Death and Dying

This is the first chapter of a projected book to be entitled, The Ego and the Spirit. This book will endeavor to examine what lies at the heart of human spiritual aspiration from a psychological, philosophical, and religious perspective. In this first chapter, I discuss the predicament of the human ego, charged with a task that it cannot fulfill: To establish itself securely within being. The ego's efforts to fulfill this task through its dealings with the things and people of (...) the material world lead to distortions in its self-experience, its relations with others, and its involvement in life in general. The world's spiritual traditions have long recognized the predicament of the ego and present themselves as a means to its resolution. In this first chapter, though, the focus is on the ego and its predicament. (shrink)

In December of 2013, my Dad died of advanced Alzheimer's and a condition called Myasthenia Gravis. This is a selection of journal entries I made over the course of the two years leading up to my Dad's death. It is not a philosophical essay, but a personal reflection, in "real time" so to speak, on the nature of the dying process in relation to questions of faith, hope, despair, and the meaning of a man's life. I offer it here for (...) any who might find it worthwhile. (shrink)

The 2017 story of Charlie Gard is revisited. Upon the British High Court’s ruling in favor of the physicians that the infant should be allowed to die without the experimental treatment, the view of the public as well as the opinions of bioethicists and Catholic bishops are divided, interestingly along with a cultural line. American bioethicists and Catholic bishops tend to believe that the parents should have the final say while British/European bioethicists and Catholic bishops in general side with the (...) court’s decision. The paper explores the place of culture in bioethical reasoning between the UK/Europe and the US while claiming that cultural differences are more important than geopolitical or religious differences to understand the bioethical positions of a group. In addition, the authors introduce a decision-making program for handicapped neonates which is developed by the American Jesuit Bioethicist, Richard McCormick, and modified further by the contemporary American Jesuit Bioethicist, Peter A. Clark, in an attempt to see if the program’s normatizing categories can contribute to the culture-laden ethical discussions on Charlie’s case. However, it is admitted that the McCormick-Clark device is borne out of the American and Catholic theological context. (shrink)

Samuel Scheffler defends “The Afterlife Conjecture”: the view that the continued existence of humanity after our deaths—“the afterlife”—lies in the background of our valuing; were we to lose confidence in it, many of the projects we engage in would lose their meaning. The Afterlife Conjecture, in his view, also brings out the limits of our egoism, showing that we care more about yet unborn strangers than about personal survival. But why does the afterlife itself matter to us? Examination of Scheffler’s (...) second argument helps answer this question, thereby undermining his argument. Our concern for the afterlife involves bootstrapping: we care more about the afterlife than about personal survival precisely because the latter has such salient limits that our lives are structured by adaptation to mortality, and it is only because the afterlife does provide a measure of personal survival that it can give meaning to our projects. (shrink)

In this paper I revisit a dispute between Mikel Burley and Robin Le Poidevin about whether or not the B-theory of time can give its adherents any reason to be less afraid of death. In ‘Should a B-theoretic atheist fear death?’, Burley argues that even on Le Poidevin’s understanding of the B-theory, atheists shouldn’t be comforted. His reason is that the prevalent B-theoretic account of our attitudes towards the past and future precludes treating our fear of death as unwarranted. I (...) examine his argument and provide a tentative defense of Le Poidevin. I claim that while Burley rightly spots a tension with a non-revisionary approach to our ordinary emotional life, he doesn’t isolate the source of that tension. The real question is how to understand Le Poidevin’s idea that on the B-theory, we and our lives are ‘eternally real’. I then suggest that there is a view of time that does justice to Le Poidevin’s remarks, albeit a strange one. The view takes temporal relations to be quasi-spatial and temporal entities to exist in a totum simul. (shrink)

This paper is a reflection on the puzzle of life after death. It explores the meaning, types and causes of death so as to contemplate the purpose of life. Thus, the paper takes into consideration metaphysical, moral and epistemic issues in the belief in life after death (or life after life). This exploration is done considering the Yoruba philosophy of death (iku), life (iye) and life after death (aye atun wa). We note that, for the Yoruba, life as seen in (...) the body is ephemeral, whereas death (that is, the separation of the soul from the body—iku ara) is a transitory process of life to a renewed life. The paper shows that the Yoruba’s idea of death is not an end to life but a change in its form. It is argued, then, that the Yoruba ontology has the implications that: (a) life is a continuum and, (b) man is not his body, (c) hence, a theory of immortality of the soul is implied. The paper observes that, though certain contradictions exist in the Yoruba worldview, the ethos of the belief seems significant. The paper examines the notions of imo (knowledge) and igbabo (belief) in Yoruba epistemology and thus advances the thesis that their belief in life after death cannot be corroborated, though not unreasonable. (shrink)

What, if anything, makes death bad for the deceased themselves? Deprivationists hold that death is bad for the deceased iff it deprives them of intrinsic goods they would have enjoyed had they lived longer. This view faces the problem that birth too seems to deprive one of goods one would have enjoyed had one been born earlier, so that it too should be bad for one. There are two main approaches to the problem. In this paper, I explore the second (...) approach, by Anthony Brueckner and John Martin Fischer, and suggest that it can be developed so as to meet deprivationists’ needs. On the resulting view, metaphysical differences between the future and the past give rise to a corresponding axiological difference in the intrinsic value of future and past experiences. As experiences move into the past, they lose their intrinsic value for the person. (shrink)

This article has two main sections. In Section I, I argue against the skeptic's position. I examine an attempt to see both prima facie objections as arising from features that killing and letting die have in common, and then argue that all such attempts are doomed to failure. In Section II, I explain how even defenders of the distinction's significance have misconstrued the difference between the two objections. In so doing I attempt to develop a better account of why killing (...) and letting die are prima facie objectionable. I also briefly explore some related matters. (shrink)

An e-book devoted to 13 critical discussions of Thaddeus Metz's book "Meaning in Life: An Analytic Study", with a lengthy reply from the author. -/- Preface Masahiro Morioka i -/- Précis of Meaning in Life: An Analytic Study Thaddeus Metz ii-vi -/- Source and Bearer: Metz on the Pure Part-Life View of Meaning Hasko von Kriegstein 1-18 -/- Fundamentality and Extradimensional Final Value David Matheson 19-32 -/- Meaningful and More Meaningful: A Modest Measure Peter Baumann 33-49 -/- Is Meaning in (...) Life Comparable?: From the Viewpoint of ‘The Heart of Meaning in Life’ Masahiro Morioka 50-65 -/- Agreement and Sympathy: On Metz’s Meaning in Life Sho Yamaguchi 66-89 -/- Metz’s Quest for the Holy Grail James Tartaglia 90-111 -/- Meaning without Ego Christopher Ketcham 112-133 -/- Death and the Meaning of Life: A Critical Study of Metz’s Meaning in Life Fumitake Yoshizawa 134-149 -/- Metz’ Incoherence Objection: Some Epistemological Considerations Nicholas Waghorn 150-168 -/- Meaning in Consequences Mark Wells 169-179 -/- Defending the Purpose Theory of Meaning in Life Jason Poettcker 180-207 -/- Review of Thaddeus Metz’s Meaning in Life Minao Kukita 208-214 -/- A Psychological Model to Determine Meaning in Life and Meaning of Life Yu Urata 215-227 -/- Assessing Lives, Giving Supernaturalism Its Due, and Capturing Naturalism: Reply to 13 Critics of Meaning in Life Thaddeus Metz 228-278 . (shrink)

Book synopsis: Dying and death are topics of deep humane concern for many people in a variety of circumstances and contexts. However, they are not discussed to any great extent or with sufficient focus in order to gain knowledge and understanding of their major features and aspects. The present volume is an attempt to bridge the undesirable gap between what should be known and understood about dying and death and what is easily accessible. Included in the present volume are chapters (...) arranged in three sections. First, there are chapters on aspects of dying, written by people who have professional experience and personal insights into the nature of the processes at work and the ways it should be treated. Secondly, there are chapters on assisted death (Euthanasia) that illuminate the practices involved in the professional assistance given to persons who suffer from an incurable illness and who do not want their painful life to be medically extended. Thirdly, there are chapters on mourning, examined in a variety of cultural contexts. These provide insights for different ways of maintaining the presence of the dead in the life of the living: “life in the hearts”. (shrink)

When people suffer they always suffer as a whole human being. The emotional, cognitive and spiritual suffering of human beings cannot be completely separated from all other kinds of suffering, such as from harmful natural, ecological, political, economic and social conditions. In reality they interact with each other and influence each other. Human beings do not only suffer from somatic illnesses, physical pain, and the lack of decent opportunities to satisfy their basic vital, social and emotional needs. They also suffer (...) when they are not able to experience and grasp any meaning of life even if such suffering is not quite as obvious as most forms of physical, social and emotional suffering. Suffering from the lack for the sense of the meaning of life is a special form of emotional, cognitive, and spiritual suffering. Although all human beings share the same basic human need for some meaning of life, the fulfilment of this need is highly individual and personal. Although all forms of human suffering can be a challenge to the meaning of life, the personal conditions of suffering usually are a stronger challenge for the meaning of life. Among the personal conditions of human suffering, the Grenzsituationen cannot be cancelled or raised at all, but only accepted and coped with as existential aspects of the conditio humana. According to Karl Jaspers these are: death, suffering, struggling, guilt, and failing. The challenge for human beings to cope with these Grenzsituationen is a way to move from the mere Being-there to true human Existence. (shrink)

Kertomus René Descartesin kuolemasta / An account of the Death of René Descartes.

Käsittelen tässä artikkelissa Leibnizin käsitystä kuolemasta, jota ei tarkkaan ottaen ole olemassa. Kuoleminen on Leibnizin mukaan vain tila, jossa havaintomme eivät nouse tarkoiksi ja vaivumme ikäänkuin elottoman luonnon tasolle.

When I was fifteen, I was having serious doubts about the existence of a supernatural entity benevolently looking over me, and—perhaps even more disturbingly—about the possibility of an afterlife in which I would again see my friends and relatives and exist happily ever after. It was at that point that I started reading the writings of Bertrand Russell,1,2 one of the most controversial philosophers and political activists of the Twentieth century.

This paper—written for nonspecialist readers—asks whether life after death is in any sense possible given the apparent fact that after we die our remains decay to the point where only randomly scattered atoms remain. The paper argues that this is possible only if our remains are not in fact dispersed in this way, and discusses how that might be the case. -/- 1. Life After Death -- 2. Total Destruction -- 3. The Soul -- 4. Body-Snatching -- 5. Radical Resurrection (...) -- 6. Irreversibility -- 7. Atomic Reassembly -- 8. The Transporter -- 9. Replicas and Originals -- 10. Survival and Causal Connections. (shrink)

This is a review of Johnston's book Surviving Death.

In the future, human destiny may depend on our ethics. In particular, biotechnology and expansion in space can transform life, raising profound questions. Guidance may be found in Life-centered ethics, as biotic ethics that value the basic patterns of organic gene/protein life, and as panbiotic ethics that always seek to expand life. These life-centered principles can be based on scientific insights into the unique place of life in nature, and the biological unity of all life. Belonging to life then implies (...) a human purpose: to safeguard and propagate life. Expansion in space will advance this purpose but will also raise basic questions. Should we expand all life or only intelligent life? Should we aim to create populations of trillions? Should we seed other solar systems? How far can we change but still preserve the human species, and life itself? The future of all life may be in our hands, and it can depend on our guiding ethics whether life will fulfil its full potentials. Given such profound powers, life-centered ethics can best secure future generations. Our descendants may then understand nature more deeply, and seek to extend life indefinitely. In that future, our human existence can find a cosmic purpose. (shrink)

Sadly, there are people in very bad medical conditions who want to die. They are in pain, they are suffering, and they no longer find their quality of life to be at an acceptable level anymore. -/- When people like this are kept alive by machines or other medical treatments, can it be morally permissible to let them die? -/- Advocates of “passive euthanasia” argue that it can be. Their reasons, however, suggest that it can sometimes be not wrong to (...) actively kill some patients, i.e., that “active euthanasia” can be permissible also. This essay reviews these arguments. (shrink)

Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

[On the Ethics of Euthanasia Again: A Reply to Critics] The article is a reply to three critics of a previous piece on the ethics of euthanasia in which I defended physician-assisted suicide. According to Ingrid Strobachová it is necessary to give a greater attention to the significance of pain, which, she claims, may benefit from a phenomenological description. According to Marta Vlasáková my argument is not valid because two principles on which it is founded – i.e. the conception of (...) life as of fundamental value and the autonomy of the patient – are not in mutual harmony. Jakub Jirsa criticises the very concept of assisted suicide and the moral legitimacy and need for the legalisation of assisted suicide. To Dr Strobachová I reply that phenomenological description is as acceptable a method as any other – as long, that is, as it is not only a verbal game, but constitutes a real source of knowledge. To Dr. Vlasáková I argue that a more charitable reading of my argument is possible. The arguments of Dr. Jirsa against assisted suicide are beset with various inconsistencies, including the fact that he himself allows that doctors should tolerate suicide by the refusal of food and drink. Such an act does not, however, differ in any relevant way from doctor-assisted suicide. (shrink)

Evidence from jurisdictions that allow assisted dying is frequently used in the debate about assisted dying in the UK, since it provides important information about how assisted suicide and voluntary euthanasia work in practice. However, in order to interpret these data meaningfully, it is essential that they are understood in the context of the different legal and regulatory frameworks in operation in these countries. -/- The Commission on Assisted Dying has commissioned this expert briefing paper in order to help unpick (...) these complexities, and identify evidence for the effectiveness of the various legal safeguards that have been employed in jurisdictions that allow assisted dying. In the briefing paper the authors identify and explain the features of the legal regimes that regulate assisted dying in four target jurisdictions: the Netherlands, Belgium, Oregon and Switzerland. -/- They explore the evidence for the effectiveness of individual safeguards in each of these regimes in turn. Then they evaluate the evidence for the effectiveness of each safeguard, drawing on a detailed examination of the evidence, and, where possible, make recommendations on how these regimes could implement and regulate assisted dying more effectively. (shrink)

Stoicism is an ancient Greco-Roman practical philosophy focused on the ethics of everyday living. It is a eudaemonistic (i.e., emphasizing one’s flourishing) approach to life, as well as a type of virtue ethics (i.e., concerned with the practice of virtues as central to one’s existence). This paper summarizes the basic tenets of Stoicism and discusses how it tackles the issues of death and suicide. It presents a number of exercises that modern Stoics practice in order to prepare for death (one’s (...) own, or those of relatives and friends). It argues that modern Stoicism is a viable personal philosophy. (shrink)

Commentary on the European Court of Human Rights judgment in Haas v Switzerland.

This article examines the reporting requirements in four jurisdictions in which assisted dying (euthanasia and/or assisted suicide) is legally regulated: the Netherlands, Belgium, Oregon and Switzerland. These jurisdictions were chosen because each had a substantial amount of empirical evidence available. We assess the available empirical evidence on reporting and what it tells us about the effectiveness of such requirements in encouraging reporting. We also look at the nature of requirements on regulatory bodies to refer cases not meeting the legal criteria (...) to either prosecutorial or disciplinary authorities. We assess the evidence available on the outcomes of reported cases, including the rate of referral and the ultimate disposition of referred cases. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to (...) ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

Belgium has recently extended its euthanasia legislation to minors, making it the first legislation in the world that does not specify any age limit. I consider two strands in the opposition to this legislation. First, I identify five arguments in the public debate to the effect that euthanasia for minors is somehow worse than euthanasia for adults—viz. arguments from weightiness, capability of discernment, pressure, sensitivity and sufficient palliative care—and show that these arguments are wanting. Second, there is another position in (...) the public debate that wishes to keep the current age restriction on the books and have ethics boards exercise discretion in euthanasia decisions for minors. I interpret this position on the background of Velleman’s “Against the Right to Die” and show that, although costs remain substantial, it actually can provide some qualified support against extending euthanasia legislation to minors. (shrink)

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of (...) requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable. (shrink)

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

[For an Ethics without Theology] This study is a critical reflection on Marek Vácha's article on the ethics of euthanasia. In the first part the author offers a short consideration of the reasons for the moribund state of ethics in Czech philosophy, after which, in the second part, he presents a critique of Vácha's article. The article in question is, above all, lacking in a philosophical approach to the problem of euthanasia, and we find in it not so much arguments (...) as rhetoric. The only line of argument that is detectable in the article is founded on natural theology, something that Vácha elsewhere repudiates, and it offers the reader a false dilemma between accepting theistic ethics on the one hand or total subjectivism on the other. In reality, of course, there is a wide range of kinds of objective secular ethics. In the third part, one of these forms is summarised--a system of "everyday morality" which is founded on the concept of harm, and which treats conduct as immoral primarily when it causes unjustifiable harm to others. This form of ethics does not presuppose any controversial theory of value, and it constitutes the viewpoint from which the author then defends physician-assisted suicide. A doctor who helps a patient die--or who causes the patient's death on his own request--does not cause that individual harm if she has only a period of life filled with pain left. In conclusion the author indentifies certain points of contact between secular and theistic ethics. (shrink)

Euthanasia or mercy killing is, now a day, a major problem widely discussed in medical field. Medical professionals are facing dilemma to take decision regarding their incompetent patient while tend to do euthanasia. The dilemma is by nature moral i.e. whether it is morally permissible or not. In some countries of Europe and in some provinces of USA euthanasia is legally permitted fulfilling some conditions. It is claimed by Rachels that in our practical medical practice we do euthanasia by forbidding (...) patients from taking drugs. He concludes that if that type of euthanasia can be practiced in our society without any hesitation then why assisting euthanasia will not be permitted1. There are so many arguments both pro and con of euthanasia. But it is not the function of the current paper to discuss all the arguments. Philippa Foot in her article „Euthanasia‟ and J Velleman in his article titled as „A Right to Self-termination‟ discussed about the permissibility of euthanasia. The objective of the paper is to justify their arguments and then come to a conclusion regarding the permissibility of euthanasia. The focus will be given mainly on non- voluntary active and non-voluntary passive euthanasia. The method of discussion will be that an example will be given from Bangladesh and then the arguments provided by Foot and Velleman in their above mentioned papers will be discussed to justify the act of euthanasia on concerned patient. In the last section of the paper the situation of Bangladesh will also be considered for the permissibility of euthanasia i.e. whether the act of euthanasia can be permitted in our country considering the existing socio-cultural-religious practice. (shrink)

In her paper, The case for physician assisted suicide: not proven, Bonnie Steinbock argues that the experience with Oregon’s Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this brief paper, we (...) suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide. (shrink)

Extended review of Assisted Suicide and Euthanasia: A Natural Law Ethics Approach by Craig Paterson. Ashgate, 2008.

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why we (...) are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ‘it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy with respect (...) to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)

There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this (...) paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. (shrink)

Proponents of the legalization of assisted suicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assisted suicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception of dignity fits best (...) with our intuitions about the conditions under which a life has dignity, it supports the legalization of assisted suicide only under very limited circumstances. (shrink)

In 1959 two French neurologists, Pierre Mollaret and Maurice Goullon, coined the term coma dépassé to designate a state beyond coma. In this state, patients are not only permanently unconscious; they lack the endogenous drive to breathe, as well as brainstem reflexes, indicating that most of their brain has ceased to function. Although legally recognized in many countries as a criterion for death, brain death has not been universally accepted by bioethicists, by the medical community, or by the public. I (...) this paper, I defend brain death as a biological concept. I challenge two assumptions in the brain death literature that have shaped the debate and have stood in the way of an argument for brain death as biological. First, I challenge the dualism established in the debate between the body and the brain. Second, I contest the emphasis on consciousness, which prevents the inclusion of psychological phenomena into a biological criterion of death. I propose that the term organism should apply both to the functioning of the body and the brain. I argue that the cessation of the organism as a whole should take into account three elements of integrated function. Those three elements are: 1) the loss of integrated bodily function; 2) the loss of psychophysical integration required for processing of external stimuli and those required for behavior; and, 3) the loss of integrated psychological function, such as memory, learning, attention, and so forth. The loss of those three elements of integrated function is death. (shrink)

Bioethics, neuroscience, medicine are contributing to a debate on the definition and criteria of death. This topic is very controversial, and it demonstrates clashing views on the meaning of human life and death. Official medical and legal positions agree upon a biological definition of death as irreversible cessation of integrated functioning of the organism as a whole, and whole-brain criterion to ascertain death. These positions have to face many criticisms: some scholars speak of logical and practical inconsistency, some others of (...) invalid scientific theory about the supreme integrator. In this paper some criticisms are exposed and discussed in order to reconstruct the state of the art in bioethical debate. -/- . (shrink)

I criteri neurologici per accertare il decesso, da impiegare in alternativa a quelli cardiorespiratori se il paziente ha subìto lesioni cerebrali e si trova collegato alle apparecchiature per la ventilazione artificiale, sono entrati nell’uso comune della pratica medica occidentale da circa quarant’anni ed il consenso di cui essi godono nella comunità scientifica sembra, a prima vista, essere ancora oggi molto solido. Si diceva a prima vista, perché se si esamina con attenzione la letteratura dal 1992 ad oggi, si possono scoprire (...) i crescenti numeri del dissenso: ripensamenti e critiche provengono soprattutto da esperti di area medico-biologica, che associano le loro voci a quelle di filosofi, teologi, studiosi di etica. I motivi del dissenso sono molteplici, e l’ampia letteratura che li documenta riguarda la teoria scientifica posta a fondamento dei criteri neurologici, ed evidenzia le contraddizioni, teoriche ed applicative, derivanti dall’uso di quei criteri. (shrink)

Since 1968, the irreversible loss of functioning of the whole brain, called brain death, is assimilated to individual’s death. The almost universal acceptance of this neurological criterion of death had decisive consequences for the contemporary medicine, such as the withdrawal of mechanical ventilation in these patients and organ retrieval for transplantation. The new criterion was successfully accepted in part because the assimilation of brain death state to death was presented by medicine --and acritically assumed by most of societies-- as a (...) scientific and objective fact. Nevertheless, many people do not think that the patients suffering brain death are actually dead. We show here that those people are not necessarily wrong. It can be argued that, in fact, the justification of the neurological criterion is not scientific but moral. We outline the thesis that the problem surrounding the vital status of brain dead patients is due to a confusion between factual and normative questions. Furthermore, we claim that the donation of organs and the withdrawal of life-support could be ethically acceptable even if the patients suffering brain death are considered as alive. As an alternative to the dead donor rule, we propose a justification for organ donation of brain-dead patients based on the (moral) concepts of harm and consent : what truly justifies the procurement of organs on those patients is not that they are dead, but that they wish to donate their organs and that, since they have irreversibly lost their brain, they cannot be harmed. (shrink)

In this issue of the Report, James L. Bernat proposes an innovative and sophisticated distinction to justify the introduction of permanent cessation as a valid substitute standard for irreversible cessation in death determination. He differentiates two approaches to conceptualizing and determining death: the biological concept and the prevailing medical practice standard. While irreversibility is required by the biological concept, the weaker criterion of permanence, he claims, has always sufficed in the accepted standard medical practice to declare death. Bernat argues that (...) the medical practice standard may be acceptable on the ground that proving circulatory or brain permanence is sufficient to assure complete accuracy for death diagnosis. -/- The topic requires public deliberation: processes to survey people's opinions and mechanisms to channel their opinions into policy-making. What is at stake is the nature of our society. Do we want an expertocracy, in which an enlightened few design policies for the greater good of the majority and exploit the lack of public knowledge to achieve compliance? (shrink)

In this paper, I would like to argue that brain-dead small children have a natural right not to be invaded by other people even if their organs can save the lives of other suffering patients. My basic idea is that growing human beings have the right to grow in the form of wholeness, and dying human beings also have the right to die in the form of wholeness; in other words, they have the right to be protected from outside invasion, (...) unless they have declared their wish to abandon that right beforehand. I call this the principle of wholeness. Natural rights, which were discussed by Hobbes and Locke in the 17th century, have to be extended to include the right to grow and die in the form of wholeness in the age of scientific civilization, where peripheral human lives are being threatened by aggressive biomedicine and other advanced technologies. (shrink)

A brain death case is presented and reinterpreted using the narrative approach. In the case, two Japanese parents face a dilemma about whether to respect their daughter’s desire to donate organs even though, for them, it would mean literally killing their daughter. We argue that the ethical dilemma occurred because the parents were confronted with two conflicting narratives to which they felt a “narrative responsibility,” namely, the responsibility that drives us to tell, retell, and coauthor the (often unfinished) narratives of (...) loved ones. We suggest that moral dilemmas arise not only from conflicts between moral justifications but also from conflicts between narratives and human relationships. (shrink)

When I was fifteen, I was having serious doubts about the existence of a supernatural entity benevolently looking over me, and—perhaps even more disturbingly—about the possibility of an afterlife in which I would again see my friends and relatives and exist happily ever after. It was at that point that I started reading the writings of Bertrand Russell,1,2 one of the most controversial philosophers and political activists of the Twentieth century.

The dead donor rule justifies current practice in organ procurement for transplantation and states that organ donors must be dead prior to donation. The majority of organ donors are diagnosed as having suffered brain death and hence are declared dead by neurological criteria. However, a significant amount of unrest in both the philosophical and the medical literature has surfaced since this practice began forty years ago. I argue that, first, declaring death by neurological criteria is both unreliable and unjustified but (...) further, the ethical principles which themselves justify the dead donor rule are better served by abandoning that rule and instead allowing individuals who have suffered severe and irreversible brain damage to become organ donors, even though they are not yet dead and even though the removal of their organs would be the proximal cause of death. (shrink)