This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with a clear justification of why it is important to take best standards, norms, and physician judgment seriously and a clear (...) justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. (shrink)

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted—or terminated—in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult (...) decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

The enormous destructive power of present stocks of nuclear weapons poses the greatest threat to public health in human history. Technical changes in weapons design are leading to an increased emphasis on the ability to fight a nuclear war, eroding the concept of deterrence based on mutually assured destruction and increasing the risk of nuclear war. Medical planning and civil defence preparations for nuclear war have recently been increased in several countries although there is little evidence that they will be (...) of significant value in the aftermath of a nuclear conflict. These developments have raised new ethical dilemmas for those in health professions. If there is any risk of use of weapons of mass destruction, then support for deterrence with these weapons as a policy for national or global security appears to be incompatible with basic principles of medical ethics and international law. The primary medical responsibility under such circumstances is to participate in attempts to prevent nuclear war. (shrink)

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of (...) basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge. (shrink)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, and (...) health policy discuss if age should guide rationing decisions. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

Supernatural beliefs are ubiquitous around the world, and mounting evidence indicates that these beliefs partly rely on intuitive, cross‐culturally recurrent cognitive processes. Specifically, past research has focused on humans' intuitive tendency to perceive minds as part of the cognitive foundations of belief in a personified God—an agentic, morally concerned supernatural entity. However, much less is known about belief in karma—another culturally widespread but ostensibly non‐agentic supernatural entity reflecting ethical causation across reincarnations. In two studies and four high‐powered samples, including mostly (...) Christian Canadians and mostly Hindu Indians (Study 1, N = 2,006) and mostly Christian Americans and Singaporean Buddhists (Study 2, N = 1,752), we provide the first systematic empirical investigation of the cognitive intuitions underlying various forms of belief in karma. We used path analyses to (a) replicate tests of the previously documented cognitive predictors of belief in God, (b) test whether this same network of variables predicts belief in karma, and (c) examine the relative contributions of cognitive and cultural variables to both sets of beliefs. We found that cognitive tendencies toward intuitive thinking, mentalizing, dualism, and teleological thinking predicted a variety of beliefs about karma—including morally laden, non‐agentic, and agentic conceptualizations—above and beyond the variability explained by cultural learning about karma across cultures. These results provide further evidence for an independent role for both culture and cognition in supporting diverse types of supernatural beliefs in distinct cultural contexts. (shrink)

Recent influential criticisms attack the reputation of Thomas Harriot by citing the contents of his ethnographic and economic survey, A briefe and true report of the new found land of Virginia, first published in 1588. This interpretation makes Harriot, together with Shakespeare and others, agents of a colonialist project. But profound differences are indicated in the comparison of the relatively unbiased depiction and analysis by Harriot and his artist collaborator John White with the interpretations of America and Americans by (...) some of their contemporaries. A briefe and true report conveys, and John White's drawings support, insight into particular non-European features of the cultural and economic lives of the Algonquian peoples. On the contrary, Captain Arthur Barlowe's Discourse and the illustrations by Theodore de Bry for the 1600 edition of Harriot's book instance romanticizing, stereotyping, and unanalytic condescension very unlike Harriot's and White's. These differences prove the faultiness of the recent assessment. (shrink)

Public health care interventions—regarding vaccination, obesity, and HIV, for example—standardly take the form of information dissemination across a community. But information networks can vary importantly between different ethnic communities, as can levels of trust in information from different sources. We use data from the Greater Pittsburgh Random Household Health Survey to construct models of information networks for White and Black communities--models which reflect the degree of information contact between individuals, with degrees of trust in information from various sources correlated (...) with positions in that social network. With simple assumptions regarding belief change and social reinforcement, we use those modeled networks to build dynamic agent-based models of how information can be expected to flow and how beliefs can be expected to change across each community. With contrasting information from governmental and religious sources, the results show importantly different dynamic patterns of belief polarization within the two communities. (shrink)

The Latin manuscript of Hobbes’s critique of White’s De mundo dialogi tres was discovered among the Mersenne papers in the Bibliothèque Nationale by Jean Jacquot and published by Jacquot and Jones. The present English translation makes generally available a text that, while following the disposition of White’s, goes beyond commentary to constitute a work of philosophy in its own right and a significant addition to the Hobbesian corpus.

The vestibular system encodes motion and orientation of the head in space and is essential for negotiating in and interacting with the world. Recently, random waveform electric vestibular stimulation has become an increasingly common means of probing the vestibular system. However, many of the methods used to analyze the behavioral response to this type of stimulation assume a linear relationship between frequencies in the stimulus and its associated response. Here we examine this stimulus-response frequency linearity to determine the validity of (...) this assumption. Forty-five university-aged subjects stood on a force-plate for 4 min while receiving vestibular stimulation. To determine the linearity of the stimulus-response relationship we calculated the cross-frequency power coupling between a 0 and 25 Hz bandwidth limited white noise stimulus and induced postural responses, as measured using the horizontal forces acting at the feet. Ultimately, we found that, on average, the postural response to a random stimulus is linear across stimulation frequencies. This result supports the use of analysis methods that depend on the assumption of stimulus-response frequency linearity, such as coherence and gain, which are commonly used to analyze the body’s response to random waveform electric stimuli. (shrink)

Analytic philosophers have been rather timid about moving beyond the relatively well defined epistemological issues and meta-ethical issues which have been the central concern of Anglo-Saxon philosophers. Yet there has always been the implicit claim that analytic tools could be extended to a much larger horizon. While there is little that is dramatic in this collection of essays, it does present some of the best contemporary Anglo-Saxon philosophers attempting to chart the logical geography of the concept of education and to (...) clear up a number of muddles that persistently cling to discussions of education. In addition to Peters, there are essays by Hamlyn, Hirst, Vesey, Dearsen, Black, Ryle, Scheffler, Oakeshott, J. P. White and Passmore.--R. J. B. (shrink)

AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on (...) global and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)

The ethical principle of ‘respect for persons’ in clinical research has traditionally focused on protecting individuals’ autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals’ rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English or Spanish (...) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female, identified as Hispanic/Latino or non-Hispanic white, reported annual household income under US$60 000 and did not have a Bachelor’s degree ; 30% had limited health literacy. We identified four key domains for demonstrating respect: personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; study communication processes, including following up and sharing results with participants; inclusion, particularly ensuring materials are understandable and procedures are accessible; and consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

The existential analysis -- The death of dasein -- The timeliness of dasein -- The derivation of time -- The time of being.

From Greek antiquity to the latest theories, this historical survey of political philosophy not only covers the major thinkers in the field but also explores the theme of how political philosophy relates to the nature of man. It illustrates how the great political thinkers have always grounded their political thought in what the author terms a "normative anthropology," which typically has not only ethical but metaphysical and/or theological components. Starting with the ancient Greek Sophists, author Michael J. White examines (...) how thinkers over the centuries have approached such political and philosophical concerns as justice, morality, and human flourishing, offering substantial studies of--among others--Plato, Aristotle, Cicero, Locke, Hobbes, Rousseau, Marx, and J. S. Mill. White highlights the impact of Christianity on political philosophy, illustrating the diversity of that impact by studies of Augustine, Aquinas, and Marsilius of Padua. Concluding with an in-depth analysis of John Rawls and contemporary liberal political philosophy, this text blends insight and information in a refreshing and useful manner. A brief Epilogue considers both the value and the limitations of political philosophy and its study. (shrink)

The social, educational and political writings of Jean-Jacques Rousseau have become enormously influential in the 200 years since his death. But the breadth as well as the depth of Rousseau's achievement - he was amongst other things a creative writer and musical composer as well as a philosopher - is not always appreciated. In around 100 articles, alphabetically arranged and fully cross-referenced, N. J. H. Dent explores all facets of Rousseau's work and thoughts, while his subject's remarkable life is summarized (...) in a biographical introduction. Details of works by and about Rousseau are listed in an extensive bibliography. For students or general readers seeking an introduction to Rousseau's work, and for those already familiar with the material who require a convenient reference source, this dictionary is essential reading. (shrink)

A high percent of oxidative energy metabolism is needed to support brain growth during infancy. Unhealthy diets and limited nutrition, as well as other environmental insults, can compromise these essential developmental processes. In particular, iron deficiency anemia has been found to undermine both normal brain growth and neurobehavioral development. Even moderate ID may affect neural maturation because when iron is limited, it is prioritized first to red blood cells over the brain. A primate model was used to investigate the neural (...) effects of a transient ID and if deficits would persist after iron treatment. The large size and postnatal growth of the monkey brain makes the findings relevant to the metabolic and iron needs of human infants, and initiating treatment upon diagnosis of anemia reflects clinical practice. Specifically, this analysis determined whether brain maturation would still be compromised at 1 year of age if an anemic infant was treated promptly once diagnosed. The hematology and iron status of 41 infant rhesus monkeys was screened at 2-month intervals. Fifteen became ID; 12 met clinical criteria for anemia and were administered iron dextran and B vitamins for 1–2 months. MRI scans were acquired at 1 year. The volumetric and diffusion tensor imaging measures from the ID infants were compared with monkeys who remained continuously iron sufficient. A prior history of ID was associated with smaller total brain volumes, driven primarily by significantly less total gray matter and smaller GM volumes in several cortical regions. At the macrostructual level, the effect on white matter volumes was not as overt. However, DTI analyses of WM microstructure indicated two later-maturating anterior tracts were negatively affected. The findings reaffirm the importance of iron for normal brain development. Given that brain differences were still evident even after iron treatment and following recovery of iron-dependent hematological indices, the results highlight the importance of early detection and preemptive supplementation to limit the neural consequences of ID. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

Smart grids are rolling out internationally, with the United States nearing completion of a significant USD4-plus-billion federal program funded under the American Recovery and Reinvestment Act. The emergence of smart grids is widespread across developed countries. Multiple approaches to analyzing the benefits of smart grids have emerged. The goals of this white paper are to review these approaches and analyze examples of each to highlight their differences, advantages, and disadvantages. This work was conducted under the auspices of a joint (...) U.S.-China research effort, the Climate Change Working Group Implementation Plan, Smart Grid. We present comparative benefits assessments of smart grid demonstrations in the U.S. and China along with a BA of a pilot project in Europe. In the U.S., we assess projects at two sites: the University of California, Irvine campus, which consists of two distinct demonstrations: Southern California Edison’s Irvine Smart Grid Demonstration Project and the UCI campus itself; and the Navy Yard area in Philadelphia, which has been repurposed as a mixed commercial-industrial, and possibly residential, development. In China, we cover several smart-grid aspects of the Sino-Singapore Tianjin Eco-city and the Shenzhen Bay Technology and Ecology City. In Europe, we look at a BA of a pilot smart grid project in the Malagrotta area west of Rome, Italy, contributed by the Joint Research Centre of the European Commission. The Irvine sub-project BAs use the U.S. Department of Energy Smart Grid Computational Tool, which is built on methods developed by the Electric Power Research Institute. The TEC sub-project BAs apply Smart Grid Multi-Criteria Analysis developed by the State Grid Corporation of China based on the analytic hierarchy process with fuzzy logic. The B-TEC and TNY sub-project BAs are evaluated using new approaches developed by those project teams. JRC has adopted an approach similar to EPRI’s but tailored to the Malagrotta distribution grid. (shrink)

An essay in the "new" metaphysics which has been emerging from English analytic philosophy. Acknowledging his debt to Wittgenstein, Shwayder concedes that what he has to offer "is nothing but philosophical theory in pretty much the old-fashioned sense." The three foci are referring, properties, and natural numbers. The multifarious and subtle distinctions are the source both of the book's strength and weakness. The concern and care for detailed shades of meaning frequently gets in the way of a more general metaphysical (...) view of the problems treated. --R. J. B. (shrink)

Arguing from a sort of reasonable Protestant ethic, Henry offers a worthwhile and sometimes quite practical analysis of a Christian social ideal. In Henry's approach, no "prattling about love" can take the place of justice when the latter is what is needed.—D. J. B.

Marsh borrows Richard McKeon's methodological notion of the "problematic" approach to intellectual history. Concentrating on their dialectical character, English criticism from 1650-1800 is explored in the writings of the third Earl of Shaftesbury, Mark Akenside, David Hartley, and James Harris.—D. J. B.

Weaving together a diverse range of scholarly-activist intersectional voices from around the world, Critical Animal Studies and Activism: International Perspectives on Total Liberation and Intersectionality co-edited by Anthony J. Nocella II and Richard J. White makes a powerful contribution to knowledge and understanding. It is essential reading for environmentalists, animal advocates, social justice organizers, policy-makers, social change-makers, and indeed for all those who care about the future of this planet. This book spans many scholar disciplines and activist social movements, (...) and provides new insights to fundamental debates surrounding inter-species justice, liberation, and democracy. This critical theory for total liberation book expands the understanding of one struggle one fight: for human freedom, for animal rights, and for the liberation of the earth herself. Rooted in a radical praxis, the book argues that those in academia that claim critical animal studies, need to hit the streets with the protesters and the protesters need to join the theoretical conversations. Theory and practice and not binaries, but two pieces of a larger goal. Read this book and use its arguments to take the fight to smash capitalism, oppression, and domination in all its forms! (shrink)

Using the principles and sometimes the conclusions of his teacher Adolf Stöhr, Cleve insists that he is giving a philosophical interpretation and not simply a philological reconstruction of these Pre-Socratics. The philosophers have been divided into 1) "Religious Reformers", 2) "Philosophers of Nature", 3) "Champions of Culture Politics"—"The Glossomorphics". There will certainly be disagreement on some of Cleve's interpretations but it must be said that Cleve carries through his philosophical reconstruction with admirable lucidity and consistency though, occasionally, some of his (...) criticisms of the "philologists" are rather waspish. Nevertheless, this is a splendid and important study which is a tribute to the author's erudition and insight.—D. J. B. (shrink)

This out of print work offered researchers a comprehensive and easy to use bibliography of primary and secondary works by or about Collingwood. More than 1,200 citations were listed alphabetically by standard bibliographical categories in this volume, which contained a periodical index as well as author and subject indexes. In addition, each book entry included a "review alert" listing the names of reviewers. Author notes clarified the significance of a listed work when this was not apparent from the title, and (...) the number of pages was indicated for very long or very short monographs. This volume remains a standard reference work for Collingwood scholars and it is available in research libraries around the country. (shrink)

On September 1, 2023, Texas made important revisions to it its decades‐old statute granting legal safe harbor immunity to physicians who withhold or withdraw life‐sustaining treatment over the objection of critically ill patients’ surrogate decision‐makers. However, lawmakers left untouched glaring flaws in a key safeguard for patients—the transfer option. The transfer option is ethically important because, when no hospital is willing to accept the patient in transfer, that fact is taken as strong evidence that the surrogates’ treatment requests fall outside (...) accepted medical practice. But there are serious shortcomings in how the transfer option is carried out in Texas and many other states, which undermines the ethical usefulness of the process. We identify these shortcomings and recommend revisions to state statutes and professional guidelines to overcome them. (shrink)

This article focuses on the anxiety about whether God loves one or not. In the author's nearly 30-year ministry, this pastoral difficulty continues to perplex and afflict. While the presenting problem is what in theological parlance is 'a lack of assurance', a side difficulty is the poor and incorrect doctrine of God often associated with this. A Baylor University Study in 2006 characterises the kind of God that different groups of Americans believe in. While the phrase 'a lack of assurance' (...) is a part of dogmatic parlance, and has fallen out of use, the feeling of not belonging to God can be overwhelming for people. This feeling may be overwhelming. This makes it a pastoral issue. This article suggests a pastoral response to this issue and a proposal for a clarification in the nature and character of God using the therapeutic theology of 19th-century Scottish minister-theologian John McLeod Campbell. (shrink)

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)