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.

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)

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)

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)

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)

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)

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)

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)

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 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)

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)

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)

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 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)

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)

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)

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)

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.

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?

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)

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)

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)

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)

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)

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)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments and (...) biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

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 article addresses the problem of making life decisions by people during the period of late adolescence; describes the specifics of the influence of various factors, in particular, the sense of life orientations, life position, impulsivity; the questions of the influence of fear on the process of making life decisions by young people; and the influence of various types of fears on this process. -/- The results of the research show that the influence of (...) fears on the process of making life decisions during the late adolescence is largely determined by characteristics of this age period, such as the formation of identity and the affirmation of one’s own self in the society. Thus, the most influential types of fears during this period are sociophobia, which consists of fear of social opinions and fear of social interactions; and fortunophobia (fear of fate). Sociophobia has such a powerful influence because young people go through the process of separation from their parents and joining society as separate individuals, and therefore the society’s opinion about them as an identity becomes very important to them. Fortunophobia is essentially the fear of the unknown and unavoidable fate, which is an inseparable part of making any life decision, especially in such a young age when people are only making their first crucial life decisions. According to the conducted research, meaningfulness of life has a reverse effect on the impact of fears on making life decisions, which means that with a greater meaningfulness of the individual’s life, the impact of fears is reduced. At the same time, impulsiveness has a direct effect, i.e. the more impulsive an individual is, the more influence fear has on their making life decisions. Life position of “Me + World –” is the least influenced by fears during the process of making life decisions. Also, the influence of fears appears to be more of a motivating factor rather than constraining, which forces young people to act and change their lives. (shrink)

The paper aims to clarify the role of the meaning of life in Anselm Müller’s philosophy. Müller says that the ethically good life is the life of acting well, and acting well requires at least a rough conception of the meaning of life, or a conception of what makes a life go well. But why is such a conception required and what does it mean to have such a conception? I argue that such a conception (...) cannot provide us with ultimate ends in our practical deliberations. Nor can its role be merely to provide a standard against which practical reasoning can be assessed. Rather, our conception of the meaning of life is, in the first instance, that which allows us, in our practical reasoning, to see certain considerations as good reasons for certain actions and to weigh reasons for and against different options. One upshot of my interpretation is that Müller should be more optimistic about philosophy’s ability to answer the question of the meaning of life than he allows himself to be. (shrink)

The closing chapters of Aristotle’s Nicomachean Ethics x are regularly described as “puzzling,” “extremely abrupt,” “awkward,” or “surprising” to readers. Whereas the previous nine books described—sometimes in lavish detail—the multifold ethical virtues of an embodied person situated within communities of family, friends, and fellow-citizens, NE x 6-8 extol the rarified, god-like and solitary existence of a sophos or sage (1179a32). The ethical virtues that take up approximately the first half of the Ethics describe moral exempla who experience fear fighting for (...) their communities, are sensitive to the esteem and recognition of others, and feel love for a desire to live together with a wide variety of kinds of friends. Such good people take pleasure in prudently expending sums to improve their communities—communities in which they exchange goods and participate in ruling and being ruled in a cooperative fashion. The exemplum of x 7-8, by contrast, is a person whose activity consists almost entirely in exercising his or her mind (nous)—a part of one’s soul that Aristotle explicitly notes is disconnected from human emotions and that can be exercised, insofar as one as wise, in a wholly solitary fashion (1178a15-16, a19-20; 1177a33-34). Although Aristotle’s claim that a “life in accord with the mind” is best and most pleasant (1178a6-7) may jar the intuitions of many people—he himself endorses Anaxagoras’ claim that the happy person will appear as “someone who is absurd” (atopos, 1179a15) to most people—it is false to claim that his conclusions in NE x 6-8 are unexpected or unanticipated, or that the text is in any way discontinuous with what precedes it. The Nicomachean Ethics exhibits aspects of ring-composition both within the work as a whole and within book 10. In NE i 5 Aristotle introduces his rendition of a trope that he inherits (most immediately) from Plato, viz. that the problem of the good can be considered like a contest between three different kinds of life—the life of enjoyment (apolaustikos), the life of politics (politikos), and the life of contemplation (theôrêtikos). NE x 6-8 returns to that contest, rendering a verdict about which life takes first, second, and third place. As the opening lines of NE x 6 note, that verdict presupposes central claims articulated between the first and last books of the Ethics, specifically about the nature of the virtues, the nature of friendship, and the nature of pleasure. NE i 5 and x 6-8 thus serve as “bookends” which encase arguments and proposition located between them. Book 10 exhibits a similar ring-composition. NE x opens with methodological reflection on the gap between the theoretical positions that thinkers articulate and the way they live their lives (especially in the case of scolds who simultaneously criticize pleasure on a scientific level but seek it on a practical level [1172a33-b8]). Chapter 8 concludes with an explicit reiteration of the methodological point, a reiteration that underscores how Aristotle’s treatment of the contest of lives incorporates central aspects of the discussion of pleasure in NE x 1-5. Aristotle’s reiteration of the problem of a gap between theory and practice also draws attention to the centrality of his treatment of pleasure in his adjudication of the three lives. Although the life of pleasure takes a distant third in the contest of lives, the contemplative life wins the contest in part because it itself is the most pleasant form of life. The central philosophical problem looming behind Aristotle’s treatment of the contest of lives concerns the relationship between the notion of activity (energeia) and the notion of a way of life (bios). In the last four decades, much of the scholarship on NE x 6-8 has sought to address the question of what activities a certain way of life includes or excludes. “Monistic” or “dominant” end interpretations of the best life have viewed it as including only contemplative activities whereas “inclusivist” end interpretations of the best life have viewed it as including non-contemplative activities. Although this chapter largely side-steps this debate—partially because there are ample recent first-rate introductory treatments of the debate, partially because I have addressed the question elsewhere in my own writing —I argue that focusing solely on the contest between the two best ways of life overshadows the way that Aristotle incorporates insights from the third way of life into the best way of life. Although the notion of a contest among different kinds of lives presupposes that the lives are mutually exclusive, Aristotle has no problem saying that the contemplative life trumps the life of pleasure because the contemplative life is more pleasant. I proceed in two parts. In the first part I examine what I will call the “outer” ring of the Ethics, namely the relationship between the contest of lives proposed in NE i 5 and its overall resolution in x 6-8. I show how i 5 and x 6 establish the framework for the contest, how x 7 adjudicates that contest in large part by relying upon premises articulated in the interim between books 1 and 10, and how x 6 and x 8 determine the second and third place positions in the contest. In the second part I focus on what I will call the “inner” ring of NE x. More than half of NE x struggles with the nature of pleasure, its role in a happy life, and the methodological problems of examining pleasure within a practical science. I show how x 1 and x 8 are “bookends” that underscore the methodological problem of examining pleasure and how the contest of lives draws upon the proximate conclusions concerning the nature of pleasure in NE x 1-5. (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)

Is the Right to the City (RTTC) still a useful framework for a transformative urban politics? Given recent scholarly criticism of its real-world applications and appropriations, in this paper, we argue that the transformative promise in the RTTC lies beyond its role as a framework for oppositional struggle, and in its normative ends. Building upon Henri Lefebvre's original writing on the subject, we develop a “radical-cooperative” conception of the RTTC. Such a view, which is grounded in the lived experiences of (...) the current city, envisions an urban society in which inhabitants can pursue their material and social needs through self-governed cooperation across social difference. Growing and diversifying spaces and sectors of urban life that are decoupled from global capitalism are, we argue, necessary to create space for this inclusionary politics. While grassroots action is essential to this process, so is multi-scalar support from the state. (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)

Some people think that the inevitability of human extinction renders life meaningless. Joshua Seachris has argued that naturalism can be conceptualized as a meta-narrative and that it narrates across important questions of human life, including what is the meaning of life and how life will end. How a narrative ends is important, Seachris argues. In the absence of God, and with knowledge that human extinction is a certainty, is there any way that humanity could be meaningful (...) and have a good ending? I will distinguish between two conceptions of how humanity could be meaningful: the traditional view and an alternative view, which I will outline. I will argue that this alternative view provides a plausible explanation for how humanity could become meaningful. I will also argue that coming to terms with our mortality and other limitations would add meaning to human life and provide humanity with a good ending. (shrink)

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)

The development of AI appears to be not only rendering humans obsolete, but in being empowered could decide that humans should be eliminated for the benefit of life and the conditions for its own future. Given the behaviour of humans, this could be seen as a relief to the rest of terrestrial life, as Günter Grass suggested in his novel, The Rat. While there are many reasons to support this contention, in this paper I argue that humans do (...) have the potential to augment rather than undermine terrestrial life, a potential celebrated by the subordinated tradition of the Radical Enlightenment. Rather than accepting the demise of humanity, it is now time to put the Radical Enlightenment into practice. (shrink)

The development of AI appears to be not only rendering humans obsolete, but in being empowered could decide that humans should be eliminated for the benefit of life and the conditions for its own future. Given the behaviour of humans, this could be seen as a relief to the rest of terrestrial life, as Günter Grass suggested in his novel, The Rat. While there are many reasons to support this contention, in this paper I argue that humans do (...) have the potential to augment rather than undermine terrestrial life, a potential celebrated by the subordinated tradition of the Radical Enlightenment. Rather than accepting the demise of humanity, it is now time to put the Radical Enlightenment into practice. (shrink)

The present text deals with the question of the meaning of life in theexistentialist theory oft heNorwegian philosopher Peter Wessel Zapffe(1899–1990). In his book On the Tragic (1941), Zapffe sketched a theory of the human condition where the meaning of life plays a decisive role together with the human need for justice. This paper aims to reconstruct the central elements of Zapffe’s analysis and to discuss them critically by focusing on his claim that human beings need a fundamental (...) meaning of life as a whole that transcends meaning in life. I pay particular attention to Zapffe’s claim that life is meaningless, since the meaning of life is fundamentallylacking.I conclude that Zapffe’s analysis is problematic for reasons both internal and external to his theory. (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)

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)

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)

This chapter examines Wittgenstein’s battles with the profound anxiety that can arise in response to a sense of the radical contingency of everything one is and everything one cares about. By giving particular attention to entries in Wittgenstein’s ‘Koder Diaries’ from the 1930s, the chapter analyses the nature of ‘the problem of life’ both as it manifested in Wittgenstein’s own life and as a universally relevant problem. It then defends the seriousness of the problem by reconstructing ways in (...) which Wittgenstein might have responded to questions about whether life really is as problematically precarious as his most angst-ridden diary entries seem to presume. (Abstract adapted from Mikel Burley’s ‘Introduction: Wittgenstein, Religion and Ethics: Seeing the Connections’, p. 7). (shrink)

In this peer commentary on L. Syd M. Johnson’s “Inference and Inductive Risk in Disorders of Consciousness,” I argue for the necessity of disability education as an integral component of decision-making processes concerning patients with DOC and, mutatis mutandis, all patients with disabilities. The sole qualification Johnson places on such decision-making is that stakeholders are educated about and “understand the uncertainties of diagnosis and prognosis.” Drawing upon research in philosophy of disability, social epistemology, and health psychology, I argue that this (...) educational qualification is insufficient to address systemic ableism and other forms of epistemic bias in quality of life judgments. (shrink)

Contemporary societies are regulated by a complex system, which tends to be exhaustive, supported by growing social and technical interdependence. This system is composed of subsystems: global economic production, liberal political institutions and a social organization based on labour. As a whole, these three dimensions – political, economical, social – tend to compress contemporary life forms into a single way of life, primarily structured by systemic functionality. Although it admits variations of degree (or even, to some extent, qualitative (...) differences), the functional codes (of systems) guide actions daily and impose severe limitations on lifestyles, which are particularly noticeable when the struggle for survival, both economically and socially, mobilizes all of one’s time and energy. The means obliterate the ends, functioning obliterates meaning, survival obliterates the proper human “life”. At the political level, liberal thought masks the “malaise of modern civilization” resulting from these limitations by evacuating the question on forms of life to the private sphere, concurrently with the insistence on an abstract political ethic of the “just”, ultimately determining the form and functioning of the institutions, which overrides any and all ethics of “good”. (shrink)

When it comes to a question as notoriously unclear as “What is the meaning of life?” clarifying the question and its conceptual setting is a necessary step before attempting to answer the question. The analysis of the concept of “the meaning of life” is a twofold task; “the meaning” and “life” both need to be examined. In this paper, I primarily focus on “the meaning”. I argue that, although there is much disagreement and confusion in the literature (...) about the meaning of “the meaning” as it is applied to life, there is one most plausible interpretation of this notion. In the end, even though I do not answer the question of the meaning of life, I propose an account of what a correct answer to the question is supposed to look like, based on my original function analysis of “the meaning.”. (shrink)

When terminally ill patients have had enough suffering they often turn to euthanasia. The Assisted suicide is still unethical and illegal in most countries. As of now it is practiced in the Netherlands but still considered illegal. The few that still use euthanasia have to go through a certain legal route. Often patients have had enough and find it easier to take matter into their own hands or in this case let the doctors help in assisting with ending their (...) class='Hi'>life. There are many different reasons why it is bad to euthanize patients and by writing this article I will explain a few of those reasons. My report will help understand why euthanasia is still illegal in most countries. Using euthanasia is unethical for physicians and goes against the oath they took to protect and do no harm to patients and no matter under what circumstances it is still illegal. Euthanasia is an unnatural way to end life. Using Euthanasia to end one patients life is still considered murder and unethical. (shrink)