One of liberalism’s core commitments is to safeguarding individuals’ autonomy. And a central aspect of liberal social justice is the commitment to protecting the vulnerable. Taken together, and combined with an understanding of autonomy as an acquired set of capacities to lead one’s own life, these commitments suggest that liberal societies should be especially concerned to address vulnerabilities of individuals regarding the development and maintenance of their autonomy. In this chapter, we develop an account of what it would mean for (...) a society to take seriously the obligation to reduce individuals’ autonomy-related vulnerabilities to an acceptable minimum. In particular, we argue that standard liberal accounts underestimate the scope of this obligation because they fail to appreciate various threats to autonomy. (shrink)

Intention is one of the masterworks of twentieth-century philosophy in English. First published in 1957, it has acquired the status of a modern philosophical classic. The book attempts to show in detail that the natural and widely accepted picture of what we mean by an intention gives rise to insoluble problems and must be abandoned. This is a welcome reprint of a book that continues to grow in importance.

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

In suicidology, the common view is that ‘rational’ suicides occur only rarely, because the competence of people who want to end their lives is compromised by mental illness. In the Netherlands and Flanders, however, patients’ requests for euthanasia or assistance in suicide are granted in 5300 and 1400 cases a year respectively, and in all these cases at least two doctors have confirmed the patient's competence. The combination of these two findings is puzzling. In other countries one would expect at (...) least some of these people to end their own lives. The article argues that we can distinguish between two types of suicide with clustering characteristics. In cases of the first type, the agent doesn't carefully plan his action, doesn't communicate his plans to relatives or others, and uses violent means. In such cases it is reasonable to presume lack of competence. The other type has the opposite characteristics. The most plausible explanation of our problem is that suicides of the second kind are invisible to suicidology, because they tend not to be registered as suicides at all. (shrink)

In a substantial number of cases, dying patients are brought into a state of lowered consciousness and kept in it until they die in order to prevent or stop severe suffering. Many guidelines and position statements have been published in recent years on sedation until death, as I will call this policy. Some have been published by professional organisations and are meant to be binding for their members, others are the work of task forces and merely aim at providing medical, (...) moral, and legal guidance.1 These guidelines all take the following positions: the patient’s consciousness should not be lowered more than is necessary for preventing her from suffering; it must be impossible to alleviate the suffering in any... (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

This is a welcome reprint of a book that continues to grow in importance.

There are, I thinks too many morally significant exceptions to accept the physician's rationales or the bioethicist's criticisms, stated siveepingly. Physicians need to take account of the harms caused by loss of hopes, especially false hopes due to deception, as Ivell, as of the harms of successfully maintained deceptive hopes. As for autonomy, hopes even..

: Within both popular and academic literature, concerns have been expressed about the implications of antidepressant use on character development. In this paper, I identify specific versions of these worries and argue that they are misguided. I begin by arguing that the obligation to suffer if it will bring about a noble character is imagined. Legitimate concerns about character enhancement remain, but they do not count against most antidepressant use. Thus there is no moral prohibition against antidepressant use. Furthermore, some (...) of the calls for caution about antidepressant use, such as those expressed by the President's Council on Bioethics, are overstated. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

An exploration of topics of everyday importance in the Socratic tradition.

Some puzzles about happiness -- Pt. I. Some things that happiness isn't. Sensory hedonism about happiness -- Kahneman's "objective happiness" -- Subjective local preferentism about happiness -- Whole life satisfaction concepts of happiness -- Pt. II. What happiness is. What is this thing called happiness? -- Attitudinal hedonism about happiness -- Eudaimonism -- The problem of inauthentic happiness -- Disgusting happiness -- Our authority over our own happiness -- Pt. III. Implications for the empirical study of happiness. Measuring happiness -- (...) Empirical research; philosophical conclusions -- The central points of the project as a whole. (shrink)

What does feeling a sharp pain in one's hand have in common with seeing a red apple on the table? Some say not much, apart from the fact that they are both conscious experiences. To see an object is to perceive an extramental reality -- in this case, a red apple. To feel a pain, by contrast, is to undergo a conscious experience that doesn't necessarily relate the subject to an objective reality. Perceptualists, however, dispute this. They say that both (...) experiences are forms of perception of an objective reality. Feeling a pain in one's hand, according to this view, is perceiving an objective condition of one's hand. Who is closer to truth? Because of such metaphysical issues, the subjectivity of pains combined with their clinical urgency raises methodological problems for pain scientists. How can a subjective phenomenon be studied objectively? What is the role of the first-person method in science? Some suggest that the subjectivity of pains is due to their metaphysical irreducibility to purely physical processes in the nervous system. Can this be true? The study of pain and its puzzles offers opportunities for understanding such larger issues as the place of consciousness in the natural order and the methodology of psychological research. In this book, leading philosophers and scientists offer a wide range of views on how to conceptualize and study pain. The essays include discussions of perceptual and representationalist accounts of pain; the affective-motivational dimension of pain; whether animals feel pain, and how this question can be investigated; how social pain relates to physical pain; whether first-person methods of gathering data can be integrated with standard third-person methods; and other methodological and theoretical issues in the science and philosophy of pain. (shrink)