Randomised clinical trials provide the most valid means of establishing the efficacy of clinical therapeutics. Ethical standards dictate that patients and clinicians should not consent to randomisation unless there is uncertainty about whether any of the treatment options is superior to the others ("equipoise"). However, true equipoise is rarely present; most randomised trials, therefore, present challenging ethical dilemmas. Minimising the tension between science and ethics is an obligation of investigators and clinicians. This article briefly reviews several techniques for addressing this (...) issue and suggests that unbalanced randomisation, a technique rarely employed in current clinical trial practice, may be useful for enhancing the ethical design of human experimentation. (shrink)

In this paper, we respond to Andrew Avins's recent review of methods whose use he advocates in clinical trials, to make them more ethical. He recommends in particular, “unbalanced randomisation”. However, we argue that, before such a recommendation can be made, it is important to establish why unequal randomisation might offer ethical advantages over equal randomisation, other things being equal. It is important to make a pragmatic distinction between trials of treatments that are already routinely available and trials of (...) restricted treatments. We conclude that unequal randomisation could, indeed, be an ethical compromise between protecting the interests of participants and those of society. (shrink)

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)

В книге продолжается обсуждение тем, представленных в труде "Психология нравственности", изданном в 2010 году. Авторы обсуждают пути решения проблем и преодоления переживаемого нашим обществом глубокого нравственного кризиса.

Tom 1. Rannekhristianskiĭ gnosticheskiĭ tekst v rossiĭskoĭ kulʹture (21 i︠a︡nvari︠a︡ 2011 g.) -- Tom 2. Sudʹby religiozno-filosofskikh iskaniĭ Nikolai︠a︡ Novikova i ego kruga (15-17 okti︠a︡bri︠a︡ 2012 g.).

Книга предназначена для исследователей, специалистов, преподавателей, аспирантов, студентов, а также всех тех, кто интересуется вопросами философии.

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

In attempting to realize the tasks facing Soviet philosophers today, at a crucial moment in the life of our society, and in an attempt to contribute as best we can to clearing up the intellectual atmosphere of the country, we turn again to the question of what philosophy is, what its place in the life of society is, and how it can and must develop. The present article is dedicated to an examination of one of the aspects of this complex (...) question. (shrink)

Nikolai Fedorovich Fedorov is one of the most original and as yet inadequately studied Russian thinkers. Neither a professional philosopher, nor a well-known scholar, nor a critical essayist, he led a kind of double existence while working as an ordinary civil servant, developing his original philosophy at his leisure in the hours free from his intensive daily work. Fedorov's life was one of selflessness and self-denial, not at all eventful outwardly. He graduated from the Gymnasium in Tambov and completed three (...) years of study in the Law Department of the Richelieu Lyceum in Odessa, after which he taught for a number of years in the Borovsk, Lipetsk, Podol'sk, and other regional schools. The quarter century he spent working in the Library of the Rumiantsev Museum in Moscow was the most stable period in Fedorov's life. Fedorov's ideas attracted the attention of outstanding cultural figures. F.M. Dostoevskii became acquainted with them in 1878 through Peterson, and on March 24 of that year he wrote: "I am essentially in full accord with these ideas. I read them as if they were my own." L.N. Tolstoy, who knew Fedorov personally, said, "I am proud to be living in the same times as such a man." V.S. Solov'ev, who also associated with Fedorov, wrote to him as follows in the mid-1880s: "Your ‘project’ is the human spirit's first advance along the path of Christ since the advent of Christianity. As for me, I can only acknowledge you as my teacher and spiritual father." A.M. Gorky was especially impressed by the activism in Fedorov's views. But none of this precludes the many and very essential divergences of these authors from Fedorov. One can find some links with his ideas in A.N. Belyi, V. Ia. Briusov, N.A. Zabolotskii, V.V. Maiakovskii, A.P. Platonov, M.M. Prishvin, I.L. Sel'vinskii, O.D. Forsh, and V.N. Khlebnikov. The artist B.N. Chekrygin drafted a large fresco entitled The Resurrection of the Dead [Voskreshenie mertvykh] and a philosophical work entitled The Synod of the Resurrecting Museum [Sobor voskreshaiushchego muzeia], both inspired by Fedorov's teachings. (shrink)

Relativistic quantum mechanics has been formulated as a theory of the evolution ofevents in spacetime; the wave functions are square-integrable functions on the four-dimensional spacetime, parametrized by a universal invariant world time τ. The representation of states with spin is induced with a little group that is the subgroup of O(3, 1) leaving invariant a timelike vector nμ; a positive definite invariant scalar product, for which matrix elements of tensor operators are covariant, emerges from this construction. In a previous study (...) a second-order equation was introduced similar to the second-order Dirac equation, based on a quadratic function of two operators which are the self-adjoint parts, in this new scalar product, of γμpμ. It is shown in this paper that one of these operators, in fact the one from which the gyromagnetic moment is obtained, can be used to construct a first-order equation. The corresponding quantum theory is somewhat analogous to Dirac's spinor form; the Hamilton equations appear to describe dynamical degrees of freedom in a spacelike hyperplane orthogonal to nμ (in Dirac's theory the motion appears to be lightlike). It is shown that the integration over nμ required by unitarity results in timelike motion (as in the expectation value of Dirac's α). Explicit forms are obtained for the wave functions and currents for free motion. The general form of the theory is written for the (five-dimensional) pre-Maxwell fields required by gauge invariance. (shrink)