Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a (...) significant bad effect (e.g., death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (shrink)

The conditions of transport and slaughter at the end of their lives are a major challenge to the welfare of agricultural animals. • End-of-life experiences should be of a greater ethical concern than others of similar intensity and duration, due to their position in the animal’s life. • End-of-life welfare can have both internal importance to the animals and external ethical importance to human decision-makers. • We should pay extra care to ensure that the conditions during (...) transport and slaughter are as positive as possible. (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)

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the (...) explanation of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis. (shrink)

This article examines the subtle interconnection between the sanctity of life and individual autonomy within the context of assisted dying, as seen through the lens of Orthodox Christianity. It seeks to unravel the complex theological, ethical, and pastoral considerations that inform the Orthodox stance on end-of-life issues, particularly the nuanced understanding of suffering, death, and the redemptive potential encapsulated within them. Orthodox theology, with its profound veneration for life as a divine gift, offers a counter-narrative to contemporary (...) discourses that often prioritize personal autonomy and the alleviation of suffering above all. This tradition emphasizes the transformative power of suffering when united with Christ’s own redemptive suffering, proposing a vision of end-of-life care that is rooted in compassion, dignity, and hope for resurrection. The exploration begins with a historical and theological examination of the Orthodox perspective on life’s sanctity, engaging with the teachings of Church Fathers and contemporary theological and bioethical discussions. It highlights the foundational concepts of Orthodox anthropology, which perceives human beings as an indivisible unity of body and soul, reflecting the imago Dei. This anthropological understanding challenges reductionist views of human existence and informs the Orthodox approach to medical ethics, palliative care, and the spiritual accompaniment of the dying. By critically evaluating arguments for and against assisted dying, the article presents a balanced discourse that respects the depth of individual suffering while upholding the intrinsic value of life. It argues that Orthodox Christianity, through its rich theological heritage and pastoral practice, provides a compassionate and ethically nuanced framework for navigating the moral complexities of assisted dying. This framework advocates for an end-of-life care that honors the fullness of the human person, supports the spiritual journey toward eternal life, and fosters a communal embrace of life’s sacred threshold, offering a dignified passage that aligns with the faith’s deepest convictions about human destiny and divine grace. (shrink)

End-of-life care has a number of characteristics that make economic evaluation particularly challenging. These include proximity to death, the improbability of survival gain, individuals’ changing priorities, declining cognition and effects on close persons. In view of these particularities of end-of-life care, some researchers have determined that current ‘extra-welfarist’ approaches to defining do not adequately reflect well-being. As a result, suggestions are being made that would see the QALY approach either replaced or subject to significant redefinition. The (...) purported goal of adopting alternative evaluation approaches is to extend the evaluative space ‘beyond’. The purpose of this chapter is to guide the definition of what should be included in the evaluative space in end-of-life care. (shrink)

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts (...) widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (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)

Thesis --University of Stellenbosch, 2004 Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health (...) class='Hi'>care professional. In addition to medical skills, the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. S Afr Med J 2008; 98: 284-286. (shrink)

The ending of the Phaedo is one of the most powerful and memorable moments in the entire Platonic corpus. It is not simply the end of a single dialogue, but a depiction of the end of the life of the man (Socrates) who is a looming presence in nearly everything that Plato wrote. In this article I offer an in-depth analysis of the final scene of the Phaedo. I argue that Plato very carefully constructs the scene for the sake (...) of specific philosophical, dramatic, and political ends. Plato uses it to unify the Phaedo as a singular text, while also provoking us to reflect on the nature of our lives, our deaths, and the possibilities and limits of philosophy itself. (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans feel reluctant (...) to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something like (...) the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (shrink)

Aristotle is the first philosopher on record to subject the meaning of life to systematic philosophical examination: he approaches the issue from logical, psychological, biological, and anthropological perspectives in some of the central passages in the Corpus Aristotelicum and, it turns out, in some fragments from his (lost) early popular work the Protrepticus (Exhortation to Philosophy). From an Aristotelian perspective, in asking about life’s “meaning”, we may be asking either a theoretical question about the definition of the term (...) life (and this either generically or with specific reference to human life), or a practical question about the final end or purpose of life (or human life). Aristotle carefully considered both questions, and in his view answering the theoretical question is the key to answering the practical question. In brief, his theoretical view is that humans are distinguished from all other living things, and thus defined by their ability to use reason; thus his practical view is that the end or purpose of human existence is intellectual activity, especially doing philosophy. (shrink)

This paper expands on another which focussed on Socrates’s question: ‘How should one live?’. The present paper also focusses on the ‘meaning of life’ and ‘meaning in life’ issues, and more on rights. To fully rationally answer Socrates’s question, we need to answer the epistemic question: ‘How can one know how one should live?’. This paper attempts to answer both. And knowing how one should live fundamentally involves knowing what values one should live by. This includes which rights (...) one should have and which rights others should have. So one’s values include how one should treat all persons (and (other) animals, the environment and so on.) All this relates to what one finds meaningful in life and the meaning or point of one’s life. In sum, all the notions in this paper’s title are interrelated. The issue of rationality is crucial here. Just one example here (qualified later) is that our rationality gives us cognitively meaningful notions. ‘Rationality’ here only concerns knowledge, e.g., ways to acquire scientific knowledge, and meta-knowledge concerning values. No values or rights as such are rational or knowledge. However:- Many factors are required for human rationality to exist and develop, e.g., life, mental health and evidence-based education. Human rationality’s need for those factors, hence their value to rationality, is rationally-unquestionable – and that applies to the practised values prescribing the prescribable factors. With this, there are rationally-unquestionable rights to those factors. Those prescribable factors require certain interrelated epistemic, moral, social, political, legal, educational and other values/rights to be practised. This implies a pro-rationality values-theory with one obligatory, general end – a uniquely rationally-unquestionable end. This end provides the basis for answering Socrates’s question as rationally (correctly) as is possible for values/rights. That end is fundamentally epistemic, namely ‘Be pro-rationality’, yet the theory has deeply-humanly-meaningful, universal applications. It has implications for current and all possible moral, social, political, legal, educational, environmental etc issues. E.g., the theory shows that human rationality crucially requires love and certain other emotions, health-care, education and upbringing. These require certain right to be respected and practised. With this, the paper discusses affection, free speech, journalism, psychotherapy, political and sexual consent, responsibilities, freedom and government. The theory’s general sub-values prescribe much prescribed by some other theories, e.g., broad and deep knowledge-acquisition (in certain areas), rationally-critical thinking, non-sexism, non-racism, general types of liberalism, holistic flourishing, happiness, unselfishness and fairness. However, all other values-theories lack pro-rationality theory’s maximum possible rational-unquestionability, internal coherence and coherence with rationality. The theory encourages (the right to) total freedom in a-rationality areas, areas irrelevant to its obligatory end. The theory inherently requires its advocates to be (self )critical, rationally viewing the theory’s necessarily human-suggested specifics as often fallible or unavoidably approximate. So the theory is a work-in-progress. (shrink)

In this commentary, I suggest expanding the deliberative aspects of critical care policy development in two ways. First, critical-care policy development should expand the scope of deliberation by leaving fewer issues up to expertise or private choice. For instance. it should allow deliberation about the relevance of age, disability, social position, and psychological well-being to allocation decisions. Second, it should broaden both the set of costs considered and the set of stakeholders represented in the deliberative process. In particular, (...) it should consider efforts to reduce the cost of end-of-life care and to redirect resources away from the provision of costly interventions, and should expand the set of individuals included in deliberation to include stakeholders outside the health-care system. (shrink)

The right to a dignified death is largely overlooked by Brazilian law. This neglect of the end-of-life process and its ramifications is the focus of this study, which aims at an exploratory survey to identify pertinent aspects requiring development to ensure a dignified end-of-life experience. In total, 50 publications were examined with online and physical surveys of works published up to March 2023. They express concerns regarding ethical dilemmas in caring for individuals nearing the end of life, (...) yet they do not delve into existing mechanisms for safeguarding end-of-life dignity or identify areas that still lack standardization to ensure effective care. This study should contribute to the enhancement of critical perspectives on the issue of end-of-life experiences, considering current safeguards, the legal boundaries set by the State, and potential future strides toward advancing studies aimed at the practical update of the Brazilian legal system. (shrink)

Patient autonomy has a critical role in making decisions in medical practice and it is accepted by international conventions on health care and various national medical codes. However, pertaining to terminally ill patients, this right becomes very problematic in regards to end of life decisions. Utilitarian ethicists motivated by materialistic worldview and individualism have made patient autonomy based arguments for the permissibility of active euthanasia. An appraisal of pro-euthanasia arguments that include the best interest, golden rule, and autonomy (...) is made in this paper. The best interest and golden rule arguments are based on subjective moral judgment thus failing the universalization test. The argument from autonomy is unconvincing because of the confounded autonomy of the terminally ill patients. (shrink)

Palliative care seeks to provide holistic care to improve the quality of life for the sick, especially as they approach the end of their lives. Addressing the spiritual dimension of the human person is useful because it provides answers to the meaning of life. Spiritual care has been shown to be of great benefit to patients. Therefore, this paper explores the importance of the spiritual dimension in palliative care; highlight the act of listening as (...) a key part of spiritual care, showing that physician burnout is the main obstacle to improving listening as an appropriate service that is both comforting and healing. -/- Los cuidados paliativos buscan ofrecer una atención holística para brindar una mejor calidad de vida a los enfermos, especialmente cuando se aproximan al fin de su existencia. Profundizar en la dimensión espiritual de la persona humana resulta útil puesto que ofrece respuestas al sentido de la vida. Se ha constatado que la atención espiritual aporta grandes beneficios para el paciente. Es por eso que en este trabajo hemos querido profundizar en la importancia de la dimensión espiritual en los cuidados paliativos; se destaca la actitud de la escucha como pieza clave de dicha atención espiritual, lo que evidencia que el burnout de los médicos es el principal obstáculo para potenciar la escucha como una adecuada disposición que resulte consoladora y sanadora. (shrink)

The intersection between virtue and care ethics is underexplored in contemporary moral philosophy. This thesis approaches care ethics from a neo-Aristotelian virtue ethical perspective, comparing the two frameworks and drawing on recent work on care to develop a theory thereof. It is split into seven substantive chapters serving three major argumentative purposes, namely the establishment of significant intertheoretical agreement, the compilation and analysis of extant and new distinctions between the two theories, and the synthesis of care (...) ethical insights with neo-Aristotelianism to generate a virtue ethical theory of care. In the first two chapters, I outline virtue ethics and care ethics, and argue for considerable agreement over central premises. Chapter 2 summarises the foundational commitments of care ethics, focusing particularly on their relational ontology and its links to the other ethical claims care ethicists universally ascribe to, namely particularism, partialism, the moral salience of emotions, and the rejection of hard public/private distinctions. Chapter 3 lays out the central concepts in neo-Aristotelian virtue ethics, including eudaimonism, virtue, and character traits, and drawing a number of comparisons between virtue and care ethics specifically with regard to relational ontology and the meta-ethical commitments it underpins. In addition to doing the necessary expository work for the remainder of the thesis, Chapters 2 and 3 also argue that care ethics and virtue ethics have much more in common than is typically acknowledged – the first major contribution of this thesis to the literature. Chapters 2 and 3 to provide at least a prima facie justification for pursuit of the questions I confront in the remainder of the thesis. In Chapter 4, I ask what differentiates these two ethical theories. I survey some of the differences which philosophers in either camp have identified and offer some of my own. I suggest that several of those differences either rest on misunderstandings of one ethic or the other, or that in erecting a divide between virtue and care ethics they also disunify ethics of care. I do, however, identify two differences which seem defensible. Specifically, they are that virtue ethics seems to lack an account of care, which I define minimally as a response or responsiveness to need, and that virtue and care ethics organise their meta-ethical and normative concepts differently. This chapter thus presents a second contribution to the literature: a study of the differences between virtue ethics and care ethics. It also serves to set the trajectory for the remaining chapters, where I respond to the claim that virtue ethics lack an account of care. I spend the remainder of the thesis constructing what I take to be a satisfying foundation for a virtue ethical theory of care. In Chapter 5, I offer three initially viable means of incorporating care into virtue ethics, all of which treat care as a virtue. These are the analogical approach, according to which care is analogous to an existing virtue; the additive approach, according to which care is a novel virtue; and the bundling approach, according to which care is a bundle of virtues. I also offer and evaluate reasons to reject the claim that care is a virtue, concluding that the claim is indeed a viable one so long as the concept of care is sufficiently thick, and I contend that analogical approaches, and particularly analogies with charity, outperform the others. Chapter 5 therefore serves two ends. First, it proffers a novel meta-analysis of concepts of care as a virtue, and thus makes a third contribution to the literature. In doing so, it makes an inroad into the second: the development of a neo-Aristotelian theory of care. Chapter 6 continues this project. I attempt to show how care can be construed as an act-type and a practice. I argue in this chapter that practices are a subcategory of actions, and that care qualifies as an Anscombean act-type which aims at the meeting of needs relating to the care-recipient’s flourishing. I go on to consider the implications of this account for ethics which deploy care as a moral concept, maintaining that it not only offers a better account of consequences than theories of care which include success criteria, but also that it affords us interesting insights into the distinction between ‘caring about’ and ‘caring for’ which allow us to make sense of certain tenets of neo-Aristotelianism. This represents a contribution to both discourses, since neither care nor virtue ethicists working at the intersection of their respective normative theories have delved very deeply into the philosophy of action. Chapter 7 discusses caring relations, suggesting that a virtue ethical theory of caring relations can lean on the work care ethicists have done, and adding some necessary refinements, such as a distinction between ideal and non-ideal caring relations, and a theory of caring relations as reasons for action. This final chapter also draws these three concepts of care together by arguing that virtuous caregivers who are invested in the flourishing of those for whom they care are also sensitive to the relations those care-recipients bear to their institutional environment. I argue that because they are caring participants in caring relations, virtuous agents are characteristically motivated by states of need and dependency to engage in certain sorts of conventionally political practices. In other words, the virtue or virtues of caring characteristically manifest in certain sorts of political or social practices, relating specifically to those areas of moral life. This allows us to build upon recent work in feminist virtue ethics of the sort offered by Tessman and Friedman. I also offer a novel analysis of migration, suggesting that the account of care presenting here is analytically useful both when it comes to historical cases of migration such as the underground railroads and escapes from Nazi-occupied Europe, but also for contemporary issues such as the migrations occurring in the Southern United States and in much of Europe. I thus conclude not only that virtue ethicists ought to incorporate care into their normative framework, and that the theory of care presented here is a coherent one, but that this leads us naturally into applied topics such as virtue politics. I conclude the thesis by considering some its implications and by identifying some further avenues for research. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life (...) care, bioethics, and health policy discuss if age should guide rationing decisions. (shrink)

Death is a state of the total disappearance of life. Dying is a process of decay of the vital system, which ends with clinical death. In current perspectives there are several approaches to research on death and dying; these are the clinical, the humanistic, the philosophical, the psychological, the anthropological, and the sociological perspective.

In modern hospitals in developed countries, deaths are determined usually after a prearranged schedule of resuscitative efforts. By default, death is diagnosed and determined after “full code” or after the failure of intensive resuscitation. In end-of-life contexts, however, various degrees of less-than-full resuscitation and sometimes no resuscitation are allowed after the consent and shared decision-making of the patient and/or surrogates. The determination of brain death is a unique exception in these contexts because such an end-of-life care plan (...) is usually not offered until after brain death is declared. This essay analyzes and critiques three arguments for denying the family and/or surrogate a chance to consent to or forego the diagnostic protocol of brain death and choose an alternative end-of-life plan. First, opponents of consent for the determination of brain death argue that presenting it as a selectable end-of-life plan undermines the integrity of death determination. The second argument is that it is inconsistent to allow foregoing the determination of brain death when the determination of circulatory death is non-negotiable. The third argument is that allowing the patient/surrogate to forego the determination of brain death would jeopardize the fair and appropriate utilization of intensive care resources and potentially reduce organ donor pools. After closer conceptual examinations of these three arguments, this essay concludes that these arguments are conceptually and morally problematic. It defends an alternative patient-centered end-of-life care plan based on consent and shared decision-making. (shrink)

This case study is a retrospection of my family’s experiences that highlight several ELE facets. Following a description, we attempt to explain some of these phenomena from the perspectives of science and other germane disciplines.

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

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)

This book is a compilation of the work published by the present authors in various scientific journals mainly focused on understanding how quantum physics could decipher the experiences observed and reported during near-death and end-of-life situations. The authors claim that various theories and models proposed herein (though not propounding to be a complete one) are just an attempt to understand few aspects associated with such experiences connected to the phenomenon of death. They investigate the possible role of the quantum (...) phenomenon in the occurrence of these events and call for a detailed scientific investigation to validate any hypotheses made. (shrink)

It seems obvious that phenomenally conscious experience is something of great value, and that this value maps onto a range of important ethical issues. For example, claims about the value of life for those in a permanent vegetative state, debates about treatment and study of disorders of consciousness, controversies about end-of-life care for those with advanced dementia, and arguments about the moral status of embryos, fetuses, and non-human animals arguably turn on the moral significance of various facts (...) about consciousness. However, though work has been done on the moral significance of elements of consciousness, such as pain and pleasure, little explicit attention has been devoted to the ethical significance of consciousness. In this book Joshua Shepherd presents a systematic account of the value present within conscious experience. This account emphasizes not only the nature of consciousness, but the importance of items within experience such as affect, valence, and the complex overall shape of particular valuable experiences. Shepherd also relates this account to difficult cases involving non-humans and those with disorders of consciousness, arguing that the value of consciousness influences and partially explains the degree of moral status a being possesses, without fully determining it. The upshot is a deeper understanding of both the moral importance of phenomenal consciousness and its relations to moral status. This book will be of great interest to philosophers and students of ethics, bioethics, philosophy of psychology, philosophy of mind and cognitive science. (shrink)

It is more than a platitude to admit that we are always dying. It is a recognition of the fundamental finitude that marks our existence as human persons. It says something essential about the human condition. We are all born. We all die. And the very living of life is, leaving aside for the moment religious considerations, oriented toward death. Phenomenologists make much of this observation, perhaps none more so than Martin Heidegger who argues that our being-toward-death permits the (...) ontological grasping of Da-sein as a whole. Indeed for him, the“existential and ontological concept of death” is “the own most nonrelational, certain, and, as such, indefinite and not to be bypassed possibility of Da-sein.” However, if one spends much time around those who are very close to death it can begin to sound disingenuous to talk about death as one’s own most possibility. It is easy to think these patients are dying—not me. Still, the phenomenologist might claim that, vis-à-vis our being-toward-death, the difference between me and the terminally ill patient is a matter of degree and not kind. But, is this so? One may be excused for thinking not. There appears to be an important difference in the kinds of possible experiences open to us. I may experience healing if I become ill; on the other hand, the very condition of the patient with a terminal illness is defined by the impossibility of her experiencing healing. The primary aim of this paper is to argue that the terminally ill patient can, in fact, experience healing at the end of her life and in the face of impending death. I will not argue that the possibility of experiencing healing at the end of life means leaving room for divine intervention, though neither do I intend to preclude such a possibility. Rather, I will argue that healing is something that we experience quite apart from what happens to our biological make-up. While healing is often correlated with a change in the state of our bodies, it need not be. (shrink)

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple reasonable (...) models” problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

In The Republic of the Living, Miguel Vatter argues that, at the end of the 1970s, Michel Foucault did not convert to but criticized neoliberalism from a republican point of view. Neoliberal governmentality allegedly represses the capacity of human collectives to democratically govern themselves. The potential for republican self- government would then constitute the basis for an affirmative variant of biopolitics. I argue that this creative reformulation of Foucault’s oeuvre does not work as an interpretation of Foucault nor as a (...) valid critique of neoliberalism. Using the influ- ence of Georges Canguilhem on Foucault, I propose to locate the potential for affirmative biopolitics not in the collective capacity for self-government, but in the fragility of living beings in their interaction with their milieu. Because life is con- stitutively dependent on infrastructural conditions to flourish, we need a biopolitics that establishes institutions which support the sustenance of life. (shrink)

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. (...) While hypocrisy is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)

Is the being in an irreversible persistent vegetative state as the result of a horrible accident numerically identical to the human person, Lindsay, who existed before the accident? Many proponents of Thomistic metaphysics have argued that Aquinas’s answer to this question must be “yes.” In particular, it seems that Aquinas’s commitment to both Aristotelian hylomorphism and the unity of substantial form (viz., that each body/soul composite possesses one and only one substantial form) entails the position that the human person remains (...) alive as long as biological life persists. I argue, however, that although Aquinas does possess a deeply integrated account of human nature and is indeed committed to the claim that the person, Lindsay, exists as long as Lindsay’s body lives, there is good reason to suppose that he also holds that the body in the PVS is not Lindsay’s body in anything more than an equivocal sense. (shrink)

Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious.

Desire comes in two kinds: attraction and aversion. But contemporary theories of desire have paid little attention to the distinction, and some philosophers doubt that it is psychologically real. I argue that one reason to think there is a difference between the attitudes, and to care about it, is that attractions and aversions contribute in radically different ways to our well-being. Attraction-motivated activity adds to the good life in a way that aversion-driven activity doesn’t. I argue further that (...) the value of attraction-motivated activity is irreducible to the prudential value of pleasure or desire-satisfaction. Rather it contributes in a distinctive way to the felt meaningfulness of life. In the end I offer a hypothesis: when we are attracted to something, we see it as (non-comparatively) good; and it is only when we pursue the apparent good that we see ourselves as engaged with value that makes our lives and the universe worth maintaining. -/- . (shrink)

Recent bioethical issues that have emerged in the field of medicine include, but are not limited to, eugenics (artificial insemination), palliative care (end of life care), euthanasia (medical resuscitation), abortion, and the development of enhanced human body parts. These bioethical issues have raised ethical questions related to the use of modern technology and how it may affect the future of society. These questions consider issues such as: what is the identity of future children? Have human beings become (...) a commodity exchanged by those who have the ability to own them? What is the meaning of justice in medical treatment? How can physicians and nurses perform humanitarian work? -/- Discussions of these questions should begin by determining their relationships with typical social and cultural values in society, such as life and death, marriage, family, fatherhood, motherhood, relatives, and next-of-kin. -/- This paper presents a review of the important Arabic literature that has been written on these bioethical issues to show the contributions of Arab scholars in this field. Arabic studies in bioethics can be classified into three types: original Arabic writings, translated studies, and congresses held in the Arab region. (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)

Erik Wielenberg recently invoked the parent-child analogy in an argument against Christian theism. The argument relies on the claim that a loving parent would never allow her child to feel abandoned in the midst of what feels like gratuitous suffering. In this paper, I offer three clear counterexamples to Wielenberg’s central premise. At the same time, a successful counterexample does not a robust theology of suffering make. To that end, and with a careful eye towards anti-theodical concerns, I defend the (...) need for a more proactive Christian philosophical examination of the role of suffering in a meaningful life. (shrink)

In states where Physician Assisted Dying (PAD) is legal, physicians occasionally receive requests for this form of end-of-life care. Here, I describe the ethically ambiguous sphere and why PAD falls into it. I argue that, given the ethical ambiguity of PAD, physicians should consider patient autonomy as the highest value in the four principles approach and act as informers and educators.

In lieu of an abstract, here is a brief excerpt of the content:“An Equivocal Couple Overwhelmed by Life”A Phenomenological Analysis of PregnancySara HeinämaaTwo conceptions of human generativity prevail in contemporary feminist philosophy. First, several contributors argue that the experience of pregnancy, when analyzed by phenomenological tools, undermines several distinctions that are central to Western philosophy, most importantly the subject-object distinction and the self-other and own-alien distinctions. This line of argument was already outlined by Iris Marion Young in her influential (...) essay “Pregnant Embodiment: Subjectivity and Alienation” (1984). The other dominant argument is related to the first one, and it states that organic birth is the event that establishes the first experiential separation between the self and the other. On this understanding, the mother-fetus relation would not involve any relations between two corporeal selves; all such relations would be postnatal. This notion has been defended, for example, by Christine Schües (1997; 2000) and Johanna Oksala (2003).1On the other hand, classical phenomenology is dominated by the idea that the rigorous first-person methodology that is essential to phenomenology dictates that the sense of birth must be studied primarily by reflection on the structures of our own recollection or memory. Consequently, the primary sense of human birth would be that of an unattainable limit. This is argued on the basis of the existential fact that we all are born but cannot recall our own birth, or else on the basis of the transcendental fact that the structure [End Page 31] of retention ties each living present to an earlier one and implies that the transcendental ego cannot be subject to generation.2 From this perspective, all analyses and reflections of the experiences of labor, gestation, and pregnancy would be secondary since the sense of birth that these experiences involve is the nativity of another human being and not the nativity of the reflecting self.This paper challenges both the feminist and the classical phenomenological approach. I maintain that careful phenomenological analyses of the experience of pregnancy undermine both notions. Such analyses show, on the one hand, that pregnancy does not imply a nondistinction or self-other fusion but on the contrary involves a specific self-other divide. At the same time, they demonstrate that the sense of birth is more complex than the classical recollection-paradigm suggests and that it includes more components than the signification of an unattainable limit. A proper phenomenology of birth must take into account not only the universal fact that we all are born, but also the equally universal fact that each of us is born from another human being, that is, some other human subject.3 This other human being who “gave” us birth or “from whose flesh we were born” provides us with a unique perspective on our own past, beyond the limits of our own recollection. Her perspective is incomparable to any other external perspective; rather than simply giving us an additional third-person viewpoint on our own organic birth, this one person is able to open a second-person perspective on our pre- and postnatal life and the transition between them—all of which is beyond our own recollection.My argument proceeds by the following steps:First, I develop a fresh discourse on the experience of pregnancy, by studying a set of remarks to be found in Julia Kristeva’s postphenomenological discourse on maternity, on the one hand, and in Simone de Beauvoir’s existential-phenomenological discourse on feminine embodiment, on the other hand. I use these remarks as leading clues for a novel phenomenological study of the experience of pregnancy.4 Contra Young’s influential account mentioned above, I argue that gestation, as experienced by women who live it in the first person, includes a separation between two sensory-motor beings in a nesting relation: the pregnant self and the embryonic other. The alternative account that I provide hinges on my analysis of the experience of fetal movements and the role of touch-sensations and kinesthetic sensations in such experiences. Ultimately, I argue that pregnancy does not erode the self-other boundary or the own-alien boundary but reestablishes both divisions.Second, I compare my account of the experience of pregnancy to Merleau... (shrink)

Intellectual history still quite commonly distinguishes between the episode we know as the Scientific Revolution, and its successor era, the Enlightenment, in terms of the calculatory and quantifying zeal of the former—the age of mechanics—and the rather scientifically lackadaisical mood of the latter, more concerned with freedom, public space and aesthetics. It is possible to challenge this distinction in a variety of ways, but the approach I examine here, in which the focus on an emerging scientific field or cluster of (...) disciplines—the ‘life sciences’, particularly natural history, medicine, and physiology —is, not Romantically anti-scientific, but resolutely anti-mathematical. Diderot bluntly states, in his Thoughts on the interpretation of nature, that “We are on the verge of a great revolution in the sciences. Given the taste people seem to have for morals, belles-lettres, the history of nature and experimental physics, I dare say that before a hundred years, there will not be more than three great geometricians remaining in Europe. The science will stop short where the Bernoullis, the Eulers, the Maupertuis, the Clairauts, the Fontaines and the D’Alemberts will have left it.... We will not go beyond.” Similarly, Buffon in the first discourse of his Histoire naturelle speaks of the “over-reliance on mathematical sciences,” given that mathematical truths are merely “definitional” and “demonstrative,” and thereby “abstract, intellectual and arbitrary.” Earlier in the Thoughts, Diderot judges “the thing of the mathematician” to have “as little existence in nature as that of the gambler.” Significantly, this attitude—taken by great scientists who also translated Newton or wrote careful papers on probability theory, as well as by others such as Mandeville—participates in the effort to conceptualize what we might call a new ontology for the emerging life sciences, very different from both the ‘iatromechanism’ and the ‘animism’ of earlier generations, which either failed to account for specifically living, goal-directed features of organisms, or accounted for them in supernaturalistic terms by appealing to an ‘anima’ as explanatory principle. Anti-mathematicism here is then a key component of a naturalistic, open-ended project to give a successful reductionist model of explanation in ‘natural history’, a model which is no more vitalist than it is materialist—but which is fairly far removed from early modern mechanism. (shrink)

This article attempts to explain the value that we assign to the presence of friends at the time when life is ending. It first shows that Aristotle’s treatment of friendship does not provide a clear account of such value. It then uses J. L. Austin’s notion of performativity to supplement one recent theory of friendship – given by Dean Cocking and Jeanette Kennett – in such a way that that theory can then account for friendship’s special value at our (...) time of death. (shrink)

Alongside a revival of interest in Thomism in philosophy, scholars have realised its relevance when addressing certain contemporary issues in bioethics. This book offers a rigorous interpretation of Aquinas's metaphysics and ethical thought, and highlights its significance to questions in bioethics. Jason T. Eberl applies Aquinas’s views on the seminal topics of human nature and morality to key questions in bioethics at the margins of human life – questions which are currently contested in the academia, politics and the media (...) such as: When does a human person’s life begin? How should we define and clinically determine a person’s death? Is abortion ever morally permissible? How should we resolve the conflict between the potential benefits of embryonic stem cell research and the lives of human embryos? Does cloning involve a misuse of human ingenuity and technology? What forms of treatment are appropriate for irreversibly comatose patients? How should we care for patients who experience unbearable suffering as they approach the end of life? _Thomistic Principles and Bioethics_ presents a significant philosophical viewpoint which will motivate further dialogue amongst religious and secular arenas of inquiry concerning such complex issues of both individual and public concern. (shrink)

Questions are currently being posed concerning the implications of the clinical uptake of psychedelics. While enthusiasm surrounds the potential therapeutic benefits of psychedelics and critique surrounds their appropriation to commercial ends, limited attention has been given to the role of psychedelics in generating social transformation. Herbert Marcuse contended radical change requires ‘new imaginaries of liberation’. We consider whether clinical uptake of psychedelics may produce the perceptual shifts necessary to generate social transformation surrounding contemporary alienating conditions. Economic structures contributing to these (...) alienating conditions are highly resistant to change and may neuter psychedelics’ revolutionary potential. We illustrate how psychedelics may be instrumentalised: regulating individuals into unjust systems; redirecting psychedelic usage away from therapeutic ends towards productivity; distracting or diverting attention from systemic forms of control; usurping non- ordinary states into the domain of self-care; and fetishistically commodifying psychedelic experience as a consumable. There are, however, reasons to believe that psychedelics, in raising consciousnesses, may prove resistant to co-option. In particular, psychedelics induce perceptual experiences that: challenge the paradigmatic assumptions of industrial society by provoking alternative epistemologies and meta- physics; generate expanded or ecological constructions of selfhood, thereby offering resignifications of meanings, desires, and life potentials; and offer the enriched phenomenological insight into self, other, and world called for in combating ubiquitous social alienation. In this way, psychedelics may induce the revolution in perception necessary to imagine liberatory potentials and spark the desire for collective emancipation. (shrink)

We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will either (...) be neglected altogether or deeply discounted in the surrogate’s incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon. (shrink)

The advance of scientific approaches to life has recorded a plethora of successes as well as failures. Man being at the center of its experiment is tossed toe and fro by the result of its inquiry. Predictions are that in the nearest time, humanity might be living absolutely under the directives of Technology based on Artificial intelligence. At present, Technology based on Artificial Intelligence is quickly finding its way into various areas of life including health and social services. (...) This spread and or interplay connotes the relinquishing of health responsibilities from man to sensor technology as well as dependency on the data and result of this technology. This effort questions this unethical dependency as well as raises moral issues associated with the use of Technology base on artificial intelligence on psychiatric patient. It dabbles into medical values such as; autonomy of the patient cum consent, Kantian universal principle and its implication to implementing the universal usage of technology in mental health care services, and so on. The work of Patricia A. Arean (2016) titled Mobile Technology for Mental Health Assessment gave an in-depth analysis of the available approaches, doting advantages of sensor technology on psychiatric patient. The paper applied the analytic, descriptive and prescriptive method of philosophy to achieve its objective. To this end, it is in the view of this work imperative for the mental-medical community to consider reflectively these issues and the philosophic recommendations provided herein. (shrink)

An important lesson that philosophy can learn from the Turing Test and computer science more generally concerns the careful use of the method of Levels of Abstraction (LoA). In this paper, the method is first briefly summarised. The constituents of the method are “observables”, collected together and moderated by predicates restraining their “behaviour”. The resulting collection of sets of observables is called a “gradient of abstractions” and it formalises the minimum consistency conditions that the chosen abstractions must satisfy. Two useful (...) kinds of gradient of abstraction – disjoint and nested – are identified. It is then argued that in any discrete (as distinct from analogue) domain of discourse, a complex phenomenon may be explicated in terms of simple approximations organised together in a gradient of abstractions. Thus, the method replaces, for discrete disciplines, the differential and integral calculus, which form the basis for understanding the complex analogue phenomena of science and engineering. The result formalises an approach that is rather common in computer science but has hitherto found little application in philosophy. So the philosophical value of the method is demonstrated by showing how making the LoA of discourse explicit can be fruitful for phenomenological and conceptual analysis. To this end, the method is applied to the Turing Test, the concept of agenthood, the definition of emergence, the notion of artificial life, quantum observation and decidable observation. It is hoped that this treatment will promote the use of the method in certain areas of the humanities and especially in philosophy. (shrink)

When many people think of bioethics, they think of gripping issues in clinical medicine such as end-of-life decision-making, controversies in biomedical research such as that over work with stem cells, or issues in allocating scarce health-care resources such as organs or money. The term “bioethics” may evoke images of moral controversies being discussed on news programs and talk shows. But this “controversy of the day” focus often treats ethical issues in medicine superficially, for it addresses them as if (...) they could be examined and discussed in isolation from the context in which they are situated. Such a focus on the latest controversies fails to take into account that medicine is a social institution and that the controversies in bioethics often reflect deeper social and moral issues that transcend the boundaries of medicine and ethics. If one moves beyond the issue-of-the-day approach to bioethics, one can see that the field must address these deeper issues. (shrink)

Spengler’s work is typically represented as speculative philosophy of history. However, I argue that there is good reason to consider much of his thought as preoccupied with existential and phenomenological questions about the nature and ends of human existence, rather than with history per se. In this paper I consider Spengler’s work in comparison with Heidegger’s history of Being and analysis of technological modernity. I argue that Spengler’s considerable proximity to much of Heidegger’s thought compels us to reconsider the nature (...) and scope of Spengler’s philosophical project. (shrink)