Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Purpose: To determine the relative value that patients place on consent for procedures in the emergency department (ED) and to define a set of procedures that fall in the realm of implied consent. Methods: A questionnaire was administered to a convenience sample 134 of 174 patients who were seen in the ED of a Midwestern teaching hospital. The questionnaire asked how much time they believed was necessary to give consent for various procedures. Procedures ranged from simple (venipuncture) to complex (procedural (...) sedation). Results: Participants valued a simple blood draw at a low mean of 1.02 minutes of extra time and a lumbar puncture at a high mean of 7.78 minutes. Of all participants 52% and 48% noted a time-value of ?0? time on blood draw and intravenous line starts, respectively, indicating that they desire no additional consent for these procedures. Conclusion: Defining a set of ED procedures covered under implied consent will be difficult because many patients value formal consent for even the simplest procedure. (shrink)

The relationship between corporate social responsiveness and profitability is investigated in a sample of corporate directors. The findings show there is no relationship between the level of director social responsiveness and corporate profitability. The implications of these results are discussed, especially as they relate to concerns about corporate governance.

I come from a medical family. My father and uncle were physicians, and my father also chaired a department at a West Coast medical school for over 30 years. I am sure I got my interest in teaching from him. My brother is a physician and is currently the safety and quality officer of a Canadian province. My mother operated the last non-automated medical laboratory in my state. I have always understood what sacrifices are made by health care professionals, and (...) I think I have managed to learn a bit about their motivations as well.I was in private practice for ten years with litigation firms, and the last five years of that time I worked for a firm that specialized in professional liability defense and health law. (shrink)

I come from a medical family. My father and uncle were physicians, and my father also chaired a department at a West Coast medical school for over 30 years. I am sure I got my interest in teaching from him. My brother is a physician and is currently the safety and quality officer of a Canadian province. My mother operated the last non-automated medical laboratory in my state. I have always understood what sacrifices are made by health care professionals, and (...) I think I have managed to learn a bit about their motivations as well.I was in private practice for ten years with litigation firms, and the last five years of that time I worked for a firm that specialized in professional liability defense and health law. (shrink)

This collection of papers by prominent feminist thinkers advances the positive feminist project of remapping the moral by developing theory that acknowledges the diversity of women.

Since its publication in 1918, Oswald Spengler's The Decline of the West has been the object of academic controversy and opprobrium. In their efforts to dispose of it, scholars have resorted to a variety of tactics: bitter invective, icy scorn, urbane mockery, or simply pretending that the book is not there. Yet generations of readers have refused to be warned off, finding in Spengler a prophetic voice and a source of profound intellectual excitement. H. Stuart Hughes's Oswald Spengler offers a (...) judicious and objective reading of Spengler's works that admirably fills the gap between hypercritical invective and naive enthusiasm. This pioneering volume makes clear why Spengler's pessimistic reading of the fate of European civilization continues to resonate with contemporary anxieties. Despite the author's self-imposed intellectual and social isolation, Spengler's work was as Hughes demonstrates, a part of the enormous effort of intellectual reevaluation that has characterized the early twentieth century. Viewing Spengler in the broadest possible perspective, the author places his thought in its cultural relationship to that of such predecessors as Giambattista Vico, Friedrich Nietzsche, and Nikolai Danilevsky and contemporaries including Benedetto Croce, Henri Bergson, and Vilfredo Pareto. A chapter of Hughes's book is devoted to Spengler's influence on later cyclical thinkers such as Arnold Toynbee and Pitirim Sorokin. Another chapter clarifies the essentially antagonistic relationship between his thought and Nazi ideology. Throughout, Hughes is carefully attuned to the complex and often bewildering shifts of Spengler's ideas and manner, providing a unified picture of the sober historian; the lofty seer; the cool, detached observer; and the impassioned participant. In his introduction to this new edition, Hughes comments on the timeliness of Spengler's message with respect to technology and environmental issues and draws some unexpected and fascinating parallels between Spengler's thought and that of Ludwig Wittgenstein. Oswald Spengler offers an illuminating view of the achievements and limitations of one of the most influential and representative figures of the twentieth century. It will be of concern to intellectual historians, philosophers, political scientists, and sociologists. (shrink)

Using NORC annual survey data, the authors selected 21 questions describing respondent attitudes toward job, life in general, and financial status. Respondents were catigorized as management, white collar, blue collar, and those not affiliated with business organizations. Attitudes were compared across the four occupational groups. Little dissatisfaction was found in any but the blue collar group. Management as a group, and men as well as women managers showed high levels of satisfaction, with few significant differences found in responses by men (...) and women. This study does not support the earlier finding of widespread alienation in business firms. (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Family carers of individual’s living with Huntington’s Disease (HD) manage a distinct and unique series of difficulties arising from the complex nature of HD. This paper presents the validation of the definitive measure of quality of life for this group. The Huntington’s Disease Quality of Life Battery for carers (HDQoL-C) was expanded and then administered to an international sample of 1716 partners and family carers from 13 countries. In terms of the psychometric properties of the tool, exploratory analysis of half (...) of the sample, demonstrated good internal consistency and reliability. Some items on the full version did not meet psychometric thresholds and a short version (HDQoL-Cs) was developed based on more stringent criteria. Confirmatory Factor Analysis of the model structure showed a good fit for all Factors and, indicated that the HDQoL-C and HDQoL-Cs are psychometrically robust measures of quality of life. We found that carers who lived with and looked after their spouse/partner had reduced sense of coping, hope for the future and overall quality of life. Carers with children who were at risk, carried the gene or were symptomatic also had poorer quality of life outcomes. Findings indicated the HDQoL-C and HDQoL-Cs are valid in multiple languages and across varied cultures as measures of self-reported quality of life in family carers of individual’s living with HD. These psychometrically validated tools can aid and guide the implementation of therapeutic interventions to improve life quality in this population. (shrink)

In this introduction to part 4 of the Common Knowledge symposium “Peace by Other Means,” the journal's editor assesses the argument made by Peace, the spokesperson of Erasmus in his Querela Pacis, that the desire to impute and avenge wrongs against oneself is insatiable and at the root of both individual and social enmities. He notes that, in a symposium about how to resolve and prevent enmity, most contributions have to date expressed caveats about how justice and truth must take (...) precedence over peace, how recovery from ill treatment may be impossible, how quietism is not a moral option, and how realism demands a national policy and a personal strategy of, at best, contingent forgiveness. He concedes that the attitudes of those opposed to quietism are healthy but suggests that there may be goods worthier than health of human devotion. This essay concludes that the main differences between what it terms “judgmental” and “irenic” regimes are disagreements over anthropology and metaphysics. The presumptions that truths are objectively knowable and that human beings are moral and rational agents characterize judgmental regimes; irenic regimes are characterized by disillusionment with those assumptions. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI). This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an (...) electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: 1. Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. 2. ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are nondisclosing. 3. The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including nonlinear dynamical analysis, complexity measures, analysis of causal interactions, graph theory and information dynamics. 4. and 5. are too long to include here. (shrink)

The state, by V.I. Lenin.--The revolutionary part played by law and the state; a general doctrine of law, by P.I. Stuchka.--The theory of Petrazhitskii: Marxism and social ideology. Law, our law, foreign law, general law, by M.A. Reisner.--The general theory of law and Marxism, by E.B. Pashukanis.--The right deviation in the Communist Party of Bolsheviks. Political report of the Central (Party) Committee to the XVI Congress, 1930, by J.V. Stalin.-- The Soviet state and the revolution in law, by E.B. Pashukanis.--Socialism (...) and law, by P. Yudin.--The fundamental tasks of the science of Soviet socialist law, by A.Y. Vyshinsky.--Report to the XVIII Party Congress, by J.V. Stalin.--The theory of the state and law, by S.A. Golunskii and M.S. Strogovich.--The Soviet state in the war for the fatherland, by A.Y. Vyshinsky.--The relationship between state and law, by I.P. Trainin. (shrink)

This article offers an account of the information condition on morally valid consent in the context of sexual relations. The account is grounded in rights. It holds that a person has a sufficient amount of information to give morally valid consent if, and only if, she has all the information to which she has a claim-right. A person has a claim-right to a piece of information if, and only if, a. it concerns a deal-breaker for her; b. it does not (...) concern something that her partner has a strong interest in protecting from scrutiny, sufficient to generate a privilege-right; c.i. her partner is aware of the information to which her deal-breaker applies; or c.ii. her partner ought to be held responsible for the fact that he is not aware of the information to which her deal-breaker applies; and finally, d. she has not waived or forfeited her claim-right. Although we present this account in the context of sexual relations, we believe a virtue of the account is that it can be easily translated into other contexts. (shrink)

Current profess ional and la y lore ove rlook the ro le of hone sty in develop ing and s ustaining intimate relationships. We w ish to ass ert its importa nce. W e begin b y analyz ing the no tion of intimac y. An intim ate encounter or exchange, we argue, is one in which one verbally or non-verbally privately reveals something about oneself, and does so in a sensitive, trusting way. An intimate relationship is one marked by (...) regular intimate encounters or excha nges. Then, we co nsider two sorts of cases wh ere it is widely thought permissible, if not lauda tory, to lie to one 's intimates. In discrediting these presumably central cases of justified dishonesty, we put forward general considerations requiring hones ty. We e nd by s ugges ting how 'meta honesty'--hone sty about one's own efforts at communication, including one's efforts to be honest--is particularly important in intimate relationships. (shrink)

Claude Bernard, the father of scientific physiology, believed that if medicine was to become truly scientiifc, it would have to be based on rigorous and controlled animal experiments. Bernard instituted a paradigm which has shaped physiological practice for most of the twentieth century. ln this paper we examine how Bernards commitment to hypothetico-deductivism and determinism led to (a) his rejection of the theory of evolution; (b) his minima/ization of the role of clinical medicine and epidemiological studies; and (c) his conclusion (...) that experiments on nonhuman animals were, "entirely conclusive for the toxicology and hygiene of man". We examine some negative consequences of Bernardianism for twentieth century medicine, and argue that physio/ogy's continued adherence to Bernardianism has caused it to diverge from the other biological sciences which have become increasingly infused with evolutionary theory. (shrink)