Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a (...) fatal disease to naturally run its course until an individual’s vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals’ wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral (...) tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Gathers medical and legal documents, opinions from various perspectives, and a timeline of events in the Terri Shiavo case to provide a resource for examining the moral and ethical issues surrounding end-of-life decisions.

Disorders of consciousness and the permanent vegetative state -- Legal and political wrangling over Terri's life -- In context--law and ethics -- Terri's wishes -- The limits of evidence -- The implications of surrogacy -- Qualities of life -- Feeding -- The preservation of life -- Respect and care : an alternative framework.

In lieu of an abstract, here is a brief excerpt of the content:FDA Releases Draft Guidance on Regulation of Genetically Engineered AnimalsJohn P. Gluck (bio) and Mark T. Holdsworth (bio)On 18 September 2008, the U.S. Food and Drug Administration (FDA) issued a draft set of guidelines for those involved in developing genetically engineered animals with heritable recombinant DNA (rDNA) constructs and is requesting comment from industry and the public about their content. The document does not impose new regulations but details (...) how existing laws and regulations apply to genetically engineered (GE) animals and offers advice to developers on how to negotiate the laws in the most efficient and productive manner. The draft guidance document is not legally enforceable at this juncture, but the guidelines are recommendations reflecting the FDA's "current thinking on a topic."The modification of GE animals being developed for commercialization, which are the focus of the document, fall into six categories: modifications intended to (1) enhance food quality—e.g., faster growing fish and meats with better nutritional profiles; (2) improve animal health via increased resistance to disease—e.g., mastitis in dairy cattle and Bovine Spongiform Encephalopathy (BSE); (3) create so-called "biopharm" animals capable of producing therapeutic products such as insulin, clotting factors, and tissues for human transplantation; (4) reduce the barriers to human animal interaction—e.g., hypoallergenic pets; (5) develop valid animal models of human disease—e.g., Parkinson's disease, Lesh-Nyhan's syndrome, and cancer; and (6) improve production of industrial or consumer products such as fiber. The timing of the guidelines coincides with the FDA's belief in an expected boon in the number of GE animals approaching the stage of commercialization.The FDA's involvement in the approval process emerges from the new animal drug provisions of the Federal Food Drug and Cosmetic Act and the definition of what constitutes a drug. The Act defines a new animal drug as "an article (other than food) intended to affect the structure or any function of the body of... animals." A rDNA construct intended to affect the structure or function of an animal meets the definition of a new animal drug, regardless of whether the resulting GE animals are intended for human food or the production of pharmaceuticals or any other substances. [End Page 393]Before proceeding to a review of the draft guidelines, it is important briefly to set the controversies around GE animals in historical and ethical context.The Ethical DebateFrom its inception, the intentional genetic modification or genetic engineering of molecules, plants, and animals by the techniques of gene splicing has consistently elicited strong responses from both the scientific community and the public. There are some data to suggest that although the concerns of scientists fall primarily into the category of possible biohazards, those of the public also reflect great concern about the intrinsic moral issues, such as whether there is something fundamentally wrong with this line of work, making it a form of forbidden knowledge (see, e.g., Gaskell 1997). When news of Paul Berg's attempts in 1970 to graft the primate tumor virus (SV 40) onto the intestinal tract bacteria Escherichia coli for the purpose of studying how normal cells may be transformed into cancerous cells was shared with colleagues, he was strongly encouraged to reflect on the potential public health risks if somehow the altered bacteria broke containment and entered the environment. Thanks to Berg's leadership, these concerns soon resulted in conferences held in Asilomar, California, and New Hampton, New Hampshire, where the ethical responsibilities of microbiologists involved in this research were discussed. These initial discussions resulted in what has come to be known as "The Moratorium Letter" (Shattuck 1996) published in the journal Science in 1974. This letter, signed by 11 leaders in the field, actually recommended restrictions on several types of experiments that were considered to be particularly risky and stated "that adherence to our major recommendations will entail postponement or possibly abandonment of certain types of scientifically worthwhile experiments" (Berg 1974). An international conference on the issues came to similar conclusions about the need for a research moratorium for the sake of public safety. Recommendations arising from conference participants led to the formation of the National Institutes... (shrink)

The Hebrew phrase tikkun olam means repairing, mending or healing the world. Today, the phrase tikkun olam, particularly in liberal Jewish American circles, has become a slogan for a diverse range of topics such as activism, political participation, call and pursuit of social justice, charities, environmental issues and healthy nutrition. Moreover, the presidents of the United States who attend Jewish religious days and Jewish ceremonies state the tikkun olam in its Hebrew origin, pointing out its origin embedded in the (...) Judaism and a religious rule and/or an obligation that is important in Jewish tradition and thought. Nevertheless, when we look at the context of religious literature in which the phrase is used, it is seen that, although it is difficult to make a clear definition, it does not reflect modern/widespread uses and their meanings. Furthermore, tikkun olam is an ignored and even rejected concept by the Rabbinic Judaism which claims to represent the tradition and its current representative Orthodox Judaism. This fact is also seen in the usage and prevalence of the term in the U.S. and Israel. Thus, in this article, especially with reference to the norms of Mishnah, the religious-juristicial contexts and possible meanings of the phrase of tikkun olam, the notion of tikkun olam in Jewish liturgy and its implied meaning and the Kabbalistic understanding of tikkun will be presented, the development, changing and conversion of the phrase in modern age and its contemporary usage areas and reinterpretations will be demonstrated.Summary: Recently and especially in the U.S., the Hebrew phrase tikkun olam are used as a slogan in a widespread manner such as for activism, political participation, social justice, all kinds of charities, environmental issues, counter terrorism and healthy nutrition. Such a common usage of the phrase is largely the result of its literal meaning and ambiguity. Hence, this article aims to explore the place of the concept of tikkun olam in Jewish religious literature and its variations and semantic changes. Tikkun olam, literally means the repairing, mending or healing the world. However, regarding its religious context, it is difficult to determine what it means accurately. In time, some has used the tikkun olam as a legislative justification for changing specific laws, some has attributed to it an eschatological meaning which indicates to the mesianic age, and some has dicussed it in the context of mystical sense. The first usage of the phrase of tikkun olam in the Jewish religious literature was simply in the form of “because of tikkun olam” in Gittin epistle, a tractate of Mishnah and Talmud. Here, the phrase was used as a reason of a judgment concerning to the subjects of marriage, divorcement, slavery, captivity etc. In the context of these subjects tikkun olam indicates to the similar meanings like “repairing, organizing, healing, changing the world; regulating and improving the society, maintaining the social order, and prioritizing the common good. In fact, the concept of tikkun olam as the reason of the judgements in these matters is likely related to a juridical reason that intends to ensure the personal and public welfare such as clarifying the marital status of woman, to prevent the capture and seizure from Jewish society, and to deal with economy and identification of juridical status of the slaves.The other reference to tikkun olam appears in the second part of the aleinu prayer. However, the notion of tikkun olam in the aleinu prayer refers to a situation that happens in God’s Kingdom if Torah and halakhah are followed carefully. Hence, the aleinu prayer’s tikkun olam points out eschatological expectation which desires a messianic age, but not the socio-political and ecological concerns of the world as in the current fields and meanings.The modern idea of tikkun olam is also associated with the Jewish mystical movement, Kabbalah. Nonetheless, the concept of tikkun in Kabbalah is not a concept related to the socio-political circumstances of the world where we live in, but it is related to the restoring of the divine world. In order to restoring the divine world, human should fulfill the commands by studying Torah and have a spiritual and moral rehabilitation process by engaging in ascetic practices.The use of the phrase of tikkun olam gradually progress in the socio-political life of the U.S. The first use of the expression of tikkun olam in the U.S. was in the 1950’s by Shlomo Bardin, the founder of the Brandeis Camp Institute in California. Bardin asserted that the Aleinu prayer was the most important expression of Jewish values, particularly the expression “le-taken olam be-malchut shaddai” that is typically translated as “when the world shall be perfected under the reign of the God.” Bardin suggested that these words referred to the obligation of Jews to work for a more perfect world. The concept of tikkun olam entered contemporary usage by the way of its being preferred as a name to those such as social justice and charity programmes which was launched by the Reformist and Conservative groups in the second half of the twentieth century. In 1970s, United Synagogue Youth which is the national youth foundation of the conservative movement adopted the expression of tikkun olam and changed the title of its social action programs from “Building Spiritual Bridges” to “Tikkun Olam.” Nowadays, United Synagogue Youth proceeds all of its social activities and tzedakah programs through the tikkun olam project.By the end of 1970’s, New Jewish Agenda, an organization devoted itself to the religious and social values, acknowledged the slogan of “Tikkun Olam” as the spirit of its ideology. In 1986, Michael Lerner entitled a left-oriented liberal publication with the concept of Tikkun by claiming that this concept represented the origin of Judaism, and he take an important role on making the concept have a prevalence.Pittsburgh Platform organized in 1999 by the Reformist Jewish Movement emphasized that people must perform the most significant moral principles in the relationships with all non-Jewish people and all other creatures. This platform also stated that making the world a better place with the help of God would quicken the upcoming the messianic age. The tikkun understanding of the Reformist movement evolved to more universal realm by embracing the non-Jewish people, as well. Over the last two decades, successive presidents of the U.S. who attended in the ceremonies of Jewish religious days and Jewish assemblages have contributed to the prevalence and usefulness of tikkun olam by mentioning the phrase of tikkun olam in Hebrew, expressing that this is an essential principle of Judaism and addressing that this has a central role in Jewish tradition and thought. On the other hand, this concept does not have an important or a central place in Rabbinic Judaism and even in Orthodox Jewish communities which are the current representatives of Rabbinic Judaism. Moreover, Reformist, Conservative, and Reconstructionist American Jews who are considered on the liberal side of the politics has put the concept on the current use and the world’s agenda. Thus, the phrase of the tikkun olam is more popular in non-Judaic milieux in the U.S. than the Jews in Israel. In Israel where the Orthodox doctrine is dominated and shaped the people, tikkun olam is regarded as a western value and is ignored. (shrink)

A wide variety of clinical situations can lead to the implementation of assisted nutrition and hydration (ANH). Both enteral ANH and parenteral assisted nutrition and hydration (PNH) serve to nourish and hydrate those who are incapable of normal eating and drinking. Although PNH via the intravenous (IV) route is comparable to enteral ANH in its intention, IV PNH bypasses the relevant body system—the digestive tract—entirely. Consequently, IV PNH is ethically comparable to mechanical ventilation and thus can (...) be withheld or withdrawn following the ethical criteria that apply to any other extraordinary therapeutic measure. However, other alternatives to oral and enteral hydration that are proportionately less challenging than IV PNH (i.e., hypodermoclysis and proctoclysis) should be further evaluated as potentially ordinary means of keeping patients adequately hydrated at the end of life. National Catholic Bioethics Quarterly 11.4 (Winter 2011): 649–659. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comment on Hospice of Washington's PolicyJohn A. Robertson (bio)The recent history of medical ethics may accurately be described as a history of coming to terms with personal autonomy and informed consent across the range of medical practice. Nowhere has this recognition been more important than in decisions to withhold or withdraw life-sustaining medical procedures from terminal and chronically ill patients.Despite the widespread acceptance of autonomy in these decisions, many (...) people—physicians, families, and policymakers—have balked at extending it to the withdrawal of artificially supplied fluids and nutrition. The symbolic connotations of food and water have led some persons to perceive cessation of medically-supplied fluids and nutrition to be a cruel, barbarous act, rather than the merciful respect for the dying patient that such withdrawal usually represents.Two recent events might help resolve the controversy, and ensure that decisions about artificial fluid and nutrition are handled like any other medical intervention—according to patient and family choice and patient welfare. One event is the Supreme Court decision in Cruzan (Cruzan v. Director of Missouri Department of Health, 110 S.Ct. 2841, 1990). Although the Supreme Court upheld Missouri's constitutional power to require artificial nutrition for a patient in a persistent vegetative state, its decision was not based on the symbolic importance of artificial fluids and nutrition. No Supreme Court justice saw a significant difference between medically-supplied nutrition and hydration and other medical interventions, thus allowing them to be discontinued either directly or by advance directive on the same basis as other medical interventions.The second event is the publication of the statement of "Philosophy Regarding Medical Intervention to Supply Fluids and Nutrition" by Hospice of Washington (or similar statements by other organizations). This statement is useful and important because it removes the issue of food and water from its symbolic overlay [End Page 139] and places it in the real context of dying hospice patients. It makes clear that the overriding consideration should be benefit to the patient "in accord with the patient's wishes or those of the appropriate surrogate(s) for the patient." Depending on those wishes and their impact on the patient, this position may or may not involve medically-supplied fluids and nutrition.This statement is also helpful in showing the medical complexity of such decisions in terms of their actual effect on dying patients. Rather than an either/or position, it recognizes that fluids may harm a dying patient by increasing discomfort, and that "persons near death do not ordinarily tolerate substantial volumes of enteral feedings." Thus rather than adhere to a symbolically-based position about the meaning of food and water to a dying patient, the important thing is to look to that patient's needs and give fluids or not, as the patient's wishes and situation demand.Fortunately, the law in most jurisdictions will recognize such a position. In those few jurisdictions that have made a fetish of artificial fluids and nutrition, the law should be changed, for the HOW statement makes clear that such a position may actually end up harming dying patients. Patient welfare should be privileged above all else, and patient welfare may often entail that fluids and nutrition not be medically supplied. Even then, however, caregivers will look to patient comfort and remedy dry mouths and lips with lubricants and ice chips.The HOW statement is, in my view, a very useful guideline not only for hospices but for hospitals, too—for any situation in which a patient is terminally ill and soon to die. A somewhat different set of issues arises, however, when the patient is chronically ill and incompetent, and will survive for long periods with medically-supplied fluids and nutrition. Recognition of patient rights in those situation should also permit cessation of fluids and nutrition on the same basis that respirators, antibiotics, and other life-sustaining measures may be withheld. But the withholding of medically-supplied fluids and nutrition from a patient who no longer has interests in surviving in an extremely debilitated condition raises different issues from withholding fluids that could cause such discomfort and nutrition when the patient is imminently dying. In either case, patient... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:94 Feminist Studies 47, no. 1. © 2021 by Feminist Studies, Inc. Jennifer C. Nash Black Lactation Aesthetics: Remaking the Natural in Lakisha Cohill’s Photographs In her 1992 essay “Selling Hot Pussy,” bell hooks recounts entering a “late night dessert place” with a group of colleagues who all began to laugh at a shelf of “gigantic chocolate breasts complete with nipples— huge edible tits.”1 For hooks, the chocolate Black (...) breasts are mammy imagery, a “displaced longing for a racist past when the bodies of black women were a commodity, available to anyone white who could pay the price.”2 For her white colleagues, the chocolate breasts are simply comical. Her colleagues’ response—their willingness to consume, laugh, and ignore racial, gendered, sexual violence—constitutes the racialized visual marketplace that hooks’s essay seeks to both describe and dismantle. The chocolate breasts become a rhetorical point of entry into hooks’s critical engagement with a visual marketplace where Black female bodies are delectable and disposable objects. hooks’s analysis has become part of a canon of Black feminist work exploring how Black breasts get taken up as signs of pathology, “excess flesh,” sexual deviance, hypersexuality, and alterity.3 From histories of the so-called Hottentot Venus and the preoccupation with her breasts, buttocks, and genitalia—including 1. bell hooks, “Selling Hot Pussy,” Black Looks: Race and Representation (Boston: South End Press, 1992), 61. 2. hooks, 61–62. 3. See Nicole R. Fleetwood, Troubling Vision: Performance, Visuality, and Blackness (Chicago: University of Chicago Press, 2010). Jennifer C. Nash 95 signature works by Zine Magubane, Janell Hobson, Samantha Pinto, and T. Denean Sharpley-Whiting4 —to scholarship on the construction of black women’s imagined corporeality as “social dead weight” by Sabrina Strings, Black feminists have given critical attention to the construction of Black breasts as the location of Black women’s imagined racial and sexual difference.5 If Black breasts have been culturally and scientifically constructed as deviant, excessive, pornographic, and desirous, they have largely been uncoupled from an identification with nutrition—from the capacity to sustain and feed babies—except their connection with wet nursing and their conscription into maternal labor for white children. In this imaginary, Black breasts provide nutrition only when recruited as white property, with their nurturance capacity oriented toward white health and futurity. We might understand the cultural inability to interpret Black breasts as nurturing Black life as part of what Andrea Freeman describes as the “unmothering” of Black women, the unseeing of Black maternity except to elevate it as a symbol of brokenness or pathology.6 But in recent years, as I argue in my forthcoming book Birthing Black Mothers, Black breasts have entered the US cultural imagination anew. Black breasts are increasingly viewed as in need of support through seemingly benign state interventions to encourage Black breastfeeding. Indeed, Black breasts are recruited by an array of actors who often find themselves strangely aligned to champion Black breastfeeding —including NGOs, public health campaigns, and reproductive justice efforts spearheaded by Black feminists—precisely because Black breastfeeding is thought to perform urgent political, emotional, and 4. See Zine Magubane, “Which Bodies Matter? Feminism, Poststructuralism, Race, and the Curious Theoretical Odyssey of the ‘Hottentot Venus,’” Gender & Society 15, no. 6 (2001): 816–834; Janell Hobson, Venus in the Dark: Blackness and Beauty in Popular Culture (New York: Routledge, 2005); Samantha Pinto, Infamous Bodies: Early Black Women’s Celebrity and the Afterlives of Rights (Durham, NC: Duke University Press, 2020); and T. Denean Sharpley-Whiting, Black Venus: Sexualized Savages, Primal Fears, and Primitive Narratives in French (Durham, NC: Duke University Press, 1999). 5. See Sabrina Strings, Fearing the Black Body: The Racial Origins of Fat Phobia (New York: NYU Press, 2019). 6. Andrea Freeman, “Unmothering Black Women: Formula Feeding as an Incident of Slavery,” Hastings Law Journal 69, no 1545 (2018): 1545–1606. 96 Jennifer C. Nash public health work. Black breastmilk is increasingly described as a crucial technology of Black life, one that supports Black infant life and inoculates it physically, psychically, and even spiritually against the array of anti-Black forces that wound and violate. The work that Black breast milk is thought to perform includes its posited... (shrink)

Bioethics has been in existence now for more than twenty years. Much has changed, however, since Van Rensselaer Potter2 first used the term bioethics in 1971. For Potter, bioethics was an applied science with its roots in the biological sciences and its orientation towards the betterment of human life. Today the concept is used in a different context. It has become the name given to the ethical research that has become necessary in light of the new possibilities created by revolutionary (...) developments in medical science. Generally speaking, bioethics is concerned with the beginning and the end of life. In a certain sense, however, this is merely a de facto definition which does not possess a great deal of internal logical consistency.If we attempt to reconstruct the incredibly rapid evolution of bioethics we quickly realize how the times were truly ripe for this new discipline to begin to mature. In a very short space of time bioethics was taken seriously in just about every University and medical centre the world over. There is no part of the world which has not organised a colloquium or developed a study programme or created a Centre for Biomedical Ethics. Yet this advance is hardly surprising if we consider the fact that there have been revolutionary developments in themedical world in the 1960’s which have made it necessary to engage in serious ethical reflection on the borderline questions of human life.From the start, bioethicists have concerned themselves primarily with ethical problems related to reproductive technology such as in vitro fertilization, medically assisted fertilization with donor gametes, pregnancy termination, and the status of the embryo. More recently, however, questions concerning the end of life have entered the bioethicist’s field of interest, e.g. ethical questions related to euthanasia and the problems surrounding the artificial nutrition and hydration of persistently vegetative patients. In the meantime, of course, bioethics has broadened its field of interest beyond questions related to the beginning and end of life. Serious ethical and juridical reflection has resulted from the problems surrounding organ transplantation, transplantation of brain tissue, and the problem of AIDS.With the many recent developments in genetics, the first applications of gene therapy, and the world-wide human genome research project bioethics is assured an exciting future. It is clear that the issues which grab the bioethicist’s attention are rather disparate. Moreover, we are now beginning to realize that a whole gamut of specific questions cannot be addressed unless the broader context of the ethics of health care in general is taken into account. Such a realization has led to something of a new movement within the bioethical sphere which is interested in widening the notion of ‘medical ethics’ or ‘ethics of health’.The purpose of this article is to help familiarize the reader with the world of bioethics. Such a task is both simple and complex; bioethics has become a house with many rooms, a house, furthermore, which is being constantly renovated and rebuilt. By way of introduction, we shall take an investigative and evaluative stroll through the broad landscape bioethics has traced in the first twenty years of its existence. (shrink)

Bioethics has been in existence now for more than twenty years. Much has changed, however, since Van Rensselaer Potter2 first used the term bioethics in 1971. For Potter, bioethics was an applied science with its roots in the biological sciences and its orientation towards the betterment of human life. Today the concept is used in a different context. It has become the name given to the ethical research that has become necessary in light of the new possibilities created by revolutionary (...) developments in medical science. Generally speaking, bioethics is concerned with the beginning and the end of life. In a certain sense, however, this is merely a de facto definition which does not possess a great deal of internal logical consistency.If we attempt to reconstruct the incredibly rapid evolution of bioethics we quickly realize how the times were truly ripe for this new discipline to begin to mature. In a very short space of time bioethics was taken seriously in just about every University and medical centre the world over. There is no part of the world which has not organised a colloquium or developed a study programme or created a Centre for Biomedical Ethics. Yet this advance is hardly surprising if we consider the fact that there have been revolutionary developments in themedical world in the 1960’s which have made it necessary to engage in serious ethical reflection on the borderline questions of human life.From the start, bioethicists have concerned themselves primarily with ethical problems related to reproductive technology such as in vitro fertilization, medically assisted fertilization with donor gametes, pregnancy termination, and the status of the embryo. More recently, however, questions concerning the end of life have entered the bioethicist’s field of interest, e.g. ethical questions related to euthanasia and the problems surrounding the artificial nutrition and hydration of persistently vegetative patients. In the meantime, of course, bioethics has broadened its field of interest beyond questions related to the beginning and end of life. Serious ethical and juridical reflection has resulted from the problems surrounding organ transplantation, transplantation of brain tissue, and the problem of AIDS.With the many recent developments in genetics, the first applications of gene therapy, and the world-wide human genome research project bioethics is assured an exciting future. It is clear that the issues which grab the bioethicist’s attention are rather disparate. Moreover, we are now beginning to realize that a whole gamut of specific questions cannot be addressed unless the broader context of the ethics of health care in general is taken into account. Such a realization has led to something of a new movement within the bioethical sphere which is interested in widening the notion of ‘medical ethics’ or ‘ethics of health’.The purpose of this article is to help familiarize the reader with the world of bioethics. Such a task is both simple and complex; bioethics has become a house with many rooms, a house, furthermore, which is being constantly renovated and rebuilt. By way of introduction, we shall take an investigative and evaluative stroll through the broad landscape bioethics has traced in the first twenty years of its existence. (shrink)

In Emotions, Values & Agency, Christine Tappolet develops a sophisticated, perceptual theory of emotions and their role in wide range of issues in value theory and epistemology. In this paper, we raise three worries about Tappolet's proposal.

This volume is a detailed study of the concept of the nutritive capacity of the soul and its actual manifestation in living bodies in Aristotle and Aristotelianism. Aristotle’s innovative analysis of the nutritive faculty has laid the intellectual foundation for the increasing appreciation of nutrition as a prerequisite for the maintenance of life and health that can be observed in the history of Greek thought. According to Aristotle, apart from nutrition, the nutritive part of the soul is also (...) responsible for or interacts with many other bodily functions or mechanisms, such as digestion, growth, reproduction, sleep, and the innate heat. After Aristotle, these concepts were used and further developed by a great number of Peripatetic philosophers, commentators on Aristotle and Arabic thinkers until early modern times. This volume is the first of its kind to provide an in-depth survey of the development of this rather philosophical concept from Aristotle to early modern thinkers. It is of key interest to scholars working on classical, medieval and early modern psycho-physiological accounts of living things, historians and philosophers of science, biologists with interests in the history of science, and, generally, students of the history of philosophy and science. (shrink)

The idea of personalized nutrition is to give tailored dietary advice based on personal health-related data, i.e. phenotoype, genotype, or lifestyle. PN may be seen as part of a general trend towards personalised health care and currently various types of business models are already offering such services in the market. This paper explores ethical issues of PN by examining how PN services within the contextual environment of four future scenarios about health and nutrition in Europe might affect aspects (...) of social justice according to Martha Nussbaum’s capability approach. The scenarios have been created by a mixed group of stakeholders and experts in three consecutive workshops. This resulted in the definition of four future scenarios within a scenario space consisting of two variables: the ‘logic of health care systems’ and ‘conception of health’. Within each scenario, PN is likely to play a more or less important role in improving health by influencing food consumption patterns in society. Nussbaum’s capability approach implies a concept of social justice as a function of a minimum standard of human dignity. This denotes an account for equality in terms of a minimum of entitlements. However, also the ability of achieving individual objectives is essential for social justice. Personalisation advice in health and food consumption patterns, as aimed for by PN, is therefore acceptable provided a minimum of entitlements is guaranteed to all members of a society, and at the same time freedom concerning personal preferences is respected. Potential variation of how different people might benefit from PN should therefore be consistent with the minimum required as defined by the list of capabilities. (shrink)

This cross sectional study was carried out among the workers of British American Tobacco Company, Dhaka with a view to explore their nutritional status, personal hygiene and health seeking behavior as because they are working on a tobacco processing company. The sample size was 179 which were selected purposively. The study showed that out of 179 respondents 89 (49.7%) were in the age groups of 30-39 years and the mean age of the respondents were 31.99 ± 6.01 years. A large (...) number of respondents (55.9%) had monthly family income of Taka 10001-20000 and the mean family income was Taka 12776.54 ± 5230.13. Maximum respondents (73.7%) were Muslim, more than half (54.2%) were shift in charge, 39.1% of the respondents consisted of 4 family members, 43.6% respondents were accustomed to other type of eating habit and 38.5% respondents knew that malnutrition was the effect of lack of proper nutrition, 59.8% of the respondents knew that night blindness was the disease due to malnutrition, most of the respondents (91.6%) performed duties to maintain health, majority (62.0%) respondents used to do nothing to maintain healthcare for their children and 35.9% visited doctor’s single time in a month, 40.2% of the respondents told regular tooth brushing as type of healthy habits. Majority (64.8%) respondents used to brush twice a day, majority (50.8%) respondents used to wash hand after toileting, majority (62.08%) respondents used to bath daily, 43.0% and 31.8% of the respondents told that dysentery and diarrhea was due to eating without proper hand washing respectively. Majority (53.6%) respondents informed that they learned about personal hygiene from television, 45.8% respondents understood that use of safe water in every work as sanitation. Majority (50.84%) came from nuclear family; most (84.92%) had exercise habit and 40.22% had education level of class VIII. Most (75.42%) of the respondents had semi pucca houses and majority (69.83%) of the respondents used only water as materials for hand washing. This study provided some important information which might help the concerned authority to take appropriate measures to improve the health status of the workers. (shrink)

The purpose of this paper is to assess Profet’s (1992) and others’ hypothesis that nausea and vomiting in pregnancy (NVP) is adaptive. A number of studies have found an association between NVP and a decreased risk for early fetal loss (<20 weeks). It is assumed that the adaptive benefits of improved survivorship associated with NVP outweigh the minimal nutritional consequences. However, in populations that experience marginal levels of nutrition, NVP may have important nutritional consequences. To test these potential consequences, (...) a study on NVP, nutritional status, and pregnancy outcome was conducted among Turkana pastoralists, who experience seasonal and chronic nutritional stress. Interviews and anthropometric assessments were conducted on 68 pregnant Turkana women of Kenya during a 1993–1994 field season. The results from the case study suggest that women who experience NVP do encounter nutritional consequences in the later stages of pregnancy and are more likely to experience poor pregnancy outcomes. These results suggest that NVP may not be adaptive in all environmental settings, particularly among marginally nourished populations. (shrink)

Medical and non-medical experts increasingly argue that individuals, whether they are diagnosed with a specific chronic disease or condition or not (and whether they are judged at minimal risk of these consequences or not), have an obligation to make ‘healthy’ food choices. We argue that this obligation is neither scientifically nor ethically justified at the level of the individual. Our intent in the article is not simply to argue against moralization of the value of prudential uses of food for nutritional (...) health, but to situate nutritional advocacy in the context of Western liberal democracy that values free choice. We have two objectives: (i) to untangle and examine the substance of discourses on ‘healthy’ food choice that simplify nutrition science and place a moral obligation on individuals and (ii) to establish a more comprehensive view of the relationship among food, ethics and health. Although critical of certain features of the liberal political and moral tradition, we argue that John Stuart Mill’s notion of experiments in living provides fertile ground for an improved ethical understanding of individual obligation and of the interconnections among food, health and well-being. (shrink)

This article considers the nature of Mr Burke's concerns in bringing his action and the practical implications of similar situations. When artificial nutrition and hydration is provided, practical issues arise regarding future, potentially long-term care. This in turn raises concerns about place of care, provision of carers and funding, which may not easily be resolved. The GMC guidance exists to provide direction and help for practitioners when difficult decisions have to be made about future treatment with the intention that (...) the patients' wishes and benefit of any potential treatment will be central to the discussions. Nevertheless, the reality of having these conversations, raising emotive issues with the patient and/or carers, and the implications of the final decision, may be very different in practice. (shrink)

SummaryThe nutritional status of under-five children is a sensitive sign of a country's health status as well as economic condition. This study investigated the differential impact of some demographic, socioeconomic, environmental and health-related factors on the nutritional status among under-five children in Bangladesh using Bangladesh Demographic and Health Survey 2007 data. Two-level random intercept binary logistic regression models were used to identify the determinants of under-five malnutrition. The analyses revealed that 16% of the children were severely stunted and 25% were (...) moderately stunted. Among the children under five years of age 3% were severely wasted and 14% were moderately wasted. Furthermore, 11% of the children were severely underweight and 28% were moderately underweight. The main contributing factors for under-five malnutrition were found to be child's age, mother's education, father's education, father's occupation, family wealth index, currently breast-feeding, place of delivery and division. Significant community-level variations were found in the analyses. (shrink)

This paper argues that focusing on Aristotle’s theory of generation as primarily ‘hylomorphic’ can lead to difficulties. This is especially evident when interpreting the association between the male and sentient soul at GA 2.5. If the focus is on the male’s contribution as form and the female’s as matter, then soul becomes divided into nutritive from female and sentient from male which makes little sense in Aristotle’s biological ontology. In contrast, by seeing Aristotle’s theory as ‘archēkinētic’, a process initiated by (...) the male, the development of nutritive and sentient capacities emerges as intertwined, neither capacity originating in only one sex. (shrink)

Nutrition and hydration—including artificially delivered, or assisted, nutrition and hydration (ANH)—are typically considered ordinary or proportionate care in the Roman Catholic moral tradition. They are thus morally obligatory, except when the benefit to the patient does not justify the burden their administration places on the patient or when they no longer prolong life (e.g., in end-stage disease when death is imminent). A review of Church documents and the medical literature provides convincing evidence that there are cases in which (...) ANH provides little hope of benefit and may impose an excessive burden on the patient. This paper closely examines advanced dementia of the Alzheimer’s (DAT) type and shows how ANH can be properly considered extraordinary care and hence is not obligatory in patients with advanced DAT. National Catholic Bioethics Quarterly 8.2 (Summer 2008): 291–305. (shrink)

Roman Catholics have a long tradition of evaluating medical treatment at the end of life to determine if proposed interventions are proportionate and morally obligatory or disproportionate and morally optional. There has been significant debate within the Catholic community about whether artificially delivered nutrition and hydration can be appreciated as a medical intervention that may be optional in some situations, or if it should be treated as essentially obligatory in all circumstances. Recent statements from the teaching authority of the (...) church have attempted to clarify this issue, especially for those with a condition known as the persistent vegetative state. I argue that these recent teachings constitute a “general norm” whereby artificial nutrition and hydration are considered obligatory for most patients, but that these documents allow for exception in cases of complication from the means used to deliver nutrition and hydration, progressive illness, or clear refusal of such treatment by patients. While the recent clarifications do not constitute a major deviation from traditional understanding and will rarely conflict with advance directives or legal statutes, there may be rare instances in which remaining faithful to church teaching may conflict with legally enshrined patient prerogatives. Using the Texas Advance Directives Act as an example, I propose ways in which ethics committees can remain faithful to their Roman Catholic identity while respecting patient autonomy and state law pertaining to end of life health care. (shrink)

Autism spectrum disorder affects an estimated 1 in 54 children aged 8 years in the United States. For many of these children, there are concomitant eating and/or behavioral challenges that can make managing their nutritional health challenging. This commentary responds to a particularly challenging case in which a pediatric patient with ASD presented to the local hospital’s emergency department with severe weight loss and malnutrition.

The effect of nutrition on fertility and its contribution thereby to population dynamics are assessed in three social groups (elite, tradesmen and subsistence) in a marginal, pre-industrial population in northern England. This community was particularly susceptible to fluctuations in the price of grains, which formed their basic foodstuff. The subsistence class, who formed the largest part of the population, had low levels of fertility and small family sizes, but women from all social groups had a characteristic and marked subfecundity (...) in the early part of their reproductive lives. The health and nutrition of the mother during pregnancy was the most important factor in determining fertility and neonatal mortality. Inadequate nutrition had many subtle effects on reproduction which interacted to produce a complex web of events. A population boom occurred during the second half of the 18th century; fertility did not change but there was a marked improvement in infant mortality and it is suggested that the steadily improving nutritional standards of the population, particularly during crucial periods in pregnancy (i.e. the last trimester), probably made the biggest contribution to the improvement in infant mortality and so was probably the major factor in triggering the boom. (shrink)

Nutrition and hydration—including artificially delivered, or assisted, nutrition and hydration (ANH)—are typically considered ordinary or proportionate care in the Roman Catholic moral tradition. They are thus morally obligatory, except when the benefit to the patient does not justify the burden their administration places on the patient or when they no longer prolong life (e.g., in end-stage disease when death is imminent). A review of Church documents and the medical literature provides convincing evidence that there are cases in which (...) ANH provides little hope of benefit and may impose an excessive burden on the patient. This paper closely examines advanced dementia of the Alzheimer’s (DAT) type and shows how ANH can be properly considered extraordinary care and hence is not obligatory in patients with advanced DAT. National Catholic Bioethics Quarterly 8.2 (Summer 2008): 291–305. (shrink)

Animals have evolved complex foraging strategies to obtain a nutritionally balanced diet and associated fitness benefits. Recent research combining state-space models of nutritional geometry with agent-based models (ABMs), show how nutrient targeted foraging behavior can also influence animal social interactions, ultimately affecting collective dynamics and group structures. Here we demonstrate how social network analyses can be integrated into such a modeling framework and provide a practical analytical tool to compare experimental results with theory. We illustrate our approach by examining the (...) case of nutritionally mediated dominance hierarchies. First we show how nutritionally explicit ABMs that simulate the emergence of dominance hierarchies can be used to generate social networks. Importantly the structural properties of our simulated networks bear similarities to dominance networks of real animals (where conflicts are not always directly related to nutrition). Finally, we demonstrate how metrics from social network analyses can be used to predict the fitness of agents in these simulated competitive environments. Our results highlight the potential importance of nutritional mechanisms in shaping dominance interactions in a wide range of social and ecological contexts. Nutrition likely influences social interactions in many species, and yet a theoretical framework for exploring these effects is currently lacking. Combining social network analyses with computational models from nutritional ecology may bridge this divide, representing a pragmatic approach for generating theoretical predictions for nutritional experiments. (shrink)

Amartya Sen’s work has contributed to shifting our focus from food availability to food access and utilisation, together called ‘nutritional capability’. Existing food insecurity instruments have been informed partially by the capability approach, but remain focused on material deprivation and its economic sub-dimensions. This narrow focus has become problematic, particularly in high-income countries, where material deprivation is largely overcome and food poverty manifests itself differently from that in low-income countries. Food poverty in high-income countries should thus be approached from a (...) ‘food capability’ perspective that fully recognises the multidimensionality of eating lives and the multiple factors that affect their dietary standards. To demonstrate the usefulness of this perspective, the Alkire-Foster method for multidimensional food poverty was utilised to analyse food poverty in Japan. The Alkire-Foster measure has a dual cut-off approach and its adapted method can produce a multidimensional food poverty index by setting reasonable food deprivation and poverty thresholds. The national data used for empirical demonstration was obtained from a web-based questionnaire conducted in Japan, to which 973 participants (aged 20–60 years) responded. The measurement identified a 20.6% food-poor population and inequalities in food capabilities among subgroups. Although economic deprivation was tightly linked to food poverty, the results suggested that gender- and age-based inequalities were larger than socioeconomic status-based ones, which reflected much wider societal problems in Japan than growing economic poverty, such as gender inequality and population ageing. The proposed measurement is effective for monitoring food policy impacts and complementing existing food insecurity assessment tools. The results will be useful for promoting social debate about what the minimal dietary standard should be in high-income societies. (shrink)

In the United States, the decision of whether to withdraw or continue to provide artificial nutrition and hydration (ANH) for patients in a permanent vegetative state (PVS) is placed largely in the hands of surrogate decision-makers, such as spouses and immediate family members. This practice would seem to be consistent with a strong national emphasis on autonomy and patient-centered healthcare. When there is ambiguity as to the patient's advanced wishes, the presumption has been that decisions should weigh in favor (...) of maintaining life, and therefore, that it is the withdrawal rather than the continuation of ANH that requires particular justification. I will argue that this default position should be reversed. Instead, I will argue that the burden of justification lies with those who would continue artificial nutrition and hydration (ANH), and in the absence of knowledge as to the patient's advanced wishes, it is better to discontinue ANH. In particular, I will argue that among patients in PVS, there is not a compelling interest in being kept alive; that in general, we commit a worse violation of autonomy by continuing ANH when the patient's wishes are unknown; and that more likely than not, the maintenance of ANH as a bridge to a theoretical future time of recovery goes against the best interests of the patient. (shrink)

This article focuses on the troubling effects of the secular values of individual freedom and autonomy and their impact on laws regarding suicide and euthanasia. The author argues that in an increasingly secularized culture, death and dying are losing their meaning and are not thought of within a moral framework. The debate regarding the provision of artificial nutrition and hydration is critically considered in light of the history of Catholic morality as well as within the modern healthcare context, and (...) finally with new insight from the recent statements made by the late pope. Drane argues that the pope's insistence on providing artificial nutrition and hydration despite irreversible persistent vegetatitive states is unconvincing. (shrink)

There is a broad consensus in nutritional-microbiota research that high-fat (HF) diets are harmful to human health, at least in part through their modulation of the gut microbiota. However, various studies also support the inherent flexibility of the human gut and our microbiota’s ability to adapt to a variety of food sources, suggesting a more nuanced picture. In this article, we first discuss some problems facing basic translational research and provide a different framework for thinking about diet and gut health (...) in terms of metabolic flexibility. We then offer evidence that well-formulated HF diets, such as ketogenic diets, may provide healthful alternative fuel sources for the human gut. We place this in the context of cancer research, where this concern over HF diets is also expressed, and consider various potential objections concerning the effects of lipopolysaccharides, trimethylamine-N-oxide, and secondary bile acids on human gut health. We end by providing some general suggestions for how to improve research and clinical practice with respect to the gut microbiota when considering the framework of metabolic flexibility. (shrink)

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by (...) double-effect reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick. (shrink)

Confusion surrounds Catholic teaching on the use of assisted nutrition and hydration, specifically the question of when, if ever, its refusal or removal is ethical. This paper focuses on two often-neglected considerations: the relationship between means and mechanism, and an assessment of proportionality of the mechanism from the patient’s perspective. The authors draw on two critical principles of Catholic moral teaching: only ordinary means are required, and proportionality is subject to the perspective of the patient, not just that of (...) experts or the culture. The mechanisms that provide food and water have distinct benefits and burdens. Their proportionality is properly subject to analysis by the patient or surrogate, who determines which mechanism is acceptable in the patient’s situation. (shrink)

Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores whether one such tradition—halachic Judaism—in fact demands the use of artificial nutrition and hydration in this setting. Traditional arguments have been advanced holding that treatment can be withheld in persons who (...) are dying, in individuals whose condition causes great suffering, or in the event that the treatment would produce suffering. Individuals with advanced dementia can be considered to be dying, often suffer as a result of their dementia, and are likely to suffer from the use of a feeding tube. Given these observations and the absence of a compelling case for distinguishing between tube feeding and other forms of medical treatment, traditional Judaism appears compatible with withholding artificial nutrition for individuals with advanced dementia. (shrink)

The food supply of the temperate lands of early-medieval western Europe, and the ways in which its peoples dealt with the central problem of feeding themselves, has been subjected to a variety of interpretations in recent years. Vern Bullough and Cameron Campbell's study of the medieval diet and female longevity concluded that early-medieval women suffered from iron deficiencies triggered jointly by poor nutrition and frequent childbearing and that these deficiencies contributed substantially to their average early age of death. Ann (...) Hagen's overview of Anglo-Saxon patterns of food production and consumption suggested that most of the early English population routinely lived at marginally adequate or outright substandard levels of nutrition. Similar conclusions were reached by Renée Doehaerd in her study of the early-medieval economy. Michel Rouche, on the other hand, asserted that the typical Carolingian—including the peasants—had access to a monotonous, but abundant, supply of foodstuffs and may have consumed an average of 6,000–9,000 calories per day. Richard Hodges likewise decided that Anglo-Saxon peasants were reasonably well fed, based on the heavy food rents per hide demanded during the reign of the West Saxon king Ina. (shrink)

In the twenty-first century, decisions to withhold or withdraw life-supporting measures commonly precede death in the neonatal intensive care unit without major ethical controversy. However, caregivers often feel much greater turmoil with regard to stopping medical hydration and nutrition than they do when considering discontinuation of mechanical ventilation or circulatory support. Nevertheless, forgoing medical fluids and food represents a morally acceptable option as part of a carefully developed palliative care plan considering the infant’s prognosis and the burdens of continued (...) treatment. Decisions to stop any form of life support should focus on the clinical circumstances, not the means used to sustain life. (shrink)

This article discuses the unexpectedly firm stance professed by John Paul II on the provision of artificial nutrition and hydration to patients who are in a persistent vegetative state, and its implications on previously held standards of judging medical treatments. The traditional ordinary/extraordinary care distinction is assessed in light of complexities of the recent allocution as well as its impact on Catholic individuals and in Catholic health care facilities. Shannon concludes that the papal allocution infers that the average Catholic (...) patient is incapable of making proper judgments about their own care. Shannon sees the preservation of life at all costs as at least highly troubling, if not as a radical move against the Catholic medical ethics tradition. (shrink)

Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional diet (...) was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts. (shrink)

With recent guidance from the BMA and RCP on the withdrawal of nutrition from patients, and how the cause of death is being recorded (1), and the case of Vincent Lambert (2), the debate surrounding withdrawal of care and treatment has been rekindled in Catholic circles. In this article, I wish to highlight some of traditional principles that form the basis of such decision-making. I discuss these within the context of the withdrawal of nutrition and hydration (NaH), as (...) well as ventilation, to elucidate the key points. (shrink)

In De Anima 2.4, Aristotle claims that nutritive soul encompasses two distinct biological functions: nutrition and reproduction. We challenge a pervasive interpretation which posits ‘nutrients’ as the correlative object of the nutritive capacity. Instead, the shared object of nutrition and reproduction is that which is nourished and reproduced: the ensouled body, qua ensouled. Both functions aim at preserving this object, and thus at preserving the form, life, and being of the individual organism. In each case, we show how (...) Aristotle’s detailed biological analysis supports this ontological argument. (shrink)

The potential health risks of vegan diets specifically for women and children are discussed. Women and children are at higher risk of malnutrition from consumption of unsupplemented vegan diets than are adult males. Those who are very young, pregnant, lactating, elderly, or who suffer from poverty, disease or other environmentally induced disadvantages are at special risk. The size of these risks is difficult to quantify from existing studies. Fortunately the risk of dietary deficiency disease can be avoided and the potential (...) health benefits of vegan diets can be realized when diets for these groups are planned in line with theRecommended Dietary Allowances so that nutrient intakes reach or exceed recommended levels, and access to preventive and curative health services is assured. (shrink)

The curious case of Bronze Age Pervert (BAP, for short), of unfortunate name, or “handle,” in his world. Author of the self-published Bronze Age Mindset (2018), BAP is present in 4Chan discussion threads and on YouTube, and he produces weekly subscription-only podcasts with approximately 6,500 paying clients (I am among them). He was banned from Twitter but reinstated in December 2022, and he now has over 100,000 followers. A Google search turns up scores of articles addressing or discussing his work, (...) all written in palatable forms. But BAP’s own subjects and rhetoric are for adults only. Who is BAP, what does he espouse, and what compels the attention of orthodox Catholics? (shrink)

Withholding and withdrawing artificial nutrition and hydration from terminally ill patients poses many ethical challenges. The literature provides little information about the Islamic beliefs, attitudes, and laws related to these challenges. Artificial nutrition and hydration may be futile and reduce quality of life. They can also harm the terminally ill patient because of complications such as aspiration pneumonia, dyspnea, nausea, diarrhea, and hypervolemia. From the perspective of Islam, rules governing the care of terminally ill patients are derived from (...) the principle that injury and harm should be prevented or avoided. The hastening of death by the withdrawal of food and drink is forbidden, but Islamic law permits the withdrawal of futile, death-delaying treatment, including life support. Nutritional support is considered basic care and not medical treatment, and there is an obligation to provide nutrition and hydration for the dying person unless it shortens life, causes more harm than benefit, or is contrary to an advance directive that is consistent with Islamic law. The decision about withholding or withdrawing artificial nutrition and hydration from the terminally ill Muslim patient is made with informed consent, considering the clinical context of minimizing harm to the patient, with input from the patient, family members, health care providers, and religious scholars. (shrink)

How can Deleuzians make his philosophy as accessible as possible to political theorists and democratic publics? This essay provides principles to enter Deleuze's political vision, namely, to research the etymology of words, to discover the image beneath concepts, to diagram schemata using rigid lines, supple lines and lines of flight, and to construct rules that balance experimentation and caution. The essay then employs this method to explicate a fecund sentence about politics in A Thousand Plateaus and presents a case why (...) Deleuze deserves greater visibility in the political theory canon. (shrink)

Background: Food is an important part of nursing care and recognized as a basic need and a human right. Nutritional care for older adults in institutions represents a particularly important area to address in nursing education and practice, as the right to food can be at risk and health personnel experience ethical challenges related to food and nutrition. Objective: The present study investigates the development of coursework on nutritional care with a human rights perspective in a nursing programme for (...) first-year nursing students and draws upon reflections and lessons learned. Research design: The study utilized educational design research. The coursework, developed through two rounds, combined on-campus learning and clinical placement in nursing homes. Nursing studentsʼ perspectives and experiences gathered through focus groups and a written assignment informed the development and evaluation of the coursework. Participants and research context: In the first round, multistage focus group interviews were conducted with 18 nursing students before, during and after placement. In the second round, four focus group interviews with 26 nursing students were conducted shortly after placement. Ethical consideration: The study was approved by the Norwegian Centre for Research Data. Findings: Three main ʽlessons learnedʼ emerged regarding introducing a human rights perspective in nursing education: 1) the contribution of the human rights perspective in changing the narrative of ʽvulnerable and malnourished patientsʼ, 2) the importance of relationships and experiences for learning about human rights and 3) the benefit of combining development of ethical competence with a human rights perspective. Conclusion: A human rights perspective enabled the students to give meaning to nutritional care beyond understanding of food as a basic physical need. Incorporating human rights in nursing education can support nursing students and nurses in recognizing and addressing ethical and structural challenges and being able to fulfil the right to food for patients. (shrink)