“Can’t you at least die with a little dignity?” The Right to Die Debates and Normative Dignity

Au cours des dernières décennies, le droit de mourir a émergé comme l’une des questions sociales et politiques les plus controversées en Amérique du Nord et en Europe. Celui-ci implique la mobilisation de nombreux acteurs sociaux et militants ainsi que plusieurs défis juridiques. Au Québec, le législateur provincial a formé le « Comité spécial sur la question de mourir dans la dignité », un groupe de législateurs chargé d’examiner la question. Dans leur rapport de 2012, ils recommandent la légalisation de « l’aide médicale à mourir » comme une partie appropriée de la continuité des soins de fin de vie. À partir d’une méta-analyse des observations écrites et orales recueillies par le Comité dans différents endroits de la province, cet article présente plusieurs significations concurrentes de ce que signifie la dignité humaine à la fin de la vie. Les définitions intrinsèques de la dignité – qu’elles soient religieuses ou philosophiques – associent souvent la dignité à une acceptation de la mort. Ces définitions sont en concurrence avec une compréhension plus relative et contingente de la dignité. Dans une telle perspective, la dignité dépend de l’état physique ou mental de l’individu. Ici, « mourir avec dignité » signifie mourir sans souffrances indues ou en perte d’autonomie. Que « mourir avec dignité » est défini comme étant une mort paisible ou significative ou bien comme une fin de vie sans souffrances indues ou sans perte d’autonomie. Ces appellations normatives tiennent toutes pour acquis que les êtres humains veulent mourir dans la dignité. Cet article analyse les multiples significations de la dignité dans le débat concernant le droit de mourir tout en contestant l’hypothèse qu’une «bonne mort» est nécessairement synonyme de « mourir dans la dignité ».In recent decades, the right to die has emerged as one of the most divisive social and political questions in North America and Europe, one that involves the mobilization of numerous social actors and activists as well as several legal challenges. In Québec, the provincial legislature formed the “Select Committee on Dying with Dignity”, a group of legislators tasked with examining the issue. In their 2012 report, they recommend the legalization of “medical aid in dying” as an appropriate part of the continuum of care at the end of life. From a meta-analysis of the written and oral submissions collected by the Committee in different locations throughout the province, this article presents several competing meanings of what human dignity means at the end of life. Intrinsic definitions of dignity – whether religious or philosophical – often associate dignity with an acceptance of death. These definitions of dignity compete with more relative and contingent understandings of dignity. In such a view, dignity depends on the physical or mental condition of the individual. Here “dying with dignity” means dying without undue suffering or loss of autonomy. Whether “dying with dignity” is defined as having a peaceful or meaningful death or alternatively as an end-of-life without undue suffering or loss of autonomy, these normative calls all take for granted that human beings want to die with dignity. This article analyzes the multiple meanings of dignity in the right to die debate while challenging the assumption that a “good death” is necessary synonymous with “dying with dignity.

Simulation of intelligent active distributed networks implementation of storage voltage control

Tese de mestrado. Engenharia Electrotécnica e de Computadores (área de especialização de Energias Renováveis). Faculdade de Engenharia. Universidade do Porto, OFPZ Arsenal Ges.m.b.H. 200

Le ton d’évidence en éthique relève-t-il de la violence verbale? Analyse des mémoires envoyés à la Commission parlementaire québécoise sur la question de mourir dans la dignité

Cet article interdisciplinaire analyse la manière avec laquelle des citoyens débattent lors d’une consultation publique organisée sur une question éthique profondément conflictuelle : l’euthanasie. Le cas étudié concerne la consultation publique québécoise organisée en 2010-2011 par la Commission spéciale sur la question de mourir dans la dignité. Ces voix citoyennes débattant publiquement sur l’euthanasie ont jusqu’ici peu retenu l’attention des chercheurs. Nous avons analysé à l’aide des outils de la rhétorique aristotélicienne les mémoires écrits (n = 149) envoyés par des citoyens à la Commission spéciale. À de très rares exceptions près, toutes les personnes engagées politiquement dans cette consultation publique, aussi différentes soient-elles, affichent une grande certitude dans leurs croyances éthiques. Chacun fait comme si les convictions de l’adversaire étaient inférieures aux siennes, qu’il présente souvent comme universelles. Concernant la formule « mourir dans la dignité », les participants prétendent implicitement à l’objectivité de leur définition. Ils agissent même comme s’il existait une seule définition de la formule « mourir dans la dignité » et une seule vérité éthique. À la suite de ces analyses, nous discutons du concept de « violence verbale » qui pourrait être associé à ces manières de débattre sur un sujet complexe

The Effect of the Sparticle Mass Spectrum on the Conversion of B-L to B

In the context of many leptogenesis and baryogenesis scenarios, B-L (baryon minus the lepton number) is converted into B (baryon number) by non-perturbative B+L violating operators in the SU(2)_L sector. We correct a common misconversion of B-L to B in the literature in the context of supersymmetry. More specifically, kinematic effects associated with the sparticle masses can be generically important (typically a factor of 2/3 correction in mSUGRA scenarios), and in some cases, it may even flip the sign between B-L and B. We give explicit formulae for converting B-L to B for temperatures approaching the electroweak phase transition temperature from above. Enhancements of B are also possible, leading to a mild relaxation of the reheating temperature bounds coming from gravitino constraints.Comment: 17 page

Incidence, complications and risk factors for severe falls in patients on maintenance haemodialysis

Background. Falls have been insufficiently studied in patients on maintenance haemodialysis (MHD). This study assessed the incidence and complications of severe falls and the ability of risk factors, including the Performance-Oriented Mobility Assessment (POMA) test, to predict them in this population. Methods. All patients on MHD from our centre were asked to participate in this survey. POMA test and a record of risk factors for falls were obtained at baseline. Severe falls, as defined by an admission in an emergency ward, were documented prospectively. Results. Eighty-four patients (median age 69.5 years, minimum 26 years, maximum 85 years) were enrolled. Predialytic POMA scores were low (median 20, minimum 5, maximum 26). After a mean follow-up of 20.6 months (142.2 patient-years), 31 severe falls were recorded in 24 patients (28.6%; incidence 0.22 per patient-year) and complicated by fractures in 54.8% of severe falls. In univariate analysis, age, a past history of falls, malnutrition, depression, but not POMA score, were associated with severe falls. A POMA score of >21 had a negative predictive value of 82%. Conclusions. Severe falls were common in MHD patients in this study and resulted in fractures in >50% of the cases. They were associated with ageing, a past history of falls, malnutrition and depression. Although there was a trend towards a lower POMA score in fallers as compared to non-fallers, the POMA score was not an independent predictor of severe falls in this study. These data may help to stratify the patient's risk of falling in order to target programmes to prevent falls in this populatio

The effect of pH-neutral peritoneal dialysis fluids on adipokine secretion from cultured adipocytes

Background. Adipokines are a group of fat-secreted hormones and cytokines, including leptin and adiponectin, with important functions in humans. Peritoneal dialysis (PD) is associated with markedly raised plasma adipokines, suggesting increased production in this setting. We have shown that low pH down-regulates leptin production. The current study was designed to test if novel pH-neutral PD fluids may regulate leptin and adiponectin secretion in vitro. Methods. We exposed 3T3-L1 adipocytes to a 50 : 50 mixture of dialysate and M199 containing 10% serum for upto 48 h. Dialysates were commercial PD fluids, i.e. conventional acidic, lactate-buffered solutions (PD-acid) and pH-neutral lactate-buffered (PD-Bal) or bicarbonate-buffered solutions (PD-Bic). Leptin and adiponectin concentrations in culture-cell media were measured by ELISA. Results. Compared with PD-acid, PD-Bal and PD-Bic produced a 25 and 43% increase, respectively, in leptin secretion at 48 h (P < 0.05). In contrast, adiponectin secretion was not affected. High glucose PD fluids (4.25%) specifically inhibited leptin secretion vs 1.5% glucose, buffer-matched solutions (P < 0.05). However, differences in leptin secretion due to pH and type of buffer remained significant. In further experiments, the pH of test media were extensively varied without the presence of dialysates. Leptin secretion was shown to increase in a parallel to pH, whereas large changes in pH did not affect adiponectin secretion. Conclusion. The pH-neutral PD solutions specifically induce leptin, but not adiponectin secretion from 3T3-L1 adipocytes. PD-Bic produced a greater leptin stimulation than PD-Bal, but this difference was attributable to pH per se, rather than the type of buffe

Glucose-containing peritoneal dialysis fluids regulate leptin secretion from 3T3-L1 adipocytes

Background. A marked elevation of serum leptin is observed soon after the start of peritoneal dialysis (PD), suggesting that leptin production may be stimulated by this treatment. Glucose metabolism is the major factor regulating leptin. The current study was designed to test if glucose-based PD fluids might regulate leptin production in vitro. Methods. 3T3-L1 adipocytes were exposed to a 50:50 mixture of dialysis solutions and medium M199 containing 10% serum for ≤48 h. Leptin secretion in culture cell supernatants was measured by enzyme-linked immunosorbent assay and leptin mRNA content by northern blot analysis. Results. The high glucose-based commercial dialysate PD4 produced a higher leptin secretion compared with an identical laboratory-manufactured dialysate (Lab-D), but with a physiological glucose concentration of 5 mM (P<0.05). Raising glucose concentration from 2.75 to 40 mM in Lab-D induced a dose-dependent increase in leptin secretion of ≤110±12% at 48 h (P<0.001) and leptin mRNA (P<0.05; glucose 2.75 vs 40 mM). Inhibition of UDP-N-acetylglucosamine biosynthesis, with 6-diazo-5-oxo-norleucine added to Lab-D, abolished most of the glucose-stimulated leptin release and downregulated leptin gene expression. Furthermore, glucose-free Lab-D supplemented with 1 mM glucosamine, an intermediate product in UDP-N-acetylglucosamine biosynthesis, increased leptin secretion by 28±11% over control (P<0.05), although without effect on leptin mRNA, after 48 h of culture. Conclusions. These results suggest that the PD-induced hyperleptinaemia could, in part, be mediated by the effect of glucose-based dialysis fluids on leptin production by adipocytes via activation of the hexosamine biosynthetic pathwa

A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges

Regional citrate anticoagulation (RCA) is proposed for various extracorporeal purification techniques to overcome the risk of bleeding that might result from systemic anticoagulation. Yet, no individualized treatment protocol has been proposed for therapeutic plasma exchange (TPE) so far. The objective of this study was to assess the determinants of blood citrate concentration needed and to develop an individualized RCA protocol useful for clinical practice. The study population included 14 patients who underwent a total of 47 TPE sessions. Citrate was infused pre-plasmafilter. Post-plasmafilter and systemic plasma ionized calcium concentrations were measured at standardized time intervals. An algorithm was proposed for the supplementation of calcium. During the discovery phase, citrate was infused at a fixed starting rate, and adapted accordingly to obtained post-plasmafilter ionized calcium levels. Using a mathematical approach, an algorithm was thereafter developed for individualized prescriptions of citrate. Pre-treatment values of hematocrit and plasma ionized calcium were the main determinants of the required rate of citrate infusion. These can be integrated into a final equation enabling to individualize the prescription. A prefilter ionized calcium concentration between 0.24 and 0.33 mmol/l prevented coagulation of the extracorporeal circuit. Significant hypocalcemia occurred in 8.5% of treatments. There were no significant acid-base disturbances. We propose a new protocol, which enables for the first time to individualize the prescription of regional citrate anticoagulation during TPE, in an efficient manner. The immediately obtained regional anticoagulation protects against both the risk of coagulation of the membrane and the exposure to an excess of citrate

Imatinib mesylate alters the expression of genes related to disease progression in an animal model of uveal melanoma

Imatinib mesylate (IM) is a compound that inhibits both BCR-ABL tyrosine kinase and c-kit receptors. Tyrosine kinases are important in cellular signaling and mediate major cellular processes such as proliferation, differentiation, apoptosis, attachment, and migration. Twenty-six albino rabbits were injected with 1 x 10(6) human uveal melanoma (UM) cells (92.1) into the suprachoroidal space. Animals were immunosuppressed (cyclosporin A) over the course of the 12-week experiment and divided into two groups (n = 13). the experimental group received IM once daily by gavage while the control group received a placebo. One animal per group was sacrificed every week after the 2nd week. Upon necropsy, organs were harvested for histopathological examination. Cells from the primary tumors were recultured and tested in proliferation and invasion assays. A PCR array was used to investigate the differences in expression of 84 genes related to tumor metastasis. in the treated group, 4 rabbits developed intraocular tumors, with an average largest tumor dimension (LTD) of 2.5 mm and 5 animals reported metastatic disease. Whereas 6 rabbits in the control group developed intraocular tumors, with an average LTD of 5.8 mm and 6 animals reported metastatic disease. the recultured cells from the treated group demonstrated lower proliferation rates and were less invasive (p < 0.001). the PCR array showed differences in expression of genes related to metastasis. Notably, there was 290-fold increase in SERPINB5, a tumor suppressor gene, and a 10-fold higher expression of KISS I, a metastasis suppressor gene, in the treated group. Proangiogenic genes such as VEGFA, PDGFA and PDGFB were downregulated in the treated group. To the best of our knowledge, this is the first report detailing the altered expression of specific genes in UM cells after treatment with IM.McGill Univ, Ctr Hlth, Dept Ophthalmol & Pathol, Montreal, PQ, CanadaHenry C Witelson Ocular Pathol Lab, Montreal, PQ, CanadaUniversidade Federal de São Paulo UNIFESP EPM, Dept Ophthalmol, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc