter that is considered insensate, immobile, or deathly animates cultural lives. Toward that end, Chen investigates the blurry division between the living and the dead, or that which is beyond the human or animal. Within the field of linguistics, animacy has been described variously as a quality of agency, awareness, mobility, sentience, or liveness. Chen turns to cognitive linguistics to stress (...) how language habitually differentiates the animate and the inanimate. Expanding this construct, Chen argues that animacy undergirds much that is pressing and indeed volatile in contemporary culture, from animal rights debates to biosecurity concerns. Chen's book is the first to bring the concept of animacy together with queer of color scholarship, critical animal studies, and disability theory. Through analyses of dehumanizing insults, the meanings of queerness, animal protagonists in recent Asian/American art and film, the lead in toys panic in 2007, and the social lives of environmental illness, _Animacies_ illuminates a hierarchical politics infused by race, sexuality, and ability. In this groundbreaking book, Chen rethinks the criteria governing agency and receptivity, health and toxicity, productivity and stillness—and demonstrates how attention to the affective charge of matter challenges commonsense orderings of the world. (shrink)
Sr. Garcia wants to bring readers the image of Marx they might draw from his 1844 economic-philosophical manuscripts which were not published until 1932, on the initiative of the Marx-Engels Institute of Moscow, under the title Zur Kritik der Nationaloeconomie mit einem Schlusskapitel über die Hegelsche Philosophie. He feels the tardy discovery of this work is as significant for the understanding of Marx as the belated discovery of the epistles of Saint John would have been to an understanding of Jesus. (...) Garcia sees his task to be that of "cleaning the coin" of Marxism in order for both of its true faces to be seen. Marx used the word "transubstantiation" to refer to the transformation of the substance of the history of philosophy by the socialist revolution. This is much more than reinterpretation. He likens the socialist transubstantiation of philosophy and Catholicism to the absorption of primitive explanations in science into modern theoretical physics. As the transformation of the son of man into the Son of God was the task of Christianity, the transformation of natural man into the creator and creature of society is the task of socialism. The author is thus trying to show that the atheism attributed to Marx is not inimical to the true values of the Christian myth, but absorbs and transforms them into Humanism, which is the "very theme of our time."—M.B.M. (shrink)
A partir de un diálogo hermenéutico-crítico con el pensamiento primero de M. Scheler y luego de M. Henry el artículo emprende un análisis fenomenológico de los sentimientos en tanto actos intencionales. Primero se elucida la esencia del sentimiento como una estricta correlación entre la auto-afectividad experimentada en el cuerpo viviente y el carácter patético del mundo, y se caracteriza esta correlación en función de una doble reversión de la dirección intencional que se da entre ambos correlatos. Luego se introduce la (...) noción de “interesabilidad” como condición originaria tracendental de posibilidad de todo sentimiento. (shrink)
Resumen Nuestro trabajo presenta una nueva propuesta de lectura de una inscripción hallada en Emporiae en honor de un M. Iuṇ[ius] cuya identidad tratamos de determinar, planteando la posibilidad de que se trate del pretor M. Iunius citado por Cicerón en su discurso Pro Cluentio y de que, por lo tanto, la inscripción corresponda a su posible proconsulado en Hispania Citerior hacia el año 68 a. C. Dicho supuesto nos permite al mismo tiempo poner al personaje en relación con las (...) circunstancias fundacionales de la ciudad romana de Emporiae, cuyo nacimiento sitúan hoy ciertos arqueólogos en las primeras décadas del siglo I a. C. (shrink)
El propósito del presente artículo es proponer un diálogo entre la novela autobiográfica Infancia del autor sudafricano J. M. Coetzee, y la transformación existencial del ser-ahí heideggeriano, tal como esta es analizada e interpretada en Ser y tiempo. El camino que seguiremos consistirá en desarrollar un procedimiento hermenéutico de carácter especular, mediante el cual podamos articular el sentido de la obra literaria con el relato formal, ontológico, de la existencia del Dasein en Ser y tiempo de Heidegger. A través de (...) este diálogo examinaremos cómo se interpelan, problematizan y, en algunos puntos, se aclaran mutuamente ambos relatos, haciendo uso de algunos conceptos claves de la analítica existencial como “disposición afectiva”, “comprensión”, “condición de arrojado”. (shrink)
Polo’s distinction between created and non-created being is developed in this paper into the distinction between God and creature and thence to the metaphysic study of the finite. In a second instance, Polo’s comprehension of Eckhart is is reviewed regarding the ontological status of creature. The author finally introduces the complex idea of the Logos, that is, the Creator’s comprehension of the creature, an issue discussed with personal differences by Thomas Aquinas, Eckhart, and Polo.
En los reproches que José Ortega y Gasset le hace a Martin Heidegger sobre el problema del ser, al afirmar que este no puede ser un ciego punto de partida, una creencia, se evidencia la distancia entre dos perspectivas unidas por el horizonte real que pretenden explorar: la vida humana. Sin embargo,..
Este artículo está dividido en dos partes. En primer lugar, contiene un análisis sobre la relación establecida por M. Foucault entre el tabú de la muerte en la sociedad contemporánea y el predomino de una determinada tecnología del poder, la biopolítica. Y, en segundo lugar, se subraya la posibilidad apuntada por Foucault de pensar otras formas de experienciar la muerte, que cuestionen los caminos preestablecidos por los biopoderes que dirigen la sociedad normalizadora.
The act/omission distinction is used throughout Western legal systems, and indeed elsewhere, to police the boundaries between acceptable medical practice and unacceptable interventions designed to bring about the death of patients. Without exception, it has proved impossible to maintain the distinction with any clarity. In the United Kingdom, for example, it is lawful both to withhold and to withdraw from a patient treatment that the medical ….
The paper is the analysis a Feyerabend philosophy of science, his criticism of glorification of science reason and his ”surprising” thoughts of the last period of his life such as ”... objectivism and relativism not only are untenable as philosophies, they are bad guides for fruitful cultural collaboration”.