In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of (...) two possible scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. (shrink)

Euthanasia and the duty to die have both been thoroughly discussed in the field of bioethics as morally justifiable practices within medical healthcare contexts. The existence of a narrow connection between both could also be established, for people having a duty to die should be allowed to actively hasten their death by the active means offered by euthanasia. Choosing the right time to end one’s own life is a decisive factor to retain autonomy at the end of our lives. However, (...) there is no definitive consensus on why physicians should be the ones performing the medical procedure to end a person’s life. The moral problems arising from such assertion are not to be taken lightly, for medical tradition has long regarded the duty not to kill, not to actively end a patient’s life, as the core moral obligation that gives meaning to the medical profession. Our concern is to question the moral justifiability of the arguments offered by physicians not to actively help patients die. (shrink)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a (...) physician’s right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (shrink)

This chapter provides empirical evidence about everyday attitudes concerning euthanasia. These attitudes have important implications for some ethical arguments about euthanasia. Two experiments suggested that some different descriptions of euthanasia have modest effects on people’s moral permissibility judgments regarding euthanasia. Experiment 1 (N = 422) used two different types of materials (scenarios and scales) and found that describing euthanasia differently (‘euthanasia’, ‘aid in dying’, and ‘physician assisted suicide’) had modest effects (≈3 % of the total variance) on permissibility (...) judgments. These effects were largely replicated in Experiment 2 (N = 409). However, in Experiment 2, judgments about euthanasia’s moral permissibility were best predicted by the voluntariness of the treatment. Voluntariness was a stronger predictor than some demographic factors and some domain general elements of moral judgments. These results help inform some debates about the moral permissibility of euthanasia (e.g., the slippery slope argument) suggesting that some of the key premises of those arguments are unwarranted. (shrink)

Introductory and advanced textbooks in bioethics focus almost entirely on issues that disproportionately affect disabled people and that centrally deal with becoming or being disabled. However, such textbooks typically omit critical philosophical reflection on disability, lack engagement with decades of empirical and theoretical scholarship spanning the social sciences and humanities in the multidisciplinary field of disability studies, and avoid serious consideration of the history of disability activism in shaping social, legal, political, and medical understandings of disability over the last fifty (...) years. For example, longstanding discussions on topics such as euthanasia, physician aid-in-dying, pre-implantation genetic diagnosis, prenatal testing, selective abortion, enhancement, patient autonomy, beneficence, non-maleficence, and health care rationing all tend to be premised on shared and implicit assumptions regarding disability, especially in relation to quality of life, yet with too little recognition of the way that “disability” is itself a topic of substantial research and scholarly disagreement across multiple fields. This is not merely a concern for academic and medical education; as an applied field tied to one of the largest economic sectors of most industrialized nations, bioethics has a direct impact on healthcare education, practice, policy, and, thereby, the health outcomes of existing and future populations. It is in light of these pressing issues that the Disability Bioethics Reader is the first reader to introduce students to core bioethical issues and concepts through the lens of critical disability studies and philosophy of disability. The Disability Bioethics Reader will include over thirty-five chapters covering key areas such as: critical histories and state-of-the-field analyses of modern medicine, bioethics, disability studies, and philosophy of medicine; methods in bioethics; concerns at the edge- and end-of-life; enhancement; disability, quality of life, and well-being; prenatal testing and abortion; invisible disabilities; chronic illness; healthcare justice; genetics and genomics; intellectual disability and neurodiversity; ethics and diagnosis; and epistemic injustice in healthcare. (shrink)

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

Philosophers have been contemplating the nature of the mind for centuries and have produced mountains of intricate jargon, thought experiments, and views, that map a landscape of interminable disputes. One such dispute is between philosophers who believe that the mind can be explained as a mechanism and philosophers who insist it cannot. In this paper I take a look at this dispute and argue that it is unique in philosophy and a key to the nature of the mind.

Ethical debates about assisted dying typically assume that only medical professionals should be able to provide patients with assisted dying. This assumption partially rests on the unstated principle that assisted dying providers may not be motivated by pecuniary considerations. Here I outline and defend a mixed provider model of assisted dying provision that contests this principle. Under this model, medically competent non-physician professionals could receive fees for providing assisted dying under the same terms and (...) conditions as physicians can in those juris- dictions where medically assisted dying is lawful. The mixed provider model blunts objections to assisted dying rooted in supposed clashes with medical values. In addition to generating a market likely to expand access to assisted dying, the mixed provider model would not create markets that are unjust because they are “noxious” in Satz’ sense or because they raise “semiotic” concerns about the value of human life. (shrink)

In this paper I present objections to the Fading Qualia and Dancing Qualia thought experiments, which David Chalmers uses to argue that functional organization fully determines conscious experience.

In this issue, Ahmadi1 reports on the practice of hymenoplasty—a surgical intervention meant to restore a presumed physical marker of virginity prior to a woman's marriage. As Mehri and Sills2 have stated, these women ‘want to ensure that blood is spilled on their wedding night sheets.’ Although Ahmadi's research was carried out in Iran specifically, this surgery is becoming increasingly popular in a number of Western countries as well, especially among Muslim populations.3 What are the ethics of hymen restoration?Consider the (...) role of the physician. Two of the doctors interviewed by Ahmadi reported being in ‘a perpetual state of guilt because of the surgery's inherent aim at deceiving the groom’ and noted their ‘personal conflict’ at being involved in this deception. Yet: "None of the doctors believed that the surgery was unethical, arguing that the girl could be ‘abused’ and ‘can even die’ if she is discovered not … ". (shrink)

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a (...) “physician-qua-friend model” of the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy (...) with respect to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative (...) approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs. (shrink)

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)

The reemergence of the question of suicide in the medical context of physician-assisted suicide seems to me one of the most interesting and fertile facets of late modernity. Aside from the disruption which this issue may cause in the traditional juridical relationship between individuals and the state, it may also help to transform the dominant conception of subjectivity that has been erected upon modernity's medicalized order of death. To enhance this disruptive potential, I am going to examine the perspectives (...) on death offered by two contemporary writers: Zygmunt Bauman and Jean Baudrillard. Each of these writers recognizes the centrality of death to modern culture, as Heidegger did, but they also go beyond him in specifying the ways in which death maintains a presence in late modernity, despite efforts to conceal it. In particular, both of these writers recognize the important role that medicine has played in ordering the modern conception of death. After situating these two perspectives in relation to each other, and in relation to Heidegger, who will serve here as a sort of benchmark, I will return to the issue of suicide. Given the differences in their readings of the role that death and medicine play in modern culture, these post-Heideggerians take strikingly different positions on this issue. By engaging these perspectives, I intend not only to point out the tremendous potential which this issue holds for a fundamental rethinking of modern subjectivity, but also reveal some of the dangers that may beset any naive optimism about the right to die. (shrink)

PrEP (Präexpositionsprophylaxe) ist ein relativ neues Mittel zur Prävention von HIV-Infektionen. HIV-negative Menschen nehmen antivirale Medikamente ein, die verhindern, dass der Kontakt mit dem Virus zu einer Infektion führt. Im Gegensatz zum Kondomgebrauch basiert dieses Präventionsverfahren auf Medikamenten und nicht auf einer Verhaltensänderung. Aus der Perspektive der Biopolitik fügt sie sich in einen größeren Trend in Richtung Medikalisierung, des Anstiegs der Macht der Pharmaindustrie und der Reglementierung des Risikos ein. Sexuelles Verhalten ist das Ergebnis der Subjektivierung, des Prozesses, durch den (...) soziale Normen Subjekte und ihre Wünsche bilden. Die Medikalisierung von schwulem Sex durch PrEP verändert die sexuelle Subjektivierung und geht daher mit einer Veränderung der Praktiken von schwulem Sex einher. Nach einer kurzen Erläuterung der medizinischen Besonderheiten und der Geschichte von PrEP (1) vereint dieser Artikel eine Rekonstruktion zeitgenössischer theoretischer Ansätze zur Biopolitik im Zusammenhang mit PrEP (2) mit einer Darstellung aktueller politischer Debatten um PrEP (3). Die Untersuchung zeigt, dass sich Gouvernementalitätsstudien und die Italienische Theorie auf repressive Machtverhältnisse konzentrieren und daher die Komplexität der Debatte nicht berücksichtigen können, die sich aus der Subjektivität und Handlungsfähigkeit verschiedener beteiligter Akteure, insbesondere schwuler PrEP-Aktivisten, ergibt. Dennoch werden Interpretationen von PrEP als repressiver Macht auch von einigen Akteuren in der politischen Debatte um PrEP genutzt, meist ohne ausdrücklichen Bezug zur biopolitischen Theorie. Nikolas Roses und Paul Rabinows differenziertes Konzept der Biopolitik bietet einige Ansätze wie diejenigen der biopolitischen Bürgerschaft und der somatischen Ethik, um die Debatte um PrEP und die damit verbundenen komplexen Verhandlungen über Sexualität zu beschreiben. Ausgehend von diesen Ideen entwickle ich ein neues Konzept der ‚demokratischen Biopolitik‘ von PrEP, die eine weitere Demokratisierung der Sexualität im biopolitischen Zeitalter ermöglicht. (shrink)

At the end of 2015, the German parliament passed a new law, entitled "Business-like Suicide Assistance", that effectively ended a rather liberal legal take on assisted suicide in Germany. §217 of the German Criminal Code was based on a proposal drafted by members of the parliament Michael Brand, Kerstin Griese, et all., The drafters’ goal was to prohibit Right-to-Die organisations such as Sterbehilfe Deutschland e.V. as well as repeatedly acting individuals from assisting people in ending their lives. The goal of (...) this article is to outline the new law in broad brushstrokes and raise some concerns. (shrink)

“Whoever does not love abides in death,” writes John in his first epistle (1Jn 3:10). This statement presents us with a paradox. Death, so we suppose, is precisely that in which one cannot 'abide.' Our first thought is to interpret this as metaphor. John is saying that a life devoid of love is a life somehow like death. But, having never died, how do we know what death is like? My paper explores these questions with the aid of two philosophical (...) interpretations of the meaning of death: Heidegger’s in Being and Time and Kierkegaard’s in The Sickness Unto Death. Having looked at these I then seek to grasp their relation to the Christian idea of agapic love as presented by John. (shrink)

What does Artificial Intelligence (AI) have to contribute to health care? And what should we be looking out for if we are worried about its risks? In this paper we offer a survey, and initial evaluation, of hopes and fears about the applications of artificial intelligence in medicine. AI clearly has enormous potential as a research tool, in genomics and public health especially, as well as a diagnostic aid. It’s also highly likely to impact on the organisational and business practices (...) of healthcare systems in ways that are perhaps under-appreciated. Enthusiasts for AI have held out the prospect that it will free physicians up to spend more time attending to what really matters to them and their patients. We will argue that this claim depends upon implausible assumptions about the institutional and economic imperatives operating in contemporary healthcare settings. We will also highlight important concerns about privacy, surveillance, and bias in big data, as well as the risks of over trust in machines, the challenges of transparency, the deskilling of healthcare practitioners, the way AI reframes healthcare, and the implications of AI for the distribution of power in healthcare institutions. We will suggest that two questions, in particular, are deserving of further attention from philosophers and bioethicists. What does care look like when one is dealing with data as much as people? And, what weight should we give to the advice of machines in our own deliberations about medical decisions? (shrink)

Biomarker-based predictive tests for subjectively asymptomatic Alzheimer’s disease (AD) are utilized in research today. Novel applications of artificial intelligence (AI) promise to predict the onset of AD several years in advance without determining biomarker thresholds. Until now, little attention has been paid to the new ethical challenges that AI brings to the early diagnosis in asymptomatic individuals, beyond contributing to research purposes, when we still lack adequate treatment. The aim of this paper is to explore the ethical arguments put forward (...) for AI aided AD prediction in subjectively asymptomatic individuals and their ethical implications. The ethical assessment is based on a systematic literature search. Thematic analysis was conducted inductively of 18 included publications. The ethical framework includes the principles of autonomy, beneficence, non-maleficence, and justice. Reasons for offering predictive tests to asymptomatic individuals are the right to know, a positive balance of the risk-benefit assessment, and the opportunity for future planning. Reasons against are the lack of disease modifying treatment, the accuracy and explicability of AI aided prediction, the right not to know, and threats to social rights. We conclude that there are serious ethical concerns in offering early diagnosis to asymptomatic individuals and the issues raised by the application of AI add to the already known issues. Nevertheless, pre-symptomatic testing should only be offered on request to avoid inflicted harm. We recommend developing training for physicians in communicating AI aided prediction. (shrink)

Sprachliche Ausdrücke, mit deren Hilfe wir Spiele beschreiben und vorantreiben, sind in ihrer Verwendungsweise so vielfältig wie kaum irgendwelche anderen Ausdrücke. Und sie haben eine Eigenschaft, die man mit dem Thema Spiel eher nicht in Verbindung bringen würde: Sie eignen sich dazu, auf substantive Weise Metaphysik zu treiben oder wieder ingangzubringen. Diese Art der Starthilfe hat die jahrtausendealte Metaphysik (metaphysica specialis) neuerdings nötig. Seit knapp hundert Jahren steht sie im Verdacht, auf nichts besseres hinauszulaufen als leeres, unverständliches Wortgeklingel. Wer diesen (...) sprachphilosophischen Verdacht auszuräumen wünscht, tut gut daran, unverdächtige Redebereiche zu bemühen. In der Tat, mithilfe unserer höchst robusten, völlig alltäglichen Rede vom Spielen und beim Spielen können wir tiefe metaphysische Möglichkeiten verständlich machen, etwa die Möglichkeit einer Wirklichkeit jenseits oder oberhalb des Bereichs derjenigen Wirklichkeit, die wir Natur oder physisches Universum nennen. Dazu betrachte ich ein philosophisches Gedankenspiel (das den Matrix-Filmen zugrundeliegt und all unsere Wissensansprüche zu unterminieren scheint): Wir sind Gehirne im Tank, d.h. wir haben keinen vollständigen menschlichen Körper, sondern nur ein Gehirn, das in einem Tank mit Nährflüssigkeit schwebt; die Nerven-Enden dieser Gehirne sind mit einem Supercomputer verbunden, der uns die Illusion verschafft, dass alles in Ordnung sei. Hiergegen hat Hilary Putnam folgende sprachphilosophische Schwierigkeit aufgeworfen: Wie soll ein Gehirn im Tank seine eigene Situation treffend auf den Punkt bringen, wenn doch seine Ausdrücke "Tiger", "Gehirn", "Tank" usw. allesamt nicht mit echten Tigern, Gehirnen usw. verknüpft sind, sondern mit Nullen und Einsen im Computer? Putnam trieb diese Schwierigkeit bis an den Punkt, an dem sich zweifelsfrei beweisen lässt, dass wir keine Gehirne im Tank sein können. Und da hatte er meiner Ansicht nach recht. Wie ich meine, sollten wir uns nicht darüber den Kopf zerbrechen, ob wir ein Gehirn im Tank sind, sondern darüber, ob wir in einer analogen Situation stecken, um eine Ebene nach oben verschoben. Um die Metaphern dieser Formulierung des Problems auszupacken, setze ich Spielvokabeln ein. Wegen ihrer atemberaubenden Flexibilität brauchen sie (im Unterschied zur naturwissenschaftlichen Sprache) bei Übersetzung aus der Tanksprache in unsere Sprache nicht verändert zu werden; solche Ausdrücke heißen semantisch stabil. Mit ihrer Hilfe können wir gravierende metaphysische Möglichkeiten aufwerfen, z.B.: "Jemand, der nicht aus Materie besteht und nicht in meinem physischen Universum vorkommt, treibt mit mir von außerhalb seine Machtspielchen". Damit beziehen wir uns vielleicht auf die außerirdische Programmiererin der Simulation, in der wir möglicherweise doch stecken. Weniger respektlos formuliert, wäre das die Frage eines allmächtigen Schöpfergottes außerhalb unserer physikalischen Raumzeit: Metaphysik pur. (shrink)

This article for the PHILOKLES Journal for Popular Philosophy surveys a few common theoretical approaches to the phenomenon of self-deception before putting forward a thus far relatively unexplored intentionalist option, namely what the author calls the "project model of self-deception". On this model, self-deception is understood as a dynamic, diachronic activity, aimed at the preservation of a certain self-image, to which an agent is implicitly committed. The author shows how this model can make subjects responsible for their self-deceptions without running (...) straightforwardly into the so-called "paradoxes" of self-deception. (shrink)

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between (...) the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to (...) ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM's goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion; while others think that HPM's practices should, like all other branches of medicine, aim at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that (...) if HPM's practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM's practices were to aim at health. According to the ars moriendi, flourishing at the end of one's life requires that one exercise her agency and pursue the goods most important to her. On this view, HPM's practices should promote patients’ health to enable them to pursue these goods. (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)

Selbst wenn die traditionellen Beweise der immateriellen Seele (von Platon bis Descartes) zu wünschen übrig lassen, muss uns das nicht davon abhalten, sie mit den Mitteln der modernen analytischen Philosophie neu zu fassen und wasserdicht zu machen. Ich werde (ohne eigene Diskussion der bereits vorliegenden Beweise) eine neue Version vorschlagen, die von Swinburne angeregt wurde, sich an wesentlichen Stellen von seinem Ansatz unterscheidet und auf zwei verblüffend schwachen Prämissen beruht: Einerseits auf der konsistenten Vorstellbarkeit von Gedankenspielen, in die irgend eine (...) beliebige Wahrheit über meine augenblickliche Situation integriert ist und denen zufolge ich meinen Tod seelisch, aber ohne Körper überlebe; diese Prämisse ergibt sich der virtuosen Macht unseres Möglichkeitssinns. Andererseits beruht der Beweis auf einer Voraussetzung, die sich (ohne exegetische Garantie) als Echo aristotelischer Substanz-Konzeptionen verstehen, aber ohne großen ontologischen Überbau begründen lässt – dem zufolge folgt aus der materialistischen Analyse meiner augenblicklichen Situation, dass diese Analyse während meiner gesamten Existenz gilt (einmal Körper, immer Körper). Die Logik des Beweises ist bodenständig und setzt keine strittigen modallogischen Prinzipien voraus. Und die Konklusion des Beweises besagt, dass ich jetzt eine immaterielle Seele habe, aber nichts über deren Unsterblichkeit. (shrink)

Staff reported paranormal experiences in connection with the outpatient Medical Assistance in Dying room at the hospital. This case study reports on staff experiences and illustrates how the Ethics team’s role expanded to deal with this novel situation by facilitating an interdisciplinary response.

HIV and AIDS is still menace bedeviling society particularly in 3rd world countries such as Zimbabwe. The impacts of HIV/AIDS are gravely felt within workplaces as affected employees suffer from stigma and prejudice. Organizations also suffer as the pandemic leads to high absenteeism and a high rate of employee turnover. This writing therefore addresses the impact of HIV/AIDS in organizations and communities and how the Zimbabwean Government, NGOS, Trade Unions and Companies have been battling this pandemic and the achievements made (...) to date. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

This letter was submitted to the Senate Standing Committee on Legal and Constitutional Affairs, Government of Canada, on 29th January, 2021, as final debate over Bill C-7 was being undertaken in the Senate regarding MAiD and the strong opposition to the legislation expressed across the Canadian disability community. It draws on our individual and joint work on eugenics, well-being, and disability.

Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?

Für Simone de Beauvoir ist der Existentialismus die einzige Philosophie, die der Aufgabe gewachsen ist, eine ethische Verhaltensweise, die sich auch unmittelbar in die Praxis umsetzen lässt, zu entwerfen. Die Werke, in denen Beauvoir eine existentialistische Ethik formuliert und deren Umsetzbarkeit veranschaulicht, sind allen voran ihr Essay Für eine Moral der Doppelsinnigkeit und ihr Theaterstück Die unnützen Mäuler. Mit der dramaturgischen Darstellung einer Grenzsituation ist es der Philosophin und Schriftstellerin gelungen, eine Synthese von Werten umrisshaft zu erläutern, aus denen sich (...) praktische Handlungshinweise, ohne die Notwendigkeit eines universellen Wertesystems vorzusehen, ableiten lassen. Einer kurzen Einführung, die auf die Umstände bzw. auf die historischen Hintergründe, die Simone de Beauvoir Beauvoir dazu bewogen haben, als engagierte Intellektuelle dezidiert zu sozialen und politischen Fragen Stellung zu beziehen, wird eine prägnante Analyse von Beauvoirs Ethikentwurf folgen. Da vorliegender Beitrag für die Aktualität von Beauvoirs Die unnützen Mäuler plädiert, werden parallele Verhaltensmuster der Vergangenheit und der Gegenwart ans Licht geführt werden, um praktische Möglichkeiten aufzuzeigen, wie es heute gelingen kann, sich für eine ethisch vertretbare Lebensweise zu entscheiden. Wohlgemerkt handelt es sich dabei – ganz in Beauvoirs Sinne – um einen Versuch bzw. um einen Entwurf. (shrink)

Philosophy is the study of the most general and fundamental problems of human life. The main areas of study in philosophy includes metaphysics, epistemology, logic, ethics and aesthetics etc. there are other several branches of philosophy which characterize different branches of knowledge. Philosophy being a very abstract branch of study, has not much scope of using equipment on a large scale to supplement the normal lecture schedules. However, in some papers/areas there are comparatively better scope to make the lectures more (...) concrete and interesting through proper use of various teaching aids and modes. We include logic, philosophy of science, applied philosophy, applied ethics, social and political philosophy, philosophy of mind, philosophy of cognitive science and history of philosophy etc., we can use various modern aids. In this article my attempt is to draw out an outlines of aids and modes for effective philosophy teaching. (shrink)

A critical evaluation of Plantinga's Free Will Defense.

Mit dem treffenden Ausdruck "Der wunderbare florentinische Geist" bezeichnet Jacob Burckhardt den Geist der Erneuerung in Florenz zur Zeit der italienischen Renaissance - des Rinascimento. Er revolutionierte die unterschiedlichsten kulturellen Bereiche, wie etwa das politische Denken, Wissenschaft, Technik und Kunst. Dieser Geist wirkt bis heute fort. In seiner vielfältigen Gestalt dient er als Ausgangspunkt, um den Hintergrund der europäischen Kultur zu erkunden.

Phenomenological psychology has emphasized that experience as it is immediately "given" to the experiencing individual is an appropriate subject matter for psychological investigation. Consideration of the methodological implications of this stance suggests that certain text analytic and cluster analytic methods could be used to discern the identifying properties of different types of experience. We present results of a study in which textual analysis was used to identify recurrent properties of participants' verbal accounts of their experience, cluster analysis was used to (...) classify participants' accounts according to the similarity of their profiles of properties, and the resulting clusters were examined for their more or less characteristic prpoerties. Using these methods, three distinct types of experience of a Renaissance painting were identified and described. This demonstration of numerically aided phenomenological methods indicates the compatibility of rigorous and sensitive descriptions of experiential accounts. (shrink)

Clinical Ethics Consultations are an important tool for physicians in solving difficult cases. They are extremely common in North America and to a lesser extent also present in Europe. However, there is little data on this practice in Poland. We present results of a survey of 521 physicians practising in Poland concerning their opinion on CECs and related practices. We analysed the data looking at such issues as CECs’ perceived availability, use of CECs, and perceived usefulness of such support. Physicians (...) in our study generally encounter hard ethics cases, even—surprisingly—those who do not work in hospitals. Most physicians have no CEC access, and those that do still do not employ CECs. However, physicians perceive this form of support as useful—even more so among actual users of CECs. We compared these findings with similar studies from other European countries and the North America. We point out peculiarities of our results as compared to those in other countries, with some possible explanations. We hope the results may encourage regulatory debate on the need to formally introduce CECs into the Polish healthcare system. (shrink)

This Thesis is analyzing the transformation of Kant's argumentation on space from "Von dem ersten Grunde des Unterschiedes der Gegenden im Raume" (1768), "De mundi sensibilis atque intelligibilis forma et principiis" (1770), and "Kritik der reinen Vernunft" (1781/87).

In den letzten Jahrzehnten sind die Emotionen zu einem der zentralen Themen der Philosophie des Geistes geworden. Erstaunlich ist in diesem Kontext einer neuen Entdeckung der Gefühle, dass die frühen phänomenologischen Beiträge der ersten Schüler Husserls zu dem Thema in Vergessenheit geraten sind. Dabei können die Gefühlskonzeptionen und Analysen emotionaler Phänomene von Pfänder, Voigtländer, Haas, Geiger, Scheler, Stein, Walther, Kolnai, Ortega y Gasset wegen ihrer einzigartigen Präzision und Erfahrungsnähe die heutige Debatte entscheidend bereichern. In diesem Buch wird einerseits die Rekonstruktion (...) einer Theorie der Emotionen unternommen, welche implizit in den Texten der ersten Phänomenologen liegt. Andererseits werden systematische Antworten auf Fragen und Problemstellungen gegeben, welche die aktuelle Diskussion bestimmen. Was sind Emotionen? Inwiefern kann man von emotionaler Realität und Irrealität, Echtheit und Unechtheit sprechen? Kann es Emotionen über Fiktionen geben? Gibt es unterbewusste Emotionen? Welche Rolle spielen leibliche Aspekte? Was bedeutet es, dass Emotionen intentional sind? In welcher Beziehung stehen sie zu den Werten? Dies sind die Leitfragen des Buches. (shrink)

Using as case studies two early diagrams that represent mechanisms of the cell division cycle, we aim to extend prior philosophical analyses of the roles of diagrams in scientific reasoning, and specifically their role in biological reasoning. The diagrams we discuss are, in practice, integral and indispensible elements of reasoning from experimental data about the cell division cycle to mathematical models of the cycle’s molecular mechanisms. In accordance with prior analyses, the diagrams provide functional explanations of the cell cycle and (...) facilitate the construction of mathematical models of the cell cycle. But, extending beyond those analyses, we show how diagrams facilitate the construction of mathematical models, and we argue that the diagrams permit nomological explanations of the cell cycle. We further argue that what makes diagrams integral and indispensible for explanation and model construction is their nature as locality aids: they group together information that is to be used together in a way that sentential representations do not. (shrink)

Was ist Sozialphilosophie? Um diese Frage zu beantworten, wird in der vorliegenden Einführung das Soziale entlang der drei Figuren Ich, Anderer und Dritter bestimmt. Davon ausgehend werden Grundbegriffe der Sozialphilosophie jeweils anhand eines maßgeblichen Primärautors erläutert. Den Lesenden wird mit dieser Einführung so dreierlei geboten: Eine Bestimmung leitender Grundfiguren, eine Vorstellung zentraler Grundbegriffe und eine Rekonstruktion einschlägiger Grundlagenautoren der Sozialphilosophie. Die vorliegende Einführung ist so gestaltet, dass sie insbesondere für Studienanfänger_innen geeignet ist. Der Text ist durchweg mit Marginalien versehen, wodurch (...) der Einstieg und die Orientierung erleichtert werden. Außerdem weisen Zusammenfassungen des Forschungsstandes und weiterführende Literaturempfehlungen den Weg zur eigenständigen Lektüre. (shrink)

Today, artificial intelligence, especially machine learning, is structurally dependent on human participation. Technologies such as Deep Learning (DL) leverage networked media infrastructures and human-machine interaction designs to harness users to provide training and verification data. The emergence of DL is therefore based on a fundamental socio-technological transformation of the relationship between humans and machines. Rather than simulating human intelligence, DL-based AIs capture human cognitive abilities, so they are hybrid human-machine apparatuses. From a perspective of media philosophy and social-theoretical critique, I (...) differentiate five types of “media technologies of capture” in AI apparatuses and analyze them as forms of power relations between humans and machines. Finally, I argue that the current hype about AI implies a relational and distributed understanding of (human/artificial) intelligence, which I categorize under the term “cybernetic AI”. This form of AI manifests in socio-technological apparatuses that involve new modes of subjectivation, social control and discrimination of users. (shrink)