Strange bedfellows: The ethics and politics of medical futility in Texas

Background: Futile medical treatments are interventions that are not associated with a benefit to the patient. The definition and concept of medical futility are controversial. The Texas Advance Directives Act (TADA) was passed in 1999 to address medically inappropriate interventions by allowing providers to withdraw inappropriate interventions against a surrogate decision maker's wishes following a review, attempt to transfer the patient, and 10-day waiting period. The original legislation was a negotiated compromise by players across the political spectrum. However, in recent years there has been increasing controversy regarding TADA and attempts to alter its applicability in Texas. ^ Purpose: The purpose of this project was to apply Paul Sabatier's advocacy coalition framework (ACF) to gain understanding into the historical, ethical, and political basis of the initial compromise, and determine the sources of conflict that have led to increased opposition to TADA. ^ Methods: Using the ACF model, key actors within the medical futility policy debate in Texas were aggregated into coalitions based on shared beliefs. A narrative summary based analysis identified the core elements of the policy subsystem, as well as the constraints and resources of the subsystem actors. Externalities that promoted adjustments to coalition beliefs and tactics used by coalition participants were analyzed. Data sources included review of the published literature regarding medical futility, as well as analysis of published newspaper accounts and editorials regarding the medical futility issue in Texas, legislative testimony, and review of weblogs and online commentaries dealing with the issue. ^ Results: Primary coalition participants in developing compromise legislation in 1999 were the Providers and Vitalists, with Autonomists gaining a prominent role starting in 2006. Internal factors associated with the breakdown of consensus included changes to the makeup of the governing coalition and changes in individual case information available to the Vitalist coalition. Externalities related to the intertwining of the Sun Hudson case and the Terri Schiavo case generated negative publicity for the TADA from progressive and conservative viewpoints. Dissemination of information in various venues regarding contentious cases was associated with more polarization of viewpoints, and realignment of coalition alliances. ^ Conclusions: The ACF provided an outline for the initial compromise over the creation of the Texas Advance Directives Act as well as the eventual loss of consensus. The debate between the Provider, Vitalist, and Autonomist coalitions has been affected by internal policy evolution, changes in the governing coalition, and important externalities. The debate over medical futility in Texas has had much broader implications in the dispute over Health Care Reform.^

Evaluation of a User-Adapted Spoken Language Dialogue System: Measuring the Relevance of the Contextual Information Sources

We present an evaluation of a spoken language dialogue system with a module for the management of userrelated information, stored as user preferences and privileges. The flexibility of our dialogue management approach, based on Bayesian Networks (BN), together with a contextual information module, which performs different strategies for handling such information, allows us to include user information as a new level into the Context Manager hierarchy. We propose a set of objective and subjective metrics to measure the relevance of the different contextual information sources. The analysis of our evaluation scenarios shows that the relevance of the short-term information (i.e. the system status) remains pretty stable throughout the dialogue, whereas the dialogue history and the user profile (i.e. the middle-term and the long-term information, respectively) play a complementary role, evolving their usefulness as the dialogue evolves.

Estimating Adaptacion of Dialogue Partners with Different Verbal Intelligence

This work investigates to what degree speakers with different verbal intelligence may adapt to each other. The work is based on a corpus consisting of 100 descriptions of a short film (monologues), 56 discussions about the same topic (dialogues), and verbal intelligence scores of the test participants. Adaptation between two dialogue partners was measured using cross-referencing, proportion of "I", "You" and "We" words, between-subject correlation and similarity of texts. It was shown that lower verbal intelligence speakers repeated more nouns and adjectives from the other and used the same linguistic categories more often than higher verbal intelligence speakers. In dialogues between strangers, participants with higher verbal intelligence showed a greater level of adaptation.

Relating dominance of dialogue participants with their verbal intelligence scores

In this work we investigated whether there is a relationship between dominant behaviour of dialogue participants and their verbal intelligence. The analysis is based on a corpus containing 56 dialogues and verbal intelligence scores of the test persons. All the dialogues were divided into three groups: H-H is a group of dialogues between higher verbal intelligence participants, L-L is a group of dialogues between lower verbal intelligence participant and L-H is a group of all the other dialogues. The dominance scores of the dialogue partners from each group were analysed. The analysis showed that differences between dominance scores and verbal intelligence coefficients for L-L were positively correlated. Verbal intelligence scores of the test persons were compared to other features that may reflect dominant behaviour. The analysis showed that number of interruptions, long utterances, times grabbed the floor, influence diffusion model, number of agreements and several acoustic features may be related to verbal intelligence. These features were used for the automatic classification of the dialogue partners into two groups (lower and higher verbal intelligence participants); the achieved accuracy was 89.36%.

Business ethics: a way to identify fraud from the basics

When we look to perform a work for developing a framework to create a business and take it correctly, there are always some persons looking as a challenge those bases and finding a mistake. The way to work in these situations is not a matter of law, is a matter of devoting time to identify these situations. It is always said that the evil goes a step ahead. The business ethics have been altered for quite time by some would-be entrepreneurs. These people have learned to play with business ethics to show your business as prosperous as something that is sought to highlight and adulterate their results quickly. Once the company reaches an international dimension, many companies take on global responsibility and, in these cases where you can see if the objective has been to obtain a rapid capital increase or growth is in line with its proportions. A business ethics is based on establishing a strong base so that interest is encouraged from an early time. Good staff, organizational level should be achieved and not only at the company but, out of the company too. Thus, you can create a secure base to convince potential investors and employees about the business. There are no freeways in business ethics and all fast track can be or a genius or leads to failure. We must find where these jumps are occurring, such errors or corrections to business ethics and their rules. Thus we can differentiate a company or an entrepreneur who is working correctly from the cloaking. Starting from the basics of business ethics and studying the different levels from the personal to the prospect that the company shows in the world. Lets see where these changes are occurring and how we can fight against them and anticipate the market to possible cases of fraud or strange movements seeking to attract the unwary

O cuidado no espaço de intermedicalidade em uma aldeia indígena

O objetivo deste estudo foi interpretar a realidade social e política, na qual se estabelece o cuidado intercultural vivenciado por indivíduos na zona de intermedicalidade de uma aldeia, partindo da perspectiva dos usuários indígenas e dos profissionais de saúde ameríndios e não-indígenas. As bases teóricas que ancoraram a coleta e análise interpretativa dos dados incluíram: a Etnografia, Antropologia Interpretativa, Modelos explanatórios e abordagem cultural safety. Mediante aprovação do Comitê Nacional de Ética em Pesquisa, procedeu-se trabalho de campo na Terra Indígena Buriti, localizada nos munícipios Sidrolândia e Dois Irmãos do Buriti, Mato Grosso do Sul, Brasil. Realizou-se observação participante nas unidades de saúde e no cotidiano das famílias nas aldeias, bem como no Pólo de Sidrolândia. Realizaram-se entrevistas semiestruturadas com 16 indígenas usuários do serviço, 12 profissionais de saúde terenas e seis trabalhadores de saúde não-indígenas. A análise dos dados, simultânea à coleta, ocorreu na perspectiva da Hermenêutica Dialética por meio da análise temática. Os preceitos éticos foram seguidos. Neste estudo, identificaram-se dois temas: 1) \"Doença é pior que a morte: explicações sobre o processo de adoecimento\" retrata como o processo saúde-doença é interpretado pelos participantes. Saúde, para os terenas, é um aspecto primordial na vida deles. O processo de adoecer envolve a perda e/ou a redução da disposição física, psíquica e espiritual para desenvolver atividades cotidianas. Espiritualidade, higiene, alimentação e a questão da posse de terra impactam o processo de adoecimento terena. 2) \"A intermedicalidade do sistema de cuidado em saúde terena\" que retrata os significados atribuídos pelos participantes à coexistência e intercomunicações (intermedicalidade) entre as formas de cuidados em saúde terena: medicina terena, espiritualidade, modo de vida e o serviço oficial de atenção à saúde (sistema Pólo/Posto). O sistema de cuidado dos terenas revela o processo de indigenização dos serviços de saúde. A medicina terena é entendida sob dois âmbitos: um centralizado no conhecimento tradicional indígena, que inclui uso de ervas, atividades de parteiras e de \"puxadores de pernas\"; e outro nos aspectos místicos e sobrenaturais para sua execução: rezas e prática da pajelança, com destaque para redução do número de pajés. A espiritualidade como opção terapêutica é representada pela fé do terena em Deus, concretizada pela oração. O modo de vida do terena engloba principalmente dois aspectos: centralidade na família e o cuidado com higiene individual e ambiental. O sistema Polo/Posto é procurado pelo terena conforme a cartela de serviços ofertada pelas unidades e segundo suas necessidades peculiares, os casos que o terena \"não consegue resolver\". Neste âmbito de cuidado, há a produção de encontros do cuidado pautados pelo vínculo, confiança, diálogo e agir dos profissionais culturalmente sensível. Há, também, desencontros do cuidado favorecidos por prioridades estabelecidas em metas, atendimento queixa-conduta e precária infraestrutura. Observou-se um processo maciço do uso de medicação. Os aspectos identificados nos relatos dos participantes sobre o sistema de cuidado terena são atravessados pela historicidade do povo terena, questão da posse de terra, medicalização da sociedade, higienismo, integração entre corpo, cosmos e terra, espiritualidade com diversidade religiosa, cultura terena centrada na família, atividades programáticas de saúde na atenção básica, biomedicina, transporte precário e baixa resolutividade. Diabetes e hipertensão arterial foram as doenças registradas pelo Pólo e significadas pelos participantes como as principais enfermidades da população. Há a coexistência de medicinas híbridas em todos âmbitos de cuidado em saúde terena. É importante que a intermedicalidade ocorra nos espaços do sistema Pólo/Posto sem sobreposição do saber médico e/ou da lógica institucional à sabedoria terena

April 4, 1968: Death, Difference, and Dialogue

Robert Kennedy's announcement of the assassination of Martin Luther King, Jr., in an Indianapolis urban community that did not revolt in riots on April 4, 1968, provides one significant example in which feelings, energy, and bodily risk resonate alongside the articulated message. The relentless focus on Kennedy's spoken words, in historical biographies and other critical research, presents a problem of isolated effect because the power really comes from elements outside the speech act. Thus, this project embraces the complexities of rhetorical effectivity, which involves such things as the unique situational context, all participants (both Kennedy and his audience) of the speech act, aesthetic argument, and the ethical implications. This version of the story embraces the many voices of the participants through first hand interviews and new oral history reports. Using evidence provided from actual participants in the 1968 Indianapolis event, this project reflects critically upon the world disclosure of the event as it emerges from those remembrances. Phenomenology provides one answer to the constitutive dilemma of rhetorical effectivity that stems from a lack of a framework that gets at questions of ethics, aesthetics, feelings, energy, etc. Thus, this work takes a pedagogical shift away from discourse (verbal/written) as the primary place to render judgments about the effects of communication interaction. With a turn to explore extra-sensory reasoning, by way of the physical, emotional, and numinous, a multi-dimensional look at public address is delivered. The rhetorician will be interested in new ways of assessing effects. The communication ethicist will appreciate the work as concepts like answerability, emotional-volitional tone, and care for the other, come to life via application and consideration of Kennedy's appearance. For argumentation scholars, the interest comes forth in a re-thinking of how we do argumentation. And the critical cultural scholar will find this story ripe with opportunities to uncover the politics of representation, racialized discourse, privilege, power, ideological hegemony, and reconciliation. Through an approach of multiple layers this real-life tale will expose the power of the presence among audience and speaker, emotive argument, as well as the magical turn of fate which all contributes the possibility of a dialogic rhetoric.

Dialogue structure as a preference in anaphora resolution systems

Comunicación presentada en ACIDCA 2000, International Conference on Artificial and Computational Intelligence For Decision, Control and Automation In Engineering and Industrial Applications, Monastir, Tunisia, 22-24 March 2000.

A proposal of algorithm for solving definite descriptions through dialogue structure

En este trabajo proponemos un algoritmo para la resolución de las descripciones definidas en español a través de la estructura del diálogo, mediante la definición de un espacio de accesibilidad anafórico. Este algoritmo está basado en la hipótesis de que la resolución de la anáfora está relacionada con la estructura del diálogo. Así, la resolución de la anáfora mejora si se especifica un espacio de accesibilidad para cada tipo descripción definida según la estructura del diálogo. La utilización de este espacio de accesibilidad anafóico reduce tanto el tiempo de procesamiento como la posibilidad de obtener un antecedente erróneo. Además, la definición de este espacio de accesibilidad depende únicamente de la propia estructura textual del diálogo.

The Role of Civil Society Dialogue in the EU-China Cooperation on Renewable Energy. IES Policy Brief Issue 2012/05/December 2012

Summary. Expanding EU-China institutional cooperation in the energy sector has been matched by a parallel process of stronger economic ties between European and Chinese companies in the renewable energy (RE) sector (particularly wind and photovoltaics). While the foundation of early EU-China institutional relations was based primarily on trade cooperation, international efforts to mitigate climate change and the common challenge of decreasing energy dependence in a sustainable manner brought a new dimension to their partnership in the energy sector in the mid 90s. Although the role of EU-China energy cooperation has grown tremendously in the context of EU external trade policy and EU strategy to boost its energy independence and international climate policy, the potential of civil society collaboration in this partnership has remained rather unexploited. Based on major civil society initiatives in the RE field that have been developed in recent years, this policy brief argues that civil society dialogue between China and EU could be an important driving force in deepening EU-China cooperation on RE and a bridge towards a more sustainable future.

Enjeux éthiques en radiologie diagnostique : comment la bioéthique peut-elle contribuer à une meilleure radioprotection du patient?

Bien que les technologies d’imagerie soient un acquis réel de la médecine moderne, leur introduction ne semble pas avoir été précédée d’une démarche réflexive suffisante qui aurait permis d’anticiper les multiples enjeux que rencontre la pratique radiologique actuelle. En effet, à force de se focaliser sur les acquis techniques et scientifiques, le cadre de radioprotection en place semble ne pas avoir suffisamment considéré l’apport essentiel que représente la connaissance des aspects sociaux, éthiques et humains que peuvent amener des domaines comme la bioéthique. Cette insuffisance fait en sorte que l’on se retrouve aujourd’hui face à des enjeux importants relatifs à la radioprotection du patient comme la surutilisation des examens radiologiques ou encore le manque d’information des acteurs du milieu face aux risques des rayonnements. Après un état des lieux des enjeux éthiques en radiologie diagnostique ayant un impact sur la radioprotection médicale des patients, un enjeu majeur de la pratique actuelle, qui est la justification inadéquate des prescriptions d’examens radiologiques, sera analysé selon une approche par principes. De cet exercice, visant à démontrer comment l’éthique peut concrètement contribuer à la radioprotection, découle l’impératif d’une vision nouvelle et globale permettant de proposer des pistes de solution aux controverses liées à l’utilisation actuelle de l’imagerie. Dans une perspective de santé des populations, il est important de contribuer à la diminution de la banalisation du recours au rayonnement ionisant dans la pratique médicale diagnostique en alliant bioéthique et radioprotection. Ce projet de recherche se veut être une étape limitée, mais nécessaire dans l’établissement de ce dialogue interdisciplinaire.

Of Elephants and Toothaches : Ethics, Politics, and Religion in Krzysztof Kieslowski's 'Decalogue' /

This collection is the first to offer a genuinely interdisciplinary approach to Krzysztof Kie?lowski’s Decalogue, a ten-film cycle of modern tales that touch on the ethical dilemmas of the Ten Commandments. The cycle’s deft handling of moral ambiguity and inventive technique established Kie?lowski as a major international director. Kie?lowski once said, “Both the deep believer and the habitual skeptic experience toothaches in exactly the same way.” Of Elephants and Toothaches takes seriously the range of thought, from theological to skeptical, condensed in the cycle’s quite human tales. Bringing together scholars of film, philosophy, literature, and several religions, the volume ranges from individual responsibility, to religion in modernity, to familial bonds, to human desire and material greed. It explores Kie?lowski’s cycle as it relentlessly solicits an ethical response that stimulates both inner disquiet and interpersonal dialogue.

Dialogue /

Description based on : Fall 2001.

School-based clinics that work.

Mode of access: Internet.

Ethics and intervention: The 'humanitarian exception' and the problem of abuse in the case of Iraq

This article investigates the ethics of intervention and explores the decision to invade Iraq. It begins by arguing that while positive international law provides an important framework for understanding and debating the legitimacy of war, it does not cover the full spectrum of moral reasoning on issues of war and peace. To that end, after briefly discussing the two primary legal justifications for war (implied UN authorization and pre-emptive self-defence), and finding them wanting, it asks whether there is a moral 'humanitarian exceptions to this rule grounded in the 'just war' tradition. The article argues that two aspects of the broad tradition could be used to make a humanitarian case for war: the 'holy war' tradition and classical just war thinking based on natural law. The former it finds problematic, while the latter it argues provides a moral space to justify the use of force to halt gross breaches of natural law. Although such an approach may provide a moral justification for war, it also opens the door to abuse. It was this very problem that legal positivism from Vattel onwards was designed to address. As a result, the article argues that natural law and legal positivist arguments should be understood as complementary sets of ideas whose sometimes competing claims must be balanced in relation to particular cases. Therefore, although natural law may open a space for justifying the invasion of Iraq on humanitarian terms, legal positivism strictly limits that right. Ignoring this latter fact, as happened in the Iraq case, opens the door to abuse.