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)

Background: Caring for terminally ill patients is a meaningful task, however the patient’s suffering can be a considerable burden and cause of frustration.Objectives: The aim of this study is to describe the experiences of general practitioners in The Netherlands in dealing with a request for euthanasia from a terminally ill patient.Methods: The data, collected through in-depth interviews, were analysed according to the constant comparative method.Results: Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described (...) as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without “intentionally hastening a patient’s death on his request”. The other GPs explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient’s request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient’s suffering through euthanasia and their personal values.Conclusion: Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient’s suffering and to promote a peaceful death. (shrink)

This article engages various critiques of Fair Trade, from its participation in commodification to providing a cover for "Fair-washing" corporations, and argues that Fair Trade has the potential to answer the challenges contained within them if and when it initiates an ongoing process of developing the "ethical valuedadded" content of the label. This argument is made in a number of ways. First, by distinguishing between economic and human development impacts and ethics, this article argues that these impacts are necessary but (...) not sufficient conditions for ethical trade. Second, it engages the question of the possibility of ethical practice in economics generally; developing the idea that when economics is concerned with securing the material basis of a broad range of life capacities it becomes ethical. Third, Fair Trade practice itself is examined from this standpoint, and is conceived of as both comprising a promising ethical value-added practice as well as posing a problem in its current formulation that the framework of ethical valueadded can help understand and resolve. Finally, an examination of these theoretical ideas in practice is undertaken through a case study of Café Femenino, a Fair Trade coffee produced in Peru. In conclusion it is argued that for Fair Trade to build upon its economic and human impacts, and therefore remain a meaningful ethical and economic alternative to corporate capitalism and globalization, it must distinguish itself clearly in ethics from those market relations it wishes, explicitly or implicitly, to challenge. (shrink)

Restrictions on research on therapeutic cloning are questionable as they inhibit the development of a technique which holds promise for succesful application of pluripotent stem cells in clinical treatment of severe diseases. It is argued in this article that the ethical concerns are less problematic using therapeutic cloning compared with using fertilised eggs as the source for stem cells. The moral status of an enucleated egg cell transplanted with a somatic cell nucleus is found to be more clearly not equivalent (...) to that of a human being. Based on ethical considerations alone, research into therapeutic cloning should be encouraged in order to develop therapeutic applications of stem cells. (shrink)

Introduction Jan Abbink and Hans Vermeulen This volume consists of essays and studies by authors inspired by the work of Eric Wolf, a central figure in ...

At some distance from a high-rate source in an elastic half-space, the dominant wave motion at the free surface is a Rayleigh surface wave. The calculation of surface waves generated by a concentrated force in a half-space is a basic problem in elastodynamics. By straightforward manipulations, the result can be used to obtain surface waves for other kinds of wave-generating body-force arrangements. For example, appropriate combinations of double-forces (or dipoles) can be used to represent the surface loading due to laser (...) irradiation, or due to acoustic emission from the opening of a sub-surface crack or from sliding over a fault surface. The surface wave motion is usually obtained by the application of integral transform techniques and the subsequent extraction of the surface waves as the contributions from poles in the integral for the inverse transform. In this paper, we use a much simpler approach based on the elastodynamic reciprocity theorem. We consider a transversely isotropic solid whose axis of symmetry is normal to the surface of the half-space. Surface wave pulses generated by a single force, by irradiation from a laser source, and by opening of a crack, have been determined. (shrink)

In France, as in other European countries, especially Britain and Germany, the nineteenth century was a period of great progress and achievement in science. This would still have been true if Claude Bernard and Louis Pasteur had been the only outstanding French scientists of the nineteenth century, whereas there were, of course, many others apart from an impressive number of brilliant French mathematicians. Nevertheless, although it was a great century for French science there was perhaps something rather disappointing about it, (...) and something rather ingrowing about the attitude of French scientists towards scientific developments in other countries. For example, the French took it hard that the creator of the theory of evolution should have been an Englishman, remembering too late Darwin's predecessor Lamarck, and they certainly were very slow in accepting Darwin's theory of evolution.1 Again, the French may have felt that after the important contributions of French scientists such as Coulomb, Poisson, Biot and, above all, Ampère, the theory of electricity and magnetism which is today principally associated with the names of Faraday and Maxwell should have been created by a Frenchman. Once again this new theory was only accepted very slowly and hesitantly, and even unwillingly, in France—one thinks, for example, of the criticisms levelled at the theory by Pierre Duhem in his “The Aim and Structure of Physical Theory”.2 Of course it might be that if one knew how to weigh properly the various achievements of French scientists in different branches of science one would find that, allowing for her rather static population during the nineteenth century, thetotalcontribution of France compared well with those of Britain and Germany. Nevertheless, in one case at least, that of theoretical physics, there seems to have been an unmistakable failure to live up to the promise of the beginning of the century. The purpose of this paper is to advance possible reasons to explain this failure. (shrink)

First published in 1952, British Empirical Philosophers is a comprehensive picture of one of the most important movements in the history of philosophic thought. In his introduction, Professor A. J. Ayer distinguishes the main problems of empiricism and gives a critical account of the ways in which the philosophers whose writings are included in this volume attempted to solve them. Editors Ayer and Raymond Winch bring together an authoritative abridgement of John Locke’s Essay Concerning Human Understanding ; Bishop George Berkeley’s (...) Principles of Human Knowledge ; almost the entire first book of David Hume’s Treatise Concerning Human Nature ; and extracts from Thomas Reid’s Essay on the Intellectual Powers of Man and John Stuart Mill’s Examination of Sir William Hamilton’s Philosophy. (shrink)

The past thirty years have been marked by an energetic renewal of traditional just war theory. Now changes in relations among nations and changes in military technology may require a recasting of the just war ethic comparable to its recasting by Vitoria and Suarez in the six-teenth century. After reviewing the way the just war tradition met the practical tests posed by Vietnam, nuclear deterrence, and the Gulf War, I will argue that the erosion of the Westphalia legacy and the (...) collapse of the cold war press two questions upon us: Can any modern war be defended as just? Are there resources in the just war tradition for assessing what constitutes morally defensible, even morally required, intervention by one state in the affairs of another? (shrink)

arbitrary flowchart programs by introducing a new recursive function for each tag point. In the above example, one obtains: int = int1, p..... 1 h ), w...., y2r )_.

Cognitive frameworks provide important means for uniting concepts of specificity, cognition, and dynamic change in development. Two points are challenged by evidence from special populations: (1) that boundary constraints such as Residual Normality and a cognitive “endstate” compromise the use of cognitive models; and (2) the developmental process itself automatically rejects either Residual Normality or residual deviance from typical development.

A global ethic for the twenty-first century will be different from that of the twentieth century. While themes of normative and political continuity will exist, humankind's main moral challenges have changed. Between the two centuries lie the end of the cold war, the terrorist attacks of September 11, 2001, the global financial crisis, and the double transformation of the structure of power in world politics and the norms of sovereignty and intervention. Nuclear weapons will remain high on the agenda of (...) a global ethic, but they will not hold as dominant a place as they did in the past century. This essay, focused on the continuing moral challenge of nuclear weapons, recalls the intellectual and moral lessons of the last century and identifies three leading issues in nuclear ethics today: post–cold war challenges to nonproliferation and deterrence, the new challenges posed by the terrorist threat, and recent proposals for Going to Zero. (shrink)