A Distinction Without A Moral Difference? An Essay On The Difference Between Palliative Sedation And Physician-Assisted Death

Professionals engaged in palliative care have a responsibility to treat their patients by aggressively managing pain and certain kinds of suffering within legal and professional ethical boundaries. Many medical professionals and ethicists, rightly or wrongly, have considered the practices of euthanasia and physician-assisted suicide, which can be categorized as instances of physician-assisted death (PAD), to be beyond the scope of ethically appropriate health care. Many of these same individuals who oppose PAD, and the professional organizations they sometimes represent, often embrace, at the same time, the practice of palliative/terminal sedation at the end of life. Palliative sedation is thought to be an advance in palliative care that has alleviated the need for PAD when managing otherwise intractable pain in dying patients. However, there is some question as to whether this procedure is sufficiently distinct, ethically speaking, from instances of various forms of PAD and that it actually constitutes a compromise. It may be argued that if there is no legitimate moral distinction between the two sets of practices, then instances of PAD should be legal and morally legitimate end-of-life treatment options for patients along with palliative sedation. If this view is correct, then those who support the use of sedation in end-of-life palliative care should have no problem with the practice of PAD. If they were to think or act otherwise would be ethically and professionally inconsistent. The primary question of this dissertation is to determine whether or not medical professionals and others invested in this area are ethically consistent if they reject PAD while embracing the practice of palliative/terminal sedation. So this project is to be considered a work in applied analytic bioethics. I argue that there are both conceptual and empirical reasons for maintaining that there are morally relevant differences between PAD and palliative/terminal sedation for those who have some reasons to think the former is ethically problematic. Therefore, those who are morally and professionally opposed to PAD for certain reasons are not necessarily being inconsistent in their support of palliative/terminal sedation as a legitimate treatment at the end-of-life when the latter is carefully defined, understood, and practiced

Individual differences in pain sensitivity are associated with cognitive network functional connectivity following one night of experimental sleep disruption.

Previous work suggests that sleep disruption can contribute to poor pain modulation. Here, we used experimental sleep disruption to examine the relationship between sleep disruption-induced pain sensitivity and functional connectivity (FC) of cognitive networks contributing to pain modulation. Nineteen healthy individuals underwent two counterbalanced experimental sleep conditions for one night each: uninterrupted sleep versus sleep disruption. Following each condition, participants completed functional MRI including a simple motor task and a noxious thermal stimulation task. Pain ratings and stimulus temperatures from the latter task were combined to calculate a pain sensitivity change score following sleep disruption. This change score was used as a predictor of simple motor task FC changes using bilateral executive control networks (RECN, LECN) and the default mode network (DMN) masks as seed regions of interest (ROIs). Increased pain sensitivity after sleep disruption was positively associated with increased RECN FC to ROIs within the DMN and LECN (F(4,14) = 25.28, pFDR = 0.05). However, this pain sensitivity change score did not predict FC changes using LECN and DMN masks as seeds (pFDR > 0.05). Given that only RECN FC was associated with sleep loss-induced hyperalgesia, findings suggest that cognitive networks only partially contribute to the sleep-pain dyad

The Radial Structure of SNR N103B

We report on the results from a Chandra ACIS observation of the young, compact, supernova remnant N103B. The unprecedented spatial resolution of Chandra reveals sub-arcsecond structure, both in the brightness and in spectral variations. Underlying these small-scale variations is a surprisingly simple radial structure in the equivalent widths of the strong Si and S emission lines. We investigate these radial variations through spatially resolved spectroscopy using a plane-parallel, non-equilibrium ionization model with multiple components. The majority of the emission arises from components with a temperature of 1 keV: a fully ionized hydrogen component; a high ionization timescale (n_e*t > 10^12 s cm^-3) component containing Si, S, Ar, Ca, and Fe; and a low ionization timescale (n_e*t ~ 10^{11} s cm^-3) O, Ne, and Mg component. To reproduce the strong Fe Kalpha line, it is necessary to include additional Fe in a hot (> 2 keV), low ionization (n_e*t ~ 10^10.8 s cm^-3) component. This hot Fe may be in the form of hot Fe bubbles, formed in the radioactive decay of clumps of 56Ni. We find no radial variation in the ionization timescales or temperatures of the various components. Rather, the Si and S equivalent widths increase at large radii because these lines, as well as those of Ar and Ca, are formed in a shell occupying the outer half of the remnant. A shell of hot Fe is located interior to this, but there is a large region of overlap between these two shells. In the inner 30% of the remnant, there is a core of cooler, 1 keV Fe. We find that the distribution of the ejecta and the yields of the intermediate mass species are consistent with model prediction for Type Ia events.Comment: 34 pages, including 7 tables and 7 figures, Accepted by Ap

The role of physical processes controlling the behaviour of radionuclide contaminants in the aquatic environment: a review of state-of-the-art modelling approaches

This paper is aimed at presenting and discussing the methodologies implemented in state-of-the-art models for predicting the physical processes of radionuclide migration through the aquatic environment, including transport due to water currents, diffusion, settling and re-suspension. Models are briefly described, model parameter values reviewed and values recommended. The different modelling approaches are briefly classified and the advantages and disadvantages of the various model approaches and methodologies are assesse

Acceleration and Substructure Constraints in a Quasar Outflow

We present observations of probable line-of-sight acceleration of a broad absorption trough of C IV in the quasar SDSS J024221.87+004912.6. We also discuss how the velocity overlap of two other outflowing systems in the same object constrains the properties of the outflows. The Si IV doublet in each system has one unblended transition and one transition which overlaps with absorption from the other system. The residual flux in the overlapping trough is well fit by the product of the residual fluxes in the unblended troughs. For these optically thick systems to yield such a result, at least one of them must consist of individual subunits rather than being a single structure with velocity-dependent coverage of the source. If these subunits are identical, opaque, spherical clouds, we estimate the cloud radius to be r = 3.9 10^15 cm. If they are identical, opaque, linear filaments, we estimate their width to be w = 6.5 10^14 cm. These subunits are observed to cover the Mg II broad emission line region of the quasar, at which distance from the black hole the above filament width is equal to the predicted scale height of the outer atmosphere of a thin accretion disk. Insofar as that scale height is a natural size scale for structures originating in an accretion disk, these observations are evidence that the accretion disk can be a source of quasar absorption systems. Based on data from ESO program 075.B-0190(A).Comment: 14 emulateapj pages, 7 figures, ApJ in pres

Hydrogen bonding and coordination in normal and supercritical water from X-ray inelastic scattering

A direct measure of hydrogen bonding in water under conditions ranging from the normal state to the supercritical regime is derived from the Compton scattering of inelastically-scattered X-rays. First, we show that a measure of the number of electrons $n_e$ involved in hydrogen bonding at varying thermodynamic conditions can be directly obtained from Compton profile differences. Then, we use first-principles simulations to provide a connection between $n_e$ and the number of hydrogen bonds $n_{HB}$. Our study shows that over the broad range studied the relationship between $n_e$ and $n_{HB}$ is linear, allowing for a direct experimental measure of bonding and coordination in water. In particular, the transition to supercritical state is characterized by a sharp increase in the number of water monomers, but also displays a significant number of residual dimers and trimers.Comment: 14 pages, 5 figures, 1 tabl

Severe postpartum disruption of the pelvic ring: report of two cases and review of the literature

Pelvic dislocations are rare during labor, and the treatment is controversial. We report two cases of young women who sustained postpartum disruption of the pelvic ring: one case is an 8.8 cm wide separation of the pubic symphysis with sacroiliac joint disruption underwent surgical stabilization and the second case with 4.0 cm disruption being treated non-operatively. These cases illustrated of importance of accurate diagnosis, careful physical exam, fully informed consent and specific treatment for this condition