This essay explores how strategies integral to inquiry in the humanities provide insights into developing an interdisciplinary approach to studies of death and dying that will be relevant to medical practice as well as to humanistic study. The author asks how we can produce new modes of knowledge in an area where “knowing” is highly problematized and argues that while a putative field of death and dying studies must include a range of disciplinary approaches it must (...) also account for lived, subjective experience and the ways that we, as individuals and as a culture, create meaning. (shrink)
This article addresses death as a biological event and attempts to approach it as a mystery within the light of the Orthodox Christian theology and tradition. First, the value of the last moments of the life of a human being is analyzed; then the state of living is differentiated from the state of surviving that results, in some extreme cases, from the intrusion of technology in medicine. The article elaborates on the sacred and spiritual character of death which, (...) when viewed within the light of Christ's resurrection, is transformed into a great blessing. The last part of the article focuses on the newly emerged issue of euthanasia and the reasons behind it. It poses certain vital questions that ought to be answered before legalization gets on its way. Finally, the conclusion summarizes the position of the Orthodox Church of Greece on death, dying and euthanasia. (shrink)
This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total response rate of (...) 68 per cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances. (shrink)
Background The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the three major monotheistic (...) religions. Methods We searched MedLine using PubMed in order to retrieve and thematically analyze full-length scholarly journal papers or case reports dealing with religious traditions and end-of-life care. Our search consisted of a string of words that included the most common denominations of the three religions, the standard heading terms used by the National Reference Center for Bioethics Literature (NRCBL), and the Medical Subject Headings (MeSH) used by the National Library of Medicine. Eligible articles were limited to English-language papers with an abstract. Results We found that while a bibliographic search in MedLine on this topic produced instant results and some valuable literature, the aggregate reflected a selection bias. American writers were over-represented given the global prevalence of these religious traditions. Denominationally affiliated authors predominated in representing the Christian traditions. The Islamic tradition was under-represented. Conclusion MedLine's capability to identify the most current, reliable and accurate information about purely scientific topics should not be assumed to be the same case when considering the interface of religion, culture and end-of-life care. (shrink)
The word ‘dignity’ is a staple of contemporary American medical ethics, where it often follows the words ‘death with’. People unfamiliar with this usage might expect it to apply to one’s manner of dying—for example, a stately exit involving ceremonial farewells. Instead, conventional usage generally holds that “death with dignity” ends or prevents life without dignity, by which is meant life marked not by buffoonery, but by illness and disability. Popular examples of dignity-depleters include dementia, incontinence, and (...) being “dependent on machines”—provided the machines are respirators rather than furnaces, refrigerators, and computers. (shrink)
This article seeks to present for the first time a more systematic account of Edith Stein’s views on death and dying. First, I will argue that death does not necessarily lead us to an understanding of our earthly existence as aevum, that is, an experience of time between eternity and finite temporality. We always bear the mark of our finitude, including our finite temporality, even when we exist within the eternal mind of God. To claim otherwise, is (...) to make identical our eternity with God’s eternity, thereby undermining the traditional Scholastic argument, which Stein holds, that there is no real relation between the being (and, therefore, (a)temporality) of God and the being of human persons. Second, I will argue that Stein excludes the category of potentiality from her discussion of death as a relation between the fullness or actuality of being and nothingness. In fact, death is more a relation between possibility/potentiality and nothingness than a relation between actual fullness and nothingness. What Stein describes as fullness ought to be read as potential. (shrink)
This paper argues that the world-wide debate about physician assisted dying is missing a golden opportunity to focus on the orchestration of the end of life. Such a process consists of far more than adequate pain control and is a skill which, like all other skills, needs to be learned and taught. The debate offers an opportunity to press for the teaching of this skill. Beyond this, the desire to assure that all can have access to palliative care makes (...) sense only within the embrace of a universal health-care system and the desire that all can have a death with dignity is meaningful only within the embrace of a life with dignity. (shrink)
Offers over forty stories about individuals who have dealt with the loss of a loved one, and advice on handling situations surrounding death and dying such as talking with children about grief, suicide, and funeral arrangements.
This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally cause the (...) class='Hi'>death of their patients and that vital organs can be obtained only from dead donors. The aim of this book is to undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. This involves exposing the misconception that stopping life support merely allows patients to die from their medical conditions, that there is an ethical bright line separating withdrawal of life support from active euthanasia, and that determination of death of hospitalized patients prior to vital organ donation is consistent with the established biological conception of death. A novel ethical justification is required for procuring vital organs from still-living donors. It is contended that in the context of plans to withdraw life support, donors of vital organs are not harmed or wronged by organ procurement prior to death, provided that valid consent is obtained for stopping treatment and organ donation. In view of serious practical difficulties in facing the truth regarding organ donation, an alternative pragmatic account is developed for justifying current practices that relies on the concept of transparent legal fictions. In sum, it is the thesis of this book that to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics. (shrink)
No law in any jurisdiction that permits physician assisted dying offers individuals a medically assisted death without the need to comply with certain criteria. The Netherlands is no exception. There is evidence to suggest that physicians are averse to providing an assisted death even when the Dutch ‘due care criteria’ have been met and the unbearable pain and suffering requirement is especially difficult to satisfy. Some individuals with an enduring desire to die who do not meet the (...) ‘due care’ criteria under the Dutch legislation turn to other means of achieving a self-appointed death. This paper explores two alternative methods of securing a self-determined death (an assisted death involving lay assistors or a self-hastened death by stopping eating and drinking), and raises the question of how far the law should recognise autonomy in the context of physician assisted death. (shrink)
Because complex organs taken from unequivocally dead people are not suitable for transplantation, human death has been redefined so that it can be certified at some earlier stage in the dying process and thereby make viable organs available without legal problems. Redefinitions based on concepts of.
This paper examines the reactions of physicians and other health-professionals when they become involved in decisions about the death of their patients. The way people understand the condition of death has a profound influence on attitudes towards death and dying issues. Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is (...) analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary. (shrink)
Objective To determine the public's understanding of and views about a range of ethical issues in relation to death and dying. Design Random, digit-dialling, telephone interview Setting Ireland. Participants 667 adult individuals. Results The general public are unfamiliar with terms associated with end-of-life care. Although most want to be informed if they have a terminal illness, they also value family support in this regard. Most of the respondents believe that competent patients have the right to refuse life-saving treatment. (...) Most also (mistakenly) believe that families, either alone or with physicians, have the authority to make decisions about starting or stopping treatment for incompetent patients. Most Irish people are more concerned about the quality of their dying than death itself. Religious commitment is important to most Irish people, and this impacts on their views about medical treatment and care at the end of life. Conclusions The study paints a picture of a general public that is not very comfortable with or informed about the processes of dying and death. Great sensitivity is required of health professionals who must negotiate the timing and the context of breaking of bad news with patients and families. Educational interventions, public and organisational policies and legislation need to address the uncertainty that surrounds the role of professionals and families in making decisions for dying patients. (shrink)
The essay is intended to shed light on the back-stage of contemporary debates about death and the dying, and more specifically on newer trends that emphasise the importance of ‘dying well’ and the moral viability of a ‘good death’. It raises the question as to whether there is a hidden conceptual link between the high medieval tradition of ars moriendi and the modern trend towards embracing (assisted) suicide as a final expression of human autonomy and suggests (...) that this link becomes visible only when death is theologically understood in a twofold way: according to its spiritual side on the one hand, and according to its physical on the other. Drawing inspiration from Bonhoeffer’s exposition of the biblical myth of the Fall and his insights into the link between thanatos and techne, the essay suggests that the compulsive fashion in which modern societies tend to shy away from any contact with the dying that is not mediated by technology or bureaucracy is owed to their refusal to acknowledge the dual character of death, as it is open to theological analysis. (shrink)
The modern West has vigorously sought to overcome death, or at the very least minimize the suffering that it entails. Whereas the former has been predominantly pursued through modern scientific medicine, the minimization of the adversity of death and dying has been sought through ‘death technologies’. This technologization of death is analyzed in light of Martin Heidegger’s phenomenological philosophy. The analysis begins with an outline of the fundamental tenets of Heidegger’s ‘philosophy of Being’. In turn, (...) his philosophical framework is utilized to highlight the manner in which the technologization of dying serves to conceal the central existential questions about being and finitude that dying gives rise to. The paper concludes with a discussion of how Heidegger’s work can inspire a more authentic stance toward dying. Leo Tolstoy’s The Death of Ivan Ilych is referred to in order to illustrate Heidegger’s construal of this existential struggle toward dying. Indo-Pacific Journal of Phenomenology , Volume 5, Edition 1 April 2005. (shrink)
This project was undertaken to ascertain the perceptions of a group of Taiwan’s fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because (...) little is known about how Taiwan’s nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students’ reported needs during the dying process were directed towards three main goals: (1) help in reaching the ‘triple targets of individual life’; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife. (shrink)
Fundamental principles : the nature of the dispute -- Types of euthanasia -- Psychiatric assisted suicide -- Neonates -- Incompetent adults -- Human life is sacred -- The slippery slope -- Medical views -- Four methods of easing death and their effect on doctors -- Looking further ahead.
The main theme of the article is the tension between the obligation to preserve life, and the value of timely death. This tension is resolved by distinguishing between precipitating death, which is prohibited, and merely removing an impediment to it, which is permitted. In contemporary Jewish law, a distinction is made between therapy, which may be discontinued, and life-support, which must be maintained until the establishment of death. Another theme is that of “soft” patient autonomy, and its (...) role in dealing with the dying in both traditional Jewish law and Israel’s Terminal Patient Law, 2005. Preventing suffering in relation to a dying person, and praying for his or her death are also discussed in the article. (shrink)
Abstract This article explores interview data from a study of 50 Norwegian generalist nurses' focus group accounts of caring for dying patients in the hospital and care home. An eclectic discourse analytic approach was applied to nurses' accounts of the patient and three discursive contexts of reference to the patient were identified: the 'taken as read' patient, the patient paired with particular characteristics and the patient as psychologically present. Talk about the patient falls mainly into the first two contexts, (...) which position the patient in relation to three closely related discursive processes: individualization, anonymization and objectification. The third context presents the patient as a person with a particular identity. The analysis is discussed in a broader philosophical and sociological context in which we return to some of the theoretical work on death and dying of the 1990s and the topic of sequestration. We suggest that nurses' talk about the patient can be heard to participate in a continuing sequestration of the dying patient in healthcare institutions focused on 'result-oriented' care. (shrink)
With so much attention being paid to the development and refinement of appropriate criteria and tests for death, little attention has been given to the broader conceptual issues having to do with its definition or with the relation of a definition to its criterion. The task of selecting the correct criterion is, however, virtually impossible without proper attention to the broader conceptual setting in which the definition operates as the key feature. All of the issues I will discuss arise (...) because of this lack of concern with conceptual matters. Such problems as incorrectly diagnosing a patient as dead prior to the harvesting of his or her organs, defending the idea that death is reversible, and advocating a brainstem criterion of death, are all, I believe, errors that derive from this misplaced emphasis. (shrink)
In Plato’s Apology (29a-b), Socrates agues that he does not fear death; indeed, to fear death is a sign of ignorance. It is to claim to know what one in fact does not know (Ap. 29 a-b). Perhaps, Socrates suggests, death is not a great evil after all, but “the greatest of all goods.” At the end of the dialogue, after the judges have voted on the final verdict and Socrates has received the death penalty, the (...) philosopher considers two common views of death: that death is a long dreamless sleep and that death is a journey to another place - Hades. According to Socrates, either of these views of death would be acceptable to him; the one, because he would receive a wonderful rest with no dreams to disturb him; the other, because he would be able to talk philosophy with those who had gone before with impunity. In this paper, I will examine Socrates’ view of death, and I will argue that, according to Socrates, there could be a third perspective on death that will not only make him truly immortal in a certain way, but will also immortalize the practice of Socratic philosophy. Hence, Socrates embraces his sentence because dying at the right time and dying in the right way provides him the possibility of a good death. <br><br>. (shrink)
As Second Corinthians reveals, Paul forged his theology of the resurrection on the anvil of crisis. In opposition to rival apostles who preached a gospel celebrating success and self, Paul links the resurrection with the crucifixion and exhorts the Corinthians to live not for themselves but “for him who for their sake died and was raised.”.
In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that the doctrine of double (...) effect is not recognized in UK law (and similar jurisdictions); therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. (shrink)