Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

The study of emotional intelligence and its relationship with the dark triad has emerged as a popular research area. However, the complex nature of the dark triad and EI, including multiple me...

This book's importance is derived from three sources: careful conceptualization of teacher induction from historical, methodological, and international perspectives; systematic reviews of research literature relevant to various aspects of teacher induction including its social, cultural, and political contexts, program components and forms, and the range of its effects; substantial empirical studies on the important issues of teacher induction with different kinds of methodologies that exemplify future directions and approaches to the research in teacher induction.

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

The inclusion of stakeholders and knowledge systems is increasingly valued in research to address complex socio-ecological challenges around the world. Often these projects take place in cross-cultural setting where external researchers risk perpetuating historically extractive research models that not only harm local communities but damage the validity of research projects. Responsible community engagement is increasingly recognized as a practice that can improve researcher-community relationships and research quality by incorporating principles of ethics, reciprocity, and power sharing. In partnership with local community (...) leaders, researchers from a U.S. university coded 76 research articles for indicators of responsible community engagement conducted in the Samburu, Kenya community since 2000. Findings from this study suggest that most of the research in Samburu has followed extractive models. Of the 76 articles reviewed many failed to acknowledge ethical protocols, did not address relevance of the study to the local community, and did not report any indication of outreach or community change as a result of the research. While a portion of articles showed evidence of community involvement in the studies, the involvement was primarily limited to secondary roles with little to no shared decision-making power over the research process. We discuss methodological considerations for future research and steps that must be taken in order to shift the norm and practice of academic research in sites such as Samburu, Kenya. (shrink)

Introduction The bioethics literature reflects significant interest in and concern with the use of genetic and genomic information in various settings. Because psychiatric treatment and research raises unique ethical, legal, and social issues, we conducted a scoping review of the biomedical, bioethics, and psychology literature regarding the application of genetic and genomic tools to psychiatric disorders (as listed in the DSM-5) and two associated behaviors or symptoms to provide a more detailed overview of the state of the field. Objectives The (...) primary objective was to examine the available bioethics, biomedical, and psychology literature on applying genetic and genomic tools to psychiatric disorders (other than neurodevelopmental disorders) and two behaviors or symptoms sometimes associated with them (aggression or violence and suicidality) to identify the disorders to which these tools have been applied, the contexts in or purposes for which they have been applied, the ethical, legal, or social concerns associated with those uses, and proposed recommendations for mitigating those concerns. Methods We used Arksey and O’Malley’s scoping review framework: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; and (5) collate, summarize, and report results (2005). We relied on Levac et al. to inform our application of the framework (2010). The PRISMA extension for scoping reviews checklist informed our reporting (2018). We searched three electronic databases MEDLINE (PubMed), Embase, and PsycInfo (EbscoHost) for peer-reviewed journal articles in English to identify relevant literature. One author screened the initial results and additional screening was done in consultation with other authors. A data extraction form using DSM-5 diagnostic categories (excluding neurodevelopmental disorders) was developed and two authors independently each reviewed approximately half of the articles. Inter-rater reliability was ensured by double-coding approximately 10% of the papers. An additional author independently coded 10% of the articles to audit the data. Results In 365 coded publications, we identified 15 DSM-5 diagnostic categories in addition to the two pre-selected behaviors or symptoms (aggression or violence and suicidality) to which genetic or genomic tools have been applied. We identified 11 settings in or purposes for which these tools were applied. Twenty-two types of ethical, legal, or social concerns associated with the application of genetic or genomic tools to these disorders or behaviors/symptoms were identified along with 13 practices or policies that could mitigate these concerns. Conclusion Genetic and genomic tools have been applied to a wide range of psychiatric disorders. These raise a range of ethical, legal, and social concerns. Additional research is warranted to better understand the concerns and effective ways to address them. Advancing the literature to identify relevant ethical, legal, or social concerns and solutions to those problems likely requires greater attention to specific applications of genetic or genomic tools to particular psychiatric disorders and associated behaviors/symptoms as well as broad stakeholder engagement. (shrink)

The need for informed analyses of health policy is now greater than ever. The twelve essays in this volume show that public debates routinely bypass complex ethical, sociocultural, historical, and political questions about how we should address ideals of justice and equality in health care. Integrating perspectives from the humanities, social sciences, medicine, and public health, this volume illuminates the relationships between justice and health inequalities to enrich debates. Understanding Health Inequalities and Justice explores three questions: How do scholars approach (...) relations between health inequalities and ideals of justice? When do justice considerations inform solutions to health inequalities, and how do specific health inequalities affect perceptions of injustice? And how can diverse scholarly approaches contribute to better health policy? From addressing patient agency in an inequitable health care environment to examining how scholars of social justice and health care amass evidence, this volume promotes a richer understanding of health and justice and how to achieve both. -/- The contributors are Judith C. Barker, Paula Braveman, Paul Brodwin, Jami Suki Chang, Debra DeBruin, Leslie A. Dubbin, Sarah Horton, Carla C. Keirns, J. Paul Kelleher, Nicholas B. King, Eva Feder Kittay, Joan Liaschenko, Anne Drapkin Lyerly, Mary Faith Marshall, Carolyn Moxley Rouse, Jennifer Prah Ruger, and Janet K. Shim. (shrink)

In Working Virtue: Virtue Ethics and Contemporary Moral Problems, leading figures in the fields of virtue ethics and ethics come together to present the first ...

Last year, more than seven million Americans participated in yoga or tai chi classes.Yet despite its popularity the real nature of yoga remains shrouded in mystery. A diverse range of practitioners range from white-bearded Indian mystics to celebrities like Madonna and Gwyneth Paltrow. Positioning Yoga provides an overview of the development of yoga, from its introduction to Western audiences by the Indian Swami Vivekananda at the 1893 Parliament of the World's Religions in Chicago to forms of modern practice. What makes (...) yoga practitioners affiliated with Swami Sivananda's Divine Life Society of Rishikesh, India unique--whether they hail from Indian, North America, or Europe? What values around the world have supported the surging popularity of yoga over the past century? This absorbing book considers how lifestyle values have made yoga a global industry and shows how this popular "lifestyle" is produced and disseminated across boundaries. (shrink)

Conceptual engineering is to be explained by appeal to the externalist distinction between concepts and conceptions. If concepts are determined by non-conceptual relations to objective properties rather than by associated conceptions (whether individual or communal), then topic preservation through semantic change will be possible. The requisite level of objectivity is guaranteed by the possibility of collective error and does not depend on a stronger level of objectivity, such as mind-independence or independence from linguistic or social practice more generally. This means (...) that the requisite level of objectivity is exhibited not only by natural kinds, but also by a wide range of philosophical kinds, social kinds and artefactual kinds. The alternative externalist accounts of conceptual engineering offered by Herman Cappelen and Derek Ball fall back into a kind of descriptivism which is antithetical to externalism and fails to recognise this basic level of objectivity. (shrink)

We sometimes strive to achieve difficult goals when our evidence suggests that success is unlikely – not just because it will require strength of will, but because we are targets of prejudice and discrimination or because success will require unusual ability. Optimism about one’s prospects can be useful for persevering in these cases. That said, excessive optimism can be dangerous; when our evidence is unfavourable, we should be at most agnostic about whether we will succeed. This paper explores the nature (...) and rational significance of agnostic practical commitments. Most importantly, the rationality of striving against the odds can depend on investing in a plan for failure: a plan B. I aim to make headway on an account of what backup plans are, how they are related to primary plans, and whether the standard norms of plan rationality apply to our agnostic commitments. (shrink)

This essay examines the multifaceted roles of drinking parties in early Greece and in medieval China. It takes as paradigm examples descriptions of ritual intoxication in Plato’s Laws and in the poetry of Ouyang Xiu and Mei Yaochen, arguing that these divergent cultural and philosophical traditions can be both related and made distinct through concepts of pleasure, creativity, and social harmony.

Many of our most important goals require months or even years of effort to achieve, and some never get achieved at all. As social psychologists have lately emphasized, success in pursuing such goals requires the capacity for perseverance, or "grit." Philosophers have had little to say about grit, however, insofar as it differs from more familiar notions of willpower or continence. This leaves us ill-equipped to assess the social and moral implications of promoting grit. We propose that grit has an (...) important epistemic component, in that failures of perseverance are often caused by a significant loss of confidence that one will succeed if one continues to try. Correspondingly, successful exercises of grit often involve a kind of epistemic resilience in the face of failure, injury, rejection, and other setbacks that constitute genuine evidence that success is not forthcoming. Given this, we discuss whether and to what extent displays of grit can be epistemically as well as practically rational. We conclude that they can be (although many are not), and that the rationality of grit will depend partly on features of the context the agent normally finds herself in. In particular, grit-friendly norms of deliberation might be irrational to use in contexts of severe material scarcity or oppression. (shrink)

Ducks lay eggs' is a true sentence, and `ducks are female' is a false one. Similarly, `mosquitoes carry the West Nile virus' is obviously true, whereas `mosquitoes don't carry the West Nile virus' is patently false. This is so despite the egg-laying ducks' being a subset of the female ones and despite the number of mosquitoes that don't carry the virus being ninety-nine times the number that do. Puzzling facts such as these have made generic sentences defy adequate semantic treatment. (...) However complex the truth conditions of generics appear to be, though, young children grasp generics more quickly and readily than seemingly simpler quantifiers such as `all' and `some'. I present an account of generics that not only illuminates the strange truth conditions of generics, but also explains how young children find them so comparatively easy to acquire. I then argue that generics give voice to our most cognitively primitive generalizations and that this hypothesis accounts for a variety of facts ranging from acquisition patterns to cross-linguistic data concerning the phonological articulation of operators. I go on to develop an account of the nature of these cognitively fundamental generalizations and argue that this account explains the strange truth-conditional behavior of generics. (shrink)

Among the many practical failures that threaten us, weakness of will or akrasia is often considered to be a paradigm of irrationality. The eleven new essays in this collection, written by an excellent international team of philosophers, some well-established, some younger scholars, give a rich overview of the current debate over weakness of will and practical irrationality more generally. Issues covered include classical questions such as the distinction between weakness and compulsion, the connection between evaluative judgement and motivation, the role (...) of emotions in akrasia, rational agency, and the existence of the will. The also include new topics, such as group akrasia, strength of will, the nature of correct choice, the structure of decision theory, the temporality of prudential reasons, and emotional rationality. Because these questions cut across philosophy of mind and ethics, the collection will be essential reading for scholars, postgraduates, and upper-level undergraduates in both these fields. (shrink)

This book sets out to generate new ways of reflecting ethically about the purposes and values of contemporary higher education in relation to agency, learning, public values and democratic life, and the pedagogies which support these.

Some omissions seem to be causes. For example, suppose Barry promises to water Alice’s plant, doesn’t water it, and that the plant then dries up and dies. Barry’s not watering the plant – his omitting to water the plant – caused its death. But there is reason to believe that if omissions are ever causes, then there is far more causation by omission than we ordinarily think. In other words, there is reason to think the following thesis true.

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to (...) show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed. (shrink)

In this analysis I apply a Foucauldian approach to ethics to examine the politically prescribed moral and ethical character required of carers of aged persons at home in Australia and the role of nurses in shaping these behaviours. The work that spousal carers provide, although often founded on love and/or obligation, has been formalized through a variety of policy initiatives and technologies that serve to construct the moral approach they must adopt. This shaping of conduct at the most personal level (...) takes place through the application of codes of behaviour policed largely by nurses. These codes redefine the mode of coexistence between an aged husband and wife and propose a new form of relationship that is derived from and supports policies of the deinstitutionalization of care services for elderly persons. In this way modern carer policy has drawn on knowledge and governance of the self to produce a morality of caring that is both authoritative and scientific. (shrink)

Traditionally, discussions of moral participation – and in particular moral agency – have focused on fully formed human actors. There has been some interest in the development of morality in humans, as well as interest in cultural differences when it comes to moral practices, commitments, and actions. However, until relatively recently, there has been little focus on the possibility that nonhuman animals have any role to play in morality, save being the objects of moral concern. Moreover, when nonhuman cases are (...) considered as evidence of moral agency or subjecthood, there has been an anthropocentric tendency to focus on those behaviors that inform our attributions of moral agency to humans. For example, some argue that the ability to evaluate the principles upon which a moral norm is grounded is required for full moral agency. Certainly, if a moral agent must understand what makes an action right or wrong, then most nonhuman animals would not qualify (and perhaps some humans too). However, if we are to understand the evolution of moral psychology and moral practice, we need to turn our attention to the foundations of full moral agency. We must first pay attention to the more broadly normative practices of other animals. Here, we begin that project by considering evidence that great apes and cetaceans participate in normative practices. (shrink)

Introduction: Thinking, writing, and reading about the real -- Dialectic and the real : Lacan, Hegel, and the alchemy of après-coup -- 'Reality' and the real : culture as anamorphosis -- The real of sexual difference : imagining, thinking, being -- Ethics and the real : the ungodly virtues of psychoanalysis -- Politics, or, the art of the impossible.

Should monkeys be used in painful and often deadly infectious disease research that may save many human lives? This is the challenging question that Anne Barnhill, Steven Joffe, and Franklin G. Miller take on in their carefully argued and compelling article “The Ethics of Infection Challenges in Primates.” The authors offer a nuanced and even-handed position that takes philosophical worries about nonhuman primate moral status seriously and still appreciates the very real value of such research for human welfare. Overall, they (...) argue for an extension and revision of the recommendations regarding chimpanzee research offered by the Institute of Medicine in 2011; the practical upshot of their argument would allow for infection challenge research for promising interventions for Ebola and Marburg virus diseases but not for smallpox or the common cold. The IOM recommendations regarding chimpanzee research put in motion an exceptionalist policy for this great ape population. Barnhill and colleagues’ proposal would enlarge the scope of that exceptionalism to embrace NHPs other than great apes. But is such exceptionalism warranted? It is not obvious to me either that the more sophisticated capacities of a species as a whole give it greater ethical protections or that less intellectually or socially sophisticated animals ought to therefore receive less protection when it comes to painful experimental interventions. (shrink)

In Nicomachean Ethics X.7–8, Aristotle defends a striking view about the good for human beings. According to Aristotle, the single happiest way of life is organized around philosophical contemplation. According to the narrowness worry, however, Aristotle's contemplative ideal is unduly Procrustean, restrictive, inflexible, and oblivious of human diversity. In this paper, I argue that Aristotle has resources for responding to the narrowness worry, and that his contemplative ideal can take due account of human diversity.

Gregory Bateson’s career from anthropologist, through his development of cybernetics and systems theory, to developing ideas around ‘the sacred’, has parallels with Roy Bhaskar’s intellectual journey. This paper proposes that as well as Bateson’s theory of cybernetics and systemic thought making a contribution to basic and dialectic critical realism, his final and posthumously published Angels Fear: Towards and Epistemology of the Sacred adds to our understanding of Bhaskar’s metaReality. Similarities between the development of Bateson’s work from 1936 to 1987 and (...) Bhaskar’s work from 1975 to 2016 enable the development of theory that adds to both of their respective appreciations of metaReality and the sacred. Thus, by starting a conversation between Bateson and Bhaskar, we can develop a higher order understanding of the world than proposed by Bhaskar’s metaReality alone. (shrink)

Gils-Schmidt and Salloch recognise that human and climate health are inextricably linked, and that mitigating healthcare-associated climate harms is essential for protecting human health.1 They argue that physicians have a duty to consider how their own practices contribute to climate change, including during their interactions with patients. Acknowledging the potential for conflicts between this duty and the provision of individual patient care, they propose the application of Korsgaard’s neo-Kantian account of practical identities to help navigate such scenarios. In this commentary, (...) we argue that by focusing attention on this physician–patient level, the authors overlook the complexity of climate change, both within the healthcare sector and beyond. We recognise the importance of individual agency in tackling this issue, and we also recognise that the authors do briefly acknowledge the importance of considering these broader complexities; however, we emphasise the need for climate and health discussions/action to be situated in a wider framework of systemic change. Our concern is that overemphasis on patient-level interactions risks normalising the prioritisation of individual-level approaches to addressing climate change, detracting from such a broader approach. Physician training emphasises the need for trust, confidentiality and shared decision-making in the doctor–patient relationship. …. (shrink)

Advances in AI are powering increasingly precise and widespread computational propaganda, posing serious threats to national security. The military and intelligence communities are starting to discuss ways to engage in this space, but the path forward is still unclear. These developments raise pressing ethical questions, about which existing ethics frameworks are silent. Understanding these challenges through the lens of “cognitive security,” we argue, offers a promising approach.

Despite All Critique (2014) -- World Politics and Western Reason (1980) -- The Doubled Outsides of the Modern International (2005) -- The Subject of Security (1995) -- The Protection of Nature and the Nature of Protection (2005) -- Social Movements/World Politics (1994) -- Europe is Not Where It is Supposed to Be (2000) -- They Seek it Here, They Seek it There : Looking for Politics in Clayoquot Sound (2003) -- Violence, Modernity, Silence : From Weber to International Relations (1993) (...) -- Hobbes, Origins, Limits (2011) -- War, Terror, Judgement (2002) -- International, Imperial, Exceptional (2005) -- Which Democracy for Which Demos? (2013) -- The Political Theory of Boundaries and the Boundaries of Political Theory : Interview With Raia Prokhovnik (2012). (shrink)

This collection examines the question of nonhuman animal agency by shifting emphasis from the human perspective toward that of other animals, exploring modes of ...

In fragments of the lost Protrepticus, preserved in Iamblichus, Aristotle responds to Isocrates’ worries about the excessive demandingness of theoretical philosophy. Contrary to Isocrates, Aristotle holds that such philosophy is generally feasible for human beings. In defense of this claim, Aristotle offers the progress argument, which appeals to early Greek philosophers’ rapid success in attaining exact understanding. In this paper, I explore and evaluate this argument. After making clarificatory exegetical points, I examine the argument’s premises in light of pressing worries (...) that the argument reasonably faces in its immediate intellectual context, the dispute between Isocrates and Aristotle. I also relate the argument to modern concerns about philosophical progress. I contend that the argument withstands these worries, and thereby constitutes a reasonable Aristotelian response to the Isocratean challenge. (shrink)

When we define something as a crime, we generally thereby criminalize the attempt to commit that crime. However, it is a vexing puzzle to specify what must be the case in order for a criminal attempt to have occurred, given that the results element of the crime fails to come about. I argue that the philosophy of action can assist the criminal law in clarifying what kinds of events are properly categorized as criminal attempts. A natural thought is that this (...) project should take the form of specifying what it is in general to attempt or try to perform an action, and then to define criminal attempts as attempts to commit crimes. Focusing on Gideon Yaffe's resourceful work in Attempts (Oxford University Press, 2010) as an example of this strategy, I argue that it results in a view that is overly inclusive: one will count as trying to commit a crime even in the far remote preparatory stages that we in fact have good reason not to criminalize. I offer an alternative proposal to distinguish between mere preparations and genuine attempts that has its basis not in trying, but doing: a criminal attempt is underway once what the agent is doing is a crime. Working out the details of this schema turns out to have important implications for action theory. A recently burgeoning view known as Naive Action Theory holds that all action can be explained by appeal to some further thing that the agent is doing, and that that the same explanatory nexus is at work even when we appeal to what the agent is intending, trying, or preparing to do -- these notions do explanatory work because they too refer to actions that are in progress, albeit in their infancy. If this is right, than the notion of 'doing' will also be too inclusive for the purposes of the criminal law. I argue that we should draw the reverse conclusion: the distinctions between pure intending, trying, preparing, and doing serve an important purpose in the criminal law, and this fact lends support to the view that they are genuine metaphysical and explanatory distinctions. (shrink)

As the usual regulatory framework did not fit well during the last Ebola outbreak, innovative thinking still needed. In the absence of an outbreak, randomised controlled trials of clinical efficacy in humans cannot be done, while during an outbreak such trials will continue to face significant practical, philosophical, and ethical challenges. This article argues that researchers should also test the safety and effectiveness of novel vaccines in wild apes by employing a pluralistic approach to evidence. There are three reasons to (...) test vaccines in wild populations of apes: i) protect apes; ii) reduce Ebola transmission from wild animals to humans; and iii) accelerate vaccine development and licensing for humans. Data obtained from studies of vaccines among wild apes and chimpanzees may even be considered sufficient for licensing new vaccines for humans. This strategy will serve to benefit both wild apes and humans. (shrink)

Cyberfeminism and Artificial Life examines construction, manipulation and re-definition of life in contemporary technoscientific culture. It takes a critical political view of the concept of life as information, tracing this through the new biology and the changing discipline of artificial life and its manifestation in art, language, literature, commerce and entertainment. From cloning to computer games, and incorporating an analysis of hardware, software and 'wetware', Sarah Kember demonstrates how this relatively marginal field connects with, and connects up global networks (...) of information systems. As well as offering suggestions for the evolution of [cyber]feminism in Alife environments, the author identifies the emergence of posthumanism; an ethics of the posthuman subject mobilized in the tension between cold war and post-cold war politics, psychological and biological machines, centralized and de-centralized control, top-down and bottom-up processing, autonomous and autopoietic organisms, cloning and transgenesis, species-self and other species. Ultimately, this book aims to re-focus concern on the ethics rather than on the 'nature' of life-as-it-could-be. (shrink)

Discusses the moral and ethical aspects of euthanasia and related topics.