There is limited knowledge about cancer patients' experiences of uncertainty while waiting for genome sequencing results, and whether prolonged uncertainty contributes to psychological factors in this context. To investigate uncertainty in patients with a cancer of likely hereditary origin while waiting for genome sequencing results, we collected questionnaire and interview data at baseline, and at three and 12 months follow up. Participants had negative attitudes towards uncertainty at baseline, and low levels of uncertainty at three and 12 months. Uncertainty about (...) genome sequencing did not change significantly over time [t = 0.660, p = 0.510]. Greater perceived susceptibility for cancer [r = 0.14, p < 0.01], fear of cancer recurrence [r = 0.19, p < 0.01], perceived importance of genome sequencing [r = 0.24, p < 0.01], intention to change behavior if a gene variant indicating risk is found [r = 0.29, p < 0.01], perceived ability to cope with results [r = 0.36, p < 0.01], and satisfaction with decision to have genome sequencing [r = 0.52, p < 0.01] were significantly correlated with negative attitudes towards uncertainty at baseline. Multiple primary cancer diagnoses [B = −2.364 [−4.238, −0.491], p = 0.014], lower perceived ability to cope with results [B = −0.1.881 [−3.403, −0.359], p = 0.016] at baseline, greater anxiety about genome sequencing [B = 0.347 [0.148, 0.546], p = 0.0012] at 3 months, and greater perceived uncertainty about genome sequencing [B = 0.494 [0.267, 0.721] p = 0.000] at 3 months significantly predicted greater perceived uncertainty about genome sequencing at 12 months. Greater perceived uncertainty about genome sequencing at 3 months significantly predicted greater anxiety about genome sequencing at 12 months [B = 0.291 [0.072, 0.509], p = 0.009]. Semi-structured interviews revealed that while participants were motivated to pursue genome sequencing as a strategy to reduce their illness and risk uncertainty, genome sequencing generated additional practical, scientific and personal uncertainties. Some uncertainties were consistently discussed over the 12 months, while others emerged over time. Similarly, some uncertainty coping strategies were consistent over time, while others emerged while patients waited for their genome sequencing results. This study demonstrates the complexity of uncertainty generated by genome sequencing for cancer patients and provides further support for the inter-relationship between uncertainty and anxiety. Helping patients manage their uncertainty may ameliorate psychological morbidity. (shrink)

Palliative care and hospice should be the standards of care for all terminally ill patients. The first place for clinicians to go when responding to a request for assisted death is to ensure the adequacy of palliative interventions. Although such interventions are generally effective, a small percentage of patients will suffer intolerably despite receiving state-of-the-art palliative care, and a few of these patients will request a physician-assisted death. Five potential “last resort” interventions are available under these circumstances: (1) accelerating opioids (...) for pain or dyspnea; (2) stopping potentially life-prolonging therapies; (3) voluntarily stopping eating and drinking; (4) palliative sedation (potentially to unconsciousness); and (5) physician-assisted death. Patient, family, and clinicians should search for the least harmful way to respond to intolerable end-of-life suffering in ways that are effective and also respect the values of the major participants. A system that allows an open response to such cases ultimately protects patients by ensuring a full clinical evaluation and search for alternative responses, while reinforcing the need to be responsive and to not abandon. (shrink)

In my career as a primary care physician and as a palliative care consultant, I have assisted many patients to die with their full consent. None of them wanted to die, and all would have chosen other paths had their disease not been so severe and irreversible. To a person, none of these patients thought of themselves as “suicidal,” and they would have found that label preposterous and demeaning. In fact, the kind of personal disintegration that the label implies is (...) just what is trying to be prevented by those choosing this possibility. So on behalf of patients who have chosen this option, I reject the title of this debate as it unnecessarily tars the discussion with the suggestion of mental illness. In my primary care practice, I have also met many patients who were “suicidal” in the mental health sense of the word, and rest assured I have assisted none of them to die. In fact, I have at times had them involuntarily hospitalized to prevent them from carrying out their wishes. (shrink)

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical (...) climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it (...) does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers. (shrink)

Through both an historical and philosophical analysis of the concept of possibility, we show how including both potentiality and actuality as part of the real is both compatible with experience and contributes to solving key problems of fundamental process and emergence. The book is organized into four main sections that incorporate our routes to potentiality: potentiality in modern science [history and philosophy; quantum physics and complexity]; Relational Realism [ontological interpretation of quantum physics; philosophy and logic]; Process Physics [ontological interpretation of (...) relativity theory; physics and philosophy]; on speculative philosophy and physics [limitations and approximations; process philosophy]. We conclude that certain fundamental problems in modern physics require complementary analyses of certain philosophical and metaphysical issues, and that such scholarship reveals intrinsic features and limits of determinism, potentiality and emergence that enable, among others, important progress on the quantum theory of measurement problem and new understandings of emergence. (shrink)

Untying the Gordian Knot shows how the fundamental notions of process, logic and relations, woven with triads of input-output-context, can be combined with quantum distinctions associated with actuality and potentiality, enabling the leveraging of many advances in philosophy and physics to unravel several long-standing philosophical problems.

Black Panther, even with the deep problems in how it represents Black American men, grapples with messy histories directly, in plain sight of white audiences. The motivations and struggles of the characters Shuri and Erik "Killmonger" Stevens, in particular, show us how Black Panther's blend of Africanfuturism and Afrofuturism is meant to teach us how our memories of the past must connect with our visions of the future. Black Panther presents a vision of a distinctly African future that not only (...) affirms that there are in fact Black people in the future, but also gives us a glimpse of how Black people make it to the future and what kind of home we make there. Ruha Benjamin describes how our technologies coalesce to support anti‐Blackness and white supremacy – sometimes inadvertently, oftentimes explicitly. African/Afrofuturist works like Black Panther help us calibrate our walking canes, in a way. (shrink)

Voluntary active euthanasia and physician-assisted suicide remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In (...) this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

This paper examines Plutarch's treatment of education in the Parallel Lives. Beginning with a close reading of Them. 2, it identifies two distinct ways in which Plutarch exploits the education of his subjects: in the first, a subject's attitude to education is used to illustrate a character presented as basically static (a 'static/illustrative' model); in the second, a subject's education is looked at in order to explain his adult character, and education is assumed to affect character (a 'developmental' model). These (...) two models are often associated with two different forms of discourse: anecdotal for the static/illustrative model and analytical for the developmental. The developmental model, furthermore, is closer to Plutarch's thinking in theoretical discussions of character in the Moralia; the static/illustrative model to Plutarch's treatment of character in the Lives more generally, where anecdotal treatments predominate. The coexistence of these two models is probably to be seen as the result of a tension between Plutarch's philosophical thinking and his biographical practice: those few passages in the Lives which assume a developmental model occur in contexts where either Platonic texts or the activity of philosophers are being discussed. (shrink)

This paper surveys some scientific issues in physical cosmology and concludes that no current model in cosmology adequately meets all key observations. Scholars in process thought are making important contributions in both metaphysics and philosophical cosmology, independent of the outcome of debates in physical cosmology. Such scholars are advised to be very cautious when using hypotheses currently arising from contemporary cosmology.

This paper argues that the emendation ὑπερερῶν for ms. ὑπερoρῶν in Them. 2. 3, although rejected by many editors and commentators, should be accepted. The manuscripts have Themistokles ‘despising’ practical studies, that is studies which promoted ‘intelligence and action’. But this makes little sense in context and disrupts the logic of the whole chapter, which presupposes a contrast between real education, which Themistokles rejects, and practical activities, on which he concentrates and for which he was suited by nature. It is (...) much more plausible that Themistokles is presented as having ‘an excessive love’ for practical studies. Indeed, this combination – rejection of true education and enthusiasm for practical training – characterises several other subjects of Plutarch, while erotic metaphors are used to describe Themistokles’ obsession with practical success in the next chapter. (shrink)

This study focuses not on individual Lives or pairs of Lives, but on the book as a whole and its articulation across the full corpus. It argues that the Plutarchan book consists of up to four distinct sections: prologue, first Life, second Life, synkrisis. Each of these sections has a fairly consistent internal structure, and each has a distinct set of strategies for opening, for closure, and for managing the transition from one section to the next. Prologues provide an introduction (...) to both Lives, and are clearly delineated from them, even though in our manuscripts they appear as part of the first Life; in fact, there is often a stronger break between prologue and first Life than there is between the two Lives themselves. Prologues usually begin with generalized reflections, to be followed only later by the naming of the subjects and a statement of their similarities. Most Lives begin with a thematically organized section , which surveys the subject's life as a whole, not just their youth, and which is marked off with varying degrees of distinctness from the narrative that follows. Crucially, proemial openings do not narrate and the logic of their structure is not chronological. Closure in many Lives is signalled by ‘circularity’ and sometimes by a closural or transitional phrase, though first Lives are different here from second Lives. Synkriseis are structured both by a series of themes on which the two subjects are compared, and by a two-part, agonistic structure in which first one of the subjects is preferred, then the other. Synkriseis may also recall the prologue; both prologue and synkrisis operate at the level of the book, and between them frame and weld together the two Lives. (shrink)

Philosophies of nature over the past three centuries have gone through three distinct phases, beginning with classical views and now evolving into a process view at the dawn of the 21st century. These phases derive from a complex weaving of two frameworks of physics since Newton's time [classical, modern] with two principal metaphysical frameworks[substance, event]. Problematic fin de sicle claims at the end of both the 19th and 20th centuries appear to have a common root in substance metaphysics and part/whole (...) reductionism. Going beyond such simplistic forms of modernism requires a more integrated, ecological worldview, or process view of nature. (shrink)

The ongoing research program of process thought meets some of its most crucial tests in efforts towards a comprehensive philosophy of nature. Contributors to the two special focus issues on natural science for the Process Studies journal provide many examples of such tests and commentary that reflect contemporary scientific thought. A core element of modern scientific methodology is the search for invariant, physical relationships that simplify our understanding of complex systems. In addition to a preference for some form of critical (...) realism and intersubjective testability, scientists search for relationships that are both universal and repeatable. Indeed, the very success of this approach has led to more and more frequent use of 'event/process' versus 'substance/thing' language in the sciences. (edited). (shrink)

According to the biopsychosocial model, developed by the late Dr. George Engel, how physicians approach patients and the problems they present is very much ...

Russell articulates compelling reasons that bioethicists and health care professionals should take individual responsibility for deconstructing structural injustices in healthcare through in...

Book reviewed in this article: Death and Dignity: Making Choices and Taking Charge. By Timothy E. Quill.

When the character of Black Panther first appeared in Fantastic Four no. 52 in July 1966, legendary creators Stan Lee and Jack Kirby didn't just write a story about another hero with extraordinary powers, they birthed the first Black superhero. For Lee, "it was a very normal thing," because "A good many of our people here in America are not white. You've got to recognize that and you've got to include them whatever you do." While it might've seemed normal to (...) Lee, Black Panther's (and Wakanda's) significance cannot be overstated. After all, the first Black superhero isn't just a Black superhero, he's the King of an African nation endowed with otherworldly powers, and Wakanda isn't just an African nation, it's the most advanced civilization the Earth has ever seen. Indeed, it shouldn't be lost on us that when Black Panther was introduced (during the Civil Rights era of the 1960s) the thought of a Black President-or an advanced, futuristic African society-would have been, well, unthinkable for too many people. (shrink)