Introduction Substitute decision making on behalf of incapable patients is based on the ethical principle of ‘respect for autonomy’. This study was conducted to assess patients' wishes and preferences in terms of a substitute decision maker and determinants of such preferences. Methods The authors conducted a cross-sectional study and selected samples randomly from patients presenting at Farabi Eye Hospital clinics who were 18 years of age or older. Questionnaires were completed through interviews. Results 200 patients between the ages of 18 (...) and 83 years were interviewed. About 52% (N=105) were men and 73% (N=77) were married. Among married patients, the spouse was chosen as the substitute decision maker in only 51% of cases. Single men preferred their father first in 36% (N=9) of cases, while single girls chose their father in 5.6% (N=1) of cases and their most prevalent choice was other unmentioned people (33.3%, N=6). Most patients (93.5%) wished to be asked about their substitute decision maker when hospitalised. Conclusion The results of this study show that the people we usually consult for decisions concerning patient treatment are significantly different from the patients' preferred substitute decision makers. The authors suggest patients be allowed to choose their substitute decision maker while conscious. (shrink)

Rejectionists argue that collective belief ascriptions are best understood as instances of collective acceptance rather than belief. Margaret Gilbert objects to rejectionist accounts of collective belief statements. She argues that rejectionists rely on a questionable methodology when they inquire into the nature of collective belief ascriptions, and make an erroneous inference when they are led to believe that collectives do not really have beliefs. Consequently, Gilbert claims that collective belief statements are best understood as instances of belief. I critically examine (...) Gilbert’s criticisms of rejectionism. I argue that rejectionism is still a viable account of collective belief ascriptions. I also argue that Gilbert’s most powerful criticism provides important insight into what really stands between her and the rejectionists. Gilbert and the rejectionists do not yet agree about what background assumptions can be made in developing an account of collective belief ascriptions. (shrink)

Devitt has developed an interesting defense of realism against the threats posed by the Pessimistic Induction and the Argument from Unconceived Alternatives. Devitt argues that the best explanation for the success of our current theories, and the fact that they are superior to the theories they replaced, is that they were developed and tested with the aid of better methods than the methods used to develop and test the many theories that were discarded earlier in the history of science. It (...) is no surprise that theories developed earlier in the history of science needed to be replaced. But our current theories are different, having been developed and tested with the aid of these more recently developed superior methods. I critically analyze Devitt’s defense of realism. I argue that recent developments in methodology cannot support the claims Devitt makes. I present an argument I call the “Argument from Unconceived Methods.” Given the history of science, it seems likely that scientists will continue to develop new methods in the future. And some of these methods will enable scientists to generate data that cannot be reconciled with the currently accepted theories. Consequently, it seems that our current best theories are not immune from being replaced in the future by radically different theories. (shrink)

I take another look at the history of science and offer some fresh insights into why the history of science is filled with discarded theories. I argue that the history of science is just as we should expect it to be, given the following two facts about science: theories are always only partial representations of the world, and almost inevitably scientists will be led to investigate phenomena that the accepted theory is not fit to account for. Together these facts suggest (...) that most scientific theories are apt to be discarded sometime, superseded by new theories that better serve scientists’ new research interests. Consequently, it is reasonable to expect that many of the theories we currently accept, despite their many impressive successes, will be discarded sometime in the future. But I also argue that discarded theories are not always aptly characterized as a sign of failure or as a sign of some sort of shortcoming with science. Theories are discarded because scientists are making advances in their pursuit of knowledge. Thus, discarded theories are often a sign of the good health of science. Scientists are responding to their changing research interests. (shrink)

Arapçada izâfet bütünleşik bir yapı arz eden ve ögeleri arasındaki kuvvetli bağ sebebiyle iki isimli bu yapının müfred isim mesabesinde kabul edildiği bir dizilimdir. Bu yapıyı oluşturan kelimelerin diziliminde herhangi bir yer değişimi olmamakla birlikte şiir zarureti gibi oldukça istisna sayılabilecek durumlar dışında bu iki ismin arasına başka bir sözün girmesi de karşılaşılan bir durum değildir. Sözü bu derece kuvvetli bir yapıyla ifade etmenin birtakım anlamsal gerekçeleri bulunmaktadır. Ancak yine anlamın etkili olduğu başka gerekçeler, izâfetle ifadesi mümkün olan bir sözün (...) farklı dizilimlerle dile getirilmesini gerekli kılmaktadır. Bu çalışma Arapçada izâfetle ifadesi mümkün olmakla birlikte farklı yapılarla meydana getirilen dizilimleri tespit edip incelemektedir. Çalışma bir yandan izâfetle ilişkili olup gramerde farklı başlıklar altında yer alan dizilimleri analiz edip değerlendirerek bir arada sunmayı, bir yandan da bu dizilimlerin yapısal farklılıklarını ve farklılığın anlamsal gerekçelerini değerlendirerek konunun öğretimine yönelik veriler oluşturmayı amaçlamaktadır. Konunun yapısal boyutunda bu dizilimlerin izâfetten farkı ve dönüşümün biçimsel boyuta nasıl yansıdığı incelenmektedir. Anlamsal boyutta ise izâfet ve izâfet dışındaki dizilimlerin tercihinde etkili olan anlamsal faktörler incelenmektedir. Her dizilimin biçime yansıyan kendine has oluşturulma gerekçesi olmakla beraber izâfetin tercihinde veciz olmasının, izâfet formunun değişimiyle elde edilen ifadelerde ise çalışmada ayrıntıları izah edilen diğer sebeplerin etkili olduğu sonucuna ulaşılmıştır. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Irreversibility, it is claimed, is a much broader concept than is entropy increase, as is shown by the occurrence of certain processes which are irreversible without seeming to involve any intrinsic entropy change. These processes include the spreading outwards into space of particles, or of radiation, and they also include certain biological and mental phenomena. For instance, the irreversible and treelike branching which is characteristic of natural evolution is not entropic when it is considered in itself—i.e. in abstraction from accompanying (...) biochemical and physiological activity. What appears to be the common feature of all forms of irreversibility is the fanning out of trajectories, new entities or new states, in the temporal direction towards the future. (shrink)

Phenomenological analyses of ageing and old age have examined themes such as alterity, finitude, and time, not seldom from the perspective of “healthy” aging. Phenomenologists have also offered detailed analyses of lived experiences of illness including lived experiences of dementia. This article offers a phenomenological account of what we label as entering the grey zone of aging between “healthy” aging and aging with a disease. This account is developed through a qualitative phenomenological philosophy analysis of elderly persons’ lived experiences of (...) being tested for dementia through primary care in Sweden, i.e., within a cultural context where dementia commonly is understood as a frightening a loss of self even though this understanding also is questioned. To enter this grey zone of aging, we argue, does not dissolve dynamic self-becoming but can involve an experience of oneself as being old. Further, in the grey zone, the self experiences itself as neither fully healthy nor as having a disease, and as needing to negotiate and live this ambiguity. To enter this grey zone is to enter an affectively charged, sociocultural and medicalized zone, and while the self can still act in different ways within it, staying in the grey zone can result in a re-orientation in the self’s mode of being, in ways that are thoroughly beyond its control. To stay in the grey zone can have detrimental effects on the self, even though the self does not have a disease: the self can become “stuck” in a reflective mode of attending to embodiment, aging, health, and disease. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making (...) in psychiatric practice. (shrink)

The author proposes a method of verification for moral statements. (staff).

Meryem Sebti, Avicenne. Prophétie et Gouvernement du Monde. (İbn Sînâ: Nübüvvet ve Âlemin Yönetimi), Paris: Les Editions du Cerf (Islam, Nouvelles Approches), 2021, 314 sayfa. ISBN 9782204143172.

Background: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. Research question: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. Research design: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. Participants and research context: Four (...) research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. Ethical considerations: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. Findings: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. Discussion: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. Conclusion: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians’ legal competence had been greater. (shrink)

A review of empirical and theoretical work on reasoning and linguistic inference, which will be a useful introduction to the subject for students of language and thought. The book focuses on the relationship between what people do and what people are supposed to do when making inferences.

Postulating the subcortical organization of human consciousness provides a critical link for the construal of pain in patients with impaired cortical function or cortical immaturity during early development. Practical implications of the centrencephalic proposal include the redefinition of pain, improved pain assessment in nonverbal humans, and benefits of adequate analgesia/anesthesia for these patients, which certainly justify the rigorous scientific efforts required. (Published Online May 1 2007).

Clinician gate-keeping is the process whereby healthcare providers prevent access to eligible patients for research recruitment. This paper contends that clinician gate-keeping violates three principles that underpin international ethical guidelines: respect for persons or autonomy; beneficence or a favourable balance of risks and potential benefits; and justice or a fair distribution of the benefits and burdens of research. In order to stimulate further research and debate, three possible strategies are also presented to eliminate gate-keeping: partnership with professional researchers; collaborative research (...) design and clinician education. (shrink)

In the target article, Kirby (2014) explores conditions under which gestational surrogacy in developing countries (in this case India) may (or may not) be considered as exploitative. The author pro...

La théologie morale est en recherche continue de son interlocuteur philosophique et scientifique : elle se distingue par l'ouverture de son esprit. L'interdisciplinarité se présente sous la forme d'un programme de pensée. Il s'agit d'établir grâce à elle un dialogue constructif avec les sciences médicales. C'est l'interdisciplinarité qui assume une forme concrète dans les situations clefs de l'humaine existence. Confronté aux données de la biologie moléculaire et de la médecine, le théologien se doit de différencier, de moderniser et de développer (...) ses définitions habituelles voire ses modèles de pensée. L'A. se propose de contribuer par cet article à cet objectif. (shrink)