Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student’s t test, χ2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice (...) care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family’s refusal (28.2%). On a multivariate analysis, patients’ awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. (shrink)

Background: Pulsed dye laser is the gold standard for treatment of port-wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. Objective: We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. Methods: Healthy individuals with PWS were treated with PDL and then randomized to (...) apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements for 57 PWS sites were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa and ΔE were measured to quantify treatment outcome. Results: Two patients developed minor skin irritation. Other adverse effects were not noted. Average a was 0.43 for PDL + placebo sites and 1.27 for PDL + imiquimod sites indicating a greater reduction in erythema with imiquimod. Average E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod, again indicating a greater color improvement with imiquimod. Limitations: Effects were evaluated after a single treatment and duration of effect is unknown. Conclusion: Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy. © 2011 by the American Academy of Dermatology, Inc. (shrink)

The concept of rectifying names [cheng-ming] is a familiar one in the Confucian Analects. It occupies an important, if not central, position in the political philosophy of Confucius. Since, according to Confucius, the rectification of names is the basis of the establishment of social harmony and political order, one might suspect that later political theories of Confucian-ists should be traced back to the Confucian doctrine of rectifying names. It need not be added that the theory of rectifying names, as developed (...) by Hsün Tzu in the third century B. C., served the double purpose of strengthening his political doctrine of government on the one hand and repudiating doctrines of names on the other. (shrink)

This paper compares some key concepts from Buddhism with ideas from different traditions of systems thinking. There appear to be many similarities, suggesting that there is significant potential for dialogue and mutual learning. The similarities also indicate that it may be possible to develop a Buddhist systems methodology to help guide exploration and change within Buddhist organisations.

Three experiments examined repetition priming for meaningful environmental sounds in a sound stem identification paradigm using brief sound cues. Prior encoding of target sounds together with their associated names facilitated subsequent identification of sound stems relative to nonstudied controls. In contrast, prior exposure to names alone in the absence of the environmental sounds did not prime subsequent sound stem identification performance at all . Explicit and implicit memory were dissociated such that sound stem cued recall was higher following semantic than (...) nonsemantic encoding, whereas sound priming was insensitive to manipulations of depth encoding . These results extend the findings of long-term repetition priming into the auditory nonverbal domain and suggest that priming for environmental sounds is mediated primarily by perceptual processes. (shrink)

This paper proposes a novel account of why intertemporal decisions tend to display impatience: People pay more attention to the opportunity costs of choosing larger, later rewards than to the opportunity costs of choosing smaller, sooner ones. Eight studies show that when the opportunity costs of choosing smaller, sooner rewards are subtly highlighted, people become more patient, whereas highlighting the opportunity costs of choosing larger, later rewards has no effect. This pattern is robust to variations in the choice task, to (...) the participant population, and is observed for both incentivized and hypothetical choices. We argue that people are naturally aware of the opportunity costs associated with delayed rewards, but pay less attention to those associated with taking smaller, sooner ones. We conclude by discussing implications for theory and policy. (shrink)

While environmental claims are increasingly used by companies to appeal consumers, they also attract greater scrutiny from independent parties interested in consumer protection. Consumers are now able to compare corporate environmental claims against external, often disconfirming, information to form their brand attitudes and purchase intentions. What remains unclear is how the level of information specificity of both the environmental claims and external disconfirming information interact to influence consumer reactions. Two experiments address this gap in the CSR communication literature. When specific (...) claims are countered by specific external information, consumers report more negative brand attitudes and lower purchase intentions. The effect is serially mediated by skepticism toward the claims and lack of corporate credibility. We conclude by discussing strategies that firms can utilize to avoid information dilution and ensure that external disconfirming information percolates to consumers as specific. (shrink)

The effectiveness of complaint handling and service recovery policies in customer retention has been the focus of both scholars and service organizations. In the past decade, Justice Theory has provided the basis of the dominant theoretical framework for complaint management and service recovery. However, it does not explicitly address unfair trade practices, which constitute an ethical issue. Favorable outcomes in complaint handling may not be able to restore the reputation of a company and the potential harm perceived by consumers. Using (...) face-to-face interviews, this study applies Fairness Theory to explore the psychological responses of consumers in the post-complaint phase, particularly in ethical judgment. The findings suggest that an unfavorable outcome in the post-complaint stage leads to counterfactual thinking by the consumer about the consumer's state of well-being. The complaint must be due to the discretionary actions of the service provider whose accountability is assessed. Those harmful actions are then judged against an ethical standard. Explanations can reduce blame, and their effectiveness is moderated by outcome favorability but not ethical judgment. Favorable outcome, captured by "Would Perception," has only limited influence on Perceived Potential Harm (PPH), which is an important determinant of ethical judgment. This study makes both theoretical and practical contributions. It is the first study to validate Fairness Theory empirically and apply it to complaint handling as a complement of Justice Theory in the information and communication technology (ICT) service context. The study indicates that customers may condemn a service provider because of PPH even though the outcome is favorable. Unfair trade practices are what make customers hate ICT service providers. (shrink)

We extend research on the effects of local audit office characteristics on audit quality by investigating whether audit offices in highly religious U.S. Metropolitan Statistical Areas exhibit going concern decisions that reflect heightened professional skepticism relative to audit offices in less religious MSAs. Prior research links religiosity to risk aversion and ethical development and suggests audit practice offices in more religious MSAs are more likely to issue going concern opinions because they will assess the effects of mitigating factors in a (...) more skeptical manner. Our results indicate that audit practice offices located in highly religious MSAs are more likely to issue going concern audit opinions, consistent with a more skeptical assessment of mitigating factors. Additional tests provide direct evidence consistent with the argument that these audit offices are more risk averse in issuing going concern opinions. Our findings are relevant to auditors, audit clients, researchers, and regulators. (shrink)