During an initial palliative care assessment, a dying man discloses that he had killed several people whilst a young man. The junior doctor, to whom he revealed his story, consulted with senior palliative care colleagues. It was agreed that legal advice would be sought on the issue of breaching the man’s confidentiality. Two legal opinions conflicted with each other. A decision was made by the clinical team not to inform the police.In this article the junior doctor, the palliative medicine specialist, (...) a medical ethicist, and a lawyer consider the case from their various perspectives. (shrink)

Volume 3, Issue 1, March 2019, Page 95-99.

In New Zealand an advance directive can be either an oral statement or a written document. Such directives give individuals the opportunity to make choices about future medical treatment in the event they are cognitively impaired or otherwise unable to make their preferences known. All consumers of health care have the right to make an advance directive in accordance with the common law. When we consider New Zealand's rapidly ageing population, the fact that more people now live with and die (...) of chronic rather than acute conditions, the importance given to respecting autonomous decision-making, increasing numbers of individuals who require long-term residential care, and financial pressures in the allocation of medical resources, there would seem to be a number of compelling reasons to encourage individuals to write or verbalise an advance directive. Indeed the promotion of advance directives is encouraged. However, caution should be exercised in promoting advance directives to older people, especially in light of several factors: ageist attitudes and stereotypes towards them, challenges in the primary healthcare setting, and the way in which advance directives are currently focused and formulated. This paper considers some of the specific challenges that need to be addressed if the promotion of advance directives are to improve outcomes of patient treatment and care near the end of life. (shrink)

This case concerns aspects of the treatment of a post-surgical patient in a major public hospital in New Zealand during the author's experiences as a fourth year medical student. This case is used to consider the interlinked ethical issues of sympathy, moral virtue, dignity and how the medical environment can realign these values.

:This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand’s medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the “professionalism” and “professional development” in medical curricula.

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a (...) questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the ‘four principles’ determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in ‘real’ settings and this information may help educators prepare students for these clinical ethical dilemmas. (shrink)

Le relativisme ; sa signification en politique. La politique scientifique et la science politique ; leur accord sur l’impossibilité d’un critère objectif ; leur divergence sur la nature de ce critère, sur le sujet qui décide de la vérité politique ; le rôle de l’action ; l’homme concret opposé à l’homme théorique ; vérité rationnelle et vérité de fait ; l’irrationalité de l’action ; « sécularisation matérielle » et « sécularisation spirituelle ».

This paper presents students’ views about honest and dishonest actions within the pharmacy and medical learning environments. Students also offered their views on solutions to ameliorating dishonest action. Three research questions were posed in this paper: (1) what reasons would students articulate in reference to engaging in dishonest behaviours? (2) What reasons would students articulate in reference to maintaining high levels of integrity? (3) What strategies would students suggest to decrease engagement in dishonest behaviours and/or promote honest behaviours? The design (...) of the study incorporated an initial descriptive analysis to interpret students’ responses to an 18-item questionnaire about justifications for dishonest action. This was followed by a qualitative analysis of students’ commentaries in reference to why students would engage in either honest or dishonest action. Finally a qualitative analysis was conducted on students’ views regarding solutions to dishonest action. The quantitative results showed that students were more likely to use time management and seriousness justifications for dishonest actions. The qualitative findings found that students’ actions (honest or dishonest) were guided by family and friends, the need to do well, issues of morality and institutional guidelines. Students suggested that dishonest action could be ameliorated by external agencies and polarised views between punitive and rewards-based mechanisms were offered. These results suggest that these students engaged in dishonest action for various reasons and solutions addressing dishonest action need to consider diverse mechanisms that likely extend beyond the educational institution. (shrink)

ObjectiveBulimia nervosa and binge eating disorder are eating disorders characterized by recurrent binge eating episodes. Overlap exists between ED diagnostic groups, with BE episodes presenting one clinical feature that occurs transdiagnostically. Neuroimaging of the responses of those with BN and BED to disorder-specific stimuli, such as food, is not extensively investigated. Furthermore, to our knowledge, there have been no previous published studies examining the neural response of individuals currently experiencing binge eating, to low energy foods. Our objective was to examine (...) the neural responses to both low energy and high energy food images in three emotive categories in BN and BED participants.MethodsNineteen females with BN or BED, comprising the binge eating group, and 19 age-matched healthy control ’s completed thorough clinical assessment prior to functional MRI. Neural response to low energy and high energy foods and non-food images was compared between groups using whole-brain exploratory analyses, from which six regions of interest were then selected: frontal, occipital, temporal, and parietal lobes; insula and cingulate.ResultsIn response to low energy food images, the BEG demonstrated differential neural responses to all three low energy foods categories compared to HCs. Correlational analyses found a significant association between frequency of binge episodes and diminished temporal lobe and greater occipital lobe response. In response to high energy food images, compared to HC’s, the BEG demonstrated significantly decreased neural activity in response to all high energy food images. The HC’s had significantly greater neural activity in the limbic system, occipital lobe, temporal lobe, frontal lobe, and limbic system in response to high energy food images.ConclusionResults in the low energy food condition indicate that binge frequency may be related to increased aberrant neural responding. Furthermore, differences were found between groups in all ROI’s except the insula. The neural response seen in the BEG to disgust food images may indicate disengagement with this particular stimuli. In the high energy food condition, results demonstrate that neural activity in BN and BED patients may decrease in response to high energy foods, suggesting disengagement with foods that may be more consistent with those consumed during a binge eating episode. (shrink)

There is a narrow thread in the vast literature on Kafka which pertains to Kafka’s knowledge of philosophy, and more precisely to Kafka’s use in his fictional writings of some of the main ideas of Franz Brentano. Kafka attended courses in philosophy at the Charles University given by Brentano’s students Anton Marty and Christian von Ehrenfels, and was for several years a member of a discussion-group organized by orthodox adherents of the Brentanian philosophy in Prague. The (...) present essay summarizes what is known about Kafka’s relations to the Brentanist movement. It draws on Brentanian ideas on the evidence of inner perception, on oblique consciousness, on active introspection, on correct and incorrect judgment, and on consciousness as a species of inner tribunal, in order to throw light on central features of Kafka’s writings, including stylistic features. Special attention is directed towards Die Verwandlung and Der Prozess, and a reading of the latter is offered according to which the trial of Joseph K. occurs entirely within the mind of K. himself. The revisions in the 1997 version of the paper relate especially to the treatment of Kafka and Brentano in Arnold Heidsieck’s book The Intellectual Contexts of Kafka’s Fiction: Philosophy, Law, Religion, of 1994. (shrink)

Through an analysis of Kafka's "Before the Law," Vardoulakis considers both various philosophical responses to Kafka's story and philosophical conceptions of the law. In particular, Vardoulakis suggests an affinity between Kafka and Spinoza's conceptions of the law.

Through the study of the behaviour of the protagonists in the work of Franz Kafka, we will try to expose the control mechanisms used by the administrative authorities, providing at the same time with an antidote to uncritical submission. A thorough observation of the configuration of diegetic situations will allow to reverse the situations of forced compliance to proffer, in the voice of the so-called secondary figures, a critical understanding to enable the recovery of individual freedom.

Analyses of Kafka’s The Trial often read the text as an existentialist work, arguing that the novel metaphorizes the absurdity of a modern world where God no longer exists. However, I agree with Slavoj Žižek, who posits that such a modernist reading ignores what is most vital in Kafka’s text—that the absence of God is “always already filled by an inert, obscene, revolting presence”. I argue that this “revolting presence” for Josef K is the presence of the Court; (...) The Trial describes the subject within a society organized by the symbolic order, the big Other, the symbolic network of rules regulating our lives and structuring our reality. For this reason, I read The Trial as pointing the way toward critical postmodernism. But a strictly postmodernist reading of The Trial cannot work without the Lacanian intervention of the split subject. Readings of The Trial based solely on the framework of Foucault’s power/knowledge theory, without a consideration of Lacanian subject formation, are incomplete. Foucault posits that individuals only become subjects via discourse, becoming subjects either through interpellation or via relationship to power. This begs the question, how does an individual become the desiring subject? How does a defendant such as Josef K. come to accept the power of the Court? I answer these questions by applying a necessary psychoanalytic intervention to Foucauldian readings of The Trial, interpreting the text as the narration of Josef K.’s unconscious experience as a split subject in relation to the big Other. (shrink)

Este artículo explora varios motivos en los que Arendt pudo inspirarse en Benjamin para distanciarse luego. Sobre todo, la concepción de la naturaleza como ruina y la relación entre historia y naturaleza que él caracterizaría como historia natural. Junto a ello, la “nuda vida” y la noción de “creatura”, que Benjamin reelabora a partir del drama barroco y Arendt reconstruye en la figura de los refugiados y la “abstracta desnudez del ser humano”. Ambas figuras reaparecen en la lectura que los (...) dos hacen de Kafka como anticipación profética del totalitarismo. Pero, mientras que Arendt extrae de él las figuras opuestas del paria y del parvenu, Benjamin se fija en el mesianismo y en el carácter opresivo de la ley. La desatención de Arendt a esto último es la condición de su apuesta por la natalidad y la política, lo que le distancia de Benjamin y del propio Kafka. (shrink)

It explains the importance of the concept of freedom in Kafka's work.

“I also talked to Buber yesterday; as a person he is lively and simple and remarkable, and seems to have nothing to do with the lukewarm things he has written” – wrote Franz Kafka to his fiancée Felice Bauer in the early 1913. What is the meaning of this harsh, yet respectful portraiture of Buber? Was it a casual ironic remark – or was it rather the way Kafka really thought of Martin Buber? And to what extent was (...) Kafka important for Buber? How can we understand the collaboration between the writer and philosopher? Close reading, contextualization and Begegnungsereignis. (shrink)

O artigo desenvolve uma leitura em paralelo de dois textos: um trecho de _Der tolle Mensch_ e a parábola _Ein commentar_. Não procurando realizar uma análise comparada, procura-se apontar algumas aproximações e alguns distanciamentos. Como mediadores desta tentativa de leitura, utilizamos uma carta de Walter Benjamin e os comentários de Modesto Carone sobre a parábola de Kafka.