Neste artigo, interrogamos os funcionamentos do conceito de platô em "Mil Platôs" (1980), a obra-prima de Deleuze e Guattari. Essa pesquisa esclarece, de forma concreta, duas linhas de pensamento, que são a epistemológica, por um lado, e a ética, por outro, enfocando os parágrafos nos quais Deleuze e Guattari usam efetivamente esse conceito. Do ponto de vista epistemológico, o conceito de platô permite praticar uma maneira de escrita rizomática e a explicação antiteleológica. Do ponto de vista ético, esse conceito, tirado (...) de Gregory Bateson, nos convida a formar a alegria contínua e global, ou a gaieté em termos espinosistas. In this paper, we question the workings of the concept of plateau in "A Thousand Plateaus" (1980), Deleuze and Guattari's chef-d'oeuvre. This research specifically clarifies two lines of thought, which are epistemological on the one hand, and ethics on the other hand, focusing on the paragraphs where Deleuze and Guattari actually employ this concept. From the epistemological point of view, the concept of plateau allows practicing a way of rhizomatic writing and anti-teleological explanation. From the point of view of ethics, this concept borrowed from Gregory Bateson invites us to form the continuous and global joy, or gaiety in Spinoza's terms. (shrink)

Volume 26, Issue 2, June 2019, Page 163-167.

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha (...) Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support. (shrink)

This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52.4%) valid responses were completed and returned. The survey is the first of its kind in Singapore. Questions were framed around issues of medical paternalism, consent and patient autonomy. As the doctors were (...) exposed to Western ethical concepts in their training, we were not surprised to find that they would mostly allow patients some say in decision-making and keep patients reasonably informed. In respecting patient autonomy, they would usually seek to influence patient choice by persuasion. However, the residual "Asian-ness" of doctors in Singapore gives rise to some inconsistencies between values and practices. Many doctors still believe that a number of their patients are incapable of rational choice. There is some lack of openness in telling patients the whole truth. When patients choose to refuse treatment, many doctors are prepared to involve family members in making a consensus decision. Doctors were also asked how they made ethical judgements in the face of dilemmas, and how they would like disputes with patients to be resolved. By and large, the doctors prefer to make their own judgements rather than to rely on rules. They also wish to keep the law courts out of disputes with patients, preferring less public ways of settling disputes. (shrink)

Projects that challenge students to practice service leadership for civic improvement can address the aim of developing civic-mindedness in undergraduates. We conducted two qualitative studies. First, we investigated the learning experiences of four teams of undergraduate business students, who undertook semester-long course-embedded service-learning projects in partnership with four Hong Kong-based social enterprises. The students described five modes of civic engagement as project purposes, mentioned applying six types of service leadership practice for civic improvement, and described eight types of developmental outcome (...) within the domain of civic-mindedness. Comparisons suggested that besides relational support through training and guidance, empowering infrastructure, opportunities to exercise autonomy, and opportunities to demonstrate competence, three project-related features that varied between projects were important in fostering civic-mindedness. These were direct contact with grassroots-based beneficiaries; the experience of making a tangible difference; and linking the campus with the wider community. A second qualitative study indicated that course-embedded team projects with these features that were undertaken in mixed teams that included freshman and senior year business students fostered civic-mindedness for both categories of student. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine. In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health and prevent harm, the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is (...) one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care. (shrink)

BackgroundThis study aimed to identify the healthcare providers’ experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician’s order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act.MethodsA cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects—94 attending physicians, 87 resident physicians, and 293 nurses—participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the (...) SPSS 24.0 program.ResultsStudy results showed that respondents were aware of terminal illness and physician’s order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers’ side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation.ConclusionBased on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician’s order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for. (shrink)

Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates.

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer (...) patients assessed at six-months post-cancer treatment, 593 previously worked; detailed work status, psychological distress, physical symptom distress, supportive care needs, health-related quality of life, and illness perception were assessed. Six months later, work productivity and activity impairment were assessed. Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% were working, 26% on sick leave, and 35% were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: (...) This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Transformation of Hearts and Minds:Chan Zen-Catholic Approaches to PreceptsHarry L. WellsCatholic and Buddhist priests, monastics, teachers, and community leaders participated in the second of an anticipated four annual dialogues. The series is sponsored by the Dharma Realm Buddhist Association, the San Francisco Zen Center, and the United States Conference of Catholic Bishops (USCCB). The conference took place 4–7 March 2004 at Mercy Center in Burlingame, CA, whose own (...) East-West meditation program, led by Fr. Thomas Hand, celebrated its twentieth anniversary that year. A popular retreat center and home to the Sisters of Mercy of Burlingame, the Center offered participants tree-dotted, spacious grounds and strolling paths, as well as a labyrinth for contemplative walking.Each day began with both Catholics and Buddhists in Mercy Center's Rose Room, a Zen-style meditation space, for an hour of silent meditation in the morning. Catholic liturgy was celebrated in the afternoon in the main chapel, with all participants invited to attend and share prayer and blessings. On the two full days, Friday and Saturday, two sessions of presentations were held each morning, with one session following in the afternoon. Each of the six sessions focused on a position paper, with three papers given from a Buddhist and three from a Christian perspective. Each paper was presented by its authors, followed by two formal responses, one by a Buddhist and one by a Catholic participant. This was in turn followed by an open discussion within the whole group. A minute of silent meditation began and ended each session.The presentations focused on various meanings embraced by the term "precepts" in each tradition. One paper introduced perspectives on Buddhist precepts in three different Buddhist lineages. Another presented six guidelines as "Precepts on the [End Page 155] Mind-Ground" that connect ethical commitments with social engagement. A third paper focused on Bodhisattva practice, which embraces and unifies all sentient beings. On the Christian side, presentations discussed the precepts as signposts on the path that leads away from suffering, as motivations that move us, and as the practice of the presence of God, exemplified by the writings of Brother Lawrence.A glossary prepared by Fr. Francis Tiso helped define Catholic Christian terms for the Buddhist participants in the dialogue. Similarly, a book distributed to all participants by the Dharma Realm Buddhist Association provided background on "Buddhism A–Z." Formal discussion sessions in the evenings, as well as informal talks by the participants while walking outside or in the form of impromptu hallway meetings added to the depth and richness of the dialogue. Some recurring themes were the importance and meaning of a personal teacher in both traditions; another was the "embodiment" of the teachings, the value of teaching through presence. Personal stories and practical experiences offered by individual participants were much appreciated and added poetry and emotion to the headiness of theological discussion.Members of both the Buddhist and the Catholic traditions reported that the encounter with the spiritual practices and beliefs of the other faith provides both affirmation of the familiar and welcome discovery of unexpected riches of the spirit. The next meeting will be held 20–23 January 2005 at the San Francisco Zen Center. The theme will be "Practice: Method and Experience Toward Transformation."Participating in the 2004 dialogue were Rev. Heng Sure (Berkeley Buddhist Monastery), Bishop John C. Wester (Auxiliary Bishop, Archdiocese of San Francisco), Rev. Taigen Dan Leighton (Mountain Source Sangha), Fr. Arthur Kennedy (Secretariat for Ecumenical and Interreligious Affairs, USCCB), Bhikshuni Heng Liang (Dharma Realm Buddhist Association), Dr. Martin Verhoeven (Institute for World Religions), Dr. Ron Epstein (Institute for World Religions), Dr. Snjezana Akpinar (Dharma Realm Buddhist University), Rev. Shosan Victoria Austin (San Francisco Zen Center), Rev. Alan Senauke (Berkeley Zen Center), Jan Chozen Bays (Zen Community of Oregon), Sr. Phyllis D'Anna, SND (Center for the Practice of Applied Spirituality), Fr. Thomas W. Devereaux (Diocese of Santa Rosa), Robert Hale, OSB Cam. (Incarnation Monastery, Berkeley, CA), Thomas Hand, S.J. (Mercy Center, Burlingame, CA), Fr. Rafael Luévano (Diocese of Orange), Deacon Thomas McGowan (Diocese of Oakland), Lorraine Moriarity (St. Vincent de Paul Society of San Mateo County), Fr. Gerry O'Rourke (Archdiocese... (shrink)

Despite the supreme political and economic significance of boundaries--and ongoing challenges to existing national boundaries--scant attention has been paid to their ethics. This volume explores how diverse ethical traditions understand the political and property rights reflected in territorial and jurisdictional boundaries. It is the first book to bring together thinkers from a range of traditions, both religious and secular, to discuss the ethics of boundaries. Each contributor represents a tradition's views on questions surrounding the use of boundaries to delimit property (...) and political rights. What does it mean to own something? What resources should not be privately owned? What justifies the erection of political boundaries between one people and another? How ''hard'' should such boundaries be? What rights extend to minorities within a state? Should territorial boundaries coincide with social ones? Does national autonomy have an ethical basis, or is it an aspect of modern power politics? Should we aim for a more inclusive community than that afforded by modern nation-states? Cross-chapter dialogue and a substantive conclusion draw out similarities and differences among the traditions represented, traditions that include Christianity, classical liberalism, Confucianism, international law, Islam, Judaism, liberal egalitarianism, and natural law. In addition to the editors, the contributors are Nigel Biggar, Joseph Boyle, Joseph Chan, Russell Hardin, Will Kymlicka, Loren Lomasky, Robert McCorquodale, Richard B. Miller, David Novak, Sulayman Nyang, Michael Nylan, Raul C. Pangalangan, Daniel Philpott, Jeremy Rabkin, Hillel Steiner, M. Raquibuz Zaman, and Noam J. Zohar. (shrink)

An interdisciplinary study of postmodern ethics and literary criticism from the perspective of Chan/Seon/Zen Buddhism, this book combines the tradition of Western metaphysics and its contact with Asian thought, contemporary Western thought, Buddhism, Taoism, and literary criticism.