BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

The coronavirus disease 2019 (COVID-19) crisis ought to serve as a reminder about the costs of failure to consider another long-term risk, climate change. For this reason, it is imperative to consider the merits of policies that may help to limit climate damages. This essay rebuts three common objections to carbon taxes: (1) that they do not change behaviour, (2) that they generate unfair burdens and increase inequality, and (3) that fundamental, systemic change is needed instead of carbon taxes. The (...) responses are (1) that there is both theoretical and empirical reason to think that carbon taxes do change behaviour, with larger taxes changing it to a greater extent; (2) that undistributed carbon taxes are regressive but distributing the tax receipts can alleviate that regressivity (and, in many cases, make the overall effect progressive); and (3) that while small changes for increasing democratic decision-making may be helpful, (fundamental) change takes time and the climate crisis requires urgent action. [Open access] //// -/- La crise de lamaladie à coronavirus 2019 (COVID-19) devrait servir de rappel sur les coûts de la non-prise en compte d’un autre risque à long terme, les changements climatiques. Pour cette raison, il est impératif de considérer lesmérites des politiques susceptibles de contribuer à limiter les changements climatiques. Cet essai réfute trois objections courantes aux taxes sur le carbone : (1) qu’elles ne changent pas les comportements (2) qu’elles génèrent des charges injustes et augmentent les inégalités, et (3) qu’un changement fondamental et systémique est nécessaire au lieu de taxes sur le carbone. Les réponses sont (1) qu’il existe des raisons à la fois théoriques et empiriques de penser que les taxes sur le carbone modifient effectivement les comportements, et que des taxes plus élevées les modifient dans une plus grande mesure; (2) que les taxes sur le carbone non distribuées sont régressives,mais que la distribution des recettes fiscales peut atténuer cette régressivité (et, dans de nombreux cas, rendre l’effet global progressif); et (3) que, bien que de petits changements pour l’amélioration de la prise de décision démocratique peuvent être utiles, un changement (fondamental) prend du temps et la crise climatique exige une action urgente. (shrink)

This Correspondence argues in response to Coolsaet et al. (2024) that there is an important role to play for stance-independent justice discussions that are not tied to specific social, political or critical perspectives. These can be valuable for climate research audiences, but also as a basis upon which to critically debate and research injustices.

While mitigation and adaptation will help to protect us from climate change, there are harms that are beyond our ability to adapt. Some of these harms, which may have been instigated from historical emissions, plausibly give rise to duties of compensation. This chapter discusses several principles that have been discussed about how to divide climate duties—the polluter pays principle, the beneficiary pays principle, the ability to pay principle, and a new one, the polluter pays, then receives principle. The chapter introduces (...) several challenges to these principles from the literature, before discussing which policies and institutions might be relevant to compensation, whether internationally (e.g. the Green Climate Fund) or intergenerationally (e.g. Broome and Foley’s World Climate Bank). It also describes some recent successful climate cases which require both the Dutch government and a private firm to act in accordance with climate targets to avoid potential rights-violations. Finally, it discusses one of the most important international concepts with respect to compensation: the Loss & Damage pillar of climate policy. (shrink)

[Comment] Jonathan Herington argues that harms can occur whether or not there is actually a loss. He claims that subjectively or objectively merely being at risk of losing access to basic goods is sufficient for lowering that individual’s well-being for the value of ‘security’. I challenge whether losing access to basic goods is sufficient to justify the introduction of this value. I also point to some issues in his interpretation of IPCC risk categories and the social science research he relies (...) on. [Open access]. (shrink)

The three main types of policies for addressing climate change are command and control regulation, carbon taxes (or price instruments), and cap and trade (or quantity instruments). The first question in the ethics of carbon pricing is whether the latter two (price and quantity instruments) are preferable to command and control regulation. The second question is, if so, how should we evaluate the relative merits of price and quantity instruments. I canvass relevant arguments to explain different ways of addressing these (...) important policy questions, suggesting that carbon pricing is preferable to command and control regulation, and that price instruments have the theoretical edge over quantity instruments. [Open access]. (shrink)

It is often taken for granted that Paul Hirst’s switch from emphasis on liberal education to a social practices view of education is a radical one. This depends on how we understand the relation between the two views. From the perspective of a ‘weak’ interpretation I argue that Hirst’s later position differs little from his earlier one in the light both of the relation between the forms of knowledge and social practices, and of the rationalistic character of Hirst’s conception of (...) social practices in their connection with education. (shrink)

교사와 장학관을 역임한 저자가 들려주는 전통도덕의 원리와 실천서. 유가의 사상, 유가의 생활, 제도와 예법, 유가 전적의 이해 등을 설명했다. 전통적 생활방 식과 가치를 이해하고 실천하는데 도움이 되도록 엮었다.

As one aspect of China's modernization, the importation of Western psychiatric ideas poses a mystery. How are such ideas integrated with traditional assumptions? The apparently wholesale adoption of Western psychiatric categories runs counter to the fact that the Chinese have been generally reluctant to define problems in highly individualized psychiatric terms. Our lack of knowledge as to how the Chinese and Western medical models interface raises questions about the cross-cultural applicability of psychiatric theory. Ironically, the very conceptual categories intended to (...) facilitate professional discourse obscure cultural, political, and epistemological differences between Chinese and Western thought.This paper focuses on certain incongruities in psychiatric theory and practice in order to underscore many unresolved issues that still exist with respect to our cross-cultural understandings of mental illness. Insofar as the trend has been towards standardizing methodology, taxonomies have been generated without a corresponding development in textured comparison. Originating from Western theoretical frameworks, comparative analyses have been otherwise devoid of culture-specific knowledge. (shrink)

I make a case for the hope that God is the supremely guilty person whose death on the cross represents God's apology to us in history. I motivate this hope by examining Kant's quest to find satisfaction in humans' moral life. After explaining why moral satisfaction is so significant in his practical philosophy, I point out that the human moral vocation in his second Critique boils down to endless progress toward the highest good, governed by God as the moral ruler. (...) However, he shifts away from this account due to the worry that it offers no prospect of moral satisfaction. But this shift, which involves lowering the bar of morality, does not eliminate moral discontent, so the question of how to prevent it from abating our interest in morality remains. With this question in mind, I turn to Kierkegaard's critique of Kant's later shift as the way to secure moral satisfaction. Kierkegaard instead underscores the absolute God-human difference so that we can be content with accepting always standing guilty before God, but his argument for embracing this position can be turned around to suggest that a boundlessly loving God would desire to be the guilty party in relation to us. I explore this direction by adapting his kenotic Christology in writings under the pseudonym Johannes Climacus into the distinctive form of Kantian moral theology. This exploration, which is based on the Irenaean affirmation of divine omni-responsibility as explained by John Hick, can lead some theists to find consolation for their moral discontent in God who has descended to the moral low ground. If there was a God-human in history who manifested this descent by an apology on the cross, this person can be interpreted as offering universal salvation here and now, even to the faithless. (shrink)

Substituted judgement is often used in the absence of advanced directives to guide decision-making when patients lack decisional capacity. We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. (...) This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem ethically appropriate to continue treatment, even with substantial disability the likely outcome. (shrink)

Alters the landscape of Lacanian film theory by revealing an "emancipatory drive" in transnational cinema.

The Sadanch’iljŏng nonbyŏn 四端七情論辨, or Sach’il nonbyŏn 四七論辨, for short, primarily refers to a debate that began in the form of a correspondence between Yi Hwang and Ki Tae-sŭng in sixteenth-century Korea.1 It is generally agreed that the Four-Seven Debate “was a great theoretical achievement” and “also set an excellent example in the pursuit of philosophical discussions” in Korea.2 It was the most famous and influential debate in the history of Korean Neo-Confucianism, bringing about vigorous scholarly discussion and resulting in (...) the formation of two major competing schools, the T’oegye School and the Yulgok School.... (shrink)

When the odds of achieving world peace seem so long, do hopes for peace amount to anything more than wishful thinking? In this paper, I introduce the idea of meaningful hope, which can help us to u...

It is a hallmark of a good model to make accurate a priori predictions to new conditions (Busemeyer & Wang, 2000). This study compared 8 decision learning models with respect to their generalizability. Participants performed 2 tasks (the Iowa Gambling Task and the Soochow Gambling Task), and each model made a priori predictions by estimating the parameters for each participant from 1 task and using those same parameters to predict on the other task. Three methods were used to evaluate the (...) models at the individual level of analysis. The first method used a post hoc fit criterion, the second method used a generalization criterion for short‐term predictions, and the third method again used a generalization criterion for long‐term predictions. The results suggest that the models with the prospect utility function can make generalizable predictions to new conditions, and different learning models are needed for making short‐versus long‐term predictions on simple gambling tasks. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what (...) they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)