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.

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)

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)

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)

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)

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)

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)

Most properties have comparatives, which are relations. For instance, the property of width has the comparative relation denoted by `_ is wider than _'. Let us say a property is reducible to its comparative if any statement that refers to the property has the same meaning as another statement that refers to the comparative instead. Width is not reducible to its comparative. To be sure, many statements that refer to width are reducible: for instance, `The Mississippi is wide' means the (...) same as `The Mississippi is wider than most rivers'. But some statements that refer to width are not reducible: for instance, `Electrons have zero width' is not. A property is not reducible to its comparative if it has absolute degrees, and specifically an absolute zero. A property's comparative relation places things in an order from those that have the property least to those that have it most. If there is an absolute zero point somewhere in this ordering, the property is not reducible to its comparative. For width, there is an absolute zero at one end of the ordering, so width is not reducible. The property of goodness is reducible to its comparative, betterness. In particular, there is no absolute zero of goodness. Things are ordered by betterness – some things are better than others – but nothing is absolutely good or absolutely bad. This is an exaggeration. In certain applications, goodness does have absolute degrees of a sort, and an absolute zero. For instance, it makes sense to say an event is good, and another event bad. These are absolute degrees of a sort, but they are themselves reducible to betterness. To say an event is good simply means the event is better than what would otherwise have happened. The goodness of lives has a different sort of absolute zero. Lives are ordered by betterness; some lives are better than others. We can make sense of the question `Where in this ordering is the division between lives that are good and those that are bad?' The division between good and bad lives is again reducible to betterness. To say a person's life is good means it is better that the person should continue living, rather than that she should die. Or it may mean it is better that her life should be lived rather than that it should never have been lived at all. As it is often put: a good life is a life worth living. Derek Parfit appears to attach a different sense to the idea of a good life. He appears to mean a life that contains a preponderance of good things (such as pleasure) over bad things (such as pain). If a life contains no good things and no bad things, it has zero goodness in this sense. In this sense, absolute goodness and the absolute zero of goodness are not reducible to betterness. However, this is a naturalistic sense of goodness, and it is subject to the open-question objection. If a life contains no good things and no bad things, it is an open question whether it has zero goodness. It might, for instance, be a bad thing that this life should be lived. In discussing the evil of death, some philosophers seem to have been searching for an absolute goodness that is not reducible to betterness. Thomas Nagel speaks of an asymmetry between what is good about life and what is bad about death. But if a person's life is good, that only means it would be better that she should continue living than that she should die. And if a person's death would be bad, that only means it would be worse that she should die than that she should continue living. So there can be no asymmetry. (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.

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)

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)

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)

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 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)

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

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)

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)

With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision-makers had to determine the order in which different groups were prioritized. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared prioritization regulations in 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two types of priority categories: groups that have increased (...) infection fatality rate (IFR) compared to the average for the general population and groups chosen because their members experience increased risk of being infected (ROI). Our findings show a clear trend: all researched schedules prioritized criteria referring to IFR (being over 65 years old and coexisting health conditions) over the ROI criteria (eg occupation and housing conditions). This is surprising since, in the context of treatment, it is common and justifiable to adopt different allocation principles (eg introducing a saving more life-year approach or prioritizing younger patients). We discuss how utilitarian, prioritarian, and egalitarian principles can be applied to interpret normative differences between the allocation of curative and preventive interventions. (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)

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

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)

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)

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)

Human life in contemporary society is extremely complex and there are various external factors that directly affect the realization in the individual ends. In this work I analyze the effects of the global market economy, manifested by a mode of production and distribution of goods and services in the form of a global network of economic relations, which involve people, transnational corporations and political and social institutions in moral sphere of people, affecting their choices and the realization of (...) these choices. Individual freedom can be understand as a freedom to realize our choices in the environment of a global economic market, but it is still problematic in the sense that the choices of goods and services available in this market do not reflect individual choices, but a set of preferences standardized according to the market itself. In this paper I will reflect about the individual freedom in economic globalization pointing from the debate between Pettit and Berlin that social freedom advocated by Republican Petit can be satisfactory for a start. (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.

Famous ant-man E.O. Wilson has always been one of my heroes --not only an outstanding biologist, but one of the tiny and vanishing minority of intellectuals who at least dares to hint at the truth about our nature that others fail to grasp, or insofar as they do grasp, studiously avoid for of political expedience. Sadly, he is ending his long career in a most sordid fashion as a party to an ignorant and arrogant attack on science motivated at least (...) in part by religious fervor. It shows the vile consequences when universities accept money from religious groups, science journals are so awed by big names that they avoid proper peer review, and when egos are permitted to get out of control. It takes us into the nature of evolution, the basics of scientific methodology, how math relates to science, what constitutes a theory, and even what attitudes to religion and generosity are appropriate as we inexorably approach the collapse of industrial civilization. -/- Those wishing a comprehensive up to date framework for human behavior from the modern two systems view may consult my book ‘The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle’ 2nd ed (2019). Those interested in more of my writings may see ‘Talking Monkeys--Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet--Articles and Reviews 2006-2019 3rd ed (2019), The Logical Structure of Human Behavior (2019), and Suicidal Utopian Delusions in the 21st Century 4th ed (2019). (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)

Famous ant-man E.O. Wilson has always been one of my heroes --not only an outstanding biologist, but one of the tiny and vanishing minority of intellectuals who at least dares to hint at the truth about our nature that others fail to grasp, or insofar as they do grasp, studiously avoid for political expedience. Sadly, he is ending his long career in a most sordid fashion as a party to an ignorant and arrogant attack on science motivated at least in (...) part by the religious fervor of his Harvard colleagues. It shows the vile consequences when universities accept money from religious groups, science journals are so awed by big names that they avoid proper peer review, and when egos are permitted to get out of control. It takes us into the nature of evolution, the basics of scientific methodology, how math relates to science, what constitutes a theory, and even what attitudes to religion and generosity are appropriate as we inexorably approach the collapse of industrial civilization. -/- Those wishing a comprehensive up to date framework for human behavior from the modern two systems view may consult my book ‘The Logical Structure of Philosophy, Psychology, Mind and Language in Ludwig Wittgenstein and John Searle’ 2nd ed (2019). Those interested in more of my writings may see ‘Talking Monkeys--Philosophy, Psychology, Science, Religion and Politics on a Doomed Planet--Articles and Reviews 2006-2019 3rd ed (2019) and Suicidal Utopian Delusions in the 21st Century 4th ed (2019) . (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)

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?

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of (...) a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

Der berühmte Ameisenmann E.O. Wilson war schon immer einer meiner Helden - nicht nur ein hervorragender Biologe, sondern eine der winzigen und verschwindenden Minderheit von Intellektuellen, die es zumindest wagt, die Wahrheit über unsere Natur anzudeuten, die andere nicht verstehen oder, soweit sie es verstehen, aus politischen Gründen unermüdlich vermeiden. Leider beendet er seine lange Karriere auf äußerst schäbige Weise als Partei eines ignoranten und arroganten Angriffs auf die Wissenschaft, der zumindest teilweise durch die religiöse Inbrunst seiner Harvard-Kollegenmotiviertist. Es zeigt (...) die abscheulichen Folgen, wenn Universitäten Geld von religiösen Gruppen annehmen, Wissenschaftszeitschriften von großen Namen so bewundert sind, dass sie eine ordnungsgemäße Peer Review vermeiden und wenn Egos außer Kontrolle geraten dürfen. Es führt uns in die Natur der Evolution, die Grundlagen der wissenschaftlichen Methodik, wie Mathematik mit Wissenschaft zusammenhängt, was eine Theorie ausmacht, und sogar, welche Einstellungen zu Religion und Großzügigkeit angemessen sind, wenn wir uns unaufhaltsam dem Zusammenbruch der industriellen Zivilisation nähern. Ich fand Abschnitte in 'Conquest' mit dem üblichen prägnanten Kommentar (obwohl nichts wirklich Neues oder Interessantes, wenn man seine anderen Werke gelesen hat und auf biologie im Allgemeinen ist) in der oftgestylten Prosa, die sein Markenzeichen ist, aber war ziemlich überrascht, dass der Kern des Buches seine Ablehnung inklusiver Fitness (die seit über 50 Jahren ein Standbein der Evolutionsbiologie ist) zugunsten der Gruppenauswahl ist. Man nimmt an, dass von ihm kommen und mit den articles er bezieht sich auf veröffentlicht von sich selbst und Harvard Mathematik Kollege Nowak in großen Peer-Review-Zeitschriften wie Nature, muss es ein wesentlicher Fortschritt sein,, trotz der Tatsache, dass ich wusste, Gruppenauswahl wurde fast überall abgelehnt, da mit jeder großen Rolle in der Evolution. Ich habe zahlreiche Rezensionen im Netz gelesen und viele haben gute Kommentare, aber die, die ich am meisten sehen wollte, war, dass von renommierten Wissenschaftsautor und Evolutionsbiologe Richard Dawkins. Im Gegensatz zu den meisten von Fachleuten, die in Zeitschriften nur für diejenigen mit Zugang zu einer Universität zur Verfügung stehen, ist es leicht im Netz verfügbar, obwohlanscheinend, entschied er sich, es nicht in einer Zeitschrift zu veröffentlichen, da es angemessen abscheulich ist. Leider findet man eine vernichtende Ablehnung des Buches und den acerbic Kommentar über einen wissenschaftlichen Kollegen, den ich je von Dawkins gesehen habe -- über alles in seinem vielen Austausch mit dem verstorbenen und unbeklagten Demagogen und Pseudowissenschaftler Stephan Jay Gould. Obwohl Gould für seine persönlichen Angriffe auf seinen Harvard-Kollegen Wilson berüchtigt war, stellt Dawkins fest, dass ein Großteil von "Conquest" einen unbequem an Goulds häufige Verfehlungen in "bland, unfocussed ecumenicalis" erinnert. Dasselbe gilt mehr oder weniger für Wilsons populäres Schreiben, einschließlich seines jüngsten Buches "The Meaning of Human Existence" – eine weitere schamlose Eigenwerbung seiner diskreditierten Ideen zu Inklusiver Fitness (IF). Dawkins weist darauf hin, dass das berüchtigte 2010-Papier von Nowak, Tarnita und Wilson in Nature von über 140 Biologen, die einen Brief unterzeichnet haben, fast überall abgelehnt wurde und dass es in Wilsons Buch kein Wort darüber gibt. Auch in den folgenden 4 Jahren mit Artikeln, Vorträgen und mehreren Büchern haben sie dies nicht korrigiert. Es gibt keine andere Wahl, als Dawkins trenchant Kommentar zuzustimmen: "Für Wilson nicht zu zugeben, dass er für sich selbst gegen die große Mehrheit seiner professionellen Kollegen spricht - es schmerzt mich, dies von einem lebenslangen Helden zu sagen -- ein Akt mutwilligen Arroganz." Angesichts von Nowaks späterem Verhalten muss man ihn auch einbeziehen. Ich habe das Gefühl, dass einer der fassungslosen Menschen, die man im Fernsehen sieht, interviewt wird, nachdem der nette Mann von nebenan, der seit 30 Jahren alle Kinder babysitten, als Serienmörder entlarvt wird. Dawkins weist auch darauf hin (wie er und andere seit vielen Jahren), dass inklusive Fitness mit dem Neo-Darwinismus (d.h. logischerweise folgt) entsteht und nicht abgelehnt werden kann, ohne die Evolution selbst abzulehnen. Wilson erinnert uns erneut an Gould, der Kreationisten von der einen Seite seines Mundes anprangerte, während er ihnen Trost spendete, indem er endlosen ultraliberalen marxistisch gefärbten Kauderwelsch über Spandrels, unterbrochenes Gleichgewicht und Evolutionspsychologie von der anderen ausspeist. Die Unbestimmtheit und mathematische Opazität (für die meisten von uns) der Mathematik der Gruppen- oder Mehrebenenauswahl ist genau das, was die Sanftmütigen ihnen ermöglichen wollen, dem rationalen Denken in ihren endlosen antiwissenschaftlichen Gerüchten und (in der Wissenschaft) postmodernen Wortsalate zu entkommen. Schlimmer noch, Wilsons "Eroberung" ist ein schlecht durchdachtes und schlampig geschriebenes Durcheinander voller Nonsequiturs, vager Streifzüge, Verwirrungen und Inkohärenz. Eine gute Bewertung, die einige davon im Detail ist, dass von Absolvent Gerry Carter, die Sie im Netz finden können. Wilson hat auch nichts mit unserem gegenwärtigen Verständnis der Evolutionspsychologie (EP) zu tun (siehe z.B. die letzten 300 Seiten von Pinkers 'The Better Angels of our Nature'). Wenn Sie eine seriöse Buchlänge Bericht über die soziale Evolution und einige relevante EP von einem Experten wollen, siehe 'Principles of Social Evolution' von Andrew F.G. Bourke, oder ein nicht ganz so ernster und zugegebenermaßen fehlerhafter und irrender Bericht, aber ein Muss,das Robert Trivers dennoch lesen muss—'The Folly of Fools: The Logic of Deceit and Self-Deception in Human Life' und ältere, aber immer noch aktuelle und durchdringende Werke wie 'The Evolutionof Cooperation':Revised Edition by Robert Axelrod and 'The Biology ofMoral Systems' von Richard Alexander. (shrink)

With the ageing of the Portuguese population, there are more people in dependency situations and needing long-term care (LTC). In this context, it is important to ensure the quality of life (QoL) of those individuals, and that quality can be measured through their health-related quality of life (HRQoL) and overall well-being. Also, understanding how perceived service quality (PSQ) can be related to how people perceive their QoL is pertinent since service quality is an important factor to achieve patient (...) health outcomes. To develop this project, a LTC unit located in the district of Lisbon was chosen, the LTC unit of Arruda dos Vinhos. The main objective was to assess the relation between the PSQ, the HRQoL and the overall well-being of patients receiving LTC at the LTC unit of Arruda dos Vinhos. A project based on a case study was performed, through interviews based on the items of the SERVPERF, EQ-5D and ICECAP-O questionnaires, which were then analysed through content analysis. Results showed there is a relation between PSQ and HRQoL and between HRQoL and overall well-being. It was also possible to realise that to better evaluate the quality of this specific service, other subjects as the activities performed at the LTC unit, the physiotherapy service and the food provided, should be taken in consideration. Concluding, there is a relation between PSQ and the QoL of the patients receiving LTC at the LTC unit of Arruda dos Vinhos, when quality of life is measured through HRQoL. (shrink)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps for Coding (...) and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (shrink)

Suppose you want to do as much good as possible. What should you do? According to members of the effective altruism movement—which has produced much of the thinking on this issue and counts several moral philosophers as its key protagonists—we should prioritise among the world’s problems by assessing their scale, solvability, and neglectedness. Once we’ve done this, the three top priorities, not necessarily in this order, are (1) aiding the world’s poorest people by providing life-saving medical treatments or alleviating (...) poverty itself, (2) preventing global catastrophic risks, such as those posed by nuclear war or rogue artificial intelligence, and (3) ending factory farming. These claims are both plausible and striking. If correct, they should prompt a stark revision of how we approach our altruistic activities. However, the project of determining how to do the most good—as opposed to say, whether we should do the most good—has only recently, within the last ten years, become the subject of serious academic attention. Many key claims have not yet been carefully scrutinised. This is a cause for concern: are effective altruists doing good badly? In this thesis, I critique and develop some of the latest claims about how individuals can do the most good. I do this in three areas: the value of saving lives (preventing premature deaths), how best to improve lives (making people happier during their lives), and cause prioritisation methodology (frameworks for determining which problems are the highest priorities). In each case, I raise novel theoretical considerations that, when incorporated, change the analysis. Roughly speaking, my main conclusions are (1) saving lives is not as straightforwardly good we tend to suppose, may not be good at all, and is not clearly a priority; (2) happiness can be measured through self-reports and, based on the self-reported evidence, treating mental health stands out as an overlooked problem that may be an even more cost-effective way to improve lives than alleviating poverty; (3) the cause prioritisation methodology proposed by effective altruists needs to be moderately reconceptualised and, when it is, it turns out it is not as illuminating a tool as we might have thought and hoped. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury (...) patients. Nonetheless, research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (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)

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)

著名的蚂蚁人E.O.Wilson一直是我的英雄之一——不仅是一位杰出的生物学家,而且是一小撮正在消失的知识分子,他们至少敢于暗示我们本性的真相,而其他人却无法领会,或者只要他们所掌握的,刻意避免政治权 宜之计。可悲的是,他以最脏的方式结束了他漫长的职业生涯,成为对科学的无知和傲慢攻击的一方,至少部分是出于哈佛同事的宗教热情。它显示了当大学接受宗教团体的钱,科学期刊被大牌们敬畏,以至于他们避免适当的同 行评议,当自我被允许失控时,后果不堪设想。它带我们进入进化的本质,科学方法论的基础,数学如何与科学的关系,什么构成一个理论,甚至什么态度的宗教和慷慨是适当的,因为我们无情地接近工业的崩溃文明。 那些希望从现代两个系统的观点来看为人类行为建立一个全面的最新框架的人,可以查阅我的书《路德维希的哲学、心理学、Min d和语言的逻辑结构》维特根斯坦和约翰·西尔的《第二部》(2019年)。那些对我更多的作品感兴趣的人可能会看到《会说话的猴子——一个末日星球上的哲学、心理学、科学、宗教和政治——文章和评论2006-20 19年第3次(2019年)和自杀乌托邦幻想21篇世纪4日 (2019) .

प्रसिद्ध चींटी आदमी ई.ओ. विल्सन हमेशा मेरे नायकों में से एक रहा है - न केवल एक उत्कृष्ट जीवविज्ञानी, लेकिन बुद्धिजीवियों के छोटे और गायब अल्पसंख्यक जो कम से कम हमारी प्रकृति के बारे में सच्चाई पर संकेत करने की हिम्मत है कि दूसरों को समझने में विफल, या insofar के रूप में वेओ समझ , जोर से राजनीतिक expience के लिए बचने के लिए. अफसोस की बात है, वह एक पार्टी के रूप में सबसे कठोर फैशन में अपने लंबे (...) कैरियर को समाप्त कर रहा है विज्ञान पर एक अज्ञानी और अभिमानी हमले के लिए कम से कम अपने हार्वर्ड सहयोगियों केधार्मिक उत्साह से प्रेरित भाग में. यह नीच परिणाम से पता चलता है जब विश्वविद्यालयों धार्मिक समूहों से पैसे स्वीकार करते हैं, विज्ञान पत्रिकाओं तो बड़े नाम है कि वे उचित सहकर्मी की समीक्षा से बचने के द्वारा awed रहे हैं, और जब अहं को नियंत्रण से बाहर निकलने की अनुमति दी जाती है. यह हमें विकास की प्रकृति में ले जाता है, वैज्ञानिक पद्धति की मूल बातें, कैसे गणित विज्ञान से संबंधित है, क्या एक सिद्धांत का गठन किया है, और यहां तक कि धर्म और उदारता के दृष्टिकोण क्या उचित हैं के रूप में हम inexorably औद्योगिक के पतन दृष्टिकोण सभ्यता. आधुनिक दो systems दृश्यसे मानव व्यवहार के लिए एक व्यापक अप करने के लिए तारीख रूपरेखा इच्छुक लोगों को मेरी पुस्तक 'दर्शन, मनोविज्ञान, मिनडी और लुडविगमें भाषा की तार्किक संरचना से परामर्श कर सकते हैं Wittgenstein और जॉन Searle '2 एड (2019). मेरे लेखन के अधिक में रुचि रखने वालों को देख सकते हैं 'बात कर रहेबंदर- दर्शन, मनोविज्ञान, विज्ञान, धर्म और राजनीति पर एक बर्बाद ग्रह --लेख और समीक्षा 2006-2019 3 एड (2019) और आत्मघाती यूटोपियान भ्रम 21st मेंसदी 4वें एड (2019) . (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)

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)

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)

The odds of encountering a senior citizen selling on the street have increased. The claim that they have no choice but to work and sell on the street, despite the dangers, illnesses, and psychological issues they may face, to provide for their family’s needs is very evident. Therefore, this study explores the quality of life, lived experiences, challenges, and coping mechanisms of senior citizen street vendors in Bulacan, Philippines. The study employed Heideggerian Phenomenology and Interpretative Phenomenological Analysis (IPA). Moreover, (...) the following themes arise (1) Golden years, (2) Socially connected, and (3) Unknown journey. These themes highlighted the experiences and challenges faced by the participants. Moreover, it is highly suggested that local government agencies enhance and strictly monitor the existing program that alleviates mental and physical health concerns and senior citizens' safety and financial assistance. (shrink)