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)

Liz JacksonEducation University of Hong KongGiven how important textbooks continue to be in education, how textbooks are read for learning and research remains poorly understood. As Michael Apple n...

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In an almost forgotten passage of the Postenor Analytics (Bk I, ch. III) Aristotle argues against 'another school', according to which it is possible to proof things 'by each other and in a circle'. His logical refutation of this opinion became so dominant in the Western philosophical tradition, that the 'vicious circle' has always deemed a crime since. A scientific demonstration has to be built on firm premisses in order to deduce conclusions from them in a straight, ongoing proces, in (...) which one does not have to return to the premisses for a reconsideration of them on the basis of their implications. Although Aristotle does not mention names, he in fact reacts against Plato and the mainstream of Greek thought, which stresses the essential circularity of human argumentation. In the first, the historical part of the treatise the roots of this circular logic are unearthed in the work of Heraclitus and Parmenides, who both defended a ring structure of their metaphysical explication of nature. Truth is described as well-rounded, because you can follow it in a circle, passing through each of its links in turn, back to your startingpoint. The association of circular motion with thought is fully present in the work of Plato, who speeks many times about the 'periforas tès dianoias' and the essential interdependance of our ideas. Not the theory of an anonymous alternative school but Aristotle's own rectilinear formal logic was the exceptional, untraditional standpoint, which, moreover, was in conflict with his explication of divine thinking as 'noèsis noèseôs'. In modern times Hegel, Nietzsche and Heidegger were the main representatives of an anti-Aristotelian attitude. All three reject the logical prohibition of the circular argument, because it is inadequate to the life of concrete scientific thinking. The path of science always turns around towards its origins and results in a correction of its fundamental hypotheses on a higher level. Circularity is considered as a hallmark of sound logical procedure, as a characteristic of excellence in human understanding. The famous 'hermeneutic circle' is interpreted as the modern equivalent of the Hegelian 'Kreislauf and the Greek ' to par'allèlôn'. In the second, the more systematic part of the text the circular nature of our cognitive and scientific behaviour is demonstrated along three different lines. Reflection on the natural language with its finite stock of words, whose meanings are structurally connected, leads us to the so called semiotical circularity. Natural language is a complex network in which circular argumentation is not only unavoidable, but even the only means of explication. We have to work with the material contained in our dictionary, in which the items are defined by each other. The second reason is constituted by the system-orientation of science. In science we try to systematize our knowledge by means of formalisations and abstractions. The development of science can be characterised as a succession of systems, in which every element gets its meaning from the whole organisation. If we accept systematicity as the arbiter of truth, our logic is anti-fundamentalistic and the path of our thought is in fact circular (or better : spiralistic). The third adstruction of our theory is afforded by the coupling, that is realised in a rational proof. We draw conclusions from the coherence of our perceptions, from the reciprocal implications of our ideas. Never any of our ideas is without the repercussions of the movements elsewhere in the field. When we proof something, we also disproof and correct our startingpoints at the same time. The tradition of the circular nature of human thinking is very old, but not antiquated. The accusation of committing a fallacy in the case of circularity in normal and in scientific thinking is unfouded. It is now the formal logicians turn to defend his claim. (shrink)

Outside France the epistemology of G. Bachelard is unknown ; in France his influence is considerable, especially on philosophers like L. Althusser, M. Foucault, G. Canguilhem, J. Hyppolite, M. Serres, G. G. Granger, D. Lecourt and many others. Bachelard occupies a strategic point on the crossroads of all theoretical debates concerning science. The fact that he seems to give satisfactory answers on the problems which have risen after the breakdown of the logical-positivistic philosophy of science, justifies an exposition and evaluation (...) of his original contribution to philosophy. The author distinguishes the following items. 1. The determination of Bachelards philosophy as a scientific philosophy which is wedded to a history of the sciences, especially the natural sciences. 2. The 'systematicity' as the criterium of science against other, traditional, criteria like empiricalness, logical deducibility, correspondence with reality and so on. 3. The rectification-principle : the formation of a scientific system cannot be conceived otherwise than as the restructuring or reorganisation of the ruling system or system-sets. 4. The transformation of scientific knowledge shows many discontinuities in all its phases and branches. Bachelard calls them ruptures. 5. The translation of a theory into another, more coherent and comprehensive one, is baptised as a 'dialectisation' of the concept. By a dialectisation a system is both generalised and specified. Formal logic, which is based on identity and the principle of the excluded middle, is not able to interprete this dynamic aspect of scientific thinking. 6. Central in Bachelards philosophy is also the concept of recurrence. Each new organisation of the scientific system (global or partial) sheds new light on their history and their logical foundations. History has to be rewritten after each progress. Recurrence, however, also has systematic implications. Science always desimplifies its own evidences. 7. The scientist has to demolish the obstacles which he made himself by surcharging the content of the concepts not in use and by not assimilating them in the system. 8. Bachelards philosophy of science is both idealistic and realistic ; the phenomenology becomes phenomenotechnique under the hands and in the brains of the scientist. 9. He always denies (negativity) the earlier theories and objects by incorporating them in new relationships. 10. This constructive aspect of theory formation is the same in natural science and mathematics. Bachelard opposes the logical-positivistic idea that these are methodically dissimilar. In a critical commentary the author discusses the question of 'dialectical logic' in the sciences, in relation to some recent research in this field by I. Lakatos en Errol E. Harris. In his opinion the epistemology of Bachelard affords a creative renewal of the understanding of science, although further research is needed in many aspects. (shrink)

An accurate analysis of the text shows that the small treatises have a logical structure and a style which is in all aspects unspinozistic. The main points of difference are : a formalistic interpretation of mathematics‚ the opposition between mathematics and physics‚ slavish cartesianism‚ the presence of numerous pleonasms‚ carelessness of expression‚ parade of learning‚ prolixity‚ attention for irrelevant qualities of authors quoted‚ educational purpose. Together with De Vet’s demonstration that the author of SRR and RK is still alive in (...) 1693 (see Tijdschr. v. Filosofie 45‚ 1983) these arguments force us‚ to consign Spinoza’s authorship‚ recently still defended by Petry a.o.‚ to the realm of fancy. (shrink)

The traditional philosophical treatises on culture, who mostly started from neohumanistic inheritance, recently got a serious, though revolutionary partner for discussion in the person of Herbert Marcuse. The ideas, which this thinker launches on culture and society, are not loose propositions or emotionally determined interpretations, but form a structural theory, that earns further consideration. This article tries to give a survey of his opinions on this theme as well as a critical look at their suppositions and coherence. Eventually are discussed (...) Marcuse's concept of the prevailing culture as an affirmative culture, i.e. an attitude in which one accepts the existing social conditions and resigns to them. After that it discusses Marcuse's deepened interpretation of culture as a civilisation, in which the repression of the truely human needs and impulses is so to say institutionalised, and finally his matured judgement on the recovery of culture by means of the play-impulse and sufficient space for speculative and practical negation in a non-operational dimension. Retrospecting we stated that Marcuse is taking back now something of his original, marxistic aversion of the theoretical attitude, that is inaugured by the Greeks. One must also criticise his unilateral reviewing of the technical and social acquisitions of mankind. But his realising and objectifying of the old spiritual ideal of culture is no doubt a profit in relation to the neo-humanistic philosophy of culture. (shrink)