This chapter contains sections titled: Weighing the Value of Meat Stalking the Essence of Hunting Same As It Ever Was The End of Hunting Notes.

Currently in Japan, it is extremely difficult to realize the basic wish of protecting personal dignity at the end of life. A patient’s right to refuse life-sustaining treatment has not been substantially warranted, and advance directives have not been legally enforceable. Unfortunately, it is not until the patient is moribund that all concerned parties start to deliberate on whether or not death with dignity should be pursued. Medical intervention is often perceived as a worthwhile goal to not only preserve life, (...) but also provide psychological benefit to the family, regardless of its effect on the patient. To feel they are doing something, family members tend to act against the imperative “Do not inflict on others what you would not wish done to you,” and permit extraordinary measures they would not want themselves. Another complication in Japanese culture is the necessity of unanimous decisions for end-of-life care. If there is conflict between a patient and his/her family on accepting medical intervention, the view of the latter is more likely to prevail due to different perceptions of human dignity. As a result, incapacitated patients in Japanese clinical settings often suffer through extraneous medical procedures, particularly during end-of-life care. Patient dignity is in danger from a national refusal to accept major bioethical principles such as having respect for patient autonomy, serving the best interests of the patient, doing no harm, and ensuring fairness at the end of life. We argue that more education about human dignity and legislation for death with dignity are necessary. Peace of mind for patients during end-of-life care will never be achieved in this society unless drastic changes take place in medical ethics and law. (shrink)

Social, legal and health-care changes have created an increasing need for ethical review within end-of-life care. Multiprofessional clinical ethics committees (CECs) are increasingly supporting decision-making in hospitals and hospices. This paper reports findings from an analysis of formal summaries from CEC meetings, of one UK hospice, spanning four years. Using qualitative content analysis, five themes were identified: timeliness of decision-making, holistic care, contextual openness, values diversity and consensual understanding. The elements of an engaged clinical ethics in a hospice context is (...) not generally acknowledged nor its elements articulated. Findings from this study have the potential to explain some of the most challenging ethical problems and to contribute to their resolution. It may also guide future deliberation and raise CEC members' awareness of the recurrent issues and values of their CEC practice. (shrink)

Theoretical and empirical research in bioethics frequently focuses on ethical dilemmas or problems. This paper draws on anthropological and phenomenological sources to develop an alternative framework for bioethical enquiry that allows examination of a broader range of how the moral is experienced in the everyday lives of individuals and groups. Our account of moral experience is subjective and hermeneutic. We define moral experience as “Encompassing a person's sense that values that he or she deem important are being realised or thwarted (...) in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust”. In our conceptualisation, moral experience is not limited to situations that are heavily freighted with ethically-troubling ramifications or are sources of debate and disagreement. Important aspects of moral experience are played out in mundane and everyday settings. Moral experience provides a research framework, the scope of which extends beyond the evaluation of ethical dilemmas, processes of moral justification and decision-making, and moral distress. This broad research focus is consistent with views expressed by commentators within and beyond bioethics who have called for deeper and more sustained attention in bioethics scholarship to a wider set of concerns, experiences and issues that better captures what is ethically at stake for individuals and communities. In this paper we present our conceptualisation of moral experience, articulate its epistemological and ontological foundations and discuss opportunities for empirical bioethics research using this framework. (shrink)

The paper attempts to account for the confusion over the validity of the concept of schizophrenia in terms of two closely related aspects of conceptual indeterminacy. Firstly, it is identified on the basis of a breakdown in intelligibility, but what constitutes such a breakdown is indeterminate. Secondly, the concept sits between the categories of natural disease or illness on the one hand, and character trait or moral failing or gift on the other. This entails an indeterminacy in attempting to define (...) the role that physiological explanation could have. Light may be thrown on the concept by exploring a distinction between a life story in which the schizophrenic condition emerges as the conclusion of the story and a causal process in which the condition is the end result or final consequence. (shrink)

Weberís sociology of inner-worldly mysticism, Almaasí recent synthesis of transpersonal and psychoanalytic object relations theory, and Jungís related metaphorical psychology of alchemy, are brought to bear on the development of Heideggerís evocations of the felt sense of Being between 1927 and 1946, understood as the noetic core of spirituality. In particular, Heideggerís assumption of the Nazi rectorship at Freiburg in 1933ñ34 is seen as a specifically spiritual crisis based on the "metapathological" grandiosity that can result from the miscarriage of self (...) realization in inner-worldly mysticism. In Heideggerís case, as in much contemporary spirituality, this crisis was intensified by pre-existent narcissistic vulnerabilities of character. Heideggerís later writings are considered as expressions of a more genuine spiritual or essential realization, which, while invaluable as a conceptual framework for transpersonal psychology, nonetheless stops short of a balanced personal integration. This analysis constitutes a specific example of how the combination of transpersonal psychology and psychodynamics can be used to understand the emotional conflicts stirred up by transpersonal realization and the resultant potential for distortion in modern spiritual development, as presented by Hunt. (shrink)

Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

While pharmaceutical industry involvement in producing, interpreting, and regulating medical knowledge and practice is widely accepted and believed to promote medical innovation, industry-favouring biases may result in prioritizing corporate profit above public health. Using diabetes as our example, we review successive changes over forty years in screening, diagnosis, and treatment guidelines for type 2 diabetes and prediabetes, which have dramatically expanded the population prescribed diabetes drugs, generating a billion-dollar market. We argue that these guideline recommendations have emerged under pervasive industry (...) influence and persisted, despite weak evidence for their health benefits and indications of serious adverse effects associated with many of the drugs they recommend. We consider pharmaceutical industry conflicts of interest in some of the research and publications supporting these revisions, and in related standard-setting committees and oversight panels. We raise concern over the long-term impact of these multifaceted involvements. Rather than accept industry conflicts of interest as normal, needing only to be monitored and managed, we suggest challenging that normalcy, and ask: what are the real costs of tolerating such industry participation? We urge the development of a broader focus to fully understand and curtail the systemic nature of industry’s influence over medical knowledge and practice. (shrink)

The term “euthanasia” is used in conflicting ways in the bioethical literature, as is the term “assisted suicide,” resulting in definitional confusion, ambiguities, and biases which are counterproductive to ethical and legal discourse. I aim to rectify this problem in two parts. Firstly, I explore a range of conflicting definitions and identify six disputed definitional factors, based on distinctions between (1) killing versus letting die, (2) fully intended versus partially intended versus merely foreseen deaths, (3) voluntary versus nonvoluntary versus involuntary (...) decisions, (4) terminally ill versus non-terminally ill patients, (5) patients who are fully conscious versus those in permanent comas or persistent vegetative states, and (6) patients who are suffering versus those who are not. Secondly, I distil these factors into six “building blocks” and combine them to develop an unambiguous, value-neutral taxonomy of “end-of-life practices.” I hope that this taxonomy provides much-needed clarification and a solid foundation for future ethical and legal discourse. (shrink)

Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient’s life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics.

Background Making the right decisions, while simultaneously showing respect for patient autonomy, represents a great challenge to nursing home staff in the issues of life-prolonging treatment, hydration, nutrition and hospitalisation to dying patents in end-of-life. Objectives To study how physicians and nurses protect nursing home patients' autonomy in end-of-life decisions, and how they justify their practice. Design A qualitative descriptive design with analysis of the content of transcribed in-depth interviews with physicians and nurses. Participants Nine physicians and ten nurses in (...) 10 nursing homes in Norway. Results and interpretations Assessment of the patient's competence to consent to treatment is almost absent. The physicians build their practice on the principles of beneficence and nonmaleficence. Nurses tend to trust the patients' rejection of life support, even when the patients have difficulty speaking or suffer from dementia. Relatives were, according to the health personnel, included in decision-making processes to a very limited extent. However, futile life support is sometimes provided contrary to the physicians' judgement of what constitutes the patient's best interest on occasions when they are pressurised by next of kin. Conclusions The study reveals a need to improve decision-making routines according to ethical ideals and legislation. Conflicts between relatives and healthcare professionals in the decision-making process deflect the focus from searching for the best possible treatment for the terminal patient. Further discussion is required as to whether the concept of autonomy is applicable in situations in which the patient is impaired and dying. (shrink)

The ethics of adolescent decision making is a complicated mine­field with laws that vary from state to state. The case of a fourteen-year-old girl, who simultaneously was diagnosed with cancer and discovered she was pregnant, highlights several weaknesses in our current approach to adolescent decision making in the context of pregnancy. In addition, adolescents with life-limiting conditions face similar challenges that can be examined through the framework of Catholic doctrine.

While ethical conflicts in the provision of healthcare are common, the current third-party mediator model is limited by a lack of expert ethical mediators, who are often not on site when conflict escalates. In order to improve clinical outcomes in situations such as conflicts at the end of life, we suggest that clinicians—physicians, nurses and social workers—be trained to prevent and deescalate emerging conflicts. This can be achieved using a mediation model framed by a communication-training approach. A case example is (...) presented and the model is discussed. The implication of this preventative/early intervention model for improving clinical outcomes, in particular end-of life conflict, is considered. (shrink)

Objectives: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies.Design and participants: Cross-sectional postal survey of doctors in Victoria.Results: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the (...) definition of euthanasia.Conclusions: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. (shrink)

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

Introduction Hundreds of thousands of premature neonates born in low-income countries are implicitly denied treatment each year. Studies from India show that treatment is rationed even for neonates born at 32 gestational age weeks (GAW), and multiple external factors influence treatment decisions. Is withholding of life-saving treatment for children born between 28 and 32 GAW acceptable from an ethical perspective? Method A seven-step impartial ethical analysis, including outcome analysis of four accepted priority criteria: severity of disease, treatment effect, cost effectiveness (...) and evidence for neonates born at 28 and 32 GAW. Results The ethical analysis sketches out two possibilities: (a) It is not ethically permissible to limit treatment to neonates below 32 GAW when assigning high weight to health maximisation and overall health equality. Neonates below 32 GAW score high on severity of disease and efficiency and cost-effectiveness of treatment if one gives full weight to early years of a newborn life. It is in the child's best interest to be treated. (b) It can be considered ethically permissible if high weight is assigned to reducing inequality of welfare and maximising overall welfare and/or not granting full weight to early years of newborns is considered acceptable. From an equity-motivated health and welfare perspective, we would not accept (b), as it relies on accepting the lack of proper welfare policies for the poor and disabled in India. Conclusion Explicit priority processes in India for financing neonatal care are needed. If premature neonates are perceived as worth less than other patient groups, the reasons should be explored among a broad range of stakeholders. (shrink)

Baumard proposes that life history slowing in populations over time is the principal driver of innovation rates. We show that this is only true of micro-innovation rates, which reflect cognitive and economic specialization as an adaptation to high population density, and not macro-innovation rates, which relate more to a population's level of general intelligence.

In lieu of an abstract, here is a brief excerpt of the content:Thus Spake Howard Roark:Nietzschean Ideas in The FountainheadLester H. HuntIThe position I will be taking here will seem very peculiar to many people. I will be treating a novel as a discussion of the work of a philosopher—namely, Friedrich Nietzsche. Worse yet, I will be treating it as a discussion that is philosophically penetrating and deserves to be taken seriously. Still worse, the novel is Ayn Rand's early novel (...) The Fountainhead. I think it is safe to say that her reputation, among academics who discuss the works of philosophers, is very low. If the reader will only bear with me, though, I think I can make a case that Rand opens a line of inquiry about Nietzsche's ideas and values that is not only quite interesting in itself but one that ought to be pursued further by others.There has always been ample reason to associate Nietzsche with The Fountainhead.1 He is after all, the only philosopher who is more or less directly quoted in the book.2 Beyond that, Rand's novel has many other passages that students of Nietzsche instantly recognize as conscious references to him or deliberate echoes of his style. In addition, she revealed, in an introduction written for the twenty-fifth anniversary edition, that the following quotation from Beyond Good and Evil had originally stood at the head of the book when it was still in manuscript:It is not the works, but the belief which is here decisive and determines the order of rank to—employ once more an old religious formula with a new and deeper meaning—it is some fundamental certainty which a noble soul has about itself, something which is not to be sought, is not [End Page 79] to be found, and perhaps, also, is not to be lost—The noble soul has reverence for itself.—3She said, in the same introduction, that she removed the quotation (evidently, immediately before publication) for philosophical reasons, because of her "profound disagreement with the philosophy of its author." Nietzsche, she says, was fundamentally "a mystic and irrationalist," and even in this quotation, chosen for its content, insinuates a philosophical position that she regards as erroneous (namely, determinism). Even her statement of what she likes about this passage is rather constrained: "as a poet [ie., not as a philosopher], he projects at times (not consistently) a magnificent feeling for man's greatness, expressed in emotional, not intellectual terms."4It is of course true enough that Rand does disagree with Nietzsche, and for more or less the reasons that she suggests here, but it is also true that the passage she has quoted expresses some ethical themes—nobility, order of rank, the "pathos of distance," and (most obviously) the idea of self-reverence as a characteristic of the ethically good—which are at least as important in The Fountainhead as they are in Nietzsche's writings. Though Rand's spirited disclaimer serves to remind us of her deep differences with Nietzsche, the quotation itself suggests that there might be an interesting philosophical, not merely literary or emotional, connection between The Fountainhead and Nietzsche's ideas. What I would like to show here is that this connection merits a much closer look than it has ever been given heretofore. Not only is the presence of Nietzschean themes in Rand's novel deep and pervasive, but the book actually contains a very interesting and powerful internal critique of one of Nietzsche's most characteristic ideas, a criticism based in large part on values and assumptions that he shares. Before I can set out this critique, I will need to explore some of the positive thematic and philosophical connections.IIOne evening, rather late in the novel, Gail Wynand, the corrupt newspaper publisher and financier, surprises his wife, Dominique, with a present: he has had an architect design a house for them. The architect, she realizes with shock as she sees the drawings for the house, is her former lover, Howard Roark, a man with whom she is still in love. None of this is known to her husband, who innocently tells her that [End Page 80] Roark... (shrink)

BackgroundOne of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it.MethodsWe conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the (...) United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable.ResultsAll four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants’ comfort and needs at the EOL.ConclusionBecause of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research’s impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings. (shrink)

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

In this article I attempt to transcend the mainstream conception of health care ethics, including nursing ethics, by bringing into the foreground a tension between a sense of life and an industrial-bureaucratic style of health care, with its emphasis on the systematic and procedural work culture necessary for mass production. I use the concept of ‘a sense of life’ to draw attention to the wisdom, sensitivity and responsibility that is necessary for the authentic care of others to be given a (...) chance in the development of modern health care. I emphasize the mindfulness that the professional requires for genuine care, and how the systematic organization of modern health care, on the whole, ignores, obstructs and even suppresses such mindfulness. (shrink)

Why does institutional police brutality continue so brazenly? Criminologists and other social scientists typically theorize about the causes of such violence, but less attention is given to normative questions regarding the demands of justice. Some philosophers have taken a teleological approach, arguing that social institutions such as the police exist to realize collective ends and goods based upon the idea of collective moral responsibility. Others have approached normative questions in policing from a more explicit social-contract perspective, suggesting that legitimacy is (...) derived by adhering to (limited) authority. This article examines methodologies within political philosophy for analyzing police injustice. The methodological inquiry leads to an account of how justice constrains the police through both special (or positional) moral requirements that officers assume voluntarily, as well as general moral requirements in virtue of a polity’s commitment to moral, political and legal values beyond law enforcement and crime reduction. The upshot is a conception of a police role that is constrained by justice from multiple foundational stances. (shrink)

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the explanation (...) of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis. (shrink)

The principle of alternate possibilities (PAP), making the ability to do otherwise a necessary condition for moral responsibility, is supposed by Harry Frankfurt, John Fischer, and others to succumb to a peculiar kind of counterexample. The paper reviews the main problems with the counterexample that have surfaced over the years, and shows how most can be addressed within the terms of the current debate. But one problem seems ineliminable: because Frankfurt''s example relies on a counterfactual intervener to preclude alternatives to (...) the person''s action, it is not possible for it to preclude all alternatives (intervention that is contingent upon a trigger cannot bring it about that the trigger never occurred). This makes it possible for the determined PAPist to maintain that some pre-intervention deviation is always available to ground moral responsibility. In reply, the critic of PAP can examine all the candidate deviations and argue their irrelevance to moral responsibility (a daunting prospect); or the critic can dispense with counterfactual intervention altogether. The paper pursues the second of these strategies, developing three examples of noncounterfactual intervention in which (i) the agent has no alternatives (and a fortiori no morally relevant alternatives), yet (ii) there is just as much reason to think that the agent is morally responsible as there was in Frankfurt''s original example. The new counterexamples do suffer from one liability, but this is insufficient in the end to repair PAP''s conceptual connection between moral responsibility and alternate possibilities. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.2 (2002) 273-295 [Access article in PDF] Billy Budd:Melville's Dilemma Lester H. Hunt I THE CHAIN OF EVENTS NARRATED in Herman Melville's Billy Budd, Sailor (An Inside Narrative)—how Billy is falsely accused of plotting mutiny by his Master-at-Arms, John Claggart, how Billy accidentally kills Claggart and, finally, is executed at the urging of the Captain of the Ship, Edward Fairfax Vere, despite Vere's personal conviction that (...) Billy does not deserve to be killed—is simple enough. The text itself, nonetheless, is troublesomely complex. It is a very difficult work to interpret with both honesty and confidence. Melville unflinchingly represents to us the moral horror of what Captain Vere does to Billy, and yet he also depicts Vere himself with a respect that borders on admiration. The attentive reader experiences a painful cognitive dissonance that can only be soothed by a coherent interpretation, and perhaps by a bit of philosophy.Given the way in which the text of Billy Budd emerged—it was assembled by scholars, long after Melville's death, from a confusing collection of manuscript pages he had left behind when he died—it may well be an unfinished work. It is possible that ill health and death overtook Melville before he had a chance to iron out the inconsistencies that inevitably arise as a book is written, and it is therefore also possible that some of our sense of dissonance is produced by this brute fact. 1 Whether or not this is the case, this book is, according to the view I will present here, at least very close to being coherent. The point of view it represents is actually quite appropriate to an unfinished work, and little damaged by textual indeterminateness. Billy Budd is about the inescapably dilemmatic nature of certain choices. It alleges the impossibility of resolving them in any comfortable way. Melville beckons us to [End Page 273] look through the window of Billy Budd into an abyss of undecidability, and perhaps a text that contains some chaos within itself will better serve as such a window than one that does not.The best way to begin trying to understand how we should take this work is to begin at its very beginning. The very beginning of a story is of course its title, and the title of this story, or more exactly its subtitle, tells quite literally what sort of story it is. It is an "inside" narrative. Of course, this immediately raises the question of what an inside narrative is. Inside what? Are we supposed to contrast it with an outside narrative? And what sort of story would that be?Melville does not leave us entirely without an answer to this question. Billy Budd does contain another story, one that contrasts so sharply with the main narrative that it might well be described as its opposite: it is virtually an inverted version of the book's plot. In an "authorized weekly publication" quoted at some length at the end of the book, the events of Melville's tale are briefly recounted. In this version of the story, apparently the only officially sanctioned one, Billy Budd is depicted as the ringleader of a genuine mutiny, who "vindictively stabbed" Claggart for exposing him. Claggart is motivated only by a "strong patriotic impulse" and Billy Budd by "extreme depravity."This account, Melville tells, us was written "for the most part" sincerely enough, "though the medium, partly rumor, through which the facts must have reached the writer served to deflect and in part falsify them" (1432.27-30). 2 It could be called an "outside" narrative in virtue of the fact that its author was not there and consequently was not in a position to know what actually happened. The most direct way to give literal meaning to the "inside" status of Melville's main narrative is simply to observe that it gives a view from inside the ship, from inside the Bellipotent. It represents things that were known by people who were there, and precisely because they were there.This... (shrink)

The use of deception and dishonesty is widely accepted as a fact of life in policing. This paper thus defends a counterintuitive claim: Good faith is a normative foundation for the police as a political institution. Good faith is a core value of contracts, and policing is contractual in nature both broadly (as a matter of social contract theory) and narrowly (in regard to concrete encounters between law enforcement officers and the public). Given the centrality of good faith to policing, (...) dishonesty and deception on par with fraud are justified only as a narrowly circumscribed investigative tool that is constrained by institutional commitments to the fair distribution of security and the rule of law. The practical upshot is the preclusion of most dishonest and deceptive police tactics on par with fraud, leading to an institution that is less proactive and more reactive. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Calling Obesity a Disease Is A Terrible DecisionMoose FinklesteinFactsThe medical world struggles to see the difference between health and body weight. It is still mostly combined with the strong belief that there is no way a fat person can be fit and healthy. Despite repeated studies and work to show differently, this prejudice remains. This has become part of what I call “Everyone Knows” pseudoscience, where data that (...) have no scientific basis become “fact” due to constant repetition.Obesity is already the cause of great stigma in our society. Fat people are considered “ugly,” fat jokes are acceptable in everyday life, and being called ‘fat’ is, to many, as big an insult as a racial slur. Fat prejudice can approach the levels of racial prejudice (Puhl, Andreyevea & Brownell, 2008). Fat children are bullied, sometimes to the point of suicide. Some studies have found children as young as five trying to diet for being fat, no matter their actual weight. Fat people are more likely to be unemployed or underemployed, and there are prejudicial beliefs that fat workers are more problematic, despite research saying otherwise (Roehling, Roehling, & Odland, 2008).Obesity is seen by the masses as something people choose. However, science disagrees. There has long been a link between depression and obesity. Mental health is tightly tied to obesity, where those who experience weight discrimination are more likely to gain weight, although unhealthy behaviours such as binge eating and exercise avoidance are sometimes seen as a coping mechanism (Sutin & Teracciano, 2013).It has been reported in a number of journals that 90–95% of the people who lose weight regain the weight within 10 years (Mann et al., 2007; Miller, 1999). “Everyone Knows” claims that this is because people go back to bad habits. Science, however, says that there are complex ways the body wants to regain the weight (Sumithran & Proietto, 2013; Sumithran et al., 2011). Worse, dieting may contribute to obesity. Adolescent girls who diet are at 324% greater risk for obesity than those who do not diet (Stice, Cameron, R. P., Killen, J. D., Hayward, C. & Taylor, C. B. 1999). Weight loss dieting may cause other health problems as well, such as immune system problems (Shade ED, et al. 2004).In the medical world, doctors are encouraged to talk to patients about their weight. Every fat person has heard, “What are we going to do about your weight?” The “we” is supposed encourage the patient to feel that the doctor is on the patient’s side in their battle. Yet what many patients hear is, “I don’t see you as a patient, I see you as fat.” Science says that the higher a patient’s BMI the less respect a doctor has for the patient (Huzinga, Cooper, Bleich, Clark, & Beach, 2009).Horror stories about fat people trying to get decent health care are everywhere. For a good example, see Bruce Taylor Seeman’s piece, “The Perils of Obesity May Include the Doctor” (2006). [End Page E1] There are many blogs and stories on the internet about the way patients are not just shamed for their weight, but actively bullied by medical professionals. One blog, The Well Rounded Mama (wellroundedmama.blogspot.com), discusses the bias of doctors against pregnant fat women, who are told things like, “You cannot have a healthy baby when you are this fat” and encouraged to abort. Tales from people told that their weight is the cause for everything and anything can be found on sites like First Do No Harm (fathealth.wordpress.com). Reading blogs by medical professionals can show the disdain they have for fat people. In one, an emergency room nurse declared that all fat diabetics have poor control, based solely on perceptions from her job. Comments were mostly other nurses agreeing with how “disgusting” fat people are to have to deal with. However, Yale University’s Rudd Center for Food Policy & Obesity not only recognizes the problem but aims to help medical professionals eliminate the bias.If obesity becomes a disease, weight loss surgery (WLS) becomes a bigger gold mine. Medical insurance will be more likely to cover weight loss surgery. WLS is an ever-changing target: there... (shrink)

End-of-life decisions concerning euthanasia, stopping life-support machines, or handling advance directives are very complex and highly disputed in industrialized, democratic countries. A main controversy is how to balance the patient’s autonomy and right to self-determination with the doctor’s duty to save life and the value of life as such. These EoL dilemmas are closely linked to legal, medical, religious, and bioethical discourses. In this paper, we examine and deconstruct these linkages in Germany and Israel, moving beyond one-dimensional constructions of ethical (...) statements as “social facts” to their conflicting and multifaceted embedding within professional, religious, and cultural perspectives. (shrink)

Background: Patients in a vegetative state pose problems in diagnosis, prognosis and treatment. Currently, no prognostic markers predict the chance of recovery, which has serious consequences, especially in end-of-life decision-making. Objective: We aimed to assess an objective measurement of prognosis using advanced electroencephalography (EEG). Methods: EEG data (19 channels) were collected in 14 patients who were diagnosed to be persistently vegetative based on repeated clinical evaluations at 3 months following brain damage. EEG structure parameters (amplitude, duration and variability within quasi-stationary (...) segments, as well as the spatial synchrony between such segments and the strength of this synchrony) were used to predict recovery of consciousness 3 months later. Results: The number and strength of cortical functional connections between EEG segments were higher in patients who recovered consciousness (P < .05 – P < .001) compared with those who did not recover. Linear regression analysis confirms that EEG structure parameters are capable of predicting (P = .0025) recovery of consciousness 6 months post-injury, whereas the same analysis failed to significantly predict patient outcome based on aspects of their clinical history alone (P = .629) or conventional EEG spectrum power (P = .473). Conclusions: The result of this preliminary study demonstrates that structural strategy of EEG analysis is better suited for providing prognosis of consciousness recovery than existing methods of clinical assessment and of conventional EEG. Our results may be a starting point for developing reliable prognosticators in patients who are in vegetative state, with the potential to improve their day-to-day management, quality of life, and access to early interventions. (shrink)

Daniel Callahan has argued that economic and social benefits would result from a policy of withholding medical treatments which prolong life in persons over a certain age. He claims 'the real goal of medicine' is to conquer death and prolong life with the use of technology, regardless of the age and quality of life of the patient, and this has been responsible for the escalation of health care expenditure. Callahan's proposal is based on economic rationalism but there is little evidence (...) to suggest that substantial economic savings could be achieved. Moreover, his argument raises serious moral objections. A policy of withholding treatments from members of a social group involves elements of compulsion and discrimination, both of which would intrude on the doctor-patient relationship, undermine the autonomy of elderly patients, and invoke the slippery slope towards involuntary forms of euthanasia. Life-death decisions should be based on more than the one criterion of age, and take account of more relevant factors such as the patient's usual state of well-being, her/his expressed wishes, informed consent and the type of illness. Any move to the implementation and enforcement of the policy Callahan recommends would be rejected by health professionals and the public. (shrink)

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The (...) design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students. (shrink)

Background: Pediatric guidelines recommend that children and adolescents participate in a developmentally appropriate way in end-of-life decision making. Shared decision making in pediatrics is unique because of the triadic relationship of patient, parents, and physician. The involvement of the patient may vary on a continuum from no involvement to being the sole decision maker. However, the effects of child participation have not been thoroughly studied. The aims of this literature review are to identify studies on end-of-life decision making in pediatrics, (...) to explore patient participation, and to assess the effects of such participation. Methods: Five databases—PubMed, PsycInfo, Medline, CINAHL, and Sociological Abstract—were searched for empirical studies on end-of-life decision making in pediatrics. Selected articles fulfilling the criteria were assessed for type of decision, participants’ characteristics, reports on participation of the minor patient, and outcome. Results: Fifty-seven articles on end-of-life decision making in pediatrics were identified. The majority of papers (n = 43, 75%) investigated parents’ and clinicians’ perspectives, while only 14 articles (25%) included perspectives of children and adolescents. Twenty-two articles (39%) reported some details on various forms of children's participation (e.g., receive information, plan care details, consulted before or after a decision was made). Positive (e.g., respect for patient's preferences) and negative (e.g., conflict due to diverging opinions) effects of children's participation in end-of-life decision making were reported. Conclusions: This systematic review highlights the need for research to identify factors that contribute to a favorable participation of minors in decision-making processes, as well as strategies to solve possible conflicts. More research should take into account the dynamics in the triadic process of decision making and emphasize children and adolescents’ perspectives. A better understanding of how to meaningfully involve children and adolescents in end-of-life decision making could facilitate the practice of patient participation in pediatrics. (shrink)

The moral economy of American medicine has been transformed by contentious innovations in organization, administration, regulation, and finance. In many settings old fee-for-service incentives and disincentives have been replaced by those of ``managed care,'' while in other settings they have been diluted or distorted. In the everyday care of patients, old and new may alternate or interact. These innovations may also be having secondary effects on participation in life-sciences research and the development and employment of new technologies, discouraging collective support (...) for preliminary investigation and delaying adoption of improved goods and services until cost-reducing potential has already been realized. This motivational complexity, particularly in its moral dimensions, is hard to address using standard assumptions and methods. I argue for different assumptions, based on the clinical behavior of individual patients rather than the market behavior of aggregated consumers, and I describe a different method, based on an old idea in political economy. I then present a new way to explain the core obligations of clinicians, researchers, and planners and to interpret the policy problems they must now share. (shrink)

Early in Peter Abelard's Dialogue between a Philosopher, a Jew, and a Christian, the philosopher and the Christian easily come to agreement about what the point of ethics is: “[T]he culmination of true ethics … is gathered together in this: that it reveal where the ultimate good is and by what road we are to arrive there.” They also agree that, since the enjoyment of this ultimate good “comprises true blessedness,” ethics “far surpasses other teachings in both usefulness and worthiness.” (...) As Abelard understood them, both fundamental elements of his twelfth-century ethical culture — Greek philosophy and Christian religion — held a common view of the nature of ethical inquiry, one that was so obvious to them that his characters do not even state it in a fully explicit way. They take for granted, as we take the ground we stand on, the premise that the most important function of ethical theory is to tell you what sort of life is most desirable, or most worth living. That is, the point of ethics is that it is good for you, that it serves your self-interest. (shrink)

From the celebrated author of When Bad Things Happen to Good People , a profound and practical book about doing well by doing good. For decades now, from the pulpit and through his writing, Harold Kushner has been helping people navigate the rough patches of life: loss, guilt, crises of faith. Now, in this compelling new work, he ad-dresses an equally important issue: our craving for significance, the need to know that our lives and our choices mean something. We sometimes (...) do great things, and sometimes terrible things, to reassure ourselves that we matter to the world. We sometimes confuse fame, power, and wealth with true achievement. But finally we need to think of ourselves as good people, and we are troubled when we compromise our integrity in the pursuit of what we think of as success. Harold Kushner tells us that the path to a truly successful and significant life is through friendship, through family, and through acts of generosity and self-sacrifice. He describes how, in affecting the life of even one person in a positive way, we make a difference in the world, and prove that we do in fact matter. Persuasive and sympathetic, anecdotal and commonsensical, Living a Life That Matters inspires and uplifts. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Literature as Fable, Fable as ArgumentLester H. HuntIIn an ancient Chinese text we find the following exchange between the Confucian sage Mencius and one of his adversaries:Kao Tzu said, "Human nature is like whirling water. Give it an outlet in the east and it will flow east; give an outlet in the west and it will flow west. Human nature does not show any preference for either good or (...) bad, just as water does not show any preference for either east or west.""It certainly is the case," said Mencius, "that water does not show any preference for either east or west, but does it show the same indifference to high and low? Human nature is good just as water seeks low ground. There is no man who is not good; there is no water that does not flow downwards."1The subject of this colloquy is a familiar one in philosophy as we know it in the West. Its form and style are also vaguely familiar: it is a clashing exchange of theories, in which the speakers do not seem to be speaking merely to express themselves, but in order to persuade others that they are right. Yet at the same time it seems quite alien to us. It would be hard to find anything in it that a Western philosopher since the time of Plato would recognize as an argument. The participants seem to be speaking entirely in illustrative analogies and clever aphorisms, not in arguments at all. The style seems to be literary rather than philosophical. Yet what they are doing does look curiously like arguing. There is a rhythm of statement and counter-statement, in which each speaker seems to be answering the claims of the other.A related, though different, sort of ambiguity, in which the author [End Page 369] really does seem to be both arguing and not arguing, can be found in the following text, traditionally attributed to a Westerner of the sixth century B.C.:Between the North Wind and the Sun, they say, a contest of this sort arose, to wit, which of the two would strip the goatskin from a farmer plodding on his way. The North Wind first began to blow as he does when he blows from Thrace, thinking by sheer force to rob the wearer of his cloak. And yet no more on that account did he, the man, relax his hold; instead he shivered, drew the borders of his garment tight about him every way, and rested with his back against a spur of rock. Then the Sun peeped forth, welcome at first, bringing the man relief from the cold, raw wind. Next, changing, he turned the heat on more, and suddenly the farmer felt too hot and of his own accord threw off the cloak, and so was stripped.Thus was the North Wind beaten in the contest. And the story means: "Cultivate gentleness, my son; you will get results oftener by persuasion than by the use of force."2Here Aesop, to use the traditional name for the author of this ancient fable, is plainly doing something "literary": he is telling a story. But narration in the Aesopian mode is never simply telling a story, and in this case what is present in addition to the story seems to have something logical about it. Personally, I read this fable with a certain sense, however faint, that I am being enlightened by it. That of course is Aesop's aim. He is not merely expressing his opinion, but in some way showing us the truth of it. This is the sort of thing that, in philosophy, is done through argument. However, as in the text from the Mencius, it seems there may be no argument here.Clearly, we are dealing with forms of persuasion that are common at certain times in the development of a culture: namely, those periods when the philosophical muse is a mere suckling babe. We are looking, one might think, at a level of development so rudimentary that the distinction between argument as we think of it today and other forms of persuasion has not been made... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Literature as Fable, Fable as ArgumentLester H. HuntIIn an ancient Chinese text we find the following exchange between the Confucian sage Mencius and one of his adversaries:Kao Tzu said, "Human nature is like whirling water. Give it an outlet in the east and it will flow east; give an outlet in the west and it will flow west. Human nature does not show any preference for either good or (...) bad, just as water does not show any preference for either east or west.""It certainly is the case," said Mencius, "that water does not show any preference for either east or west, but does it show the same indifference to high and low? Human nature is good just as water seeks low ground. There is no man who is not good; there is no water that does not flow downwards."1The subject of this colloquy is a familiar one in philosophy as we know it in the West. Its form and style are also vaguely familiar: it is a clashing exchange of theories, in which the speakers do not seem to be speaking merely to express themselves, but in order to persuade others that they are right. Yet at the same time it seems quite alien to us. It would be hard to find anything in it that a Western philosopher since the time of Plato would recognize as an argument. The participants seem to be speaking entirely in illustrative analogies and clever aphorisms, not in arguments at all. The style seems to be literary rather than philosophical. Yet what they are doing does look curiously like arguing. There is a rhythm of statement and counter-statement, in which each speaker seems to be answering the claims of the other.A related, though different, sort of ambiguity, in which the author [End Page 369] really does seem to be both arguing and not arguing, can be found in the following text, traditionally attributed to a Westerner of the sixth century B.C.:Between the North Wind and the Sun, they say, a contest of this sort arose, to wit, which of the two would strip the goatskin from a farmer plodding on his way. The North Wind first began to blow as he does when he blows from Thrace, thinking by sheer force to rob the wearer of his cloak. And yet no more on that account did he, the man, relax his hold; instead he shivered, drew the borders of his garment tight about him every way, and rested with his back against a spur of rock. Then the Sun peeped forth, welcome at first, bringing the man relief from the cold, raw wind. Next, changing, he turned the heat on more, and suddenly the farmer felt too hot and of his own accord threw off the cloak, and so was stripped.Thus was the North Wind beaten in the contest. And the story means: "Cultivate gentleness, my son; you will get results oftener by persuasion than by the use of force."2Here Aesop, to use the traditional name for the author of this ancient fable, is plainly doing something "literary": he is telling a story. But narration in the Aesopian mode is never simply telling a story, and in this case what is present in addition to the story seems to have something logical about it. Personally, I read this fable with a certain sense, however faint, that I am being enlightened by it. That of course is Aesop's aim. He is not merely expressing his opinion, but in some way showing us the truth of it. This is the sort of thing that, in philosophy, is done through argument. However, as in the text from the Mencius, it seems there may be no argument here.Clearly, we are dealing with forms of persuasion that are common at certain times in the development of a culture: namely, those periods when the philosophical muse is a mere suckling babe. We are looking, one might think, at a level of development so rudimentary that the distinction between argument as we think of it today and other forms of persuasion has not been made... (shrink)

Objectives: To assess French district nurses’ opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients.Design and setting: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses.Participants: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate .Main outcome measures: Opinion towards the legalisation of euthanasia , attitudes towards terminal patients (...) .Results: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients , who consider competent patients should always be told their prognosis and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients . Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny.Conclusions: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care. (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)

This article examines a series of Schelling-like models of residential segregation, in which agents prefer to be in the minority. We demonstrate that as long as agents care about the characteristics of their wider community, they tend to end up in a segregated state. We then investigate the process that causes this and conclude that the result hinges on the similarity of informational states among agents of the same type. This is quite different from Schelling-like behavior and suggests that segregation (...) is an instance of macrobehavior that can arise from a wide variety of micromotives. (shrink)

Early in Peter Abelard's Dialogue between a Philosopher, a Jew, and a Christian, the philosopher and the Christian easily come to agreement about what the point of ethics is: “[T]he culmination of true ethics … is gathered together in this: that it reveal where the ultimate good is and by what road we are to arrive there.” They also agree that, since the enjoyment of this ultimate good “comprises true blessedness,” ethics “far surpasses other teachings in both usefulness and worthiness.” (...) As Abelard understood them, both fundamental elements of his twelfth-century ethical culture — Greek philosophy and Christian religion — held a common view of the nature of ethical inquiry, one that was so obvious to them that his characters do not even state it in a fully explicit way. They take for granted, as we take the ground we stand on, the premise that the most important function of ethical theory is to tell you what sort of life is most desirable, or most worth living. That is, the point of ethics is that it is good for you, that it serves your self-interest. (shrink)

With armed conflict in the Persian Gulf now upon us, Harvard archaeologist Steven LeBlanc takes a long-term view of the nature and roots of war, presenting a controversial thesis: The notion of the "noble savage" living in peace with one another and in harmony with nature is a fantasy. In Constant Battles: The Myth of the Peaceful, Noble Savage , LeBlanc contends that warfare and violent conflict have existed throughout human history, and that humans have never lived in ecological balance (...) with nature. The start of the second major U.S. military action in the Persian Gulf, combined with regular headlines about spiraling environmental destruction, would tempt anyone to conclude that humankind is fast approaching a catastrophic end. But as LeBlanc brilliantly argues, the archaeological record shows that the warfare and ecological destruction we find today fit into patterns of human behavior that have gone on for millions of years. Constant Battles surveys human history in terms of social organization-from hunter gatherers, to tribal agriculturalists, to more complex societies. LeBlanc takes the reader on his own digs around the world -- from New Guinea to the Southwestern U.S. to Turkey -- to show how he has come to discover warfare everywhere at every time. His own fieldwork combined with his archaeological, ethnographic, and historical research, presents a riveting account of how, throughout human history, people always have outgrown the carrying capacity of their environment, which has led to war. Ultimately, though, LeBlanc's point of view is reassuring and optimistic. As he explains the roots of warfare in human history, he also demonstrates that warfare today has far less impact than it did in the past. He also argues that, as awareness of these patterns and the advantages of modern technology increase, so does our ability to avoid war in the future. (shrink)

Nietzsche and the Origin of Virtue : This book is a discussion of Nietzsche's ethical and political ideas. It is an attempt to be both scholarly and, in a sense, activist. The ultimate point is to see how believers in liberal democracy (like me and most of my readers) should respond to the challenge that Nietzsche represents. As with any profound challenge, one is never the same again after it is overcome. In particular, I suggest that liberals can learn something (...) very important from the ideas that grow out of Nietzsche's early discussion of Homer's notion of agon or Wettkampf (roughly, conflict or competition). (shrink)

Background: The increasing number of elderly people in nursing homes with failing competence to give consent represents a great challenge to healthcare staff’s protection of patient autonomy in the issues of life-prolonging treatment, hydration, nutrition and hospitalisation. The lack of national guidelines and internal routines can threaten the protection of patient autonomy. Objectives: To place focus on protecting patient autonomy in the decision-making process by studying how relatives experience their role as substitute decision-makers. Design: A qualitative descriptive design with analysis (...) of the contents of transcribed in-depth interviews with relatives. Participants: Fifteen relatives of 20 patients in 10 nursing homes in Norway. Results and Interpretations: The main findings reveal deficient procedures for including relatives in decision-making processes. Relatives have poor knowledge about the end of life, and there is little discussion about their role as substitute decision-makers for patients who are not competent to give consent. Few relatives understand the concept of patient autonomy. In Norway the treating physician is responsible for patient treatment. When relatives are included in discussions on treatment, they perceive themselves as responsible for the decision, which is a burden for them afterwards. This qualitative study describes relatives’ experiences, thus providing important information on the improvement potential with the main objective of safeguarding patient autonomy and caring for relatives. Conclusion: The study reveals failing procedures and thus a great potential for improvement. Both ethical and legal aspects must be addressed when considering patient autonomy. (shrink)

Western civilization has probably reached an impasse, expressed as a crisis on all fronts: economic, technological, environmental and political. This is experienced on the cultural level as a moral crisis or an ethical deficit. Somehow, the means we have always assumed as being adequate to the task of achieving human welfare, health and peace, are failing us. Have we lost sight of the primacy of human ends? Governments still push for economic growth and technological advances, but many are now asking: (...) economic growth for what, technology for what? Health care and nursing are caught up in the same inversion of human priorities. Professionals, such as nurses and midwives, need to take on social responsibilities and a collective civic voice, and play their part in a moral regeneration of society. This involves carrying civic rights and duties into the workplace. (shrink)

This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but (...) together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

The principle that one cannot deliberate over what one already knows is going to happen, when suitably qualified, has seemed to many philosophers to be about as secure a truth as one is likely to find in this life. Fortunately, it poses little restriction on human deliberation, since the conditions which would trigger its prohibition seldom arise for us: our knowledge of the future is intermittent at best, and those things of which we do have advance knowledge are not the (...) sorts of things over which we would deliberate in any case. But matters appear to stand otherwise with an all-knowing agent such as God is traditionally conceived to be; for what an omniprescient deity ‘already knows is going to happen’ is everything that is going to happen; and if He cannot deliberate over such things, there is nothing over which He can deliberate. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Have We Been Careless with Socrates' Last Words?:A Rereading of the PhaedoLaurel A. Madison (bio)In section 340 of The Gay Science, Nietzsche offers what he believes will be received as a scandalous interpretation of Socrates' last words. "Whether it was death or the poison or piety or malice—something loosened his tongue at that moment and he said: 'O Crito, I owe Asclepius a rooster.' This ridiculous and terrible (...) 'last word' means for those who have ears: 'O Crito, life is a disease.'"1 Nietzsche might be surprised, however, to discover just how many readers "have ears" to hear the pessimism and resentment in Socrates' voice as he bids farewell to his life. Indeed, this interpretation has become standard among both Plato scholars and non-scholars, taking on the air of orthodoxy.2Not only is this "Nietzschean" reading widespread, it also has a significant impact on how we understand Plato's project in general and, ultimately, whether or [End Page 421] not we believe that Plato still has something to teach us. This commonly accepted interpretation reinforces the view that Socrates and Plato were ascetics of the worst kind, hostile to life and the body in particular. As a consequence, significant portions of Plato's thought are treated as woefully unenlightened. Indeed, how can we take seriously the views of such a dualist who denigrates our earthly existence and urges us to deny and repress our passions, instincts, desires, and drives—i.e., to live for death?It is assumed correctly, I think, that Socrates' last words speak volumes about both his and Plato's view of the nature and task of human existence. However, the meaning of these words, I will argue, has been seriously misinterpreted and their intended significance fundamentally obscured. Thus it is time to take another, closer look at what is arguably Socrates' most important statement—a statement uttered with his last breath:Crito, we owe a cock to Asclepius; make this offering to him and do not forget.3How are we, as readers of this dialogue, to interpret Socrates' last words? What is the meaning of his final thought, his dying wish and command? According to the standard reading of this passage, Socrates awaits the termination of his life with gratitude and relief. As death closes in on him, he asks Crito to make an offering to Asclepius, the god of healing. By invoking this god, Socrates appears to be calling attention to the recovery from an illness. But what is the illness and what is the cure? At the moment these words are uttered, Socrates is on the brink of death and it is assumed that he views his death as the cure to the illness of life. This reading is substantiated by an earlier passage where Socrates argues that "the one aim of those who practice philosophy in the proper manner is to practice for dying and death" (64a3-4). The body, Socrates argues, obscures our pursuit of the truth and the sooner we can separate our soul from this hindrance (i.e., in death) the better off we will be, for "as long as we have a body and our soul is fused with such an evil we shall never adequately attain what we desire, which we affirm to be the truth" (66b3-5). From the philosopher's perspective, then, the body is something to "disdain" (, 65d1) and "despise" (, 68c11)—indeed, to "flee" from (, 65d1). Thus given the disparagement of our bodily existence in this earlier passage, how else can we interpret Socrates' final statement?4Because this "Nietzschean" reading of Socrates' last words appears to be based in large part upon the discussion of philosophy as preparation for death, any examination of it must include an analysis of the earlier passage as well.5 However, [End Page 422] to adequately interpret the discussion of philosophy as preparation for death (or any passage in the dialogues, for that matter), we must first place it in its context within the drama of the dialogue, the philosophical significance of which has been argued at length elsewhere.6 Let us then turn to the opening scene of the dialogue, for... (shrink)