In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that the doctrine of double (...) effect is not recognized in UK law ; therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. (shrink)

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to (...) give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical. (shrink)

The celebration of the revived Olympic games in London in the summer of 1948 gave to ‘records’ an unusually prominent place in men's thoughts and in their speech and writing, and we instinctively turn back to the ancient Greek world, which witnessed the foundation of the Olympic festival and its long history of wellnigh twelve centuries, to seek traces of any similar phenomenon.

Of all the numerous inscriptions which throw light “upon the organization and activities of the ancient religious and social guilds, none is more valuable and none more vivid than that which contains the minutes of a meeting of the Athenian Iobacchi followed by acomplete text of the statutes which were then unanimously ratified. This document, originally published by S. Wide in A th. Mitt. XIX. 248 sqq., appears in a number of well-known and widely accessible collections—Dittenberger's S.I.G. 737, 1109; Roberts (...) andGardner's Introduction to Greek Epigraphy, II. No. 91; Ziehen's Leges Graecorum Sacrae, II. 46; Michel's Recueil, 1564; and I.G. II. 1368—and has been discussed in detail by E. Maass , who republishes the text with a translation and commentary, and by E. Drerup. (shrink)

These words occur in Appian's account of the riot which led to the death of Tiberius Sempronius Gracchus in 133 B.C. The tribunician elections had been adjourned from the previous day, and Gracchus, who irregularly sought re-election, had with his supporters taken possession of the temple of Jupiter on the Capitol. The assembly broke up in disorder amid wild rumours that Gracchus had deposed all his colleagues or had declared himself tribune for the following year without election or had actually (...) demanded the diadem. The Senate meanwhile had been in session in the temple of Fides, and upon receipt of the news from the Capitol Publius Cornelius Scipio Nasica Serapio urged the consul, Publius Mucius Scaevola, to crush the tyrant. When he declared that he would not put any citizen to death without trial, Nasica, calling loudly upon those who desired the safety of their country to follow him, mounted the Capitol at the head of a considerable body of Senators and led the attack on Gracchus and his partisans. (shrink)