A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a (...) defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings. (shrink)

For the last fifty years, the United States healthcare system has done an extremely poor job of delivering healthcare in a just and fair manner. The United States holds the dubious distinction of being the only industrialized nation in the world lacking provisions to ensure universal coverage. We attempt to provide some of the reasons this dysfunctional system has persisted and show that healthcare should not be a commodity. We begin with a brief historical overview of healthcare delivery in the (...) United States since WWII. This is followed by a critical analysis of the for-profit model including reasons to support the view that healthcare should not be a free market commodity. We also demonstrate how special interest groups have been able to win support for their practices based on propaganda rather than fact. A brief analysis of the Affordable Care Act is offered along with critical comments regarding its ineffectiveness. We conclude with a brief overview of international approaches that have resulted in universal coverage and suggest the United States ought to adopt an approach similar to those outlined so that it no longer stands as the only industrialized nation to ignore the glaring problems that exist. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is (...) not. Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma’s particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility—a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices. (shrink)

Richard Janko's acclaimed translation of Aristotle's _Poetics_ is accompanied by the most comprehensive commentary available in English that does not presume knowledge of the original Greek. Two other unique features are Janko's translations with notes of both the _Tractatus Coislinianus_, which is argued to be a summary of the lost second book of the Poetics, and fragments of Aristotle’s dialogue On Poets, including recently discovered texts about catharsis, which appear in English for the first time.

It is often alleged that liberalism and nationalism are mutually antagonistic in theory and practice. Max Weber is a good example, the dominant interpretation maintains, as his political thought betrays its liberal foundation by embracing an ardent nationalism that was popular in Wilhelmine Germany. Weber was, in short, a nationalist, and thus illiberal, political thinker. Against this conventional wisdom I argue that Weber's liberal nationalism cannot be placed squarely in the authoritarian, ethnic tradition of German nationalism, and its idiosyncrasy becomes (...) evident once Weber's twofold political project of revivifying a robust civil society while imbuing it with the spirit of public citizenship is foregrounded more clearly. Thus recast, Weber's political thought reveals a strong affinity with that of Tocqueville and Mill, especially in their similar concern with moral personality and political maturity in a mass democracy. (shrink)

Samuel H. LiPuma and Joseph P. DeMarco argue for a positive right to continuous sedation until death (CSD) for any patient with a life expectancy less than six months. They reject any requirement of proportionality. Their proposed guideline makes CSD an option for a decisional adult patient with an appropriate terminal diagnosis regardless of whether suffering (physical or existential) is present. This guideline purports to “empower” the patient with the ability to control the timing and manner of her death. (...) This extends even to the option to “opt out” of the awareness and experience of dying and to avoid suffering altogether, even if one’s symptoms and suffering could be effectively treated.We respond first with a critique of their terminology. We then turn to some purely practical considerations of how this guideline might be enacted in the current atmosphere of American hospice and palliative care medicine. We close with a consideration of one philosophical concern that might ground the discussion of risks, benefits, and alternatives necessary for informed consent. (shrink)

A statement in contemporary terms of an Aristotelian approach to ethics, spiced with numerous illustrations from the modern arts and sciences. Veatch attempts to persuade the reader of the importance of the moral and intellectual virtues for leading an ethical life, and ends with a definition of the good "simply as the perfect with respect to the imperfect, the complete with respect to the incomplete, the actual with respect to the potential". He argues against ethical relativism and scepticism, Platonic "intellectualism", (...) Utilitarianism, the contemporary second-intentional linguistic approach, and certain aspects of existentialism.--A. S. H. (shrink)

Philosophers of chemistry, following the lead of physicists, have been slow to realize that molecular descriptions issuing from quantum mechanics in the absence of chemical theory are fatally flawed. In the wake of this realization, new topics have begun to unfold—including new metaphysical issues, new concerns about the philosophy of chemistry's place in the philosophy of science, and new accounts of how properties are observed, inferred, and presented. A recent collection of essays, Of Minds and Molecules: New Philosophical Perspectives on (...) Chemistry edited by Nalini Bhushan and Stuart Rosenfeld, reveals what some of these new issues are and suggests new directions for the philosophy of chemistry. (shrink)

This volume contains a critical edition and annotated translation of three previously unpublished and virtually neglected commentaries of Averroes on Aristotle. The edition is based on the two extant Judaeo-Arabic MSS which were collated with the thirteenth-century Hebrew translation of Jacobben Makhir and the sixteenth-century Latin translation. In addition, there is an introduction that includes a discussion of the teaching of the text and indices of names and titles and technical terms. The latter index also functions as an English-Arabic glossary. (...) This important book is published under the auspices of the Society for the Study of Islamic Philosophy and Science. (shrink)