Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical (...) judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated. (shrink)

A contemporary examination of the past, present, and future of Marxist philosophy.

In Marquis's recent paper he has not satisfactorily shown that killing does not adversely affect the victim's present self-represented desires for their future. Marquis is correct in believing life and death are distinct, but living and dying are not. In fact, to use a well-known saying, “the second we are born we start to die”. During the process of dying, whether it be long as in over our lifetime or short as in as we are being killed, there comes a (...) point when the present realistic desires we have we know will never be satisfied. This is why killing can be wrong. This would imply killing an unconscious person, infant, or fetus cannot be wrong. But such killing can be wrong, despite the person killed not experiencing the desire not to be killed as he was dying. Killing can be wrong because others can have a present self-represented desire for that person not to be killed to have been killed. If this line of reasoning is correct, then the “best interests” principle often applied to life and death considerations regarding unconscious persons, infants, and fetuses, is invalid, as such human beings do not have present desires. All that matters is what relevant others rationally desire, after being informed of the facts and the consequences, for that unconscious person, infant or fetus. (shrink)

Mood profiling has a long history in the field of sport and exercise. Several novel mood profile clusters were identified and described in the literature recently (Parsons-Smith, Terry, & Machin, 2017). In the present study, we investigated whether the same clusters were evident in an Italian language, sport and exercise context. The Italian Mood Scale (ITAMS; Quartiroli, Terry, & Fogarty, 2017) was administered to 950 Italian-speaking sport participants (659 females, 284 males, 7 unspecified; age range = 16–63 yr., M (...) = 25.03, SD = 7.62) and seeded k-means clustering methodology applied to the responses. Six distinct mood profiles were identified, termed the iceberg, inverse iceberg, inverse Everest, shark fin, surface, and submerged profiles, which closely resembled those reported among English-speaking participants (Parsons-Smith et al., 2017). Significant differences were found in the distribution of specific mood profiles across gender and age groups. Findings supported the cross-cultural generalizability of the six mood profiles and offer new research avenues into their antecedents, correlates and behavioral consequences in Italian-language contexts. (shrink)

The integrins are receptors for proteins of the extracellular matrix, both providing a physical link to the cytoskeleton and transducing signals from the extracellular matrix. Activation of integrins leads to tyrosine and serine phosphorylation of a number of proteins, elevation of cytosolic calcium levels, cytoplasmic alkalinization, changes in phospholipid metabolism and, ultimately, changes in gene expression. The recently discovered focal adhesion kinase localizes to focal contacts, which are sites of integrin clustering, and focal adhesion kinase can physically associate with integrins (...) in vitro. As integrins lack intrinsic catalytic activity, focal adhesion kinase is a candidate for a signaling molecule that is recruited by integrins in order to trigger the generation of intracellular second messengers. Thus, focal adhesion kinase may play a central role in signal transduction through integrins. (shrink)

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the (...) reasoning of four women. The implications for ethical decision-making and future research are discussed. (shrink)

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence (...) or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the ‘four principles’ approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students. (shrink)

Caring for hospitalized patients with COVID-19 raises ethical dilemmas in which clinicians must weigh the unknown value of an intervention against the unknown risk of viral transmission. Current guidelines for delivering high-value care in the time of the COVID-19 pandemic do not directly address ethical dilemmas that arise from the unique concerns of individual patients. We propose an “ethical pause” in which clinicians address ethical dilemmas by taking time to ask three questions that invoke the major bioethical principles of beneficence, (...) nonmaleficence, and distributive justice: will this intervention help my patient? Could this intervention harm my patient? Could this intervention harm or help others? Using two exemplar cases, we demonstrate how the process of deliberately asking and answering structured ethical questions is a mindful problem-solving strategy that facilitates delivery of high-value care. (shrink)

This collection of papers by prominent feminist thinkers advances the positive feminist project of remapping the moral by developing theory that acknowledges the diversity of women.