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)

A new English translation of Schelling’s unfinished magnum opus, complete with a contextualizing introduction by the translator.

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)

"[Mitchell] undertakes to explore the nature of images by comparing them with words, or, more precisely, by looking at them from the viewpoint of verbal language.... The most lucid exposition of the subject I have ever read."—Rudolf Arnheim, _Times Literary Supplement_.

ABSTRACT:Regulatory focus theory is proposed as offering an explanation for the influence of ethical leadership on organizational citizenship behaviors and employee commitments. The prevention focus mindset of an employee is argued to be the mechanism by which an ethical leader influences extra-role compliance behavior as well as normative commitment, whereas the promotion focus mindset of an employee is argued to be the mechanism by which an ethical leader influences extra-role voice behavior as well as affective commitment. Moreover, leader-member exchange is (...) proposed as a moderator of the relationship of ethical leadership to regulatory focus mindsets and employee behavior and commitments. Using the data collected in two waves from 250 working adults, we tested the proposed relationships with moderated mediation bootstrap procedures. The findings generally support the hypothesized relationships and point toward important implications for ethical leadership in work settings. (shrink)

W. J. Mander examines the nature of idealist ethics, that is to say, the form and content of ethical belief most typically adopted by philosophical idealists. His inquiry has two aims. The first is historical: from the record of past philosophy, Mander demonstrates that there exists a discernible idealist approach to moral philosophy; a tradition of 'idealist ethics', and examines its characteristic marks and varieties. The second aim is apologetic. He argues that such idealist ethics offers an attractive way of (...) looking at moral questions and that it has much to contribute to contemporary discussion. In particular he argues that Idealist ethics have the power to cut through the sterile opposition between moral realism and moral anti-realism. To be an idealist is precisely to hold that the universe is so constituted that things are real if and only if they are ideal; to hold that uncovering in something the work of mind makes it more not less significant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Epistemic Value Commitments”W. John Livesley (bio)A disquieting feature of contemporary psychiatric nosology is the tendency to adopt positions that imply that current classifications are simply statements of fact. Clinicians and researchers alike seem to assume that the DSM diagnostic concepts are factual descriptions based only on scientific analysis that reflect the essential nature of psychiatric disorders. The architects of the DSM acknowledge in various ways that this (...) is not the case. Frances et al. (1991), for example, noted the provisional and pragmatic nature of DSM-IV. Nevertheless, these cautions are largely ignored. The DSM is partly responsible. The assertion that the DSM is atheoretical with regard to etiology, although clearly incorrect, tends to generalize to other aspects of the system. Similarly, the emphasis on description that has proved so valuable in improving diagnosis is presented as if clinical description is unencumbered by values and assumptions. Moreover, the failure to state explicitly the assumptions underlying the classification encourages the conclusion that the system is free from theoretical and other influences.In fact the DSM is theory laden. Implicit theoretical models and etiological concepts lie behind many diagnoses, including adjustment, dissociative, and posttraumatic stress disorders. Assumptions about the nature of mental disorders and the way psychopathology is organized underlie the entire system (Livesley and Jackson 1992). Pragmatic and political considerations influenced the final structure. Moreover, as Dr. Sadler and others working on the same issues (Fulford 1989, 1994; Agich 1994) point out, the DSM is also value laden. It is value laden not only in the obvious sense that some diagnostic concepts are highly evaluative or biased against certain groups (Kaplan 1983), but also in the fundamental sense that values are built into the very structure of the system (Agich 1994; Russell 1994; Wakefield 1992).Value influences begin with the definition of mental disorder. As Wakefield (1992) and others have argued, the concept of disorder cannot be value free. Values are also involved in the descriptive terms adopted as diagnostic criteria (Agich 1994) and, as Dr. Sadler convincingly demonstrates, they are intrinsic to the way that the classification is constructed and evaluated—the very aspects of the classification that are generally assumed to be value free. By emphasizing this aspect, Dr. Sadler draws attention to the fact that despite being implicit and informal, these values exert a major influence. They influence kinds of information considered relevant to the classification, the way this information is weighted and evaluated, and the way it is organized into diagnostic concepts. Thus, values shape the classification and the research agenda. This point has not [End Page 223] been fully recognized, or at least not fully acknowledged, by those responsible for developing contemporary classifications. There is a tendency to assume that any values involved in the DSM are largely evaluative and incidental, as if they crept into the system inadvertently due to our limited knowledge. The implication is that their presence is merely a temporary embarrassment to be eliminated automatically as clinical description and phenomenology are refined. But this is not the case; any classification of mental disorders inevitably consists of fact plus value (Fulford 1994). Acknowledgment of the evaluative element does not detract from the achievements of the DSM. It is not a limitation but an essential component.The general failure to attend to the non-factual or non-descriptive aspects of classification means that important aspects of classifications are neglected. The impact of pragmatic considerations, political and economic factors, and ethical and epistemic values on the organization and evaluation of scientific information has not received appropriate attention given the social, clinical, and scientific consequences of contemporary psychiatric classifications. In essence, only a limited aspect of classification has been studied, and even this has been studied in isolation from its context. Under these circumstances there is much to be gained from explicit acknowledgment and analysis of the value component. We are more likely to make progress in resolving nosological issues if we take a broad perspective.For the nosologist, Dr. Sadler makes two useful contributions to understanding the broader view. First, the analysis of value is extended beyond discussion of evaluative or ethical values into a detailed analysis of the epistemic values that... (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)

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.

W. J. Mander presents a history of metaphysics in nineteenth-century Britain. He traces the story of the development and interplay of three great schools of thought, the agnostics, the empiricists, and the idealists, and their different responses to the idea of an ultimate but unknowable way that things really are in themselves.

This is the first full assessment of British philosophy in the 19th century. Specially written essays by leading experts explore the work of the key thinkers of this remarkable period in intellectual history, covering logic and scientific method, metaphysics, religion, positivism, the impact of Darwin, and ethical, social, and political theory.