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)

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

The purpose of this study was to develop a Physician's Spiritual Well-Being Scale (PSpWBS). The significance of a physician's spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physician's characteristics; medical practice challenges; response to changes; and overall well-being. The explainable (...) total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

Studie van de oud-direkteur van het Humanistisch Verbond over een verantwoorde humanistische levenshouding, waarin ook de religieuze dimensie een plaats heeft.

This book traces the development of formal logic from its origins in ancient Greece to the present day. The authors first discuss the work of logicians from Aristotle to Frege, showing how they were influenced by the philosophical or mathematical ideas of their time. They then examine developments in the present century.

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 287-292 [Access article in PDF] Book Review Original Tao: Inward Training and the Foundations of Taoist Mysticism Laughing at the Tao: Debates Among Buddhists and Taoists in Medieval China Taoist Tradition and Change: The Story of the Complete Perfection Sect in Hong Kong Lord of the Three in One: The Spread of a Cult in Southeast China Original Tao: Inward Training and the Foundations of (...) Taoist Mysticism. By Harold D. Roth. New York: Columbia University Press, 1999. xv + 275 pp. Laughing at the Tao: Debates Among Buddhists and Taoists in Medieval China. By Livia Kohn. Princeton: Princeton University Press, 1995. xii + 281 pp. Taoist Tradition and Change: The Story of the Complete Perfection Sect in Hong Kong. By Bartholomew P. M. Tsui. Hong Kong: Chinese Study Centre on Chinese Religion and Culture, 1991. 207 pp. Lord of the Three in One: The Spread of a Cult in Southeast China. By Kenneth Dean. Princeton: Princeton University Press, 1998. xii + 406 pp. Buddhism in China has many forms: sometimes functioning as a foreign object provoking attraction, rivalry, or persecution, and at other times being so integrated that it epitomized or completed Chinese culture. Although the elite monastic community maintained its distinctive Buddhist identity throughout its history, the story of the various forms of popular appropriation of Buddhist elements beyond the monastic [End Page 287] walls is just beginning to be studied. Probably the most important arena where Buddhism became part of Chinese culture is its mixture with Daoist practice, but only in the 1990s have Daoist studies evolved to the point where the Buddhist presence can be traced and evaluated. The four books listed above are among a shelf-full of new studies on Daoism that offer resources for exploring the complex relationships among Buddhism, Daoism, and Chinese culture.The study of the Inner Training by Harold Roth clarifies a core practice within early Daoism that was later integrated--usually without acknowledgment--as a central practice by both Confucianists and Buddhists, especially Ch'an. In contrast, the definitive study by Livia Kohn of the Xiaodao lun shows a carefully constructed Buddhist attack on Daoist scriptures. During the last millennium, the two most influential integrations of the three religions--Daoism, Buddhism, and Confucianism--were achieved by Wang Chong-yang (1113-1170) and Lin Zhao-en (1517-1598). Bartholomew Tsui offers an important field study of the liturgical practices of the contemporary followers of Wang as embodied in Hong Kong temples of Quanzhen (Complete Perfection) Daoism, while Kenneth Dean provides a massive field report of over one thousand temples of the Xiajiao movement in contemporary Fujian Province that revere the teachings of Lin Zhao-en as Lord of the Three-in-One. All four books provide rich materials for reflecting on interreligious encounter in China.The archaeological discovery of lost Chinese texts has made clear that the Lao-tzu is no earlier than the beginning of the third century b.C.E. and did not exist at the time of Confucius. Harold Roth's book argues that earlier than the book of Lao-tzu there was a movement of internal cultivation that was first expressed in two fourth-century b.C.E. texts, the first seven chapters of Chuang-tzu and a text found among the seventy-six texts in the Kuan-tzu that Roth calls Inner Training. Roth proposes that this latter text constitutes the "original Tao" in the sense that it is the core practice embodied in those thinkers who were grouped together by later historians. Roth observes that the earliest identification of a Daoist school (daojia) by Ssu-ma T'an about 110 b.C.E. emphasized techniques or practices, "not the philosophies that developed along with them and that support them.... Techniques must be seen as a way to define pre... (shrink)