Extra-corporeal membrane oxygenation has been introduced to clinical practice for several decades. It is unclear how internet and newspapers portray the use of extra-corporeal membrane oxygenation. This study were: (1) to quantify the coverage of extra-corporeal membrane oxygenation use in newspapers and on the Internet; (2) to describe the characteristics of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in (...) comparison with those shown in extra-corporeal membrane oxygenation studies in Taiwan; and (3) to examine the survival rates of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those in Taiwan and in the Extracorporeal Life Support Registry Report International Summary for January 2014. (shrink)

Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan.

LANGUAGE NOTE | Document text in Chinese; abstract also in English. ECMO是一項高風險、高創傷、高消耗的創新技術，它能夠為新冠病毒肺炎重症患者提供挽救性治療°ECMO的治療目標是幫助患者恢復心肺功能，或者橋接最終治療，包括器械植入，或者器官移植等。然而，容易被忽視的 事實是，ECMO挽救了一些患者的生命，但也可能讓那些沒有康復機會的患者陷入醫療困境。於是，ECMO的臨床應用不得不面對一些反對意見，包括嚴重併發症危害患者生命安全、無效治療導致技術失敗，以及大量佔用資 源損害醫療公平等。ECMO技術的臨床應用應該在尊重生命價值和患者意願的基礎上，合理設置治療目標、確立可接受退出標準、妥善處理患者意願與ECMO設備撤除困境之間的倫理衝突，建立適度倫理框架以合理控制醫療 干預的邊界。 Characterized by high risk, high trauma and high consumption, Extra-Corporeal Membrane Oxygenation (ECMO) is an innovative technology that can be used as salvage therapy for COVID-19 patients. ECMO treatment can help restore patients' cardiopulmonary function or can bridge their final treatment, including device implantation or organ transplantation. However, although ECMO saves some patients' lives, it can also leave those with no chance of recovery in (...) a medical dilemma. ECMO is thus controversial: it is criticized for technical failures and ineffective treatments, and its use raises questions about medical equity. This paper argues that the clinical application of ECMO technology should be based on a respect for the value of life and the will of patients, reasonably set therapeutic goals, acceptable withdrawal criteria, proper management of the conflict between patients' desires and the medical dilemma, and the establishment of an ethical framework to control the limits of medical intervention. (shrink)

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values. Clearly, this is a major challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely witnessed assessments where (...) both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates. (shrink)

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects (e.g., better tumour control, pain relief, improved mobility, etc.) at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values (e.g., individual responsibility for preserving good health, the value of human life, etc.). Clearly, this is a major (...) challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely witnessed assessments where both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates. (shrink)

Extracorporeal membrane oxygenation (ECMO) is a form of life support for cardiac and/or pulmonary failure with unique ethical challenges compared to other forms of life support. Ethical challenges with ECMO exist when conventional standards of care apply, and are exacerbated during periods of absolute ECMO scarcity when “crisis standards of care” are instituted. When conventional standards of care apply, we propose that it is ethically permissible to withhold placing patients on ECMO for reasons of technical futility or when (...) patients have terminal, short-term prognoses that are untreatable by ECMO. Under crisis standards of care, it is ethically permissible to broaden exclusionary criteria to also withhold ECMO from patients who have a low likelihood of recovery, to maximize the overall number of lives saved. Unilateral withdrawal of ECMO against a patient’s preferences is unethical under conventional standards of care, but is ethical under crisis standards of care to increase access to ECMO to others in society. ECMO should only be rationed when true scarcity exists, and allocation protocols should be transparent to the public. When rationing must occur under crisis standards of care, it is imperative that oversight bodies assess for inequities in the allocation of ECMO and make frequent changes to improve any inequities. (shrink)

Neonatal extracorporeal membrane oxygenation (ECMO), a technology for the treatment of respiratory failure in newborns, is used as a case study to examine statistical and ethical aspects of clinical trials and to illustrate a proposed 'ethics of evidence', an approach to medical uncertainty within the context of contemporary biomedical ethics. Discussion includes the twofold aim of the ethics of evidence: to clarify the role of uncertainty and scientific evidence in medical decision-making, and to call attention to the need (...) to confront the irreducible nature of uncertainty. (shrink)

Background Pediatric critical care physician attitudes about withdrawal of ventricular assist devices and extracorporeal membrane oxygenation in cases of medical futility are poorly defined. Our aim was to define current attitudes regarding the withdrawal of these devices. Methods IRB-approved, cross-sectional observational survey conducted among pediatric critical care attending physicians and fellow physicians in the United States between 2016 and 2017. Data was collected anonymously and statistically analyzed. Results A total of 158 physicians responded with 67% being attending physicians. (...) Compared to a VAD, a higher percentage had taken care of a patient on ECMO where the device was turned off because care was believed to be futile, including currently. Nearly all reported that it can be ethically permissible to withdraw support from a patient with a VAD and on ECMO, but varied opinions existed as to who should ultimately make this decision if the patient/their family disagrees. More respondents agreed that a patient/their family should agree to withdrawal of VAD or ECMO support prior to initiation if futility is later determined and that protocols should be created for VAD and ECMO withdrawal. Conclusion Most pediatric critical care physicians felt that it can be ethically permissible to withdraw VAD and ECMO support. Our study indicates that pediatric VAD and ECMO withdrawal protocols are desired, but further investigation is needed to determine how to best design protocols that would incorporate multiple stakeholders. (shrink)

Although the generation of reactive oxygen species is an activity normally associated with phagocytic leucocytes, mammalian spermatozoa were, in fact, the first cell type in which this activity was described. In recent years it has become apparent that spermatozoa are not the only nonphagocytic cells to exhibit a capacity for reactive oxygen species production, because this activity has been detected in a wide variety of different cells including fibroblasts, mesangial cells, oocytes, Leyding cells endothelial cells, thryroid cells, adipocytes, tumour cell (...) and platelets. Since the capacity to generate reactive oxygen species is apparently so widespread, the risk‐benefit equation for these potentially pernicious molecules becomes a matter of intese interest. In the case of human spermatozoa, the risk of manufacturing reactive oxygen metabolites is considerable because these cells are particularly vulnerable to lipid peroxidation. Indeed, there is now good evidence to indicate that oxygen radicals are involved in the initiation of peroxidative damage to the sperm plasma membrane, seen in many cases of male infertility. This risk is off‐set by recent data suggesting that superoxide anions and hydrogen peroxide also participate in the induction of key biological events such as hyperactiavated motility and the acrosome reaction. Thus, human spermatozoa appear to use reactive oxygen species for a physiological purpose and have the difficult task of ensuring the balanced generation of these potentially harmful, but biologically important, modulators of cellular function. (shrink)

Inner membranes of mitochondria are extensively folded, forming cristae. The observed overall correlation between efficient eukaryotic ATP generation and the area of internal mitochondrial inner membranes both in unicellular organisms and metazoan tissues seems to explain why they evolved. However, the crucial use of molecular oxygen (O2) as final acceptor of the electron transport chain is still not sufficiently appreciated. O2 was an essential prerequisite for cristae development during early eukaryogenesis and could be the factor allowing cristae retention upon loss (...) of mitochondrial ATP generation. Here I analyze illuminating bacterial and unicellular eukaryotic examples. I also discuss formative influences of intracellular O2 consumption on the evolution of the last eukaryotic common ancestor (LECA). These considerations bring about an explanation for the many genes coming from other organisms than the archaeon and bacterium merging at the start of eukaryogenesis. (shrink)

The Corporate Social Performance (CSP) model (Wood, Acad Manag Rev 164:691–718, 1991) assesses a firm’s social responsibility at three levels of analysis—institutional, organizational and individual—and measures the resulting social outcomes. In this paper, we focus on the individual level of CSP, manifested in the managerial discretion of a firm’s principles, processes, and policies regarding social responsibilities. Specifically, we address the human resources management of employees as a way of promoting CSR values and producing socially minded outcomes. We show that applying (...) the humanist philosophy to the managerial discretion of a business organization leads to the creation of an “autonomy supportive work environment”—as defined by the self-determination theory—which in turn, facilitates the internalization of social values, citizenship behaviors, and cooperation. The objective of promoting self-determination at work (i.e., the core of a humanist management) fits well with the ontology of social responsibility since autonomy and consideration of individuals as moral actors are central tenets. Furthermore, we show that applying humanistic management philosophy to the discretion of managers can lead to socially responsible outcomes. First, intra-organizational stakeholders (e.g., employees) are treated with respect and focus is put on their well-being, satisfaction, and self-actualization at work. Second, as employees’ need of self-determination is addressed by managers, it is likely that pro-social behaviors toward other stakeholders of the organization will be adopted, leading to socially responsible outcomes for extra-organizational stakeholders (Gagné, Motiv Emot 77:58–75, 2003). Thus, this paper ultimately posits that humanistic management applied to the HRM can be a solution for developing and maintaining socially responsible outcomes as determined at the individual level of the CSP model, through managerial discretion. (shrink)

In _Biocultural Creatures_, Samantha Frost brings feminist and political theory together with findings in the life sciences to recuperate the category of the human for politics. Challenging the idea of human exceptionalism as well as other theories of subjectivity that rest on a distinction between biology and culture, Frost proposes that humans are biocultural creatures who quite literally are cultured within the material, social, and symbolic worlds they inhabit. Through discussions about carbon, the functions of cell membranes, the activity of (...) genes and proteins, the work of oxygen, and the passage of time, Frost recasts questions about the nature of matter, identity, and embodiment. In doing so, she elucidates the imbrication of the biological and cultural within the corporeal self. In remapping the relation of humans to their habitats and arriving at the idea that humans are biocultural creatures, Frost provides new theoretical resources for responding to political and environmental crises and for thinking about how to transform the ways we live. (shrink)

Corporate social responsibility (CSR) has become a focal point for research aimed at extending business ethics to extra-corporate issues; and as a result many companies now seek to at least appear dedicated to one or another version of CSR. This has not affected the arms industry, however. For, this industry has not been discussed in CSR literature, perhaps because few CSR scholars have questioned this industry's privileged status as an instrument of national sovereignty. But major changes in the organization (...) of political communities call traditional views of sovereignty into question. With these considerations in mind I assess the U.S. arms industry on the basis of CSR requirements regarding the environment, social equity, profitability, and use of political power. I find that this industry fails to meet any of these four CSR requirements. Countering a claim that these failings should not be held against arms manufacturers because their products are crucial to national defense, I contend that many of these companies function not as dutiful agents of a nation-state but as politically powerful entities in their own right. So, I conclude, they should be held responsible for the foreseeable consequences that flow from use of their products. This responsibility should include civil liability and, in cases involving war crimes and violations of human rights, responsibility under international human rights standards. (shrink)

Recently, the group of McBride reported a stunning observation regarding peroxisome biogenesis: newly born peroxisomes are hybrids of mitochondrial and ER-derived pre-peroxisomes. What was stunning? Studies performed with the yeast Saccharomyces cerevisiae had convincingly shown that peroxisomes are ER-derived, without indications for mitochondrial involvement. However, the recent finding using fibroblasts dovetails nicely with a mechanism inferred to be driving the eukaryotic invention of peroxisomes: reduction of mitochondrial reactive oxygen species generation associated with fatty acid oxidation. This not only explains the (...) mitochondrial involvement, but also its apparent absence in yeast. The latest results allow a reconstruction of the evolution of the yeast's highly derived metabolism and its limitations as a model organism in this instance. As I review here, peroxisomes are eukaryotic inventions reflecting mutual host endosymbiont adaptations: this is predicted by symbiogenetic theory, which states that the defining eukaryotic characteristics evolved as a result of mutual adaptations of two merging prokaryotes. See also the video abstract here: https://youtu.be/HtyKhQ3DSxg Eukaryotic peroxisomes illustrate effects of symbiogenesis, following the non-phagocytotic merger of an archaeon and a bacterium. Internal ROS formation upon fatty acid oxidation was reduced by the invention of peroxisomes for extra-mitochondrial FA oxidation. Both peroxisomal membranes and their oldest enzymes seem ultimately derived from the pre-mitochondrion. (shrink)

What kind of symbiosis between archaeon and bacterium gave rise to their eventual merger at the origin of the eukaryotes? I hypothesize that conditions favouring bacterial uptake were based on exchange of intermediate carbohydrate metabolites required by recurring changes in availability and use of the two different terminal electron chain acceptors, the bacterial one being oxygen. Oxygen won, and definitive loss of the archaeal membrane potential allowed permanent establishment of the bacterial partner as the proto‐mitochondrion, further metabolic integration and (...) highly efficient ATP production. This represents initial symbiogenesis, when crucial eukaryotic traits arose in response to the archaeon‐bacterium merger. The attendant generation of internal reactive oxygen species (ROS) gave rise to a myriad of further eukaryotic adaptations, such as extreme mitochondrial genome reduction, nuclei, peroxisomes and meiotic sex. Eukaryotic origins could have started with shuffling intermediate metabolites as is still essential today. (shrink)

Management scholars have paid close attention to the construct of organizational or corporate reputation, particularly in the applied business ethics and corporate social responsibility fields. Extant research demonstrates that CR is one of the key mediators between CSR and important organizational outcomes, which ultimately improve organizational performance. Yet, hitherto the research focused on CR construct has been plagued by multiple definitions, conflicting conceptualizations, and unclear operationalizations. The purpose of this article is to provide theoretical ground for positioning of CR as (...) an assessment construct that is modeled as a second-order factor affecting individual first-order dimensions, and to provide methodological and empirical support toward such conceptualization. We assert that intangible, socially complex, and causally ambiguous CR can be accurately estimated through its individual measurable dimensions. Using survey data from Peru, we empirically test the hypothesized second-order reflective model within a hierarchy of nested and non-nested models, and compare its model fit and predictive power with alternative conceptualizations. Modeling CR as a second-order reflective construct relies on a set of theoretical propositions and yields several methodological advantages, including strong conceptual interpretability and parsimony when tested within a nomological context. We explicitly demonstrate positive organizational outcomes of CR: customer trust, corporate identification, in-role behavior, and extra-role behavior. Then, we demonstrate that the shorter scales of CR can be used as a good proxy for the full construct measure. The paper concludes by highlighting theoretical insights, and methodological and managerial implications of the findings. (shrink)

The United Nations Special Representative on Transnational Corporations and Human Rights, John Ruggie, has adopted a new framework for considering this issue within the international legal system. This article examines this framework in terms of its coherence, its consistency with international human rights law and how it can be 'operationalized' (which is required by the United Nations). In regard to the states legal obligation to protect human rights, it is considered whether this obligation is broader and deeper than is envisaged (...) in the framework, especially if it can include the extra-territorial activities of corporations. The corporate responsibility to respect human rights is examined in terms of its conceptual and definitional problems, and the article also questions whether there will be sufficient legal remedies available to victims under the framework. (shrink)

All the biological membranes contain oxidoreduction systems actively involved in their bioenergetics. Plasma membrane redox systems seem to be ubiquitous and they have been related to several important functions, including not only their role in cell bioenergetics, but also in cell defense through the generation of reactive oxygen species, in iron uptake, in the control of cell growth and proliferation and in signal transduction. In the last few years, an increasing number of mechanistic and molecular studies have deeply widened (...) our knowledge on the function of these plasma membrane redox systems. The aim of this review is to summarize what is currently known about the components and physiological roles of these systems. (shrink)

Corporate social responsibility has become a focal point for research aimed at extending business ethics to extra-corporate issues; and as a result many companies now seek to at least appear dedicated to one or another version of CSR. This has not affected the arms industry, however. For, this industry has not been discussed in CSR literature, perhaps because few CSR scholars have questioned this industry's privileged status as an instrument of national sovereignty. But major changes in the organization of (...) political communities call traditional views of sovereignty into question. With these considerations in mind I assess the U.S. arms industry on the basis of CSR requirements regarding the environment, social equity, profitability, and use of political power. I find that this industry fails to meet any of these four CSR requirements. Countering a claim that these failings should not be held against arms manufacturers because their products are crucial to national defense, I contend that many of these companies function not as dutiful agents of a nation-state but as politically powerful entities in their own right. So, I conclude, they should be held responsible for the foreseeable consequences that flow from use of their products. This responsibility should include civil liability and, in cases involving war crimes and violations of human rights, responsibility under international human rights standards. (shrink)

This study investigates whether employees attribute different motives to their organization's corporate social responsibility efforts and if these motives influence employee performance. Specifically, we investigate whether employees could distinguish between intrinsic and extrinsic CSR motives by surveying 229 employee–supervisor dyads from various industries , and the impact of these perceptions on in-role and extra-role performance of subordinates. We found that employee task performance increases when employees attribute both intrinsic and extrinsic motives for CSR. Moreover, when employees perceive that their (...) organization invests in a CSR practice that is both intrinsic and extrinsic, they also tend to exert extra effort in their work. Theoretical and practical implications are also discussed alongside future research directions. (shrink)

Despite the extensive research in both the determinants and the results of corporate social responsibility (CSR), relatively few studies have considered extra-legal institutions as potential determinants of CSR. Our work fills this gap by looking at how media attention affects CSR over a long-term period in a continental European setting. Our results show that media coverage positively affects CSR. Additional scrutiny triggered by media coverage encourages dominant owners to signal their commitment to limiting self-dealing transactions and their orientation toward (...) stakeholders' needs through CSR investments. Additionally, our results reveal that this signaling device offers greater benefits and lower costs in firms where controlling owners show a voting-cash flow wedge. Our results are relevant to different actors such as investors, auditors, and policy makers as they provide solid evidence that media coverage is an important driver of CSR orientation in a continental European setting. (shrink)

This study examines the impact of corporate tax avoidance on board of directors and chief executive officer reputation. Our regression results show that when firms engage in tax avoidance, both directors and CEOs, on average, are rewarded by improvements in their reputations as proxied by an increased number of outside board seats. In particular, both independent directors and non-CEO executive directors undergo positive changes in reputation. We also find that CEOs of tax-aggressive firms experience enhanced reputations by gaining extra (...) board seats. Our main regression results hold based on additional analyses. Overall, this study provides important empirical evidence confirming an association between tax avoidance and the individual reputations of directors and CEOs. (shrink)

Porter and Kramer are very clear that shared value is not corporate social responsibility. Not only do they criticize the four principles on which CSR rests: moral obligation, sustainability, license to operate, and reputation, as ineffective and vague, they maintain that the only reason for companies to engage in sustainability projects is to decrease costs and thus increase profits, not because they have a corporate responsibility to help protect the environment the people who dwell in it. Because social problems cause (...) extra costs for companies and thus decrease profits, they say that companies should have strategies that might appear to be socially responsible, but are not because the intent is to improve profits. This paper will describe the current definitions and focus of CSR, explain shared value, and then propose ways that commitment to CSR can be made public by leaders and their businesses, such as using social license to operate, third-party assessors, and new business structures. (shrink)

The use of language models in Web applications and other areas of computing and business have grown significantly over the last five years. One reason for this growth is the improvement in performance of language models on a number of benchmarks — but a side effect of these advances has been the adoption of a “bigger is always better” paradigm when it comes to the size of training, testing, and challenge datasets. Drawing on previous criticisms of this paradigm as applied (...) to large training datasets crawled from pre-existing text on the Web, we extend the critique to challenge datasets custom-created by crowdworkers. We present several sets of criticisms, where ethical and scientific issues in language model research reinforce each other: labour injustices in crowdwork, dataset quality and inscrutability, inequities in the research community, and centralized corporate control of the technology. We also present a new type of tool for researchers to use in examining large datasets when evaluating them for quality. (shrink)

In this paper, the process for firms to decide whether or not to invest in corporate social responsibility is treated from a real option perspective. We extend the Husted framework with an important extra parameter that allows us to understand the timing of CSR investment and explain why some companies drag their feet over CSR investments. Our model explicitly allows for the impact of the opportunity cost of delaying the CSR investment decision, providing firms with tools to determine the (...) optimal moment of exercising the CSR investment option. We illustrate our timing model through a case study and analyze governmental support strategies for CSR from a real options perspective. (shrink)

In this paper, the process for firms to decide whether or not to invest in corporate social responsibility is treated from a real option perspective. We extend the Husted framework with an important extra parameter that allows us to understand the timing of CSR investment and explain why some companies drag their feet over CSR investments. Our model explicitly allows for the impact of the opportunity cost of delaying the CSR investment decision, providing firms with tools to determine the (...) optimal moment of exercising the CSR investment option. We illustrate our timing model through a case study and analyze governmental support strategies for CSR from a real options perspective. (shrink)

This essay identifies epistemological, theoretical and methodological problems in a potentially influential subset of the interdisciplinary corporate responsibility literature, that which appears in the management literature. The received conceptualization of stakeholder analysis is criticised by identifying six sets of factors conventionally considered as promoting social responsibilities in the firm: inter-organizational factors, economic competitors, institutional investors, end-consumers, government regulators and non-governmental organizations. Each is addressed on conceptual grounds, its empirical salience in terms of the latest relevant research and prospects to be (...) a significant factor in promoting outcomes consistent with social welfare. Despite obvious antagonistic relations between organization centred economic objectives and extra-organizational-directed social considerations, the huge body of research we address drifts in a disengaged Sargasso Sea. The essay argues for appropriate directions for continuing business ethics/responsibility/corporate citizenship research, suggesting certain sociological works on moral leadership, moral courage, and academic leadership. (shrink)

Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in (...) favor of withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

Extracorporeal membrane oxygenation (ECMO) is currently reserved predominantly for bridging patients to a different destination therapy, but the use of ECMO as a destination therapy itself (ECMO-DT...

The history of the concept of “religion” in Western tradition has intrigued scholars for years. This important collection of eighteen essays brings further light to the ongoing debate. Three of the invited participants, W.C. Smith, M. Despland and E. Feil, has each previously written impressive books treating this subject; the last two acknowledged the impact and continuing influence of Smith’s work, The Meaning and End of Religion. An introduction and a recapitulation of Smith’s contribution as a scholar set the stage (...) for a retrospective look at the published literature. Contributors then examine the transformation of words (the classical religio to the modern religion), particularities of religion in nineteenth-century France, Troeltsch’s concept of religion, the study of religion from an Asian point of view and the categorization of “World Religions.” The concluding essays elaborate contemporary anthropological, cross-disciplinary, semiological, deconstructive and psychoanalytical methodological approaches to the concept and study of “religion.” Exploring critically different aspects of the concept and study of religion, these provocative essays typically reflect the methodological pluralism currently existing in the field of Religious Studies. Of interest to scholars and students alike, this collection also contains a complete bibliography of W.C. Smith’s publications. (shrink)

Extracorporeal membrane oxygenation (ECMO) provides continuous circulation and/or oxygenation to adults with cardiac failure, pulmonary dysfunction, or both. The technology is similar to the traditional heart-lung bypass machines used during surgical procedures, however ECMO may be used outside the confines of the operating room and for extended periods of time. This paper explores the complexities, both clinical and ethical, of a donot-resuscitate (DNR) order for patients with cardiopulmonary failure on veno-arterial (VA-ECMO), a type of ECMO that provides (...) resuscitation superior to the chest compressions that DNR is intended to prevent. Clinically, a DNR order has limited utility for patients on VA-ECMO and its presence can serve to create confusion. Symbolically, however, the designation may serve as a stepping-stone for surrogates facing difficult end-of-life decisions. The paper concludes by suggesting that it is prudent to avoid DNR discussions in the context of VA-ECMO. (shrink)