Дисертації з теми "Futility"
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1
Barlow, Gabriel Lashley. "Confrontation: Endeavors in Futility." VCU Scholars Compass, 2007. http://scholarscompass.vcu.edu/etd/697.
Анотація:
This paper is intended to compliment and describe the body of work that has been produced within the time I have been enrolled as a graduate student at Virginia Commonwealth University's Photography and Film department. The paper will include information on both my MFA candidacy presentation as well as a description of the evolution of my artistic endeavors. The main focus of this document is to discuss my formal examination of performance based video works pertaining to the absurd as described by Camus, and later expressed by Samuel Beckett, also the role of the masculine body's physicality within ritualized actions.
2
Loeben, Gregory Scott. "Medical futility and the goals of medicine." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/288943.
Анотація:
I begin by exploring the distinction between the physiologic, quantitative, and qualitative conceptions of futility. I argue that if medical futility is going to be a useful and appropriate normative tool in the medical lexicon, it should not duplicate and confuse judgments which we already have the tools to make. Hence, I distinguish qualitative futility from the concepts of distributive justice, rationing, harm, and insufficient benefit. Lastly, I consider the argument that providing qualitative futility violates professional integrity. Next I consider the claim that futility judgments are a form of unjustified paternalism. I also explore the relationship of physician imposition of values and the ideas of individual patient well-being, and self-determination. I consider an argument put forth by Thomlinson and Brody that futility judgments actually support autonomy, concluding that their argument must be restricted to individuals whose choices can be shown to be inconsistent with their values and aims. Lastly, I provide a comparison of futility judgments and the ordinary/extraordinary distinction which shows futility to be normatively vague and clinically dangerous. Because of the potential for misuse and confusion, I compare futility and rationing judgments. I argue that rationing decisions are necessary but should be explicit rather than disguised as futility. The consequences of failing to adequately distinguish these two are unfairness to individual patients, and harm to the doctor-patient relationship and societal trust of medicine. I detail a number of models of the physician patient relationship and attempt to determine two things: (1) whether these allow for physician authority to withhold qualitatively futile care, and (2) how well these models can answer this question in the absence of an account of the goals of medicine. I conclude that various accounts offer little specific guidance about the physician's right to withhold qualitatively futile treatment. Finally, in chapter seven I attempt to ground the debate about medical futility in the larger context of a debate about the appropriate ends and goals of medicine, arguing that such limits require an extended social dialogue.
3
Roberts, Sharon. "The Parental Leave Directive : an exercise in futility?" Thesis, University of South Wales, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442504.
4
Christie, Timothy Kuma Sordzi. "Authority, futility, and clinical treatment, the challenge to authority." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0019/NQ45169.pdf.
5
Christie, Timothy. "Authority, futility, and clinical treatment: The challenge to authority." Thesis, University of Ottawa (Canada), 1999. http://hdl.handle.net/10393/8915.
Анотація:
The doctrine of informed consent established a distinctive role for both the doctor and the patient, in the doctor-patient relationship. This doctrine, represented by the compound word "informed consent" placed a duty on the physician to "inform" and gave a specific task to the patient "consent." The physician was required to inform the patient to the extent that a reasonable person in that situation would want to be informed. Then the patient had the prerogative of whether to consent or refuse to consent. However, during the late 1980's and early 1900's different clinical situations arose which could not be accommodated by simply giving patients the right to consent or refuse to consent. Situations developed in which health care professionals wanted to refuse to provide treatment on the grounds that further treatment is medically futile and patients' (and/or their families) wanted to insist on treatment claiming that it was not futile and that it served a genuine purpose. Essentially, the informed consent doctrine provided patients with the "negative right" to refuse treatment. The idea of medical futility revealed the limitations of informed consent by demonstrating that some patients also wanted a "positive right" to demand treatment. After analysing this new phenomenon it appears that it is the most recent manifestation of the age-old debate between professional paternalism and patient autonomy. As a result, this thesis analyses the futility debate and then takes a step back in order to evaluate it from the more general perspective of establishing the legitimate domains of both patient and professional authority. Standard approaches to the futility debate generally argue for unilateral decision making authority for either the patient or professional, concerning futility issues. However, the problem with this approach is that it renders the doctor-patient relationship as a zero-sum game; in other words, if one side wins the other side loses. Alternatively, the focus of this thesis is to propose a model of professional and patient authority which allows each party substantial decision-making authority but is also mutually supportive. Therefore, this new approach to the futility debate, and indeed the doctor-patient relationship in general, is undertaken with the intention of preventing these types of disputes from arising, rather than attempting to resolve the conflict once it is fully developed.
6
Bandrauk, Natalie. "Futility and the proper goals of medicine : a critical care perspective." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=78243.
Анотація:
While the concept of medical futility has existed for as long as medicine has been practiced, it remains a controversial issue that has become more clouded as medicine has advanced. This thesis will explore futility in the most technologically rich and emotionally charged of settings, the intensive care unit. The complex interactions of biology, ethics and the law, with their competing and sometimes conflicting interests will be explored. Disputes between patients, families and health care workers over life-sustaining interventions occur most often in the ICU, and the factors that influence this dynamic, such as lack of communication, time constraints, media-driven misconceptions and value-conflicts, will be examined. Attempts to address futility through advance health directives and conflict resolution policies will be critiqued. But most importantly, this thesis will explain, by appealing to the proper goals of medicine, why limitations should be placed on end-of-life care, and why physicians have an important role to play in making these determinations.
7
Li, Qing. "Interim monitoring efficacy, safety and futility in phase III clinical trials." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/li.pdf.
8
Tutu, James. "Corporate governance reforms post 2008 financial crisis : an exercise in futility?" Thesis, University of Surrey, 2018. http://epubs.surrey.ac.uk/846463/.
Анотація:
The Financial Crisis which began in 2007/2008 remains the most severe since the Great Depression of the 1930s. It exposes the inherent dangers of unregulated markets and highlights the weaknesses of the corporate governance system that has been constructed and determined by the shareholder primacy theory. The crisis sparked and intense debate on the causes and the response needed to correct the largely dysfunctional governance, legal and regulatory regime that has characterised the pre-crisis corporate governance landscape. In response, governments in the United States of America (USA) and United Kingdom (UK) embarked on different governance and regulatory reforms ostensibly to contain the damage and possibly prevent future occurrence. The Thesis argues that corporate governance failures merely triggered the crisis and that the underlying cause of the crisis is the idea that the sole purpose of the corporation is shareholder value maximisation. The reforms merely provide immediate and temporary solutions but leave intact the problem of how to deal with the issue of shareholder primacy in the long-term. Thus, the Thesis contends that the reforms in the US and the UK are at best ad-hoc and cosmetic measures that only treat the symptoms and not the causes of the financial crisis. An original contribution of this Thesis is that it may lead to a reconceptualization of the nature and purpose of the corporation and the emergence of a more long-term governance model. It has wider implications as it will be useful not only for students and researchers but also provides insights for policy makers and business managers to make informed decisions.
9
Sidler, Daniel. "Medical futility as an action guide in neonatal end-of-life decisions." Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/50017.
Анотація:
Thesis (MPhil)--University of Stellenbosch, 2004.ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof- life decisions. The concept is contextualized within the narrative of medical progress, the uncertainty of medical prognostication and the difficulty of just resource allocation, within the unique African situation where children are worse off today than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties ought to accept moral responsibility. Such a model of deliberation has the added advantage of transcending the limitations of the participants to arrive at a higher-level solution, which is considered more than just a consensus. It has been argued that medical progress has obscured the basic need for human compassion for the dying and for their loved ones. The literature furthermore reports that the quality of end-of-life care is unsatisfactory for both patients and their families. It is within this context that the concept of medical futility is positioned as a useful action guide. As we do not have the luxury of withdrawing from the responsibility to engage in the deliberation of end-of-life decisions, such responsibility demands an increasing awareness of ethical dilemmas and a model of medical training where communication, conflict-resolution, inclusive history taking, with assessment of patient values and preferences, is focussed on. The capacity for empathetic care has to be emphasized as an integral part of such approach. Finally, in this thesis, the concept of medical futility is tested and applied to clinical case scenarios. It is argued that the traditional medical paradigm, with its justification of an 'all out war' against disease and death, in order to achieve utopia for all, is outdated. Death in the neonatal intensive care unit is increasingly attributed to end-of-life decisions. Futile treatment could be considered a waste of scarce resources, contradicting the principle of nonmaleficence and justice, particularly in an African context. The ongoing confidence in, and uncritical submission to the technological progress in medicine is understood as a defence and coping mechanism against the backdrop of the experience of life's fragility, suffering and the inevitability of death. Such uncritical acceptance of the technological imperative could lead to a harmful fallacy that cure is effected by prolonging life at all cost. What actually occurs, instead, is the prolongation of the dying process, increasing suffering for all parties involved. The historical development of the concept of medical futility is discussed, highlighting its applicability to the paradigmatic scenario of cardio-pulmonary resuscitation. Particular attention is given to ways in which the concept could endanger patient-autonomy by allowing physicians to make unilateral, paternalistic decisions. It is argued that the informative model of the patient-physician relationship, where the physician's role is to disclose information in order for the patient to indicate her preferences, ought to be replaced by a more adequate deliberative model, where both
AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese prognostikering en die probleme wat geassosieer IS met regverdige hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie. Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence') en regverdigheid. Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese vooruitgang lil geneeskunde, kan beskou word as verdediging- en hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die onafwendbaarheid van die dood. Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye. Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre resussitasie. Spesifieke aandag word gegee aan maniere waarop die konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word 'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring. Die argument word ontwikkel dat mediese vooruitgang meelewing met die sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n maatstaf vir aksie. Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan- lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering. Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te pas op kliniese situasies.
10
Cullen, James Peter. "The futility of stock-based compensation in light of imperfect market pricing." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/the-futility-of-stockbased-compensation-in-light-of-imperfect-market-pricing(ebbc88ab-b317-4fc6-9d61-01beff69b1a8).html.
Анотація:
This thesis addresses the mechanics of executive remuneration from an unorthodox perspective; the view presented through the lens of imperfect market pricing. Whilst many of the criticisms of existing compensation arrangements are merited, they ignore the integrity of a crucial aspect of the way remuneration awards are calculated; the market pricing mechanism. The original contribution of knowledge of this thesis is to explain how imperfect market pricing undermines the utility of stock-based compensation awards, especially in light of the Global Financial Crisis of 2007-11 (‘GFC’).The existing position with regard to Anglo-American corporate governance emphasises the role of the market in determining optimal governance solutions. However, the market cannot regulate all conflicts. For example, the separation of ownership and control in modern corporations creates an agency problem whereby managerial and shareholder interests may diverge. Public companies therefore use performance-related pay to align the interests of management with those of firm owners. This performance-related pay often includes an element with a specific link to the price of company stock. A by-product of these arrangements is that incentives are created for executives to inflate the value of their companies in order to benefit from short-run price appreciation. This reduces the utility of stock-based pay and encourages market short-termism. There is however, a further fundamental flaw in the use of stock-based pay; it places complete faith in modern finance theory; a theory which asserts that market pricing is flawless (the so-called Efficient Capital Markets Hypothesis). However, financial and asset markets are susceptible to forces which drive prices away from intrinsic value for protracted periods and contribute to serious price distortion. Behavioural finance explains how these distortions occur and provides a more appropriate paradigm for securities market operation. The Financial Instability Hypothesis (‘FIH’) also explains how endogenous instability, emanating from the banking sector, arises as an inevitable consequence of the functioning of the capitalist economy. It further demonstrates how markets may be driven away from fundamental value, how asset bubbles occur, and how the market pricing mechanism is seriously distorted. The most serious recent crisis, the GFC, exhibited the FIH taxonomy. It exposed serious flaws in modern finance theory and revealed the dangers of flawed incentive systems in generating asset bubbles. Executives at financial institutions stand accused of short-termism, over-leveraging and poor risk management. Monitoring of management was impossible to perform effectively due to various behavioural and structural obstacles arising from the size and complexity of the institutions concerned. Moreover, a system of perverse incentives led to the failure of effective regulation of executive compensation.Reform is therefore required. The thesis will conclude with a critical analysis of recent amendments to the regulation of compensation systems at financial institutions. Based on this examination, the thesis will make some proposals for future remuneration packages in the wider economy. These proposals are designed to reduce the potential for financial instability through removing incentives for firm executives to concentrate on short-term results, and emphasize the role of qualitative indices of performance.
11
Harvey, Jacqueline Christine. "Morality and Mortality: the Role of Values in the Adoption of Laws Governing the Involuntary Removal of Life Sustaining Medical Treatment in Us States." Thesis, University of North Texas, 2012. https://digital.library.unt.edu/ark:/67531/metadc149554/.
Анотація:
Disputes between patients and providers regarding life-sustaining medical treatment (LSMT) are universal across all U.S. states, yet policies regarding these disputes differ significantly. This dissertation determines that all 50 states have advance directive laws that protect a patient’s right to refuse LSMT even when a healthcare provider objects, yet only some states have policies that protect the patient’s right to choose to continue LSMT when a healthcare provider objects (a dispute known as medical futility). Some states have pro-patient laws that protect the patient’s right to make the final decision, while other states have enacted pro-provider medical futility policies that explicitly grant the provider authority to remove LSMT against the patient’s wishes. Finally, in one state, the law delegates the final decision to a third-party: institutional healthcare ethics committees. This dissertation studies the innovation and adoption of these 17 state medical futility policies, examining the theory that values determine both whether the state adopts a medical futility policy as well as what type of medical futility policy a state will adopt- as the policy actors that represent these values: policy entrepreneurs and interest groups. A comparative case study of successful third-party policy adoption in Texas contrasted against a failed effort in Idaho could not affirm the necessity of policy entrepreneurs for policy adoption but did affirm the necessity of interest group consensus and the role of values. Furthermore, quantitative analysis failed to offer statistically-significant evidence of value indicators, but did suggest that government ideology and political party affiliation may potentially become indicators of the type of medical futility policy that states choose to adopt.
12
Schulte-Herbrüggen, Anna Katharina [Verfasser]. "Medical futility und "medizinische Indikation" im Kontext der präklinischen Reanimation : eine medizinethische Analyse / Anna Katharina Schulte-Herbrüggen." Köln : Deutsche Zentralbibliothek für Medizin, 2016. http://d-nb.info/1122030940/34.
13
Mittermaier, Sten. "The Intolerableness of All Earthly Effort : of Futility and Ahab as the Absurd Hero in Melville's Moby Dick." Thesis, Stockholm University, Department of English, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-8324.
Анотація:
In 1942, Algerian writer Albert Camus published a philosophical essay called The Myth of Sisyphus along with a fictional counterpart, The Stranger, wherein he presumed the human condition to be an absurd one. This, Camus claimed, was the result of the absence of a god, and consequently of any meaning beyond life itself. Without a god, without an entity greater than man, man has no higher purpose than himself and he himself is inevitably transient. As such, man, so long as he lives, is cursed with the inability to create or partake in anything lasting. The absurd is life without a tomorrow, a life of futility. As one of the main precursors of this view of life and of the human experience, Camus mentioned Herman Melville and Captain Ahab’s chase for the white whale - Moby Dick.
Now, as will be indicated in the following, the most common critical position holds that the white whale of Moby-Dick, Melville’s magnum opus, is to be interpreted as a symbol of God, and thus Ahab’s chase is tragic by virtue of its impossibility for success. As such, the tragedy is entailed by the futility vis-à-vis its impermanence. However, the ambiguity of Moby-Dick allows for the possibility of several alternative interpretations as to the role of the whale: for instance that of the devil, evil incarnate or merely a "dumb brute". As such, Ahab’s quest might as well be the pursuit of a creature which understands nothing of vengeance, thus rendering his objective equally, if not more fruitless, than the pursuit of a god.
14
McClure, Anne Carey. "Ritualized Futility via Clinical Momentum at the End of Life in the Intensive Care Unit:An Ethical Inquiry into Moral Distress in Nurses as a Response to a Culturally MediatedHealthcare System Failure." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1587082543896911.
15
Harper, Mark C. "The violent act of femininity sexual politics, narrative futility, and gender performativity in the blood melodramas of Francois Truffaut /." [Bloomington, Ind.] : Indiana University, 2006. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:3210040.
Анотація:
Thesis (Ph.D.)--Indiana University, Dept. of Comparative Literature, 2006.Source: Dissertation Abstracts International, Volume: 67-03, Section: A, page: 0756. Adviser: Joan Hawkins. "Title from dissertation home page (viewed March 16, 2007)."
16
Rethore, Florent Philippe. "The evolution of the role of humanism in the combat against the absurd, from futility to essential: 1938-1945." Ohio University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1555177391619455.
17
Burt, Stephanie. "Re-Branding Palliative Care: Assessing Effects of a Name Change on Physician Communicative Processes During Referrals." Thesis, University of North Texas, 2011. https://digital.library.unt.edu/ark:/67531/metadc67964/.
Анотація:
Although provision of palliative care on the United States is growing, referrals to the service are often late or non-existent. The simultaneous care model provides a blueprint for the most progressive form of palliative care, which is palliation and disease-oriented treatments delivered concurrently. Research indicates the existence of a widespread misconception that associates palliative care with imminent death, and some organizations have chosen to re-brand their palliative care services to influence this perception. The goal of this study was to assess the effects of a name change from palliative care to supportive care on the communicative process during referrals to the service.
18
Ting, Roy P. "Scriptural and cultural influences on second-generation Asian Americans concerning their elders implications for decision making in situations of "medical futility" /." Theological Research Exchange Network (TREN), 1999. http://www.tren.com.
19
Onstott, Wilson Wright. "Articulation as an Act of Futility: A Deconstructive Exploration of Textual Articulation as It Functions within a First-Person Narrative Structure." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etd/2198.
Анотація:
The inability of language to convey complete meaning and truth is a central point of address for much post-structuralist literary theory and criticism. When these theories are applied to a first-person narrative structure, whether it is a work of fiction or non-fiction, certain specific incongruities arise. When a narrative seeks to recall certain events, a presupposed reexamination takes place as the narrative unfolds text comes into being. If a narractice is contructed in this way then the intent of the text then is to convey comprehensive meanings or truths of those cataloged experiences. According Deconstructive Theory, it is language's inherent nature to resist ultimate meaning. This focus on the articulation of truth is futile because meaning, like language, is always already in a state of fragmentation. This project explores five individual works from different literary traditions-ranging from the canonical to the relatively obscure. The works exhibit various approaches to articulation; including varying degrees of self-definition, personal fiction, and narrative movement toward inarticulation.
20
Taylor, Dan. "Field of futility or hidden hope? : agricultural knowledge and practice of low resource farmers in the Kwazulu-Natal Province of South Africa." Thesis, University College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325329.
21
Dogan, Buket. "Shakespeare'." Master's thesis, METU, 2008. http://etd.lib.metu.edu.tr/upload/12609471/index.pdf.
Анотація:
ABSTRACT
SHAKESPEARE&rsquoS HAMLET AS A PRECURSOR OF THE THEATRE OF THE ABSURD Dogan, Buket M.A., in English Literature Supervisor: Assoc. Prof. Dr. Ü
nal Norman May 2008, 121 Pages Being regarded as a dramatist of all times, Shakespeare and his work is studied with a modern view point by many critics. Every historical period finds in him what it is looking for and what it wants to see. Shakespeare is part of a modern tradition trying to mirror human psychology and condition in all its absurdity. The innovations that the theatre of the Absurd has brought to the stage not only provide an influence for the works of the later generations but also, they make it possible to look back at the past works of the theatre with a contemporary critical eye. Shakespeare&rsquo
s vision of the world is similar to that of the absurdists, mainly due to their shared confidence in humanity&rsquo
s capacity to endure, and the precarious nature of human existence. This thesis analyzes Shakespeare&rsquo
s masterpiece Hamlet, mainly the drama of its protagonist, as a precursor of Absurd drama. In Hamlet, Shakespeare represents man&rsquo
s existential anxiety and precarious condition in a nonsensical world, which is stripped of all logical explanations and accounts. To examine the play in the context of the theatre of the Absurd, it will be discussed in relation to Samuel Beckett&rsquo
s Waiting for Godot and Endgame with regard to their common concerns for the themes of the theatre of the Absurd such as uncertainty and inertia.
22
Hagström, Karolina. "Klimatkompensera mera? : Albert O. Hirschmans teori om reaktioner mot samhällsförändringar tillämpad på den svenska debatten om klimatkompensation." Thesis, Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-166365.
Анотація:
By implementing Albert O. Hirschman’s theory about reactions, the purpose of this thesis is to analyse the arguments against carbon offsetting presented in Swedish media. More specifically, I will structure and analyse the counter-arguments I find in the articles about carbon offsetting presented by the Swedish paper Dagens Nyheter between October 2019 and January 2020. Hirschman’s theory of the reactionary rhetoric is based on the notion that every social action is followed by a reaction. To illustrate this, Hirschman introduces three types of theses –arguments -deployed by those who oppose a new idea or reform. The three principal arguments Hirschman identifies is the futility thesis, the perversity thesis and the jeopardy thesis. The futility thesis suggests that an action aiming to improve the society in any way won’t have any effect, the perversity thesis claims that the action will result in the opposite outcome of what was intended and the jeopardy thesis implies that the action will result in intolerable consequences in other areas. Hirschman suggests that a debate where any of these theses are present both is a danger for democracy and is likely to result in suffering in other ways as well. In that way, his theory provides a tool for identifying dangerous arguments in order to take a step towards a more democracy friendly discussion. By analysing 85 arguments against carbon offsetting I find that 51 of them easily can be categorized as either one of the theses, while 22 can’t be categorized at all. The remaining 12 arguments can either partly or in full be placed in the model. The majority of the 51 arguments fitting in Hirschman’s model are futility theses, which implies that the Swedish debate in this area largely consists of arguments claiming that carbon offsetting doesn’t make any difference. My conclusion based on Hirschman’s theory and the analysis of the arguments is that the Swedish debate about carbon offsetting unarguably contains signs of the polarized discussion Hirschman claims to be a democratic danger and that both the debate itself and the climate overall probably would benefit from a more nuanced and balanced debate.
23
Bertolino, Karla Cristiane Oliveira. "REPRESENTAÇÕES SOCIAIS DE MÉDICOS E ENFERMEIROS SOBRE DISTANÁSIA EM UTI." Universidade Federal de Santa Maria, 2009. http://repositorio.ufsm.br/handle/1/7326.
Анотація:
Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorThis research aimed to understand the social representations of physicians and nurses about excessive investment related to the terminal patient during the health care process in an Adult ICU. The specific aims of such project were to describe how physicians and nurses mean the end of life and the excessive investment regarding the terminal patient, to investigate how such professionals evaluate their academic learning process concerning health care during the dying process, and to identify reactions and feelings of physicians and nurses related to the death of the terminal patient. It consisted of a qualitative, exploratory/descriptive research, founded on Social Representations Theory. Data collection techniques consisted on focused interviews and participant observations. Analysis was based on content analysis. The ethical principles were respected, so that the participants rights were preserved, and an Informed Consent Document was signed as a condition to participate in the research. Among the results, it was possible to observe that physicians and nurses build their social representations about dysthanasia in the ICU under the influence of several factors, having as a starting point the absence of teaching and preparation to deal with death in the hospital context during undergraduate studies and medical residency, as well as the complexity of the daily contact with death and the dying process, together with feelings and defense mechanisms, spirituality and religiosity. Moreover, there are assertions that dysthanasia really happens, the firm pleads of the family of the terminal patient admitted in an ICU, the great complexity of decision making, that begins before admission of the patient in the ICU, decisions whether to invest on the patient or not, and the criteria used to decide when to stop investing, the role of the health professionals team on decision making, the enormous preoccupations concerning ethical and legal repercussions related to the decisions made as concerns the Code of Professional Ethics and the Brazilian Law, besides absences and euphemisms employed when registering the diagnosis, prognosis and care offered to the terminal patient, and last, the expectation of a dignified death as concerns the professional himself and the family, wishing to die at home, together with the family, having accepted the end of life. This study concludes that there are urgent needs of improvement regarding multiple aspects related to death: its approach during undergraduate studies and residency; adequate communication among professionals during decision making process and during the professional activities in the ICU, the ponderation between the wishes of the family and the real possibilities of survival of the patient. It is important to consider the situation of the patient and think that, concerning a hypothetical end of life, everything the professional dispenses to the patient in an ICU is solely what he would not desire as a dignified death, for himself or his family members.
Esta pesquisa objetivou compreender as representações sociais de médicos e enfermeiros acerca do investimento excessivo no paciente terminal durante o processo de cuidar em uma UTI Adulto. Os objetivos específicos visaram descrever como médicos e enfermeiros significam terminalidade de vida e o investimento excessivo no paciente terminal; investigar como estes profissionais avaliam a sua formação acadêmica face ao cuidado no processo de morrer; e identificar reações e sentimentos de médicos e enfermeiros frente à morte do paciente. Constou de uma pesquisa qualitativa, exploratório-descritiva, fundamentada na Teoria das Representações Sociais. As técnicas de coletas de dados foram a entrevista focalizada e a observação participante. O processo de análise foi embasado na análise de conteúdo. Os princípios éticos foram respeitados, de forma a proteger todos os direitos dos participantes, com formalização da participação por meio de Termo de Consentimento Livre e Esclarecido. Dentre os resultados, observou-se que os médicos e enfermeiros constroem as suas representações sociais sobre a distanásia em UTI sob influência de múltiplos fatores, partindo da ausência do ensino e preparação para lidar com a morte no cotidiano hospitalar durante a graduação e a residência médica; a complexidade da convivência cotidiana com a morte e o processo de morrer, juntamente com os sentimentos e mecanismos de defesa; a espiritualidade e a religiosidade; as afirmações de que a distanásia realmente acontece; os pedidos obstinados da família do paciente terminal internado na UTI; as grandes complexidades das tomadas de decisão, que se iniciam desde antes da admissão do paciente na UTI, passando pelas dúvidas em relação ao investimento, ou não, no mesmo e nos critérios utilizados para se saber até onde investir; o papel da equipe nas tomadas de decisão; o enorme receio das repercussões éticas e legais em relação às decisões tomadas, no que se refere aos códigos de ética profissional e o Código Penal brasileiro, além das ausências e eufemismos empregados nos registros de diagnóstico, prognóstico e cuidado ofertado ao enfermo terminal; e, por fim, os anseios de boa morte para o próprio profissional e seus familiares, com desejos de falecer em casa, junto com a família, como forma de aceitação da sua finitude. Concluiu-se, neste estudo, que existem necessidades de aperfeiçoamento no que tange a múltiplos aspectos referentes à morte: sua abordagem, na graduação e residência; comunicação adequada entre os profissionais durante os processos decisórios e durante o trabalho na UTI; a ponderação entre os desejos da família e as reais possibilidades de sobrevivência do doente. É importante se colocar no lugar do doente e considerar que, em uma hipotética terminalidade de vida, tudo o que o profissional dispensa ao paciente dentro de uma UTI é tão somente aquilo que não desejaria, como morte digna, para si ou familiares.
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Vasques, Tânia Cristina Schäfer. "Percepção dos trabalhadores de enfermagem acerca dos cuidados paliativos e de sua implementação." reponame:Repositório Institucional da FURG, 2012. http://repositorio.furg.br/handle/1/3512.
Анотація:
Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2012.Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-01-11T12:44:51Z No. of bitstreams: 1 taniavasques.pdf: 1211854 bytes, checksum: 38f410e383455c8514629775645d6efd (MD5)
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Cuidados Paliativos (CP) tem o propósito de melhorar a qualidade de vida de pacientes que recebem um diagnóstico de doença incurável que ameace a continuidade da vida, proporcionando-lhes um processo de terminalidade digno e com alívio do sofrimento. Este estudo teve como objetivo conhecer a percepção dos trabalhadores de Enfermagem que atendem pacientes em situação de impossibilidade de cura e com risco de vida acerca dos Cuidados Paliativos e de sua implementação no cotidiano do trabalho em saúde. Trata-se de um estudo qualitativo, desenvolvido no primeiro e segundo semestre de 2011, por meio da técnica de entrevista semi estruturada, realizada com vinte e três trabalhadores de enfermagem. O estudo foi submetido ao Comitê de Ética em Pesquisa na Área da Saúde (CEPAS/FURG) sob parecer de número 43/2011. Para a análise dos dados, utilizou-se a Análise Textual Discursiva, construindo-se duas categorias: Percepção dos trabalhadores de enfermagem acerca dos cuidados paliativos e Percepção dos trabalhadores de enfermagem acerca da implementação dos cuidados paliativos. Os resultados mostram um aparente desconhecimento dos trabalhadores de enfermagem sobre Cuidados Paliativos, e manifestações de sofrimento ao cuidar dos pacientes fora da possibilidade de cura e com risco de vida. Evidenciou-se ainda a necessidade de capacitação acerca da temática, enfocando um diálogo franco e aberto com os pacientes e seus familiares, evitando-se o sofrimento do paciente com a obstinação terapêutica. Verificou-se, ainda, que o processo decisório acerca dos cuidados a serem prestados a esses pacientes requer compartilhamento entre os profissionais, a fim de que tal decisão não seja exclusiva de uma só categoria. Ações de aproximação com a filosofia dos Cuidados Paliativos foram identificados, tais como:parar para tocar o paciente, dar atenção as suas queixas, entre outros. Ao finalizar o estudo pode-se dizer que a educação permanente direcionada aos trabalhadores de enfermagem que cuidam de paciente fora da possibilidade de cura e com risco de vida em relação aos cuidados Paliativos pode proporcionar uma assistência paliativa eficaz, atentando para a qualidade de vida do paciente cuidado, bem como para a a qualidade de vida no trabalho da equipe de enfermagem. Ações de cuidado embasadas nos princípios paliativos contribuem para proporcionar um fim digno a esses pacientes.
Palliative Care (PC) aims to improve life quality of patients who receive a diagnosis of an incurable disease that threatens life continuity, giving them a dignified process of terminality with relief of suffering. This study aimed to learn the perception of nursing workers who serve patients in situations of healing impossibility and life-threatening, about Palliative Care and its implementation in health daily work. This is a qualitative study, developed in the first and second semesters of 2011, through the semi-structured interview technique, performed with twenty-three nursing workers. The study was submitted to the Ethics Committee in Research in Health Area (CEPAS / FURG) under opinion number 43/2011. For data analysis, we used the Discursive Textual Analysis, building up two categories: Perception of nursing workers about palliative care and perception of nursing workers about the implementation of palliative care. The results show an apparent lack of knowledge about Palliative Care by nursing workers, and expressions of sorrow when caring for patients with no possibility of cure and life-threatening. It was evident, moreover, the need for training on the theme, focusing on a frank and open dialogue with patients and their families, avoiding the patient's suffering with therapeutic obstinacy. It was also noticed that the decision-making process about the care to be provided to these patients requires sharing among the professionals, so that such a decision is not exclusive to only one category. Proceedings of approximation to the philosophy of Palliative Care were identified, such as: stopping to touch patients, listening to their complaints, among others. At the end of the study, it can be said that continuing education in relation to Palliative Care, directed at nursing workers who care for patients with no healing possibility and life-threatening, can provide an effective palliative care, paying attention to the cared patient's life quality, as well as to the life quality at work of nursing staff. Care actions based in the palliative principles contribute to provide a worthy end to these patients.
Cuidados Paliativos (CP) tiene como objetivo mejorar la calidad de vida de los pacientes que reciben un diagnóstico de enfermedad incurable que amenaza la continuidad de la vida, dándoles un proceso digno de la terminal y el alivio del sufrimiento. Este estudio tuvo como objetivo conocer la percepción de los trabajadores de enfermería que atienden a los pacientes ante la imposibilidad de la curación y la amenaza para la vida-sobre los cuidados paliativos y su aplicación en el trabajo diario en la salud. Se trata de un estudio cualitativo, desarrolló la primera y segunda mitad de 2011, mediante la técnica de entrevista semiestructurada, realizada con veintitrés personal de enfermería. El estudio fue sometido al Comité de Ética en Investigación en el Ámbito de la Salud (CEPAS / FURG) aparecen bajo el número 43/2011. Para el análisis de los datos, se utilizó el análisis del discurso textual, la creación de dos categorías: Percepción del personal de enfermería sobre los cuidados paliativos y la percepción del personal de enfermería sobre la aplicación de los cuidados paliativos. Los resultados muestran una aparente falta de personal de enfermería en cuidados paliativos, y las expresiones de dolor para atender a los pacientes fuera de la posibilidad de la curación y potencialmente mortales. Era evidente la necesidad de capacitación en el tema, centrándose en un diálogo franco y abierto con los pacientes y sus familias, evitando el sufrimiento de los pacientes con obstinación terapéutica. También estaba el proceso de toma de decisiones acerca de la atención que debe proporcionarse a estos pacientes requiere compartir entre los profesionales, por lo que tal decisión no es exclusivo de una categoría. Las acciones de acercamiento con la filosofía de los cuidados paliativos fueron identificados, tales como dejar de tocar al paciente, preste atención a sus quejas, entre otros. Al final del estudio, se puede afirmar que la educación continua dirigidos al personal de enfermería que atienden a pacientes de fuera de la posibilidad de la curación y la vida en peligro, en relación a los cuidados paliativos pueden proporcionar cuidados paliativos eficaces, prestando atención a la calidad de vida de los atención de los pacientes, así como a la calidad de la vida de trabajo del personal de enfermería. Las acciones basadas en los principios de los cuidados paliativos que contribuyan proporcionando un final digno a estos pacientes.
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Barbieri, Ângela. "Distanásia em crianças: significados atribuídos por médicos de unidades de terapia intensiva." Universidade Federal de Santa Maria, 2014. http://repositorio.ufsm.br/handle/1/10338.
Анотація:
Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorThis research aimed to know as the physicians of the Neonatal and Pediatric Intensive Care Units (ICU) mean the dysthanasia. The specific objectives sought to identify the impact of the children's death to the physician; to understand like they live the difficulty of a child's cure; and to understand as the physician of the Neonatal and Pediatric Intensive Care Units identify their preparation to work with situations of life end in children. For so much, it was used an exploratory/descriptive study, of qualitative approach. Participated in the research 6 physicians and 5 residents, belonging to the Neonatal and Pediatric Intensive Care Units. As instrument for the data collection it was used a semi-structured interview. The information of the interviews was transcribed and analyzed starting from the content analysis. The ethical principles were respected, so that the participants rights were preserved, and an Informed Consent Document was signed as a condition to participate in the research. Among the results, it was observed that the physicians mean the dysthanasia in Neonatal and Pediatric Intensive Care Units under influence of multiples factors, leaving of the absence of the teaching and preparation to work with the death in the hospital daily during the graduation; the complexity of the daily coexistence with the death and the process of dying, together with the feelings and defense mechanisms; the statements that the dysthanasia really happens; the obstinate requests of the terminal patient's family interned in ICU, are going to have doubts in relation to the investment, or no, in the same and in the criteria used to know if they apply investing; the divergences of the team in the sockets of decision; the enormous fear of the ethical and legal repercussions in relation to the taken decisions, in what refers to the codes of practice and the Brazilian Penal code. It was ended, in this study, that improvement needs exist with respect to multiple aspects regarding the death: their approach, in the graduation and residence; appropriate communication among the professionals during decision making process and during the work in ICU; the consideration between the desires of the family and the real possibilities of survival of the patient.
Esta pesquisa objetivou conhecer como os médicos das UTIs neonatal e pediátrica significam a distanásia. Os objetivos específicos visaram identificar o impacto emocional da morte de crianças nos médicos; entender como eles vivenciam a dificuldade de cura de uma criança; e compreender como os médicos das UTIs neonatal e pediátrica identificam o seu preparo para lidar com situações de final de vida em crianças. Para tanto, utilizou-se de um estudo exploratório/descritivo, de abordagem qualitativa. Participaram da pesquisa 6 médicos e 5 residentes, pertencentes às UTIs neonatal e pediátrica. Como instrumento para a coleta de dados, utilizou-se de uma entrevista semiestruturada. As informações das entrevistas foram transcritas e analisadas a partir da análise de conteúdo. Os princípios éticos foram respeitados, de forma a proteger todos os direitos dos participantes, com formalização da participação por meio de Termo de Consentimento Livre e Esclarecido. Dentre os resultados, observou-se que os médicos significam a distanásia em UTI pediátrica e neonatal sob influência de múltiplos fatores, partindo da ausência do ensino e preparação para lidar com a morte no cotidiano hospitalar durante a graduação; a complexidade da convivência cotidiana com a morte e o processo de morrer, juntamente com os sentimentos e mecanismos de defesa; as afirmações de que a distanásia realmente acontece; os pedidos obstinados da família do paciente terminal internado na UTI, passando pelas dúvidas em relação ao investimento, ou não, no mesmo e nos critérios utilizados para se saber até onde investir; as divergências da equipe nas tomadas de decisão; o enorme receio das repercussões éticas e legais em relação às decisões tomadas, no que se refere aos códigos de ética profissional e o Código Penal brasileiro. Concluiu-se, neste estudo, que existem necessidades de aperfeiçoamento no que tange a múltiplos aspectos referentes à morte: sua abordagem, na graduação e residência; comunicação adequada entre os profissionais durante os processos decisórios e durante o trabalho na UTI; a ponderação entre os desejos da família e as reais possibilidades de sobrevivência do doente.
26
Rydvall, Anders. "Withhold or withdraw futile treatment in intensive care : arguments supported by physicians and the general public." Doctoral thesis, Umeå universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128863.
Анотація:
Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary. Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV). Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV). Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making. The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.
27
Stonestreet, John Ryan. "A Confession of Miraculous Mythological Epistemology for Health Communication." Ohio University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1412942733.
28
Chiang, Lien-Ying, and 江蓮瑩. "Intensive care nurses'' experience of medical futility." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/71228921357908189720.
Анотація:
碩士中山醫學大學
護理研究所
103
Advanced medical technology could extend life of critical patients, but it has its limitations. Medical interventions that prolong life without effect that someone can appreciate as a benefit. It is imperative to develop a policy of medical futility for critical patients. However, medical futility of critical patients not only lacks of knowing but also has no consensus about its definition in Taiwan. The purpose of this phenomenological study was to explore the ICU nurses'' medical futility experience on taking care of critical patients. Snowball sampling and purposeful sampling were used to recruit nurses at one medical center and a regional hospital located in central Taiwan. Researcher collected data using in-depth, semi-structured and tape-recorded interviews. Eight participants participated in this study. The trustworthiness of the study was examined using Lincoln and Guba (1985) principles. Data were analyzed using the Colaizzi (1978) method. Five major themes emerged, including ICU nurse’s definition of futility; the patients evolved into medical futility; consideration of medical futility; reasons for providing futilely care; and facing futile care. The study findings could help understand medical futility in critical patients, and provide clinical care, education and medical policy development.
29
Wei, Pi-Ching, and 魏碧青. "Evaluation of Critical Care Nurse’s Knowledge of the Medical Futility when CPR." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/dukw6a.
Анотація:
碩士國立陽明大學
臨床暨社區護理研究所
102
Background: According to the World Health Organization recommends that end of life care, the primary goal is to enhance the quality of life, rather than the culmination of prolonged life. Resuscitate again to try to extend the life of terminally ill patients, health care can be regarded as invalid. Critical Care Nurses often based on patients, their families and the various expectations of the community, the need to communicate with physicians in clinical practice, it requires considerable background knowledge to think about whether to provide a medical futility for terminally ill patients. Objective: To explore critical nurses face medical futility when CPR in the professional level of knowledge, through a knowledge-based communication background, early push to stop medical futility. Methods: A cross-sectional survey study, the use of three parts (basic information, knowledge assessment, educational needs) self-structured questionnaire, purposive sampling to evaluate critical nurses’ knowledge and their educational needs. Samples from a medical center agreed to participate in this study 248 emergency and intensive care units (excluding pediatrics, burns ward) nurses. Results: Critical care nurses averaged 34.4 years, 11.1 years in nursing, emergency and intensive working years 6.1 years, 98.0% had medical futility care when CPR. Display (1) When CPR, medical futility knowledge average score 67.8 points. (2)Medical futility knowledge in order to score high ethical knowledge, conceptual knowledge score low. (3) Nursing titles, occupation level higher, regularly received relevant training courses had higher knowledge scores. (4) Subjective conscious knowledge broadly adequate in only 50.4%, but perceived need for relevant education trainers up to 83.0%. (5) The main source of knowledge is the hospital service education, when in doubt order to ask the nursing staff, physicians, according to the division of tranquility to the settlement (6) The degree of knowledge of the conscious subjective and objective knowledge assessment showed a positive correlation, subjective consciousness the higher level of consciousness, the higher the degree of objective knowledge, and knowledge between the demand is not showing significant correlation and differences. Conclusion: Critical nursing titles, occupation level higher, regularly received relevant training courses had higher knowledge scores, new nurses can be used as a good counseling object. Expectation with the results, increase specialized consulting establishments, the cross- team discussions and related training courses, to mention critical care nurses’ knowledge of medical futility when CPR.
30
TSAI, TZU-LING, and 蔡姿玲. "Perspectives of Medical Futility in Community-Dwelling Older Adults with Chronic Illnesses." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/10605546772239125467.
Анотація:
碩士長榮大學
護理學系碩士班
104
Most studies of futile care focus on the perspective of ethicists, lawyers, and health care providers. This qualitative study explores perceptions of medical futility in community-dwelling older adults 75 years or older with chronic illnesses. Nine older adults were recruited through purposive sampling to participate in individual face-to-face interviews. These semi-structured interviews were audio-taped, transcribed verbatim and analyzed by content analysis. Five themes and thirteen sub-themes emerged from the data: (1) Sense of medical futility: expectations of medical technology, dependence on the National Health Service, prolonging the agony of life, discussion of death-related issues; (2) Severe chronic disease as a caregiver’s burden: encumbering family members, financial burden, physical and psychological burden; (3) Compliance with the physician's advice: respect toward professionals; (4) Living with chronic disease: learning to live with the disease, watching for health problems, looking for social support; and (5) Documenting advance directives in a timely manner: favoring palliative care, uncertainty regarding advance directives. Study findings may help health-related institutions understand medical futility from the perspective of health care consumers, which will allow them to better inform community-dwelling old adults about palliative care and the Patient Autonomy Bill.
31
Winch, Chad. "An Investigation and Review of Futility Analysis Methods in Phase III Oncology Trials." Thesis, 2012. http://hdl.handle.net/1974/7689.
Анотація:
The general objective of this thesis was to improve understandings of design, conduct and analysis of randomized controlled trials (RCTs). The specific objective was to evaluate the methodological and statistical principles associated with conducting analyses of futility, a component of interim analysis, as part of the conduct of RCTs. This objective was addressed by first performing a systematic review, which included a detailed literature search, as well as data from a cohort of previously extracted studies. The systematic review was designed to identify futility analysis principles and methodologies in order to inform the design and conduct of retrospective futility analyses of two completed NCIC CTG trials. The results of these trials have been previously published; one trial met its stated endpoint and the other did not. Neither trial underwent an interim analysis of futility during its conduct. The retrospective futility analyses assessed the accuracy of frequently used methods, by comparing the results of each method to each other and to the original final analysis results. These assessments were performed at selected time points using both aggressive and conservative stopping rules. In order to increase the robustness of the comparisons, bootstrapping methods were applied. The results of this thesis demonstrate principles associated with the conduct of futility analyses and provide a basis for hypotheses-testing of optimum methodologies and their associated trade-offs.Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-12-12 13:10:15.619
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Veltman, Andrea. "Transcendence, creativity and futility : labor and work in the ethics of Simone de Beauvoir /." 2004. http://www.library.wisc.edu/databases/connect/dissertations.html.
33
Billa, Manyangane Raymond. "An ethical and legal commentary on access to renal dialysis programmes in public hospitals in South Africa: reflections on Thiagraj Soobramoney versus the Minister of Health (Kwa-Zulu Natal) 1997." Thesis, 2010. http://hdl.handle.net/10539/8555.
Анотація:
MSc(Med), Bioethics and Health Law, Faculty of Health Sciences, University of the WitwatersrandThe current exclusion criteria for accessing renal dialysis in South African public hospitals places great emphasis on the allocation of scarce resources. The case of Soobramoney at the Constitutional Court highlighted the ethical and legal implications of providing this scarce resource. Mr. Soobramoney was denied access to renal dialysis on the basis of scarce resources and he did not qualify for care due to not meeting the criteria set for renal care. The Soobramoney case was considered mainly on the basis of scarce allocation of resources and offering treatment on an emergency basis. It was argued by the appellant that the state had an obligation to provide him with the treatment in terms of s 27(3) read with s 11 of the Constitution (para 14). This report takes a different slant and looks at the quality of life argument for increasing access to renal dialysis for those denied it based on current South African protocols. In exploring this concept one would venture to offer a definition of ‘quality of life’ according to Brown as an overall sense of well-being. This includes an individual’s satisfaction with their own lives (Brown, 2007: 72). A health related quality of life extends the definition to include the way a person’s v health affects their ability to carry out normal social and physical activities (ibid). A case is made for increasing access by developing programmes to cater for those in need of enhancing their quality of life. This is what is being motivated for in cases similar to Soobramoney, especially those with comorbid disease. The quality of life argument is based on the fact that there are indications in literature that patients with end-stage renal disease rate their own quality of life to be as important as the quality of life of the general population. Furthermore, there is no indication that the elderly live more miserable lives when they are on dialysis. The idea of respect for persons is highlighted - respect for the autonomous choices patients make concerning how they live their lives and including respect for them towards the end of their lives. Finally, I reflect on some legal issues concerned with the Soobramoney versus the Minister of Health Kwa-Zulu Natal 1997.
34
Austin, Emily Parker. "Grief, longing, and anger: a study of emotions in the Iliad." Thesis, 2016. https://hdl.handle.net/2144/17060.
Анотація:
Readers of Homer’s Iliad immediately confront the anger of Achilles; the first word of the poem, μῆνις, forefronts the hero’s godlike wrath. Yet little attention has been paid to the important relationship that exists between Achilles’ anger and his grief. In this dissertation I identify language in the poem unique to Achilles, linking his grief for Patroklos with a longing, ποθή. The most important interpretive consequence of this link between ποθή and grief, I argue, is the proper understanding of the insatiable roots of his subsequent anger. Achilles experiences the death of Patroklos as a rending of the fabric of his life. In this state of restless volatility, we see that Achilles’ anger is one more response to an underlying experience of rupture and thus is both aimless and fruitless. Although Achilles succeeds in ensuring the future sack of Troy by killing Hektor, his behavior remains insatiate, since his deeds of anger are motivated by a desire for what cannot be achieved, life shared with Patroklos. The persistence of his attempted vengeance beyond the slaying of Hektor reveals the futility of his underlying longing, such that, according to the poem, the only end he can make of his grief-driven anger, finally, is to let it go.
The Trojans’ grief for Hektor is never described with the language of longing, and this surprising exclusion underscores the contrast between Achilles and Hektor. Where Achilles has a uniquely independent status, Hektor is continuously tied to the city as a whole and part of a rich network of close relations. Rather than exploring the rupture of a single, highly personal relationship, perhaps typical of a warrior far from home many years, with Hektor’s death the poem depicts the impending destruction of an entire civilization. Thus every expression of grief for this warrior refers not only to personal loss but to the multiple relationships that will be impacted by his death. The Trojans’ grief for their defender cannot linger on the sense of rupture in the present, but rather their grief is shaped by a forward-looking sense of doom.2022-07-31T00:00:00Z
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Hung, Ya-Hui, and 洪雅惠. "The Perceptions and Predicaments of Medical Futility in Cardiopulmonary Resuscitation among the Emergency and Critical Care Nurses." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/07136840750769901312.
Анотація:
碩士國立陽明大學
臨床暨社區護理研究所
102
The purpose of this study was to investigate the experience, predicament and related factors of medical futility in cardiopulmonary resuscitation among the nurses in critical care units. The study adopted a cross-sectional study design with mixed methods of a clinical survey at a medical center hospital in northern Taiwan. The instrument was a self-made questionnaire including items on nurse’s basic data as well as experiences and predicaments in caring CPR medical futility for data collection. In this study, a total of 260 questionnaires were distributed, and 248 effective questionnaires returned. The medical futility perception revealed that those nurses who were different in the level of education, job level and no effect CPR experiences. Predicaments in medical futility were related to ever DNR or palliative education programs. The nurses’ experiences in medical futility were well correlated to their predicaments about such care. Although the education for palliative care is inadequate which have correlations to predicaments in medical futility. If nurses have the shortage of end-of-life (EOL) care knowledge, their attitudes about caring will also be lack of self-confidence. Nurses will difficult to discuss the issues related to EOL care with patients and their families. Furthermore, the goal of this study is to create a meaningful and useful learning from the process surrounding CPR medical futility. It is anticipated that could provide medical staffs via education program and policy guidance to improve the knowledge and attitudes of EOL care.
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Huang, Li-hsu, and 黃麗續. "The Boundary of the Medical Futility and the Extreme Limit of the Medicine--An Aspect of DNR Analysis." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/81902893709995340019.
Анотація:
碩士南華大學
生死學研究所
97
The main subject of this research is for patient, the family members of patient, nursing staff and doctors. To probe into the diversity of the DNR（Do-Not-Resuscitate）in these four different role, and the influence of the DNR decision processing, to notify and to execute of the DNR. At the same time investigate the boundary of the extreme limit of the medicine and the definition of the medical futility in these four different roles. The researcher selects qualitative research methods, collecting the information by interviewing 21 cases. Including 2 patients, 6 family member of the patient, 5 doctors and 8 nursing staff. The texts of interviews are analyzed with constant comparative method. The result of the research is shown below : 1.The patient, the family member and the medical care personnel have the diversity to the DNR cognition. When the medical care personnel is more clear about the DNR cognition, they could discuss the DNR with the patient and family member more initiatively. In the same way, when the family member or patient understands about the DNR more, the more willing they are to fill in the DNR form. 2.In accordance with medical futility, rather than to debate the definition of medical futility objectively, it had better to search back the essence of the medicine. Only to take care of patient humanity and as the central, through good communication between medical staff and patients, to give them the best care. 3.In the situation of respect of autonomy and informed consent for the patient at the end of their life, DNR is another choice when patient face to extreme limit of the medicine. 4.The medical care personnel needs to realize the Hospice palliative medicine rule, They must have mutual recognition regarding the DNR execution. 5.Recommend to make the end of life education more popular: It will help the patient and their family members to face the end of life in a positive way, it will help them to make more better choices. 6.Not only the medical problem of the medical futility, but also including morality issue. Therefore, there is no absolute right or wrong, there is no standard answer for all patient, either. Only consider the patient as a center, to select a better choice. 7.Nice communication could start a relationship reciprocally. Through the nice communication , it could help doctor to know the patient and their family members better. It will more realize the necessary of patient and family member.
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Yu, Cheng-Ling, and 游承霖. "The Spiritual Dimension and the Meaning of Life: The Problem of Futility, The Humanist Thesis of Meaning and Spirituality." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/64307708904115589423.
Анотація:
博士國立臺灣大學
哲學研究所
102
This dissertation is a research into the topic of the meaning of life. The question about the meaning of life has too often been neglected by the contemporary philosophers. Many philosophers dismiss the question as "pseudo" or "logically unanswerable". Ayer, for example, argues that since whether life has meaning cannot be verified either through demonstration or observation, the question is therefore "unanswerable". Many philosophers, following Ayer, adopt this line of reasoning. I believe this is unfortunate. Socrates, the man who has had tremendous impact on the development of the western philosophy, can be seen as occupying himself with this very question when he claimed that: "The unexamined life is not worth living." An inquiry into the meaning of life can therefore be seen as nothing less than the continuity of this Socratic project of self-examination. After the topic about the meaning of life has been neglected for so long, it is encouraging to see that in the recent years, more and more philosophers have become interested in the topic again. Kurt Baier, Richard Taylor, Susan Wolf and John Cottingham, just to name a few, have written on the topic. This resurgence of interest in the topic about the meaning of life among the philosophers makes us hopeful of the prospect that philosophy, the "mother of all sciences", may still have something constructive to offer in this field of study. Perhaps, as some have remarked, humanity has always had a deep need to raise the "ultimate" questions. This dissertation is an attempt to contribute to the topic of the meaning of life from the philosophical perspective. Most contemporary philosophers writing on the topic of the meaning of life are naturalists and humanists, and they usually focus on analyzing the logical structure of the question, discovering the necessary and sufficient conditions for living meaningfully and examining the subjectivity or objectivity of "meaning values". This dissertation, however, focuses on an aspect of the question that is less commonly addressed in the literature—what I shall call the "Problem of Futility" (PoF). PoF refers to a state of consciousness in which one feels that—after contemplating the finitude of one''s existence—one''s existence (and the existence in general) lacks lasting significance and meaning. In this dissertation, I shall argue that PoF is a genuine problem that arises from our nature—that there is something deep within our nature that longs to transcend the finite; PoF, so I shall argue, cannot be simply dismissed as pseudo or as a problem arising from our mental instability. After showing that a consideration of PoF reveals the inadequacy of the humanist thesis of meaning, I shall argue that the idea of spirituality is what provides a solution to PoF. Spirituality, as I shall define it in this dissertation, refers to a state of being in which one''s consciousness is identified with a transcendent reality in a certain way. By identifying with a transcendent reality and by being fully attentive to the present instant, it becomes possible for one to transcend the finitude of one''s existence. But spirituality, fundamentally, is about experience rather than theory—it is a mode of being in which one''s consciousness is attuned to what some call the "cosmic life" or the "universal self". As such, the spiritual view cannot be verified by our "ordinary consciousness"—either by our intellect or senses. One must, so the writers on spirituality tell us, embark on the path of spirituality in order to experience for oneself.
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"Articulation as an Act of Futility: A Deconstructive Exploration of Textual Articulation as it Functions within a First-Person Narrative Structure." East Tennessee State University, 2006. http://etd-submit.etsu.edu/etd/theses/available/etd-0402106-214133/.
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Naito, Tatsuhiko. "Retrospective analysis of ethics consultations at the Boston Medical Center." Thesis, 2015. https://hdl.handle.net/2144/15629.
Анотація:
OBJECTIVE: The vast majority of physicians frequently faces ethical dilemmas and feels overwhelmed as a result. Those at Boston Medical Center are no exception. Various studies show more adept handling of ethical issues can improve the quality of care and patient safety by reducing moral distress of physicians and fostering better patient-physician relationship. The method of Preventive Ethics, which actively identifies recurrent themes and underlying systematic issues among ethics consultations, is more effective than the traditional, case-by-case approach in reducing the number of ethical conflicts. The purpose of this study is to identify common themes prompting ethics consultations and any hotspots among recurrent ethical dilemmas at Boston Medical Center by using the Armstrong Clinical Ethics Coding System.
METHODS: A total of 32 ethics consultations handled by the BMC Ethics Committee between October 2010 and April 2013 were reviewed. Each consultation was coded using the Armstrong Clinical Ethics Coding System. The data was analyzed to identify the types of ethical dilemma that are most prevalent at BMC. The consultations involving the most frequently occurring issues were evaluated further to expose common themes among these cases and potential underlying systematic failures.
RESULT: "Clinical Candidacy or Risk / Benefit Analysis" (6.25%), "Concern About Decision Maker Choices" (14.6%) and "Futility / Inappropriate or Nonbeneficial Treatment" (13.5%) were the most prevalent types of ethical issues at BMC. Not only are these three frequently occurring, they also have a very high tendency to occur simultaneously. Further analysis of consultations involving these three issues revealed that at BMC, there are frequent instances of conflict, in which family members serving as healthcare proxies disagreed with physicians in deciding the best interest of patients with severe ailments, ultimately precipitating ethics consultations.
DISCUSSION: Comparison with similar retrospective studies previously carried out at other institutions suggests that consultation involving the issue of futility may be more frequently occurring at BMC, which might be coming from unique systematic problems. Several interventions such as improved policies or educational training in physician-family communication should be considered.
CONCLUSION: According to the principles of Preventive Ethics, the issue of physician-healthcare proxy conflict regarding patient futility should be issue to be addressed at BMC. The Armstrong Clinical Ethics Coding System can serve as a much needed standard documentation format for ethics consultations, which would open up the possibility of more detailed future studies
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Vilhena, Rita Rasquilho Vidal Saragoça Mendes. "Cuidados paliativos e obstinação terapêutica : decisões em fim de vida." Master's thesis, 2013. http://hdl.handle.net/10400.14/16391.
Анотація:
Os inúmeros avanços científicos e tecnológicos do século XX, na área da medicina, fizeram que a “cura” se fosse impondo no contexto das doenças agudas, afastando a morte para o culminar de doenças crónicas e evolutivas. Esta cultura triunfalista da cura (compreendida como vitória) instalou sentimentos de derrota e frustração face à morte e levou os profissionais a querer curar e salvar a todo o custo, adiando o mais possível o momento da morte. É neste contexto que se começa a questionar o uso de todos os meios disponíveis para prolongar a vida, fazendo-se a distinção, primeiro, entre meios ordinários e extraordinários e, depois, entre meios proporcionados e não proporcionados. Assiste-se, entretanto, à adopção do termo “futilidade”. Um meio é fútil se, através dele, não somos capazes de atingir o fim pretendido: o de beneficiar o doente.
Este trabalho pretende reflectir sobre os critérios que devem orientar a tomada de decisão de “não iniciação” ou de “interrupção” de tratamentos em doentes terminais. A metodologia usada é a da revisão integrativa da literatura e da reflexão crítica dos artigos existentes sobre o tema em cinco anos (entre 2007 e 2011), publicados nas revistas Hastings Center Report, British Medical Journal e Medicine, Health Care and Philosophy.
Da análise dos artigos resultam seis grandes temas de discussão. O conceito de futilidade (a obstinação terapêutica e os cuidados paliativos); os conflitos entre, por um lado, a autonomia e os direitos dos doentes e, por outro, a responsabilidade e os deveres da equipa de saúde; a importância da comunicação equipa de saúde / doente no processo de tomada de decisão; os critérios de decisão de não iniciação ou de interrupção de tratamentos; o princípio do duplo efeito; e, finalmente, a questão da interrupção da alimentação e da hidratação artificiais.The countless scientific and technological advances of the twentieth century in the medical field have made the concept of “healing” gain the upper hand in the context of acute diseases, leaving to death the last word only in chronic and evolutionary diseases. Having thus been glorified, the culture of healing (seen as a victory) has created feelings of defeat and frustration in the face of death, and has led health care professionals to pursue healing and cure at all costs, postponing death as long as possible. In this context, the use of all available means to extend life has started to be questioned, with the distinction being drawn first between ordinary and extraordinary means and, then, between proportionate and disproportionate means. In the meantime, the term “futility” was adopted. A means is considered futile if it proves unable to achieve the intended result: benefitting the patient. This work intends to reflect on the criteria that should guide the decision-making process of “withholding” or “withdrawing” treatments to terminal patients. The methodology used is based on the integrative review of, and the critical reflection on, the articles published on this subject along five years (2007 to 2011) in the following journals: Hastings Center Report, British Medical Journal and Medicine, Health Care and Philosophy. As a result of this analysis, six main discussion themes were identified: (1) the concept of futility (therapeutic obstinacy and palliative care); (2) the conflict between the patient’s autonomy and rights on the one hand and, on the other, the health care personnel’s responsibility and duties; (3) the importance of communication between health care personnel and patient in the decision-making process; (4) the decision-making criteria on withholding or withdrawing treatments; (5) the principle of the double effect; (6) and, finally, the interruption of artificial nutrition and hydration.
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KADLECOVÁ, Jana. "Dystanazie jako manipulace s přirozenou smrtí." Master's thesis, 2016. http://www.nusl.cz/ntk/nusl-253321.
Анотація:
This diploma thesis deals with the ethical problems contemporary dying and relationships society to death. One is devoted to issue dysthanasia, that approached as manipulation with death. Work looks for sources of dysthanasia and one finds is in contemporary attitudes medicine and patients to deaths, dehumanization of medicine and diversion from traditions. That also looks for pathway to prevention of dysthanasia. One sees is in repeated humanization of medicine, in accept the concept futile treatment and the capabilities to distinguish ordinary and extraordinary means. This work offers the alternative of dysthanasia palliative care and seeks for a position of social worker in it.
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PINTA, Daniel. "Komenského Labyrint světa a ráj srdce jako svébytná sociální utopie." Master's thesis, 2008. http://www.nusl.cz/ntk/nusl-49774.
Анотація:
Jan Amos Komenský is a great figure of the Czech nation. However, despite his fame, he is a much more significant thinker than he is generally regarded to be. Labyrinth of the World and Paradise of the Heart has no equivalent in its time or in older Czech literature. Even if Komenský wrote nothing else, this book would guarantee him a prominent place in Czech literature. In Labyrinth, Komenský shows himself as a great believer who exactly uncovers human pride, uncovers imaginary and untrue independence of man and shows exactly and aptly the futility and true face of many human endeavours. Labyrinth is a merciless criticism of man. It is never nihilistic, though {--} it is always based on a deep and realistic sense of purpose, a deep feeling for the ethical. That is why Komenský{\crq}s irony {--} which is the essential accord of Labyrinth {--} is irony of sadness. Some of Komenský{\crq}s ideas are close and understandable to us; however, some are much more distant. It remains a question if what seems to us to be old, outdated or naive in Komenský, is a basis without which it is not possible to understand well and realize what we are no longer willing to identify with. Is the ``critic of rationalism{\crqq} and great believer in Komenský, so distant to us, his most important basis that gives viability and future to his own ideas as well as to all human endeavours? This work briefly describes the ideas and storyline of Komenský{\crq}s Labyrinth. Each chapter of this thesis attempts to find what is most important in the mass of text of Labyrinth and thus to briefly point out the significance of each part of the book. Sometimes exact quotations are used which should show the real sense of Komenský{\crq}s ideas in a better way. Quotations from the Bible which could be a base of Komenský{\crq}s ideas are matched to individual chapters. The attempt is to find those ideas of Komenský which could be used and could be useful in our society. On the basis of an elaboration on the book, this work attempts to point out the importance of real belief and keeping to its rules for the life of a man and a society as a whole.