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)

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

We extend the theory of “Fine structure and iteration trees” to models having more than one Woodin cardinal.

Holistic Learning is designed as a practical guide for teachers on how to integrate curriculum around human processes and human themes. Specifically, problem solving (human process) and mythology (human theme) have been selected as vehicles for curriculum integration. Along with a number of specific strategies for classroom use, the book includes a rationale and framework for integrated studies, teaching approaches in problem solving and mythology, guidelines for writing units in integrated studies, and implementation strategies for integrated studies. The primary audience (...) is teachers at the intermediate and senior levels, although muc of the material is applicable to teachers at all levels of the curriculum. Individuals in curriculum leadership positions (e.g., principals, co-ordinators, and superintendents) should also find the work of interest. Holistic Learning is a practical guide for teachers seeking approaches to integrate diverse subject matter. (shrink)

Economic models are founded in the idea of taking individuals' preferences as both known and given. This article explores the evolution of personal preferences, within a context of both entrepreneurial discovery and Objectivist philosophy. It begins by formalizing Ayn Rand's theory of Objectivism applied to human values, and continues by modeling preference changes similar to Schumpeter's theory of creative destruction—a process of self-discovery. Next the role of societal factors is examined in forming shared preference sets. Finally, the article describes how (...) the strength of human preferences is used to narrow choice sets in the presence of greater consumption options. (shrink)

Objective: To evaluate moral development as an indicator of the capacity to consent among two groups of patients from the Hospital de Clínicas in Porto Alegre, RS, Brazil.Method: Fifty-nine adolescents and 60 patients over 60 years of age participated in a cross-sectional study to assess moral development using Loevinger’s model of ego stages.Results: Age and moral development showed no association, with most participants in the two groups being in the conscientious phase.Conclusions: Age is probably not an adequate variable to measure (...) decision-making capacity, because questions of medical consent relate to participants’ own personal health. Decision-making capacity should be viewed as a continuous function. While the age of the person whose consent is needed should be considered, age alone, from a moral perspective, is not the main determinant of this capacity. (shrink)

This collection of eight articles of uneven quality examines ethical and moral considerations surrounding "euthanasia." They all concentrate more on philosophic issues such as decision-making, principles and theories of action and accountability, and definitions than on medical dilemmas which bring such questions to prominence. Except for Ladd’s they seem unfamiliar with current law on the issues, and most, we suspect, took shape before Saikewicz, if not before the appellate decision on Quinlan. There are four principal themes. The alleged distinction, rejected (...) by all but P. Foot, between active and passive euthanasia. The nature and origin of certain concepts such as "right", "death," and "person." The problem of whether rights can be located elsewhere than in persons. Special problems such as Down’s Syndrome infants and infanticide in general. (shrink)

XLRI, in association with a few Tata Group companies, established the XLRI-JRD Tata Foundation in Business Ethics in 1991 to mark their long-standing commitment and contribution to business ethics in India. The foundation seeks to address this by publicly affirming the urgent need for ethics in business and the need to bring about a conducive culture in which it can thrive.

“Towards a Theory of Taxation” is a proper theme for an Englishman to take when giving a paper in America. After all it was from the absence of such a theory that the United States derived its existence. The Colonists felt strongly that there should be no taxation without representation, and George III was unable to explain to them convincingly why they should contribute to the cost of their defense. Since that time, understanding has not advanced much. In Britain we (...) still maintain the fiction that taxes are a voluntary gift to the Crown, and taxing statutes are given the Royal Assent with the special formula, “La Reine remercie ses bons sujets, accepte leur benevolence, et ainsi le veult” instead of the simple “La Reine le veult,” and in the United States taxes have regularly been levied on residents of the District of Columbia who until recently had no representation in Congress, and by the State of New York on those who worked but did not reside in the State, and so did not have a vote. Taxes are regularly levied, in America as elsewhere, on those who have no say on whether they should be levied or how they should be spent. I am taxed by the Federal Government on my American earnings and by state governments on my American spending, but I should be hard put to it to make out that it was unjust. Florida is wondering whether to follow California in taxing multinational corporations on their world-wide earnings. (shrink)

This paper addresses the definition and the operational use of intuitions in philosophical methods in the form of a research study encompassing several regions of the globe, involving 282 philosophers from a wide array of academic backgrounds and areas of specialisation. The authors tested whether philosophers agree on the conceptual definition and the operational use of intuitions, and investigated whether specific demographic variables and philosophical specialisation influence how philosophers define and use intuitions. The results obtained point to a number of (...) significant findings, including that philosophers distinguish between intuitions used to formulate (discovery) and to test (justification) philosophical theory. The survey results suggest that strategies implemented to characterise philosophical intuition are not well motivated since, even though philosophers do not agree on a single account of intuition, they fail to capture a preferred usage of intuitions as aspects of discovery. The quantitative summary of survey findings informs the debate on this topic, and advances more defined routes for subsequent approaches to the study of intuitions. (shrink)

J. R. Jones; VI.—The Two Contexts of Mental Concepts, Proceedings of the Aristotelian Society, Volume 59, Issue 1, 1 June 1959, Pages 105–124, https://doi.org/1.

According to the legend, Bishop Wilberforce at a meeting of the British Association for the Advancement of Science in Oxford on Saturday, June 30th, 1860, turned to Thomas Huxley, and asked him ``Is it on your grandfather's or your grandmother's side that you claim descent from a monkey''; whereupon Huxley delivered a devastating rebuke, thereby establishing the primacy of scientific truth over ecclesiastical obscurantism. Although the legend is historically untrue in almost every detail, its persistence suggests that it may nonetheless (...) be true in some deeper, mythical, sense. To explore this possibility the British Academy has invited Dr Janet Browne to be a neo-Huxley confronting Mr J.R. Lucas, as a neo-Wilberforce, with each reconsidering their earlier arguments. (shrink)

A report by the Nuffield Council on Bioethics, contrary to the Declaration of Helsinki, permits most important research initiatives in developing countries.The Ethics of Research Related to Health Care in Developing Countries by the Nuffield Council on Bioethics makes a number of innovative recommendations that depart from codes such as the Declaration of Helsinki. It recommends that standards of care might be relativised to the standard of that nation. It recommends that very good reasons need to be given for not (...) giving post-trial access to medications but recognises that there may be justifiable instances of this. It is the view of the authors that these and other recommendations of the report are sensible pieces of advice given the complexities of the developing world. (shrink)