Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

This paper explores The New Rhetoric’s concept of universal audience in the contexts of philosophical and traditional rhetorical discourse. It argues that, since Perelman’s final English-language article, published in 1984 to clarify misunderstandings among rhetorical scholars about his theory, rhetorical scholars have persisted in three primary misconceptions of the concept of universal audience: appeals to the real are made only to universal audiences, only universal audiences are qualified to establish the reasonableness of arguments, and only universal audiences prevent The New (...) Rhetoric’s rhetorical theory from degenerating into relativism. It explains why each of these misconceptions is inaccurate and provides a corrected view of universal audience that places it exclusively in the province of philosophical discourse. Finally, it questions whether constructed audiences in general add explanatory power to rhetorical analyses or are merely unnecessary constructs that should be dispensed with for the sake of theoretical parsimony. (shrink)

Medical education at the Colombian School of Medicine has undergone a reconceptualization and reorganization so as to encompasses three fundamental elements of medical practice: 1) development of general abilities and standards necessary for appropriate professional medical practice; 2) technical education which makes it possible to utilize the bases that science and technology have provided for the development and application of knowledge, and in turn, to expand this base through research and development; and 3) humanistic education to guide students into ethical (...) professional practice. (shrink)

The recent far-reaching developments of Physics have produced the widespread impression that all those ideas of mechanics and mechanism, which were so influential in the nineteenth century, have now been completely abandoned, because they have proved to be quite inadequate as explanations, or even as mere descriptions, of the ultimate constitution of the physical world. “Has not modern physics”, asks Prof. Millikan, “thrown the purely mechanistic view of the universe root and branch out of its house?“ It is frequently contended, (...) still further, that the place of these concepts has been taken by others, very closely approximating to biological, or even to psychological, interpretations of all natural phenomena; the physics of today, in short, and yet more of tomorrow, is essentially non-mechanical. (shrink)