Background: Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day care of older people.Objectives: To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the (...) information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided.Method: A descriptive questionnaire given to 200 patients and 200 relatives during the patients’ stay in hospital.Results: Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives , despite the irregularities observed.Conclusions: The capacity of elderly patients to participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. (shrink)

Cet article propose une vue d’ensemble de la doctrine des Intermédiaires mathématiques (τὰ μεταξύ) qu’Aristote attribue à Platon dans sa Métaphysique, des objections qu’Aristote lui adresse et des questions philosophiques qu’elle soulève. Suivant Aristote, Platon avance que les vérités de la géométrie et de l’arithmétique ne peuvent pas porter sur des objets perceptibles ni sur des Formes, mais doivent porter sur une troisième classe d’entités intermédiaires entre les deux. Je soutiens que la critique d’Aristote la plus efficace de cette doctrine (...) montre que les raisons avancées en faveur de l’existence des Intermédiaires par les Platoniciens ne sont pas concluantes, mais ne peut pas montrer qu’ils n’existent pas. En m’appuyant sur quelques remarques de David Ross sur la démarche d’Aristote, je soutiens également que, s’il est vrai que le fait que toute science est caractérisée par des propositions de la forme « Tout F est G » n’implique pas qu’elle porte sur des entités intermédiaires, il peut y avoir des raisons pour accepter leur existence eu égard à une science mathématique en particulier, à savoir la géométrie. (shrink)

Je remercie Stéphane Marchand : ses objections me fournissent l’occasion d’éclaircir certains points capitaux de mon livre et de mon interprétation de Sextus Empiricus. Scepticisme et langage veut affronter la question de savoir si le sceptique pyrrhonien décrit par Sextus peut maîtriser une langue. Après avoir identifié le pyrrhonien à un sceptique radical, un individu dépourvu de croyances, je m’efforce de lui assurer la possibilité de parler en proposant plusieurs façons d’expliquer son co...

Le volume offre huit articles sur le scepticisme pyrrhonien. Les essais, de la plume de M. Bonazzi, T. O’Keefe, J. Warren, F. Grgić, H. Thorsrud, S. Marchand, D. E. Machuca et O. Bueno, sont tous en anglais. Précédés d’une préface, d’une notice sur les auteurs et d’une brève introduction, ils sont suivis d’index des noms propres, des passages et des sujets. Chaque contribution est munie d’une bibliographie. Les deux premiers articles sont consacrés à la section des Esquisses Pyrrhoniennes (PH...

Gennaro Chtjerchia, Dynamics of meaning: anaphora, presupposition, and the the of grammar. Chicago and London: The University of Chicago Press, 1995.xv+ 270 pp, £59.95, £31.95 G. Pr...

This book provides a detailed account of intellectual, other neuropsychological and behavioral manifestations of general pediatric diseases. The conditions discussed include the whole range of pediatric diseases - genetic syndromes, other congenital conditions, metabolic, endocrine, gastrointestinal, infectious, immunologic, toxic, trauma, and neoplastic, as well as sensory disabilities including deafness and blindness. Although the book is not intended to discuss cognitive and behavioral manifestations of conditions usually considered to be primary neurological disease, some of those, including cerebral palsy, muscular dystrophy, myotonic (...) dystrophy and epilepsy, are included.Where possible, a. (shrink)

Upshot: We respond to three main challenges that the commentaries have raised. First, we argue that to deal successfully with the hard problem of consciousness, it is not enough to posit a remedy by which to move beyond the hard problem. Second, we argue that it makes no sense to explain identity. Yet this does not commit us to definitions by fiat. The strategy we pursue here, and in the target article, is not to explain identity but to explain away (...) the appearance of non-identity. Finally, while we are sympathetic to Varela’s call for a paradigm shift in consciousness studies, we argue here, and in the target article, that this call can only be properly successful if the hard problem is dismantled. (shrink)

AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

Based on two workshops held February 1990 in New York and March 1990 in San Francisco. Following the presentation and discussion of three clinical case histories, psychotherapists James F. Masterson, Marian Tolpin, and Peter E. Sifneos compare and contrast developmental, self, and object relations.

Human aesthetic experiences are pervasive; they are triggered by faces, art, natural scenery, foods, ideas, theories, and decision-making situations, among many sources, and seem to be a distinctive trait of our species. Our moral sense, understood as our capacity to judge events, actions, or people as good or bad, appropriate or inappropriate, also seems to be an exclusively human endowment (Ayala 2010). As part of the scientific efforts to characterize the biological foundations of our human uniqueness, recently there has been (...) interest in the brain’s underpinnings of aesthetic reactions to art on the one hand, and in the neural correlates of moral judgment and decision-making on the other (Greene and Paxton .. (shrink)

Open peer commentary on the article “Exploring the Depth of Dream Experience: The Enactive Framework and Methods for Neurophenomenological Research” by Elizaveta Solomonova & Xin Wei Sha. Upshot: This commentary focuses on an ontological claim made by the authors of this target article: that perceiving, imagining and dreaming are inseparable. It explores how best to understand this “inseparability condition.” It is shown that the evidence needed to justify a strict reading of the inseparability condition is lacking, while there is room (...) for a more relaxed rendition of the inseparability condition. The inferred lesson is that in developing an enactive neurophenomenology of dreaming, it is a non-trivial task to achieve clarity about the ontology of dreaming, and its relationship to imagining as well as perceiving. (shrink)

To avoid misinterpretations one should substitute the ambiguous notion of 'new disease' with 'emerging disease'. A disease can be classified emergent in at least five dif férent historical situations; 1) it existed before it could be first identified but was overlooked from a médical point of view because it could not be conceptualized as a nosological entity; 2) it existed but was not noticed until a quantitative and/or qualitative change in its mani festations; 3) it did not exist in a (...) particular région of the world before its introduction from other régions; 4) it never existed in a human population but only in an animal population; 5) it is completely new - the triggering germ and/or necessary environmental conditions did not exist prior to the first clinical manifestations. A sériés of historical examples illustrate this classification. (shrink)

Written with poignancy and compassion, ____Do We Still Need__ ____Doctors?__ is a personal account from the front lines of the moral and political battles that are reshaping America's health care system.

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)