A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

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)

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who (...) were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence. Des interviews structurés ont eu lieu avec 149 infirmiers/ères dans sept pays en Amérique, Asie, Australie et Europe concernant l'alimentation des malades gravement dément qui refusent de manger. La raison la plus générale pour des infirmiers/ères d'être prêt à changer leures décisions de donner à manger ou non sont: un ordre du médecin, la demande du mari de la malade ou de la réunion du personnel. Il y avait un lien entre la volonté de nourir et le rang des principes éthiques. Les infirmiers/ères les plus enclins de nourir la malade le plus souvent donnaient un rang supérieur au principe éthique de la sainteté de vie, pendant que ceux et celles qui choisissaient de ne pas nourrir la malade donnaient un rang supérieur au principe éthique de l'autonomie. Tous insistaient sur l'importance du principe éthique de la bienfaisance. Konstruktive Interviews wurden mit 149 ausgebildeten Krankenschwestern und Pfleger in sieben Ländern in Amerika, Asien, Australien und Europa gehalten über die Ernährung von schwer von Dementia praecox leidenden Patienten, die das Essen verweigern. Die gewöhnlichsten Gründe des Pflegepersonals für die Bereitwilligkeit, ihre Entscheidung, zu ernähren oder nicht, zu ändern, waren Anordnungen vom medizinischen Chef, Anfragen vom Ehemann der Patientin und/oder einer Personalsitzung. Es bestand ein Zusammenhang zwischen der Bereitwilligkeit zur Ernährung und dem Rang der ethischen Prinzipien. Die Pflegenden, die sich am meisten neigten, die Patientin zu ernähren, gaben dem ethischen Prinzip der Heiligkeit des Lebens einen hohen Rang, während die, die meistens vorzogen, die Patientin nicht zu ernähren, gaben dem ethischen Prinzip der Autonomie einen hohen Rang. Alle Pflegenden legten grossen Wert auf das ethische Prinzip der Wohltätigkeit. (shrink)

Nanotechnology shows great promise in a variety of applications with attractive economic and societal benefits. However, societal issues associated with nanotechnology are still a concern to the general public. While numerous technological advancements in nanotechnology have been achieved over the past decade, research into the broader societal issues of nanotechnology is still in its early phases. Based on the data from the Web of Science database, we applied the main path analysis, cluster analysis and text mining tools to explore the (...) main research fronts and hierarchical structure of these societal issues. We found that the research studies fell into four categories: "General Toxicity and EHS (Environment, Health and Safety)," "Medicine and Cytotoxicity," "Assessment and Regulation," and "Environment and Ecotoxicity." These research studies have disclosed much information about the potential effect of nanotechnology on public health and the environment. Relatively speaking, the studies on the assessment, regulation, preventive solutions, and environmental protection are just emerging. This finding indicates that an abundance of effort should be conducted on these emerging themes to maximize the benefits of nanotechnology while minimizing its potential harm. The implications for various parties in this domain are also presented. (shrink)

In this paper I focus on a major aspect of the later Wittgenstein’s investigation of thinking – his discussion of the idea of thinking as a process or an activity. I shall show that Wittgenstein’s remarks, apart from some concerning the methodology and conception of philosophy, are grammatical remarks, meaning that they describe the use of the word “thinking” and can be agreed to by every competent speaker. I thus show that Wittgenstein’s investigation of thinking is a grammatical one, and (...) hence that there is no inconsistency between his conception of philosophy and his philosophical practice. In the process of doing so, I shall also review previous studies on this topic and point out their deficiencies. (shrink)

We present the logic K/2 which is a logic with classical implication and only the left part of classical negation.We show that it is possible to define a classical negation into K/2 and that the classical proposition logic K can be translated into this apparently weaker logic.We use concepts from model-theory in order to characterized rigorously this translation and to understand this paradox. Finally we point out that K/2 appears, following Haack's distinction, both as a deviation and an extension of (...) K. (shrink)

Originating in a 1983 Mexican Government Program, the term ‘food sovereignty’ was coined in 1996 by La Via Campesina—a global peasant network—to address concerns within the civil society for food security. Rather than to accept the neoliberal framework of mainstream food security definition and governance, the food sovereignty movement seeks to view food security as the right of peoples to define their own food and agriculture systems with limited corporation intervention. As a result, food production should be geared toward the (...) domestic and local markets and not toward international trade that only benefits corporations. This food sovereignty movement was inducted into China in 2013 just as China’s agricultural systems were shifting toward a more corporate-centric structure that increasingly exploits the small-scale farmers. A question was hence raised: How have the global civil society networks influenced the Chinese civil society and promoted China’s local food sovereignty movement? Through the world society theory, the author has identified social forums, such as international conferences and social media channels, as an expedient means for interactions. However, as the Chinese government continues to develop a corporate-centric food security governance system and tighten its civil society space, the impacts of China’s food sovereignty movement remain unclear. (shrink)

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and (...) third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. (shrink)

Literature on testimonial injustice and ways that perpetrators might combat it have flourished since Miranda Fricker’s ground-breaking work on testimonial injustice. Less attention has been given, however, to the role of bystanders. In this paper, I examine the accountability that bystanders may have for their omissions to redress testimonial injustice. I argue that bystander accountability applies in cases where it is opportune for bystanders to intervene, and if they are also sufficiently equipped and able to redress the testimonial injustice. Moreover, (...) I recommend that we move beyond virtue responsibilism for ameliorative thinking about testimonial injustice. (shrink)

Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more (...) systematic conceptualization of the family—the kind of family that matters morally—is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members. (shrink)

It was natural and inevitable that his two Aethiopias, in the eastern and western extremities of the world, should be identified with the countries of the two dark-skinned peoples in the Far East and the Far West of the Ancient World: India and Mauretania. There was the difficulty that the real Aethiopia was in Africa, neither in the Far East nor in the Far West. Serious writers on geography tried to reconcile Homer and the geographical facts. I wish to excerpt (...) from Strabo three theories concerning Aethiopia and the Aethiopians which will then be used to elucidate passages in Latin literature. (shrink)

It was natural and inevitable that his two Aethiopias, in the eastern and western extremities of the world, should be identified with the countries of the two dark-skinned peoples in the Far East and the Far West of the Ancient World: India and Mauretania.There was the difficulty that the real Aethiopia was in Africa, neither in the Far East nor in the Far West. Serious writers on geography tried to reconcile Homer and the geographical facts.I wish to excerpt from Strabo (...) three theories concerning Aethiopia and the Aethiopians which will then be used to elucidate passages in Latin literature. (shrink)

Abortion is the deliberate termination of a pregnancy. In current practice, this involves the death of the foetus. Consequently, the debate on whether those experiencing an unwanted pregnancy have the right to abortion is usually dichotomized as a matter of pro-choice versus pro-life. Pro-choice advocates maintain that abortion is acceptable under various circumstances. The idea that we ought to respect pregnant people’s rights to choose what to do with their bodies – respect for bodily autonomy – is cited as a (...) major reason for granting them abortion rights. Pro-life advocates, on the other hand, claim that abortion is not acceptable under most circumstances. They argue, typically, that the foetus has a right to life. Recent events, such as Poland’s High Court decision in October 2020 to ban most abortions, and the huge protests and outcries this generated around the world, indicate that the abortion debate is far from resolved. (shrink)

Originally published: Oxford: Clarendon Press, 1932.