French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering.

OBJECTIVE: Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially "existential suffering." This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable). METHODS: We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians. RESULTS: 74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000). Significance of the results: The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.

Specificities of psychodynamic psychotherapy in the medically ill

Psychodynamic psychotherapy with patients suffering from somatic diseases is based on general principles of psychodynamic understanding, such as the influence of development and biographical elements on patient.s adaptation to illness or the role of defense mechanisms when facing existential threat. However, differences exist, such as the adaptation of the therapeutic setting, which thus loses some of its diagnostic and therapeutic power, or the early emergence of powerful transference, which cannot always be interpreted by the therapist. In addition, psychodynamic psychotherapy in the medically ill has some specificities, which differentiate it from classical psychoanalytic theory. The specificities concern, for example, transference of the medically ill, which is more adequately conceived by concepts of the existential analysis (Daseinsanalyse), or the patient.s loss of a sense of continuity, which needs an understanding beyond psychological theory taking into account philosophical (e.g. phenomenology), anthropological and ethical concepts.

Religion in Times of Crisis

Religion is alive and well all over the world, especially in times of personal, political, and social crisis. Even in Europe, long regarded the most "secular" continent, religion has taken centre stage in how people respond to the crises associated with modernity, or how they interact with the nation-state. In this book, scholars working in and on Europe offer fresh perspectives on how religion provides answers to existential crisis, how crisis increases the salience of religious identities and cultural polarization, and how religion is contributing to changes in the modern world in Europe and beyond. Cases from Poland to Pakistan and from Ireland to Zimbabwe, among others, demonstrate the complexity and ambivalence of religion's role in the contemporary world.

Meaning in life and perceived quality of life in Switzerland: results of a representative survey in the German, French and Italian regions.

BACKGROUND: The concept of meaning in life (MIL) has become a central one in recent years, particularly in psycho-oncology and palliative care. The Schedule for Meaning in Life Evaluation (SMILE) has been developed to allow individuals to choose the life areas that they consider to be important for their own MIL. This approach relates to the "World Health Organisation" definition of quality of life (QOL) as an individual's perception of his own position. The aims of this study were (i) to assess MIL in a representative sample of the Swiss population according to the three linguistic regions and (ii) to evaluate whether MIL constitutes a significant determinant of the perceived QOL. METHODS: A telephone survey of the Swiss population, performed by a professional survey company, was conducted between November and December 2013. The interview included the SMILE, perceived QOL (0-10) and health status (1-5), and various sociodemographic variables. In the SMILE, an index of weighting (IOW, 20-100), an index of satisfaction (IOS, 0-100), and a total SMILE index (IOWS, 0-100) are calculated from the areas mentioned by the participants as providing MIL. RESULTS: Among the 6671 telephonic contacts realized, 1015 (15 %) participants completed the survey: 405 French, 400 German and 210 Italian participants. "Family" (80.2 %), "occupation/work" (51 %), and "social relations" (43.3 %) were the most cited MIL-relevant categories. Italian participants listed "health" more frequently than German and French participants (50.4 % vs 31.5 % and 24.8 % respectively, χ(2) = 12.229, p = .002). Age, gender, education, employment, and marital status significantly influenced either the MIL scores or the MIL-relevant categories. Linear regression analyses indicate that 24.3 % of the QOL variance (p = .000) is explained by health status (B = .609, IC = .490-.728, p = .000), MIL (B = .034, IC = .028-.041, p = .000) and socioeconomic status (F = 11.01, p = .000). CONCLUSION: The major finding of our analysis highlights the positive and significant influence of MIL on the perceived QOL in a representative sample of a general, multilingual and multicultural population. This result indicates that the existential dimension is not only determinant for QOL in some critical life events, as shown e.g. in psycho-oncology and palliative care, but also in everyday life.

Brand Authenticity: An Integrative Framework and Measurement Scale

Although brand authenticity is gaining increasing interest in consumer behavior research and managerial practice, literature on its measurement and contribution to branding theory is still limited. This article develops an integrative framework of the concept of brand authenticity and reports the development and validation of a scale measuring consumers' perceived brand authenticity (PBA). A multi-phase scale development process resulted in a 15-item PBA scale measuring four dimensions: credibility, integrity, symbolism, and continuity. This scale is reliable across different brands and cultural contexts. We find that brand authenticity perceptions are influenced by indexical, existential, and iconic cues, whereby some of the latters' influence is moderated by consumers' level of marketing skepticism. Results also suggest that PBA increases emotional brand attachment and word-of-mouth, and that it drives brand choice likelihood through self-congruence for consumers high in self-authenticity.

Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.

Impact of simultaneous pancreas-kidney transplantation: patients' perspectives

Background: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. Methods: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. Results: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as"miracle","being reborn" or"coming back to life". Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. Conclusion: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients" existential framework and their experience of disease are key factors for planning new intervention and improvement strategies.

Impact of simultaneous pancreas-kidney transplantation: patients' perspectives

Background: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. Methods: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. Results: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as"miracle","being reborn" or"coming back to life". Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. Conclusion: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients" existential framework and their experience of disease are key factors for planning new intervention and improvement strategies.

La intervenció psicomotriu educativa com estratègia per afavorir la inclusió d'alumnes amb trastorn de l'espectre autista (TEA) dins l'aula ordinària: Anàlisi d'un cas

Des de la inclusió es pretén aconseguir una societat més justa per tothom, on els infants per molt diferents que siguin puguin estar i participar en una escola ordinària, gaudint de les mateixes oportunitats i els mateixos drets. Amb la diversitat ens enriquim els uns amb els altres i aquest fet dóna sentit a l’educació. Amb aquest marc referencial, el present treball d’investigació tracta sobre la millora de la inclusió d’un infant amb TEA (Trastorn de l’Espectre Autista) a través de la pràctica psicomotriu educativa i vivencial, és a dir, una educació més lliure, donant lloc a l’experiència i a uns espais relacionals per dur a terme una activitat espontània psicomotriu. De fet, tracta de demostrar, de manera més específica, que la pràctica psicomotriu millora la capacitat d’interacció social de l’infant amb TEA, és a dir, la relació amb els altres, així com assegurar que aquesta pràctica vivencial aporta més beneficis en la implicació del joc dels infants amb TEA, que una intervenció psicomotriu més funcional.

Lorsque les électrosensibles racontent : des douleurs chroniques aux pratiques d'auto-éviction

Résumé : Cet article propose une analyse du vécu de personnes électrosensibles et de la façon dont ils ont répondu aux douleurs chroniques. L'approche proposée vise à relater les stratégies de réponse à ces formes de morbidité en valorisant les récits des protagonistes ; plus particulièrement, l'accent est mis sur les dimensions cognitives, sensorielles, émotionnelles, relationnelles et existentielles engendrées par une symptomatologie qui ne correspond à aucune explication scientifique causale. Leurs récits mettent ainsi en perspective des trajectoires de vie avec les conditions sociales, médicales et somatiques dans lesquelles est menée leur quête de santé. Mettre l'accent sur les expériences quotidiennes qui fondent la représentation que les électrosensibles ont de leurs troubles permet de comprendre les raisons et les modalités des formes d'auto-éviction qu'ils pratiquent. La réalisation des modalités de l'auto-éviction sont alors interprétées comme l'aboutissement d'une trajectoire de vie, produit de choix intuitifs - et non stratégiques - basés sur des sensibilités singulières. Il en résulte un regard anthropologique invitant à interpréter l'expérience des douleurs chroniques au prisme des rapports sensibles que les individus entretiennent avec leur corps, les autres et l'environnement. Abstract: This paper analyses the lived experience of electrosensitive people and the way they reply to chronic pain. The approach aims to relate the way they reply to this kind of morbidity by highlighting their narratives; especially by emphasising the cognitive, the sensorial, the emotional, the relational and the existential dimensions produced by a symptomatology that is not scientifically explained. Their narratives put into perspective their life trajectories with the social, medical and somatic conditions that lead their health quest. Focusing on the ordinary, that shapes the representations the electrosensitive people have of their troubles, would allow us to understand the reasons and modalities of auto-eviction practices. Auto-eviction achievement is interpreted as a life trajectory fulfilment produced by intuitive choices - nonstrategic - based on singular sensitivities. As a result, it invites an anthropological interpretation of chronic pain experiences built on the sensitive relationships that individuals have with their body, the others and the environment.

A dívida de Hume com Pascal

Embora a bibliografia secundária tenha negligenciado a importância de Pascal para Hume, argumenta-se que, em muitos assuntos e ao longo de toda a vida, Hume beneficiou-se da leitura de Pascal. O artigo se concentra mais nas questões epistemológicas e metafísicas, fazendo somente breves alusões à moral e religião. Dois são os eixos principais da apropriação humeana do pensamento de Pascal: suas reflexões sobre o ceticismo e seu anti-cartesianismo, em particular sua crítica ao cogito e à concepção cartesiana de ciência.

A SKETCH ON NĀGĀRJUNA'S PERSPECTIVES ON "RELATION"

ABSTRACT The aim of this paper is to provide a sketch on the way Nāgārjuna deals with the idea of 'relation'. The concept of 'relation' as expressed in the Pāli sources is here theoretically systematized according to three patterns: 1. (onto)logical, 2. strictly subordinative existential, 3. non-strictly subordinative existential. After having discussed Nāgārjuna's acceptance and treatment of these three patterns, particular attention is paid to the non-strictly subordinative existential relation. This kind of relation is meant to describe the way the factors of the conditioned co-origination are linked to each other and is exemplified by Nāgārjuna by means of the father-son bond. A possible way to explain the conditioned co-origination doctrine in the light of the father-son example is here suggested by having resource to the 'Cambridge change' theory. Even if in the Pāli Canon the non-strictly subordinative existential pattern is said to apply to all the other factors of the conditioned co-origination, there is no direct evidence that it concerns also the avidyā-saṃskāras link. It will be shown how Nāgārjuna, by applying it to the avidyā-saṃskāras link, seems to introduce a new perspective in the conditioned co-origination theory.

Beyond the obvious : three acts in educational drama

Researching research is not a common theme in educational drama. Nor is the educational drama process from a participant perspective a typical focus of research, at least not if the participants are disabled. Yet this is the theme of this thesis, a drama in three acts. The aim of this thesis is to describe, analyse, and discuss both the ways in which research within educational drama can be carried out and represented, and the experiences of the participants of the educational drama process. The theoretical framework that steers the research process is built up of two pairs of frames, each of them, like Russian nesting dolls, containing further frames. The first frame, relating to the outcomes of conducting research in educational drama, comprises philosophical, representational, and personal theories. As the second question asks what educational drama is, the subject related frame is built up of pedagogical, drama educational, and aesthetic theories. The study in its entirety follows the structure of the researcher’s hermeneutical learning process and takes the form of a journey starting from what is familiar, stretching towards what is new and different, and finally returning back to the beginning with a new view on what was there at the start. The thesis consists of two separate but related studies. The first, a familiar study conducted earlier, Alpha in Act I, was carried out among upper secondary school pupils. In the second, the new and therefore unfamiliar study, Omega in Act III, the participants are adult individuals who are physically and communicatively disabled. In between these two Acts an element of “Verfremdung” where the Alpha study is systematically scrutinized as the purpose is to teach and to manage the reader to think. Meta-discussions on the philosophical issues of the study are conducted throughout the text, parallel to the empirical parts. The outcomes of the first research question show that philosophical, methodical, and representational consistency is crucial for research. While this may sound like stating the obvious, this has nevertheless not always been considered fact, especially not within qualitative research. The outcomes further stress that representational issues are also to be recognized when presenting non-rational aspects of educational drama. By wording the world, through the use of visualising language, the surplus of meanings of educational drama can be, as they are within this study, made visible, sensible, and almost tangible, not only cognitively understandable. The outcomes of the second question point to the different foci of the studies, with Alpha focusing on the rationally retold experiences and Omega focusing on nonrational experiences. The outcomes expose educational drama as a learning process comprising doing, reflecting, and being. The doing aspect communicates the concrete efforts in creating a piece of theatre, while the being aspect relates experiences of being as situated, embodied and sensuous, reciprocal, empowering, aesthetic and artistic, and existential. Reflection is the twine that runs throughout the process and connects both doing and being. In summary, the outcomes could be formulated as “learning from learning how to make theatre”.

Den talande bokens poetik : en studie med fokus på olika unga vuxnas reception av tre fiktiva texter inlästa på band

The purpose of the research project The poetics of the talking book is to contribute to the knowledge about patterns of understanding in young adults’ reception of fiction, which they listened to through audio books. The problem explored was: How do different groups of listeners receive fictive text presented as a talking book with variations regarding use of voice, engagement and sound effects? The problem formulation rendered four specific research questions: 1. What patterns can be identified in the listeners’ answers regarding story structure and cognitive content in a comparative perspective comprising different reading styles in the taped versions of the text? 2. What patterns of understanding in interpretative reading can be identified in different listeners? 3. Which thoughts do the listeners have about what the talking book should sound like? 4. What affordances for young adults with the functional disability of mild mental retardation can be made visible through guided literature conversations? The theoretical frame of reference was formed by text–reader-oriented literary theory, psychological schema theory, and research regarding voice quality and communication. The project was carried out in two steps. The first phase was to produce the audio books with two variations of reading practice of three short stories with an existential theme in each text. The second step comprised interviewing of 32 young adults (a special group with a reading handicap in form of mild mental retardation, and a reference group with no handicap). The interviews formed as literary conversation were carried out three times during one year. The phenomenological-hermeneutic approach focused on the life worlds of the participants as meaning seeking beings. The analysis was carried out using method triangulation, mainly using phenomenological meaning concentration. The double hermeneutics in use when interpreting the interpretations of the participants revealed a capacity for aesthetic reading of fiction in the special group as well as in the reference group. The aesthetic qualities were found sufficient in all variations of reading by the professional readers of the audio book they listened to. The young adults also could describe how they wanted the audio book to sound: just as if you were reading yourself. A model describing the analytical steps and concepts in use was a result that can serve as an outline of a poetics for the talking book. Unexpected research results were how important the guided literary conversation turned out to be in order to realise the affordances given by the texts regarding exploration of existential themes in the young adults’ life worlds. Thus the result of the research project can be positioned as a piece of emancipatory research stressing the importance of including this group of young adults in the society’s conversation about culture and meaning.

Dialogue in the crisis of representation : realism and antirealism in the context of the conversation between theologians and quantum physicists in Göttingen 1949-1961

The aim of this study is to analyse the content of the interdisciplinary conversations in Göttingen between 1949 and 1961. The task is to compare models for describing reality presented by quantum physicists and theologians. Descriptions of reality indifferent disciplines are conditioned by the development of the concept of reality in philosophy, physics and theology. Our basic problem is stated in the question: How is it possible for the intramental image to match the external object?Cartesian knowledge presupposes clear and distinct ideas in the mind prior to observation resulting in a true correspondence between the observed object and the cogitative observing subject. The Kantian synthesis between rationalism and empiricism emphasises an extended character of representation. The human mind is not a passive receiver of external information, but is actively construing intramental representations of external reality in the epistemological process. Heidegger's aim was to reach a more primordial mode of understanding reality than what is possible in the Cartesian Subject-Object distinction. In Heidegger's philosophy, ontology as being-in-the-world is prior to knowledge concerning being. Ontology can be grasped only in the totality of being (Dasein), not only as an object of reflection and perception. According to Bohr, quantum mechanics introduces an irreducible loss in representation, which classically understood is a deficiency in knowledge. The conflicting aspects (particle and wave pictures) in our comprehension of physical reality, cannot be completely accommodated into an entire and coherent model of reality. What Bohr rejects is not realism, but the classical Einsteinian version of it. By the use of complementary descriptions, Bohr tries to save a fundamentally realistic position. The fundamental question in Barthian theology is the problem of God as an object of theological discourse. Dialectics is Barth¿s way to express knowledge of God avoiding a speculative theology and a human-centred religious self-consciousness. In Barthian theology, the human capacity for knowledge, independently of revelation, is insufficient to comprehend the being of God. Our knowledge of God is real knowledge in revelation and our words are made to correspond with the divine reality in an analogy of faith. The point of the Bultmannian demythologising programme was to claim the real existence of God beyond our faculties. We cannot simply define God as a human ideal of existence or a focus of values. The theological programme of Bultmann emphasised the notion that we can talk meaningfully of God only insofar as we have existential experience of his intervention. Common to all these twentieth century philosophical, physical and theological positions, is a form of anti-Cartesianism. Consequently, in regard to their epistemology, they can be labelled antirealist. This common insight also made it possible to find a common meeting point between the different disciplines. In this study, the different standpoints from all three areas and the conversations in Göttingen are analysed in the frameworkof realism/antirealism. One of the first tasks in the Göttingen conversations was to analyse the nature of the likeness between the complementary structures inquantum physics introduced by Niels Bohr and the dialectical forms in the Barthian doctrine of God. The reaction against epistemological Cartesianism, metaphysics of substance and deterministic description of reality was the common point of departure for theologians and physicists in the Göttingen discussions. In his complementarity, Bohr anticipated the crossing of traditional epistemic boundaries and the generalisation of epistemological strategies by introducing interpretative procedures across various disciplines.