There is good news, and there is bad news. The good news is that in my experience, younger physicians generally are much more concerned about the cost of clinical tests and treatments, and about justly distributing finite medical resources, than were those who practiced medicine in the fee-for-service era. The bad news has at least three components. First, with respect to medically nonbeneficial treatment in the ICU, managed care has not yet given evidence of wanting to put the brakes on (...) unrealistic family demands for aggressive medical interventions. Second, managed care is frustrating many healthcare professionals as well as patients. And third, managed care has no apparent interest in addressing, and may even have contributed to, the problem of medical indigence. Let me develop these propositions more fully. (shrink)

Next SectionObjectives To evaluate the adequacy of paediatric informed consent and its augmentation by a supplemental computer-based module in paediatric endoscopy. Methods The Consent-20 instrument was developed and piloted on 47 subjects. Subsequently, parents of 101 children undergoing first-time, diagnostic upper endoscopy performed under moderate IV sedation were prospectively and consecutively, blinded, randomised and enrolled into two groups that received either standard form-based informed consent or standard form-based informed consent plus a commercial (Emmi Solutions, Inc, Chicago, Il), sixth grade level, (...) interactive learning module (electronic assisted consent). Anonymously and electronically, the subjects' anxiety (State Trait Anxiety Inventory), satisfaction (Modified Group Health Association of America), number of questions asked, and attainment of informed consent were assessed (Consent-20). Statistics were calculated using t test, paired t test, and Mann Whitney tests. Results The ability to achieve informed consent, as measured by the new instrument, was 10% in the control form-based consent group and 33% in the electronic assisted consent group (p<0.0001). Electronically assisting form-based informed consent did not alter secondary outcome measures of subject satisfaction, anxiety or number of questions asked in a paediatric endoscopy unit. Conclusions This study demonstrates the limitations of form-based informed consent methods for paediatric endoscopy. It also shows that even when necessary information was repeated electronically in a comprehensive and standardised video, informed consent as measured by our instrument was incompletely achieved. The supplemental information did, however, significantly improve understanding in a manner that did not negatively impact workflow, subject anxiety or subject satisfaction. Additional study of informed consent is required. Clinical trial registration number ClinicalTrials.gov Identifier NCT00899392. (shrink)

Throughout the U.S., state laws require professionals who work with children to report cases of suspected child abuse to child protection services. Both practically and conceptually, however, significant problems arise from a lack of clarity regarding the threshold that has been set for reporting. Specifically, there is no consensus as to what constitutes reasonable suspicion, and little direction for how mandated reporters should gauge their legal and professional responsibilities when they harbor suspicion. In this paper we outline the context of (...) the problem, discuss the nature and scope of its conceptual underpinnings, and offer recommendations for moving towards a concrete, practical solution. (shrink)

What are the moral stakes involved when we will have the same power to engineer our bodies as we do our automobiles? Which specific bioethics problems will put the most pressure on our ethical traditions? What should we do now to prepare for this brave new world? With Greg Loeben, Ronald Munson, and Wade Robison.

The use of traditional ethical methodologies is inadequate in addressing a constructed maternal–fetal rights conflict in a multicultural obstetrical setting. The use of caring ethics and a relational approach is better suited to address multicultural conceptualizations of autonomy and moral distress. The way power differentials, authoritative knowledge, and informed consent are intertwined in this dilemma will be illuminated by contrasting traditional bioethics and a caring ethics approach. Cultural safety is suggested as a way to develop a relational ontology. Using caring (...) ethics and a relational approach can alleviate moral distress in health-care providers, while promoting collaboration and trust between providers and their patients and ultimately decreasing reproductive disparities. This article examines how a relational approach can be applied to a cross-cultural reproductive dilemma. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2016 Heft: 208 Seiten: 35-47.

Comparative analytical study on two truths according to interpretation of eminent masters Gautama Buddha and Mi-bo Gśen-rab of Bon-po sect; includes their brief biographies.

Buddist literature; explanatory commentaries on Tantra philosophy, and commentary on the Mañjuśrīnāmasaṅgīti (Praise to Manjushri).

GS 341 is one of the most familiar of Nietzsche’s writings. This article proposes a new reading that stands in contrast with most English-language Nietzsche scholarship. The text presents a communication and its reception. A ‘demon’ makes an announcement, and a hearer responds in one way or another. But there is also another narrative altogether, whose conceptual vocabulary comes from a dynamic world-view. In this an interaction of forces leads to a new situation. If the hearer is not crushed by (...) the ‘greatest weight’, there must be an inner force that counteracts its impact. I argue that what Nietzsche calls amor fati is a state that allows our drives to achieve full expression, and so makes possible a collective strength able to withstand the greatest impact. The final sentence refers to a “confirmation and sealing”. What happens is that the demon’s message makes an impression on the receptive hearer. For Nietzsche this is a working metaphor, not a turn of phrase. In a draft from this period he writes: “Let us stamp the image of eternity on our life!” That sudden and forceful act, embodying an evaluative judgement, is the event that GS 341 is all about. (shrink)