Ethically defensible decision-making in health care: challenges to traditional practice

The concept of paternalism is deeply entrenched in health care. Decision-making about health care can be extremely difficult at times, and many competing interests may influence the outcomes. However, ethically defensible practice aligns itself with acknowledging the patient's prima facie right to be treated as an autonomous individual. This includes the patient's right to make informed decisions or to decide that other(s), such as the close family, should make decisions on his or her behalf. (author abstract)

On the edge: how well do fire mitigation strategies work on the urban fringe?

The reduction of loss of lives and assets during bushfire is one of the primary aims or lire management agencies. Traditional fire mitigation strategies include strategic fire hreaks, static water points, management of ignition sources, rapid detection and local response, air attack, and fuel reduction burning. There have been few quantitative studies that assess the success or these strategies. We need to promote 'new' strategies more focused on human hehaviour and community preparedness.
DeJcndable space provides our best strategy for reducing losses during major bushfires. The size or the defendable space depends on the type of house to be defended, who is defending it, and the spatial context of the property. In the urban fi'inge, remnant vegetation on private property often has
high conservation values, and application of traditional mitigation strategies, as well as the vegetation modification required to achieve defendable space, may have significant impacts on conservation and biodiversity values.

Euthanasia and assisted suicide : a liberal approach versus the traditional moral view

Within the context of the debate over the recent suspended sentence given to John Stuart Godfrey by Underwood J in the Supreme Court of Tasmania for assisting his elderly mother with her suicide, this article examines some of the more popular arguments for and against the moral acceptability of euthanasia and assisted suicide. This article considers the arguments put forward on the “difference principle” by Rachels and Nesbitt before critically examining the liberal approach to the euthanasia issue as proposed by Kuhse. It is argued that whilst Kuhse is correct to reject the difference principle, she does so for the wrong reasons. The penultimate section of the article provides an overview of the traditional moral view against killing. The final part assesses whether the arguments put forward by proponents of the liberal approach are capable of overcoming this view.

Ranah minang: the changing conception of a traditional minangkabau homeland

The Minangkabau people of West Sumatra, Indonesia, view the physical world as having two distinct components, Ranah Minang (which is itself further divided) and the rantau. Ranah Minang is the traditional, ancient homeland of the group, while the rantau is everything beyond the boundaries of their ancestral lands. This distinction is institutionalised in the folklore of the group and serves as a characterizing dichotomy in their worldview. Even today, when the outlines of the ancestral home are indistinct and the region has been overlaid with the modern administrative structure of modern Indonesia, the distinction between Ranah Minang and the rantau remains strong in societal perceptions and occurs repeatedly, not just in traditional folklore, but in modern expressions of traditional culture. This paper will describe the spatial division of territory in Minangkabau culture as it exists in the folklore of the group and will discuss the ways in which this traditional perception is manifested in modern society. Further, it will discuss the changing nature of the conception of Ranah Minang with respect to the physical landscape as well as to the institutions and structures of society.

A house in history, heritage and tourism : shifting times at Blundell's Cottage, Canberra

The history of history's institutions can offer a gritty context in which to understand historical production. A wide spectrum of influences, from the personal to the intellectual to the political, can be seen at work in shaping the history made and communicated at Blundell's Cottage over the years. Even though it has always been a humble participant in the project of history, its products probably reach some of history's larger audiences. Hence it is worthwhile to review fifty years of historio-museography.

Randomized controlled trial comparing traditional with two "mobile" epdural techniques

Background: The authors recently showed that “mobile” epidural analgesia, using low-dose local anesthetic–opioid mixtures, reduces the impact of epidural analgesia on instrumental vaginal delivery, relative to a traditional technique. The main prespecified assessment of pain relief efficacy, women’s postpartum estimates of labor pain after epidural insertion, did not differ. The detailed analgesic efficacy and the anesthetic characteristics of the techniques are reported here.
Methods: A total of 1,054 nulliparous women were randomized, in labor, to receive boluses of 10 ml 0.25% bupivacaine (traditional), combined spinal–epidural (CSE) analgesia, or lowdose infusion (LDI), the latter groups utilizing 0.1% bupivacaine with 2 g/ml fentanyl. Visual analog scale pain assessments were collected throughout labor and delivery and 24 h later. Details of the conduct of epidural analgesia, drug utilization, and requirement
for anesthesiologist reattendance were recorded.
Results: A total of 353 women were randomized to receive traditional epidural analgesia, 351 received CSE, and 350 received LDI. CSE was associated with a more rapid onset of analgesia, lower median visual analog scale pain scores than traditional in the first hour after epidural insertion, and a significant reduction in bupivacaine dose given during labor. Pain scores reported by women receiving LDI were similar to those in the traditional group throughout labor and delivery. Anesthesiologist reattendance was low but greater with each mobile technique.
Conclusions: Relative to traditional epidural analgesia, LDI is at least as effective and CSE provided better pain relief in the early stages after insertion. The proven efficacy of mobile epidurals and their beneficial impact on delivery mode make them the preferred techniques for epidural pain relief in labor.

Adoption of the world wide web by traditional Australian media organisations

The aim of this paper is it to identify whether Australian media companies moved online with a clear business model in mind or in an ad-hoc manner. In-depth interviews were conducted with four Internet media managers from two large Australian media organisations. All four had been involved in Web publishing from its early stages and had extensive knowledge of the development of Web publishing in the industry. The interviews focused on the period around the mid 1990’s when the early development of the organisations’ websites took place. We also review an analytical approach of examining narratives from research interviews developed by Davidson (Davidson 1997) and Mishler (Mishler1986a, 1986b).

From parallel descriptions to parallel grammars: unravelling the complexity of Lutyen's country house folio

Based on an analysis of a corpus of forty of Sir Edwin Lutyens's country house designs (Rollo 1997) a procedure for developing Parallel Descriptions will be discussed. This procedure will attempt to facilitate an integrated approach to the analysis of complex architectural forms and will provide a framework for investigating the development of parallel grammars. This is an approach which acknowledges that design does not necessarily involve the importance of one aspect, but rather a number of coextensive issues with emphasis on the ordering and priority of these issues periodically shifting.

Dwelling in the landscape: from Blairgowrie House to Portsea Palace

Ackerman begins his book "The Villa" (1995) with these words: 'A villa is a building in the country designed for its owner's enjoyment and relaxation .... [it] accommodates a fantasy which is impervious to reality.' He concludes: , ... the country, in exacting confrontations with the immanent brute forces and sensuous enchantments of nature, prompts inspired responses.' Blairgowrie House - the villa in the landscape - was built in the 1870s and the 'Portsea Palace' - a personal club med resort - in the late 1990s. The notion of an inspired response and the concept of dwelling poetically are manifestly absent in the Portsea Palace. Why?

This paper explores architecture and landscape - particularly 'domestic' architecture and coastal landscapes in Victoria's Nepean Peninsula. It looks closely at what architects mean when they say their design reflects place, relates to site, is climate specific, is close to nature, responds to the landscape, and/or is sensitive to the environment. Exemplars from different centuries are examined in their philosophical contexts and frames of reference. The complexities of the notion of place and identity, belonging, and dwelling (in the Heideggerian sense) are examined to identify the shift that has occurred over time as science and technology have ostensibly freed 'modern man' from 'a direct dependence on places' (Norberg Schultz). The alienation and loss that has eventuated - for humans and for the environment - will be critically analysed and assessed.