Disputes between patients and providers regarding life-sustaining medical treatment (LSMT) are universal across all U.S. states, yet policies regarding these disputes differ significantly. This dissertation determines that all 50 states have advance directive laws that protect a patient’s right to refuse LSMT even when a healthcare provider objects, yet only some states have policies that protect the patient’s right to choose to continue LSMT when a healthcare provider objects (a dispute known as medical futility). Some states have pro-patient laws that protect the patient’s right to make the final decision, while other states have enacted pro-provider medical futility policies that explicitly grant the provider authority to remove LSMT against the patient’s wishes. Finally, in one state, the law delegates the final decision to a third-party: institutional healthcare ethics committees. This dissertation studies the innovation and adoption of these 17 state medical futility policies, examining the theory that values determine both whether the state adopts a medical futility policy as well as what type of medical futility policy a state will adopt- as the policy actors that represent these values: policy entrepreneurs and interest groups. A comparative case study of successful third-party policy adoption in Texas contrasted against a failed effort in Idaho could not affirm the necessity of policy entrepreneurs for policy adoption but did affirm the necessity of interest group consensus and the role of values. Furthermore, quantitative analysis failed to offer statistically-significant evidence of value indicators, but did suggest that government ideology and political party affiliation may potentially become indicators of the type of medical futility policy that states choose to adopt.

MSc(Med), Bioethics and Health Law, Faculty of Health Sciences, University of the Witwatersrand / The current exclusion criteria for accessing renal dialysis in South African public hospitals places great emphasis on the allocation of scarce resources. The case of Soobramoney at the Constitutional Court highlighted the ethical and legal implications of providing this scarce resource. Mr. Soobramoney was denied access to renal dialysis on the basis of scarce resources and he did not qualify for care due to not meeting the criteria set for renal care. The Soobramoney case was considered mainly on the basis of scarce allocation of resources and offering treatment on an emergency basis. It was argued by the appellant that the state had an obligation to provide him with the treatment in terms of s 27(3) read with s 11 of the Constitution (para 14). This report takes a different slant and looks at the quality of life argument for increasing access to renal dialysis for those denied it based on current South African protocols. In exploring this concept one would venture to offer a definition of ‘quality of life’ according to Brown as an overall sense of well-being. This includes an individual’s satisfaction with their own lives (Brown, 2007: 72). A health related quality of life extends the definition to include the way a person’s v health affects their ability to carry out normal social and physical activities (ibid). A case is made for increasing access by developing programmes to cater for those in need of enhancing their quality of life. This is what is being motivated for in cases similar to Soobramoney, especially those with comorbid disease. The quality of life argument is based on the fact that there are indications in literature that patients with end-stage renal disease rate their own quality of life to be as important as the quality of life of the general population. Furthermore, there is no indication that the elderly live more miserable lives when they are on dialysis. The idea of respect for persons is highlighted - respect for the autonomous choices patients make concerning how they live their lives and including respect for them towards the end of their lives. Finally, I reflect on some legal issues concerned with the Soobramoney versus the Minister of Health Kwa-Zulu Natal 1997.

This art project focuses in a voyeuristic way on the fatality and futility of war. With its accompanying emotional responses; the aim is to reflect on these issues through a cyclical process of construction and destruction. The motivation for this research is to generate a personal and intimate understanding of the experience of war by exploring notions of helplessness and loss through art making processes. The research presumes war exists as a continuous fatal and futile cycle. Within this investigation fatality is defined as accepting the conditions of death, dying and disaster while also alluding to the philosophical concept of fate: futility is defined as pointless, hopeless or useless. Through methods of construction and destruction this project seeks to initiate alternate ways of emotionally processing, responding to, and understanding the experiences of war from a distance. This thesis is constituted as practice based artwork 80% accompanied by an exegesis 20%.

This art project focuses in a voyeuristic way on the fatality and futility of war. With its accompanying emotional responses; the aim is to reflect on these issues through a cyclical process of construction and destruction. The motivation for this research is to generate a personal and intimate understanding of the experience of war by exploring notions of helplessness and loss through art making processes. The research presumes war exists as a continuous fatal and futile cycle. Within this investigation fatality is defined as accepting the conditions of death, dying and disaster while also alluding to the philosophical concept of fate: futility is defined as pointless, hopeless or useless. Through methods of construction and destruction this project seeks to initiate alternate ways of emotionally processing, responding to, and understanding the experiences of war from a distance. This thesis is constituted as practice based artwork 80% accompanied by an exegesis 20%.

The general objective of this thesis was to improve understandings of design, conduct and analysis of randomized controlled trials (RCTs). The specific objective was to evaluate the methodological and statistical principles associated with conducting analyses of futility, a component of interim analysis, as part of the conduct of RCTs. This objective was addressed by first performing a systematic review, which included a detailed literature search, as well as data from a cohort of previously extracted studies. The systematic review was designed to identify futility analysis principles and methodologies in order to inform the design and conduct of retrospective futility analyses of two completed NCIC CTG trials. The results of these trials have been previously published; one trial met its stated endpoint and the other did not. Neither trial underwent an interim analysis of futility during its conduct. The retrospective futility analyses assessed the accuracy of frequently used methods, by comparing the results of each method to each other and to the original final analysis results. These assessments were performed at selected time points using both aggressive and conservative stopping rules. In order to increase the robustness of the comparisons, bootstrapping methods were applied. The results of this thesis demonstrate principles associated with the conduct of futility analyses and provide a basis for hypotheses-testing of optimum methodologies and their associated trade-offs. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-12-12 13:10:15.619

Readers of Homer’s Iliad immediately confront the anger of Achilles; the first word of the poem, μῆνις, forefronts the hero’s godlike wrath. Yet little attention has been paid to the important relationship that exists between Achilles’ anger and his grief. In this dissertation I identify language in the poem unique to Achilles, linking his grief for Patroklos with a longing, ποθή. The most important interpretive consequence of this link between ποθή and grief, I argue, is the proper understanding of the insatiable roots of his subsequent anger. Achilles experiences the death of Patroklos as a rending of the fabric of his life. In this state of restless volatility, we see that Achilles’ anger is one more response to an underlying experience of rupture and thus is both aimless and fruitless. Although Achilles succeeds in ensuring the future sack of Troy by killing Hektor, his behavior remains insatiate, since his deeds of anger are motivated by a desire for what cannot be achieved, life shared with Patroklos. The persistence of his attempted vengeance beyond the slaying of Hektor reveals the futility of his underlying longing, such that, according to the poem, the only end he can make of his grief-driven anger, finally, is to let it go. The Trojans’ grief for Hektor is never described with the language of longing, and this surprising exclusion underscores the contrast between Achilles and Hektor. Where Achilles has a uniquely independent status, Hektor is continuously tied to the city as a whole and part of a rich network of close relations. Rather than exploring the rupture of a single, highly personal relationship, perhaps typical of a warrior far from home many years, with Hektor’s death the poem depicts the impending destruction of an entire civilization. Thus every expression of grief for this warrior refers not only to personal loss but to the multiple relationships that will be impacted by his death. The Trojans’ grief for their defender cannot linger on the sense of rupture in the present, but rather their grief is shaped by a forward-looking sense of doom. / 2022-07-31T00:00:00Z

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<p>In 1942, Algerian writer Albert Camus published a philosophical essay called The Myth of Sisyphus along with a fictional counterpart, The Stranger, wherein he presumed the human condition to be an absurd one. This, Camus claimed, was the result of the absence of a god, and consequently of any meaning beyond life itself. Without a god, without an entity greater than man, man has no higher purpose than himself and he himself is inevitably transient. As such, man, so long as he lives, is cursed with the inability to create or partake in anything lasting. The absurd is life without a tomorrow, a life of futility. As one of the main precursors of this view of life and of the human experience, Camus mentioned Herman Melville and Captain Ahab’s chase for the white whale - Moby Dick.</p><p>Now, as will be indicated in the following, the most common critical position holds that the white whale of Moby-Dick, Melville’s magnum opus, is to be interpreted as a symbol of God, and thus Ahab’s chase is tragic by virtue of its impossibility for success. As such, the tragedy is entailed by the futility vis-à-vis its impermanence. However, the ambiguity of Moby-Dick allows for the possibility of several alternative interpretations as to the role of the whale: for instance that of the devil, evil incarnate or merely a "dumb brute". As such, Ahab’s quest might as well be the pursuit of a creature which understands nothing of vengeance, thus rendering his objective equally, if not more fruitless, than the pursuit of a god.</p>

In 1942, Algerian writer Albert Camus published a philosophical essay called The Myth of Sisyphus along with a fictional counterpart, The Stranger, wherein he presumed the human condition to be an absurd one. This, Camus claimed, was the result of the absence of a god, and consequently of any meaning beyond life itself. Without a god, without an entity greater than man, man has no higher purpose than himself and he himself is inevitably transient. As such, man, so long as he lives, is cursed with the inability to create or partake in anything lasting. The absurd is life without a tomorrow, a life of futility. As one of the main precursors of this view of life and of the human experience, Camus mentioned Herman Melville and Captain Ahab’s chase for the white whale - Moby Dick. Now, as will be indicated in the following, the most common critical position holds that the white whale of Moby-Dick, Melville’s magnum opus, is to be interpreted as a symbol of God, and thus Ahab’s chase is tragic by virtue of its impossibility for success. As such, the tragedy is entailed by the futility vis-à-vis its impermanence. However, the ambiguity of Moby-Dick allows for the possibility of several alternative interpretations as to the role of the whale: for instance that of the devil, evil incarnate or merely a "dumb brute". As such, Ahab’s quest might as well be the pursuit of a creature which understands nothing of vengeance, thus rendering his objective equally, if not more fruitless, than the pursuit of a god.

ABSTRACT SHAKESPEARE&rsquo / S HAMLET AS A PRECURSOR OF THE THEATRE OF THE ABSURD Dogan, Buket M.A., in English Literature Supervisor: Assoc. Prof. Dr. &Uuml / nal Norman May 2008, 121 Pages Being regarded as a dramatist of all times, Shakespeare and his work is studied with a modern view point by many critics. Every historical period finds in him what it is looking for and what it wants to see. Shakespeare is part of a modern tradition trying to mirror human psychology and condition in all its absurdity. The innovations that the theatre of the Absurd has brought to the stage not only provide an influence for the works of the later generations but also, they make it possible to look back at the past works of the theatre with a contemporary critical eye. Shakespeare&rsquo / s vision of the world is similar to that of the absurdists, mainly due to their shared confidence in humanity&rsquo / s capacity to endure, and the precarious nature of human existence. This thesis analyzes Shakespeare&rsquo / s masterpiece Hamlet, mainly the drama of its protagonist, as a precursor of Absurd drama. In Hamlet, Shakespeare represents man&rsquo / s existential anxiety and precarious condition in a nonsensical world, which is stripped of all logical explanations and accounts. To examine the play in the context of the theatre of the Absurd, it will be discussed in relation to Samuel Beckett&rsquo / s Waiting for Godot and Endgame with regard to their common concerns for the themes of the theatre of the Absurd such as uncertainty and inertia.