BackgroundHospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions.ObjectivesTo determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards.DesignSemi-structured interview study of the experience and process of decision making.SettingA public safety-net hospital and a tertiary referral (...) hospital in a large city in the Midwest United States.ParticipantsThe study included 35 surrogates with a recent decision-making experience for an inpatient aged 65 or older.MeasurementsThe key factors that surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis.ResultsSurrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: respecting the patient’s input, using past knowledge of the patient to infer the patient’s wishes, and consider ing what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included: surrogate’s wishes as a guide, surrogate’s religious beliefs and/or spirituality, surrogate’s interests, and family consensus.ConclusionOur study indicates that surrogate decision making is more complex than the standard ethical models, which are limited to considerations of the patient’s autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patients’ preferences suggests a need for greater advance care planning. (shrink)

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university–based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling (...) stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well–being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients’ hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients’ hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients’ goals. (shrink)

Виходячи з запитаності в сучасній культурі метафізичного осмислення природи людини, укоріненого в філософському спадку Канта, автор зосереджує увагу на експлікації антропологічних інтенцій кантівських «Критик», акцентуючи амбівалентність позиції мислителя на проблемі автентичної форми метафізичної антропології.

This book distinguishes itself in its integrated approach towards scientific research, and studies the basics of the methodology of scientific research and the organization of scientific activity from the viewpoint of systems science and system analysis. The book discusses the basics of the methodology including philosophical, psychological, epistemological and ethical/aesthetical foundations, the characteristics of scientific activity, including principles of scientific cognition, the means and methods of scientific research, the organization of a research implementation process and its chronological structure and finally, (...) the organization of a collective scientific research design. (shrink)

Purрose of the рaрer is to emphasize affinity and succession in the aррroaches of Descartes and Kierkegaard to the interpretation of key factors of their philosophical search. It could be implemented through understanding such viewpoints of both thinkers as a) appropriate reasons for human existence; b) possible factors for human freedom as a condition of self-actualization; c) original approach to prove the existence of God. Theoretical basis. The use of phenomenology and hermeneutics enable us to comprehend the key philosopher’s ideas (...) as the manifestation of their personalities. Originality. The author believes that it is quite right to refer to the philosophy of the early modern period as a form of its demand fulfillment for human development. An essential prerequisite for revealing the toрic of the article is a focus on the latest investigations of Descartes’ philosophy, which demonstrate the anthropological significance. Since Kierkegaard’s viewpoint was developed through depersonalized understanding of philosophy, related motives of their thoughts are expressed by emphasizing their personal motives of philosophizing. This affinity is reflected firstly, in distancing from depersonalized and dehumanized world view; secondly, in religion-oriented search and proof of God’s existence based on human nature. Conclusions. Due to the modern state of historical and philosophical science, it is possible to argue that Descartes and Kierkegaard had content-related philosophizing motives, which are close to current search. Interpreting Descartes’ anthropological project by Kierkegaard, the author states the accepted determining influence of Hegel’s philosophy interpretation in general and his interpretation of Descartes, in particular. This argument allows to understand Kierkegaard’s search as Hegel’s deconstruction, because further uncritical retention and reproduction of his viewpoints are evaluated as a threat to fulfill human spiritual calling. A common and important thing in the views of both thinkers is their strong interest in individual and personal aspects of human nature as a constituent factor of God’s existence. (shrink)

This book presents and exemplifies the theory of grammar called Semantic Syntax. The grammar, which offers a syntactic theory closely connected with semantic analyses, is a direct continuation of Generative Semantics; it will re-ignite interest in that framework which flourished and promised so much in the 1960s and 1970s.

In classical Greek poetry there is a familiar distinction between verse which repeats line upon line, and that which forms patterns liable to closure at intervals, in stanzas or lyric sections. This is often equated with the distinction between spoken and sung verse, but the equation is only approximate. At an earlier stage all verse had some musical accompaniment—so much can be deduced from a number of passages in Homer, and is in any case implicit in the nature of quantitative (...) verse. By Hellenistic times it seems that, in new composition, the more complex lyric structures had died out, while of the simpler ones more and more were being taken over as spoken verse. In the fifth century—and this can probably be extended to at least the late sixth and most of the fourth—only two kinds of verse are known to have dispensed with music altogether in performance: the heroic hexameter and the iambic trimeter. (shrink)

In classical Greek poetry there is a familiar distinction between verse which repeats line upon line, and that which forms patterns liable to closure at intervals, in stanzas or lyric sections. This is often equated with the distinction between spoken and sung verse, but the equation is only approximate. At an earlier stage all verse had some musical accompaniment—so much can be deduced from a number of passages in Homer, and is in any case implicit in the nature of quantitative (...) verse. By Hellenistic times it seems that, in new composition, the more complex lyric structures had died out, while of the simpler ones more and more were being taken over as spoken verse. In the fifth century—and this can probably be extended to at least the late sixth and most of the fourth—only two kinds of verse are known to have dispensed with music altogether in performance: the heroic hexameter and the iambic trimeter. (shrink)

Text, interpretation and metre present a tangled problem in this threnody, and the solutions of editors differ widely. The chief function of detailed metrical study in such corrupt passages of lyric is to weight the scales in favour of—or more often against—certain methods of handling the text. The positive results of this present attempt to apply metrical criteria are necessarily modest and tentative; negatively they are, I think, sometimes decisive.

It is known from work of P. Young that there are recursively enumerable sets which have optimal orders for enumeration, and also that there are sets which fail to have such orders in a strong sense. It is shown that both these properties are widespread in the class of recursively enumerable sets. In fact, any infinite recursively enumerable set can be split into two sets each of which has the property under consideration. A corollary to this result is that there (...) are recursive sets with no optimal order of enumeration. (shrink)

"Forster was the first to lay the foundation of the world view that has now become dominant thanks to the progress of positive knowledge. He rebelled with all the power of his thought against the philosophical systems then in favor and counterposed to the subjective speculations of philosophy the logic of experience and the direct witness of common sense." This was the characterization of Georg Forster given by D. I. Pisarev. Upon reading the works of Forster one cannot but agree (...) that their author was possessed of an extraordinary intellect and that he ranks with the outstanding materialist philosophers. A passionate striving to remake the existing order of things characterized his entire life and activity. He took an active part in the French Revolution, and was one of the organizers of the commune in Mainz. Forster was the author of a number of philosophical works that had an enormous influence upon his contemporaries and upon the development of philosophical thought in general. (shrink)

In the light of the remarkable changes of political colour which Aeschylus has undergone in the hands of scholars, there is a certain amusing irony about the fact that the satyr-play which followed the Oresteia was the Proteus. Sadly, we know too little of the Proteus to say whether it would have resolved this debate about the Oresteid's political stance, though one may have one's doubts.