Abstract Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical–ethical discussions in the opinion sections of medical and nursing journals. Some argue that CSD is morally equivalent to physician-assisted death (PAD), that it is a form of “slow euthanasia.” A qualitative thematic content analysis of opinion pieces was conducted to describe and classify arguments that support or reject a moral difference between CSD and PAD. Arguments pro (...) and contra a moral difference refer basically to the same ambiguous themes, namely intention, proportionality, withholding artificial nutrition and hydration, and removing consciousness. This demonstrates that the debate is first and foremost a semantic rather than a factual dispute, focusing on the normative framework of CSD. Given the prevalent ambiguity, the debate on CSD appears to be a classical symbolic struggle for moral authority. Content Type Journal Article Category Original Research Pages 1-13 DOI 10.1007/s11673-012-9369-8 Authors Sam Rys, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium Reginald Deschepper, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium Freddy Mortier, End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium Luc Deliens, End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium Douglas Atkinson, Interfacultair Departement voor Taalonderwijs (ITO), Vrije Universiteit Brussel, Brussels, Belgium Johan Bilsen, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussel, Belgium Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529. (shrink)
The relatively new practice of continuous sedation at the end of life (CS) is increasingly being debated in the clinical and ethical literature. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assisted suicide (PAS) unnecessary, as CS could alleviate even the most severe suffering. This view has been widely adopted. In this article, we perform an in-depth analysis of four versions of this ?argument of preferable alternative.? Our goal (...) is to determine the extent to which CS can be considered to be an alternative to PAS and to identify the grounds, if any, on which CS may be ethically preferable to PAS. (shrink)
Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives (...) and patients.We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases. (shrink)
Abstract The paper is meant to be a contribution to the study of Indian and comparative ethics. It treats the Vajj?laggam, an anthology of Pr?krit stanzas (subh?sita literature) dealing with a variety of topics. Focusing on the ?ethical? sections of the VL, it tries to describe and analyse its underlying ethical system. In Part I the different ethical themes of the VL (Valour and Destiny, Virtues and Vices, Masters and Servants, Friendship and Affection, Poverty and Charity) are described in detail. (...) In Part II it is shown that the VL. offers a clear example of a virtue ethic with a strong emphasis on self?regarding virtues (gunas), based on a pluralistic and instrumental theory of the good. The paper also treats the crucial ethical problem of the relationship between personal well?being and virtuousness as described in the VL. (shrink)
The paper is meant to be a contribution to the study of Indian and comparative ethics. It treats the Vajj laggam, an anthology of Pr krit stanzas (subh sita literature) dealing with a variety of topics. Focusing on the 'ethical' sections of the VL, it tries to describe and analyse its underlying ethical system. In Part I the different ethical themes of the VL (Valour and Destiny, Virtues and Vices, Masters and Servants, Friendship and Affection, Poverty and Charity) are described (...) in detail. In Part II it is shown that the VL. offers a clear example of a virtue ethic with a strong emphasis on self-regarding virtues (gunas), based on a pluralistic and instrumental theory of the good. The paper also treats the crucial ethical problem of the relationship between personal well-being and virtuousness as described in the VL. (shrink)
Abstract The structure of value education in Flanders is deeply shaped by segregation, i.e. a pattern of separate social organisation based on world view. Several religious authorities are officially recognized which control their own course in the community and official schools. A course of non?denominational ethics is offered to students who do not identify with a recognized religion. Representatives of the catholic and of the humanist groups base the legitimacy of separate value education on the claim that students of respectively (...) the Roman Catholic and the ethics course reflect the sociomoral diversity in the wider population. A newly devised Dutch adaptation of the DIT and a questionnaire were administered to 631 secondary school students from the highest two grades. It was found that either (1) values education in the Flemish schools has no or very little effect on the students as far as moral reasoning is concerned, or (2) that values education in the Flemish schools does have an effect on the moral reasoning skills of the students, but that the respective populations of the courses are not influenced in an appreciably different way. (shrink)