Background This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. Argument We argue that sedation is ethically and legally (...) permissible not only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. Conclusion In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly. (shrink)

Within bioethics, Kant’s conception of autonomy is often portrayed as excessively rationalistic, abstract, and individualistic, and, therefore, far removed from the reality of patients’ needs. Drawing on recent contributions in Kantian philosophy, we argue that specific features of Kantian autonomy remain relevant for medical ethics and for patient experience. We use contemporary end-of-life illness narratives—a resource that has not been analyzed with respect to autonomy—and show how they illustrate important Kantian themes, namely, the duty to know oneself, the interest in (...) elaborating universalizable principles, and the emphasis on ideals as points of orientation that guide behavior without ever being fully realized. As Kant does, the patient-authors discussed here perceive the end of life as a moment to reflect on the constitutive principles which have governed that life, thereby offering a privileged moment to pursue self-knowledge. We argue that bioethical conceptions of autonomy stand to gain if they revise their conception of Kantian moral philosophy as too formal, abstract, and detached from emotions and personal relationships to be helpfully applied. (shrink)

The experiences of clinicians who care for the sick and dying after withdrawal of treatment are rarely documented. This may be because these narratives, which offer insight into the intentionality and character of the clinician, do not lend themselves to clinical reports. The experience of palliative care touches clinicians in different ways and often confronts them with complex ethical dilemmas about care and treatment. This article explores the character of the clinician in relation to the telos of medicine and the (...) experience of accompanying the dying after withdrawal of treatment. (shrink)

This text prepares undergraduate mathematics students to meet two challenges in the study of mathematics, namely, to read mathematics independently and to understand and write proofs. The book begins by teaching how to read mathematics actively, constructing examples, extreme cases, and non-examples to aid in understanding an unfamiliar theorem or definition (a technique famililar to any mathematician, but rarely taught); it provides practice by indicating explicitly where work with pencil and paper must interrupt reading. The book then turns to proofs, (...) showing in detail how to discover the structure of a potential proof from the form of the theorem (especially the conclusion). It shows the logical structure behind proof forms (especially quantifier arguments), and analyzes, thoroughly, the often sketchy coding of these forms in proofs as they are ordinarily written. The common introductroy material (such as sets and functions) is used for the numerous exercises, and the book concludes with a set of "Laboratories" on these topics in which the student can practice the skills learned in the earlier chapters. Intended for use as a supplementary text in courses on introductory real analysis, advanced calculus, abstract algebra, or topology, the book may also be used as the main text for a "transitions" course bridging the gab between calculus and higher mathematics. (shrink)

A woman, perhaps a couple, learn they are pregnant. Perhaps she is elated for this desired news. Perhaps she is also overwhelmed or scared by the daunting task of parenthood ahead. Then, a prenatal screening reveals something worrisome about the fetus. A tumbling series of appointments and exams confirm the concerning findings. As Pope Francis notes, this news “changes the experience of pregnancy.” In place of optimistic wonderment for the future, parents now have new worries about whether their baby will (...) have a shortened life, experience suffering, or face many medical interventions in order to survive. I am a pediatric and perinatal palliative care doctor. I am often called to meet these wounded yet resilient... (shrink)

Introducción: Se presenta un análisis cualitativo del acompañamiento psicosocial a jóvenes en condiciones de vulnerabilidad desde la ecología humana durante 12 meses entre 2010 a 2011; utilizando técnicas pedagógicas evaluativas participativas. Éstas, son una alternativa para crear espacios reflexivos con el propósito de potenciar la resiliencia en las relaciones comunicativas y formar en el respeto. Objetivo: Generar bienestar, prevenir la farmacodependencia y contribuir a la promoción de la salud. Material y Métodos: Se revisaron los antecedentes temáticos, fueron seleccionados 100 estudiantes (...) entre 11 y 19 años de dos instituciones educativas públicas en condiciones vulnerables;se desarrollaron cuatro talleres reflexivos y cuatro prácticas lúdicas y se realizaron tres grupos focales con estudiantes, profesores y padres de familia. Resultados y Discusión: El contexto social de la población intervenida, revela problemas de abuso sexual, violencia intrafamiliar y eventos violentos en el vecindario por grupos armados ilegales, entre otros, que constituyen factores de riesgo importantes para la farmacodependencia. Conclusión: Se infiere que lo psicosocial incide en la farmacodependencia, afectando la convivencia de la población estudiada por múltiples causas del orden psicoafectivo, sociocultural, económico y político que van desde el consumo cultural hasta la seguridad alimentaria. Introduction: A qualitative analysis of the psycho-social support to young people in situations of vulnerability from human ecology is presented for 12 months between 2010 to 2011; using participatory evaluative pedagogical techniques. These are an alternative to create reflective spaces with the purpose of enhancing resilience in communicative relationships and working in respect. Objective: to generate well-being, prevent drug abuse and contribute to the health promotion. Material aids and methods: the thematic background was reviewed, 100 students between 11 and 19 years of two public schools in vulnerable conditionswere selected; four reflective workshops and four playful practices were developed and three focus groups with students, teachers and parentswere conducted. Results and discussion: the social context of the manipulated population reveals sexual abuse problems, domestic violence and violent events in the neighborhood by illegal armed groups, among others, which constitutemajor risk factors for drug abuse. Conclusion: It can be inferred that the psychosocial factors impact on drug dependence, affecting the coexistence of the population studied by multiple causes of the psychological, socio-cultural, economic and political order, ranging from cultural consumption to food security. (shrink)

In this accompanying study guide to The Many Worlds of Logic, 2/e, author Paul Herrick opens each chapter with a summary of its content and the skills that students will learn or master at its end. To avoid repetition, the Selected Answers section from the back of the main text--consisting of approximately one-third of the book's problems--is not presented in this study guide. Instead, students have access to the answers to most of the remaining problems. The author has purposely left (...) some questions unanswered in both the textbook and this study guide so that they can be assigned as homework assignments. (shrink)

In this accompanying study guide to The Many Worlds of Logic, 2/e, author Paul Herrick opens each chapter with a summary of its content and the skills that students will learn or master at its end. To avoid repetition, the Selected Answers section from the back of the main text--consisting of approximately one-third of the book's problems--is not presented in this study guide. Instead, students have access to the answers to most of the remaining problems. The author has purposely left (...) some questions unanswered in both the textbook and this study guide so that they can be assigned as homework assignments. (shrink)

In this essay, the author describes the trajectory toward a just peace framework in contemporary Catholic social teaching, as well as similar trends in the broader Christian community. He articulates a refined just peace framework or process that has arisen from and within a pastoral approach that listens to the experiences and voices of people in conflict situations across various cultural spaces. He then turns to the recent and challenging case of the war in Ukraine to explore and argue for (...) a just peace approach rooted in the praxis of accompaniment. The author also reflects on the distinction between and implications of an accompaniment approach and a justification-of-war approach to initiate more inquiry on this topic. (shrink)

abstract: Anaxagoras is notorious for his view that every perception is accompanied by pain but that not all concurrent pains are distinctly felt by the perceiving subject. This thesis is reported and criticized by Aristotle's heir Theophrastus in his De Sensibus. Traditionally, scholars believe that Theophrastus rejects Anaxagoras's thesis of the ubiquity of pain as counterintuitive, with the appeal to unfelt pain looking like a desperate category mistake given that pain is nothing but a feeling. Contra the traditional view, this (...) paper argues that Theophrastus neither aims to defend ordinary phenomenology nor is bothered by the concept of unfelt pain; instead, he develops a series of new Aristotelian arguments to defend a controversial, optimistic picture about the distribution of affective qualities in animal life. More than a supplement to Aristotle's psychology, his engagement with Anaxagoras reveals an important yet often ignored ethical concern behind the Peripatetic philosophy of perception. (shrink)

Since the 1990s, educators and social commentators have raised alarms regarding the moral character of successive generations of Americans. A consistent concern within those calls for alarm directs attention to teaching ethics in secondary education. A pedagogy of accompaniment recognizes the timeliness for objective and subjective approaches to learning social ethics, transcending the either/or of subject-object, content-skill educational conflicts as well as the disordered distractions of a performance-merit based assessment of learning. In secondary education, the praxis of accompaniment (...) through social ethical discernment creates an occasion wherein students hear and take seriously for the first time their moral voices and imagine their social ethical horizons. (shrink)

In this paper, we offer a phenomenological and hermeneutical perspective on the presence of clinicians who care for the suffering and dying patients in the context of end-of-life care. Clinician presence is described as a way of (1) being present to the patient and to oneself, (2) being in the present moment, and (3) receiving and giving a presence (in the sense of a gift). We discuss how presence is a way of restoring human beings’ relational and dialogical nature. To (...) inform a different perspective on relational ethics, we also discuss how accompaniment refers to the clinician’s awareness of the human condition and its existential limits. (shrink)

COVID-19 has made it difficult to adopt traditional face-to-face psychological intervention under this situation because of the blocked down and social distancing, which brings big psychological crisis to the public among the global. To explore the emotional change of the public in China at the outburst of the pandemic at different phases, to establish an online working platform and create a new model of an online intervention to hold public emotions under pandemic, and test its effectiveness, so to give advisement (...) for government emergency management system. We established an online organization to work for this program ad innovated a model of online group counseling with online emotional support accompany group right after the outburst of a pandemic. We analyzed 53 OESAGs from February 10 to April 9, including 555 application forms, 253 feedback from members, and 139 feedback from group leaders by using NVivo and SPSS to explore the evolution and characteristics of public emotion during COVID-19 and the effectiveness of OESAG. Our results showed that the emotional changes of members ranged from shock to depression to positive. The public's emotions swiftly changed from stress, anxiety, and isolation, to the hope of returning to work or finding a job during the pandemic with the help of OESAG. OESAG has effectively regulated the negative emotions of members by conducting psychological crisis intervention to provide members a space to communicate with each other, especially the female and frontline staff. Policy makers can set up an online systematic psychological crisis intervention system as soon as possible to make up for the lack of psychological assistance in the emergency management system. (shrink)

This article explores the spiritual and pastoral dimensions of accompanying people who are living with dementia. It is estimated that 40 per cent of people living with dementia will experience ‘prolonged dwindling’. The article develops the understanding of the face-to-face attentive presence of one person ministering to another and supporting the sick person in a breadth of life experience. It argues that insight from the thought of Jean Vanier and the community of L’Arche can be used to reflect on care (...) for people with dementia who share in the Passion of Christ and who are accompanied by others standing in solidarity with them. (shrink)

In discussions of end-of-life care and what the often-used but often-misunderstood buzzword “accompaniment” means, the core of the issue has often been missed, leading to inappropriate responses by physicians, loved ones, and the dying persons themselves. Emphasis is often placed on the care of circumstances rather than the care of persons. In what follows, these issues are systematically addressed to show that when patients face physical death, a truly ethical response is authentic, loving accompaniment of them. This form (...) of such accompaniment is explored. (shrink)

This extensive Instructor's Manual contains answers to the exercises that appear throughout the text.

This article identifies three geographical shifts that have altered the relative social, spatial and temporal locations of dying, church and health care, and axiology causally contributing to our culture’s deformed dying processes. It proposes an alternative script for a new art of dying drawing upon the early church’s practice of the order of widows.

In a clinic-wide approach to establish liberal policies, a closed psychiatric ward was planned to be opened. The leaders of the multi-professional team of this ward requested continuous ethics support during the first few months after the transition from their previously closed ward into an open one. During the process of accompanying the team through this ethically sensitive period of institutional change, several variations of ethics consultation were developed: the ‘context-adjusted’ clinical ethics support. Some ethics consultations focused on a retrospective (...) evaluation of a patient case, in other ethics consultations consolidation of a previous case discussion was worked out, and/or reflections on fundamental ethical issues were included. Based on our experiences and the feedback of the team, we consider this context-adjusted clinical ethics support as feasible and effective. (shrink)

Although the field of surgical ethics focuses primarily on informed consent, surgical decision‐making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment. The ethic of accompaniment (...) is born from a theological tradition that has motivated work to improve health outcomes in those at the margins through its emphasis on listening, solidarity against systemic drivers of disease, and proximity to individuals and communities. Through a review of surgical ethics and exploration of a central patient case, we argue for applying an ethic of accompaniment to the care of surgical patients and their communities. (shrink)

Our memories are private and particular; when you and I share an experience our experience is yet in the very moment of sharing different for you and for me, and our two memories of an event in the past are still more disparate. For memories are shaped and constrained by the deep-lying organic stress of what we have lived through, of our actual living, in the interval between then and now. A memory follows the solitary track of our individual experience, (...) and, like the particle in modern Physical theory, is changed in and by the route it has traced. (shrink)

This essay begins with a metaphor describing who enters the field of humanities in medicine and healthcare and the types of work they do. The role of witness is discussed, underscoring tensions between witnessing and analyzing. The essay then turns to my own background as an example of how each professional in this field brings something distinct. I briefly describe the three basic principles of my work with narrative: the injunction to keep the stories in the foreground, the work of (...) amplifying and connecting stories, and the need for generous interpretation. The second half of the essay tells three illness stories, describing their importance to me over several decades. These stories are by Audre Lorde, Reynolds Price, and Stewart Alsop, dealing with problems of silences imposed on ill people, problems caused by physicians’ perceived lack of time, and dilemmas of the end of life, respectively. (shrink)

The main objectives of the present paper is to present the difference between the prudent and the unscrupulous in Aristotle’s Nicomachean Ethics, or even try to understand if these two moral types differ only morally, or also rationally. It must be subjected, to this end, with: a) the presentation of prudence, cleverness and unscrupulousness; b) the presentation of the intellectual dispositions that accompany prudence, sýnesis, gnóme and noûs; c) an analysis about these dispositions: if they are actually dispositions or intellectual (...) capacities. (shrink)