In 2001, leaders with palliative care convened to discuss the standardization of palliative care and formed the National Consensus Project for Quality Palliative Care. In 2004, the National Consensus Project for Quality Palliative Care produced the first edition of Clinical Guidelines for Quality Palliative Care. The Guidelines were developed by leaders in the field who examined other national and international standards with the intent to promote consistent, accessible, comprehensive, optimal palliative care through the health care spectrum. Within the guidelines there (...) are eight domains to the provision of palliative care. This article focuses on the last, but very significant Domain 8—Ethical and Legal Aspects of Care. (shrink)

Exploitation of the executive exercise of covert operations has presented a dilemma, but Colby maintains that even in peacetime a "democratic society must have and respect some secrets.".

We discuss a case where clinical genomic investigation of muscle weakness unexpectedly found a genetic variant that might (or might not) predispose to kidney cancer. We argue that despite its off-target and uncertain nature, this variant should be discussed with the man who had the test, not because it is medical information, but because this discussion would allow the further clinical evaluation that might lead it to becoming so. We argue that while prominent ethical debates around genomics often take ‘results’ (...) as a starting point and ask questions as to whether to look for and how to react to them, the construction of genomic results is fraught with ethical complexity, although often couched as a primarily technical problem. We highlight the need for greater focus on, and appreciation of, the ethical work undertaken daily by scientists and clinicians working in genomic medicine and discuss how public conversations around genomics need to adapt to prepare future patients for potentially uncertain and unexpected outcomes from clinical genomic tests. (shrink)

This popular and classic text chronicles America's roller-coaster journey through the decades since World War II. Considering both the paradoxes and the possibilities of postwar America, William H. Chafe portrays the significant cultural and political themes that have colored our country's past and present, including issues of race, class, gender, foreign policy, and economic and social reform. He examines such subjects as the Vietnam War, the civil rights movement, the origins and the end of the Cold War, the culture (...) of the 1970s, the rise of the New Right, the events of September 11th and their aftermath, and various presidencies.Now thoroughly revised and updated, the seventh edition of The Unfinished Journey combines and reorganizes several chapters. The former Chapter 14, "New Rules, Old Realities," is now divided into two chapters. The new Chapter 14, "An Era of Political Malaise," covers the political history of the 1970s. It is followed by Chapter 15, "A Divided Culture, A Divided Society," which assesses the shifting cultural landscape of the 1970s and the emergence of major fissures in the social system of the nation. The final chapter contains substantial new material on the administration of George W. Bush, the wars in Iraq and Afghanistan, the election of 2008, and the first year of Barack Obama's presidency. Brilliantly written by a prize-winning historian, The Unfinished Journey, Seventh Edition, is an essential text for all students of recent American history. (shrink)

A central motif of R. G. Collingwood's philosophy of history is the idea that historical understanding requires a re-enactment of past experience. However, there have been sharp disagreements about the acceptability of this idea, and even its meaning. This book aims to advance the critical discussion in three ways: by analysing the idea itself further, concentrating especially on the contrast which Collingwood drew between it and scientific understanding; by exploring the limits of its applicability to what historians ordinarily consider their (...) proper subject-matter; and by clarifying the relationship between it and some other key Collingwoodian ideas, such as the place of imagination in historical inquiry, the sense in which history deals with the individual, the essential perspectivity of historical judgement, and the importance of narrative and periodization in historical thinking. Professor Dray defends Collingwood against a good deal of recent criticism, while pointing to ways in which his position requires revision or development. History as Re-enactment draws upon a wide range of Collingwood's published writings, and makes considerable use of his unpublished manuscripts. It is the most systematic study yet of this central doctrine of Collingwood's philosophy of history, and will stand as a landmark in Collingwood studies. 'For many years William Dray has been working at the task of retrieving Collingwood for contemporary philosophy.... It is something of an event then to have this new work, the culmination of a lifetime of thought, appear in his retirement. As one would expect, it is a deeply considered book, lucidly written, and scrupulously fair to all parties... a sound and serious philosophical commentary... anyone interested in either Collingwood or the philosophy of history should consider joining the dialogue and will learn much in the process.' Canadian Journal of History. (shrink)

Diphtheria is an acute toxin-mediated superficial infection of the respiratory tract or skin caused by the aerobic gram-positive bacillus Corynebacterium diphtheriae. The epidemiology of infection and clinical manifestations of the disease vary in different parts of the world. Historical accounts of diphtheria epidemics have been described in many parts of the world since antiquity. Developed in the late 19th century, the diphtheria antitoxin played a pivotal role in the history of public health and vaccinology prior to the advent of the (...) diphtheria-tetanus toxoids and acellular pertussis vaccine. One of the most significant demonstrations of the importance of DAT was its use in the 1925 diphtheria epidemic of Nome, Alaska. Coordinated emergency delivery of this life-saving antitoxin by dog-sled relay in the harshest of conditions has left a profound legacy in the annals of vaccinology and public health. Lead dogs Balto and Togo, and the dog-led antitoxin run of 1925 represent a dynamic illustration of the contribution made by non-human species towards mass immunization in the history of vaccinology. This unique example of cooperative interspecies fellowship and collaboration highlights the importance of the human-animal bond in the one-health initiative. (shrink)

The Power of Ideals examines the lives and work of six 20th century moral leaders who pursued moral causes ranging from world peace to social justice and human rights, and uses these six cases to show how people can make choices guided by their moral ideals rather than by base emotion or social pressures.

Science fiction is often held up as a particularly philosophical genre. For, beyond actualising mind-experiment-like fantasies, science fiction films also commonly toy with speculative ideas, or else engineer encounters with the strange and unknown. Denis Villeneuve's Arrival is a contemporary science fiction film that does exactly this, by introducing Lovecraft-esque tentacular aliens whose arrival on Earth heralds in a novel, but ultimately paralysing, inhuman perspective on the nature of time and reality. This article shows how this cerebral film invites viewers (...) to confront a counterintuitive model of time that at once recalls and reposes what Gilles Deleuze called a “third synthesis” of time, and that which J. M. E. McTaggart named the a-temporal “C series” of “unreal” time. We finally suggest that Arrival's a-temporal conception of the future as having already happened can function as a key to understanding the fate of humanity as a whole as we pass from the anthropocene, in which humans have... (shrink)

Taking a schizoanalytic approach to audio-visual images, this article explores some of the radical potentia for deterritorialisation found within David Fincher's Fight Club (1999). The film's potential for deterritorialisation is initially located in an exploration of the film's form and content, which appear designed to interrogate and transcend a series of false binaries between mind and body, inside and outside, male and female. Paying attention to the construction of photorealistic digital spaces and composited images, we examine the actual (and possible) (...) ways viewers relate to the film, both during and after screenings. Recognising the film as an affective force performing within our world, we also investigate some of the real-world effects the film catalysed. Finally, we propose that schizoanalysis, when applied to a Hollywood film, suggests that Deleuze underestimated the deterritorialising potential of contemporary, special effects-driven cinema. If schizoanalysis has thus been reterritorialised by mainstream products, we argue that new, ‘post-Deleuzian’ lines of flight are required to disrupt this ‘de-re-territorialisation’. (shrink)

Heyman's model, paradoxically, predicts that whereas a maximizing approach to drug choice will prevent escalation of drug use it will never yield complete abstinence. We suggest an alternative model that overcomes this difficulty by focusing on changes in drug tolerance. A small modification allows maximization to predict either abstinence or moderation (e.g., social drinking).