Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: (...) irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD. (shrink)

The Liverpool Care Pathway for the Dying Patient (LCP) was an integrated care pathway for patients in the final days or hours of life, developed at the Royal Liverpool University Hospital in conjunction with the Marie Curie Palliative Care Institute, Liverpool. The LCP became increasingly the normative style of care for patients in the terminal stage across NHS England from the 1990s onwards. Following significant questions raised in Parliament, by the media and other stakeholders, an independent review panel was established (...) under Baroness Neuberger in 2013 to investigate the LCP. The findings of the panel were published as More Care Less Pathway: a Review of the Liverpool Care Pathway identifying significant failings in the delivery of the LCP thus leading to it being phased out some six months later. Rather than being euthanasia through the backdoor, many of the criticisms of the LCP and its poor implementation are indicative of poor communication, limited knowledge of the dying process and a paucity of death education. (shrink)

For the most of us, work is an entirely non-discretionary activity, an inescapable and irreducible fact of existence. According to E. F. Schumacher one of the darkest aspects of contemporary work life is the existence of an appalling number of men and women condemned to work which has no connection with their inner lives, no meaning for them whatever. Work for too many people is perceived as down-time, something that has to be done, but seldom adding to who they are. (...) And yet recent surveys indicate that 74% of the work force would chose to work even if they were not financially required to do so. Why?This paper contends that people want to work because they are intuitively aware that work, be it bad or good, helps to shape them. It gives them a sense of direction and allows them the opportunity for personal creativity and fulfillment. Work is the axis of human self-making. Work molds the person and work is the mark of a person. Satisfaction with life seems to be related to satisfaction with our work and the quality of our lives seems dependent on the quality of work that we do. (shrink)

Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny (...) to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing. (shrink)

Natural selection favors not only more adaptive structural features but also more effective behavioral programs. Crucial for the prospering and very survival of an extremely sophisticated social species like homo sapiens is the biological/psychological program that might be conveniently labeled the human sense of fairness: a feeling often referred to in societies featuring supernaturalized explanations as one's "God given conscience." The sense of fairness and related programs derive a measure of their effectiveness from the fact that, in addition to the (...) pleasure/pain mechanisms reinforcing their implementation, we are programmed to want to want the goals they introduce and to experience repugnance in the face of goals that strongly conflict. (shrink)

David Benatar argues that coming into existence is always a harm, and that – for all of us unfortunate enough to have come into existence – it would be better had we never come to be. We contend that if one accepts Benatar’s arguments for the asymmetry between the presence and absence of pleasure and pain, and the poor quality of life, one must also accept that suicide is preferable to continued existence, and that his view therefore implies both anti-natalism (...) and pro-mortalism . This conclusion has been argued for before by Elizabeth Harman – she takes it that because Benatar claims that our lives are ‘awful’, it follows that ‘we would be better off to kill ourselves’ (Harman 2009: 784). Though we agree with Harman’s conclusion, we think that her argument is too quick, and that Benatar’s arguments for non-pro-mortalism deserve more serious consideration than she gives them. We make our case using a tripartite structure. We start by examining the prima facie case for the claim that pro-mortalism follows from Benatar’s position, presenting his response to the contrary, and furthering the dialectic by showing that Benatar’s position is not just that coming into existence is a harm, but that existence itself is a harm. We then look to Benatar’s treatment of the Epicurean line, which is important for him as it undermines his anti-death argument for non-pro-mortalism. We demonstrate that he fails to address the concern that the Epicurean line raises, and that he cannot therefore use the harm of death as an argument for non-pro-mortalism. Finally, we turn to Benatar’s pro-life argument for non-pro-mortalism, built upon his notion of interests, and argue that while the interest in continued existence may indeed have moral relevance, it is almost always irrational. Given that neither Benatar’s anti-death nor pro-life arguments for non-pro-mortalism work, we conclude that pro-mortalism follows from his anti-natalism, As such, if it is better never to have been, then it is better no longer to be. -/- . (shrink)

He then proceeds with an examination of the picture theory developed by Wittgenstein, Carnap, and Goodman, and concludes with an examination of Patricia Churchland, Ruth Millikan, Robert Cummins, and Mark Rollins. The use of the historical development of representationalism to pose a central problem in contemporary cognitive science is unique.

How do physicians handle informing patients of their diagnoses and how much information do patients really want? How do registered nurses view both sides of this question? Three questionnaires were constructed and administered in a mid-size hospital in New York state. Physicians and nurses underestimate the number of patients who want detailed information. Patients who earn more than average, have a college education, and who are under age 60 are more likely to want information, and state that their physician should (...) give it to them. Only 42% of physicians state that patients want a detailed description of their diagnosis and treatment options. Physicians educated outside the USA appeared to be more likely to change their criteria for informing patients and, along with American-educated nurses, were more willing to participate in formal discussions of the issue. Physicians should comply with the wishes of patients for information and include them in the team deciding on diagnosis and treatment. (shrink)

We dedicate this book to John Thibaut. He was mentor and personal friend to one of us, and his work had a profound intellectual influence on both of us. We were both strongly influenced by Thibaut's insightful articulation of the importance to psychology of the concept of pro cedural justice and by his empirical work with Laurens Walker in reactions to legal institu demonstrating the role of procedural justice tions. The great importance we accord the Thibaut and Walker work is (...) evident throughout this volume. If anyone person can be said to have created an entire field of inquiry, John Thibaut created the psychological study of procedural justice. (To honor Thibaut thus in no sense reduces our recognition of the contributions of his co-worker, Laurens Walker, in the creation of the field. We are as certain that Walker would endorse our statement as we are that Thibaut, with characteristic modesty, would demur from it. ) Even to praise Thibaut in this fashion falls short of recognizing all of his contributions to procedural justice. Not only did he initiate the psy chological study of the topic, he also built much of the intellectual foun dation upon which the study of procedural justice rests. Thibaut's work with Harold Kelley (1959; Kelley & Thibaut, 1978) created a social psy chological theory of interdependence that, among many other applica tions, serves as the basis for one of the major models of the psychology of procedural justice. (shrink)

School psychologists often break confidentiality if confronted with risky adolescent behavior. Members of the National Association of School Psychologists ( N = 78) responded to a survey containing a vignette describing an adolescent engaging in risky behaviors and rated the degree to which it is ethical to break confidentiality for behaviors of varying frequency, intensity, and duration. Respondents generally found it ethical to break confidentiality when risky adolescent behaviors became more dangerous or potentially harmful, although there was considerable variability between (...) respondents. Significant gender effects were found between male and female respondents for alcohol use, and a significant Form Type (i.e., male or female vignette) Frequency/Duration interaction was observed for antisocial behaviors. School psychologists could benefit from further training in ethical decision making because these ethical dilemmas are not always clear-cut. (shrink)

The lively debate over the constitutional foundations of judicial review has been marred by a formalism which obscures its point and value.ed from genuine issues of substance, the rival positions offer inadequate accounts of the legitimacy of judicial review; constitutional theory must regain its connection with questions of political principle and moral value. Although the critics of ultra vires have rightly emphasized the foundational role of the common law, they have misconceived its nature and implications. On the one hand, they (...) have invited the charge of judicial supremacism by marginalizing the role of legislative intent; on the other, their affirmation of absolute parliamentary sovereignty (within the context of this debate) undermines the critique of ultra vires. In substance, therefore, the rival camps occupy essentially the same ground, equally trapped by a formalism that entrenches a stark confrontation between parliamentary sovereignty and the rule of law. A conception of shared sovereignty, or interdependent sovereignties, provides a better foundation for judicial review. (shrink)

Ronald Dworkin's theory of law forges a close connection between questions about the truth of propositions of law and the question of political obligation: law as integrity is a theory of legal practice that purports to explain, not only how the content of law is determined, but also why the law—in ordinary cases—imposes an obligation of obedience. The theory (as presented) is ultimately incoherent. If we accept Dworkin's theory of the grounds of law we are obliged to reject his claims (...) about its force; alternatively, if we accept his view of the force of law, we must reject his theory about its grounds: he cannot be correct about both force and grounds. Dworkin supposes that, in extraordinary cases, the force of law is cancelled or overridden; but the relevant considerations of justice are wholly internal to our identification of the content of law. Consistently elaborated, integrity denies the offending requirements legal status: lex injusta non est lex. (shrink)

This study aimed to understand the preserved elements of self-identity in persons with moderate to severe dementia attributable to Alzheimer’s disease. A semi-structured interview was developed to explore the narrative self among residents with dementia in a residential care facility and residents without dementia in an independent living setting. The interviews were transcribed verbatim from audio recordings and analyzed for common themes, while being sensitive to possible differences between the groups. The participants with dementia showed evidence of self-reference even though (...) losses in explicit memory were evident. The most noticeable difference between the two groups was time frame reference. Nonetheless, all participants showed understanding of their role in relationships and exhibited concrete preferences. Our findings suggest that memory loss and other cognitive deficits associated with moderate to severe dementia do not necessarily lead to a loss of “self.”. (shrink)

When legal practice satisfies certain modest conditions of legitimacy, affirming the equal dignity of persons, the law is what it ought to be. It provides the morally appropriate basis for the reso...

This book builds on the idea that pragmatics and philosophy are strictly interconnected and that advances in one area will generate consequential advantages in the other area. The first part of the book, entitled ‘Theoretical Approaches to Philosophy of Language’, contains contributions by philosophers of language on connectives, intensional contexts, demonstratives, subsententials, and implicit indirect reports. The second part, ‘Pragmatics in Discourse’, presents contributions that are more empirically based or of a more applicative nature and that deal with the pragmatics (...) of discourse, argumentation, pragmatics and law, and context. The book presents perspectives which, generally, make most of the Gricean idea of the centrality of a speaker’s intention in attribution of meaning to utterances, whether one is interested in the level of sentence-like units or larger chunks of discourse. (shrink)