Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

In 1964, the American Medical Association invited liberal theologian Abraham Joshua Heschel to address its annual meeting in a program entitled “The Patient as a Person” [1]. Unsurprisingly, in light of Heschel’s reputation for outspokenness, he launched a jeremiad against physicians, claiming: “The admiration for medical science is increasing, the respect for its practitioners is decreasing. The depreciation of the image of the doctor is bound to disseminate disenchantment and to affect the state of medicine itself” [1, p. 35]. Heschel’s (...) reference to “disenchantment” suggests that he may have been familiar with the work, or at least the outlook, of sociologist Max Weber, whose 1917 address “Science as a Vocation” portrays the modern world as disenchanted by the progress of rationalism. Heschel’s life’s vocation had been to uncover the inner meaning of religious faith and to translate that faith into principled action. Heschel saw disenchantment not as an inescapable aspect of modern life but rather as the byproduct of physicians’ conscious choices to seek worldly success and material comfort. Yet, because of their privileged position as witnesses to human vulnerability, physicians possess an obligation to develop their own personhood, to re-enchant medicine, and through medicine to spark a positive transformation in all of modern life. As Heschel says, “The doctor must realize the supreme nobility of his vocation, to cultivate a taste for the pleasures of the soul. … The doctor is a major source of moral energy affecting the spiritual texture and substance of the entire society” [1, pp. 34, 38]. While Heschel’s conception of the physician’s role is romanticized and idealized, changes in the organization and practice of medicine have validated his concerns. (shrink)

On the life and philosophy of Bhāskarācārya, 8th cent., Vedanta philospher and commentator of Brahmasūtra.

The Groningen protocol allows for the euthanasia of severely ill newborns with a hopeless prognosis and unbearable suffering. We understand the impetus for such a protocol but have moral and ethical concerns with it. Advocates for euthanasia in adults have relied on the concept of human autonomy, which is lacking in the case of infants. In addition, biases can potentially influence the decision making of both parents and physicians. It is also very difficult to weigh the element of quality of (...) life on the will to live. We feel an important line has been crossed if the international medical community consents to the active euthanasia of severely ill infants and are concerned about the extension of the policy to other at risk groups. (shrink)

The validity of the double effect doctrine is examined in euthanasia and abortion. In these two situations killing is a method of treatment. It is argued that the doctrine cannot apply to the care of the dying. Firstly, doctors are obliged to harm patients in order to do good to them. Secondly, patients should make their own value judgments about being mutilated or killed. Thirdly, there is little intuitive moral difference between direct and indirect killing. Nor can the doctrine apply (...) to abortion. Doctors kill fetuses as a means of treating the mother. They also kill them as an inevitable side effect of other treatment. Drawing a moral distinction between the direct and the indirect killing gives counterintuitive results. It is suggested that pragmatic rules, not ethics, govern practices around euthanasia and cause it to be more restricted than abortion. (shrink)

This paper studies in detail about the early years of José Gaos (1900- 1969) and his education in philosophy and literature. Therefore, we know that their studies (academic or not) were not purely “philosophical” in 1915. Literature and philosophy played in Gaos an equally important role. The first real encounter with philosophy happens before he comes to Valencia in 1915; but in this year Gaos also receives a strong education, in aesthetic and literary, through press and philosophical journals, and especially (...) within the group formed with Max Aub, José Medina Echeverría and his brother Carlos Gaos. (shrink)

Ii is a well-known fact that the men of the Macedonian phalanx under Philip and Alexander were known collectively asor ‘foot companions’. Our first reference to the name comes from Demosthenes, who in his second Olynthiac tries unconvincingly to disparage the fighting qualities of Philip's mercenaries andDemosthenes adds no explanation, and it was left to commentators and lexicographers to unearth a relevant fragment from thePhilippicaof Anaximenes of Lampsacus.

Estudio sobre el alcance de la concepción del pensamiento hispanoamericano en José Gaos, en su obra de los años 40. A History of Latin American Philosophy (s. XVI- XIX): / José Gaos (1900-1969).

Estudio sobre diferentes aspectos, desde la E. Moderna a la Contemporánea, en el pensamiento de J. Gaos en sus textos de los años 40.

This book is a study of the second-edition version of the 'Transcendental Deduction', which is one of the most important and obscure sections of Kant's Critique of Pure Reason. By way of a close analysis of the B-Deduction, Adam Dickerson makes the distinctive claim that the Deduction is crucially concerned with the problem of making intelligible the unity possessed by complex representations - a problem that is the representationalist parallel of the semantic problem of the unity of the proposition. Along (...) the way he discusses most of the key themes in Kant's theory of knowledge, including the nature of thought and representation, the notion of objectivity, and the way in which the mind structures our experience of the world. (shrink)