Death and Dying

The fear of the largely unknown consequences of being exposed to coronavirus should have brought a more dynamic interplay of beliefs and opinions for those who in the footsteps of J.S. Mill believe that the limits of power, which can be legitimately exercised by society over the individual, is to prevent harm to others (Mill, 1859, Introduction). To be kept in a room is an invitation to think or do things with a higher degree of intelligence, empathy and tact. Our (...) surprise is that not much debate or critical interaction has taken place on the choice of locking down the majority of the populations of over 185 countries, after the outbreak of the newest Coronavirus (COVID-19). Instead of testing and isolating those who are sick, general lockdown occurred which could be seen as “a gross usurpation upon the liberty of private life” in the absence of a clear demonstration that lockdown is preventing some harm. The anthropologist Jean-Dominique Michel has recently unfold in a diachronic process the lockdown process (Michel, 2020), through his daily reporting, pointing out some the potentially harmful consequences of this choice. He has critically analysed the idea of an allegedly constructive and positive “social distancing”, which will have deep educational, economic, health consequences, without clearly having a grip on the overall pandemic, which rolls out without possible control. Le deep axiological and ethical question for philosophers is what type and degree of authority is needed during this period. Is it as Stoic philosophers many have thought self-discipline which is needed, as precondition “to follow the path of duty and virtue”? To resolve the struggle between liberty and authority would not yet mean rushing into blind and passive submission to drastic and non-useful constraints. In an authority based understanding severity means working harder, to do what is needed in order to “never permit [our] soul to be caught by […] pain” (Seneca, Clem., Nussbaum, 1994:426). Consequently, we should not accept to suspend critical thinking in order to remain loyal to any authority, which doesn’t mean not respecting public health policy measures. It means instead have the courage to affirm our resistance toward misconceptions, in particular if they are likely to have harmful consequences. Our article will review some of these problematic situations highlighting that no society is free or can achieve the objective of a fairly pluralistic set of values (including freedom of access to education, of a good health protection for all, or of having independent media and a credible press), without a given social practice of these values. No general basic liberties can be respected on the whole, as Mill claims, without some previous and gradual evolution can happen, namely before other more specific liberties have met sustainable social practice. Let’s show how this logic of spreading of values unfolds in the context of the Coronavirus crisis and the omnipresent focus on some physical spread of the disease, as it is always the case in infectious disease epidemics. (shrink)

Among those who reject the Epicurean claim that death is not bad for the one who dies, it is popularly held that death is bad for the one who dies, when it is bad for the one who dies, because it deprives the one who dies of the good things that otherwise would have fallen into her life. This view is known as the deprivation account of the value of death, and Fred Feldman is one of its most prominent defenders. (...) In this paper, I explain why I believe that Feldman’s argument for the occasional badness of death fails. While staying within an Epicurean framework, I offer an alternative that adequately accounts for a significant range of widely held intuitions about prudential value. My account implies that death is almost always good for the one who dies, yet often less good than not dying. Finally, I discuss some puzzles that remain for my account and hint at possible ways to address them. (shrink)

From Dawn till Dusk embraces the conceptual challenges often associated with Bioethics by taking the reader on a journey that embodies the circle of life and what it means to be human. The beginning and the end of life have always been an impossible riddle to humans. Bioethics does not aspire to unveil utter truths regarding the purpose of our existence; on the contrary, its task is to settle controversial issues that arise within this finite, very fragile and vulnerable life, (...) yet a life we still have to live. This book discusses thorny ethical issues that transcend time and are related to the dawn and the dusk of life: abortion and infanticide, genetic engineering, human reproductive cloning, the fear of death, rational suicide, and the right to die. The book's highest aspiration, though, is to both provide the reader with an opportunity to see the world from different perspectives and to showcase the irresistible charms of bioethical debates. (shrink)

Berger (forthcoming) states that moral intimacy is important in applying the best interests standard. But what he calls moral intimacy requires that someone has overcome epistemic burdens needed to represent the patient. We argue elsewhere that good surrogate decision-making is first and foremost a matter of overcoming epistemic burdens, or those obstacles that stand in the way of a surrogate decision-maker knowing what a patient wants and how to satisfy those preferences. Berger’s notion of moral intimacy depends on epistemic intimacy: (...) the fact that a surrogate's epistemic burdens with respect to the best interests of the incapacitated patient have been adequately surmounted, plus some other feature. Thus, where a particular patient-surrogate relationship fails to be morally intimate, what is lacking is either epistemic intimacy or this second feature. Furthermore, Berger uses the notion of moral intimacy as an explanans for the application of the best interests standard. We argue that the notions of epistemic intimacy and epistemic burdens not only help to explain the notion of moral intimacy, but also better explain the application of the best interests standard. Given the role of epistemic burdens and the epistemic intimacy that overcoming them enables, bioethicists and physicians should consider a surrogate’s epistemic standing relative to the patient’s best interests before pronouncing on the former’s ethical probity. (shrink)

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has (...) a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice. (shrink)

This essay aims to construct a relationship between Aristotle's account of friendship in the Nicomachean Ethics and the ideal of companionship articulated and lived out by St. Ignatius of Loyola, the founder of the Jesuit order. Although on the surface, it may seem as though Aristotelian friendship and Ignatian companionship have little in common, given that the accounts were developed in such different contexts, I argue that there are similarities worth exploring. Taken together, the accounts can help illuminate the good (...) of friendship as we experience it in the current age. The essay has three parts. In Part I, I set out Aristotle's account of friendship, focusing especially on his claims about shared activity in friendship and the role that friends play in times of suffering and bad fortune. In Part II, I turn to the Ignatian idea of companionship, both as he wrote about it and as he lived it. Ignatian spirituality takes it as a given that human life often follows a very rocky and difficult path. The spiritual practices of the Ignatian tradition are designed to help us cultivate the dispositions and habits necessary to sustain us through those experiences of grief, agony, and isolation. Those same dispositions and habits, I will suggest, also enable us to sustain our friends and be good companions during times of both joy and despair. In Part III, I will draw these two accounts together and consider what friendship on this Aristotelian-Ignatian model might look like today. Here I will focus on the ways in which friends are companions to each other during the despair and isolation occasioned by serious illness, trauma, and death. Both Aristotle and Ignatius have important insights into the value and function of friendship in these moments, insights that can help us think through the contemporary version of the same problem. (shrink)

In ’Abortion and deprivation: a reply to Marquis’, Anna Christensen contends that Don Marquis’ influential ’future like ours’ argument for the immorality of abortion faces a significant challenge from the Epicurean claim that human beings cannot be harmed by their death. If deprivation requires a subject, then abortion cannot deprive a fetus of a future of value, as no individual exists to be deprived once death has occurred. However, the Epicurean account also implies that the wrongness of murder is also (...) not grounded in the badness of death, which is strongly counterintuitive. There is an alternative: we can save our intuitions by adopting a more moderate Epicurean account such as that proposed by David Hershenov, who grounds the wrongness of killing in the prevention of the benefit of further good life rather than in the badness of death. Hershenov’s account, however, is equally applicable to Marquis’ argument: abortion similarly prevents a fetus from enjoying the benefit of a future like ours. Consequently, we conclude that Christensen’s criticism of Marquis’ argument fails to undermine his reasoning. (shrink)

This is the first chapter of a projected book to be entitled, The Ego and the Spirit. This book will endeavor to examine what lies at the heart of human spiritual aspiration from a psychological, philosophical, and religious perspective. In this first chapter, I discuss the predicament of the human ego, charged with a task that it cannot fulfill: To establish itself securely within being. The ego's efforts to fulfill this task through its dealings with the things and people of (...) the material world lead to distortions in its self-experience, its relations with others, and its involvement in life in general. The world's spiritual traditions have long recognized the predicament of the ego and present themselves as a means to its resolution. In this first chapter, though, the focus is on the ego and its predicament. (shrink)

Rilke's remark conjures up an officious array of well-meaning persons bent on completing our orderly passage from cradle to grave. They tidy our files cosily about us, inject us with extreme unction and slide us into the warm embrace of the undertaker. At the forefront of the array stands the doctor, part mechanic and part priest. His main task is to repair the living with resources whose effective and impartial allocation is a chief topic of medical ethics. But his role (...) is not that of an impartial allocator: his patients want his partisan support. This builds a moral tension into a role played out where system meets patient, and one made instructively plain in the care of the dying. The system no doubt prefers death to be cheap and orderly but this thought may not move someone like Rilke wanting a death of his own. The doctor is then caught between his general duty to patients at large and his particular duty to the patient in front of him, a tension tautened for a Hippocratic promoter of health and life by a patient in search of an exit. (shrink)

A substantial proportion of human embryos spontaneously abort soon after conception, and ethicists have argued this is problematic for the pro-life view that a human embryo has the same moral status as an adult from conception. Firstly, if human embryos are our moral equals, this entails spontaneous abortion is one of humanity’s most important problems, and it is claimed this is absurd, and a reductio of the moral status claim. Secondly, it is claimed that pro-life advocates do not act as (...) if spontaneous abortion is important, implying they are failing to fulfill their moral obligations. We report that the primary cause of spontaneous abortion is chromosomal defects, which are currently unpreventable, and show that as the other major cause of prenatal death is induced abortion, pro-life advocates can legitimately continue efforts to oppose it. We also defend the relevance of the killing and letting die distinction, which provides further justification for pro-life priorities. (shrink)

In December of 2013, my Dad died of advanced Alzheimer's and a condition called Myasthenia Gravis. This is a selection of journal entries I made over the course of the two years leading up to my Dad's death. It is not a philosophical essay, but a personal reflection, in "real time" so to speak, on the nature of the dying process in relation to questions of faith, hope, despair, and the meaning of a man's life. I offer it here for (...) any who might find it worthwhile. (shrink)

It is not uncommon for hospice admission nurses to receive requests from loved ones to withhold information from patients about their diagnosis or prognosis. Such requests may occur in the context of similar requests having previously been honored by other, nonhospice care teams. This article explores the ethical questions raised by such requests and the motivations behind them. Following, it offers ways to engage requests for nondisclosure that honor ethical obligations to patients and families in a manner consistent with the (...) hospice philosophy of care. The principles of truthfulness, sensitivity, and beneficence are introduced, and a framework using those principles to respond to requests for nondisclosure is proposed. (shrink)

Hope takes on a particularly important role in end of life situations. Sustaining hope can have considerable benefits for the quality of life and any prospect of a good death for the dying. However, it has proved difficult to adequately account for hope when dying, particularly in some of the more extreme end of life situations. Standard secular accounts of hope struggle to establish how the fostering of hope may be possible in such situations. This leads to a practical ethical (...) dilemma for those caring for the dying, the ‘paradox of hope’, whereby one can either help maintain the welfare of the dying by generating a misleading ‘false hope’ or maintain truthfulness and concede that hope is not possible. These two problems combine to leave individuals the prospect of dying in terrible circumstances facing only despair. To address this, I argue that we should look beyond standard intentional or dispositional accounts of hope in such cases and treat hope as a cluster concept. Rather than appeal to a unitary conception, what we precisely mean by ‘hope’ may therefore vary depending on the context of use. I outline an account of hope based on Marcel’s account of ‘absolute’ hope but offering an alternative, secular foundation based on solidarity that can explain how hope when dying in extreme circumstances is possible. Hence, where the more familiar accounts break-down in these circumstances, ‘hope talk’ may still be possible if it is seen as relying on this conception of hope. (shrink)

The 2017 story of Charlie Gard is revisited. Upon the British High Court’s ruling in favor of the physicians that the infant should be allowed to die without the experimental treatment, the view of the public as well as the opinions of bioethicists and Catholic bishops are divided, interestingly along with a cultural line. American bioethicists and Catholic bishops tend to believe that the parents should have the final say while British/European bioethicists and Catholic bishops in general side with the (...) court’s decision. The paper explores the place of culture in bioethical reasoning between the UK/Europe and the US while claiming that cultural differences are more important than geopolitical or religious differences to understand the bioethical positions of a group. In addition, the authors introduce a decision-making program for handicapped neonates which is developed by the American Jesuit Bioethicist, Richard McCormick, and modified further by the contemporary American Jesuit Bioethicist, Peter A. Clark, in an attempt to see if the program’s normatizing categories can contribute to the culture-laden ethical discussions on Charlie’s case. However, it is admitted that the McCormick-Clark device is borne out of the American and Catholic theological context. (shrink)

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death (...) of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances. (shrink)

Confidentiality is one of the foundations on which psychotherapy is built. Limitations on confidentiality in the therapeutic process have been explained and explored by many authors and organizations. However, controversy and confusion continue to exist with regard to the limitations on confidentiality in situations where clients are considering their options at the end of life and after a client has died. This article reviews these 2 areas and provides some suggestions for future research.

The relevance of double effect for end of life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore no secondary “double” effect is brought about. In my paper I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that (...) the prevailing view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm. (shrink)

Wit explores modes of reading representations of death and dying, both through the play’s sustained engagement with Donne’s Holy Sonnets and through Vivian’s self-reflexive approach to her illness and death. I argue that the play dramatizes reparative readings, a term coined by Eve Kosofsky Sedgwick to describe an alternative to the paranoid reading practices that have come to dominate literary criticism. By analyzing the play’s reparative readings of death and dying, I show how Wit provides lessons about knowledge-making and reading (...) practices in the field of health humanities. (shrink)

[A Defence of Assisted Death: Philosophical Arguments for Euthanasia and Physician-Assisted Suicide] První monografie v českém jazyce, která nabízí detailní filozofickou obranu různých forem asistované smrti včetně eutanazie. Autor vysvětluje kontext a příčiny současné diskuse, zavádí a zdůvodňuje potřebné pojmové distinkce a analyzuje argumenty ve prospěch asistovaného sebeusmrcení i vyžádané eutanazie. Hlavní část knihy je ve formě odpovědí na časté otázky: Je smrt za všech okolností pro umírajícího újmou? Řeší strategie, například nezahájení nebo ukončení léčby či paliativní péče, jež jsou (...) v současnosti považovány za morálně nekontroverzní, všechny problémy, na něž měla být odpovědí asistovaná smrt? I kdybychom se dohodli, že vyžádaná eutanazie je relativně přijatelná, neocitneme se její legalizací na kluzkém svahu, po němž sklouzneme ke katastrofálně nemorální praxi? (shrink)

In ‘Pro-life arguments against infanticide and why they are not convincing’ Joona Räsänen argues that Christopher Kaczor's objections to Giubilini and Minerva's position on infanticide are not persuasive. We argue that Räsänen's criticism is largely misplaced, and that he has not engaged with Kaczor's strongest arguments against infanticide. We reply to each of Räsänen's criticisms, drawing on the full range of Kaczor's arguments, as well as adding some of our own.

There are ethical guidelines that form the foundation of the traditional doctor–patient relationship in medicine. Health care providers are under special obligations to their patients. These include obligations to disclose information, to propose alternative treatments that allow patients to make decisions based on their own values, and to have special concern for patients’ best interests. Furthermore, patients know that these obligations exist and so come to their physicians with a significant level of trust. In this sense, therapeutic medicine significantly differs (...) from straightforward business practices such as the buying and selling of houses, cars, cell phones, etc. However, we argue that this relationship differs when medicine is used for enhancement rather than therapy. When patients seek enhancements they are not as vulnerable as when they are ill. And in an enhancement setting, physicians have little role outside of medical risks to discuss motivation and alternatives. Therefore, we conclude that a more reasonable alternative may be for doctors and patients to use ethical norms associated more with straightforward business practices, specifically sales. We believe that full disclosure of this different set of norms will benefit both physicians and patients. (shrink)

This article traces the history of the concept of dignity in Western thought, arguing that it became a formal Catholic theological concept only in the late nineteenth century. Three uses of the word are distinguished: intrinsic, attributed, and inflorescent dignity, of which, it is argued, the intrinsic conception is foundational. The moral norms associated with respect for intrinsic dignity are discussed briefly. The scriptural and theological bases for adopting the concept of dignity as a Christian idea are elucidated. The article (...) concludes by discussing the relevance of this concept of dignity to the spiritual and ethical care of the dying. (shrink)

Herbert, Dilinie How should health professionals respond if a patient nearing the end of life expresses a wish to hasten their death? To answer this question, this article draws upon peer‐reviewed literature, the practices of palliative care, and the experiences of two palliative care physicians, Associate Professor Natasha Michael and Associate Professor Mark Boughey. The expression of a wish to hasten death does not necessarily imply a genuine desire to hasten death or to be helped to die. To the contrary, (...) almost always this means that the patient has been overwhelmed by one or more serious concerns. While inadequate pain relief may be one such factor, more typically these concerns are social and spiritual, such as loneliness, social isolation, feeling oneself to be a burden on others, hopelessness, and fears about the process of dying. If a patient expresses a wish to hasten death, health professionals should therefore discuss with them the reasons for this request, and then devise and effectively communicate an individualised care plan which begins to address these concerns. (shrink)

With narrow exception, physicians’ treatment of incapacitated patients requires the consent of health surrogates. Although the decision-making authority of surrogates is appropriately broad, their moral authority is not without limits. Discerning these bounds is particularly germane to ethically complex treatments and has important implications for the welfare of patients, for the professional integrity of clinicians, and, in fact, for the welfare of surrogates. Palliative sedation is one such complex treatment; as such, it provides a valuable model for analyzing the scope (...) of surrogates’ moral authority. Guidelines for palliative sedation that present it as a “last-resort” treatment for severe and intractable suffering yet require surrogate consent in order to offer it are ethically untenable, precisely because the moral limits of surrogate authority have not been considered. (shrink)