As the team in this volume shows through groundbreaking research, surveys, interviews, and vignettes, death awareness has grown strong, and has changed the way ...

Drawing from religion and the human sciences, particularly psychology after Freud, the author attempts to demonstrate that the fear of death is man's central ...

The use of terminal sedation to control theintense discomfort of dying patients appearsboth to be an established practice inpalliative care and to run counter to the moraland legal norm that forbids health careprofessionals from intentionally killingpatients. This raises the worry that therequirements of established palliative care areincompatible with moral and legal opposition toeuthanasia. This paper explains how thedoctrine of double effect can be relied on todistinguish terminal sedation from euthanasia. The doctrine of double effect is rooted inCatholic moral casuistry, but (...) its applicationin law and morality need not depend on theparticular framework in which it was developed. The paper further explains how the moral weightof the distinction between intended harms andmerely foreseen harms in the doctrine of doubleeffect can be justified by appeal to alimitation on the human capacity to pursue good. (shrink)

This standard work in thanatology is updated with ten essays new to the second edition, and features a new introduction by Donnelly. The collection addresses certain basic issues inherent in a philosophy of death.

The prolonged life support of individuals with no hope for recovery has been an unfortunate consequence of recent advances in medical technology. The use of intensive therapy in such patients is contrary to the physician's obligation to relieve suffering and also creates an enormous economic burden for society. Once the physician has determined that there is no hope for a meaningful recovery, it becomes ethically correct for him to withhold or withdraw intensive therapy from that patient provided that such an (...) action will not increase the patient's suffering. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

In the first part of this talk I show how some ideas in the new "4EA" branch of cognitive science (embodied, embedded, extended, enactive, affective), which gets away from the computer metaphor to talk about affective cognition as the direction of action of an organism, can be illuminated by Deleuze's ontology. Now that may sound ridiculous, as Deleuze's terminology is notoriously baroque – how could it ever "illuminate" anything? So I'm going to be using plain English translations of his concepts; (...) I think his concepts are too good, too useful, for his terminology to be such a barrier to entry. Then I'm going to use this mixture of Deleuze and 4EA ideas to examine a case study which has, besides its metaphysical and psychological implications, some ethical, political, and legal ones as well. So to deal with them we'll deal just a bit with Agamben and Foucault. (shrink)

Who should decide? In When Doctors Say No, philosopher and bioethicist Rubin examines this controversial issue.

In two recent papers, Hugh McLachlan, Jacob Busch and Raffaele Rodogno have criticised my new perspective on euthanasia. Each paper analyses my argument and suggests two flaws. McLachlan identifies what he sees as important points regarding the justification of legal distinctions in the absence of corresponding moral differences and the professional role of the doctor. Busch and Rodogno target my criterion of brain life, arguing that it is a necessary but not sufficient condition and that it is not generalisable. In (...) this paper I indicate flaws in all of these criticisms, and again suggest that my perspective does add something new to the debate. (shrink)

It is widely accepted in clinical ethics that removing a patient from a ventilator at the patient’s request is ethically permissible. This constitutes voluntary passive euthanasia. However, voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient’s life, is ethically proscribed, as is assisted suicide, such as providing a patient with lethal pills or a lethal infusion. Proponents of voluntary active euthanasia and assisted suicide have argued that the distinction between killing and (...) letting die is flawed and that there is no real difference between actively ending someone’s life and "merely" allowing them to die. This paper shows that, although this view is correct, there is even less of a distinction than is commonly acknowledged in the literature. It does so by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations: if a patient is mentally competent and wants to die, his body itself constitutes unwarranted life support unfairly prolonging his or her mental life. (shrink)

Disorders of consciousness and the permanent vegetative state -- Legal and political wrangling over Terri's life -- In context--law and ethics -- Terri's wishes -- The limits of evidence -- The implications of surrogacy -- Qualities of life -- Feeding -- The preservation of life -- Respect and care : an alternative framework.

The great irony of the work of right-to-life advocates who sought in vain to prolong Terri Schiavo's life is that all the publicity about the case has triggered a surge in the number of people completing advance declarations, making it clear that they do not wish to continue to live in circumstances like those in which Schiavo lived for the fifteen years before her death. Thus, the fight over the removal of Schiavo's feeding tube is likely to significantly increase the (...) number of feeding tubes removed. More broadly, the case has revived interest in the full range of right-to-die questions, including issues like active voluntary euthanasia and physician-assisted suicide-which, because they require a patient to be competent to make decisions, raise ethical questions very different from those at issue in the Schiavo case. (shrink)

: Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead and that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be (...) to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law—such as authorizing procuring surgeons to end the lives of patients by means of organ procurement—and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained. (shrink)

" Journal of the American Medical Association "Walton has made a successful attempt to write about medical concerns without ever leaving the layperson to ...