This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I then assess Lazenby's account, which applies Rawls’ (...) general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue first that the existence of young terminally ill patients undermines a number of Rawlsian arguments for the difference principle. I then argue that the structure of ageing undermines the Rawlsian decision mechanism of the ‘veil of ignorance’ on which Lazenby relies. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice. (shrink)

My ambition in this paper is to provide an account of an unacknowledged example of blameless guilt that, I argue, merits further examination. The example is what I call carer guilt: guilt felt by nurses and family members caring for patients with palliative-care needs. Nurses and carers involved in palliative care often feel guilty about what they perceive as their failure to provide sufficient care for a patient. However, in some cases the guilty carer does not think that he has (...) the capacity to provide sufficient care; he has, in his view, done all he can. These carers cannot legitimately be blamed for failing to meet their own expectations. Yet despite acknowledging their blamelessness, they nonetheless feel guilty. My aims are threefold: first, to explicate the puzzling nature of the carer guilt phenomenon; second, to motivate the need to solve that puzzle; third, to give my own account of blameless guilt that can explain why carers feel guilty despite their blamelessness. In doing so I argue that the guilt experienced by carers is a legitimate case of guilt, and that with the right caveats it can be considered an appropriate response to the progressive deterioration of someone for whom we care. (shrink)

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization (...) is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)

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

Hegel reads the poet Novalis as an expression of terminal irony, a pathological case of Gemüt, where the conscious mind is alienated from reality and turns its negativity inwards on the contents of its own natural soul. The condition of self-feeling, presented in Hegel’s “Anthropology”, is a self-consumption that manifests itself somatically in the physical disease (consumption) from which Novalis dies. The poet’s literary production represents a pathological fixation that impedes the dynamic organicity of Hegelian Science. As such, Novalis’s (...) mental illness and death constitute an expression of romantic irony and an ongoing threat to Hegel’s philosophy. (shrink)

The illness immersion condition prevents patients from enjoying everything worth living life for. In any case, according to Frank, this condition could represent one of the most insightful experiences towards understanding the meaning of life. Using the metaphor of phoenix taken from May, Frank identified four kinds of embodiments through which the phoenix can reveal itself in a patient after an illness immersion experience: the phoenix that could ever be and the phoenix that might have been; the recurrent (...) and cumulative phoenix and the reluctant phoenix. Based on these considerations, a qualitative study was conducted in order to give voice to the different phoenix embodiments focusing on several autobiographies of patients afflicted with severe or terminal illness. The analysis highlights several similarities that the different phoenixes shared ; however, a deep difference emerged in their worldview which proves able to lead them towards different epiphanies. These evidences reveal that every sick person should be understood, stimulated and accompanied throughout his lived experience of illness by an expressly designed and dedicated care. (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 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)

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)

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)

Warren Zevon’s musical career, though brilliant throughout, is particularly notable for its ending: diagnosed with a terminal illness, Zevon refused a potentially debilitating medical treatment to put his remaining energy into recording another album. The resulting record –2003’s 'The Wind' – was in many ways the perfect farewell: songs of dirty, dark, uncompromising, country-tinged rock, blistering guitar solos, all mixed with intelligent, black-as-coal gallows humour. But it was also a moving farewell to his fans, a heartfelt, personal reflection (...) on his life and impending death: it begins with the words “sometimes I feel like my shadow’s casting me” and ends with “keep me in your heart for a while”. 'The Wind' ranks among Zevon’s very best and belongs in the same category as albums like David Bowie’s 'Blackstar' and Leonard Cohen’s 'You Want It Darker': works of great artists that knew the end was coming and made that knowledge musical. But though it had a particular force towards the end, death had always featured as a prominent theme in Zevon’s music. In fact, the albums that preceded his terminal diagnosis – especially 2000’s 'Life’ll Kill Ya' – have a marked preoccupation with death and dying, and many of his song’s characters (gunmen, gangsters, boxers, murderers of all stripes) either dealt death out, died, or both. -/- In this chapter, I argue that Zevon’s music and speech in his late public appearances personify an idea in Martin Heidegger’s philosophy called ‘authentic being-towards-death’. In his landmark text 'Being and Time', Heidegger undertakes a painstaking analysis of human existence. One of its conclusions is that to live a fully authentic life, we must reckon with our mortality, come to terms with it and allow this reckoning to have a transformative effect on how we live and how we think about our existence. This results, Heidegger argues, in a distinct way of being that he calls ‘being-towards-death’ and ‘anticipatory resoluteness’ in the face of death. Authentic being, which involves properly taking ownership of our lives and their meaning, cannot be adequately achieved without a serious confrontation with the fact that we will one day die. I claim that Warren Zevon’s music, with its continual engagement with death which culminates in 'The Wind', is one of the great musical manifestations of exactly this type of project. Heidegger’s writing is often notoriously abstract, but it pertains to the most fundamental issues about what it means to be human. Engaging with it alongside Zevon’s music provides a fruitful opportunity to make it concrete, better able to understand its most important aspects while providing an interesting conceptual toolkit to apply to the music of one of the great songwriters of death. (shrink)

Kant has famously argued that human beings or persons, in virtue of their capacity for rational and autonomous choice and agency, possess dignity, which is an intrinsic, final, unconditional, inviolable, incomparable and irreplaceable value. This value, wherever found, commands respect and imposes rather strict moral constraints on our deliberations, intentions and actions. This paper deals with the question of whether, as some Kantians have recently argued, certain types of (physician-assisted) suicide and active euthanasia, most notably the intentional destruction of the (...) life of a terminally-ill, but rational and autonomous patient in order to prevent certain serious harms, such as enduring or recurring pain or the loss of the meaning in life, from befalling him really are inconsistent with respect for the patient’s human dignity. I focus on two independent, though interrelated explications of the rather vague initial idea that the patient (as well as the doctor), in intending and bringing about his death, treats his person or rational nature merely as a means and so denigrates his dignity: (i) that in doing what he is doing, he does not act for the sake of his person, but for the sake of something else; (ii) that, by trading his person for pain relief, he engages himself in an irrational and hence immoral exchange. After critically discussing some suggestions about how to understand this charge, I eventually find Kantian objections to suicide and (active) euthanasia, based on the idea of human dignity, less than compelling. For all the paper proves, suicide and (active) euthanasia may still be morally impermissible, but then this must be so for some other reason than the one given above. (shrink)

Typical philosophical discussions of physician-assisted death have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally (...) ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad. (shrink)

In my ethnographic research on death and dying in contemporary Finland, I explore how Finns facing end of life due to a long-term illness or other terminal condition seek to orient themselves and make meaning with cultural tools such as imagery, language, and metaphysical thinking. My primary research material is based on extensive fieldwork at Terhokoti Hospice and in the cancer clinic of Helsinki University Hospital, where I have had numerous conversations with terminally ill patients. This paper seeks (...) to explore the way in which metaphysical aesthetics is assuming the role that religious thinking has traditionally played. When the role of institutional religion is diminishing, it becomes important to understand how emotional and spiritual resolution can be arrived at by means of aesthetics. (shrink)

Abstract: In Vacco v. Quill, 521 U.S. 793 (1997), the Supreme Court for the first time in American case law explicitly applied the principle of double effect to reject an equal protection claim to physician-assisted suicide. Double effect, traced historically to Thomas Aquinas, proposes that under certain circumstances it is permissible unintentionally to cause foreseen evil effects that would not be permissible to cause intentionally. The court rejected the constitutional claim on the basis of a distinction marked out by the (...) principle, i.e., between directly intending the death of a terminally ill patient as opposed to merely foreseeing that death as a consequence of medical treatment. The Court held that the distinction comports with fundamental legal principles of causation and intent. Id. at 802. -/- Critics allege that the principle itself is intrinsically flawed and that, in any event, its employment in Vacco is without legal precedent. I argue in response to contemporary objections that double effect is a valid principle of ethical reflection (Part II); claims to the contrary notwithstanding, double effect analysis is a pervasive, albeit generally unacknowledged principle employed regularly in American case law (Part III); and drawing on the preceding two sections, Vacco's application of the principle of double effect is appropriate (Part IV). -/- My conclusion is that [o]peration of some form of the principle, by whatever name, is inevitable. In an imperfect world where duties and interests collide, the possibility of choices of action foreseen to have both good and evil consequences cannot be avoided. In rare circumstances, ethics and the law require that a person refrain from acting altogether. More often, however, they provide that a determination of whether an actor may pursue a good effect although knowing it will or may unintentionally cause an harmful effect requires a more complex analysis - a double effect analysis. -/- Keywords: Equal protection, double effect, intention, physician-assisted suicide, Constitutional Law, Bioethics. (shrink)

Introduction In 2013, Dr. J. Muizelaar and Dr. R. Schrot, two neurosurgeons at the University of California Davis Medical Center (UCDMC), were found guilty of research misconduct due to failure to comply with institutional policies as well as Food and Drug Administration (FDA) regulations governing human subjects research. At issue here, however, is the difference between research and innovative therapy in the clinical setting of patient care where clinical judgment is reasonably to be privileged. Methods The UCDMC investigative document is (...) reviewed along with standard literature on clinical ethics and clinical data about glioblastoma multiforme (GBM) cancer. Results In this paper I argue that, by tendentiously focusing on policies, regulations, and procedures governing human subjects research, the UCDMC investigation failed to account for the centrality of clinical judgment and clinical ethics pertinent to judicious review of this matter, especially given the unique clinical context of terminally ill patients having exhausted standard care treatment options for glioblastoma multiforme (GBM) cancer. Conclusions The UCDMC investigation raises serious problems for clinicians who are engaged in innovative therapy in the clinical setting, requiring a regulatory framework separate from the normal Institutional Review Board (IRB) process. (shrink)

This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and life insurance (...) institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (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)

1: Placebo effect sometimes plausibly has powerful effects. 2: Buddhism philosophy holds that every living animal is sentient, and has a consciousness and killing them is bad for the killer and freeing them is good somehow. Consciousness may involve some aspects of quantum mechanism as Roger Penrose’s Orch OR' theory of consciousness pointed out. -/- 3: Although previous studies show that there is no “demonstrable effects of distant intercessory prayer. Anecdotal cases of a special kind of Buddhist activity of freeing (...) captive animals in huge amount seem to have powerful therapeutic effects on severe and terminal patients. We want test it experimentally. 4: The cunning point that exceeds previous stuies is, it’s reasonable to consider there may be collective and superpositional effects of this activity due to the likely quantum mechanism of consciousness, and it may play as a sort of magnifying glass that shows a discernible placebo effect. -/- 5:We recruit a considerable number of patients that are terminally ill and the doctors said they can not help them anymore and have double-blind experiments of the above idea.The statistics may show some anomalous distribution. Ethical concerns shall take into consideration. (shrink)

James Rachels’s distinction between killing and letting die maintains that there is morally no difference between killing a terminally ill patient and letting him/her die. Therefore, active and passive euthanasia dichotomy is a distinction without a difference. Hence, if passive euthanasia is allowed, active euthanasia should be permitted too. The paper demonstrated that the distinction between killing and letting die is: (1) irrelevant to euthanasia(2) extraneous to the medical profession, and (3) methodologically degressive. Furthermore, the paper demonstrated invalidity of the (...) bare difference argument of Rachels based on the distinction because of four reasons: (1) irrelevance to American Medical Association’s statement; (2) differences between the cases such as intentionality, causality, and agency; (3) straw man fallacy, (4) and weak analogy. Therefore, the paper concluded that relating the distinction between killings and letting die to bioethics and euthanasia is unjustifiable. (shrink)

An Islamic approach from its theological sources to address the spiritual pain related to palliative care of terminally ill patients can be established on attaining a spiritual stage of soul or spirit termed as reassured soul. The attainment of such stage is based on hope of the patient to receive mercy and forgiveness of God. And the way of attainment of hope is possible by doing the repentance, praying, and patience. In combating the pain and suffering, the patient is supposed (...) to understand that the life in its reality is a test and facing such a test is possible by two ways, one is patient centric by building patience within to endure the suffering and second is seeking help from God by praying. For the spiritual wellbeing, the patient should understand that his suffering is in fact expiation for his sins. On the other hand, the visitors and caregivers of patients have certain responsibilities that contribute to enhancing of the spiritual well-being of the patient, including comforting them by giving hope to the patients and at the same time praying for their recovery. These all elements enhance the spiritual well-being of patients and help in prevention of suffering by spiritual means. (shrink)

In a society where filial piety is regarded as a social norm, should a son consent to withdrawing treatments to his terminally ill father or should he request that his father’s life be maintained as long as possible? Leaving a father unattended is regarded as unfilial in a Confucian society, let alone untreated while being ill. Although Taoism also teaches filial piety, it asserts artificially as unnatural. In other words in Taoist view, uselessly prolonging a life through life-sustaining devices or (...) futilely treating an incurable terminal patient is against the will of Heaven. This paper is not an argument in favor of euthanasia but a discussion of what is natural and un-natural in terms of life and death phenomenon from Taoist perspective. Artificial life relying on external means is not harmonious with nature. Thus keeping a person in PVS stage alive should be ethically flaw. In this sense, don’t all attempts to cure illness un-natural? This author will say that if treatments can restore health, then it is not un-natural. But if medical procedures fail to revert the deterorating health of a terminally ill patient and treatments prove to be futile, foregoing treatments can be regarded as flowing with Heaven and thus is ethically justifiable. (shrink)

There are common concepts between euthanasia and suicide because euthanasia is historically connected with the discourse on suicide. In widespread literature on euthanasia there is confusion over the concepts and definitions. These definitions are analyzed in this paper and along with other conclusions and distinctions the researcher has substantially defended his definition of euthanasia. There are two different usages of the term euthanasia: a narrow construal of euthanasia and broad construal of euthanasia. Contrary to other researches, the researcher agrees only (...) with the narrow construal of euthanasia, i.e. active euthanasia. The researcher’s definition of euthanasia is: intentionally causing a terminally ill person’s death through an action performed by a physician. As a result, passive euthanasia is expunged from the definition of euthanasia. In addition to that, the definition excludes suicide, assisted suicide, and physician-assisted suicide. (shrink)

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

Why do we consider killing and letting someone die to be two different things? Why do we believe that a doctor who refuses to treat a terminally ill patient is doing anything less than administering a lethal substance? After all, the consequences are the same, and perhaps the moral status of these acts should be judged accordingly. -/- Reviewed: Jonathan Glover, Questions de vie ou de mort (Causing Death and Saving Lives), translated into French and introduced by Benoît Basse, Genève, (...) Labor et Fides, 2017, 386 pp. (shrink)

Advocates of physician-assisted suicide often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have sufficient certainty (...) that a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable. (shrink)

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant information—in this (...) unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

Azərbaycan elm tarixini tədqiq edərkən dövrün tələbindən çıxış edilərək ərəb və fars dillərində yazılmış çoxlu əsərlərə rast gəlirik. Bu əsərlərdən biri də dahi alim Nəsirəddin Tusinin fars dilində məntiqə dair yazdığı Əsasül-iqtibas əsəridir. Əsər ilk dəfə 2022-ci ildə nəşr edilərək oxucu və tədqiqatçıların ixtiyarına verilmişdir. Əsasül-iqtibas əsəri XIII əsrin ortalarında yazılmışdır. Əsərin yazılmasından təqribən səkkiz əsrə yaxın vaxt keçmişdir. Bu müddət ərzində həmin əsərdə istifadə edilən bir sıra termin və sözlər artıq müasir fars dilində istifadə edilmir. Əsərin məntiqə aid olması (...) və həm də bir sıra sözlərin günümüzdə istifadə edilməməsi onun tərcüməsini çətinləşdirən amillər kimi qeyd etmək olar. Bundan əlavə burada istifadə edilən bəzi terminlərin gündəlik danışığımzda fərqli mənada istifadə edildiyindən həmin sözlərin və terminlərin izah edilməsi zərurəti yaranmışdır. Habelə orta əsr müəlliflərinin əsərlərinin tədqiqi zamanı eyni bir sözün müxtəlif müəlliflər tərəfindən fərqli mənalarda işlədildiyinin də şahidi oluruq ki, bu da həmin termin və anlayışların Azərbaycan dilinə tərcüməsi zamanı izahının verilməsinə ehtiyac yaradır. Hal-hazırda müraciət etdiyiniz bu kitab Nəsirəddin Tusinin ən mühüm və genişhəcmli əsərlərindən biri olan “Əsasül-iqtibas”-ın tərcüməsi zamanı əsərin orijinalında işlədilmiş ərəb-fars sözlərinin izahlı tərcüməsi yönündə tərtib edilmişdir. Bu lüğətlərin tərcüməsi və izahı ilə tanış olmaqla Nəsirəddin Tusinin ərəb-fars dillərində yazılmış digər əsərlərinin tərcüməsi zamanı da yararlanmaq olar. Müəyyən bir ixtisas və peşəni və ya həmin peşə və ixtisasa aid olan terminləri başa düşmək üçün həmin istiqamət üzrə tərtib edilən terminolji lüğətlərə ehtiyac duyulur. Bu istiqamətdə zaman-zaman müxtəlif ixtisaslar üzrə terminoloji lüğətlərin nəşr edildiyini müşahidə edirik. Azərbaycan dilində məntiqi terminlərin izahından ibarət xüsusi termonoloji lüğətlərin də tərtib edilməsi zərurəti vardır. Çünki məntiq terminlərinin izahınına adətən rus dilində yazılmış ədəbiyyatda, bir neçə terminin izahı verilmiş məntiq kitablarında və ya fəlsəfi terminlərdən ibarət ensiklopediya və lüğətlərdə rast gəlmək mümkündür. Bir tərəfdən, yaranmış boşluğu doldurmaq, digər tərəfdən isə məntiq ixtisası üzrə təhsil alan tələbə və mütəxəssislərə kömək etmək üçün bu lüğəti tərtib etmək qərarına gəldik. 222 sözün izah və tərcüməsindən ibarət olan bu kitabı həmin istiqamətdə olan boşluğu doldurmaq üçün kiçik və eyni zamanda mühüm bir addım hesab etmək olar. Burada sözlərin tərcüməsi ilə yanaşı bir sıra terminlərin izahı da verilmişdir. Əsasən Əsasül-iqtibas adlı məntiqi əsəri tərcümə edərkən qarşıya çıxan çətin və mürəkkəb sözlərin izahının verilməsinə üstünlük verilmişdir. Tərcümə zamanı müxtəlif illərdə nəşr edilən Əsasül-iqtibas əsərlərinə də müraciət edilmişdir. Bu əsərlərin bəzisində Əsasül-iqtibas əsərində istifadə edilən bəzi terminlərin izahı da verilmişdir. Bu izahlar bəzən tərcümə zamanı ifadənin daha səlis və daha dəqiq başa düşülməsinə imkan vermişdir. Bu lüğət kitabı tərtib edilərkən həmin əsərlərdə mövcud olan terminlər və onların izahından da istifadə edilmişdir. Bəzən məntiqi terminlərlə yanaşı kəlam, fəlsəfə və s. elmlərdə istifadə edilən terminləri də qeyd etmişik. Çünki bu terminlər bizə məntiqdə işlədilən bəzi ifadələrin daha asan başa düşülməsinə imkan verəcəkdir. “Əsasül-iqtibasa dair terminlər” lüğəti adlı bu kitabı bu sahədə atılmış ilk addımlardan biri olduğu üçün gələcəkdə daha sanballı və həcmcə daha geniş terminoloji lüğətlərin hazırlanması nəzərdə tutulur. (shrink)

Human-centered explainable AI (HCXAI) advocates for the integration of social aspects into AI explanations. Central to the HCXAI discourse is the Social Transparency (ST) framework, which aims to make the socio-organizational context of AI systems accessible to their users. In this work, we suggest extending the ST framework to address the risks of social misattributions in Large Language Models (LLMs), particularly in sensitive areas like mental health. In fact LLMs, which are remarkably capable of simulating roles and personas, may lead (...) to mismatches between designers' intentions and users' perceptions of social attributes, risking to promote emotional manipulation and dangerous behaviors, cases of epistemic injustice, and unwarranted trust. To address these issues, we propose enhancing the ST framework with a fifth 'W-question' to clarify the specific social attributions assigned to LLMs by its designers and users. This addition aims to bridge the gap between LLM capabilities and user perceptions, promoting the ethically responsible development and use of LLM-based technology. (shrink)

Historically, the hypothesis that our world is a computer simulation has struck many as just another improbable-but-possible “skeptical hypothesis” about the nature of reality. Recently, however, the simulation hypothesis has received significant attention from philosophers, physicists, and the popular press. This is due to the discovery of an epistemic dependency: If we believe that our civilization will one day run many simulations concerning its ancestry, then we should believe that we are probably in an ancestor simulation right now. This essay (...) examines a troubling but underexplored feature of the ancestor-simulation hypothesis: the termination risk posed by both ancestor-simulation technology and experimental probes into whether our world is an ancestor simulation. This essay evaluates the termination risk by using extrapolations from current computing practices and simulation technology. The conclusions, while provisional, have great implications for debates concerning the fundamental nature of reality and the safety of contemporary physics. (shrink)

I introduce the concept pathophobia, to capture the range of morally objectionable forms of treatment to which somatically ill persons are subjected. After distinguishing this concept from sanism and ableism, I argue that the moral wrongs of pathophobia are best analysed using a framework of vice ethics. To that end I describe five clusters of pathophobic vices and failings, illustrating each with examples from three influential illness narratives.

A theory of blameworthiness must answer two fundamental questions. First, what makes a person blameworthy when they act? Second, what makes a person blameworthy after the time of action? Two main answers have been given to the second question. According to interminability theorists, blameworthiness necessarily doesn’t even diminish over time. Terminability theorists deny this. In this paper, I argue against interminability and in favour of terminability. After clarifying the debate about whether blameworthiness is interminable or terminable, I argue there’s no (...) positive case for interminability. I then respond to three objections to terminability. In doing so, I clarify the nature of blame, self-blame, and posthumous blame. I also give theoretical reasons in favour of the view that a person’s blameworthiness for a minor wrong can not only diminish but also cease completely. (shrink)

Termination in international contracts is considered a harsh sanction that harms international trade for each breach of contract or its provisions. The interest of international trade is fulfilled in maintaining and completing performance of contract, even if with a breach rectifiable by remedy. The termination destroys the contract and results in returning goods after their dispatch in addition to the accompanying new freight and insurance expenses and administrative and health procedures necessary for the entry and exit of goods and to (...) pay then refund the price. Moreover, the goods are exposed again to damage and perishing risks. Furthermore, the international sale contract is inherently associated with other international contracts such as goods transport contract, insurance contract and documentary credit through which the price is paid. If the sale contract is terminated, its effect will apply to all other associated contracts, if not performed, which produces many issues and hardships. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

One bi-lingual - hungarian-ENGLISH - meditation and research about the Illness and the Living Being. Concentrated, of course, to the specific HUMAN reporting to them. The book investigates philosophically the issue of human illness and its organic pertinence to the meaning of human life starting from the recognition that the dangerous encounter with the experience of illness is an unavoidable – and as such crucial – experience of the life of any living being. As for us humans, (...) there is probably no mortal man who has never suffered of some – any! – kind of disease from his birth to the end of his life… Illness is therefore an experience or outright a danger of existence and its possibility, as well as a way of being that nobody has ever been and will ever be ontological or existentially exempted from. So, it may well be “arbitrary” or “accidental” which disease affects which being or person, when and to what degree, in what way, etc., but it is factually unavoidable that in the course of one’s entire life – from its very beginning to its very end – one would never fall ill in some respect. The paper discusses this issue by the ontological investigation of possibility. Together with the analyses about of the origins and history of the MEDICINE. -/- The english CONTENTS -/- Illness – A Possibility of the Living Being Prolegomena to the Philosophy of Human Illness ............................................. 127 -/- Excursus Sketchy considerations regarding the problems of Christian medicine and Christian healing ...................................................... 135 -/- A dialogue-attempt with Aristotle: Dynamis, energeia, entelecheia, and steresis ...................................................... 147 . (shrink)

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do (...) not lose the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

This article explores the Nuffield Council on Bioethics’ recent report about non-invasive prenatal testing. Given that such testing is likely to become the norm, it is important to question whether there should be some ethical parameters regarding its use. The article engages with the viewpoints of Jeff McMahan, Julian Savulescu, Stephen Wilkinson and other commentators on prenatal ethics. The authors argue that there are a variety of moral considerations that legitimately play a significant role with regard to (prospective) parental decision-making (...) in the context of NIPT, for example, views on the morality of abortion and understandings of the impact of disability on quality of life. The variable nature of such considerations, both singularly and combined, suggests that any approach to NIPT should be sensitive to and understanding of similarly variable parental assessments and decisions. The implications of the approach developed for current and future policies in this area are explored, along with the impact of such arguments on ideas about procreative beneficence. (shrink)

This conversational opinion article between two parties – Kate, a disability performance scholar and Sarah, an interdisciplinary artist-scholar with lived experience of disability – considers the dancing body as redeemer in the specific case of a dancer experiencing ‘chemo fog’, or Chemotherapy-Related Cognitive Impairment (CRCI) after undergoing oncological treatments for Hodgkin Lymphoma. This work draws on Pini’s own lived experience of illness (Pini & Pini, 2019) in dialogue with Maguire-Rosier’s study of dancers with hidden impairments (Gibson & Maguire-Rosier, 2020). (...) In an exploratory account based on an interview with one another, the authors ask: when our senses and perceptions of ourselves and the world we become are obfuscated, what is the nature of the new relationship between the performing self and its absent body/mind/world? How can we shape our narrative and articulate who we are, what we are doing or where we are going, if we are moving in the ‘fog’? Our discussion reveals how Pini’s dancing body elucidates healing, while recovering an agentic perspective in her experience of alienation and frustration tied to chemo fog and related impairments. With this work we offer an original perspective on how a dancing body can resist theoretical diagnosis. (shrink)

Many people report that reading first-person narratives of the experience of illness can be morally instructive or educative. But although they are ubiquitous and typically sincere, the precise nature of such educative experiences is puzzling—for those narratives typically lack the features that modern philosophers regard as constitutive of moral reason. I argue that such puzzlement should disappear, and the morally educative power of illness narratives explained, if one distinguishes two different styles of moral reason: an inferentialist style that (...) generates the puzzlement and an alternative exemplarist style that offers a compelling explanation of the morally educative power of pathographic literature. (shrink)

The notion of a simulating termination analyzer is examined at the concrete level of pairs of C functions. This is similar to AProVE: Non-Termination Witnesses for C Programs. The termination status decision is made on the basis of the dynamic behavior of the input. This paper explores what happens when a simulating termination analyzer is applied to an input that calls itself.

In an era of dramatic technological progress, the consequent economic transformations, and an increasing need for an adaptable workforce, the importance of education has risen to the forefront of the social discourse. The concurrent increase in the awareness of issues pertaining to social justice and the debate over what this justice entails and how it ought to be effected, feed into the education policy more than ever before. From the nexus of the aforementioned considerations, a concern over the so-called education (...) gap has emerged, with worldwide efforts to close it. I analyse the premises behind such efforts and demonstrate that they are founded upon fundamentally flawed ideas. I show that in a society in which education is delivered equitably, education gaps emerge naturally as a consequence of differentiation due to talents, the tendency for matched mate selection, and the heritability of intellectual traits. Hence, I issue a call for a refocusing of efforts from the ill-founded idea of closing the education gap, to the understanding of the magnitude of its unfair contributions, as well as to those social aspects which can modulate it in accordance to what a society deems fair according to its values. (shrink)

In her book, Illness as Metaphor, Susan Sontag focuses on metaphors and myths on diseases such as cancer and tuberculosis, which occur in different historical periods. Sontag argues that the metaphors produced related to illness overhaul illness and the things that define illness now have become metaphors produced related to them rather than their concrete and physical aspects. Illness becomes not just an illness, but a phenomenon defined by evil, mystery, fear, evil, madness, passions, (...) wealth and poverty, temporal loginess or speed, and a set of metaphors or myths that are spatially identified with the space. Metaphors and myths turn into means of socially stigmatizing the illness itself rather than giving a meaning to illness. The disease literally turns into a situation that needs to be hidden in order to avoid social stigma. The explanation of mass diseases through metaphors and myths has been seen since ancient times and this understanding of mass diseases continues to exist today. As a matter of fact, the Covid-19 pandemic has also ceased to be the subject of only medical science since it first emerged, and it has turned into an issue that concerns many areas from politics to economics, from sociology to psychology. The metaphors generated on the Covid-19 disease, which we have witnessed its reflections in many areas from the discourses of daily life to the discourse of politicians, from art to literature, have a similar function with the metaphors attributed to diseases like cancer and tuberculosis that Sontag discussed. Covid-19 is not only seen as a disease, but as a disease defined by a series of metaphors such as mysterious, evil, invisible enemy, insidious danger, and democratic virus. The metaphors generated on the disease cause the struggle against the disease itself to be explained with various metaphors. The metaphors derived from Covid-19 such as "invisible enemy" and "biological war" cause the struggle against it to be turned into a military terminology, and the metaphor of "Chinese virus" is a means of social stigmatization / marginalization by racializing the virus directly. This study tackles the issue of how Covid-19, which is the subject of medical science, has become the subject of unscientific myths and metaphors attributed to the disease, and that the disease is perceived through metaphors rather than itself in the context of Susan Sontag's thought. In the study, answers for the questions of what kind of effects appeared due to the stigmatizing power of metaphors derived from the Covid-19 and whether the metaphors are the outcomes of the strategy for coping with the pandemic will be sought. (shrink)

Exemption from blameworthiness is often bound to implicit or explicit claims of diminished agency, or even non-agency. This poses a dilemma in navigating moral relationships affected by mental illness. While it is crucial for assessments of responsibility to be responsive to the significance of mental illness, must this responsiveness come at a cost to symmetrical moral relations? In this paper we argue, contra recent critiques, that Strawsonian accounts of responsibility are able to navigate this dilemma, and can accommodate (...) significant exculpation on the basis of mental illness while maintaining symmetrical relations. We understand this to be part of the larger recognition that while we have certain fundamental entitlements within our moral relationships, it is also possible to be over-entitled, and to expect too much of others. Our account draws, in particular, on the moral significance of difficulty. Difficulty is inherently scalar, and in drawing on this explanatory framework we explicate a theory of both excuse and exemption by degree. We argue for a significant realm of excuse on the basis of mental illness that is fully compatible with symmetrical relations. However, we also acknowledge the limits of this accommodation on Strawsonian grounds, and argue that these limits are justified and appropriate. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and (...) that which belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

An essay review of Havi Carel, 'Phenomenology of Illness' (OUP 2015).

Any foreign manufacturer desiring to market its products in Jordan has several courses open to it. The foreign manufacturer could establish a branch or wholly-owned subsidiary in Jordan or enter into a licensing or joint venture agreement with a company doing business in Jordan. If it wants a less significant presence, however, it is left with the alternative of having a local commercial agent market and sells its products. -/- The purpose of this article is to study certain aspects-exclusivity and (...) termination- of commercial agency according to the Jordanian law. The article is divided into four sections. Section two explains the general rules governing commercial agency in Jordan. Section three analyzes exclusivity of commercial agents. This section introduces the WTO's General Agreement on Trade in Services (GATS), the basic instrument covering trade in services, and analyses the current commercial agencies regulation in Jordan and its relation to articles VIII and IX of GATS. Also, section two explores Jordan schedule of specific commitments under the GATS in order to shed light on the extent and limit of its obligations with regard to commercial agents. Section four discusses agency termination. Finally, the article concludes by summarizing the main. (shrink)

Prof. Cohen and I answer six questions: (1) Why do we lock people up? (2) How can involuntary civil commitment be reconciled with people's constitutional right to liberty? (3) Why don't we treat homicide as a public health threat? (4) What is the difference between legal and medical approaches to mental illness? (5) Why is mental illness required for involuntary commitment? (6) Where are we in our efforts to understand the causes of mental illness?

Depression is a common and devastating instance of ill-being which deserves an account. Moreover, the ill-being of depression is impacted by digital technology: some uses of digital technology increase such ill-being while other uses of digital technology increase well-being. So a good account of ill-being would explicate the antecedents of depressive symptoms and their relief, digitally and otherwise. This paper borrows a causal network account of well-being and applies it to ill-being, particularly depression. Causal networks are found to provide a (...) principled, coherent, intuitively plausible, and empirically adequate account of cases of depression in every-day and digital contexts. Causal network accounts of ill-being also offer philosophical, scientific, and practical utility. Insofar as other accounts of ill-being cannot offer these advantages, we should prefer causal network accounts of ill-being. (shrink)

Definying illness is not an easy process, nor from medical perspective nor from theological one or individual perspective. However, the most important and truely significant seems to be the latter; how the contemporary man defines illnesses and how he uses this process to redefine his true being. Nowadays we face an obvious spiritual crisis meant to urge each of us to start a new process of redefining our spiritual identity. This paper is intented to remind us of the essence (...) of our being on the one hand and of the Christian duty to fight against illness on the other hand, to bear permanently with us the model of Jesus, of the Holly Parents, who were subject to deseases also out of reasons that are related to God’s iconomy. The limits of medicine are visible there where miracles start to reveal themselves and the healing of the body symbolizes and announces the healing of the entire Being. (shrink)

COVID-19 virus caused drastic changes in people's lives, especially in terms of employment. Employees were greatly impacted by this pandemic, as there were terminated from their jobs. This study investigated how depression affects terminated workers and how they manage it throughout the pandemic. -/- A qualitative design was employed to perform this study. A structured type of interview was conducted on five samples using an online platform. To establish the number of samples required for the investigation, convenience sampling was used. (...) The data was analyzed in-depth using a narrative technique, which resulted in the study's findings and conclusions. Five (5) terminated employees such as professional photographer, construction worker, hairdresser, driver, and varsity coach were among the participants. -/- The participants in this study were found to experience depression due to family financial issues caused by the loss of a job during the pandemic. Participants reported feelings of sadness and loneliness, as well as inability to think, low self-esteem, insomnia and hypersomnia, a lack of ambition to accomplish anything, and suicidal or negative thoughts. Accordingly, through their families' emotional support, the participants have been able to overcome their depression. (shrink)