A collection of writings by Thomas Paine previously unseen since their first appearance, including political pieces, private letters and verse. Covers his Common Sense years in the revolutionary American colonies; his time in Europe, when he published Rights of Man and The Age of Reason ; and his last years in the firmly united states of America.

Thomas Paine is one of history's most renowned thinkers and was indispensible to both the American and French revolutions. The three works included, Common Sense, The Rights of Man, and The Age of Reason, are among his most famous publications. Paine is probably best known for his hugely popular pamphlet, Common Sense, which swayed public opinion in favor of American independence from England. The Rights of Man and The Age of Reason further advocated for universal human rights, a republican instead (...) of monarchical government, and truth and reason in politics. The works of this moral visionary, whose ideas are as relevant today as ever, are now available as part of the Word Cloud Classics series, providing a stylish and affordable addition to any library. (shrink)

Thomas Paine was an English-American political activist, philosopher, political theorist, and revolutionary. One of the Founding Fathers of the United States, he authored the two most influential pamphlets at the start of the American Revolution, and he inspired the rebels in 1776 to declare independence from Britain. His ideas reflected Enlightenment-era rhetoric of transnational human rights. He has been called "a corsetmaker by trade, a journalist by profession, and a propagandist by inclination." Odin's Library Classics is dedicated to bringing the (...) world the best of humankind's literature from throughout the ages. Carefully selected, each work is unabridged from classic works of fiction, nonfiction, poetry, or drama. (shrink)

The little-known story of the architectural project that lay at the heart of Paine's grand political vision for the United States. Thomas Jefferson praised Tom Paine as the greatest political writer of the age. The author of 'Common Sense' and Rights of Man, Paine helped make revolutions in America and France. But beyond his inspiring calls to action, Paine harbored a deeper political vision for his adopted country. It was embodied in an architectural project that he spent decades planning: an (...) iron bridge to span the Schuylkill River at Philadelphia. The bridge was Paine's answer to the political puzzle of the new nation: how to sustain a republic as large and geographically fragmented as the United States. Among its patrons were other giants of the time, including Benjamin Franklin and Edmund Burke, Paine's ideological opponent. Set against the background of the American Revolution, the story of his iron bridge reveals a new Tom Paine and connects this revolutionary to the vast program of internal improvements that soon transformed America"--Provided by publisher. (shrink)

Thomas Paine Colloquium 1987 Message from the Secretary-General of the United Nations, his Excellency Javier Pérez de Cuéllar, to the participants in the ...

Context and AimsAlthough some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity, their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.MethodsFollowing a cross-sectional correlational study design, both (...) standardized andad hocmeasurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form ], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control ; Determinants of Physical Activity Questionnaire ]; sedentary behavior [Sedentary Behavior Questionnaire ]; pain [36-Item Short Form Survey Instrument ] and PRMDs ; reported physical exertion ; anxiety [Hospital Anxiety and Depression Scale ]; practice behaviors ; and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.ResultsDemographic information was obtained from 111 respondents, mostly undergraduate students from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information, and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.ConclusionThe relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged. (shrink)

The lack of medical availability of effective pain medication is an enduring and expanding global health calamity. Despite important medical advances, pain remains severely under-treated worldwide, particularly in developing countries. This article contributes to the discussion of this global health crisis by considering international legal and institutional mechanisms to promote wider accessibility to critical narcotic drugs for pain relief.

Important medical advances over the last several decades have vastly improved the technical capacity to control human pain. Millions of patients suffering from cancer, HIV/AIDS, and other conditions have been able to find relief from incapacitating chronic and acute pain. However, despite these developments, pain remains severely under treated worldwide, particularly in developing countries. The tragic consequence is that for millions of people around the globe, excruciating pain is an inescapable reality of life.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The experience of having to suffer debilitating pain is far too common in the United States, and many patients continue to be inadequately treated by their doctors. Although many physicians freely admit that their pain management practices may have been somewhat lacking, many more express concern that the prescribing of heightened levels of opioid analgesics may result in closer regulatory scrutiny, criminal investigation, or even criminal prosecution.Although several researchers have examined the regulatory environment and the threat of sanction (...) or harm it poses to physicians and patients, few have examined the likelihood of investigation or prosecution stemming from the aggressive use of opioids in physician-directed pain management. Accordingly, in an effort to assess whether the fear of prosecution is realistic and, if so, what factors contribute to its likelihood, we surveyed chief prosecutors in four states about their knowledge, opinions, and attitudes concerning opioids and the prosecution of physicians stemming from the treatment of patients who were either terminally ill or suffering from chronic noncancer pain. (shrink)

The experience of having to suffer debilitating pain is far too common in the United States, and many patients continue to be inadequately treated by their doctors. Although many physicians freely admit that their pain management practices may have been somewhat lacking, many more express concern that the prescribing of heightened levels of opioid analgesics may result in closer regulatory scrutiny, criminal investigation, or even criminal prosecution.Although several researchers have examined the regulatory environment and the threat of sanction (...) or harm it poses to physicians and patients, few have examined the likelihood of investigation or prosecution stemming from the aggressive use of opioids in physician-directed pain management. Accordingly, in an effort to assess whether the fear of prosecution is realistic and, if so, what factors contribute to its likelihood, we surveyed chief prosecutors in four states about their knowledge, opinions, and attitudes concerning opioids and the prosecution of physicians stemming from the treatment of patients who were either terminally ill or suffering from chronic noncancer pain. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The assessment and management of pain is a significant public health problem in the United States. Long-term care facilities face unique barriers and challenges to pain management due to the large population of cognitively impaired residents, little physician contact and poor pain education for nurses and nurse assistants. In addition, common misconceptions about pain and pain treatment in the elderly along with health professional and resident fears of addiction and drug toxicity, add to the problem (...) of pain management. The basic principles of pain treatment in long-term care are identical to all other health care settings – utilizing a combination of drug and non-drug treatments. Recent efforts to institutionalize improved pain management practices, through assessment procedures and defined pain management policies, standards and education programming, is a promising venue for systemically improving pain treatment in long-term care settings. (shrink)

Pain policy is not drug policy. If society wants to improve the lives of people in pain and compress the terrible inequalities in its diagnosis and treatment, we have to tailor policy to the root causes driving our problems in treating pain humanely and equitably. In the United States, we do not. Instead, we have proceeded to conflate drug policy with pain policy, relying on arguably magical thinking for the conclusion that by addressing the drug overdose (...) crisis, we are simultaneously addressing the pain crisis. This is a category error, decades of commitment to which have resulted mostly in a worsening of both public health problems. Disentangling our problems in treating pain fairly and equitably from our problems with drugs and substance use is the only path to humane and ethical policy for each. (shrink)

Sheila Kitzinger describes pain and its control throughout the various stages of childbirth. She stresses the value of antenatal preparation as well as the need for a supportive environment during the labour stages. All concerned--the porspective parents, doctors, midwives and any other personnel in a maternity unit should be educated to be able to provide such an environment.

This book propels the study of American revolutionary and radical Thomas Paine into the twenty-first century by engaging an interdisciplinary and international group of scholars in an exploration of Paine's role in politics, literature, and the invention of the global.

Since its publication in 1976, Tom Paine and Revolutionary America has been recognized as a classic study of the career of the foremost political pamphleteer of the Age of Revolution, and a model of how to integrate the political, intellectual, and social history of the struggle for American independence. Foner skillfully brings together an account of Paine's remarkable career with a careful examination of the social worlds within which he operated, in Great Britain, France, and especially the United States. He (...) explores Paine's political and social ideas and the way he popularized them by pioneering a new form of political writing, using simple, direct language and addressing himself to a reading public far broader than previous writers had commanded. He shows which of Paine's views remained essentially fixed throughout his career, while directing attention to the ways his stance on social questions evolved under the pressure of events. This enduring work makes clear the tremendous impact Paine's writing exerted on the American Revolution, and suggests why he failed to have a similar impact during his career in revolutionary France. And it offers new insights into the nature and internal tensions of the republican outlook that helped to shape the Revolution. In a new preface, Foner discusses the origins of this book and the influences of the 1960s and 1970s on its writing. He also looks at how Paine has been adopted by scholars and politicians of many stripes, and has even been called the patron saint of the Internet. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Colombia, a country at civil war for over 50 years, has one of the highest rates of landmine injury in the world. This article is based on ethnographic research conducted at the Amputation and Rehabilitation Unit of Bogota’s Central Military Hospital. Through an ethnographic description of surgical amputation and rehabilitation, I examine medical understandings of vitality and masculinity in respect to the senses – primarily that of pain in the act of amputation.

Introduction: the use and abuse of Thomas Paine in the transatlantic world / Sam Edwards and Marcus Morris -- Part I. The image and idea(s) of Paine: origins, use and reuse -- The image of Tom: Paine in print and portraiture / W.A. Speck -- "I am made to say what I never wrote": deism, spiritualism and ventriloquizing Paine, c.1790s-1850s / Patrick W. Hughes -- All Paine: the American mind and the creation of the League of Nations and the U.N. (...) / Michael Holm -- The distortion of Thomas Paine's philosophy of government / Gary Berton -- Part II. Discovering and using Paine's radicalism -- "Revolutions are the order of the day": Atlantic fragments of Thomas Paine, c.1819-1832 / Matteo Battistini -- Posthumous Paine in the United Kingdom, 1809-1832: Jacobin or loyalist cult? / Matthew Roberts -- "The neglect of Paine seems particularly strange at the present political juncture": explaining British socialists' relationship to Paine, c. 1884-1914 / Marcus Morris -- Citizens of the world: Paine and the political prisoners transported to Australia / Tony Moore -- Part III. Remembering and remaking Paine -- Common sense on the Lower East Side: Thomas Paine and the era of immigration, c.1900-1950 / Louis Mazzari -- "A monument in every city?": Thomas Paine in memoriam / Theodore Marotta -- "He came from America didn't he?": the Thetford Statue controversy and the problem of Paine in transatlantic memory, c.1909-1970 / Sam Edwards -- Afterword: the struggle for Paine's memory and the making of American democracy / Harvey J. Kaye. (shrink)

The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, (...) sensory, affective, and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing amultidimensional phenomenal spacefor pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whosestructurereflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes aprimitivephenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses theutilityof continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

This essay concerns what people should do in conflict situations when a doubt of fact bears on settling whether an alternative under consideration is legitimate or not. Its principal audience are those who believe that abortion can be legitimate when not having an abortion gives rise to serious harms that can be avoided by having one, but who are concerned that fetuses might feel pain when being aborted, and who believe that causing unnecessary pain should be avoided when (...) doing so would not pose an undue burden. The essay remains neutral on the substantive questions of the moral status of the unborn and the morality of abortion. The question of fetal pain has taken center stage in the last few years in the .. (shrink)

The American School of Empire considers how an American idea of empire evolved in the 1790s and would shape and be shaped by the literature and art of the early US. Hamilton's introductory essay suggests that empire was as important to the foundation of the US as concepts like democracy, freedom, nation, and republic. This book thus begins from the premise that the history of empire in the United States can be traced back to the inception of the country, if (...) not earlier. It contends that the United States was conceived as an empire, culturally, politically, and legally. Empire, as a broad theory for organizing not only the state but also the understanding of difference and the relationship to space, in other words, was a crucial conceptual frame shaping the culture of the early US"--Provided by publisher. (shrink)

The Helsinki Declaration, first published in 1964, is the universally accepted standard for ethical behavior in research involving human subjects. The Declaration was formulated in response to the abuses of human subjects by the scientists in Nazi Germany and to update the Nuremberg Code. Amended in 1975, 1983, 1989, 1996, and 2000, the Declaration provides the foundation for the United States federal regulations for research involving human subjects.To conform to standards developed in the Declaration, a researcher must fulfill the following: (...) respect the autonomy of the individual; promote and safeguard the individual’s health; provide informed consent without coercion; take special measures with vulnerable populations; compare new therapies to the best current therapies; have a thorough scientific knowledge of the subject; assess risk versus benefit of the intervention; perform studies that will ultimately benefit the population involved in the research; accurately report their findings; and fully disclose ethical concerns in their research protocols. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A New Look at Animal-to-Human Organ TransplantationCharles R. McCarthy (bio)The acute shortage of organs available for transplantation into human beings combined with a new scientific understanding of the immune systems of both humans and animals make it probable that animal-to-human solid organ transplants (xenografts) may soon be attempted at a frequency rate unknown in the past. 1 Optimism about successful animal-to-human organ transplantation is greater than at any previous (...) time. The creation of a reliable supply of animal organs appears to be technically feasible. At least five major transplant centers in the United States are currently considering plans to pursue xenotransplantation. Although, at the time of this writing, no federal guidelines prohibit animal-to-human organ transplantation, the institutions considering such programs are awaiting deliberations on the subject by the Institute of Medicine (IOM), the Food and Drug Administration (FDA), and the Department of Health and Human Services (DHHS).The demand for organs suitable for transplantation into human beings greatly exceeds the supply. According to the United Network for Organ Sharing (UNOS 1996a), approximately 44,000 patients in the United states awaited organ transplantation at the end of 1995. In 1994, more than 3,000 patients died while on the transplant waiting list, and the demand for transplantable organs increases annually (UNOS 1996b). The figures do not include the hundreds or perhaps thousands of patients who could profit from a transplant, but who do not meet the requirements of the UNOS waiting list. Even if efforts to persuade persons to donate organs are redoubled, and even if the consent to donate organs should become a legal presumption, there is little prospect of developing a sufficient supply of transplantable human organs to meet the growing demand.As technical and biological barriers to successful animal-to-human xenografts are lowered, the prospect of raising dedicated colonies of animals, genetically altered to reduce the chances that human hosts will reject organs derived from them, is being seriously discussed. 2 Such colonies do not exist at the present time. [End Page 183] However, if new techniques for animal-to-human transplantation prove successful, it is likely that animal colonies will be established to provide a ready and predictable supply of organs for transplantation to humans. Some believe that commercial investment in colonies of purpose-bred animals to serve as a source of transplantable organs is close at hand (Leventhal 1994).New drugs and new combinations of existing drugs have improved the chances of successful medical outcomes for patients who receive solid organ transplants. It is now recognized that serial application of immunosuppressive drugs can reduce the likelihood of both short- and long-term organ rejection (Makowka 1994). Improved understanding of both human and animal immune systems, insights into histocompatibility, new agents to control graft-versus-host disease, animal breeding programs for the production of transgenic animals, and improved surgical techniques have opened, as never before, the possibility of successful transfer of organs from animals to humans. Some rate the chances of good patient outcomes (usually measured in terms of time of patient survival) as high, others make more conservative predictions, but virtually all experts believe that the chances for successful human patient outcomes resulting from xenotransplantation are improved. Because many patients face immanent death unless their organs can be replaced, there can be little doubt that many humans will readily consent to xenotransplantation.History Suggests CautionDespite the advances in immunosuppression, the frequency of failure in past animal-to-human xenograft attempts should temper the optimism of the transplant community. To date, all efforts to prolong human life by implanting solid organs from animals into human recipients have failed. The first attempts at animal-to-human xenotransplantation early in the twentieth century resulted in the early death of all recipients (Neuhof 1923). More sophisticated efforts at xenotransplantation occurred in the late 1960s and early 1970s, a period when anti-rejection drugs began to make allografts more feasible. Although one human recipient of a xenograft survived for nine months (with poor quality of life), most patients died within a matter of minutes, hours, or a few days following the transplantation of organs from chimpanzees or baboons (Starzl... (shrink)

This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with (...) believing patients' complaints regarding pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice. (shrink)

Physicians’ fear of criminal prosecution for prescribing opioid analgesics is a major reason why many chronic pain patients are having an increasingly difficult time obtaining medically appropriate pain relief. In Ruan v. United States, 142 S. Ct. 2370 (2022), the Supreme Court unanimously vacated two federal convictions under the Controlled Substances Act. The Court held that the government must prove that the defendant knowingly or intentionally acted in an unauthorized manner.

Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice (...) and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pain, however, violates respect for persons and beneficence. This paper reviews literature supporting these claims and offers a narrative description of the author’s attempts to find relief from shingles and postherpetic neuralgia. It argues that physicians in most specialties are not, but should be, familiar with palliative evidence and guidelines so that they are equipped to relieve pain and symptoms quickly and effectively. Such information should be routinely introduced in medical curricula to encourage the mastery of knowledge, attitudes and skills necessary to upholding ethical principles and to ensure that more doctors in any discipline are willing to believe and be compassionate to patients whose pain is unresponsive to initial treatments. Routinely exposing students to such information would better prepare them to fulfil their professional duties to patients and society. (shrink)

would like for them to know that I am in pain or this part of my body hurts or the other part hurts — that I am not lying about it. To examine me and to cut down on the pain….And help me out.Patient with Sickle Cell Disease, Focus Group ParticipantPain in the United States is widely recognized to be undertreated; however, the capacity to treat pain has never been greater. The causes of this undertreatment are varied. (...) As we focus on pain and why it is too often ineffectively treated, we also discover that this undertreatment afflicts some more than others. What divides the some from the others isn't limited to one factor, but one particularly disturbing factor is race and ethnicity. Racial and ethnic minority populations are at higher risk for oligoanalgesia, or the ineffective treatment of pain. Only through further study of the differences in pain treatment based on race and ethnicity can we develop strategies to reduce the disparities in care. (shrink)

In nursing, the concept of advocacy is often understood in terms of reactive or proactive action aimed at protecting patients' legal or moral rights. However, advocacy activities have not often been researched in the context of everyday clinical nursing practice, at least from patients' point of view. This study investigated the implementation of nursing advocacy in the context of procedural pain care from the perspectives of both patients and nurses. The cross-sectional study was conducted on a cluster sample of (...) surgical otolaryngology patients (n = 405) and nurses (n = 118) from 12 hospital units in Finland. The data were obtained using an instrument specially designed for this purpose, and analysed statistically by descriptive and non-parametric methods. According to the results, patients and nurses have slightly different views about which dimensions of advocacy are implemented in procedural pain care. It seems that advocacy acts are chosen and implemented rather haphazardly, depending partly on how active patients are in expressing their wishes and interests and partly on nurses' empowerment. (shrink)

In recent years, the opioid crisis in the United States has sparked significant discussion on doctor–patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when (...) describing chronic pain, narrating symptoms and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How We Keep Caring While Walking Through Our PainOla Ziara and Rachel CoghlanAuthor Dedication. To my dear brother Omar Ziara, a bright doctor, entrepreneur, and community advocate who was killed in an Israeli bombing in November 2023.May your soul rest in peace and may your memory remain alive in our hearts. May your unborn child grow up to become the wonderful man that you were. Forever loved by all.Palestinian-American (...) poet, Suheir Hammad, writes:Occupation means that every day you die, and the world watches in silence. As if your death was nothing, as if you were a stone falling in the earth, water falling over water.And if you face all of this death and indifference and keep your humanity, and your love and your dignity and you refuse to surrender to their terror, then you know something of the courage that is Palestine.I am a doctor from the Gaza Strip in Palestine. I live through acute war and protracted occupation. I work under missiles and through scant resources. I experience risks and dangers and face abominable choices made from nightmares. I know heartbreaking death.As doctors here, we fear, suffer, cry, and grieve alongside our patients and their families. This is my story of how we continue to care.Summer 2014 A Fifty-Two-Day War: How To Stay And How To Keep Them SafeThe huge bombardment strikes close to the hospital, scattering glass and rubble. It brings an abrupt end to my rare, quiet pause for coffee. Are the babies hit? We sprint to the Neonatal Intensive Care Unit, our full attention only on those infants, hastily checking every crib. My thoughts are frenzied. What if the next missile strikes us? Will I be able to rescue them? Will I have time to carry their tiny bodies outside through wreckage and fire? How will I choose who to save, and who to leave behind? Could I choose? Will I even be able to think lucidly, act logically for those babies if the fire consumes us? We stay.Somewhere, a house razed to the ground, a mother and her children dead. This time, our babies are safe.Summer 2014 A Fifty-Two-Day War: How To Cast Off Danger And How To Find ConsolationA missile shatters our neighbour’s roof. I am about to leave home for my evening shift. I check on my shaking mum; she is okay, not hurt at least. I ring the senior doctor. I am sorry. I am coming. I will be a little late. Two further missiles hit, wiping out the next-door building completely. No, do not send an ambulance for me. It is too dangerous. I will come [End Page 153] alone. Trembling through the dust and darkness, I leave on foot to reach those babies. I must compose myself. We are needed there to bring calm, to keep caring.And we gamble our lives to seek distraction and comfort for ourselves. We find solace through unbearable pain in our caring.Winter, Spring, Autumn, Summer, Any Day: How To Question Purpose And How To Feel HelplessIt is an ordinary night shift in ‘quiet’ times. Tonight, all the beds are occupied. All the ventilators are taken, forcing life into small, sick faces. At dawn, the phone call comes. A new baby struggling to breathe is on his way. I call around. No more beds to take him here or anywhere. No more ventilators—here or anywhere. Bring him here. We will care for him.He is in a very bad way. He needs immediate life-saving care. We take turns manually ventilating him, working to the hissing rhythm of the Ambu Bag1—inflating, deflating, inflating. Our arms ache. We keep pumping the bag. Do not stop. The moment when the morning shift arrives is our moment of salvage. We can go home. We have made it through the night without medicines, machines, disposables, or enough manpower, our arms throbbing. We have kept him alive.But he is so fragile, the system is fragile, we are fragile. Dare I even ask—is it worth it? Is it worth a baby surviving the... (shrink)

Dr. M is a fifty-nine-year-old internist with a successful practice in a major Eastern United States city. He has lived in this city his whole life and is a highly esteemed citizen. Because of his broader social concerns and energetic support of activities to improve access to health care and quality of care for the underserved, Dr. M became involved in a number of local and regional medical organizations and quickly rose to prominence as as a director of a board (...) of a major national organization. In this position, he was an effective, articulate spokesperson, highly respected for his integrity and thoughtfulness.Before one of the meetings of thithis s board, Dr. M personally contacted the organization's other directors, including me, to warn us that we might be hearing some scandalous news about him. He wanted us first to hear it from him personally. This was the scandalous news.Dr. M had assumed the care of a patient of a recently retired colleague. The patient was an older woman with multiple musculoskeletal complaints related to lumbar stenosis and advanced degenerative arthritis of the spine, which left her in immense pain. (shrink)

Dr. M is a fifty-nine-year-old internist with a successful practice in a major Eastern United States city. He has lived in this city his whole life and is a highly esteemed citizen. Because of his broader social concerns and energetic support of activities to improve access to health care and quality of care for the underserved, Dr. M became involved in a number of local and regional medical organizations and quickly rose to prominence as as a director of a board (...) of a major national organization. In this position, he was an effective, articulate spokesperson, highly respected for his integrity and thoughtfulness.Before one of the meetings of thithis s board, Dr. M personally contacted the organization's other directors, including me, to warn us that we might be hearing some scandalous news about him. He wanted us first to hear it from him personally. This was the scandalous news.Dr. M had assumed the care of a patient of a recently retired colleague. The patient was an older woman with multiple musculoskeletal complaints related to lumbar stenosis and advanced degenerative arthritis of the spine, which left her in immense pain. (shrink)

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, (...) sensory, affective, and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing a multidimensional phenomenal space for pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whose structure reflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes a primitive phenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses the utility of continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

Ben Rich, J.D., Ph.D., presents a scholarly, passionate view of the ethics of the “barriers to effective pain management.” His manuscript is detailed, analytical, and compassionate. No reasonable sensitive person, especially a physician committed to caring for patients, can disagree with the proposal that human beings should have their physical, emotional, and spiritual pain tended to aggressively, meticulously, and compassionately. Similarly, the same individuals advocating for such pain management would agree that no one should go to jail (...) unless he or she is guilty of a serious crime, that decent people should not be robbed or murdered, that children should not be hungry or homeless, and that all citizens of the United States deserve healthcare. Our society attempts to achieve these goals. Laws are written, discussed, and approved by state and federal congresses, voted on by citizens, and theoretically upheld by the courts, churches, and decent individuals. But, unless the world suddenly becomes inhabited by virtuous, ethical humans who can unfailingly differentiate “good” from “bad,” then, in spite of an abundance of laws and lawyers, doctors, and nurses, this world will continue to have pain and suffering. And, although we want to hold our doctors, politicians, educators, champion athletes, and others to “higher standards” than the average citizen, it is best to remind ourselves frequently that all humans can be weak and are bound to make imprecise judgments, that there is not a homogenous definition of “good,” that values and religious beliefs are variable. (shrink)

In this book, Camila Loew analyzes four women’s testimonial literary writings on the Holocaust to examine and question some of the tenets of the fields of Holocaust studies, gender studies, and testimony. Through a close reading of the works of Charlotte Delbo, Margarete Buber-Neumann, Ruth Klüger, and Marguerite Duras, Loew foregrounds these authors’ search for a written form to engage with their experiences of the extreme. Although each chapter contains its individual focus and features, the book possesses a unity in (...) intention, concerns, and consequences. In the theoretical introduction that unites the four chapters, Loew eschews essentialism and revises the emergence of the field of Women and Holocaust studies from the early 1980s on, and signals some of its shortcomings. In response, and in accordance with a recent turn in various disciplines of the Humanities, Loew highlights the ethical dimension of testimony and its responsible commitment to the other. In dealing with the texts as literary testimonies—a complex genre, between literature and history—, testimony is freed from the obligation to respond to the requirements of factual truth, and becomes a privileged form to voice the traumatic event, and to symbolically explore the role of excess. (shrink)

Health care spending comprises about 16% of the total United States gross domestic product and continues to rise. This article examines patterns of health care spending and the factors underlying their proportional growth. We examine the “usual suspects” most frequently cited as drivers of health care costs and explain why these may not be as important as they seem. We suggest that the drive for technological advancement, coupled with the entrepreneurial nature of the health care industry, has produced inherently inequitable (...) and unsustainable health care expenditure and growth patterns. Successful health reform will need to address these factors and their consequences. (shrink)

Virtually all Americans are part of the health care system. They may be patients, health professionals, employers providing benefits, insurers, medical manufacturers, regulators, innovators, or investors. Each has a stake in this burgeoning sector of the United States economy, and each may be critically affected, in multiple and diverse ways, by changes to the system under health reform. As health care expenditures continue to rise, it is increasingly important to understand where these expenditures go and the factors that drive these (...) cost increases. This article examines health care expenditure patterns, considering both the “usual suspects” that frequently are cited as spending drivers, as well as certain significant dynamics that may be the main contributors to rising costs. We conclude that in order to successfully contain costs, health reform will need to address these underlying factors. (shrink)

Common sense -- African slavery in America -- An occasional letter on the female sex -- Agrarian justice -- The rights of man -- The age of reason.

Selections from Paine's Common sense, Dissertation of the first principles of government, and Dissertations on government, the affairs of the bank, and paper money, along with several American federal documents and state constitutions, all in Spanish.

The capacity to treat pain has never been greater; but, as you will read in the articles that follow, the problem of undertreated and neglected pain in the United States persists. Deep-seated perceptions and practices undergird this strong and well-documented pattern of neglect. Among the reasons frequently noted for the inadequacy of treatment for pain, however, is that the legal system actually penalizes effective interventions to relieve pain while it leaves neglect of pain unthreatened. It (...) is the mission of the American Society of Law, Medicine & Ethics to explore areas, such as this one, where developments in medicine directly encounter the law and, in turn, create ethical issues for clinicians, regulators, patients, and lawyers.This special issue of the Journal of Law, Medicine & Ethics is part of a multi-year project in which ASLME, with the wonderful support of the Mayday Fund, has worked to address legal and regulatory barriers to effective pain relief. (shrink)

The capacity to treat pain has never been greater; but, as you will read in the articles that follow, the problem of undertreated and neglected pain in the United States persists. Deep-seated perceptions and practices undergird this strong and well-documented pattern of neglect. Among the reasons frequently noted for the inadequacy of treatment for pain, however, is that the legal system actually penalizes effective interventions to relieve pain while it leaves neglect of pain unthreatened. It (...) is the mission of the American Society of Law, Medicine & Ethics to explore areas, such as this one, where developments in medicine directly encounter the law and, in turn, create ethical issues for clinicians, regulators, patients, and lawyers.This special issue of the Journal of Law, Medicine & Ethics is part of a multi-year project in which ASLME, with the wonderful support of the Mayday Fund, has worked to address legal and regulatory barriers to effective pain relief. (shrink)

The eminent 20th-century Polish philosopher Tadeusz Kotarbiński (1886–1981) is the author of a novatory philosophy of combating global suffering. Kotarbiński’s theory states that although humans are by nature rational, and additionally endowed with goodwill, human life nonetheless offers an endless stream of pain and suffering. Some of this suffering results from the essence of the human condition and can not be helped, mostly, however, it is the effect of the meanderings of the human mind and can be eliminated by (...) education. More than by anything else, the human mind is brought to err by so-called phantasmats, or emotion-laden intellectual mirages, mainly of a religious, national and political nature. Such phantasmats are the source and fundament of humanity’s divisions into hostile cultures, nations and political systems, which in turn gives rise to conflict between civilizations, countries and ideologies, inadvertently accompaniedby mounting mistrust, suspiciousness, xenophobia, hatred, armaments—and ultimately war. All this means an ocean of suffering for countless individuals. Both in philosophy and praxis Kotarbiński strove to eliminate all sources of suffering, including that stemming from differences in culture, development, nationality, and politics. He believed in the motivating powers of reason and the creative powers of persuasion, and consequently sought to attain his goal by rationalization, or focusing solely on the logic-driven and common experiencing of the human fate in a bid to eradicate cultural, national and political difference. Thus united, humanity would melt into one big human state devoted to lingering inevitable suffering. Today similar views are promoted as “global humanism”—which makes Kotarbiński a pioneer of the Humanistic Manifesto 2000. An Appeal for New Global Humanism brochure. (shrink)