Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

In the first paragraph of the Grundlage der gesammten Wissenschaftslehre Fichte gives an extended exposition of his first principle. The aim of the article is to show that, first, this exposition is in fact an argument in favour of the first principle of the Wissenschaftslehre, and, second, that it answers the central point of the sceptical criticism put forward by Jacobi, Maimon and Schulze against Kantian philosophy. In order to corroborate these theses, the central point of the sceptical critique has (...) to be identified in a first step. Next, I examine Fichte’s strategy to meet the sceptical challenge. As a result, only a pre-systematic form of argument is adequate for Fichte to establish a principle that is immune to sceptical doubts, and, therefore, is a suitable starting point for a transcendental deduction. Finally, Fichte’s argument against the sceptics can be reconstructed in the following way: He takes up the central point of the sceptical critique and reformulates it as a criterion for a first principle. He then shows that the criterion is fulfilled by the I, if it is conceived in his own way, i.e. as pure activity. Fichte entwickelt im ersten Paragraphen der Grundlage der gesammten Wissenschaftslehre eine ausführliche Exposition seines ersten Grundsatzes. Der Beitrag hat zum Ziel zu zeigen, dass diese Exposition ein Argument für das erste Prinzip der Wissenschaftslehre darstellt und dass es ein Argument gegen den zentralen Punkt der skeptischen Kritik an der Transzendentalphilosophie, wie sie Jacobi, Maimon und Schulze formulierten, ist. Um diese Thesen zu untermauern, wird in einem ersten Schritt der zentrale Punkt der skeptischen Kritik identifiziert. Dem folgt eine Untersuchung der Strategie, mit der Fichte der Kritik begegnet, wobei sich eine vorsystematische Argumentation als geeignet erweist, einen ersten Grundsatz aufzustellen, der gegen die vorgebrachten Zweifel resistent und daher als Basis einer transzendentalen Deduktion tauglich ist. Fichtes Argumentation gegen den Skeptizismus kann dann folgendermaßen rekonstruiert werden: Fichte nimmt den zentralen Punkt der skeptischen Kritik auf und formt ihn in ein Kriterium für ein erstes Prinzip um. Er kann dann zeigen, dass das Ich das Kriterium erfüllt, sofern es als reine Tätigkeit aufgefasst wird. (shrink)

BackgroundDefensive medicine (DM) practice refers to the ordering or prescription of unnecessary treatments or tests while avoiding risky procedures for critically ill patients with the aim to alleviate the physician’s legal responsibility and preserve reputation. Although DM practice is recognized, its dimensions are still uncertain. The subject has been highly investigated in developed countries, but unfortunately, many developing countries are unable to investigate it properly. DM has many serious ramifications, exemplified by the increase in treatment costs for patients and health (...) systems, patients’ exposure to risks, and negative effects on the psychological health of both health providers and recipients. Ultimately, the most serious consequence is the ethical consequences.MethodsThis work is based on a review of the literature related to DM worldwide and a comparison with the available knowledge found in Jordan. It is qualitative with a descriptive nature, aiming to diagnose the current DM practice in Jordan.ResultsThis is the first published article that discusses DM in Jordan by diagnosing its ethical and economic consequences for the health system as well as for patients. Despite the knowledge of the reasons that support its practice, little is being done to solve this issue. The absence of agreeable medical malpractice law, the dearth of unified medical protocols, the overwhelming pressure imposed by patients on medical staff, and the deteriorating patient-physician relationship are some of the causes of DM practice. Surely, the solution to these issues is to focus on fortifying the ethical and humanitarian aspects on the side of both the physician and the patient to ensure positive collaboration. The ethical aim of the physician to treat the patient faithfully and do what is possible to help combined with the appreciation of the physician’s efforts and the choice to not take advantage of the physician through litigation could be the most reasonable solution in the near future.ConclusionJordan is suffering from DM due to the limited financial expenditure on the health sector and the impracticality of medical malpractice law. The authors highlight that the cardinal step in solving this dilemma is restoring the ethical dimension of the patient-physician relationship. (shrink)

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality (...) of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2000 g) contributed 75·6% of the population-attributable risks to stillbirths and 59·4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77·7% of stillbirths and 87·9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study. (shrink)

Reductionism and holism, that is, antireductionism, are two of the prevailing paradigms within the philosophy of biology. Reductionists strive to understand biological phenomena by reducing them to a series of levels of complexity with each lower level forming the foundation for the subsequent level, by mapping such biological phenomena inasmuch as possible to the principal phenomena within the fundamental sciences of chemistry and physics. In this way, complex phenomena can be reduced to assemblages of more elementary explananda. Holism, in counterpart, (...) claims that there independently exist phenomena arising from ordered levels of complexity that have intrinsic causal power and cannot be reduced in this way. When dealing with the nature of biology and its unique foundations of essentialism, determinism and ethics, the pedagogical lens through which these foundations are conveyed to learners could provide a limited perspective if only the reductive approach is followed as it would not sensitise learners to the true complexity of the phenomenon of life and the study thereof, and it is the purpose of this article to frame the reductionist–antireductionist debate in order to illustrate this.Contribution: This article contributes new knowledge to the field of the philosophy of science; more specifically, the philosophy of biology by critically evaluating the pervasive dialectic between the theoretical frameworks of reductionism and antireductionism and alluding to the pedagogical consequences thereof. (shrink)

In the past decade, the notion of a neural correlate of consciousness has become a focal point for scientific research on consciousness. A growing number of investigators believe that the first step toward a science of consciousness is to discover the neural correlates of consciousness. Indeed, Francis Crick has gone so far as to proclaim that ‘we need to discover the neural correlates of consciousness. For this task the primate visual system seems especially attractive. No longer need one spend time (...) attempting to endure the tedium of philosophers perpetually disagreeing with each other. Consciousness is now largely a scientific problem’. Yet the question of what it means to be a neural correlate of consciousness is actually far from straightforward, for it involves fundamental empirical, methodological, and philosophical issues about the nature of consciousness and its relationship to the brain. Even if one assumes, as we do, that states of consciousness causally depend on states of the brain, one can nevertheless wonder in what sense there is, or could be, such a thing as a neural correlate of consciousness. (shrink)

Objectives To evaluate whether the requirement of “minimal risk and burden” for paediatric research without direct benefit to the subjects compromises the ability to obtain data necessary for improving paediatric care. To provide evidence-based reflections on the EU recommendation that allows for a higher level of risk. Design and setting Systematic analysis of the approval/rejection decisions made by the Dutch Central Committee on Research involving Human Subjects (CCMO). Review methods The analysis included 165 proposals for paediatric research without direct benefit (...) that were reviewed by the CCMO between January, 2000, and July, 2007. A separate, in-depth analysis of all drug studies included 18 early phase drug studies and nine other drug studies without direct benefit. Results 11 out of 165 studies were definitively rejected because the CCMO did not regard the risk and/or burden to be minimal. In three of these 11 cases (including two early phase drug studies) the requirement of minimal risk and burden was cited as the only reason for rejection. Four other early phase drug studies also involved risks and/or burdens that were not regarded to be minimal but were nevertheless approved. Conclusions The requirement of minimal risk and burden, aiming to protect research subjects, occasionally leads to rejection of protocols. Early phase drug studies relatively often do not comply with the requirement. Committees may find ways to approve important studies that formally should be rejected, but that is not a desirable solution. The regulatory framework should be revised to make such occasional exceptions to the requirement legitimate and transparent. (shrink)

One of the ways in which a poet may show his quality is by discrimination and originality in his choice of adjectives. Poetry likes to adorn the bare noun; a noun such as ‘the sky’ calls out for an attribute. But in practice the poet has to take care to avoid the cliche. He can seldom write ‘the blue sky’; even ‘the azure sky’ has become trite. He has to search for the epithet which will be both apt and original.