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...

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)

Overzicht van de invloed van klassieke auteurs op het werk van de Nederlandse wijsgeer.

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ABSTRACT Both the general structure of Nozick's entitlement theory of justice and the particular arguments he directs against Rawls presuppose a conception of the person. The essay argues that this initial conception of the person is flawed and that Nozick must amend it. However, those amendments lead either to an equally flawed conception or to a conception which is substantially similar to that which Rawls invokes. On either possibility the entitlement theory is weakened. The argument has two steps. First, the (...) initial conception of the person which emerges from Anarchy, State and Utopia is stated. Second, the problems with that initial conception lead to the elucidation of subsequent conceptions, only the last of which is capable of avoiding those problems. The cost of avoidance is, however, a high one for Nozick's arguments against Rawls, in particular, and the entitlement theory in general. (shrink)

After some preliminaries on the logic of change and the logic of action the author develops an extended theory of norms in this companion volume to his The Varieties of Goodness. Although the book will be of particular interest to deontic logicians, its philosophic value is greatly enhanced by a concern for broader issues, including problems in the ontology of norms. The usefulness of the work is very much decreased by numerous undeveloped suggestions and unanswered questions.—F. W. N.