Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been (...) well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of “listening” to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome. (shrink)

This article applies some conceptual tools from semiotics to better understand the disastrous impacts of the world economy on global ecology. It traces the accelerating production of material disorder and waste to the logic of the money sign, as economic production processes simultaneously increase exchange-values and entropy. The exchange of indexical and iconic signs is essential to the dynamics of ecological systems and the proliferation of biological diversity. The human species has added a third kind of sign, the symbol, (...) and more recently a fourth: all-purpose money. Money does not refer to any referent either through contiguity, similarity, or convention. It is an empty sign, capable of assuming any significance that its owner attributes to it. The article argues that the concept of symbolic reference should be restricted to cultural and linguistic phenomena. Money qualifies as a new species of sign based on its exceedingly open mode of reference. It does not refer to any object by social convention but owes its specific properties precisely to the absence of such conventions. The logic of money pivots on decontextualisation: it presupposes and encourages the detachment of exchange values, people, and concepts from the particular and the local. Selective advantage is no longer primarily about calibration within local contexts, but increasingly a matter of transcending or emancipating oneself from the specific. This drift toward decontextualisation reverses the evolution of complexity and diversity throughout the planetary biosphere. (shrink)

The author discusses B.G. Yudin's image technoscience as having two contours, the external one dealing with science, business and society, and the internal one represented by laboratories. Together these two contours present a multidimensional net of relations between science and technology in conducting experiments, development of instruments (e.g. visualization tools), etc. The author argues that, in such a system, coordinated activity of the internal and the external contours is provided by a synergy of regulatory principles of truth, good and usefulness. (...) He discusses a case of synthetic biology which, as he argues, demonstrates that the internal and external contours of technoscience undergo a process of technologization. Technologization is understood as a transition from research techniques to systematic use of technologies. Biotechnologies are claimed to have a double socio-biological helix network structure. Each network is formed as a kind of ad hoc "factory" and is aimed at solving specific research problems. (shrink)

For centuries the question of the origin of life had focused on the question of the spontaneous generation of life, at least primitive forms of life, from inanimate matter, an idea that had been promoted most prominently by Aristotle. The widespread belief in spontaneous generation, which had been adopted by the Church, too, was finally abandoned at the beginning of the twentieth century, when the question of the origin of life became related to that of the (...) artificial generation of life in the laboratory. This paper examines the role of social authorities, researchers’ basic beliefs, crucial experiments, and scientific advance in the controversies about spontaneous generation from the seventeenth to the nineteenth centuries and analyzes the subsequent debates about the synthesis of artificial life in the changing scientific contexts of the nineteenth and early-twentieth centuries. It shows that despite the importance of social authorities, basic beliefs, and crucial experiments scientific advances, especially those in microbiology, were the single most important factor in the stepwise abandoning of the doctrine of spontaneous generation. Research on the origin of life and the artificial synthesis of life became scientifically addressed only when it got rid of the idea of constant smooth transitions between inanimate matter and life and explored possible chemical and physical mechanisms of the specificity of basic molecules and processes of life. (shrink)

In this article several signs of life present in the Shroud of Turin are pointed out. Following the development of rigor mortis, the body posture of the image on the Shroud is analyzed. This, together with the presence of specific facial folds indicate that the person wrapped in it is alive. Therefore, the image on the Shroud of Turin shows both signs of death and life in a person whose image was imprinted when he was alive. If this (...) is a fraud case, it should be considered as an artwork performed by a genius with medical, forensic and image processing knowledge from at least the XX century. But if we read the Gospels, a remarkable symmetry is found between the data obtained from the image and the events described in the Gospels, both regarding the death and resurrection of Jesus. (shrink)

Autism is often taken to be a specific kind of mind. The dominant neuro‐cognitivist approach explains this via static processing traits framed in terms of hyper‐systemising and hypo‐empathising. By contrast, Wittgenstein‐inspired commentators argue that the coherence of autism arises relationally, from intersubjective disruption that hinders access to a shared world of linguistic meaning. This paper argues that both camps are unduly reductionistic and conflict with emerging evidence, due in part to unjustifiably assuming a deficit‐based framing of autism. It then develops (...) a new Wittgensteinian account—autism as a different form of life—which avoids these issues. Rather than autistic systemising being the basis of autistic cognition, it is taken to be a reaction to pre‐epistemic and semantic anxieties that come with developing as a minority within a different form of life. This re‐framing can provide a coherent account of the autistic mind, and has significant conceptual, practical, and ethical implications. (shrink)

Healthcare professionals working in intensive care units are often involved in end-of-life decision-making. No research has been done so far about these processes taking place in Croatian ICUs. The aim of this study was to investigate the perceptions, experiences, and challenges healthcare professionals face when dealing with end-of-life decisions in ICUs in Croatia. A qualitative study was performed using professionally homogenous focus groups of ICU nurses and physicians of diverse professional and clinical backgrounds at three research sites. (...) In total, six institutions at the tertiary level of healthcare were included. The constant comparative analysis method was used in the analysis of the data. Differences were found between the perceptions and experiences of nurses and physicians in relation to end-of-life decisions. Nurses’ perceptions were more focused on the context and features of immediate care, while physicians’ perceptions also included the wider sociocultural context. However, the critical issues these specific professional groups face when dealing with end-of-life decisions seem to overlap. A high variability of practices, both between individual practitioners and between different organizational units, was omnipresent. The lack of adequate legal, professional, and clinical guidelines was commonly expressed as one of the most critical source of difficulties. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique (...) circumstances surrounding end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

The question of specific properties of life compared to nonliving things accompanied biology throughout its history. At times this question generated major controversies with largely diverging opinions. Basically, mechanistic thinkers, who tried to understand organismic functions in terms of nonliving machines, were opposed by those who tried to describe specific properties or even special forces being active within living entities. As this question included the human body, these controversies always have been of special relevance to our self-image and also (...) touched practical issues of medicine. During the second half of the twentieth century, it seemed to be resolved that organisms are explainable basically as physicochemical machines. Especially from the perspective of molecular biology, it seemed to be clear that organisms need to be explained solely by the chemical functions of their component parts, although some resistance to this view never ceased. This research program has been working quite successfully, so that science today knows a lot about the physiological and chemical processes within organisms. However, again new doubts arise questioning whether the mere continuation of this analytical approach will finally generate a fundamental understanding of living entities. At the beginning of the twenty-first century the quest for a new synthesis actually comes from analytical empiricists themselves. The hypothesis of the present paper is that empirical research has been developed far enough today, that it reveals by itself the materials and the prerequisites to understand more of the specific properties of life. Without recourse to mysterious forces, it is possible to generate answers to this age-old question, just using recent, empirically generated knowledge. This view does not contradict the results of reductionistic research, but rather grants them meaning within the context of organismic systems and also may increase their practical usefulness. Although several of these properties have been discussed before, different authors usually concentrated on a single one or some of them. The paper describes ten specific properties of living entities as they can be deduced from contemporary science. The aim is to demonstrate that the results of empirical research show both the necessity as well as the possibility of the development of a new conception of life to build a coherent understanding of organismic functions. (shrink)

In spite of extensive research on theory of mind, lay theories about the unconscious have scarcely been investigated. Three questionnaire studies totaling 689 participants, examined to what extent they thought that a range of psychological processes could be unconscious. It was found that people are less willing to countenance unconscious processes in themselves than in others, regardless of the time period considered – present, past or future. This is especially true when specific experience-like situations are envisioned, as opposed (...) to considering the question in abstract or generic terms. In addition, the notion of unconscious psychological processes is resisted for certain domains in particular: intending, sensing, believing, and thinking. We interpret this pattern by positing the existence of two conceptions about the unconscious that are differentially applied according to circumstances: one originating in prevalent social representations about the unconscious, the other based on self-model of the person as an intentional actor. (shrink)

The theoretical explication and conceptualization of the concept of episteme in religious philosophy (Anselm of Canterbury) is carried out; epistemological configurations and specifications of philosophical and theological discourse are revealed (Dietrich Bonhoeffer). Anselm of Canterbury’s epistemological discourse is based on his postulated ontology: the ontological configurability of his ideas ranges from the a priori ability to think of God to reflection on his predicates. The consequence of Anselm of Canterbury’s ideas is the idea that in the act of religious faith, (...) God becomes an ontological reality. Within the framework of the article, it is noted that the ideas of D. Bonhoeffer, like many areas of modern religious philosophy, constitute the context of the study and substantiation of the religious episteme. The simultaneity and discreteness of the act of life correlates in this concept with eternal nature of God. The concept of “irreligious Christianity” by the German theologian is a part of the processes of reforming Christian theology that took place in the 20th century. The article contains a conceptual analysis of theoretical approaches to the study of religion and religious consciousness. The role of religious knowledge in the formation of new approaches to personality and religious life is considered. The concept of religious episteme as an object of philosophical and religious analysis is explicated. The interpretive perspective of the concept of religious episteme is presented, the field of variable possibilities in the study of this phenomenon is revealed, its theoretical configurations and key, dominant features are shown. The work includes the analysis of the concept of religious episteme from the scientific and philosophical points of view, from the point of view of theoretical reflection. The problems of religious epistemology are considered on the base of historical and cultural material of approaches and concepts of both medieval and modern religious philosophy. It is concluded that religious epistemology is also a philosophical and methodological reflection on the possibility of comprehending the ultimate foundations of religious being. (shrink)

What sets someone on a life trajectory? This question is at the heart of studies of 21st-century neurosciences that build on scientific models developed over the last 150 years that attempt to link psychopathology risk and human development. Historically, this research has documented persistent effects of singular, negative life experiences on people’s subsequent development. More recently, studies have documented neuromolecular effects of early life adversity on life trajectories, resulting in models that frame lives as disproportionately affected (...) by early negative experiences. This view is dominant, despite little evidence of the stability of the presumably early-developed molecular traits and their potential effects on phenotypes. We argue that in the context of gaps in knowledge and the need for scientists to reason across molecular and phenotypic scales, as well as time spans that can extend beyond an individual’s life, specific interpretative frameworks shape the ways in which individual scientific findings are assessed. In the process, scientific reasoning oscillates between understandings of cellular homeostasis and organisms’ homeorhesis, or life trajectory. Biologist and historian François Jacob described this framework as the “attitude” that researchers bring to bear on their “objects” of study. Through an analysis of, first, historical and contemporary scientific literature and then ethnographic research with neuroscientists, we consider how early life trauma came to be associated with specific psychological and neurobiological effects grounded in understandings of life trajectories. We conclude with a consideration of the conceptual, ontological, and ethical implications of interpreting life trajectories as the result of the persistence of long-embodied biological traits, persistent life environments, or both. (shrink)

Reporting systems based on mobile technologies and feedback from regular citizens are becoming increasingly popular, especially as far as protection of environmental and cultural heritage is concerned. Reporting life-threatening situations, such as sudden natural disasters or traffic accidents, belongs to the same class of problems and could be aided by IT systems of a similar architecture. Designing and developing systems for reporting life-threatening situations is not a trivial task, requiring close cooperation between software developers and experts in different (...) domains, who could possibly find industrially recognized languages and notations difficult. Thus, the question is whether using simplified graphical domain-specific languages (SGDSLs) could help in creating a common communication platform. It has been revealed that domain experts have a preference for such languages as they offer good learnability, readability and ability to focus on the idea of application. The perspective of developers (technical persons) is introduced on the basis of feedback obtained from 84 students of Computer Science at the Lublin University of Technology, who attended comprehensive workshops followed by an anonymous survey. All participants received theoretical and practical training in modeling mobile software using the same set of languages as domain experts. An analysis of the results revealed that opinions expressed by technical and nontechnical persons concerning SGDSLs oriented on defining a flow of actions is consistent. Most respondents claimed that such languages might be valuable as tools for creating a common communication platform. (shrink)

Hans Jonas’ “philosophical biology,” although developed several decades ago, is still fundamental to the contemporary reflection upon the meaning of life in a systems thinking perspective. Jonas, in fact, closely examines the reasons of modern science, and especially of Wiener’s Cybernetics and Bertalanffy’s General System Theory, and at the same time points out their basic limits, such as their having a reductionistic attitude to knowledge and ontology. In particular, the philosopher highlights the problematic consequences of scientific reductionism for human (...) nature. As the final result of an overall process of naturalization, the essence of the human being is reduced to its quantitative features only, while the “meaning” of life as such becomes no different from the “fact” of its material consistency. However, the problem is that by such a process, the human being is deprived of his specificity. (shrink)

Autistic children with sensory processing differences successfully navigate and engage in meaningful family daily occupations within home and community environments through the support of their family. To date however, much of the research on autistic children with sensory processing differences, has primarily been deficit focused, while much of the caregiver research has focused on issues of distress, burden, effort, and emotional trauma in coping with their child's diagnosis. This study aimed to conduct a qualitative evidence synthesis, using a meta-ethnographic approach (...) to explore the gap identified in understanding successful occupational experiences of family participation and daily family routines when supporting an autistic child with sensory processing differences and to offer an alternative strengths-based perspective. Inclusion criteria were studies which were peer-reviewed qualitative design, published from 2000 to 2021, and that concerned parents/caregivers' perspectives of family occupations of children diagnosed with autism spectrum disorder. Studies were electronically searched in eight databases from October to December 2021 and 23 studies were identified which met the inclusion criteria. Noblit and Hare's seven step approach for conducting analysis in meta-ethnography was used, and three themes identified: sensory processing differences in daily life, what is hard about hard, and orchestrating family life. Results identified the centrality of sensory experiences in understanding family life. Living with unpredictability while orchestrating certainty through routines was core to successful participation. This review provides insights into how parents negotiate the complexities of constructing family life when living with an autistic child. The results can inform the design of future interventions that specifically address the relationship between meaningful participation in family occupations and daily routines and sensory processing in autistic children.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022298938, identifier: CRD42022298938. (shrink)

This essay employs Charles Peirce’s triadic semiotics in order to develop a biosemiotic theory of life that is capable of illuminating the function of information in living systems. Specifically, I argue that the relationship between biological information structures , selecting environments, and the adapted bodily processes of living organisms is aptly modelled by the irreducibly triadic relationship between Peirce’s sign, object, and interpretant, respectively. In each instance of information-based semiosis, the information structure is a complex informational sign that (...) represents the informational object ; and the bodily, behavioral, mental, or intellectual processes that are organized by the informational sign to more or less accurately interpret the present environment constitute a complex informational interpretant—a living, interpreting organism. The essay begins by discussing the precise sense in which this biosemiotic theory is based upon Charles Peirce’s semiotic theory. Next, the theory is developed at length in relation to genetic information structures. Finally, I present a brief outline of how the theory applies to neural and linguistic information structures. The essay concludes with a reflection upon the anti-reductionist implications of the theory. (shrink)

This present article explores the effects of cultural value, economic prosperity, and community mental wellbeing through multi-sectoral infrastructure growth projects under the Belt and Road Initiative. The implications of the social exchange theory are applied to observe the support of the local community for the China-Pakistan Economic Corridor. This study explores the CPEC initiative, it’s direct social, cultural, economic development, and risk of environmental factors that affect residents’ lives and the local community’s wellbeing. CPEC is a multibillion-dollar project to uplift (...) economic growth and free trade between Pakistan, China, and other regional stakeholders. Although CPEC is still in its initial phases with partial startups, policymakers and government officials claim this mega project as a “game-changer” in the region, mainly for Pakistan and China. This gigantic project offers the significant potential to generate business slews and employment opportunities with international outreach. Due to the term’s newness, numerous studies have recently explored the macro and microeconomic benefits of the CPEC initiatives; still, these projects are theoretical. The existing literature insufficiently explored how helpful CPEC would be to a specific group and how residents perceive its advantages. This study fills in the literature gaps and explores the likely advantageous potential of the CPEC for the regional states. The study applied a convenient sampling technique for the data collection process. It used a mixed-method approach to gain scientific results, with a standardized questionnaire survey of 459 people from five major cities of Pakistan. The study results designate that residents believe that CPEC infrastructure projects will significantly improve residents’ life quality through more job openings and community poverty reduction. Still, they raised their concerns regarding environmental protection issues in the region. The findings specified that residents had an optimistic approach to better educational productivity by adopting environment-oriented policies. Policymakers should establish new CPEC study centers in different areas, and investors should be encouraged to participate in the industrial sector. Officials can overwhelm community worries about environmental degradation. Government officials in both countries can utilize the findings to raise public awareness about CPEC’s social, economic, cultural, mental wellbeing, and ecological implications. (shrink)

This paper offers a counterpoint to the prevailing account of waste in the human sciences. This account identifies waste, firstly, as the anomalous product of arbitrary social categorizations, or ‘matter out of place’, and, secondly, as a distinctly human way of leaving behind and interpreting traces, or a mirror of culture. Together, these positions reflect a more or less constructivist and anthropocentric approach. Most commonly, waste is placed within a framework that privileges considerations of meaning over materiality and the threat (...) of death over the perpetuity of life processes. For an alternative I turn to bio-semiotics and cross-species scholarship around the question of the animal. Specifically, the paper asks what theories of waste would look like if instead of taking ‘dirt’ as their starting point, they began with trans-species encounters with animal scat. Following bio-semiotics and efforts to deconstruct the animal/human binary, it is suggested that the objectual forms commonly referred to as ‘waste’ are not arbitrarily classified but purposefully expended, and thus symptomatic of life’s spatio-temporal continuation. Waste matter, therefore, is best construed not as anthropocentric but as semi-biotic: a sign of the form of life to which it once belonged. This alternative perspective has implications for how approaches to industrial forms of mass waste can be reconceived. (shrink)

We draw on Short’s work on Peirce’s theory of signs to propose a new general definition of interpretation. Short argues that Peirce’s semiotics rests on his naturalised teleology. Our proposal extends Short’s work by modifying his definition of interpretation so as to make it more generally applicable to putatively interpretative processes in biological systems. We use our definition as the basis of an account of different kinds of misinterpretation and we discuss some questions raised by the definition by reference (...) to parallel problems in the field of teleosemantics. We propose that interpretative responses fulfilling the criteria of our definition may be made by relatively simple molecular entities and we suggest two specific empirical applications of the definition to experimental work in the field of origin of life research. Our wider aim is to suggest that a well formulated naturalistic definition of interpretation will allow a re-evaluation of the role of semiotic phenomena in biological systems, including the generation of empirically testable hypotheses. (shrink)

The three processes needed to create life, compartmentalization, metabolism, and information transfer (memory stored in nucleic acids and manipulation operated by proteins) are embedded in organized genome features. The core of life puts together growth and maintenance (which drives survival), while life in context explores and exploits specific niches. Analysis of gene persistence in a large number of genomes shows that the former constitutes the paleome, which recapitulates the three phases of the origin of life: (...) metabolism of small molecules on surfaces, substitution of surfaces by an RNA-world where transfer RNA played a central role, and invention of template mediated information transfer. Colonization of each niche is performed using an almost unlimited set of genes, forming the cenome. The agreement of the paleome structure with a consistent scenario for the origin of life is such that we may consider extant genomes as providing us with an archive of the origin rather than as a palimpsest where most of our past would be irremediably hidden. (shrink)

Although clinical ethics consultation has existed for more than 40 years in the USA and Europe, it was not available in Bulgaria until recently. In introducing clinical ethics consultation into our country, the Modular, Ethical, Treatment, Allocation of resources, Process methodology has been preferred because of its potential to be used in resource-poor settings and its strong educational function. This paper presents the results of a METAP evaluation in a hospital palliative care ward in the town of Vratsa. The evaluation (...) was based on Beauchamp and Childress’ four principles of biomedical ethics and involves implementation of specific instruments for clinical ethics decision-making. Research tasks emphasised analyses of ethics meetings in the ward. Data were processed by SPSS v.24 using descriptive statistical analysis. Altogether, 32 ethics meetings of an average duration 20.63 min were conducted on cases involving critically ill patients. Most of the participants expressed satisfaction with the ethics process. The principlist approach supported resolution of conflicts between autonomous patients and their relatives, clarified definitions of “medical benefit” and “social good,” and enabled assessments of the risk of unequal treatment. Even as the specific research tasks were achieved, further participant follow-up is necessary to identify any improvement in healthcare personnel’s ethical competence. METAP worked well in end-of-life care settings. Participants experienced several benefits, including improved team communication, better understanding of patient preferences, and confidence in the correctness of decisions. Despite the significant educational potential of METAP, the need for additional and ongoing ethics training of health professionals should not be underestimated. (shrink)

Dual process models of higher cognition have become very influential in the cognitive sciences. The popular Default-Interventionist model has long favoured a serial view on the interaction between...

This paper proposes an initial epistemological course related to the notions of life, cognition, and culture from the fundamental elements of the complexity theory and, specifically, related to the notion of self-eco-organization. With these, we pretend to search isomorphic or transverse properties to all these notions; emphasizing the ideas of complexity, autonomy and dependence. El presente trabajo propone un derrotero epistemológico preliminar en torno a las nociones de vida, cognición y cultura, desde la base de algunos elementos de la (...) teoría de la complejidad y en específico, en torno a la noción de auto-eco-organización. Con ellos, se pretende la búsqueda de isomorfismos o propiedades transversales a todas estas nociones, centrándose en la ideas de complejidad, autonomía y dependencia. (shrink)

The origins of the evolutionary concept of history have normally been associated with the development of an organicist notion of society. The meaning of this notion, in turn, has been assumed as something perfectly established and clear, almost self-evident. This assumption has prevented any close scrutiny of it. As this article tries to show, the idea of "organism" that underlies the emergence of the evolutionary concept of history, far from being "self-evident," has an intricate history and underwent a number of (...) radical and successive redefinitions from the mid-eighteenth century up to approximately 1830 . More specifically, this paper traces some of these transformations in order to contextualize and shed some new light on Herder's philosophy of history and the complex process of its inception-a process that was not concluded by the end of his intellectual career. As the article shows, Herder did not actually succeed in solving some key problems involved in an evolutionary concept of history. The difficulties he found were analogous to those that emerged at that very moment in the development of a dynamic, ontogenetical theory , and both were ultimately linked to the combination of some uneven developments produced in the natural sciences of that time. Herder's philosophy of history thus appears as a paradoxical case of a system of thought that formulates problems which it is still radically unable to solve, lacking the tools to devise a possible solution for them. (shrink)

The building blocks and origins of life have fascinated scientists since the earliest of times. What is required for life to work in terms of building blocks? An outline of the building blocks that have to be present in living systems to allow the processes that are required for life is given. These building blocks have to be organised in a specific way to allow living processes to be functional, which are summarised in what is (...) referred to as the seven pillars of life. In essence, these are the fundamental characteristics of all living systems. Evidences of when and how living systems developed on the Earth shortly after the Earth established itself as a planet are discussed. This comes from the growing body of geological evidence of the age of rocks and rock formations in different places on the Earth. This review is concluded with the latest evidence of where on Earth living systems may have started. A large amount of uncertainty exists about these processes, but more and more consilient evidence is giving us important pointers as to the origins of life on the planet Earth.Contribution: As part of this special collection, the building blocks or origins of life give insights into the chemical principles and constituents of living organisms and how their interactions allow life to function on earth. (shrink)

Background:The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what (...) is considered to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years?Research question:The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation.Participants:Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia.Ethical considerations:Ethical processes and procedures have been adhered to by the researchers.Findings:A qualitative approach was used to analyse the data. The theme ‘difficult choices’ was generated which comprised three sub-themes: ‘damaged through survival’, ‘the importance of the brain’ and ‘families are important’. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even more difficult for the nurses to say when an extremely premature baby’s life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family’s life was important, and possibly more so than the quality of life of the surviving baby. This finding contrasts markedly with much of the existing literature in this field.Conclusion:Quality of life for extremely premature babies was an important consideration for neonatal nurses; however, they experienced difficulty deciding how to operationalise such considerations in their everyday clinical practice. (shrink)

The article is a description of Rimas Kociunas’ seminar “The picture of human life and the therapeutic process: the introduction of an existential psychotherapist”, held in Moscow from February 13 to 16, 2020. The seminar was devoted to the study of the basic philosophical principles of existential psychotherapy on which work with a client is based. A specificity of existential therapy is the lack of specific technical methods and methods of working with a client, therefore the content of (...) therapeutic work is determined by a particular vision of a person and his problems. From the point of view of existential therapists, the personality is in constant interaction with the world, the result of which is continuous formation; therefore, instead of studying the qualities and structures of the personality, one should study its life world and ways of building relationships with reality. (shrink)

The recognition memory for inverted faces is especially difficult when compared with that for non-face stimuli. This face inversion effect has often been used as a marker of face-specific holistic processing. However, whether face processing without awareness is still specific remains unknown. The present study addressed this issue by examining the face inversion effect with the technique of binocular rivalry. Results showed that invisible upright faces could break suppression faster than invisible inverted faces. Nevertheless, no difference was found for invisible (...) upright houses and invisible inverted houses. This suggested that face processing without awareness is still specific. Some face-specific information can be processed by high-level brain areas even when that information is invisible. (shrink)

The author discusses B.G. Yudin's image technoscience as having two contours, the external one dealing with science, business and society, and the internal one represented by laboratories. Together these two contours present a multidimensional net of relations between science and technology in conducting experiments, development of instruments (e.g. visualization tools), etc. The author argues that, in such a system, coordinated activity of the internal and the external contours is provided by a synergy of regulatory principles of truth, good and usefulness. (...) He discusses a case of synthetic biology which, as he argues, demonstrates that the internal and external contours of technoscience undergo a process of technologization. Technologization is understood as a transition from research techniques to systematic use of technologies. Biotechnologies are claimed to have a double socio-biological helix network structure. Each network is formed as a kind of ad hoc "factory" and is aimed at solving specific research problems. (shrink)

This article focuses on the epistemological challenges of comprehending organic life. It explores the cognitive and experiential basis of the perspective that organisms are autonomous agents of their own teleological organization and development. According to Immanuel Kant and Hans Jonas, the conditions of the knowability of organic life lie within our mental faculties and inner experiences. This statement is often interpreted to mean that we cannot attain ontological knowledge about the life of an organism. Alternatively, attempts are (...) made to “naturalize” life, i.e. to explain the self-generating capacity of an organism from the interaction of its material components. In contrast, I posit that through the active mental representation of biological processes, such as the development of a plant, we can gain first-person insight into the life forces at play, suggesting a profound connection between our cognitive processes and the dynamic and teleological nature of life. Specifically, the parallels between life and our mental capacities lie in a blend of sensory perception, imaginative activity, conceptual thought, and the agential self, mirroring the physical structure and the autopoietic, teleological and agential organization of a living organism. It is shown that these parallels comprise four types of subject-object relationships. I propose and discuss that this correlation is not merely an analogy but reflects a deep ontological correspondence between life and mind and that this correspondence can provide empirical access to the study of life through first-person experience. I advocate for a re-evaluation of the materialistic view of nature to include qualities and experiences of life and mind, proposing that life’s properties can be “naturalized” by recognizing them as qualities we experience mentally. Overall, I call for a broader approach to understanding life that incorporates both empirical evidence and phenomenological, first-person experiences. (shrink)

Resumen: En este artículo se presentan diversas nociones útiles para explicar las relaciones de complementariedad y antagonismo que ocurren entre lenguas que comparten un espacio geosociocultural determinado. Dicha relación dinámica es reconocida con el nombre de interacción lingüística o interactividad lingüística. Se reflexiona acerca de los procesos dinámicos generados entre el mapuzugun y el castellano y se discuten las descripciones sociolingüísticas realizadas en torno a la lengua mapuche. Se observa que en ellas hay un énfasis en los estados de las (...) lenguas, en las relaciones asimétricas existentes y en los productos finales de esas relaciones, lo que se entiende como una visión generalizada de la situación. Ante esta generalización, se propone la revisión in situ de la interacción lingüística entre el castellano y el mapuzugun y la generación de diagnósticos territoriales que den cuenta de los procesos interactivos, dinámicos, históricos, dialécticos e identitarios, que tienen el mapuzugun y el castellano en las comunidades.: In this paper we discuss some useful concepts to explain the opposing and complementary relationship between languages that share a specific geosociocultural context. This dynamic relationship is known as linguistic and social interactions. This paper discuss the dynamic processes arising between the mapuzugun and Spanish language, and it also explores some sociolinguistic descriptions about the Mapuche language which are mostly narrow and focus on the asymmetric relationship between languages and the results of these relationships. In this context we propose a new in situ revision of the linguistic interaction to generate territorial diagnostics that consider interactive processes, dynamic and historical, dialectical and identitary concerns that both Spanish and Mapuzugun have in the communities. (shrink)

Historically nurses have lacked significant input in end-of-life decision-making, despite being an integral part of care. Nurses experience negative feelings and moral conflict when forced to aggressively deliver care to patients at the EOL. As a result, nurses participate in slow codes, described as a limited resuscitation effort with no intended benefit of patient survival. The purpose of this study was to explore and understand the process nurses followed when making decisions about participation in limited resuscitation. Five core categories (...) emerged that describe this theory: (1) recognition of patient and family values at the EOL; (2) stretching time and reluctance in decision-making; (3) harm and suffering caused by the physical components of CPR; (4) nurse’s emotional and moral response to delivering aggressive care, and; (5) choosing limited resuscitation with or without a physician order. Several factors in end-of-life disputes contribute to negative feelings and moral distress driving some nurses to perform slow codes in order to preserve their own moral conflict, while other nurses refrain unless specifically ordered by physicians to provide limited care through tailored orders. (shrink)

Background: Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan-European study was conducted to determine the frequency and types of end of life practices in European intensive care units , including those in Israel. Several results of the Israeli subsample were different to those of the overall sample.Objective: The objective of this article was to explore these differences and provide a possible (...) explanation based on the impact of culture on end of life decision making.Method: All adult patients admitted consecutively to three Israeli ICUs who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively . These patients were compared with a similar sample taken from the larger study carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation , brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process . The data also included patient characteristics , specific therapies limited, and the method of SDP.Results: The majority of patients had treatment withheld, none underwent SDP, 62 received CPR , 31 had brain death , and 18 underwent withdrawal of treatment . The primary reason given for limiting treatment was that the patient was unresponsive to therapy . End of life discussions were held with 132 families , the vast majority of which revolved around withholding treatment and the remainder concerned withdrawing treatment .There was a statistically significant association between the type of end of life decision and region—that is, the northern region of Europe, the central region, the southern region, and Israel.Conclusions: Regional culture plays an important part in end of life decision making. Differences relating to end of life decision making exist between regions and these differences can often be attributed to cultural factors. Such cultures not only affect patients and their families but also the health care workers who make and carry out such decisions. (shrink)

Open peer commentary on the target article “From Objects to Processes: A Proposal to Rewrite Radical Constructivism” by Siegfried J. Schmidt. Upshot: My suggestion is that the shift from objects to processes can be seen as grounded in the processes of self-generation common to all living organisms. Specifically human cognition is a subsequent evolutionary emergence.

This article first of all attempts to assess the proposals of 2006–2007 to amend Poland’s Constitution, aimed mostly at strengthening constitutional protection of unborn human life. Parliamentary work on this proposal begins with the submission of the Deputy’s bill on amendment of the Constitution, published in the Sejm Paper No. 993 of September 5, 2006, and ends with a series of votes at the 39th sitting of the Sejm of the fifth term of office, held on April 13, 2007, (...) on which it was decided not to adopt any amendment. In the course of the legislative process, several modifi cation were offered not only to Article 38 concerning protection of life, but also to Article 30 dealing with dignity as a source of rights. Each of these proposals had drawbacks, including inter alia: the lack of a definite period of protection or entitlement to dignity, resulting in the decreased protection in relation to issues concerning euthanasia; the application of new categories granting a specific status to unborn human life; specifying the standards for protection by means of legislative acts ranking lower than a constitution, resulting in the transfer of life protection into the sphere of regulation of ordinary legislation. The most conducive for strengthening of the protection of unborn human life, even if not free of imperfections, was an amendment of Article 30 proposed by the Committee in the following wording: “The inherent and inalienable dignity, conferred on the person from the moment of conception, shall be a source of freedoms and rights of persons and citizens. It shall be inviolable; the respect and protection thereof shall be the obligation of public authorities.” From the rejection of the proposals it is diffi cult to draw conclusions that are vital for interpretation of the existing provisions. However, a conclusion that the intention of the authors of the constitution was not to strengthen the constitutional protection of life is not legitimate, mostly because of their doubts about formal correctness of the proposed amendments (when deciding to reject them), particularly the doubts about legal consequences of their adoption. -/- Streszczenie Zasadniczym celem opracowania jest próba całościowej oceny propozycji nowelizacji Konstytucji RP mającej miejsce w latach 2006-2007, zmierzającej przede wszystkim do wzmocnienia konstytucyjnej ochrony życia człowieka przed narodzeniem. Prace parlamentarne nad analizowaną nowelizacją otwiera poselski projekt ustawy o zmianie Konstytucji zawarty w druku sejmowym 993 z dnia 5 września 2006 (projekt wpłynął do Sejmu 7 września); zamyka seria głosowań na 39 posiedzeniu Sejmu V kadencji, dnia 13 kwietnia 2007 roku; głosowań, które przesądziły o niewprowadzeniu żadnych zmian. W trakcie procesu legislacyjnego proponowano szereg formuł, zmieniających nie tylko art. 38 dotyczący ochrony życia, ale także art. 30, który dotyczy godności jako źródła praw. W zasadzie wszystkie zgłoszone propozycje posiadały wady, wśród których najważniejsze to: brak domknięcia okresu ochrony lub przysługiwania godności, skutkujący obniżeniem ochrony w kwestiach związanych z eutanazją; stosowanie nowych kategorii, prowadzące do nadania specyficznego statusu człowiekowi przed narodzeniem; określanie standardu ochrony za pośrednictwem aktów o randze niższej od konstytucji, prowadzące do przesunięcia ochrony życia przed narodzeniem w sferę ustawodawstwa zwykłego. Z punktu widzenia celu, jakim było wzmocnienie konstytucyjnej ochrony życia człowieka przed narodzeniem i wzmocnienie jego pozycji prawnej, najlepsza, choć nie pozbawiona usterek, była zaproponowana przez Komisję zmiana brzmienia art. 30 prowadząca do formuły: „Źródłem wolności i praw człowieka i obywatela jest przyrodzona i niezbywalna godność człowieka, przynależna mu od chwili poczęcia. Jest ona nienaruszalna, a jej poszanowanie i ochrona jest obowiązkiem władz publicznych.”. Na podstawie odrzucenia propozycji zmian trudno wyciągać wnioski istotne dla interpretacji aktualnie obowiązujących przepisów; wniosek, że ustrojodawca nie chciał wzmocnienia konstytucyjnej ochrony życie nie jest prawomocny, przede wszystkim ze względu na – istotne w procesie podejmowania decyzji o odrzuceniu propozycji zmian – wątpliwości, co do formalnej poprawności formułowanych propozycji, w tym wątpliwości co do konsekwencji prawnych ich przyjęcia. (shrink)

Health-related quality of life is the ultimate general goal for medicine, health care and public health, including health promotion and health education. The other important general goal is health-related welfare. The aim of the paper is to explain what this means and what the consequences of these assumptions are for health work. This involves defining the central terms “health”, “quality of life” and “welfare” and showing what their conceptual relations are. Health-related quality of life has two central (...) meanings: health-related well-being, which constitutes quality of life, and health as ability, which contributes causally to quality of life. Four meanings of health-related welfare are put forward: general well-being, health as ability, other inner properties of the individual, and external factors. States and processes covered by these categories contribute causally to health-related quality of life. Finally, using these distinctions, some more specific goals for medicine and health care, on the one hand, and for public health and health promotion, on the other, are outlined. In the former fields work is primarily directed towards changing the health-related quality of life of the individual through direct measures, “manipulating” the individual, whereas public health work and health promotion primarily use indirect measures and further health through various sorts of health-related welfare changes, e.g. through changing the environment. (shrink)

This paper departs from the assumption that the critique of neoliberalism should not restrict itself to a criticism of an economic project. Another possible criticism of neoliberalism consists of a critique of how this specific form of life forms subjects. In this paper, we argue that a critique of a form of life is only justified in a reasonable way if it starts from the experiences of suffering produced by this form of life. As we will show, (...) we must criticise neoliberalism not because it is inadequate for solving problems, since for a specific portion of the world population it has been extremely effective, but because it causes suffering. Suffering, unlike mere unsolved problems, represents sufficient grounds for highlighting the existence of a normative problem in a form of life. According to Max Horkheimer, the first step of a critical project committed to the transformation of a form of life are the crises of the present, which are not fully understood through the theoretical tools of “problem solving” or “learning processes”, as Rahel Jaeggi resorts to in her critical theory of society. (shrink)

In this paper I argue that the rationality of law and legal decision making would be enhanced by a systematic attempt to recognize and respond to the implications of empirical uncertainty for policy making and decision making. Admission of uncertainty about the accuracy of facts and the validity of assumptions relied on to make inferences of fact is commonly avoided in law because it raises the spectre of paralysis of the capacity to decide issues authoritatively. The roots of this short-sighted (...) view are found in primitive mechanical models of relationships in the empirical and social world – those of objective causality and determinism. Insofar as it is believed that if we had sufficient data a clear and unequivocal answer would be available to each question, admission of uncertainty is seen as a sign of insufficiency, incompetence, impotence, and is avoided whenever a decision that must be seen to be based on valid reasons, cannot be avoided. Avoidance of some decisions, duplicity in others, is the result. -/- Decision-making must be restructured to recognize the provisional and context-bound validity and relevance of the models we use to conceptualize and order our understanding of phenomena, and to utilize this awareness as an instrument in the production of legal policies and decisions that will be authoritative precisely because they are honestly accurate and socially responsible. The paper makes a start on such a re-structuring of the legal process by exploring the implications of the observation that if law is to be “just”: 1) legal policy must be based on accurate information and rationally related to social goals; and 2) decisions applying policy to individual fact situations must be based on assumptions that are both relevant and accurate. -/- Reasons for determinations of fact must be given, otherwise the presumption that the trier of fact is “reasonable” is an unconditional licence to use private modes of logic and theories of social and natural science. What is not disclosed cannot be challenged on grounds of invalidity or irrelevance. -/- Use of “objective validity” as a standard to evaluate conclusions made by the trier of fact in contentious cases would only serve to beg all important questions by concealing: 1) fundamental normative conflict, and 2) the limited nature and applicability of many validity claims. -/- Our use of the phrases “undue risk,” “public interest,” “reasonable,” and “necessary,” reflects the weight we choose to give conflicting social values and goals when we must make decisions in relative ignorance of all the consequences. “Objective criteria” are of limited utility in legal decision-making because their social meaning is derivative. Policy generation in the absence of any coherent conceptual-normative framework, use of vague terminology in legislation stating policy, and the absence of rational means to distinguish between individual cases to which decision-makers are required by law to apply policy, make it inevitable that many legal “decisions” made in the guise of determinations of objective fact, are charades, an arbitrary, capricious, intuitive, subjective (and thus private) use of public decision-making power. -/- Law must alter its aspirations and recognize that rational decision-making is a process that can occur only within parameters set by present knowledge and societal preference structures. Only by working with the constraints imposed by these parameters is it possible to achieve “just” decisions. Where no rational basis for differentiating cases exists, “individualized justice” must be avoided and public policy articulated in law applied uniformly to all cases in a class. The terms “reasonable” and “necessary,” used to describe policy and its consequences for specific cases, must be understood to represent provisional societal assessments, attempts to implement societal preference structures in the face of limited knowledge. Heightened awareness of the limited nature of our knowledge can only result in legal policies that have a more explicit normative basis. -/- The volume is is published with an introduction by Michael D. Bayles. It is available in hardback, paperback, and as an ebook. (shrink)

The modern realities of life in Ukraine, plunged into war by the Russian Federation, as well as those countries that are in a state of ontological threat, with new force actualize the problem unfolding in the social plane (we are talking about the antinomy of “chaos – stability”). In other words, modern social cataclysms – COVID-19 and war – have disrupted the stability of everyday life. The presence of the threat of nuclear escalation of the international conflict expands (...) the metaphysical horizons of thanatological and suicidal problems, the aggravation of which can destroy the established order of the civilized world, which has found itself in a borderline situation. In view of the above, the purpose of this study is to clarify the essence of the phenomenon of chaos and social processes derived from it – the end, catastrophe, according to the philosophical views of the French thinker J.Baudrillard. Achieving the specified goal will contribute to the development of modern methods and technologies of social work in the community to minimize/overcome difficult life circumstances determined by the war situation. J.Baudrillard was deeply convinced that chaos is not completely opposed to rationality. The thinker believed that the dominance of rationality over reality is limited, because in reality it is not the subject who dominates the objective world, but the competition between the subject and the object. This study is focused on the actual existential problem of a person being in a borderline situation of chaos, determined by the reality of a thanatological situation, which enables the perspective of an ontological threat of a planetary scale, the origins of which are contained in the obsessive idea of total control, the realization of which leads to the disappearance of the social and the replacement of reality with an illusion, including even the illusion of security as a fundamental basis of the rescue economy, which is clearly observed in the ideology of the russian federation, which is based on the consumption of disaster in everyday life. The social work specialist’s awareness that chaos is not the end of everything (it is better to define this phenomenon as the end of the old order transformed into disorder, an example of which can be anomie), but the beginning of a new order, will directly contribute to the achievement of effective results in his professional activities in the community, in particular, in the direction of minimizing/overcoming the consequences of anomie as a type of chaos. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Children's Perspectives:A Model of Aesthetic Processing in TheatreJeanne Klein (bio)Since the children's theatre movement began, producers have sought to create artistic theatre experiences that best correspond to the adult-constructed aesthetic "needs" of young audiences by categorizing common differences according to age groups. For decades, directors simply chose plays on the basis of dramatic genres (e.g., fairy tales), as defined by children's presupposed interests or "tastes," by subscribing to (...) Winifred Ward's broad descriptions of the "imaginative period" (ages six to nine), the "heroic period" (ages nine to twelve), and the "romantic period" (over age thirteen).1 Years later, Moses Goldberg elaborated upon these generalized divisions while cautioning that "no individual fits exactly into any set of categories."2 In his position paper on aesthetic development, he argued for individual access to aesthetic techniques, processes, and products for all ages, paralleled by four stages of cognitive capabilities, based on exposure to (1) arena-style participation theatre (for ages five to eight), which emphasizes story enactments; (2) a wide range of proscenium-style theatrical conventions; (3) relevant play content that directly relates characters' problems to spectators' lives and growing self-awareness; and (4) social issue plays that pose ethical dilemmas as cultural reflections.3 Meanwhile, Jed Davis compiled Age Group Profiles, organized by cognitive, spatial, emotional, and moral/ethical development, from his review of Piagetian literature; and Johnny Saldaña summarized stages of young interpretations of theatre from his seven-year longitudinal study.4Suffice it to say, the field of developmental psychology has come a long way since Piaget formulated his four constructivist stages. Since the mid-1950s, the cognitive revolution has spurred more integrated theories of information processing and depth-of-processing models that explain and predict how people construct schematic frameworks of knowledge and [End Page 40] assimilate and accommodate new information as a function of perception, attention, emotion, comprehension, memory, and social and moral behaviors. Although masculinist metaphors of hierarchical "staircases" and linear networks of associative learning still dominate computational models, feminist perspectives, which engender social cognitive, co-relational negotiations of narratives in situated contexts, have gained more widespread acceptance—by including theatre as an apt metaphor for development.5 Over the past twenty years or more, cognitive psychologists have finally discovered what dramatic theorists have known about narrative structures since Aristotle's Poetics: Powerful stories contain universal themes about the human condition through characters' conflicting actions. The most successful dramas are those that allow spectators to enter into a protagonist's psychological consciousness or "inner" vision in order to empathize with her "outer" reality.6While several developmental models of aesthetic understanding, experience, and appreciation exist in the realms of visual art and music education, few examples have been proposed in regard to theatre, particularly for child audiences.7 Instead, producers of Theatre for Young Audiences (TYA) tend to romanticize its social and moral "effects" upon youth by believing passionately that viewing one remarkable performance has the potential (the operative word) to "cause" positive, social changes in children's minds, hearts, and behaviors, given the presumed "power of human imagination."8 This obsession with progressive change foregrounds adults' desires to control human destiny by predicting "causes and effects" located in children's responses to live performances. However, this "folk theory" fails to explain how young imaginations actually function aesthetically from the contextual evidence of reception studies with child audiences. Just as feminists have argued for a distinctive "feminist aesthetics," based on women's alternative ways of knowing,9 I argue that children gaze upon theatre in differential ways by including age as a variable factor. "Children's aesthetics," their perceived interpretations of theatre, differ from that of adults' theorized postulations, based in part on their shorter life experiences with this medium. To this end, over the course of my career, I have sought to understand theatre from children's perspectives by focusing my research in the social cognitive theories and social science methods of child development, primarily through the vast literature of television and mass media studies conducted with young people over the past forty years. In particular, medium-specific studies that parse theatrical forms from dramatic content... (shrink)

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use (...) of Life-Sustaining Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

Interpretative phenomenological analysis (IPA) is an idiographic approach to qualitative research. It is widely used in psychologically-informed studies which aim to understand the meaning and context of specific experiences. In this paper, we provide some background and introduction to the principles and processes underpinning IPA research. We extend this via a practical example, reporting on selected analyses from a study which explores the phenomenology and meaning of loneliness, through interviews conducted with a group of religious women. Through our observations (...) on the complex role of absence for loneliness, we show that IPA can be a powerful tool for exploring and understanding the meaning of salient experiences. We reflect on the significance of the results for advancing theories of loneliness; and on the capacity of the IPA approach to provide researchers with an important and useful phenomenological perspective, through its emphasis on context, and its commitment to integrating convergent and divergent claims. (shrink)

Scholars and providers are coming to realize that one’s ability to notice and respond to internal body sensations contributes to an overall sense of wellbeing. Research has demonstrated a relationship between interoceptive awareness and anxiety, for example. Currently, however, tools for evaluating one’s interoception lack the conceptual foundation and clarity necessary to identify everyday behaviors that specifically reflect interoceptive awareness. Unlike existing interoceptive measures, the Sensory Profile Interoception scale is participation-based and grounded in Dunn’s Sensory Processing framework. In this study (...) we investigated concurrent validity by correlating the SPI with the Adolescent/Adult Sensory Profile ; we investigated construct validity by correlating the SPI with the Perth Alexithymia Scale, the Body Awareness Scale, and the State-Trait Anxiety Inventory. Using the REDCAP online platform, 74 college-aged participants completed the measures. Using Spearman rank order correlations there were statistically significant relationships between the corresponding sensory pattern subscales on SPI and A/ASP. The PAS was only weakly related to the registration subscale of the SPI. The BAS had significant relationships with seeking and avoiding on the SPI. The STAI had significant relationships with sensitivity and registrations of the SPI. Taken together, these findings provide evidence of construct validity of the SPI to identify participation patterns associated with both high and low interoception. With the more precise information the SPI provides, professionals can design tailored interventions to support everyday life goals and researchers can study interoception within authentic activities. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This (...) theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction and the assignment of responsibilities . This theoretical (...) framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as ‘intentionally taking the life of another person by a physician, upon that person’s request’ can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction and the assignment of responsibilities. This theoretical framework (...) prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as ‘intentionally taking the life of another person by a physician, upon that person’s request’ can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of (...) life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

Here, I lay the foundations of a high-level ontology of particulars whose structuring principles differ radically from the 'continuant' vs. 'occurrent' distinction traditionally adopted in applied ontology. These principles are derived from a new analysis of the ontology of “occurring” or “happening” entities. Firstly, my analysis integrates recent work on the ontology of processes, which brings them closer to objects in their mode of existence and persistence by assimilating them to continuant particulars. Secondly, my analysis distinguishes clearly between (...) class='Hi'>processes and events, in order to make the latter abstract objects of thought (alongside propositions). Lastly, I open my ontological inventory to properties and facts, the existence of which is commonly admitted. By giving specific roles to these primitives, the framework allows one to account for static and dynamic aspects of the physical world and for the way that subjects conceive its history: facts account for the life of substances (physical objects and processes), whereas events enable cognitive subjects to account for the life story of substances. (shrink)

The article deals with the problems of methodology for studying the dynamics of socio-cultural processes of local communities in the context of globalization. The purpose of the study is a methodological analysis of the problem of competition, from the point of view of global and local specifics of the development of culture and sociality. Modernization processes generate a paradigm of socio-cultural development that fixes the scale of action, methods and means of interrelation and existence of elements and subsys­tems (...) that influence the formation of evolution models of the socio-cultural space. The emerging models of socio-cultural development have a high degree of dynamism, maintaining a certain level of locality in the sphere of socio-cultural life. The use of the coherence principle makes it possible to ensure the iden­tification of all components and modifications of the socio-cultural system. (shrink)