OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

The speculative power of theoretical reason is not only incapable of grounding itself, but is also powerless to integrate and unify all of the different aspects of our intellectual and spiritual life. This impotency of what Schelling called negative philosophy gives rise to the demand for a positive philosophy that supplies the integrative grounding in which das Unvordenkliche—that before which nothing can be thought—is rooted. I contrast what Schelling calls an “inverted concept” with Huineng’s account of wu-nien (no-thought) found in (...) the Platform Sutra (Tun-Huang Manuscript). Both Schelling and Huineng advance their respective ideas as not only the necessary basis of their thinking, but as a necessary experience one must undergo in order to realize and thus truly comprehend their teaching. Huineng connects this lived knowing with sudden enlightenment, while Schelling speaks of the exuberant fullness of ecstasy. I close with a brief account of Schelling’s appeal for pluralistic tolerance among different philosophical and religious traditions, in which he argues that such traditions are in error to the degree they lay claim to exclusive and infallible truth. (shrink)

What should we make of the intuitions marshaled on behalf of the existence of supererogatory actions, or actions that are “good but not required”? Are they trustworthy or dissembling? This question is important considering the great respect many writers give to them. The attitude of Daniel Guevara is not unusual: "My discussion relies upon the intuition that certain acts, such as those described by Urmson, are supererogatory, indeed, that they are paradigms…I shall proceed on the assumption that a theory is (...) discredited if in fact it makes supererogation impossible." There is thus a widespread attitude that the supererogatory status of certain acts should be taken to be one of those elements out of which a moral theoryshould be constructed, something like one of Rawls’s “considered moral judgments” or “considered convictions of justice.” The comparison with Rawls’ methodology is sometimes quite explicit. My purpose is to throw this conviction – that the supererogatory status of these actions can be accepted with a confidence not too much less than that with which we accept that slavery is wrong – into doubt. Whether there is a category of the supererogatory acts is a matter for another paper; personally I see no conceptual incoherence but merely doubt that it is instantiated very often. My goal shall be rather narrow: to cast doubt upon the reputation of the intuitions. First I shall describe my conclusion abstractly, and why I think the intuitions are much less indubitable than supposed. Then I shall discuss a few common examples of supererogatory acts and show how my account explains them. Finally I shall consider how most important intuitions of supererogatory status – those associated with extreme self-sacrifice – might be integrated into my overall account. (shrink)

F. H. Bradley did not write extensively or systematically on the philosophy of religion, and much of what he did write has the character of either tentative speculation or the pre-emptive rebuttal of potential misinterpretations that might threaten his general philosophical position. ‘I admit that on this subject I never had much to say’ he warns. But such a remark should not discourage us from considering his views on this topic, since the disclaimer is typically Bradleian, and more reflective of (...) his high standards for what is required in order to claim to have something to say about some matter than of any genuine lack of opinion. On closer inspection we find that he has, scattered throughout his work, a great many important things to say about this subject. (shrink)

W. J. Mander presents the first ever synoptic history of British Idealism, the school of thought which dominated English-language philosophy from the 1860s to the early 20th century. He restores to its proper place this neglected period of philosophy, introducing the exponents of Idealism and explaining its distinctive concepts and doctrines.

What precisely, W. J. T. Mitchell asks, are pictures (and theories of pictures) doing now, in the late twentieth century, when the power of the visual is said to be greater than ever before, and the "pictorial turn" supplants the "linguistic turn" in the study of culture? This book by one of America's leading theorists of visual representation offers a rich account of the interplay between the visible and the readable across culture, from literature to visual art to the mass (...) media. (shrink)

In Search of a Political Philosophy is an analysis of the three democratic `isms'--conservatism, liberalism, and socialism--and of the distinct nature of the all-consuming ideology of Marxist communism. W. J. Stankiewicz is concerned with the conscious and unconscious assumptions of the proponents and followers of each ideology, and those of their theoreticians and critics. Stankiewicz examines the norms by which political ideologies are characterized, and discusses which of these are given precedence. He provides an analysis of how each ideology views (...) such issues as freedom and restraint, responsibility, equality, justice, power, authority, property, human nature and happiness. He also examines the areas of ideological contiguity and mutual influences, the sources of ideological incomprehension in our society, and the forces that split Western societies. In Search of a Political Philosophy takes issue with the positions of some of our leading political theorists and represents an original contribution to political philosophy in its own right. It makes a stimulating and challenging contribution to the areas of politics, political philosophy, ethics, political and social theory, the history of political thought, and the history of ideas. (shrink)

W. J. Mander provides a brief introduction to and critical assessment of the thought of the greatest of the British Idealist philosophers, F. H. Bradley (1846-1924), whose work has been largely neglected in this century. After a general introduction to Bradley's metaphysics and its logical foundations, Mander shows that much of Bradley's philosophy has been seriously misunderstood. Mander argues that any adequate treatment of Bradley's thought must take full account of his unique dual inheritance from the traditions of British empiricism (...) and Hegelian rationalism. The scholarship of recent years is assessed, and new interpretations are offered of Bradley's views about truth, predication, and relations, and of his arguments for idealism. (shrink)