I am writing a mediocre paper on a topic you are not particularly interested in. You don't have, it seems safe to assume, a (normative) reason to read my draft. I then ask whether you would be willing to have a look and tell me what you think. Suddenly you do have a (normative) reason to read my draft. By my asking, I managed to give you the reason to read the draft. What does such reason-giving consist in? And how (...) is it that we can do it? In this paper, I characterize what I call robust reason giving, the kind present in requests. I distinguish it from epistemic and merely triggering reason-giving, I discuss in detail the phenomenology of robust reason-giving, and I offer an analysis of robust reason-giving in terms of the complex intentions of the reason-giver and of the normative background. (shrink)
I am writing a mediocre paper on a topic you are not particularly interested in. You don't have, it seems safe to assume, a (normative) reason to read my draft. I then ask whether you would be willing to have a look and tell me what you think. Suddenly you do have a (normative) reason to read my draft. What exactly happened here? Your having the reason to read my draft – indeed, the very fact that there is such a (...) reason – depends, it seems, on my having asked you to read it. By my asking, I managed to make it the case that you have such a reason, or to give you the reason to read the draft. What does such reason-giving consist in? And how is it that we can do it? In the next section, I distinguish between purely epistemic reason-giving, merely triggering reason-giving, and the kind of reason-giving I will be primarily interested in, the kind presumably involved in requests, which I call robust reasongiving. Then, in section 3, I try to characterize in some detail the intuitive or phenomenological data. I try, in other words, to clarify what it is we want an account of robust reason-giving to accommodate. But at the end of section 3 it remains entirely open whether any possible account in fact satisfies the desiderata elaborated in that section. In section 4 I thus proceed to inquire whether such an account is there to be found. I argue that the only plausible way of making sense of robust reason-. (shrink)
I greatly enjoy meeting with all of you today, because I see you are all especially capable and intelligent young people. In the future you certainly can help America to be even better; you can cause its glory to be even greater. Today I would like to thank Professor Lancaster very much for inviting me here to meet with all of you. I fully see this professor's methods, by which he is able to cause your knowledge to increase daily. So, (...) day by day you have new things to learn. One can say that among present-day professors, his professorial methodology represents a very special kind of genius. I hope that you will all be able to receive this professor's continually fine inducement. Since your professor teaches you in this way, none of you should be ungrateful for the hopes which he has for you. (shrink)
Although it seems intuitively clear that acts of requesting are different from acts of commanding, it is not very easy to sate their differences precisely in dynamic terms. In this paper we show that it becomes possible to characterize, at least partially, the effects of acts of requesting and compare them with the effects of acts of commanding by combining dynamified deontic logic with epistemic logic. One interesting result is the following: each act of requesting is appropriately differentiated from an (...) act of commanding with the same content, but for each act of requesting, there is another act of commanding with much more complex content which updates models in exactly the same way as it does. We will also consider an application of our characterization of acts of requesting to acts of asking yes-no questions. It yields a straightforward formalization of the view of acts of asking questions as requests for information. (shrink)
The paper explores the ethical and psychological issues that arise when family members request that "everything possible" be done for a particular patient. The paper first illustrates this phenomenon by reviewing the well known case of Helga Wanglie. We proceed to argue that in Wanglie and similar cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not be abandoned (...) or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand. We maintain that families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients' dignity and comfort, rather than by applying futile interventions. Keywords: medical futility, medical decision-making, palliative care, autonomy, paternalism CiteULike Connotea Del.icio.us What's this? (shrink)
We propose that in addition to children's requests for word names being a reflection of an understanding of the referential nature of words, they may also be requests for adult's teaching. These possible requests for teaching among toddlers, along with other indications, suggest that teaching may be a natural cognition that may be related to the development of theory of mind.
Required request policies create clinical, psychological and economic conflicts of interest. They should be repealed or substantially modified to restore public confidence in organ donation.
The offender who desires to restore or maintain a relationship after a conflict apologises to his or her victim. Not only an individual but also a group can make apology. Groups do it through their representatives who are recognised as such by both sides. Sometimes offenders acknowledge wrongdoing and express regret for it. At other times while apologising, they may also ask for forgiveness. Does apology without a request for forgiveness mean the same as apology with such a request? Are (...) there any cases where apology may be appropriate, but not a request for forgiveness? Do those who apologise without asking for forgiveness really not want to be forgiven? This article answers these questions by exploring the notion of apology and its relation to forgiveness. (shrink)
This paper reviews the usefulness of bioethical instruments such as the informed consent principle to handle ethical and political challenges of clinical trials in genotyping and DNA-banking and discusses an informed request model as well as other contractual relations between research institutions, patients, and their families.
Although chimpanzees have been reported to understand to some extent others' visual perception, previous studies using food requesting tasks are divided on whether or not chimpanzees understand the role of eye gaze. One plausible reason for this discrepancy may be the familiarity of the testing situation. Previous food requesting tasks with negative results used an unfamiliar situation that may be difficult for some chimpanzees to recognize as a requesting situation, whereas those with positive results used a familiar situation. The present (...) study tested chimpanzees' understanding of others' attentional states by comparing two requesting situations: an unfamiliar situation in which food was put on a table, and a familiar situation in which chimpanzees requested food held by an experimenter. Chimpanzees showed evidence of understanding the experimenter's attentional variations and the role of eye gaze only in the latter task. This suggests that an unfamiliar requesting situation may keep subjects from expressing their understanding of others' attentional states even though they are sensitive to them. Keywords: Understanding attention; Social cognition; Chimpanzees. (shrink)
John Searle offers what he thinks to be a reasonable scientific approach to the understanding of consciousness. I argue that Searle is demanding nothing less than a Kuhnian-type revolution with respect to how scientists should study consciousness given his rejection of the subject-object distinction and affirmation of mental causation. As part of my analysis, I reveal that Searle embraces a version of emergentism that is in tension, not only with his own account, but also with some of the theoretical tenets (...) of science. I conclude that Searle has offered little to motivate scientists to adopt his proposal. (shrink)
Margaret Otlowski investigates the complex and controversial issue of active voluntary euthanasia. She critically examines the criminal law prohibition of medically administered active voluntary euthanasia in common law jurisdictions, and carefully looks at the situation as handled in practice. The evidence of patient demands for active euthanasia and the willingness of some doctors to respond to patients' requests is explored, and an argument for reform of the law is made with reference to the position in the Netherlands (where active (...) voluntary euthanasia is now openly practiced). (shrink)
In discussions of animal ethics, hypothetical scenarios are often used to try to force the clarification of intuitions about the relative value of human and animal life. Tom Regan requests, for example, that we imagine a man and a dog adrift in a lifeboat while Peter Singer explains why the life of one's child ought to be preferred to that of the family dog in the event of a house fire. I argue that such scenarios are not the usefully (...) abstract analytic tools they purport to be, but indirectly reinforce assumptions that are not only anthropocentric, but also tied to racist, sexist and ethnocentric stereotypes. An analysis of some of the cultural and ethical associations of the notion of self-sacrifice proves especially useful in revealing some of the limitations of certain popular Western approaches to animal ethics. (shrink)
Reeder’s article offers a new and intriguing approach to the study of people’s ordinary understanding of freedom and constraint. On this approach, people use information about freedom and constraint as part of a quasi-scientific effort to make accurate inferences about an agent’s motives. Their beliefs about the agent’s motives then affect a wide variety of further psychological processes, including the process whereby they arrive at moral judgments. In illustrating this new approach, Reeder cites an elegant study he conducted a number (...) of years ago (Reeder & Spores, 1983). All subjects were given a vignette about a man who goes with his date to a pizza parlor and happens to come across a box that has been designated for charitable donations. In one condition, the man’s date then requests that he make a donation; in the other, she requests that he steal the money that is already in the box. In both conditions, the man chooses to comply with this request. The key question is how subjects will use his behavior to make inferences about whether he is a morally good or morally bad person. The results revealed a marked difference between conditions. When the man donated to charity, subjects were generally disinclined to conclude that he must have been a morally good person. It is as though they were thinking: ‘He didn’t just do this out of the goodness of his heart. (shrink)
Managers encounter difficulties in developing corporate social responsibility programmes. These difficulties arise from conflicting interests and priorities. Pressures may be both internal and external and corporate social responsibility programmes usually evolve from a combination of proactive and reactive policies. The first experiences of a company are likely to be reactive, in response to requests for equipment, sponsorship or charitable donations but companies soon become aware of the benefits of planned programmes. Planning implies objectives, performance criteria and evaluation, and a (...) rational framework for decision-taking. This paper attempts to highlight problem areas for managers and to develop a pragmatic framework of analysis which will help identify and clarify corporate social responsibilities. The paper, which is written from a UK perspective discusses the contribution of stakeholder models and highlights limitations of this approach. It develops an ethical framework focused on concepts of responsibility. (shrink)
To assert something is to perform a certain kind of act. This act is different in kind both from other speech acts, like questions, requests, commands, promises, and apologies, and from acts that are not speech acts, like toast buttering and inarticulate yodeling. My question, then is this: what features of an act qualify it as an assertion, and not one of these other kinds of act? To focus on a particular example: in uttering “Bill will close the window,” (...) one might be practicing English pronunciation, asserting that Bill will close the window, or requesting that Bill close the window. What makes it the case that one is doing one of these and not another? (shrink)
This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with (...) so-called early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of (late onset) Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)
That was followed but a deluge of reactions from all over the world. It is far from a scientific sample of course, but nevertheless, the tendencies may be of some interest. Overwhelmingly, those from the “third world†were on the order of “thanks for saying what we think.†There were similar ones from the US, but many others were infuriated, often virtually hysterical, with almost no relation to the actual content of the posted form letter. That was true in particular (...) of the posted or published responses brought to my attention. I have received a few requests to comment on several of these. Frankly, it seems to me superfluous. If there is any interest, I’ll nevertheless find some time to do so. (shrink)
abstract My aim in this paper is to argue that we have at least some obligations to the dead. After briefly considering some previous (unsuccessful) attempts to establish such obligations, I offer a reductio argument which establishes at least some obligations to the dead. Following this, the surprising extent of these obligations (given a few roughly Kantian assumptions) is considered. I then argue that there are and must be some significant limitations on the duties of the living in relation to (...) the dead. My aim in this paper is not to sort out how we should deal with all of the particular cases in which the question of obligations to the dead emerge — in archaeological digs, research involving the newly dead, the execution of wills, or the fulfilment of last requests — but I will attempt to lay some groundwork for the future assessment of these questions. (shrink)
Modern medicine emphasizes treatment of the sick. It is often said that the widespread genetic testing soon to follow the completion of the Human Genome Project will usher in a new era of preventive medicine. Such changes require new ways of thinking, however. For example, there may be nothing clinically wrong with a healthy patient who requests genetic testing, even if the tests reveal disease genes. Since all individuals have genetic skeletons in their closets, it is important to be (...) careful not to confuse having disease genes with having the diseases that they cause. Unfortunately, many in the public have adopted a kind of genetic determinism that sees genes as destiny: for example, having the gene associated with colon cancer means they will develop colon cancer. Physicians tend to be more careful, yet even they are not immune to subtle versions of genetic determinism. One example of this is the uncritical categorization of certain diseases as “genetic”. In fact, an adequate concept of genetic disease is extremely difficult to come by. The simplest notion would require a 1:1 correspondence between a disease and its genes, but this is the exception rather than the rule. For example, cystic fibrosis (CF) is often put forward as a good example of a genetic disease, since it seems to result from mutations in a single gene, CFTR. Even in this case, however, the exact relationship between CFTR mutations and disease is not clear, as virtually every possible combination of sweat chloride test results, genetic test results, and symptoms has been observed.[1] If a patient presents with the classic symptoms of CF and is found to have a mutation in the CFTR gene, the physician might understandably infer that the mutation caused the disease. But if an asymptomatic patient is tested and it is discovered that he or she has a CFTR mutation, it is unclear what this means. The doctor might tell the patient the gene is abnormal and that he or she is likely to develop pulmonary problems, etc., but it’s not really known whether even this qualified prognosis is true.. (shrink)
The objective of this paper is to understand from a sociological perspective how the moral question of euthanasia, framed as the “right to die”, emerges and is dealt with in society. It takes France and Germany as case studies, two countries in which euthanasia is prohibited and which have similar legislation on the issue. I presuppose that, and explore how, each society has its own specificities in terms of practical, social and political norms that affect the ways in which they (...) deal with these issues. The paper thus seeks to understand how requests for the “right to die” emerge in each society, through both the debate (analysis of daily newspapers, medical and philosophical literature, legal texts) and the practices (ethnographic work in three French and two German hospitals) that elucidate the phenomenon. It does so, however, without attempting to solve the moral question of euthanasia. In spite of the differences observed between these two countries, the central issue at stake in their respective debates is the question of the individual’s autonomy to choose the conditions in which he or she wishes to die; these conditions depend, amongst others, on the doctor-patient relationship, the organisation of end-of-life care in hospital settings, and more generally, on the way autonomy is defined and handled in the public debate. (shrink)
1.1 Are commercial societies unfriendly to friendship? Many critics of commercial societies, from both the left and the right, have thought so. They claim that the free-market system of property rights, freedom of contract, and other liberty rights – the “negative” right of individuals to peacefully pursue their own ends – is impersonal and dehumanizing, or even inherently divisive and adversarial. Yet (their complaint goes) the psychology and morality of markets and liberty rights pervade far too many relationships in a (...) commercial society, eroding the bonds of personal and civic friendship. My main aim in this paper is to analyze and evaluate this claim. In this section I will give an overview of the critics’ complaints against various features of the free-market system, discuss the empirical data that might be thought to support their complaints, and show why they largely fail to do so. In Section II I will get to the heart of the matter: the nature of the market and of friendship. I will address the thesis that the modes of valuation proper to production are radically opposed to the modes of valuation proper to friendship, love, sexuality, and so on, arguing that the thesis rests on a misunderstanding of both markets and friendship. A proper understanding of the two reveals that, as voluntary, reciprocal relationships, market relationships and friendship share important moral and psychological properties, and are not the natural enemies, or even the odd bed-fellows, many critics take them to be. In Section III I will address the related thesis that market societies – societies based on the free-market system of property rights, freedom of contract, and other liberty rights - tend to commodify relationships and, thereby, weaken the bonds of personal and civic friendship. I will argue that free markets are the most powerful force for decommidifying or, more generally (since commodification is not the only way of objectifying people), deobjectifying people and relationships.. (shrink)
Dialectical egalitarianism holds that every asserted proposition requires defence when challenged by an interlocutor. This view apparently generates a vicious 'regress of justifications', since an interlocutor can challenge the premises through which a speaker defends her original assertion, and so on ad infinitum . To halt the regress, dialectical foundationalists such as Adler, Brandom, Leite, and Williams propose that some propositions require no defence in the light of mere requests for justification. I argue that the putative regress is not (...) worrisome and that egalitarianism can handle it quite satisfactorily. I also defend a positive view that combines an anti-foundationalist conception of dialectical interaction with a foundationalist conception of epistemic justification. (shrink)
Ape species-specific communication is grounded on the present, possesses some referential qualities and is mostly used to request objects or actions from others. Artificial systems of communication borrowed from humans transform apes' communicative exchanges by freeing them from the present (i.e. displaced reference) although requests still predominate as the main reason for communicating with others. Symbol use appears to enhance apes' relational abilities and their inhibitory control. Despite these substantial changes, it is concluded that even though artificial communication enhances (...) thought and enables its expression more openly, it does not create it or modify the motivation behind communicative exchanges. (shrink)
When people speak, they often insinuate their intent indirectly rather than stating it as a bald proposition. Examples include sexual come-ons, veiled threats, polite requests, and concealed bribes. We propose a three-part theory of indirect speech, based on the idea that human communication involves a mixture of cooperation and conflict. First, indirect requests allow for plausible deniability, in which a cooperative listener can accept the request, but an uncooperative one cannot react adversarially to it. This intuition is sup- (...) ported by a game-theoretic model that predicts the costs and benefits to a speaker of direct and indirect requests. Second, language has two functions: to convey information and to negotiate the type of relationship holding between speaker and hearer (in particu- lar, dominance, communality, or reciprocity). The emotional costs of a mismatch in the assumed relationship type can create a need for plausible deniability and, thereby, select for indirectness even when there are no tangible costs. Third, people perceive language as a digital medium, which allows a sentence to generate common knowledge, to propagate a message with high fidelity, and to serve as a reference point in coordination games. This feature makes an indirect request qualitatively different from a direct one even when the speaker and listener can infer each other’s intentions with high confidence. (shrink)
While there is now considerable experimental evidence that, on the one hand, participants assign to the indicative conditional as probability the conditional probability of consequent given antecedent and, on the other, they assign to the indicative conditional the ?defective truth-table? in which a conditional with false antecedent is deemed neither true nor false, these findings do not in themselves establish which multi-premise inferences involving conditionals participants endorse. A natural extension of the truth-table semantics pronounces as valid numerous inference patterns that (...) do seem to be part of ordinary usage. However, coupled with something the probability account gives us?namely that when conditional-free ? entails conditional-free ?, ?if ? then ?? is a trivial, uninformative truth?we have enough logic to derive the paradoxes of material implication. It thus becomes a matter of some urgency to determine which inference patterns involving indicative conditionals participants do endorse. Only thus will we be able to arrive at a realistic, systematic semantics for the indicative conditional. (shrink)
Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)
Professionals often find themselves in ethical dilemmas and seek the advice of their peers. This article offers a template for those who wish to assist their colleagues in these situations. After making various assumptions, the author lists questions to ask oneself before accepting such requests. Then, a step-by-step framework is offered, followed by recommendations.
The authors empirically examine the nature and extent of ethical problems confronting senior level AICPA members (CPAs) and examine the effectiveness of partner actions and codes of ethics in reducing ethical problems. The results indicate that the most difficult ethical problems (frequency reported) were: client requests to alter tax returns and commit tax fraud, conflict of interest and independence, client requests to alter financial statements, personal-professional problems, and fee problems. Analysis of attitudes toward ethics in the accounting profession (...) indicated that (1) CPAs perceive that opportunities exist in the accounting profession to engage in unethical behavior, (2) CPAs, in general, do not believe that unethical behavior leads to success, and (3) when top management (partners) reprimand unethical behavior, the ethical problems perceived by CPAs seem to be reduced. (shrink)
In recent years, historians David S. Wyman and Deborah E. Lipstadt have contended in carefully documented books that the U.S. media provided inadequate coverage of Holocaust developments. Thus, these historians contend, American media helped create public apathy, which led to inadequate responses of the Roosevelt administration to requests for aid to Holocaust victims. Wyman believes ?several hundred thousand?; Jews might have been saved from gas chambers if the United States had insisted on determined Allied rescue action earlier than belated (...) efforts of the War Refugee Board, established in 1944. This paper examines U.S. media responses to Holocaust news and the reasons for those responses. It contends the objectivity ethic and violations of other ethical standards by U.S. media may have contributed to the magnitude of the Holocaust tragedy. (shrink)
The purpose of this paper is to give a semantical analysis of why-questions. Why-questions will be construed as requests for knowledge. Special attention will be paid to considering what the conditions for conclusive answerhood are in the case of why-questions. Since explanations can often be thought of as answers to why-questions, we also discuss some topics in the theory of explanation.
This article is a response to McLeod and Baylis (2007) who speculate on the dangers of requesting fresh ‘spare’ embryos from IVF patients for human embryonic stem cell (hESC) research, particularly when those embryos are good enough to be transferred back to the woman. They argue that these embryos should be frozen instead. We explore what is meant by ‘spare’ embryos. We then provide empirical evidence, from a study of embryo donation and of embryo donors' views, to substantiate some of (...) their speculations about the problems associated with requesting fresh embryos. However, we also question whether such problems are resolved by embryo freezing, since further empirical evidence suggests that this raises other social and ethical problems for patients. There is little evidence that the request for embryos for research, in itself, causes patients distress. We suggest, however, that no requests for fresh embryos should be made in the first cycle of IVF treatment. Deferring the request to a later cycle ensures that potential donors are better informed (by experience and reflection) about the possible destinations of their embryos and about the definition of ‘spare embryos’. Both this article, and that by McLeod and Baylis, emphasize the need to consider the views and experiences of embryo donors when evaluating the ethics of embryo donation for hESC research. (shrink)
Children often refer to things ambiguously but learn not to from responding to clarification requests. We review and explore this learning process here. In Study 1, eighty-four 2- and 4-year-olds were tested for their ability to request stickers from either (a) a small array with one dissimilar distracter or (b) a large array containing similar distracters. When children made ambiguous requests, they received either general feedback or specific questions about which of two options they wanted. With training, children (...) learned to produce more complex object descriptions and did so faster in the specific feedback condition. They also tended to provide more information when requesting stickers from large arrays. In Study 2, we varied only distracter similarity during training and then varied array size in a generalization test. Children found it harder to learn in this case. In the generalization test, 4-year-olds were more likely to provide information (a) when it was needed because distracters were similar to the target and (b) when the array size was greater (regardless of need for information). We discuss how clear cues to potential ambiguity are needed for children to learn to tailor their referring expression to context and how several cues of heuristic value (e.g., more distracters > say more) can promote the efficiency of communication while language is developing. Finally, we consider whether it would be worthwhile drawing on the human learning process when developing algorithms for the production of referring expressions. (shrink)
Background: The Albanian medical system and Albanian health legislation have adopted a paternalistic position with regard to individual decision making. This reflects the practices of a not-so-remote past when state-run facilities and a totalitarian philosophy of medical care were politically imposed. Because of this history, advance directives concerning treatment refusal and do-not-resuscitate decisions are still extremely uncommon in Albania. Medical teams cannot abstain from intervening even when the patient explicitly and repeatedly solicits therapeutic abstinence. The Albanian law on health care (...) has no provisions regarding limits or withdrawal of treatment. This restricts the individual's healthcare choices.DiscussionThe question of 'medically futile' interventions and pointless life-prolonging treatment has been discussed by several authors. Dutch physicians call such interventions 'medisch zinloos' (senseless), and the Netherlands, as one of the first states to legislate on end-of-life situations, actually regulates such issues through appropriate laws. In contrast, leaving an 'advance directive' is not a viable option for Albanian ailing individuals of advanced age. Verbal requests are provided during periods of mental competence, but unfortunately such instructions are rarely taken seriously, and none of them has ever been upheld in a legal or other official forum.SummaryEnd-of-life decisions, treatment refusal and do-not-resuscitate policies are hazardous options in Albania, from the legal point of view. Complying with them involves significant risk on the part of the physician. Culturally, the application of such instructions is influenced from a mixture of religious beliefs, death coping-behaviors and an immense confusion concerning the role of proxies as decision-makers. Nevertheless, Albanian tradition is familiar with the notion of 'amanet', a sort of living will that mainly deals the property and inheritance issues. Such living wills, verbally transmitted, may in certain cases include advance directives regarding end-of-life decisions of the patient including refusal or termination of futile medical treatments. Since these living wills are never formally and legally validated, their application is impossible and treatment refusal remains still non practicable. Tricks to avoid institutional treatment under desperate conditions are used, aiming to provide legal coverage for medical teams and relatives that in extreme situations comply with the advice of withholding senseless treatment. (shrink)
Speakers often do not state requests directly but employ innuendos such as Would you like to see my etchings? Though such indirectness seems puzzlingly inefficient, it can be explained by a theory of the strategic speaker, who seeks plausible deniability when he or she is uncertain of whether the hearer is cooperative or antagonistic. A paradigm case is bribing a policeman who may be corrupt or honest: A veiled bribe may be accepted by the former and ignored by the (...) latter. Everyday social interactions can have a similar payoff structure (with emotional rather than legal penalties) whenever a request is implicitly forbidden by the relational model holding between speaker and hearer (e.g., bribing an honest maitre d’, where the reciprocity of the bribe clashes with his authority). Even when a hearer’s willingness is known, indirect speech offers higher-order plausible deniability by preempting certainty, gossip, and common knowledge of the request. In supporting experiments, participants judged the intentions and reactions of characters in scenarios that involved fraught requests varying in politeness and directness. (shrink)
Under what conditions is it morally permissible to commit suicide, to assist in someone’s suicide, or to kill another person with his/her consent? Under what conditions is it morally permissible to use force to prevent such acts? I shall defend a libertarian answer to these questions. On this view, autonomous agents initially fully own themselves in the same sense that one can fully own an inanimate object such as a car. Just as full owners of cars are morally permitted, under (...) a broad range of conditions, to destroy their cars or have someone else do so, autonomous agents who fully own themselves are permitted, under a broad range of conditions, to terminate their lives or to have someone else do so. Furthermore, under these conditions, other agents are not permitted to use force to prevent a full self-owner’s consensual death. I shall focus on consensual killing (i.e., with the killed person’s consent) of autonomous agents. This includes suicide, assisting with suicide, voluntary euthanasia, and even cases where a non-sick person requests that another kill her. I shall not address cases of killing that are involuntary (against the will of the person killed) or non-voluntary (where the being killed is not autonomous; e.g., killing animals, children, and incapacitated adults). These are important issues, but they cannot be addressed here. (shrink)
In recent years there has been an increase in the number of requests formercy killings by patients and their relatives. Under certain conditions,the patient may prefer death to a life devoid of quality. In contrast to thosewho uphold this quality of life approach, those who hold the sanctity oflife approach claim that life has intrinsic value and must be preservedregardless of its quality. This essay describes these two approaches,examines their flaws, and offers a golden path between the two extremepositions.We (...) discuss the halachic and the secular views, arguing for a balancebetween the sanctity of life and the quality of life. We argue that, indeed,such a balance exists in practice, and that life is important, but it is not sacred. Life can be evaluated, but quality of life is not the solecriterion. (shrink)
Advances in science are the combined result of the efforts of a great many scientists, and in many cases, their willingness to share the products of their research. These products include data sets, both small and large, and unique research resources not commercially available, such as cell lines and software programs. The sharing of these resources enhances both the scope and the depth of research, while making more efficient use of time and money. However, sharing is not without costs, many (...) of which are borne by the individual who develops the research resource. Sharing, for example, reduces the uniqueness of the resources available to a scientist, potentially influencing the originator’s perceived productivity and ultimately his or her competitiveness for jobs, promotions, and grants. Nevertheless, for most researchers—particularly those using public funds—sharing is no longer optional but must be considered an obligation to science, the funding agency, and ultimately society at large. Most funding agencies, journals, and professional societies now require a researcher who has published work involving a unique resource to make that resource available to other investigators. Changes could be implemented to mitigate some of the costs. The creator of the resource could explore the possibility of collaborating with those who request it. In addition, institutions that employ and fund researchers could change their policies and practices to make sharing a more attractive and viable option. For example, when evaluating an individual’s productivity, institutions could provide credit for the impact a researcher has had on their field through the provision of their unique resources to other investigators, regardless of whether that impact is reflected in the researcher’s list of publications. In addition, increased funding for the development and maintenance of user-friendly public repositories for data and research resources would also help to reduce barriers to sharing by minimizing the time, effort, and funding needed by individual investigators to comply with requests for their unique resource. Indeed, sharing is an imperative, but it is also essential to find ways to protect for both the original owner of the resource and those wishing to share it. (shrink)
It is often claimed that when a nation or group requests that a cultural treasure of importance be returned to it from a foreign museum, this appeal may reasonably be denied on the grounds that compliance would set “a dangerous precedent.” Different versions of this slippery slope argument are identified, analyzed, and criticized, revealing this to be a flawed consideration against repatriation, and a self-defeating form of argument in general. (There may, of course, be other grounds counting against restoring (...) the item.) Particular attention is given to the Elgin marbles, housed in the British Museum since the early 19th century. (shrink)
In his commentary on Aristotle’s Peri hermeneias,1 Abelard distinguishes the form of an expression2 (oratio) from what it says, that is, its content. The content of an expression is its understanding (intellectus). This distinction is surely the most well-known and central idea in Abelard’s commentary. It provides him with the opportunity to distinguish statements (enuntiationes) from other kinds of expressions without implying a diference in their content, since the ability of a statement to signify something true or false (verum vel (...) falsum)3 cannot be found in its content. More precisely, Abelard distinguishes statements both from complete expressions (orationes perfectae) that are not statements but rather questions, requests, commands, etc. and from incomplete expressions, that is, mere word strings (orationes imperfectae), such as homo albus. These kinds of expressions, according to Abelard, do not differ in the understanding they present but in the way they present it. (shrink)
Torture is unethical and usually counterproductive. It is prohibited by international and national laws. Yet it persists: according to Amnesty International, torture is widespread in more than a third of countries. Physicians and other medical professionals are frequently asked to assist with torture. -/- Medical complicity in torture, like other forms of involvement, is prohibited both by international law and by codes of professional ethics. However, when the victims of torture are also patients in need of treatment, doctors can find (...) themselves torn. To accede to the requests of the torturers may entail assisting or condoning terrible acts. But to refuse care to someone in medical need may seem like abandoning a patient and thereby fail to exhibit the beneficence expected of physicians. -/- In this paper, we argue that this dilemma is real and that sometimes the right thing for a doctor to do, overall, is to be complicit in torture. Though complicity in a wrongful act is itself prima facie wrongful, this judgment may be outweighed by other factors. We propose three criteria for analyzing how those factors apply to particular cases of medical complicity in torture. (shrink)
Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of (...) time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. (shrink)
The nationally-famous advocate of physician-assisted suicide did not die by his own hand. Dr. Jack Kevorkian died the old-fashioned way in America: in a hospital, with multiple disorders undercutting his life. Kevorkian took up interest in assisted suicide early in his medical career, and he wanted prisoners on death row to volunteer for experiments just before their execution. Kevorkian saw individual consent as the wheel, axle, and grease for all decisions in these matters. He helped many people die, but it (...) is unclear what moral principle guided his decisions to say yes and no to requests for help in dying. His spree in helping people die came to an end, when he himself injected a man with a lethal substance. Because of his single-minded focus on the value of assisted suicide and experimentation before execution, he had little impact on the broader ethical analysis of assisted-suicide and the rights of prisoners. He leaves little legacy in ethics for the analysis of assisted-suicide or in vivo experimentation. (shrink)
Clinical neuroethics and neuroskepticism are recent entrants to the vocabulary of neuroethics. Clinical neuroethics has been used to distinguish problems of clinical relevance arising from developments in brain science from problems arising in neuroscience research proper. Neuroskepticism has been proposed as a counterweight to claims about the value and likely implications of developments in neuroscience. These two emergent streams of thought intersect within the practice of neurology. Neurologists face many traditional problems in bioethics, like end of life care in the (...) persistent vegetative state, determination of capacity in progressive dementia, and requests for assisted suicide in cognition-preserving neurodegenerative disease (like amyotrophic lateral sclerosis). Neurologists also look to be at the forefront of downstream clinical applications of neuroscience, like pharmacological enhancement of mental life. At the same time, the practice of neurology, concerned primarily with the structure, function, and treatment of the nervous system, has historically fostered a kind of skeptical attitude toward its own subject matter. Not all problems that appear primarily neurological are primarily neurological. This disciplinary skepticism is generally clinical in orientation and limited in scope. The rise of interest in clinical neuroethics and in neuroskepticsim generally suggests a possible broader application. The clinical skepticism of neurology provides impetus for thinking about the appropriate role for skepticism in clinical areas of neuroethics. After a brief review of neuroskepticism and clinical neuroethics, a taxonomy of clinical neuroskepticism is offered and reasons why a stronger rather than weaker form of clinical neuroskepticism is currently warranted. (shrink)
A number of logicians and philosophers have turned their attention in recent years to the problem of developing a logic of interrogatives. Their work has thrown a great deal of light on the formal properties of questions and question-sentences and has led also to interesting innovations in our understanding of the structures of performatives in general and, for example, in the theory of presuppositions. When, however, we examine the attempts of logicians such as Belnap or Åqvist to specify what, precisely, (...) a question is, or what it is to ask or raise a question, then what we are offered is somewhat less illuminating. Two alternative reductionist accounts seem in particular to have gained most favor: questions are identified either as special sorts of statements, or as special sorts of requests. As we hope will become clear in what follows, neither of these accounts is even nearly adequate; and matters are not improved if questions are identified, by force majeure, as combinations of statements and requests. (shrink)
Elephant 2000 is a proposed programming language good for writing and verifying programs that interact with people (eg. transaction processing) or interact with programs belonging to other organizations (eg. electronic data interchange) 1. Communication inputs and outputs are in an I-O language whose sentences are meaningful speech acts identified in the language as questions, answers, offers, acceptances, declinations, requests, permissions and promises. 2. The correctness of programs is partly defined in terms of proper performance of the speech acts. Answers (...) should be truthful and responsive, and promises should be kept. Sentences of logic expressing these forms of correctness can be generated automatically from the form of the program. 3. Elephant aource programs may not need data structures, because they can refer directly to the past. Thus a program can say that an airline passenger has a reservation if he has made one and hasn't cancelled it. 4. Elephant programs themselves can be represented as sentences of logic. Their extensional properties follow from this representation without an intervening theory of programming or anything like Hoare axioms. 5. Elephant programs that interact non-trivially with the outside world can have both input-output specification, relating the programs inputs and outputs, and accomplishment specifications concerning what the program accomplishes in the world. These concepts are respectively generalizations of the philosophers' illocutionary and perlocutionary speech acts. 6. Programs that engage in commercial transactions assume obligations on behalf of their owners in exchange for obligations assumed by other entities. It may be part of the specification of an Elephant 2000 program that these obligations are exchanged as intended, and this too can be expressed by a logical sentence. 7. Human speech acts involve intelligence. Elephant 2000 is on the borderline of AI, but the article emphasizes the Elephant usages that do not require AI. (shrink)
We are encouraged that the majority of commentators endorse our evolutionary framework for studying culture, and several suggest extensions. Here we clarify our position, dwelling on misunderstandings and requests for exposition. We reiterate that using evolutionary biology as a model for unifying the social sciences within a single synthetic framework can stimulate a more progressive and rigorous science of culture. (Published Online November 9 2006).
A key requirement for the automatic generation of argumentative or explanatory text is to present the constituent propositions in an order that readers will find coherent and natural, to increase the likelihood that they will understand and accept the author’s claims. Natural language generation systems have standardly employed a repertoire of coherence relations such as those defined by Mann and Thompson’s Rhetorical Structure Theory. This paper models the generation of persuasive monologue as the outcome of an “inner dialogue”, where the (...) author attempts to anticipate potential challenges or clarification requests. It is argued that certain RST relations such as Motivate, Evidence and Concession can be seen to emerge from various pre-empting strategies. (shrink)
Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when (...) the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. (shrink)
This bibliography aims to gather together studies in the philosophy of literature by Finnish researchers. It consists of articles and monographs which treat i) philosophical literary theory, ii) philosophical literature, or iii) literary philosophy and philosophers’ use of literary devices. The bibliography, collected by requests of publication data and from several Finnish publication databases, is not intended inclusive. Nevertheless, it is being throughout updated, and all kinds of suggestions, updates and corrections are most welcome.
Firms are beginning to evaluate requests for donations as they would investments. Critics argue that a strategy of charitable investing is conceptually inconsistent, disguised self-interest, and violates the dignity of those who receive charity. This paper argues that charity and investment are consistent (and even complementary in some cases), can preserve the virtue and the dignity of the giver and receiver, and may result in a wider distribution of charitable funds. The paper also discusses how a policy of charitable (...) investing could be implemented within a firm so as to avoid it being used merely as a public relations tool. Finally, it is suggested that charitable investments can help maintain the conditions necessary for a free market economy. (shrink)
We explore in this paper the relation between activities, communication channels and media, and common ground building in global teams. We define re-representation as a sequence of representations of the same concept using different communication channels and media. We identified the re - representation technique to build common ground that is used by team members during multimodal and multimedia communicative events in cross-disciplinary, geographically distributed settings. Our hypotheses are as follows: (1) Significant sources of information behind decisions and request for (...) actions are embedded within the fabric of communicative events in which participants use both informal and formal media to express their ideas. Capturing these information sources can facilitate common ground building and accelerate the execution of action requests. (2) Re-representations of concepts, i.e., sequences of representations using diverse media and communication channels, mediate and accelerate common ground building. (3) The use of intra- or interdisciplinary re-representations correlates with high team performance, i.e., effective team process and high product quality. We used AEC Global Teamwork course offered in 2008–2009 as the testbed for our study to validate our hypothesis. (shrink)
Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)
This is one of a series of reports of a case study of the convergence of molecular neurobiology and cognitive studies of Pavlovian conditioning. Here, I examine a fundamental disagreement between major centers of research representing each of these two domains and analyze it in terms of a hybrid historical, sociological, and philosophical concept of effective scientific communication. The specific example considered is found to fall short of the criteria for effective communication because of the absence of explicit, published reciprocity (...) in the exchange of critical appraisal of results and in requests for reformulation of investigative priorities, research designs, and criteria of scientific adequacy. The situation is dramatized and a remedy proposed by means of an imaginary dialogue linking the two research centers. The paper raises a number of key issues. (1) means for appraising the epistemic status of explanations putatively linking domains in the absence of effective scientific communication; (2) the influence of socially contingent features of the cognitive perspectives of the relatively small number of scientific translators responsible for such communication between domains; and (3) the status of dialogues of the sort presented here, e.g., as idealized philosophical critique or conjectural history of the future of science. (shrink)
There is a common view in medical ethics that the patient's right to be informed entails, as well, a correlative right not to be informed, i.e., to waive one's right to information. This paper argues, from a consideration of the concept of autonomy as the foundation for rights, that there can be no such ‘right’ to refuse relevant information, and that the claims for such a right are inconsistent with both deontological and utilitarian ethics. Further, the right to be informed (...) is shown to be a mandatory right (though not a welfare right); persons are thus seen to have both a right and a duty to be informed. Finally, the consequences of this view are addressed: since the way in which we conceptualize our problems tends to determine the actions we take to resolve them, it is important properly to conceptualize patients' requests not to be informed. There may be many reasons for acting in accord with such a request, but it is a mistake to conceptualize one's act as ‘respecting a right possessed by persons’. Keywords: medical ethics, informed consent, autonomy, information-waivers, rights, obligations CiteULike Connotea Del.icio.us What's this? (shrink)
Advances in science are the combined result of the efforts of a great many scientists, and in many cases, their willingness to share the products of their research. These products include data sets, both small and large, and unique research resources not commercially available, such as cell lines and software programs. The sharing of these resources enhances both the scope and the depth of research, while making more efficient use of time and money. However, sharing is not without costs, many (...) of which are borne by the individual who develops the research resource. Sharing, for example, reduces the uniqueness of the resources available to a scientist, potentially influencing the originator’s perceived productivity and ultimately his or her competitiveness for jobs, promotions, and grants. Nevertheless, for most researchers—particularly those using public funds—sharing is no longer optional but must be considered an obligation to science, the funding agency, and ultimately society at large. Most funding agencies, journals, and professional societies now require a researcher who has published work involving a unique resource to make that resource available to other investigators. Changes could be implemented to mitigate some of the costs. The creator of the resource could explore the possibility of collaborating with those who request it. In addition, institutions that employ and fund researchers could change their policies and practices to make sharing a more attractive and viable option. For example, when evaluating an individual’s productivity, institutions could provide credit for the impact a researcher has had on their field through the provision of their unique resources to other investigators, regardless of whether that impact is reflected in the researcher’s list of publications. In addition, increased funding for the development and maintenance of user-friendly public repositories for data and research resources would also help to reduce barriers to sharing by minimizing the time, effort, and funding needed by individual investigators to comply with requests for their unique resource. Indeed, sharing is an imperative, but it is also essential to find ways to protect for both the original owner of the resource and those wishing to share it. (shrink)
Say what you want to say -- Nothing's wrong with saying "I" -- Attacking and defending vs. speaking the truth in love -- Manipulation by guilt -- Ask and it shall be given you : how to make requests -- Free to say no -- Dealing with critical people -- How Matthew 18:15 keeps you from blowing up -- "If he listens to you" : the loving art of listening -- Wrapping the truth in love -- Telling the truth (...) in social talk : small talk. (shrink)
In France, bioethics norms have emerged in close interaction with medical practices. The first bioethics laws were adopted in 1994, with provisions for updates in 2004 and most recently, in 2011. As in other countries, bioethics laws indirectly refer to certain fundamental values. The purpose of this paper is threefold. First, I shall briefly describe the construction of the French bioethics laws and the values they are meant to protect. Secondly, I will show that the practice of clinical ethics, as (...) reported in a few studies on ART, living organ donation and PGD, challenge the role attributed to doctors as “gatekeepers” of those fundamental values. Thirdly, I will suggest that the quality of medical practices would improve if the law focused on strengthening the tacit pact between doctors and patients, rather than putting doctors in charge of enforcing societal values. Doctors, for their part, would limit their role to what they can do best: provide sufficient patient support and safe care. Against those who argue that we should dispense with bioethics laws altogether, I hold that the laws are useful in order to limit the development of abusive practices. However, a new legislative approach should be adopted which would a positive presumption in favor of patients’ requests. (shrink)
In 1697, the Presbyterian, William Bates, presented an address, on behalf of some dissenting ministers, to William of Orange. In this, he called for measures against the Socinians and Deists, and, in particular, for the banning of the publication of Socinian works. Bates' address was published in JOHN HOWE, Sermon Preech'd on the Day of Thanksgiving (1698). On 17th February, 1698, the House of Commons presented an address to the King, We do further, in all humility, beseech Your Majesty, that (...) Your Majesty would give such effectual order, as to Your Royal Wisdom shall seem fit, for the suppressing all pernicious books and pamphlets, which contain in them impious doctrines against the Holy Trinity, and other fundamental articles of our Faith, tending to the subversion of the Christian Religion; and that the authors and publishers thereof may be discounted and punished. The statute 9 and 19 William III, c. 32, An Act for the more effectual suppressing of Blasphemy and Profaneness , accepted these requests. It prohibited the writing, publishing and teaching of doctrines that were contrary to the Trinity, Christian truth or the divine authority of the Old and the New Testaments. It should be noted that the Toleration Act of 1689 does not extend tolerance to, amongst others, those who deny the dogma of the Trinity. It was not until 1813 that the Unitarians were free to practise their cult. The Trinity Act ( An Act to relieve persons who impugn the Doctrine of the Holy Trinity from certain Penalties . 53 Geo. III, c. 160) of that year exempted the Unitarians from the penalties laid down by the Toleration Act and by the Blasphemy Act quoted above. (shrink)
The Liverpool Care Pathway is intended as a palliative care regime at the end of life. Even its critics agree that certain of its recommendations may be useful and appropriate. Additionally, critics are aware that there are occasions when death may be a foreseen side effect of perfectly licit palliation whose primary ends are not homicidal at all. It is evident that treatment may be over-expensive, over-burdensome or simply futile. There is no suggestion that critics of the Pathway adhere irrationally (...) to what is known in medical ethics as the error of vitalism, the commitment to excessive, extraordinary or futile treatment, or over-burdensome care at the end of life. However, to ask whether treatment is futile, over-burdensome or over-expensive is very different to the discriminatory question about the futility, burden or expense of a frail and vulnerable patient. The sedation-dehydration aspect of the Pathway attracts much proper opposition. Doctors and families have found that those on the Pathway recovered when they intervened to take the patient off it. Senior medics have stepped forward, in the face of managerial opposition to argue that it is often impossible to know with certainty whether a person is imminently dying. One problem with the Pathway is that where a patient is misdiagnosed as terminal, the combination of morphine and dehydration has a self-fulfilling character and is likely to undermine a patient’s capacity. Persistent dehydration of even fit and healthy sedated patients will kill them. This was the difficulty highlighted by concerned medical professionals many years ago. The independent inquiry ordered in response to Freedom of Information Act requests performed in 2012 demonstrating a staggering increase in the number of people dying on the Pathway once it was financially incentivised needs to ensure certain investigations take place. What is needed, however, is not a whitewash but an independent inquiry with all interests declared and data sets interrogated and collated. These will cover a time-series medical history of each anonymised patient on the Pathway, duration until death, information about interventions provided during the period, monthly raw data from each trust, hospice or care home, medical histories, removals from the Pathway, information about journals that were corrected once a patient recovered, demographic data, location information and an audit trail of all data management. (shrink)
The traditional distinction between ordinary, i.e., obligatory means to preserve life and extraordinary, non-obligatory means is an especially useful tool for HECs in today's secular pluralist health care system, because it gives factors that can override the prima facie good of preserving the patient's life. I first indicate the need for such a tool. I then demonstrate the present misunderstanding of the distinction and give its proper understanding. Finally, I show the applicability of the distinction for HEC deliberations about three (...) important types of cases: the conscious, irreversibly but not terminally ill patient who requests cessation of curative treatment; the provision of artificial nutrition and hydration to permanently vegetative patients; and the allotment of intensive care and other scarce medical resources. (shrink)
The recent revelation that the rolling out of the Liverpool Care Pathway as the NHS National End of Life Care strategy in 2008 had been financially incentivised and implemented with astonishing compliance emerged as a thought-provoking development. Many of us have been warning for years of the financial, political and research interests that there are in institutionalising sedation-and-dehydration regimes, and then, inevitably, medical homicide. Freedom of Information Act requests exposed the millions of pounds that have been paid for the (...) implementation of this national end-of-life care strategy. Much more interestingly, it showed that some hospital trusts had been paid these funds for ensuring that up to two thirds of all deaths were Pathway deaths. Given that the very livelihood of health professionals was being judged against the new Commissioning for Quality Innovation (CQUIN) ’Gold Standards Framework’, professional observance of the pathway was predictable. The revelation of management targets, despite the best efforts of the regime’s proponents to play them down, radically alters the debate. Unlike education or housing targets, these ones are potentially homicidal. (shrink)
Levada, William Cardinal; Ladaria, Luis F The supreme law of the Church is the salvation of souls. As such, throughout its history, the Church has always found the pastoral and juridical means to care for the good of the faithful. With the Apostolic Construction Anglicanorum coetibus, promulgated on 4 November 2009, the Holy Father, Pope Benedict XVI, provided for the establishment of Personal Ordinariates through which Anglican faithful may enter, even in a corporate manner, into full communion with the Catholic (...) Church. On that same date, the Congregation for the Doctrine of the Faith published Complementary Norms relating to such Ordinariates. In conformity with what is established in Art, I and 1 and 2 of the Apostolic Coinstitution Anglicanorum coetibus, having received requests from a considerable number of Anglican faithful, and having consulted with the Australian Catholic Bishops Conference, the Congregation for the Doctrine of the Faith. (shrink)
