[V]isibility is central to the shaping of political, medical, and socioeconomic decisions. Who will be treated—how and where—are the central questions whose answers are often entwined with issues of visibility … [and] the effects that media visibility has on the perception of particular bodies .In a documentary entitled Paris: The Luminous Years , writer Janet Flanner describes the intense friendship of Pablo Picasso and Georges Braque. Both were inspired by Paul Cézanne and his retrospective at the 1907 Salon d’Automne—which, according (...) to Paris: The Luminous Years, marked in Janus-like fashion the end of the 19th and the beginning of the 20th centuries in art. Flanner tells of the frequent visits between the two painters, where they “talked and talked … two or three months that they just spent gabbling, gabbling.” And from their camaraderie and gabble emerged someth .. (shrink)

Dr Gillian Craig (1) has argued that palliative medicine services have tended to adopt a policy of sedation without hydration, which under certain circumstances may be medically inappropriate, causative of death and distressing to family and friends. We welcome this opportunity to defend, with an important modification, the approach we proposed without substantive background argument in our original article (2). We maintain that slowing and eventual cessation of oral intake is a normal part of a natural dying process, that artificial (...) hydration and alimentation (AHA) are not justified unless thirst or hunger are present and cannot be relieved by other means, but food and fluids for (natural) oral consumption should never be 'withdrawn'. The intention of this practice is not to alter the timing of an inevitable death, and sedation is not used, as has been alleged, to mask the effects of dehydration or starvation. The artificial provision of hydration and alimentation is now widely accepted as medical treatment. We believe that arguments that it is not have led to confusion as to whether or not non-provision or withdrawal of AHA constitutes a cause of death in law. Arguments that it is such a cause appear to be tenuously based on an extraordinary/ordinary categorisation of treatments by Kelly (3) which has subsequently been interpreted as prescriptive in a way quite inconsistent with the Catholic moral theological tradition from which the distinction is derived. The focus of ethical discourse on decisions at the end of life should be shifted to an analysis of care, needs, proportionality of medical interventions, and processes of communication. (shrink)

Open peer commentary on the article “Homeostats for the 21st Century? Simulating Ashby Simulating the Brain” by Stefano Franchi. Upshot: The target article proposes that Ashby’s investigations of the homeostat and ultrastability lead to a view of living systems as heteronomous, passive “sleeping” machines and thus are in fundamental conflict with concepts of autonomy developed by Jonas, Varela and others. I disagree, arguing that (1) the maintenance of essential variables within viability limits is not a passive process for (...) living systems and (2) the purpose of Ashby’s investigations of the homeostat was to investigate adaptivity, a subject that is related to, but clearly distinct from, autonomy. As such, I find Ashby’s work on adaptivity to be neither in opposition to nor in direct support of modern concepts of biological autonomy and suggest that a productive way forward involves the investigation of the intersection between these two fundamental properties of living systems. (shrink)

It is a well-known fact that the reformer Martin Luther highly esteemed Bernhard of Clairvaux. But what exactly was the significance of Bernhard for him? During the last years some Luther scholars became highly interested in the theological and historical relations between these two remarkable theologians. Recently Franz Posset published an article on this subject in Luther Jahrbuch. He discusses Bernhard of Clairvaux's Sermons of Christmas-time, Lent- and Easter-time as a source for Martin Luther. Theo Bell contributes to this discussion (...) firstly by examining some of the references, which are given by Posset. Did Luther refer to the Bernards second Easter sermon indeed? Was he not familiar at all with his Lenten sermons on Ps. 90? Secondly he argues, that Posset's statement, that Luther is a Bernardus redivivus, is a questionable one. Finally: the main question to the relation Luther-Bernard no longer is: did Luther read Bernard's writings and which ones did he explicitely know, but how did he read and understand them from his sixteenth century point of view? This reception problem should get the proper attention it deserves. (shrink)

Name der Zeitschrift: Das Mittelalter Jahrgang: 20 Heft: 1 Seiten: 80-95.

The teachings, style and impact of the Qur'an have always been matters of controversy, among both Muslims and non-Muslims. But in a modern context of intercultural sensitivity, what the Qur'an says and means are perhaps more urgent questions than ever before. This major new book by one of the world's finest Islamic scholars responds to that urgency. Building on his earlier groundbreaking work, the author challenges misinterpretations of particular Qur'anic verses from whatever quarter. He addresses the infamous 'sword' verse, frequently (...) cited as a justification for jihad. He also questions the 'tribute' verse, associated with the Muslim state subjugating Jews and Christians; and the idea of Paradise in the Qur'an, often viewed by the West as emphasising merely physical pleasures, or used by Islamic fighters as their just reward for holy war. The author argues that wrenching the verses out of the context of the whole has led to dangerous ideologies being built on isolated phrases which have then assumed afterlives of their own. This nuanced, holistic reading has vital interfaith ramifications. (shrink)

The author reviews and continues the debate initiated by her recent paper in this journal. The paper was critical of certain aspects of palliative medicine, and caused Ashby and Stoffell to modify the framework they proposed in 1991. It now takes account of the need for artificial hydration to satisfy thirst, or other symptoms due to lack of fluid intake in the terminally ill. There is also a more positive attitude to the emotional needs and ethical views of the (...) patient's family and care-givers. However, clinical concerns about the general reluctance to use artificial hydration in terminal care remain, and doubts persist about the ethical and legal arguments used by some palliative medicine specialists and others, to justify their approach. Published contributions to the debate to date, in professional journals, are reviewed. Key statements relating to the care of sedated terminally ill patients are discussed, and where necessary criticised. (shrink)

Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of (...) this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: specifying the degree of uncertainty, explaining reasons of uncertainty, providing personalized estimates of uncertainty to patients, downplaying or magnifying uncertainty, reducing or counterbalancing uncertainty, and providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their choice of words/language to convey uncertainty.Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these. (shrink)

Das Grab des Königs Ninetjer in Saqqara: Architektonische Entwicklung frühzeitlicher Grabanlagen in Ägypten. By Claudia M. Lacher-Raschdorff. Deutsches Archäologisches Institut Kairo, Archäologische Veröffentlichungen, vol. 125. Wiesbaden: Harrassowitz Verlag, 2014. Pp. 295, 44 pls., plans. €247.