Volume 3 Issue 4
Authors: Thomas De Koninck
Abstract: An eloquent example of fallacies exploiting the many-meanings of such keywords or expressions in Medical Ethics as human dignity and individual autonomy, was recently provided by the Royal Society of Canada Expert Panel in its Report entitled End-of-Life Decision Making, published in November 2011. That Report claimed that “while the language of human dignity is seemingly universal, there is currently no consensus on the moral basis or on the precise meaning of human dignity”, concluding that “the concept of human dignity is an unsuitable tool for settling normative questions pertaining to end-of-life decision making”[ ]. This stratagem enabled them to hold that there must be a moral right to assist suicide, in view of what they deem “the paramount status of the value of individual autonomy”[ ]. As we shall see, the Report is gravely mistaken, and misleading, on both counts, beginning with human dignity. There is more still. There is what, on another parallel topic, the Quebec poet Paul Chamberland has incisively summed up in the following terms: “The total alteration of the meaning of words will allow the fabrication of an official version of what shall pass for reality itself”[ ]. One could not better state the fact that, because it is unable to transform reality, ideology alters the meaning of words signifying that reality. Henceforth, as George Orwell put it: “black is white”, “war is peace”, and so forth. The principle is indeed admirably formulated by Orwell in 1984: one must aim to “dislocate the sense of reality”. “In Oldspeak it is called, quite frankly, ‘reality control’. In Newspeak it is called doublethink”. You will recall that “the whole aim of Newspeak is to narrow the range of thought”. Accordingly, “Doublethink means the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them” [ ]. This was aptly illustrated by the Quebec Special Commission on the Question of Dying with Dignity, which transformed the fine expression medical aid in dying into an oxymoron no longer meaning genuine medical aid such as palliative care, but its exact opposite, euthanasia[ ]. What made this possible was the confusion that it was able to maintain in the use of the word dignity, notably within the formula Dying with Dignity, which even served to name both the Commission and its Report. And yet it is easy to notice that the word dignity carries at least one superficial sense, which Gabriel Marcel rightly qualified as “a decorative conception of dignity”, consisting in “impressing oneself outwardly”, to quote André Gide [ ]. Whereas human dignity has, in fact, three strong universal meanings whose relevance to end-of-life care is soon evident: 1) ontological dignity, 2) dignity-decency, 3) dignity-liberty [ ]. This paper will center on those three meanings and their practical consequences, before a brief conclusion. Discussion of “individual autonomy” will find its natural place when we reach the third meaning, “dignity-liberty”.
Keywords: Human Dignity; End-of-life care; Bioethics; Medical Ethics; Fallacies
Authors: Edna Holz-Sapra; Christoph Glanzmann; Stefan Schmid; Philip Went; Gabriela Studer
Abstract: Objective: Lymphoepithelial carcinoma (LEC) of the salivary glands is a very rare condition especially in the Caucasian population. We herewith contribute a case of a Caucasian woman with LEC of the parotid gland. Furthermore we present a literature review on LEC of the major salivary glands (MSG) of the past 32 years. Materials and Methods: We reported an own case and performed a review of the medical literature (1980-2012). Results: Case report: After a Follow-up (FU) of 5 years after treatment with postoperative IMRT and concomitant carboplatin, our patient has no signs of relapse. Review: We found 404 cases with LEC of the MSG published in 33 articles over the last 32 years. The mean age of the patients was 49 years (16-86); 56% were female. 95% of the cases have been treated and published in Asia (China, Taiwan). Only 17 of the 404 cases (4%) reported in 15 publications, Caucasian patients were affected. Information on treatment and outcome was not available in 75% and 72%, respectively. After a mean FU of 5.5 years (range 0.5-14) 66 of 84 (79%) patients with reported FU showed no evidence of disease. Conclusion: LEC of the salivary glands is a rare disease especially in Caucasian populations with only 4% of published LEC cases in the reviewed literature. In only 21% of the reports, clinical information on treatment and outcome was provided. Based on the limited information available from published reports, the value of radiotherapy remains unclear.
Keywords: Lymphoepithelial Carcinoma, salivary Gland, Caucasian, Radiotherapy LEC, Outcome LEC
Authors: Valery Kh. Akparov; Vladimir I. Timofeev; Ilyas G. Khaliullin; Vytas ?vedas; Galina G. Chestukhina; Inna P. Kuranova
Abstract: Carboxypeptidase T from Thermoactinomyces vulgaris (CpT) contains aspartic acid residue on the bottom of primary specificity pocket, like carboxypeptidase B (CpB), but CpT is able to chip off hydrophobic C-terminal amino acid residues like carboxypeptidase A (CpA) as well as positively-charged (like CpB) and even negatively-charged ones. To clarify the CpT substarte recognition mechanism, the 3-D structures of complexes of CpT with sulfamide based phenylalanine and arginine transition-state analogs were determined. It is shown that conservative Leu203, (CpA numbering) Leu247 (CpA numbering) is structural determinants of hydrophobic, and Asp256 of positively charged substrates. It was shown also that Asp253 is uncharged. Variant CpT Asp256Asn has CpA-like selectivity, and variant CpT Leu247Asn can’t chip off negative charged residues. The role of calcium ions in allosteric regulation of CpT selectivity (Akparov et al., Crystallography Reports. 56(4), 596–602 as well as a role of fixed water molecules in substrate binding were revealed also. Side-chain depended shift (0.1 Ǻ) of ligand relative to Zn atom induce the conformation rearrangements of Glu270 (0.4Ǻ) and Arg127 (0.1 Ǻ) in catalytic center of CpT and as a result S1’-subsite can regulate the catalysis efficiency. This is a possible new mechanism of substrate recognition in metallocarboxypeptidases.
Keywords: Metallocarboxypeptidases; Carboxypeptidase T; Thermoactinomyces Vulgaris