With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

In light of the central role that medications play in medical progress, the declining rate of new drug development over the past decade is cause for concern . Without important breakthroughs in drug discovery, the future will not be auspicious for the many people suffering from chronic and incurable illnesses. The sluggish pace of pharmaceutical innovation has been particularly characteristic of the largest drug manufacturers, which have generally focused their energies on potential blockbuster medications, those that can generate over $1 (...) billion in annual revenue . Given Pharma’s struggles, the success of the country’s largest drug manufacturer in bringing the .. (shrink)

Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores whether one such tradition—halachic Judaism—in fact demands the use of artificial nutrition and hydration in this setting. Traditional arguments have been advanced holding that treatment can be withheld in persons who are (...) dying, in individuals whose condition causes great suffering, or in the event that the treatment would produce suffering. Individuals with advanced dementia can be considered to be dying, often suffer as a result of their dementia, and are likely to suffer from the use of a feeding tube. Given these observations and the absence of a compelling case for distinguishing between tube feeding and other forms of medical treatment, traditional Judaism appears compatible with withholding artificial nutrition for individuals with advanced dementia. (shrink)

America is aging. But even more striking than the rise in the proportion of the population over age 65 is the unprecedented number of individuals who are living into their eighties and nineties. While many people remain robust well into advanced age, the dramatic increase in the number of the oldest old has brought with it an epidemic of Alzheimer’s disease and other dementias. Dementia is a highly prevalent condition — currently 5.4 million Americans have Alzheimer’s disease, a number which (...) may rise to 16 million by 2050 if there is no breakthrough in the prevention or treatment of the disease — but it disproportionately affects those over age 85, striking between one-third and one-half of this cohort. Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. (shrink)

Modern gerontology has debunked the myth of old age as a period of inevitable decline. But what science has not been able to change is the reality that old age often is a time of illness and disability, particularly for the oldest old—those over age 85. The vaunted compression of morbidity hasn't happened; while the period of decline before death may have shrunk, it hasn't vanished. The trajectory in the last phase of life is rarely a precipice, with older people (...) living healthy lives until, abruptly, they fall off a cliff. Rather, it typically takes the form of a series of dips that return to an ever-lowering baseline or a slow fade.The... (shrink)

With great fanfare, the first baby boomer turned 65 on January 1, 2011, ushering in the new, gray society. We—I'm one of the 76 million baby boomers—were expected to transform aging: better educated, healthier, reared in an era of unprecedented prosperity, committed to individual autonomy, we would singlehandedly turn retirement from a time of decline, disability, and despair into a period of travel, adventure, and personal growth. If we did become ill, despite regular exercise, a wholesome diet, and a goodly (...) dose of vitamins, we would demand, and receive, the fruits of American technological ingenuity, vanquishing disease and perhaps even death. Concurrent with the designation of age 70 as "the new 40," we have... (shrink)

With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

Some recent discussions of narrative structure consider the narrative as a sequence of events, and assume that the structure is what is manifested by the relation between any given event and the event 1, or perhaps the whole sequence from the first event up to the th event in the book. In the present discussion this approach will be modified in two ways. It will be modified, later on, by considering what would be happening if the writer were revising his (...) work into the final version, out of a penultimate version which was, as it were, a next-most complex version: one to which some final "complexifying" process had not yet been applied. The other way in which the present discussion will modify that approach is that it will consider narrative not as one sequence of events but as an interrelated set of sequences. · 1. E.g., R. Barthes, "Introduction à l'analyse structurale du récit," Communications, no. 8 , pp.1-27. John Holloway, professor of Modern English at the University of Cambridge, has written The Victorian Sage, The Charted Mirror, The Story of the Night, Blake: The Lyric Poetry, and five volumes of verse, such as New Poems. He is presently completing a book on poetic modes from Milton to Hardy and coediting a four-volume series on English and Irish street ballads. His other contribution to Critical Inquiry," Supposition and Supersession: A Model of Analysis for Narrative Structure" appeared in the Autumn 1976 issue. (shrink)

Clarifying the mission of the American high school / Ernest L. Boyer--Educational goals and curricular decisions in the new Carnegie Report / John Martin Rich--Essential schools : a first look / Theodore R. Sizer--Teaching and learning : the dilemma of the American high school / Chester E. Finn, Jr.--The paideia proposal : rediscovering the essence of education / Mortimer Adler--The paideia proposal : noble amibitions, false leads, and symbolic politics / Willis D. Hawley--Cultural literacy : let's get specific / E.D. (...) Hirsch, Jr.--Cultural literacy : what every educator needs to know / Thomas H. Estes, Carol J. Gutman, and Elise K. Harrison--A blueprint for public education / John E. Chubb--Should market forces control educational decision making / Jack Tweedie--Teachers as transformative intellectuals / Henry A. Giroux--Dilemma language / Colin Lacey--Rich schools, poor schools : the persistence of unequal education / Arthur E. Wise and Tamar Gendler--Partial privatization of publice school finance / Thomas G. Fox and John Riew--Quality and equality in American education : public and Catholic schools / James S. Coleman--Oranges plus apples, Dr. Coleman, give you oranges plus apples / James Rogers--Synthesis of research on school-based management / Jane L. David--Unfulfilled promises / Betty Malen, Rodney T. Ogawa, and Jennifer Kranz--Effective high schools--What are the common characteristics? / Joseph Murphy and Philip Hallinger--Effective schools : a friendly but cautionary note / Larry Cuban--In education, magnets attract controversy / Mary Haywood Metz--Schools of choice : a path to educational quality or 'Tiers of inequity'? / Kathleen Sylvester--Interesting times / Alan H. Jones--Making a difference in educational quality through teacher education / Carolyn M. Evertson, Willis D. Hawley, and Marilyn Zlotnik--Developing a career ladder : getting down to the basics / Thomas Deering--The career ladder and lattice : a new look at the teaching career / Timothy J.L. Chandler, Stacey L. Lane, Janice M. Bibik, and Bernard Oliver--Equity, quality, and effectiveness in bilingual education / George M. Blanco--Bilingual--No! / Muriel Paskin Carrison--Multiethnic education and the quest for equality / James A. Banks--The limits of pluralism / M. Donald Thomas--The case for keeping mentally retarded children in your regular classrooms / Martin Tonn--Mainstreaming : a formative consideration / Harry N. Chandler--Reflections on three decades of eduction of the gifted / A. Harry Passow--Equity vs. excellence : an eductional drama / James J. Gallagher. (shrink)

Spiritual Theology's journey through these last decades shows an itinerary of development, the fruit of which is an ever more solid identity. This book seeks to present a perspective in that itinerary and in tune with the signs of our times: on one hand, militant secularism and, on the other, a widespread, concrete resurgence of experiences of transcendence. In this sense, the author is presenting a path of study organized around five concepts: presence, mystery, transcendence, lived experience, and transformation. In (...) effect, the inner transformation worked by the Presence of Mystery leaves a new knowing, in which the relationship with reality is renewed, since it has expanded and dilated beyond sensible perception, opening the subject up to an unlimited and real horizon of transcendence. The awareness of perceiving a 'greater reality' within reality leaves an emotional resonance that teaches a new way of feeling and reacting in the face of sensibly perceived reality. (shrink)

Prevalence of contract cheating and outsourcing through organised methods has received interest in research studies aiming to determine the most suitable strategies to reduce the problem. Few studies have presented an international approach or tested which variables could be correlated with contract cheating. As a result, strategies to reduce contract cheating may be founded on data from other countries, or demographics/situations which may not align to variables most strongly connected to engagement in outsourcing. This paper presents the results of a (...) series of statistical analyses aimed at testing which variables were found to be predictors of students’ self-reported formal outsourcing behaviours. The data are derived from an international research study conducted in 22 languages, with higher education students (from Europe, the Americas and Australasia. Analyses found that country and discipline of study as well as the rate at which respondents n = 7806) believed other students to be cheating, were positively correlated to their cheating behaviours. Demographic variables did not show strong statistical significance to predicting contract cheating. (shrink)

This book focuses upon the perennial question of the existence and nature of an obligation to obey the law. Leading writers have, at one time or another, emphasized considerations such as gratitude, 'divine ordering, ' prudence, contract, autonomy, and utility in seeking to justify, or to deny any justification for, some sort of obligation to obey the positive law. The book provides relevant selections from a sampling of the historical approaches to legal obligation taken by writers such as Plato, Augustine, (...) Aquinas, Hobbes, Locke, Hume, Rousseau, Thoreau, Bentham, Marx and Engels, and Martin Luther King, Jr. These classical discussions are augmented by critical questions and commentary, by independent discussions of the question of legal obligation by a wide range of contemporary writers, and by relevant judicial cases discussing matters such as conscientious objection and civil disobedience. (shrink)