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)

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)

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.

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 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 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)

Objectives—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 effectDesign, subjects and setting–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”.Results–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.Conclusions—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)

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)

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)

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)

Presupposing that our consideration of ethical issues can be enriched by examining literary works, this paper focuses on Marsha Norman's play ‘night, Mother. The play describes the last hour and a half in the life of Jessie, a young woman who decides to die by suicide. Before ending her life, Jessie explains to her mother her reasons for her suicide. In the context of the play, these are presented as quite weighty and as, perhaps, justifying her decision. Scholarly (...) research on the play has also treated Jessie's suicide favorably. In this paper I argue that Jessie, and people in similar conditions, are wrong to die by suicide. Among other points, I criticize Jessie's arguments from the impossibility to improve life; the assured termination of suffering; the badness of the world; and the right for suicide. I also criticize arguments in the scholarly literature that view Jessie's suicide favorably, such as the arguments from independence, heroism, authenticity, and emotional closeness. (shrink)

In this bioethical poem, the narrator reflects on the experience of their father's degenerative illness, and decisions that must be made about whether to continue life support technologies such as ventilation and nutrition/hydration. What is it that is owed to family and patient at the end of life? What must no one who loves anyone ever do to the one they love?

In Almost Over: Aging, Dying, Dead, Frances Kamm seeks to make sense of people’s widely variant choices about which lives they would choose to continue living. She does this by defending the Prudential Prerogative, which, in analogy to the Moral Prerogative, holds that in a fairly wide range of conditions we are under no intrapersonal rational obligation to choose either to die or to live on. I argue against Kamm's case for the Prudential Prerogative in favor of Life Holism, (...) the view that you ought to live the life that would be best for you as an individual when each potential life is considered as a whole. I argue that the features of the Moral Prerogative that make it an attractive principle do not transfer to the Prudential Prerogative, and that Life Holism can better account for the perspectival and non-summative features of the normative phenomena Kamm wants to capture while retaining a tight connection between reasons and goodness. (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 Humanity’s End: Why We Should Reject Radical Enhancement, Nicholas Agar presents a novel argument against the prospect of radical life-extension. Agar’s argument hinges on the claim that extended lifespans will result in people’s lives being dominated by the fear of death. Here we examine this claim and the surrounding issues in Agar’s discussion. We argue, firstly, that Agar’s view rests on empirically dubious assumptions about human rationality and attitudes to risk, and secondly, that even if those assumptions are (...) granted, the fears that Agar adverts to are unlikely to dominate people’s lives if and when radical life-extension is made possible. Further, we claim that the structure of the decision-making process around life-extension is unlikely to be the way that it would have to be in order for Agar’s claims about fear of death to make sense. Finally, we argue that Agar is implicitly committed to a narrow conception of human value. In response, we suggest that the pursuit of life-extension can itself be seen as an expression of certain important aspects of our distinctively human nature. (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)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive (...) analysis and chi2-tests for dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (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)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should be (...) respected. (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.

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)

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)

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 Netherlands was the first country to legalize euthanasia and physician-assisted suicide. This paper offers a first legal perspective on the prospects of using AI in the Dutch practice of euthanasia and physician-assisted suicide. It responds to the Regional Euthanasia Review Committees’ interest in exploring technological solutions to improve current procedures. The specific characteristics of AI – the capability to process enormous amounts of data in a short amount of time and generate new insights in individual cases – may for (...) example alleviate the increased workload of review committees due to the continuous increase of euthanasia cases. The paper considers three broad categories for the use of AI in the Dutch euthanasia practice: (1) the physician’s assessment of euthanasia requests, (2) the actual execution of euthanasia, and (3) the retrospective reviews of cases by the Regional Euthanasia Review Committees. Exploring the legal considerations around each avenue, both in the EU AI Act and the Dutch legal framework, this paper aims to facilitate the societal discussion on the role of technology in such deeply human decisions. This debate is equally relevant to other countries that legalized euthanasia (e.g. Belgium and Canada) or physician-assisted suicide (e.g. Switzerland and numerous states in the US). (shrink)

What question are decision theorists trying to answer, and why is it worth trying to answer it? A lot of philosophers talk as if the aim of decision theory is to describe how we should make decisions, and the reason to do this is to help us make better decisions. I disagree on both fronts. The aim of the decision theory is to describe how a certain kind of idealised decider does in fact decide. And the reason to (...) do this is that this idealisation, like many other idealisations, helps generate explanations of real-world behaviour. We shouldn't do what these ideal deciders do, or try to be more like them, because a lot of what they do only makes sense because of the differences between us and them. Still, sometimes those differences are small enough that they can be ignored in explanations, and that's when decision theory is useful. (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)

Entry on "Authenticity" for the fourth edition of the Encyclopedia of Bioethics, edited by Bruce Jennings. Discusses the concept in the context of end-of-life decision-making, human enhancement, and the treatment of mental disorder.

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)

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)

Although expected utility theory has proven a fruitful and elegant theory in the finite realm, attempts to generalize it to infinite values have resulted in many paradoxes. In this paper, we argue that the use of John Conway's surreal numbers shall provide a firm mathematical foundation for transfinite decision theory. To that end, we prove a surreal representation theorem and show that our surreal decision theory respects dominance reasoning even in the case of infinite values. We then bring our theory (...) to bear on one of the more venerable decision problems in the literature: Pascal's Wager. Analyzing the wager showcases our theory's virtues and advantages. To that end, we analyze two objections against the wager: Mixed Strategies and Many Gods. After formulating the two objections in the framework of surreal utilities and probabilities, our theory correctly predicts that (1) the pure Pascalian strategy beats all mixed strategies, and (2) what one should do in a Pascalian decision problem depends on what one's credence function is like. Our analysis therefore suggests that although Pascal's Wager is mathematically coherent, it does not deliver what it purports to, a rationally compelling argument that people should lead a religious life regardless of how confident they are in theism and its alternatives. (shrink)

Artificial intelligence and robotics is pervasive in daily life and set to expand to new levels potentially replacing human decision-making and action. Self-driving cars, home and healthcare robots, and autonomous weapons are some examples. A distinction appears to be emerging between potentially benevolent civilian uses of the technology (eg unmanned aerial vehicles delivering medicines), and potentially malevolent military uses (eg lethal autonomous weapons killing human com- batants). Machine-mediated human interaction challenges the philosophical basis of human existence and ethical conduct. (...) Aside from technical challenges of ensuring ethical conduct in artificial intelligence and robotics, there are moral questions about the desirability of replacing human functions and the human mind with such technology. How will artificial intelligence and robotics engage in moral reasoning in order to act ethically? Is there a need for a new set of moral rules? What happens to human interaction when it is mediated by technology? Should such technology be used to end human life? Who bears responsibility for wrongdoing or harmful conduct by artificial intelligence and robotics? -/- Whilst Kant may be familiar to international lawyers for setting restraints on the use of force and rules for perpetual peace, his foundational work on ethics provides an inclusive moral philosophy for assessing ethical conduct of individuals and states and, thus, is relevant to discussions on the use and development of artificial intelligence and robotics. His philosophy is inclusive because it incorporates justifications for morals and legitimate responses to immoral conduct, and applies to all human agents irrespective of whether they are wrongdoers, unlawful combatants, or unjust enemies. Humans are at the centre of rational thinking, action, and norm-creation so that the rationale for restraints on methods and means of warfare, for example, is based on preserving human dignity as well as ensuring conditions for perpetual peace among states. Unlike utilitarian arguments which favour use of autonomous weapons on the basis of cost-benefit reasoning or the potential to save lives, Kantian ethics establish non-consequentialist and deontological rules which are good in themselves to follow and not dependent on expediency or achieving a greater public good. -/- Kantian ethics make two distinct contributions to the debate. First, they provide a human-centric ethical framework whereby human exist- ence and capacity are at the centre of a norm-creating moral philosophy guiding our understanding of moral conduct. Second, the ultimate aim of Kantian ethics is practical philosophy that is relevant and applicable to achieving moral conduct. -/- I will seek to address the moral questions outlined above by exploring how core elements of Kantian ethics relate to use of artificial intelli- gence and robotics in the civilian and military spheres. Section 2 sets out and examines core elements of Kantian ethics: the categorical imperative; autonomy of the will; rational beings and rational thinking capacity; and human dignity and humanity as an end in itself. Sections 3-7 consider how these core elements apply to artificial intelligence and robotics with discussion of fully autonomous and human-machine rule-generating approaches; types of moral reasoning; the difference be- tween ‘human will’ and ‘machine will’; and respecting human dignity. (shrink)

Can interests survive dementia, permanent unconsciousness--even death? If not, what kills them off? Perhaps lack of attention (one could almost say "lack of interest"), if having the interest requires believing that you have it, caring about its object, and in some sense investing in that object. Thus, once you no longer care about the object, the investment--and the interest--is gone. If an interest disappears when you stop caring about its object, will it disappear when you are mentally incompetent and unable (...) to care about it? If so, then it seems such interests cannot survive the onset of incompetence (let alone death). -/- This issue arises with living wills and other ways to decide the medical care you will receive when you become mentally incapacitated and unable to decide for yourself. Such decisions are made to protect certain kinds of interest. For example, you may want to avoid expensive end-of-life care in order to protect your family's inheritance, thereby protecting your interest in your family's welfare. Or you might have a religious commitment to the sanctity of life, and therefore an interest in keeping your biological life going as long as possible, even when you are permanently unconscious. We use living wills and similar forms of advance medical decision making to protect our such interests when we anticipate being unable to protect those interests by acting autonomously at the time of treatment. If, however, those interests do not survive incompetence, then the moral authority of living wills is severely undermined, for the interests they are meant to protect do not exist. It will be argued that some interests can survive a permanent loss of mental capacity, for sometimes, as strange as it sounds, you can be disposed to care about a thing even when you will never be conscious again. (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)

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)

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)

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)

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)

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)

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)

This thesis examines the key moral principles that should govern decision-making by police and military when using lethal force. To this end, it provides an ethical analysis of the following question: Under what circumstances, if any, is it morally justified for the agents of state-sanctioned security institutions to use lethal force, in particular the police and the military? Recent literature in this area suggests that modern conflicts involve new and unique features that render conventional ways of thinking about the ethics (...) of armed conflict, and the use of lethal force, as inadequate or redundant. In particular, there is an increased concern with the moral difficulties created by “non-standard” cases. This is where the police or military are obliged to operate outside their conventional contexts. In such non-standard cases, on what moral basis can (or should) state actors – especially the police and military – use lethal force? One approach argues that there is nothing morally exceptional about the use of lethal force by police or military. This says the only available moral justification for using lethal force is killing in self-defence or defence of others. In contrast, I use an institutional approach to develop a moral framework for the state’s morally exceptional use of lethal force. The institutional approach is concerned with the ends (telos) or purpose of a social institution. It says that the moral purpose of a social institution alters the moral responsibilities of its agents; what is referred to as role morality. My analysis demonstrates that there is an important moral distinction between justified killing in self-defence and state-sanctioned uses of lethal force. My claim is that police and military uses of lethal force are not morally justified in the same way as the average person’s use of lethal force (i.e. self-defence or defence of others). Instead, I argue that the state-sanctioned institutional role of police and military give these state actors special moral duties, and therefore exceptional moral justification, for using lethal force. I argue that the institutional end of the police is the preservation of public safety. This includes using lethal force where it is necessary to protect life and prevent serious injury to jurisdictional inhabitants. In contrast, a morally responsible state uses military force to defend the “common good.” That is, when it is necessary to defend the peaceful functioning of a state from armed threats or other forms of political violence. I then conclude that non-standard cases require the addition of jus ad vim (or the just use of military force short-of-war) as a hybrid element to the moral framework for the state-sanctioned use of lethal force. This provides a better way of applying ethics to the use of military force when defending the common good against serious threats in non-standard cases. This is because jus ad vim complements the conventional military paradigm by permitting the use of military capabilities to defend the common good. But, at the same time, it inhibits the move towards the more destructive levels of violence characteristic of conventional warfighting. (shrink)

Criminal courts make decisions that can remove the liberty and even life of those accused. Civil trials can cause the bankruptcy of companies employing thousands of people, asylum seekers being deported, or children being placed into state care. Selecting the right standards when deciding legal cases is of utmost importance in giving those affected a fair deal. This Element is an introduction to the philosophy of legal proof. It is organised around five questions. First, it introduces the standards (...) of proof and considers what justifies them. Second, it discusses whether we should use different standards in different cases. Third, it asks whether trials should end only in binary outcomes (e.g. guilty or not guilty) or rather use more fine-grained or precise verdicts. Fourth, it considers whether proof is simply about probability, concentrating on the famous 'Proof Paradox'. Finally, it examines who should be trusted with deciding trials, focusing on the jury system. (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)

Major Research Paper Abstract -/- A Part of This World: Deleuze & The Logic Of Creation. -/- Is there a particular danger in following Deleuze’s philosophy to its end result? According to Peter Hallward and Alain Badiou, Deleuze’s philosophy has some rather severe conclusions. Deleuze has been known as a vitalist thinker of life and affirmation. Hallward & Badiou seek to challenge the accepted view of Deleuze; showing that these accepted norms in Deleuzian scholarship should be challenged; and that (...) initially Deleuze calls for the evacuation of political action in order to remain firm in the realm of pure contemplation. I intend to investigate and defend Deleuze’s philosophy and against critics like Badiou and Hallward; and that not only is Deleuze’s philosophy creative and vital but also highly revolutionary and ‘a part of this world.’ I will look at several works in Deleuze’s corpus, as well as look at Deleuzian scholars whom defend Deleuze’s position -/- Hallward sees Deleuze as a theophantic thinker of the one and like Spinoza an individual mode must align oneself with the intellectual love of god, so that creativity and expressivity may mediate through them. Thus, according to Hallward the major theme of Deleuze’s philosophy is creativity; and a subject or a creature must tap into this vital spark of creation, which, is also a form of creatural confinement. Hallward states this creative act can only occur in the realm of the virtual, by lines of flight leading 'out of this world'. The subject is then re-introduced to an extra-worldly existence of contemplation and remains further away from decisions and lived experience. Deleuze, according to Hallward, falls prey to a cosmological pantheism. -/- Badiou has similar concerns. Deleuze’s philosophy is too systematic and abstract. The entirety of Deleuzes’ work is surrounded by metaphysics of the one; and essentially its repercussions lead to an overt asceticism. Badiou notes that Deleuze wants us all to surrender thought to a renewed concept of the one. Through the surrender of the one, the multiple is lost and incorporated into the realm of simulacra. Everything in this Deleuzian world is ‘always-already’ in the infinite and inhuman totality of the one. According to Badiou, this entire process is articulated in the power of inorganic life that operates through all of us. Like Hallward, Badiou sees Deleuze demolishing the subject, who is stuck between machinery and exteriority. Subjects are forced to transcend and go beyond their limits, slowly collapsing into an infinite virtuality. Badiou believes this is a powerful metaphor for a philosophy of death. Thus the conditions of Deleuzian thought are contingent upon asceticism, making a Deleuzian world a sort of ‘crowned anarchy’. Badiou sees Deleuze’s ascetic mission intimately linked with a philosophy of death, and like Hallward we should pay careful attention to the outcome of such an aristocratic philosophy. Death according to Badiou, symbolizes Deleuzian thought, not only making it dangerous, but also actualizing it as an ineffective position. Badiou also points out that Deleuze’s conceptual sources are not only limited but also repeated time and time again through a monotonous selection of concepts. Is this a fair critique and representation of Deleuzian thought? -/- Eugene Holland states, that both Hallward and Badiou have misrepresented Deleuze. Deleuze does invoke the creation of a new earth but one which we all fully believe in. The only world Deleuze wants to get out of is the world of habits, conformity, power; and forces that block creative being. According to Holland, Hallward presents us a Deleuze that inhibits an engagement with the world. However Deleuze’s creative enterprise is insistent on forming concepts that can change and transform our world. -/- So the question arises where does the problem of misrepresentation begin? It begins with both Badiou and Hallward having an erroneous account of the actual/virtual distinction in Deleuze’s Philosophy. According to Protevi, Hallward posits a dualism between the actual and the virtual, denying the role of the intensive. Hallward initially sees the relationship between the intensive and the virtual, ignoring the fact that the intensive has its own ontological register that mediates both the virtual and the actual. However, Protevi notes if one could not accept the intensive for an ontological register and had to place it with one or the other; you would have to accept an interrelationship between the actual and the intensive. Hallward places it in the realm of the virtual, thus, leading us to his major claim that Deleuze’s philosophy leads us out of the world. Protevi states, intensive processes happen in our world they are a part of this world. Hallward completely empties all creativity from the actual, thus depending on the virtual and its slippery slope. Both Hallward and Badiou have missed the point altogether. We live in an intensive/actual world and the main point about Deleuze’s politics has to do with experimentation and social interaction and the transformation and intervention of the concept. As Daniel W. Smith states, unlike Badiou, Deleuze is not searching for an axiomatic approach to the world, one that is prone to reductionism but rather with problematic, inventive and creative methods to transform a society. (shrink)

-/- Did the US president who signed the order to use the atomic bomb stain his hands with blood or just ink? Are there cases in which a war is just? In such cases, is any war justifiable? Is ending the life of a terminally ill person different from murder? Do we need to agree on the definition of the embryo as a 'person' to know whether any action on the embryo is prohibited? Is the prohibition of contraception justified (...) even if it is perfectly legitimate to plan births? Anscombe, taking up Wittgenstein, Aristotle and Thomas Aquinas, elaborates a theory of action that places "intention" at the centre, an alternative to the conception of action dominant since Descartes. On this basis, he conducts an indictment against the superficiality of modern moral philosophy, lumping together the Oxford philosophers, utilitarianism and Kantian ethics. And finally, she puts her virtue ethics to work on problems of applied ethics: in the field of public ethics, the just war; in the field of bioethics, questions of the end of life and the beginning of life. This book, edited by Sergio Cremaschi, brings together Anscombe's contributions on ethical issues, allowing for the first time a comprehensive overview of this decisive figure's contribution to twentieth-century philosophy. (shrink)

This collection of articles was written over the last 10 years and the most important and longest within the last year. Also I have edited them to bring them up to date (2016). The copyright page has the date of this first edition and new editions will be noted there as I edit old articles or add new ones. All the articles are about human behavior (as are all articles by anyone about anything), and so about the limitations of having (...) a recent monkey ancestry (8 million years or much less depending on viewpoint) and manifest words and deeds within the framework of our innate psychology as presented in the table of intentionality. As famous evolutionist Richard Leakey says, it is critical to keep in mind not that we evolved from apes, but that in every important way, we are apes. If everyone was given a real understanding of this (i.e., human ecology and psychology) in school, maybe civilization would have a chance. -/- In my view these articles and reviews have many novel and highly useful elements, in that they use my own version of the recently (ca. 1980’s) developed dual systems view of our brain and behavior to lay out a logical system of rationality (personality, psychology, mind, language, behavior, thought, reasoning, reality etc.) that is sorely lacking in the behavioral sciences (psychology, philosophy, literature, politics, anthropology, history, economics, sociology etc.). The philosophy centers around the two writers I have found the most important, Ludwig Wittgenstein and John Searle, whose ideas I combine and extend within the dual system (two systems of thought) framework that has proven so useful in recent thinking and reasoning research. As I note, there is in my view essentially complete overlap between philosophy, in the strict sense of the enduring questions that concern the academic discipline, and the descriptive psychology of higher order thought (behavior). Once one has grasped Wittgenstein’s insight that there is only the issue of how the language game is to be played, one determines the Conditions of Satisfaction (what makes a statement true or satisfied etc.) and that is the end of the discussion. -/- Now that I think I understand how the games work I have mostly lost interest in philosophy, which of course is how Wittgenstein said it should be. But since they are the result of our innate psychology, or as Wittgenstein put, it due to the lack of perspicuity of language, the problems run throughout all human discourse, so there is endless need for philosophical analysis, not only in the ‘human sciences’ of philosophy, sociology, anthropology, political science, psychology, history, literature, religion, etc., but in the ‘hard sciences’ of physics, mathematics, and biology. It is universal to mix the language game questions with the real scientific ones as to what the empirical facts are. Scientism is ever present and the master has laid it before us long ago, i.e., Wittgenstein (hereafter W) beginning principally with the Blue and Brown Books in the early 1930’s. -/- "Philosophers constantly see the method of science before their eyes and are irresistibly tempted to ask and answer questions in the way science does. This tendency is the real source of metaphysics and leads the philosopher into complete darkness." (BBB p18) -/- Nevertheless, a real understanding of Wittgenstein’s work, and hence of how our psychology functions, is only beginning to spread in the second decade of the 21st century, due especially to P.M.S. Hacker (hereafter H) and Daniele Moyal-Sharrock (hereafter DMS),but also to many others, some of the more prominent of whom I mention in the articles. -/- When I read ‘On Certainty’ a few years ago I characterized it in an Amazon review as the Foundation Stone of Philosophy and Psychology and the most basic document for understanding behavior, and about the same time DMS was writing articles noting that it had solved the millennia old epistemological problem of how we can know anything for certain. I realized that W was the first one to grasp what is now characterized as the two systems or dual systems of thought, and I generated a dual systems (S1 and S2) terminology which I found to be very powerful in describing behavior. I took the small table that John Searle (hereafter S) had been using, expanded it greatly, and found later that it integrated perfectly with the framework being used by various current workers in thinking and reasoning research. -/- Since they were published individually, I have tried to make the book reviews and articles stand by themselves, insofar as possible, and this accounts for the repetition of various sections, notably the table and its explanation. I start with a short article that presents the table of intentionality and briefly describes its terminology and background. Next, is by far the longest article, which attempts a survey of the work of W and S as it relates to the table and so to an understanding or description (not explanation as W insisted) of behavior. -/- The key to everything about us is biology, and it is obliviousness to it that leads millions of smart educated people like Obama, Chomsky, Clinton and the Pope to espouse suicidal utopian ideals that inexorably lead straight to Hell On Earth. As W noted, it is what is always before our eyes that is the hardest to see. We live in the world of conscious deliberative linguistic System 2, but it is unconscious, automatic reflexive System 1 that rules. This is Searle’s The Phenomenological Illusion (TPI), Pinker’s Blank Slate and Tooby and Cosmides Standard Social Science Model. Democracy and equality are wonderful ideals, but without strict controls, selfishness and stupidity gain the upper hand and soon destroy any nation and any world that adopts them. The monkey mind steeply discounts the future, and so we sell our children’s heritage for temporary comforts. -/- The astute may wonder why we cannot see System 1 at work, but it is clearly counterproductive for an animal to be thinking about or second guessing every action, and in any case there is no time for the slow, massively integrated System 2 to be involved in the constant stream of split second ‘decisions’ we must make. As W noted, our ‘thoughts’ (T1 or the thoughts of System 1) must lead directly to actions. It is my contention that the table of intentionality (rationality, mind, thought, language, personality etc.) that features prominently here describes more or less accurately, or at least serves an heuristic for how we think and behave, and so it encompasses not merely philosophy and psychology but everything else (history, literature, mathematics, politics etc.). Note especially that intentionality and rationality as I (along with Searle, Wittgenstein and others) view it,includes both conscious deliberative System 2 and unconscious automated System 1 actions or reflexes. -/- Thus all the articles, like all behavior, are intimately connected if one knows how to look at them. As I note, The Phenomenological Illusion (oblivion to our automated System 1) is universal and extends not merely throughout philosophy but throughout life. I am sure that Chomsky, Obama, Zuckerberg and the Pope would be incredulous if told that they suffer from the same problem as Hegel, Husserl and Heidegger, but it’s clearly true. While the phenomenologists only wasted a lot of people’s time, they are wasting the earth. -/- My writings are available in updated versions as paperbacks and Kindles on Amazon. -/- Talking Monkeys: Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet - Articles and Reviews 2006-2017 (2017) ASIN B071HVC7YP. -/- The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle--Articles and Reviews 2006-2016 (2017) ASIN B071P1RP1B. -/- Suicidal Utopian Delusions in the 21st century: Philosophy, Human Nature and the Collapse of Civilization - Articles and Reviews 2006-2017 (2017) 2nd printing with corrections (Feb 2018) ASIN B0711R5LGX -/- Suicide by Democracy: an Obituary for America and the World (2018) ASIN B07CQVWV9C . (shrink)

Satisfying the demand of questioning the contemporary condition implies, first of all, a criticism of present times. From this point of view, it becomes clear that art and revolution whilst practices of creative disruption are undoubtedly in crisis. Hence, it is imperative to re-read Guy Debord, who not only refused the aestheticization of politics, but also the politicization of aesthetics. For the hermeneutics of contemporary, his work is, of course, essential. Proving it is, in short, the purpose of this paper.

With the rise and public accessibility of AI-enabled decision-support systems, individuals outsource increasingly more of their decisions, even those that carry ethical dimensions. Considering this trend, scholars have highlighted that uncritical deference to these systems would be problematic and consequently called for investigations of the impact of pertinent technology on humans’ ethical decision-making. To this end, this article conducts a systematic review of existing scholarship and derives an integrated framework that demonstrates how intelligent decision-support systems (IDSSs) shape humans’ ethical (...) decision-making. In particular, we identify resulting consequences on an individual level (i.e., deliberation enhancement, motivation enhancement, autonomy enhancement and action enhancement) and on a societal level (i.e., moral deskilling, restricted moral progress and moral responsibility gaps). We carve out two distinct methods/operation types (i.e., processoriented and outcome-oriented navigation) that decision-support systems can deploy and postulate that these determine to what extent the previously stated consequences materialize. Overall, this study holds important theoretical and practical implications by establishing clarity in the conceptions, underlying mechanisms and (directions of) influences that can be expected when using particular IDSSs for ethical decisions. (shrink)

The most trending behavioral approach of mass people nowadays hovers to acquire a specific area to live on for their mental satisfaction. It is the person registered home to live on the next days of life. This issue has firmly increased due to the rapid and mostly uncontrolled increase of population within most of the countries. Now that, it is the conscious craving for men to settle up for a property that has the highest credential service and maintenance ease (...) possibility; it leads them to the housing provider with the highest product quality offering. The easiest way is to redirect them to go for a trustworthy name in the REM providers. Now, narrowing down to a developing country such as Sri Lanka, its Real estate developers have rewarded investors with strong returns post 2009. It is the time when Sri Lanka saw the end of the civil conflict. When the real estate sector has always been a major factor in the development of the economy in every country. Regionally, Sri Lanka remains attractive as an emerging market, when considering the ROI on Real Estate. For an effective discussion, this paper states the linkage of consumer behavior to the highest quality housing provider offers to them. The paper discusses all the necessary factors to prove the enhanced purchase of supreme quality property company dealers like Prime LnadPvt. Ltd is a leading real estate company in Sri Lanka. However, the valuation of property is most vital for the real estate industry. It depends on the type of artifact, the real estate sector offers to its clients. For this industry, infrastructure quality is the most important factor. All the contributing factors, analyses reveal this lesson. This truth is supported by many theories and analyses to lead today’s provider, meeting the original demand factor of the mass people. (shrink)