Erforschung und Antworten auf den vorzeitigen Todeswunsch eines Patienten mit einer schweren fortgeschrittenen Krankheit [Exploring and Responding to a Wish to Hasten Death of a patient with Advanced Illness].

It is not uncommon for patients with an advanced disease to express a desire to their physician to hasten their death. Recent studies show that the motivation of such a desire is multifactorial and multidimensional, including depression, physical, psycho-social and spiritual suffering, fears about the process of dying and/or misunderstandings about the options for end-of-life care. The objective of this paper is to propose to the physician how to explore the dimensions of this request and some elements to answer it.

Necessitats dels familiars de pacients amb càncer

El càncer produeix un impacte a la família en totes les seves esferes, la família ha de modificar les seves rutines familiars i adoptar nous rols. En el moment del diagnòstic del càncer, a cada família hi ha una persona que assumeix el rol de cuidador principal. Aquest cuidador és el que s’ocupa del malalt a casa i fa d’enllaç entre la família i l’equip sanitari. En front del càncer, la família i el cuidador tenen un conjunt de dubtes, d’inquietuds, de preocupacions que s’acaben traduint en necessitats. L’equip sanitari i Infermeria especialment ha d’atendre aquestes necessitats i ajudar a satisfer-les. Objectiu: L’objectiu principal d’aquest treball es descriure quines són les necessitats que presenten la família i el cuidador dels pacients oncològics. Metodologia: Es va dur a terme una revisió de la literatura entre setembre del 2013 i maig del 2014. Es va utilitzar la base de dades Pubmed, a més de pàgines web i llibres. Es van obtenir un total de 75 fonts, 56 en angles, 18 en espanyol i 1 en català. Resultats: La bibliografia agrupa les necessitats de les famílies i els cuidadors en 7 grans categories: físiques, psicològiques i emocionals, socials, de informació i formació, econòmiques, de transport i espirituals. Pel que fa a necessitats més especifiques, algunes de les més freqüents són tenir informació sobre el pronòstic del malalt, assegurar-se de que l’equip sanitari està donant la millor atenció possible al malalt. Sembla haver-hi una relació entre el grau de no satisfacció de les necessitats i el grau d’ansietat i depressió en la família i el cuidador. Els autors consultats no coincideixen en afirmar si la majoria del les necessitats es veuen satisfetes o no. Conclusions: La família i el cuidador d’un pacient amb càncer també han de rebre atenció per part dels professionals. En moltes ocasions la família treu importància a les seves necessitats per tal de que l’equip sanitari es centri només en el malalt. Infermeria té un paper fonamental en detectar les necessitats dels familiars i cuidadors i en ajudar a satisfer-les, de manera que la família estigui en les millors condicions possibles per cuidar del malalt. Paraules clau: Càncer, família, cuidador, necessitats familiars, rol d’Infermeria

Le bien-être spirituel des personnes nouvellement diagnostiquees d'un cancer en début de traitement : étude descriptive correlationnelle

Problématique. Le cancer touche beaucoup de personnes en Suisse et un grand nombre en décèdent encore. Recevoir une telle annonce plonge le malade dans une crise spirituelle qui bouleverse complètement sa vie. L'incertitude de son avenir, la sensibilisation à sa finitude sont exacerbées par la proximité de la mort et par les symptômes du cancer: combien de temps les malades vont-ils encore vivre ? Qu'adviendra-t-il de leur corps désormais confronté aux symptômes du cancer et à ses traitements? Les professionnels de la santé s'attacheraient davantage au bien-être spirituel des personnes en phase palliative et peu d'études se sont intéressées au bien-être spirituel des personnes en début de traitement au moment d'une telle nouvelle. But. Décrire le bien-être spirituel des personnes nouvellement diagnostiquées d'un cancer en début de traitement, explorer sa relation avec les symptômes du cancer et l'interdépendance des différentes variables. Méthode. Cette recherche descriptive corrélationnelle a été conduite auprès de 30 patients recrutés selon un échantillonnage de convenance dans un centre d'oncologie ambulatoire situé dans un hôpital universitaire suisse. Les données ont été recueillies au moyen d'un formulaire de données sociodémographiques et de santé ainsi que de deux instruments de mesure: ESAS (Edmonton Symptom Assessment System) (Bruera, Kuehn, Miller, Selmser, & Macmillan, 1991) et FACIT-Sp-12 (Functional Assessment of Chronic Ilness Therapy-Spiritual Well- Being) (Canada, Murphy, Fitchett, Peterman, & Schover, 2008). Le premier a permis de mesurer les symptômes du cancer et le second, le bien-être spirituel. Les données ont été traitées par des analyses descriptives et corrélationnelles avec le logiciel STATA Version 11. Résultats. Les répondants étaient représentés en majorité par des femmes (73%) atteintes d'un cancer du sein (60%). La plupart des participants étaient croyants (97%) de confession catholique (50%), protestante (47%) ou musulmane (3%). Sur un rang de 0 à 48, la plupart des participants ont présenté un niveau de bien-être spirituel élevé (M=36,5 ; ĒT=6,6). Les dimensions de ce dernier atteignaient également de très bon scores : sur un rang de 0 à 16, la dimension sens affichait la moyenne la plus élevée (M=14,2 ; ĒT=1,9), suivie de celle de paix (M=12,1 ; ĒT=2,7) et finalement de celle de foi (M=10,2 ; ĒT=3,2). Le bien-être spirituel était lié significativement à l'âge (p= 0,04), à la dépression (p= 0,01) et au mal-être (p= 0,02) : être jeune, présenter des symptomatologies dépressives et de mal-être influencent négativement le bien-être spirituel des malades. Conclusions. Dépister précocement la dépression et le mal-être des personnes qui surgissent souvent à la révélation du cancer est important. Il faut se soucier particulièrement du bien-être spirituel des personnes âgées et les accompagner dans leur quête de sens singulière par la prière, l'abnégation, le récit de vie, les relations avec l'entourage, l'introspection, pour adoucir l'incertitude de l'avenir et la mouvance identitaire qui composent désormais leur quotidien.

Andreu Sala i l'arribada del barroc a Catalunya

Andreu Sala és l’escultor que millor patentitza la introducció de l’estètica i l’univers conceptual i espiritual de l’alt-barroc romà a Catalunya. En aquest treball s’intentarà donar llum a l’univers documental que amaga amb recel les poques notícies referides a l’escultor i també aportar noves hipòtesis i arguments per tal de forjar una idea més clarivident de la vida i obra de l’imaginaire Andreu Sala

George W. Bushin apologia

Kirjallisuusarvostelu

Benjamin's conception of language and Adorno's aesthetic theory

According to the theory of language of the young Benjamin, the primary task of language isn't the communication of contents, but to express itself as a "spiritual essence" in which also men take part. That conception according to which language would be a medium to signification of something outside it leads to a necessary decrease of its original strength and is thus denominated by Benjamin bürgerlich. The names of human language are remainders of an archaic state, in which things weren't yet mute and had their own language. Benjamin suggests also that all the arts remind the original language of things, as they make objects "speak" in form of sounds, colors, shapes etc. That relationship between arts as reminders of the "language of things" and the possible reconciliation of mankind with itself and with nature has been developed by Theodor Adorno in several of his writings, specially in the Aesthetic Theory, where the artwork is ultimately conceived as a construct pervaded by "language" in the widest meaning - not in the "bourgeois" sense.

Kirjallisuutta

Kirjallisuusarvostelu

Rummet i vårdandets värld

This study is made in the context of basic research within the field ofcaring science. The aim is to make a theoretical and ontological investigation of what the space is in the world of caring. The basic proposition is that the space, as a fundamental dimension, has an impact on how the appreciation of one's mental health and suffering is shaped, and vice versa. The overall purpose is to develop a theoretical model of space from the caring science point of view andalso to offer an ideal concept of space to caring science. Guided by a theoretical horizon (Eriksson 1993, Eriksson 1995, Eriksson 2001) and methodological approach grounded in Gadamer's philosophic and existential hermeneutics a three-stage analysis and interpretation is conducted. The hermeneutic spiral of this investigation starts through a procedure in accordance with Eriksson's model (1997) of concept definition. The goal is to clarify the etymology of the concept as well as semantic differences between synonymous concepts, i.e. to identify the different extents of the concept of `space` (`rum`) in order to bring these closer for an exploration. The second phase is to analyse and interpret a sample of narratives in order to explicate the ontological nature and meaning of the space. The material used here is literary texts. The goal is to clarify the characteristics of the very inside of the space when it is shaped in relation to the human being in encountering suffering. In the third phase an interview study is taken place. The focus of the study is directed towards the phenomenon of space as it is known by a patient in a landscape of psychiatric care, i.e. what the space is in a contextual meaning. Then, a gradual hermeneutic understanding of the space is attempted by using theories from the field of caring science as well as additional theories from other disciplines. Metaphors are used as they are vivid and expressive tools for generating meaning. Different metaphoric space formations depict here a variety of purports that, although not quite the same, share extensive elements. Six metaphorically summarized entities of meaning emerged. The comprehensive form of space is pointed out as the Mobile-Immobile Room. Furthermore, the Standby, the Asylum, the Wall and the Place. In the further dialogue with the texts the understanding has deepened ontologically. The theoretical model ofthe space sums up the vertical, horizontal and the inward extent of deepness inthe movement of mental health. Three entities of ontological meaning have emerged as three significant rooms: the Common Land emerges as the ideal concept of mutual creation in the freedom of doing, being and becoming health. On the interpersonal level it means freedom, which includes sovereignty, choice and dignity of the human being. The Ice World signifies, ultimately, the space as a kind of frozenness of despair which "wallpapers" the person's entire being in the world in the drama of suffering. The Spiritual Home is shaped when the human being has acquired the very core of his/her inner and outer placeness as a kind of "at-homeness" and rootedness. Time is a central element and the inward extent of deepness of this trialectic space. Each of the metaphors is then the human being's unique, although even paradoxical, way of conceiving reality, and mastering spiritual suffering. They condense characteristic structures and patterns of dynamic scenery, which take place within the movement of health. The space encloses a contradictory spatiality constituted through the dynamic field of meaningfulness and meaninglessness. Anyway, it is not through a purging of these contradictions but through bringing them together in a drama of suffering that the space is shaped as ontologically good and meaningful in the world of caring.

Hälsans grund kan bara hjärtat förstå : ett sökande efter kunskap om hälsa i ljuset av Blaise Pascals tänkande

The aim of this thesis is to gain new understanding of health based on the work Penseés (Thoughts) by Blaise Pascal. The research interest originates from the motive of the heart for the greatness of man in conjunction with his baseness. The study is hermeneutic and the purpose is to describe health formulated as new abductive theses based on the assumption that caring science and caring theology can be conjoined in the same ontology. The work Penseés is, in Gadamer’s sense, alive since the text is constantly being made use of and is in this occurence interpreted through the requirements made by caring science. Pascal’s arguments continue through the historically effected consciousness while the interpretation is confronted with the ontological model of health. In the initial horizon we find the understanding of the motion of health and the extension towards text materials which is undertaken by Pascal’s Penseés. to open up the perspective and be able to project the horizon of the text. In the encounter with the text, the core content will first be discussed in an interpretative part after which the understanding gained will be summarized into new abductive assumptions. On the basis of Gadamer’s emphasis on the applications of the interpretations, the merging of the horizons will identify health as something desired by man, what he is and what he wants to accomplish. The creation of health is the reason of the heart, and on the basis of what man wants to confide in, the rise of health will be established. The totality of greatness and baseness of man is achieved by the accomplishment of health. That man owns spiritual devotedness means health whereas unhealthy means that he is insecure of his character and leads a life with ill-considered amusements. When according to Pascal, man’s desires and thoughts are joined in the heart, a connecting relation will arise. Hence the spiritual edification that man will fail to secure if he puts too much of his confidence in transient reason is included, something that is insufficient when it comes to understand the meaning of health.

Den vårdande och helande bilden: möten med bildkonst i vårdandets värld

Denna vårdvetenskapliga avhandling syftar till att avtäcka och belysa en vårdande och helande dimension vid existentiellt lidande patienters möten med bildkonst inom vårdkontext. Kunskapssökandet sker i två studier. Den första (studie I) är en ikonografi sk tolkning av konstnären Matthias Grünewalds (ca 1460–1528) senmedeltida altarskåpsmålningar. I studien uttolkas lidandets uttryck och narrativa budskap samt symboliska gestaltningar av vårdande och helande i valda delar av detta s.k. Isenheimaltares bildprogram. Tolkningen utgår från rekonstruktionen av altarskåpets ursprungskontext, det medeltida Isenheimklostret, där svårt sjuka och döende patienter vårdades. I studie två (II) fortsätter sökandet i den moderna hospicevårdens kontext med hjälp av en kvalitativ intervjustudie som utforskar patienters meningsskapande vid möten med självvald bildkonst (oljemålningar och akvareller av fi nländska konstnärer som donerats till det sjukhus där intervjustudien gjordes). Forskningsansatsen är inspirerad av Hans-Georg Gadamers (1901–2002) hermeneutik. Vidare används några nyare tolkningsteoretiska ansatser inom bildkonstens område. Forskningens tolkningsresultat visar att bildkonsten har potentialer såväl på ett miljöestetiskt plan som på en djupare individuell symbolnivå. Som designkomponent i vårdmiljöns rumsliga gestaltning bygger bildkonsten in estetiska, etiska och andliga kvaliteter utifrån tidsmässiga och kulturella koder. I den medeltida klostervårdens kontext sammanföll bildkonstens dekorativa betydelse med andliga och helande syften. När det gäller självvalda konstverk i den moderna vårdkontexten bidrar de till det enskilda patientrummets atmosfär på ett unikt sätt utifrån patientens personlighet och behov. På en fördjupad mötesnivå, i samspel med bildens symboliska funktion, sker en inlevelsemässig förfl yttning in i bildens värld. Betraktarens inlevelse aktiveras till en transcenderande rörelse som går bortom det faktiska rummets och den reella tidens gränser. Vid resor i konstens bildvärld spelas minnesvärda händelser upp från det förgångna, men även framtiden kommer betraktaren till mötes. I en existentiell livssituation söker människan i konstverkets bildinnehåll efter symbolisk mening som kan ge svar på lidandets frågor. Bilderna iscensätter då helande motbilder som utgör korrektiv i symboliska former när olika existentiella förluster hotar. När livet förbleknats av sjukdom besvarar bildvärlden den lidandes blick med lysande violer som blommar upp, ger livskraft och bekräftar personens värdighet mitt i det förvissnande människolivet. När ångest och otrygghet nalkas inbjuds betraktaren till besök i landskap som utvidgar sjukhusrummets väggar mot hemgårdens trygghet. Där livet hotas av förgänglighet tar bildvärlden människan med sig till naturens eviga återfödelse. Upplevelsen av att vara delaktig i ett större och heligt sammanhang öppnar vägen ut ur lidandets avskurenhet. I medeltidens vårdkontext erbjöd den sakrala bilden en kollektiv och helande Symbolon som genom sin representationskraft synliggjorde det osynliga. Vid bildmöten i den moderna hospicevårdens kontext var det naturteman som gläntade på dörren till ”det hemliga rummet i djupet av hjärtat”. Forskningen antyder att även om meningsskapandet i ett bildmöte är avhängigt tidsepok, betraktarens förförståelse och kulturella kontext samt typen av bilder kan bildsymboliken, generellt förstådd som den saknade formen eller det saknade livssammanhanget, framvisa en helande och hoppingivande ordning i lidandets kaos.

Ulos antroposentrisestä matriisista

Kirjallisuusarvostelu

Syvää vai pelkästään tiheää : neuvostoliittolaisen ja venäläisen sotataidollisen ajattelun lähtökohdat, kehittyminen, soveltaminen käytäntöön ja nykytilanne. Näkökulmana 1920- ja 1930-luvun syvän taistelun ja operaation opit

Sosialistisen vallankumouksen jälkeen Neuvosto-Venäjän oli monien muiden kysymysten ohella ratkaistava sosialismin saavutusten puolustaminen. Aluksi ratkaisuksi suunniteltiin vapaaehtoisuuteen perustuvaa punakaartia, mutta riittävän miesvahvuuden turvaamiseksi päädyttiin yleiseen asevelvollisuuteen. Pian Venäjän sisällissodan jälkeen sotataidon suunta painottui enemmän vanhan armeijan asiantuntijoiden näkemysten kuin vallankumoussankarien kokemusten mukaiseksi, vaikka Frunzen puna-armeijalle kirjoittama doktriini perustui luokkataisteluun ja korosti sisällissodassa hyväksi koettua operatiivista liikkuvuutta. Neuvostoliiton ja Venäjän sotataidon perustana on Pietari I:n aloittama länsimainen suuntaus, jota kuitenkin täydentävät vahvat kansalliset piirteet. Venäläisen sotataidon henkisenä isänä voidaan hyvällä syyllä pitää Aleksandr Suvorovia, jonka opetukset näkyvät tekstilainausten lisäksi myös periaatteissa ja sotilaskasvatuksessa. Napoleonin sotien jälkeen perustettu Keisarillinen yleisesikunta-akatemia loi Venäjälle sotatieteellisen tutkimuksen ja opetuksen. Sotatieteen mahdollisuuksia ei 1800-luvun Venäjällä osattu täysin hyödyntää. Aseistuksen kasvavan tehon merkitystä vähättelevä asenne johti sotataidon taantumisen ja katastrofiin Venäjän–Japanin sodassa. Sen kokemuksia analysoidessaan Aleksandr Neznamov kehitti edelleen saksalaista operaation käsitettä ja loi perustan Neuvostoliitossa 1920-luvulla kehitetylle operaatiotaidolle. Neuvostoliittolaisen sotataidon päämääränä oli kehittää taktinen ja operatiivinen ratkaisu aseistuksen tehon kasvun aikaansaamaan puolustuksen ylivoimaisuuteen. Ratkaisussa hyödynnettiin brittien kokemuksia ja tutkimusta. Neuvostoliittolainen taktiikka ja operaatiotaito eivät kuitenkaan olleet brittiläisen mekanisoidun sodankäynnin tai saksalaisen salamasodan itäinen kopioita vaan itsenäisiin ratkaisuihin pohjautuvia. Syvän taistelun ja operaation teoriaa kokeiltiin harjoituksissa, ja sitä kehitettiin Stalinin vuoden 1937 puhdistuksiin saakka. Toisen maailmansodan taisteluissa puna-armeija sovelsi alkuvaiheen katastrofin jälkeen syvän taistelun ja syvän operaation oppeja. Komentajien ja joukkojen taito ei riittänyt teorian vaatimusten mukaiseen toimintaan, siksi syväksi aiotusta taistelusta tuli ajoittain ainoastaan tiheää. Suuren isänmaallisen sodan kokemusten perusteella neuvostoliittolainen sotatiede kehitti yleisjoukkojen taistelun periaatteet, jotka ovat säilyneet muuttumattomina nykypäivään saakka. Kylmän sodan aikakaudella ydin- ja tavanomaisen aseistuksen merkitys sodan ja taistelun kuvassa vaihteli. Lännen sotataidon ja aseteknologian kehitys pakotti Neuvostoliiton siirtymään 1980-luvulla sotilaallisessa ajattelussaan hyökkäyksestä puolustukseen. Neuvostoliiton hajoamisen jälkeen Venäjän sotilaallisen turvallisuuden takaajana on ydinaseistus. Yhdysvaltain tavanomainen ilma-avaruushyökkäyskyky vaatii Venäjää kehittämään torjuntajärjestelmiä. Tavanomaisten joukkojen rakentamisessa Venäjä seuraa tarkasti läntisen sotataidon kehittymistä, mutta pitäytyy omaperäisiin ratkaisuihin, joiden kehittämisessä sen vahvalla sotatieteellisellä järjestelmällä ja dialektisen materialismin metodilla on edelleen olennaisen tärkeä merkitys.

Att tala om det osägbara : Nicolaus Cusanus cirkulära filosofi i verket De coniecturis med särskild hänsyn till Nelson Pikes tankar om unio mystica

In my dissertation called Speaking of the unsayable: The circular philosophy of Nicholas of Cusa in his work De coniecturis, I presuppose an internal (conceptual) relation between the personal experience of God of Nicholas of Cusa (1401-64) in 1438 and, on the other hand, his philosophy. I hence try to describe the precise character of this relation. Referring to the Norwegian scholars Egil Wyller and Viggo Rossvær, I assume that there is a circularity in Cusanus’ philosophy which appears as self-references (= a sentence refers to itself: A is explained by B and B is explained by A). Wyller finds three phases in the thought of Cusanus (1. De docta ignorantia I-III, 2. De coniecturis I-II, 3. all subsequent works). Rossvær finds it impossible to presuppose certain phases, as the philosophy of Cusanus continuously proceeds and remains open to new ideas. As Cusanus however treats his experience of God far more consciously in his second work De coniecturis than in De docta ignorantia, I find it possible to distinguish between the earlier Cusanus (De docta ignorantia including his earlier works) and the later Cusanus (De coniecturis, about 1444, as well as the following works). Cusanus creates a philosophy of language in outline expressed in De coniecturis, in which he presents two concepts of necessity, i.e. absolute necessity and logical, or reasonable, necessity. These are interrelated in the sense that the mind, or the self, logically affirms the absolute, or unsayable, necessity, which shows itself in the mind and which the mind affirms conjecturally. The endeavour conceptually to understand absolute necessity implies intuitive (or intellectual) contemplation, or vision (investigatio symbolica), in which the four mental unities (the absolute, the intellectual, the rational and the sensuous) work together according to the rules described in De coniecturis. In De coniecturis Cusanus obviously turns from a negative concept of the unsayable to a paradigmatic, which implies that he looks for principles of speaking of the unsayable and presents the idea of a divine language (divinaliter). However, he leaves this idea behind after De coniecturis, although he continues to create new concepts of the unsayable and incomprehensible. The intellectual language of absolute seeing is expressed in the subjunctive, i.e. conditionally. In order to describe the unsayable, Cusanus uses tautologies, the primary one of which is a concept of God, i.e. non aliud est non aliud quam non aliud (the non-other is non-other than the nonother). Wyller considers this the crucial point of the philosophy of Cusanus (De non aliud), described by the latter as the definition of definitions, i.e. the absolute definition. However, this definition is empty regarding its content. It demonstrates that God surpasses the coincidence of opposites (coincidentia oppositorum) and that he is “superunsayable” (superineffabilis), i.e. he is beyond what can be conceived or said. Nothing hence prevents us from speaking of him, provided that he is described as unsayable (= the paradigmatic concept of the unsayable). Here the mode of seeing is decisive. Cusanus in this context (and especially in his later literary production) uses modalities which concern possibility and necessity. His aim is to conduct any willing reader ahead on the way of life (philosophia mentalis). In De coniecturis II he describes the notion of human self-consciousness as the basis of spiritual mutuality in accordance with the humanistic tradition of his time. I mainly oppose the negatively determined concept of Christian mysticism presented by the German philosopher Kurt Flasch and prefer the presentation of Burkhard Mojsisch of the translogical and conjectural use of language in De coniecturis. In particular, I take account of the Scandinavian research, basically that of Johannes Sløk, Birgit H. Helander, Egil Wyller and Viggo Rossvær, who all consider the personal experience of God described by Cusanus a tacit precondition of his philosophy.