I welcome Mr Kennedy's general approach, but query whether the concept of consumerism is so closely applicable to medical care as he maintains. However, in particular aspects, especially the handling of complaints, his criticisms echo those made by the Patients Association. Finally, I detect some ground for hope in the more enlightened attitude creeping in to the eduction of the medical student.

The phrase τά ένί διαστηματι γ ραφόμενα occurs in that part of Pappus' Collection Book VIII which deals with instrumental solutions to problems more practical than purely geometrical. In the preceding section an instrumental solution for the problem of doubling the cube has been propounded, which is dependent on the use of a ruler passing through a point about which it is turned in the generation of the locus of points known as the cissoid, and in the subsequent section a (...) solution is propounded for the problem of finding the diameter of a cylinder of which only an incomplete portion of the side remains, leaving neither base intact. (shrink)

Biobanks are increasingly being created specifically for research purposes. Concomitantly, we are seeing significant and evolving shifts in research ethics in relation to biobanking. Three discrete shifts are identified in this article. The first extends the ethical focus beyond the protection of human subjects to the promotion of broader community benefits of research utilizing biobanked resources, and an expectation that these benefits will be shared. The second involves the evolution of the traditional consent paradigm for future research uses of biobanks (...) resources that are not in contemplation at the time of donation. The third involves a move away from single project management to more dynamic governance accountability to research participants and the public. These shifts may take different local and institutional forms but share common recognizable elements. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

This article seeks to shed light on the beliefs that influence nurses’ intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses’ beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying (...) with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients’ wishes, nurses should be aware that they do not systematically guarantee respect of a patient’s autonomy, nor do they replace a relationship based on trust between patients and health care professionals. (shrink)

Ever since the work of Otto Miiller it has been generally agreed that the most important manuscript of the Thebaid is Puteaneus, a ninth-century manuscript in the Bibliothèque Nationale. It is not only the earliest extant manuscript but it has a large number of readings not found elsewhere, many of which are obviously preferable to what is offered by the other tradition, normally referred to as ω. Both traditions are early, however, since Lactantius depends on inferior ω material while Priscian (...) seems to have followed the P tradition. (shrink)

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: (...) Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. (shrink)

There is a common view in medical ethics that the patient's right to be informed entails, as well, a correlative right not to be informed, i.e., to waive one's right to information. This paper argues, from a consideration of the concept of autonomy as the foundation for rights, that there can be no such ‘right’ to refuse relevant information, and that the claims for such a right are inconsistent with both deontological and utilitarian ethics. Further, the right to be informed (...) is shown to be a mandatory right (though not a welfare right); persons are thus seen to have both a right and a duty to be informed. Finally, the consequences of this view are addressed: since the way in which we conceptualize our problems tends to determine the actions we take to resolve them, it is important properly to conceptualize patients' requests not to be informed. There may be many reasons for acting in accord with such a request, but it is a mistake to conceptualize one's act as ‘respecting a right possessed by persons’. Keywords: medical ethics, informed consent, autonomy, information-waivers, rights, obligations CiteULike Connotea Del.icio.us What's this? (shrink)

Philosophers of technology are not playing the public role that our own theoretical perspectives motivate us to take. A great variety of theories and perspectives within philosophy of technology, including those of Marcuse, Feenberg, Borgmann, Ihde, Michelfelder, Bush, Winner, Latour, and Verbeek, either support or directly call for various sorts of intervention—a call that we have failed to heed adequately. Barriers to such intervention are discussed, and three proposals for reform are advanced: post-publication peer-reviewed reprinting of public philosophy, increased emphasis (...) on true open access publication, and increased efforts to publicize and adapt traditional academic research. (shrink)

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

Infinite time Turing machines with only one tape are in many respects fully as powerful as their multi-tape cousins. In particular, the two models of machine give rise to the same class of decidable sets, the same degree structure and, at least for partial functions f : ℝ → ℕ, the same class of computable functions. Nevertheless, there are infinite time computable functions f : ℝ → ℝ that are not one-tape computable, and so the two models of infinitary computation (...) are not equivalent. Surprisingly, the class of one-tape computable functions is not closed under composition; but closing it under composition yields the full class of all infinite time computable functions. Finally, every ordinal that is clockable by an infinite time Turing machine is clockable by a one-tape machine, except certain isolated ordinals that end gaps in the clockable ordinals. (shrink)