BackgroundConsenting for retrospective medical records-based research (MR) and leftover tissue-based research (TR) continues to be controversial. Our objective was to survey Saudis attending outpatient clinics at a tertiary care hospital on their personal preference and perceptions of norm and current practice in relation to consenting for MR and TR.MethodsWe surveyed 528 Saudis attending clinics at a tertiary care hospital in Saudi Arabia to explore their preferences and perceptions of norm and current practice. The respondents selected one of 7 options from (...) each of 6 questionnaires.ResultsRespondents' mean (SD) age was 33 (11) years, 42% were males, 56% were patients, 84% had ≥ secondary school education, and 10% had previously volunteered for research. Respectively, 40% and 49% perceived that the norm is to conduct MR and TR without consent and 38% and 37% with general or proposal-specific consent; the rest objected to such research. There was significant difference in the distribution of choices according to health status (patients vs. companions) for MR (adjusted Kruskal-Wallis test P = 0.03) but not to age group, gender, education level, or previous participation in research (unadjusted P = 0.02 - 0.59). The distributions of perceptions of current practice and norm were similar (unadjusted Marginal Homogeneity test P = 0.44 for MR and P = 0.89 for TR), whereas the distributions of preferences and perceptions of norm were different (adjusted P = 0.09 for MR and P = 0.02 for TR). The distributions of perceptions of norm, preferences, and perceptions of current practice for MR were significantly different from those of TR (adjusted P < 0.009 for all).ConclusionsWe conclude that: 1) there is a considerable diversity among Saudi views regarding consenting for retrospective research which may be related to health status, 2) the distribution of perceptions of norm was similar to the distribution of perceptions of current practice but different from that of preferences, and 3) MR and TR are perceived differently in regard to consenting. (shrink)

Background The consistency of codes governing disclosure of terminal illness to patients and families in Islamic countries has not been studied until now. Objectives To review available codes on disclosure of terminal illness in Islamic countries. Data source and extraction Data were extracted through searches on Google and PubMed. Codes related to disclosure of terminal illness to patients or families were abstracted, and then classified independently by the three authors. Data synthesis Codes for 14 Islamic countries were located. Five codes (...) were silent regarding informing the patient, seven allowed concealment, one mandated disclosure and one prohibited disclosure. Five codes were silent regarding informing the family, four allowed disclosure and five mandated/recommended disclosure. The Islamic Organization for Medical Sciences code was silent on both issues. Conclusion Codes regarding disclosure of terminal illness to patients and families differed markedly among Islamic countries. They were silent in one-third of the codes, and tended to favour a paternalistic/utilitarian, family-centred approach over an autonomous, patient-centred approach. (shrink)

Background: Medical chaperones (MC) are underutilised. The influence of Islamic culture on the use of MC is not known. Aim: To examine physicians’ use and perception of MC in Islamic culture. Setting: A major tertiary care hospital in Saudi Arabia. Methods: 315 self-administered questionnaires were distributed to attendees of grand rounds of 13 departments. Results: 186 (59%) questionnaires were completed. 64.5% of the respondents were 30–49 years old, 75.8% were men and 31.2% were in training; 79% had a clinic load (...) of under 50 patients per week and 47.8% had postgraduate training (PGT) in an Islamic country. MC were reported to be infrequently (⩽25% of the time) used by 44.1% (69.2% female vs 39% male physicians, p = 0.001; 58.6% in training vs 36.8% attending, p = 0.007; 52.1% PGT in Islamic vs 35.6% in western countries, p = 0.027), offered by 52.7% (78.9% female vs 46.8% male physicians, p<0.001) and requested by 79% of patients. MC were reported to be commonly (>75% of the time) used, offered by physicians and requested by patients by 38.2%, 29% and 7.5% of respondents, respectively. The most frequently cited reasons for not using MC were privacy/confidentiality (36.6%) and understaffing (30.5%). Equal numbers of respondents perceived MC use as a protection for physicians or patients (67.7% and 65.6%, respectively). Conclusions: MC are underutilised even in Islamic culture, especially among female physicians. Training in western countries is favourably associated with MC use. Underutilisation appears to be related to privacy/confidentiality, understaffing and failure of patients to request a MC. (shrink)

Substituted judgment assumes adequate knowledge of patient’s mind-set. However, surrogates’ prediction of individual healthcare decisions is often inadequate and may be based on shared background rather than patient-specific knowledge. It is not known whether surrogate’s prediction of patient’s integrative life-story narrative is better. Respondents in 90 family pairs rank-ordered 47 end-of-life statements as life-story narrative measure and completed instruments on decision-control preference and healthcare-outcomes acceptability as control measures, from respondent’s view and predicted pair’s view. They also scored their confidence in (...) surrogate’s decision-making and familiarity with pair’s healthcare-preferences. Life-story narratives’ prediction was examined by calculating correlation of statements’ ranking scores between respondent-personal and respondent-surrogate Q-sorts and between respondent-surrogate and pair-personal Q-sorts before and after controlling for correlation with respondent-personal scores, and by comparing percentages of respondent-surrogate Q-sorts co-loading with pair-personal vs. respondent-personal Q-sorts. Accuracy in predicting decision-control preference and healthcare-outcomes acceptability was determined by percent concordance. Results were compared among subgroups defined by intra-pair relationship, surrogate’s decision-making confidence, and healthcare-preferences familiarity. Mean age was 35.4 years, 69% were females, and 73 and 80% reported ≥ very good health and life-quality, respectively. Mean surrogate’s decision-making confidence score was 3.35 and 75% were ≥ familiar with pair’s healthcare-preferences. Mean projection, simulation, and adjusted-simulation correlations were 0.68, 0.42, and 0.26, respectively. Out of 180 respondent-surrogate Q-sorts, 24, 9, and 32% co-loaded with respondent-personal, pair-personal, or both Q-sorts, respectively. Accuracy in predicting decision-control preference and healthcare-outcomes acceptability was 47 and 52%, respectively. Surrogate’s decision-making confidence score correlated with adjusted-simulation’s correlation score. There were significant differences among the husband-wife, parent-child, and sibling-sibling subgroups in percentage of respondent-surrogate Q-sorts co-loading with pair-personal Q-sorts and percent agreement on healthcare-outcomes acceptability. Despite high self-reported surrogate’s decision-making confidence and healthcare-preferences familiarity, family surrogates are variably inadequate in simulating life-story narratives. Simulation accuracy may not follow the next-of-kin concept and is 38% based on shared background. (shrink)

Although informed consent is an integral part of clinical practice, its current doctrine remains mostly a matter of law and mainstream ethics rather than empirical research. There are scarce empirical data on patients’ perceived purpose of informed consent, which may include administrative routine/courtesy gesture, simple honest permission, informed permission, patient-clinician shared decision-making, and enabling patient’s self decision-making. Different purposes require different processes.

The current doctrine of informed consent for clinical care has been developed in cultures characterized by low-context communication and monitoring-style coping. There are scarce empirical data on patients' norm perception of information disclosure in other cultures.

Disclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known.

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (shrink)

Rescued in 1972 from a storeroom in which rats and seeping water had severely damaged the fifty-year-old manuscript, this text is the earliest major work (1919-1921) of the great Russian philosopher M. M. Bakhtin. Toward a Philosophy of the Act contains the first occurrences of themes that occupied Bakhtin throughout his long career. The topics of authoring, responsibility, self and other, the moral significance of "outsideness," participatory thinking, the implications for the individual subject of having "no-alibi in existence," the difference (...) between the world as experienced in actions and the world as represented in discourse--all are broached here in the heat of discovery. This is the "heart of the heart" of Bakhtin, the center of the dialogue between being and language, the world and mind, "the given" and "the created" that forms the core of Bakhtin's distinctive dialogism. A special feature of this work is Bakhtin's struggle with the philosophy of Immanuel Kant. Put very simply, this text is an attempt to go beyond Kant's formulation of the ethical imperative. Toward a Philosophy of the Act will be important for scholars across the humanities as they grapple with the increasingly vexed relationship between aesthetics and ethics. (shrink)

This Book Brings A Clear And Insightful Presentation Of The Wisdom Of Hinduism In All Its Fundamental Principles.

The essays assembled here are all very early and differ in a number of ways from Bakhtin's previously published work.

y title links together kings, war, and the economy, and the linkage is deliberate. I do not of course wish to suggest that Hellenistic kings did nothing but fight wars, that they were responsible for all the wars in the period, that royal wars were nothing but a form of economic activity, or that the economy of the kings was dependent purely on the fruits of military success, though there would be an element of truth in all these propositions. But (...) I wish to react against the frequent tendency to separate topics that are related, the tendency to treat notions relating to what kings were or should be as something distinct from what they actually did, and the tendency to treat political and military history on the one hand as something separate from economic and social history on the other. A number of provisos should be made at the outset. The title promises more than the paper can deliver; in particular, more will be said about kings and war than about kings and the economy. The subject is handled at a probably excessive level of generalization and abstraction. I talk about Hellenistic kings in general, but in practice it would obviously be necessary to draw distinctions between different dynasties, different times and places, and individual rulers, and some of those distinctions I shall indicate. Conclusions are provisional and subject to modification and considerable expansion in detail. Finally, two points of terminology. I use the word ‘Hellenistic’ for no better reason than out of the force of acquired habit, but of course the word and the concept are modern inventions that were unknown to the ancient world. (shrink)

My title links together kings, war, and the economy, and the linkage is deliberate. I do not of course wish to suggest that Hellenistic kings did nothing but fight wars, that they were responsible for all the wars in the period, that royal wars were nothing but a form of economic activity, or that the economy of the kings was dependent purely on the fruits of military success, though there would be an element of truth in all these propositions. But (...) I wish to react against the frequent tendency to separate topics that are related, the tendency to treat notions relating to what kings were or should be as something distinct from what they actually did, and the tendency to treat political and military history on the one hand as something separate from economic and social history on the other.A number of provisos should be made at the outset. The title promises more than the paper can deliver; in particular, more will be said about kings and war than about kings and the economy. The subject is handled at a probably excessive level of generalization and abstraction. I talk about Hellenistic kings in general, but in practice it would obviously be necessary to draw distinctions between different dynasties, different times and places, and individual rulers, and some of those distinctions I shall indicate. Conclusions are provisional and subject to modification and considerable expansion in detail. Finally, two points of terminology. I use the word ‘Hellenistic’ for no better reason than out of the force of acquired habit, but of course the word and the concept are modern inventions that were unknown to the ancient world. (shrink)

Incessantly cited by critics, Bakhtin's work none the less remains relatively unavailable: partly through lack of suitable editions, partly because no individual text conveys all the key concepts or arguments. This anthology provides in a convenient format a good selection of the writing by Bakhtin and of that attributed to Voloshinov and Medvedev. It introduces readers to the aspects most relevant to literary and cultural studies and gives a focused sense of Bakhtin's central ideas and the underlying cohesiveness of his (...) thinking. (shrink)

The word ‘tyrant’ was not originally Greek, but borrowed from some eastern language, perhaps in western Asia Minor. On the other hand, tyranny as it developed in the Greek cities in the archaic age would seem to have been initially an indigenous growth, independent of any intervention by foreign powers. It then became a constantly recurring phenomenon of Greek political and social life, so long as the Greeks enjoyed an independent history.

The word ‘tyrant’ was not originally Greek, but borrowed from some eastern language, perhaps in western Asia Minor. On the other hand, tyranny as it developed in the Greek cities in the archaic age would seem to have been initially an indigenous growth, independent of any intervention by foreign powers. It then became a constantly recurring phenomenon of Greek political and social life, so long as the Greeks enjoyed an independent history.

The Dutch policy objective of a fully sustainable livestock sector without mutilations by 2023 is not compatible with the routine practice of tail docking to minimize the risk of tail biting. To examine farmer attitudes towards docking, a telephone survey was conducted among 487 conventional and 33 organic Dutch pig farmers. “Biting” (of tails, ears, or limbs) was identified by the farmers as a main welfare problem in pig farming. About half of the farmers reported to have no tail biting (...) problems in their own herd. When farmers did report problems, they most often reported figures between 1 and 5 % of the animals. High incidences of tail biting were anticipated when trying to keep undocked pigs. Enrichment materials used in the conventional sector included mainly chains (52–63 % of the farms) and hanging rubber or plastic balls (22–30 %). Straw, sawdust, or wood shavings was hardly provided in conventional pig farming (2–3 %), in contrast to organic farming (88–100 % of farms). Conventional pig farmers feel a curly tail is not very important for sustainable pig farming. They consider enrichment to be less effective and tail docking to be less stressful for them and their piglets than their organic colleagues do. Pig farmers identified climate as a main risk factor for tail biting as opposed to enrichment. The objective of reducing routine tail docking requires solutions for dealing with tail biting problems at the farm level. In this process, transfer of scientific knowledge about enrichment materials and other measures to prevent and cure tail biting is critical, as is a change in farmer attitudes and awareness of the moral issues involved. (shrink)

Nursing, a scientific and practical discipline, faces continuing challenges of finding new direction in order to decipher its core values and develop current ethical codes for nursing practice. In 2009–10, 28 nurses were purposely selected and interviewed using a semi-structured format in focus groups and individually. Thematic Content Analysis helped explore the perception of Iranian nurses on ethical values in patient care. Seven major themes emerged: respect for dignity, professional integrity, professional commitment, developing human relationships, justice, honesty, and promoting individuals (...) and the nursing profession. Iranian nurses revealed a unique and culture-based set of ethical values. This study found that Iranian nurses place a greater emphasis on preserving the dignity of those accompanying the patient and in showing regard for patients' religious beliefs in a gender appropriate environment. (shrink)