Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It is (...) hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system. (shrink)

Background Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It (...) is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Main body Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Conclusion Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system. (shrink)

I argue against pessimistic readings of the Buddhist tradition on which unawakened beings invariably have lives not worth living due to a preponderance of suffering (duḥkha) over well-being.

Many accept the following three theses in animal ethics. First, although animal welfare should not be—or at least, need not be—our top moral priority, it is not a trivial one either. Second, if an animal is sentient, then it is a moral patient. Third, the extinction of an animal species is a tragic outcome that we have moral reason to prevent. I argue that a traditional (i.e., pre-modern) Buddhist perspective pushes against the first thesis and that a naturalized Buddhist perspective (...) is inconsistent with the latter two. (shrink)

Maximize Expected Choiceworthiness (MEC) is a theory of decision-making under moral uncertainty. It says that we ought to handle moral uncertainty in the way that Expected Value Theory (EVT) handles descriptive uncertainty. MEC inherits from EVT the problem of fanaticism. Roughly, a decision theory is fanatical when it requires our decision-making to be dominated by low-probability, high-payoff options. Proponents of MEC have offered two main lines of response. The first is that MEC should simply import whatever are the best solutions (...) to fanaticism on offer in decision theory. The second is to propose statistical normalization as a novel solution on behalf of MEC. This paper argues that the first response is open to serious doubt and that the second response fails. As a result, MEC appears significantly less plausible when compared to competing accounts of decision-making under moral uncertainty, which are not fanatical. (shrink)

"A new translation by Henry Beveridge, Esq.".

The ethical restatement of the “risk and crisis communication in public health emergency” (PHERCC) matrix by Spitale et al. (2024) is a step up from mainstream approaches like the Crisis and Emerge...

The main purpose of this study was to validate a scale to examine the moral sensitivity of Korean nurses. A pre-existing scale, the Moral Sensitivity Questionnaire (MSQ), developed by Lützén, was used after deletion of three items. The reliability and validity of the scale were examined by using Cronbach’s alpha and factor analysis, respectively. According to the results, reliability of the scale was adequate but its construct validity was not fully supported. Through discussion on evidence of validity, five subconstructs emerged. (...) In particular, unlike the factor structure of the MSQ, two subconstructs, patient-oriented care and professional responsibility, were newly extracted. It was assumed that the other three MSQ subconstructs, conflict, meaning and benevolence (expressed as nurses being ethically good), would not be sensitive to cultural background. Given these findings, interpretations about the meaning of moral sensitivity of Korean nurses are discussed. (shrink)

This chapter traces some of the ancient and medieval history of the debate about whether there are distinct and potentially conflicting true goods or genuine tension between the pursuit of self-interest and the pursuit of what has intrinsic value. Much modern moral theory posits that morally good agents are prepared to restrain the pursuit of even their enlightened self-interest when it conflicts with what is intrinsically good or is good for others. This puts Morality at odds with a long Ethical (...) tradition that is especially indebted to Aristotle and his followers and that proposes the ultimate aim of any rational agent to be that agent’s flourishing or happiness. The chapter concludes, pace Elizabeth Anscombe and Alasdair MacIntyre, that while the view embedded in much modern moral theory reached its full development in the context of a theologically infused medieval tradition, which involved Anselm of Canterbury, Peter Abelard and John Duns Scotus, its roots are earlier, and its metaphysical underpinnings are independent of that context. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

logical failure or contradiction by a fact. Intuition alone can decide between two competing theories agreeing with the facts. (ibid. ...

It is often said that an argument is valid if and only if it is impossible for its premises to be jointly true and its conclusion false. Usually there is little harm in saying this but it places the concept of truth at the very heart of logic and, given how complex and obscure that concept is, one might wonder if trouble arises from this.It does — in at least two contexts. One of these was explored in the first half (...) of the fourteenth century by Jean Buridan and by the mysterious figure known as the Pseudo-Scotus of the Questions on the Prior Analytics printed in the edition of Scotus's works edited by Luke Wadding. Buridan thought that the bearers of truth were particular sentence-tokens; he thought of truth as a .. (shrink)

This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced (...) were ‘family giving up on a patient because he or she could not be cured’, and ‘not telling the truth to the patient’. The Korean Nurses’ Code of Ethics was applied, in particular the preamble, and the third, fourth, seventh and tenth clauses. The most common rule of ethics and principle applied in these nurses’ ethical decision making were veracity and nonmaleficence. With regard to the moral reasoning process, the primary concern was the welfare of the patients. These students were equipped with the ability to exercise critical and reflective thought when they experienced ethical dilemmas. (shrink)

Drawing upon Hannah Arendt's and Carl Schmitt's theories on the relationship between nomos and boundary, this paper revisits how constitutionalism and political power are reconciled as constitutional ordering. It first analyzes constitutionalism in the light of political modernity. Indicating that political power grounded by constitutions is omnipotent, complementing and completing constitutionalism, the paper contends that an omnipotent constitutional ordering is anything but an unleashed Leviathan. It is argued that constitutional omnipotence is framed and thus constrained by a constitutional nomos, the (...) matrix of which is a dual delimitation of boundaries, generational, and jurisdictional. (shrink)

We consider how human subjects establish signaling conventions in the context of Lewis-Skyrms signaling games. These experiments involve games where there are precisely the right number of signal types to represent the states of nature, games where there are more signal types than states, and games where there are fewer signal types than states. The aim is to determine the conditions under which subjects are able to establish signaling conventions in such games and to identify a learning dynamics that approximates (...) how they succeed when they do. Our results suggest that human agents tend to use a win-stay/lose-shift with inertia dynamics to establish conventions in such games. We briefly consider the virtues and vices of this low-rationality dynamics. (shrink)

Purpose: The purpose of this study was to verify the long-term effect of adverse childhood experiences, school disengagement, and the reasons for leaving school on adolescent delinquency while adjusting for sex.Methods: Data were collected from 663 teenagers [male 368, female 295; mean age = 16.81 ; age range = 13–19 years] through a Longitudinal Survey and Support Plan for Dropouts.Results: Multivariate latent growth modeling demonstrated that ACEs and school disengagement are positively associated with delinquency and the mediating effect of school (...) disengagement on association between ACEs and delinquency was verified. Teenagers who quit school for personal reasons reported fewer instances of delinquent behavior than adolescents who left because of school reasons.Conclusion: This study suggests that researchers and teachers need to consider ACEs and school disengagement as a warning index for delinquency with school dropout. In addition, the reason for leaving school should be considered to clarify the effect of school dropout on delinquency in adolescents who dropout. (shrink)

PurposeThis study aimed to examine the long-term association between social activity, physical function decline and cognitive function, as well as verify the long-term mediating effect of physical function decline on the relationship between social activity and cognitive function.MethodsData from the Korean Longitudinal Study of Aging that was collected over 10 years was analyzed. The sample included 10,240 adults aged 45–93 years. Multivariate latent growth modeling was applied to verify the long-term effect of social activity and physical function on cognitive function.ResultsThe (...) results revealed that social activity had a positive impact on cognitive function and negative impact on physical function decline after controlling for age and education level. Additionally, physical function decline negatively influenced cognitive function. Finally, social activity indirectly affected cognitive function through physical function decline.ConclusionThe contribution of this study was to test the long-term effect social activity on physical and cognitive function. (shrink)

No detailed description available for "Li Ta-Chao and the Impact of Marxism on Modern Chinese Thinking".

In _Ontological Terror_ Calvin L. Warren intervenes in Afro-pessimism, Heideggerian metaphysics, and black humanist philosophy by positing that the "Negro question" is intimately imbricated with questions of Being. Warren uses the figure of the antebellum free black as a philosophical paradigm for thinking through the tensions between blackness and Being. He illustrates how blacks embody a metaphysical nothing. This nothingness serves as a destabilizing presence and force as well as that which whiteness defines itself against. Thus, the function of (...) blackness as giving form to nothing presents a terrifying problem for whites: they need blacks to affirm their existence, even as they despise the nothingness they represent. By pointing out how all humanism is based on investing blackness with non-Being—a logic which reproduces antiblack violence and precludes any realization of equality, justice, and recognition for blacks—Warren urges the removal of the human from its metaphysical pedestal and the exploration of ways of existing that are not predicated on a grounding in Being. (shrink)