Apresentam-se os resultados clínicos principais de uma primeira investigação efectuada a familiares de doentes sob tratamento paliativo no domicílio da área de Lisboa, com o instrumento de medida da satisfação SERVQUAL Modificado. Dos 58 familiares/doentes que responderam ao questionário apenas uma minona estava insatisfeita (uma classe de 5 indivíduos mostra-se francamente insatisfeita), uma classe de 15 estava moderadamente satisfeita, havendo 38 individuos fortemente satisfeitos com a qualidade e prontidäo dos serviços prestados. Porém urna percentagem elevada de doentes, segundo a opinião (...) retrospectiva dos cuidadores, faleceu com sintomatologia agravada, nomeadamente dores (60%), obstipação (67%) e depressão/ansiedade (43%). Discute-se a consistência e validade do questionáno SERVQUAL Modificado, contextualizam-se os resultados no que é o standard da prática da MCP e integram-se na promoção da dignidade humana no fim da vida. We present the main clinical findings of research on palliative home care, carried out among relatives of patients in the Lisbon area. An adapted version of SERVQUAL was used. Of a total of 58 carers surveyed only a small number (5) was unsatisfied 15 were only moderately satisfied. 38 family carers were strongly satisfied with the services. Yet, a high percentage of patients, as viewed in retrospect by their relatives died with some aggravated symptoms: 60% with more pain, 67% constipation, and 43% anxiety/depression. We discuss the consistency and validity of this adapted SERVQUAL tool and the main results are contextualized beanng in mind the standard practice of palliative medicine and the pursuit of human dignity in death. (shrink)

Apresentamos um resumo do desenvolvimento e do contexto institucional do Projecto Humanização dos Cuidados Paliativos em Contexto Domiciliário, aprovado e financiado pela Fundação Calouste Gulbenkian. Utilizam-se largamente os próprios documentos que o justificaram e os relatórios oficiais para dar uma imagem vivida, realista e técnica das dificuldades da profissionalização e reforma dos Cuidados Paliativos, mesmo quando integrada em acções de formação num serviço de um Centro de Tratamento Compreensivo do Cancro. We put forward a synopsis of the development and institutional (...) context of the Project Humanização dos Cuidados Paliativos em Contexto Domiciliário, approved and financed by the Calouste Gulbenkian Foundation. The groundwork documents are widely used as well as official reports so as to convey a lively, realistic and technical image arising from professionalizing and reforming Palliative Medicine even when it is based on in-service training programmes in an Comprehensive Cancer Center. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)

The objective of this paper is to outline challenges associated with the inclusion of welfare issues in breeding goals for farm animals and to review the currently available methodologies and discuss their potential advantages and limitations to address these challenges. The methodology for weighing production traits with respect to cost efficiency and market prices are well developed and implemented in animal breeding goals. However, these methods are inadequate in terms of assessing proper values of traits with social and ethical values (...) such as animal welfare, because such values are unlikely to be readily available from the product prices and costs in the market. Defining breeding goals that take animal welfare and ethical concerns into account, therefore, requires new approaches. In this paper we suggest a framework and an approach for defining breeding goals, including animal welfare. The definition of breeding goals including values related to animal welfare requires a multidisciplinary approach with a combination of different methods such as profit equations, stated preference techniques, and selection index theory. In addition, a participatory approach involving different stakeholders such as breeding organizations, food authorities, farmers, and animal welfare organizations should be applied. We conclude that even though these methods provide the necessary tools for considering welfare issues in the breeding goal, the practical application of these methods is yet to be achieved. (shrink)

Background Euthanasia is a topic of intense ethical debate and it is illegal in most countries at present, including Sri Lanka. The aim of this descriptive cross-sectional study of medical students and practicing doctors was to explore the acceptance of euthanasia and physician assisted suicide, and factors influencing this opinion. Methods A customised online questionnaire which explored opinions on euthanasia was administered to first and final year medical undergraduates in University of Colombo and practicing doctors with more than 5 years (...) of work experience at The National Hospital of Sri Lanka. Attitudes on euthanasia and PAS were also assessed with the attitudes towards euthanasia Scale, which is a 10-item questionnaire. Results A total of 425 individuals responded, which included 143 first-year medical undergraduates, 141 final-year medical undergraduates and 141 practicing doctors. More participants favoured legalizing euthanasia than those directly opposing it, but a significant proportion remained undecided. The mean scores of ATE questionnaire from the whole sample were generally unfavourable towards euthanasia/PAS. Accepting euthanasia as an option for oneself was the strongest predictor of favouring euthanasia/PAS or supporting its legalization. Conclusion In this cross-sectional survey, more respondents supported legalisation of euthanasia in Sri Lanka than those openly opposing it. Yet, a significant minority that responded as “undecided” for legalisation, were more likely to have unfavourable ATE. (shrink)

This little volume is a critical introduction to the phenomenological scene through discussion of the ideas of some of its more prominent exponents and an extensive analysis of the thought of its founder. About two thirds of the book is devoted to Husserl. It traces the evolution of Husserl's philosophy from an early interest in the psychological presuppositions of number, to the phenomenological analysis of acts of meaning, and finally to his unsuccessful attempt to construct a comprehensive system embracing the (...) presuppositions of knowledge in general. Previous acquaintance with Husserl's work is not necessary as Pivcevic gives critical expositions of the main theses of Husserl's Philosophy of Arithmetic, Logical Investigations, Ideas for a Pure Phenomenology and Phenomenological Philosophy, and The Crisis of European Sciences and Phenomenological Philosophy. He is careful to establish particular philosophic problems through reference to the views of other philosophers, and on different issues the position of Husserl is compared and contrasted to those of Frege, Brentano, Russell, Descartes, the positivists, the classical Empiricists and Kant. The presentation of Sartre's views includes brief discussions of European romanticism, Hegel, and Marx. Besides Sartre, Scheler and Heidegger are discussed to illustrate differing applications of the phenomenological method. The final chapter is a brief critique of the limitations of this method: the problem of "other egos," the marked tendency to anti-rationalism, and the failure to achieve its aim of a presupposition-less philosophy. Pivcevic is not totally sympathetic with the phenomenologists, which is perhaps what makes possible this critical exposition of their views. But at times one wishes his clear prose would follow a philosopher's thought further into its more obscure dimensions. His criticisms are often the standard, uninspired objections to what are generally accepted as unjustified excesses of existentialist thought. Nevertheless, this is an excellent introduction to phenomenology and especially valuable for its exposition of the thought of Edmund Husserl.--M. S. H. (shrink)

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

An edition of the letters of Erasmus, regarded as one of the greatest humanist writers. All 12 volumes of this work have been reissued, complete with their scholarly apparatus of commentary and notes, as well as plates.

In the UK, many fundamentally important policy decisions that are likely to affect the relationship between citizens and care services are now made at the sublegislative level and without adequate ethical consideration and scrutiny. This is well exemplified in the proposed guidance on the disclosure of information on children. A recent consultation paper by the UK government on the subject proposes an approach that seeks a simple technical solution to a complex problem, emphasising control and surveillance. This reflects pressure to (...) be seen to act. The document fails with regard to ethical reflection appropriate to the complexity of the issue, an appreciation of complex relationships of trust, and a proper sense of the richness and complexity of the public interest. Such policies would, if implemented, fundamentally change the relationships between citizens and their carers, and among carers and the law and the state. This and similar proposals require far more ethical scrutiny and consideration of the public interest in the widest sense. (shrink)

The International Classification of Functioning, Disability and Health (ICF), designed by the WHO, attempts to provide a holistic model of functioning and disability by integrating a medical model with a social one. The aim of this article is to analyze the ICF’s claim to holism. The following components of the ICF’s complexity are analyzed: (1) health condition, (2) body functions and structures, (3) activity, (4) participation, (5) environmental factors, (6) personal factors, and (7) health. Although the ICF claims to be (...) holistic, it presupposes a monistic materialistic ontology. We indicate some limitations of this ontology, proposing instead: (a) a pluralistic–holistic ontology (PHO) and (b) a multidimensional view of the human being, with individual and environmental aspects, in relation to three levels of reality implied by the PHO. For the ICF to attain its holistic claim, the interactions between its components should be based on (a) and (b). (shrink)

The 2014 Varsity Medical Ethics debate convened upon the motion: “This house believes that genetic information should not be commoditised”. This annual debate between students from the Universities of Oxford and Cambridge, now in its sixth year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the circumstances under which genetic material should be considered patentable, the possible effects of this on the (...) research and development of novel therapeutics, and the need for clear guidelines within this rapidly developing field. (shrink)