Technology and responsibility: reflections on the new tasks of ethics.--Jewish and Christian elements in philosophy: their share in the emergence of the modern mind.--Seventeenth century and after: the meaning of the scientific and technological revolution.--Socio-economic knowledge and ignorance of goals.--Philosophical reflections on experimenting with human subjects.--Against the stream: comments on the definition and redefinition of death.--Biological engineering--a preview--Contemporary problems in ethics from a Jewish perspective.--Biological foundations of individuality.--Spinoza and the theory of organism.--Sight and thought: a review of "visual thinking."--Change and (...) permanence: on the possibility of understanding history.--The gnostic syndrome: typology of its thought, imagination, and mood.--The hymn of the pearl: case study of a symbol, and the claims for a Jewish origin of gnosticism.--Myth and mysticism: a study of objectification and interiorization in religious thought.--Origen's metaphysics of free will, fall, and salvation: a "divine comedy" of the universe.--The soul in gnosticism and Plotinus.--The abyss of the will: philosophical meditations on the seventh chapter of Paul's epistle to the Romans. (shrink)

The U.S. Supreme Court's majority opinion in Vacco v. Quill assumes that the principle of double effect explains the permissibility of hastening death in the context of ordinary palliative care and in extraordinary cases in which painkilling drugs have failed to relieve especially intractable suffering and terminal sedation has been adopted as a last resort. The traditional doctrine of double effect, understood as providing a prohibition on instrumental harming as opposed to incidental harming or harming asa side effect, must be (...) distinguished from other ways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care. (shrink)

Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying (...) ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia. (shrink)