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End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to (...) withdraw life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not ?futile.? Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to (...) withdraw life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, ?If this were not an attempted suicide, would a request to withdraw care be reasonable?? We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

University program dropout is a problem that has important consequences not only for the student that leaves but also for the institution in which the withdrawal occurs. Therefore, higher education institutions must study the problem in greater depth to establish appropriate prevention measures in the future. However, most research papers currently focus primarily on the characteristics of students who leave university, rather than on those who choose to pursue alternative courses of study and therefore fail to take into account the (...) different kinds of abandonment. The aim of this paper is to identify the different types of dropout to define their characteristics and propose some recommendations. Thus, an ex post facto study was carried out on a sample of 1311 freshmen from a university in the north of Spain using data gathered using an ad-hoc designed questionnaire, applied by telephone or an online survey, and completed with data available in the university data warehouse. A descriptive analysis was performed to characterize the sample and identify five different groups, including 1. Students persisting in their initiated degree 2. Students who change of program (within the same university) 3. Students transferring to a different university 4. Students enrolling in non-higher-education studies 5. Students that quit studying. Also, data mining techniques (decision trees) were applied to classify the cases and generate predictive models to aid in the design of differentiated intervention strategies for each of the corresponding groups. (shrink)

ZusammenfassungEntscheidungen am Lebensende sind Bestandteil der ärztlichen Tätigkeit. In dieser Studie wurden Berliner Medizinstudierende zu ihren Kenntnissen der rechtlichen Grundlagen und ihrer ethischen Bewertung von passiver und aktiver Sterbehilfe befragt. Im Wintersemester 2002/2003 wurde eine schriftliche Befragung zu ethischen und rechtlichen Aspekten der Sterbehilfe unter den Teilnehmenden eines Pflichtkurses für Medizinstudierende im fünften Studienjahr an der Charité, Universitätsmedizin Berlin durchgeführt. Gruppenunterschiede im Antwortverhalten wurden mit dem χ2-Test nach Pearson geprüft. Von 102 Studierenden beantworteten 85 den Fragebogen (Rücklaufquote = 82,5%). Es (...) wussten 46 Medizinstudierende (54,1%), dass die Therapiebegrenzung am Lebensende legal sein kann; 70 (82,3%) hielten dies für ethisch akzeptabel. Die Tötung auf Verlangen in bestimmten Situationen hielten 35 Studierende (41,2%) für ethisch akzeptabel; 28 (33,0%) befürworteten die Legalisierung der Tötung auf Verlangen in bestimmten Situationen. Im Vergleich zu Ärztinnen und Ärzten in Deutschland wurde die Tötung auf Verlangen von weniger Studierenden abgelehnt. Angesichts der bestehenden Unsicherheiten bei den Studierenden hinsichtlich der rechtlichen und ethischen Bewertung von Entscheidungen am Lebensende sollten diese Aspekte in der medizinischen Ausbildung stärker berücksichtigt werden. (shrink)

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics (...) discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

BackgroundThe terminal illness of late-stage Alzheimer’s and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. Options to avoid prolonged dying are limited since advanced dementia patients cannot qualify for Medical Aid in Dying. Physicians and judges can insist on clear and convincing evidence that the patient wants to die—which many advance directives cannot provide. Proxies/agents’ substituted judgment may not be concordant with patients’ requests. While advance directives can be patients’ last resort (...) to attain a peaceful and timely dying consistent with their lifelong values, success depends on their being effective and acceptable. A single flaw can provide opponents justification to refuse the directive’s requests to cease assisted feeding.AimThis article considers 24 common advance directive flaws in four categories. Process flaws focus on how patients express their end-of-life wishes. Content flaws reflect drafters’ selection of conditions and interventions, and how they are described. Inherent flaws can make advance directives unacceptable to authorities concerned about premature dying. Strategies are needed to compel physicians to write needed orders and to prevent third parties from sabotaging these orders after they are implemented. The article includes excerpts from “dementia-specific” directives or supplements that exemplify each flaw—mostly from the US and Europe. No directive critiqued here included an effective strategy to resolve this long-debated bioethical conflict: the past directive requests “Cease assisted feeding” but the incapacitated patient apparently expresses the desire to “Continue assisted feeding.” Some opponents to the controversial request, cease assisted feeding, use this conflict as a conceptual wedge to practice hard paternalism. This article proposes a protocol to prevent this conflict from emerging. These strategies may prevent authorities from requiring patients to fulfill authorities’ additional clinical criteria as a prerequisite to honor the requests in patients directives.ConclusionThis critique of flaws may serve as a guide to drafting and to selecting effective and acceptable advance directives for dementia. It also poses several bioethical and clinical questions to those in authority: Does your paternalistic refusal to honor patients’ wishes respect their self-determination? Protect vulnerable patients from harm? Force patients to endure prolonged suffering? Violate the principles of bioethics? Violate the very foundation of patient-centered care? (shrink)

Philippe Fournier | : Le point de départ de ma proposition est que la responsabilité est un terme plus approprié que la vertu pour désigner les exhortations au devoir civique dans l’ère contemporaine. De même, à défaut de voir l’implication citoyenne comme l’expression de la rationalité individuelle ou de la conscience morale dans la sphère publique, je propose de comprendre la responsabilité comme une matrice discursive et gouvernementale qui perpétue des modèles comportementaux bien spécifiques. J’entends ainsi démontrer que la responsabilité (...) est devenue une modalité indispensable du « gouvernement de la conduite » au sein d’une rationalité néolibérale. En plus de constituer une série de dispositions morales qui remédierait aux failles et aux lacunes de l’individualisme libéral, la responsabilité se matérialise dans les incitations à une citoyenneté active et participe de ce fait à la rationalisation du retranchement de l’État de la sphère sociale. Comme l’illustrent des courants aussi divers que le néoconservatisme, le communautarisme et l’économie sociale, la responsabilité se présente moins comme une solution de rechange aux créneaux du néolibéralisme qu’une série de techniques et de standards comportementaux visant à compléter et renforcer l’application élargie d’une logique micro-économique. Je montrerai que le recours à la notion de responsabilité est particulièrement visible dans les politiques d’aide sociale et au sein des nouveaux partenariats entre l’État, le milieu communautaire et les communautés locales. En effet, l’aide étatique est de plus en plus conditionnelle à la démonstration de certaines dispositions morales et psychologiques comme la volonté, la ténacité et la probité. L’article se divise en quatre parties. La première s’attarde à définir brièvement la « gouvernementalité », concept initialement développé par Michel Foucault. La deuxième se penche sur des travaux plus contemporains, notamment ceux du sociologue britannique Nikolas Rose qui se préoccupe de la responsabilité en tant que modalité gouvernementale au sein du néolibéralisme. La troisième partie met en relief les particularités du néolibéralisme américain. En vue de cerner les pratiques et discours associés à la responsabilité de façon plus précise, la dernière partie examine l’un des principaux programmes d’aide sociale aux États-Unis, l’Aid to Families with Dependent Children, devenu le Temporary Assistance for Needy Families en 1996, des années 1980 jusqu’à aujourd’hui. | : Our point of departure is that responsibility is a more appropriate term than virtue to designate the contemporary exhortations to civic duty. Instead of seeing civic engagement as a means to express individual rationality or moral conscience in the public sphere, this paper suggests that we should understand responsability as a discursive and governmental matrix that perpetuates specific behavioral standards. More specifically, the article aims to show that responsability has become an indispensable instrument of rule within a neoliberal rationality of government. As well as pointing to a range of moral dispositions that can offset neoliberalism’s shortcomings, the notion of responsibility is mobilised in the repeated public calls to active citizenship and plays a strategic role in the discursive justification of the state’s withdrawal from the social sphere. As illustrated by strands of thought as diverse as neoconservatism, communitarianism and social economy, responsibility is less an alternative to neoliberal tenets than a series of techniques and behavioral standards that complement and reinforce the extension of a microeconomic logic to all spheres of human activity. The appeals to responsibility are particularly visible in contemporary social policies and in the strategic partnerships between the state, community organisations and local communities. Indeed, state assistance has become increasingly conditional on the demonstration of aptitudes and moral qualities like earnestness, tenacity and willpower. The article proceeds in four parts. The first part briefly defines governmentality, a concept initially developed by Michel Foucault. The second part explores Nikolas Rose’s work on advanced liberalism and takes a look at contemporary articulations of responsibility. The third part examines the specificities of American neoliberalism. In order to identify the practices and discourses linked to the notion of responsibility, the final part of the article looks at one of the main social programs in the United States, namely the Aid to Families with Dependent Children, renamed the Temporary Assistance for Needy Families in 1996, from the early 1980s to our day. (shrink)

The present study was motivated by the hypothesis that inputs from internal states in obsessive–compulsive individuals are attenuated, which could be one source of the pervasive doubting and checking in OCD. Participants who were high or low in OC tendencies were asked to produce specific levels of muscle tension with and without biofeedback, and their accuracy in producing the required muscle tension levels was assessed. As predicted, high OC participants performed more poorly than low OC participants on this task when (...) biofeedback was not available. When biofeedback was provided, the difference between the groups was eliminated, and withdrawing the monitor again reversed this effect. Finally, when given the opportunity, high OC participants were more likely than low OC participants to request biofeedback. These results suggest that doubt in OCD may be grounded in a real and general deficiency in accessing internal states. (shrink)

En este artículo exploramos desde la literatura, por medio de Suenan timbres de Luis Vidales, la dinámica de las nacientes urbes colombianas que inician un proceso acelerado de modernización, carente de un desarrollo adecuado del pensamiento moderno, a la par con los nuevos avances materiales, lo que imposibilita debatir la pertinencia y el proceso de este tipo de transformaciones. Circunstancia que lleva a Colombia a experimentar los idiotismos de la modernización sin modernidad, impidiéndoles a los hombres entender las necesidades y (...) conflictos que genera el progreso. Estas aldeas de principios del siglo XX se convierten rápidamente en proyectos de ciudades determinadas por la aparición de nuevos objetos, creando una atmósfera móvil y ruidosa por oposición a la pasividad de las aldeas, realidad que nos recrea Vidales desde una poética comprometida con los cambios sociales y políticos como poeta de la crítica en Colombia. In this paper, from the literature of Luis Vidales’s Suenan timbres, we explore the dynamics of Colombian rising cities that initiate an accelerated modernization process, deprived of an appropriate development of modern thinking, along with the new material advances, which makes it impossible to debate the relevance and the process followed by these types of transformations. This situation leads Colombia to experience the idiotism of modernization without modernity, impeding men to understand the needs and conflicts generated by progress. These villages from twentieth century beginnings quickly turn into city projects determined by the arrival of new objects, creating a mobile and noisy atmosphere, opposed to villages’ passivity. From poetics committed to social and political change, Vidales recreates reality as a poet of criticism in Colombia. (shrink)

Macroergonomic compatibility refers to the extent to which macroergonomic factors and elements interact positively with humans. It is one of the most complex constructs to measure in work systems and in ergonomics. The goal of this paper is to determine the levels of MC in a manufacturing system. As methods, we use the macroergonomic compatibility index and the Macroergonomic Compatibility Questionnaire. The MCQ was administered in its three versions to collect data about the macroergonomic practices implemented in the manufacturing company. (...) Regarding results, all the macroergonomic factors and most of the macroergonomic elements showed a low level of MC; that is, MCI < 0.7. Only macroergonomic elements Education, Knowledge, and Skills reached a medium level; namely, MCI = 0.709. The factor with the highest level of MC was the Person factor. Similarly, the whole manufacturing system showed a low level of MC. In conclusion, the studied manufacturing company requires urgent macroergonomic interventions. Also, we found that the MCI can effectively measure the level of MC of MFEs and can guide the implementation of macroergonomic practices and explain the MC construct. (shrink)

Burnout syndrome and obesity are two growing conditions that affect employees’ health and company productivity. Recently, several studies have pointed to a possible relationship between both phenomena. However, such a relationship has not been clearly defined. This research analyzes the relationship between BS dimensions and body mass index, the latter being treated as a moderator variable among obese senior and middle managers in the Mexican maquiladora industry through a structural equation model. A total of 361 senior and middle managers completed (...) both the Maslach Burnout Inventory-General Survey [with emotional exhaustion, cynicism, and professional efficacy as subscale dimensions] and a sociodemographic questionnaire. The results showed a statistically significant relationship between EE and PE, with BMI acting as a moderator variable. The results showed that when BMI increases as a moderator variable, the strength of the relationship between EE and PE also changes. For example, although PE had a negative value of 0.14 before the moderator effect, the value increased up to 0.32 when the BMI was factored into the relationship. Therefore, maquiladora industries are being advised to increase their investments on the identification and prevention of employees’ EE and obesity. Such interventions would promote a better quality of life and could prevent economic losses resulting from poor employee performance. (shrink)

ABSTRACT When applying moral principles to concrete cases, we assume a background shared understanding of the boundaries of the persons to whom the principles apply. In most contexts, this assumption is unproblematic. However, in end‐of‐life contexts, when patients are receiving ‘artificial’ life‐support, judgments about where a person's self begins and ends can become controversial. To illustrate this possibility, this paper presents a case in which a decision must be made whether to deactivate a patient's pacemaker as a means to hasten (...) his death. After discussing some common moral principles that are often applied to resolve ethical problems at the end of life and after explaining why they are of no help here, the paper argues that the correct analysis of this case, and of cases of this sort, turns on considerations that relate to the constitution of the self. These considerations, the paper further argues, sometimes resist resolution. The constitution of the self is fixed in large measure by our concepts and social conventions, and these do not always provide determinate grounds for delimiting the boundaries of the self. (shrink)

According to the reading offered here, Descartes' use of the meditative mode of writing was not a mere rhetorical device to win an audience accustomed to the spiritual retreat. His choice of the literary form of the spiritual exercise was consonant with, if not determined by, his theory of the mind and of the basis of human knowledge. Since Descartes' conception of knowledge implied the priority of the intellect over the senses, and indeed the priority of an intellect operating independently (...) of the senses, and since, in Descartes' view, the untutored individual was likely to be nearly wholly immersed in the senses, a procedure was needed for freeing the intellect from sensory domination so that the truth might be seen. Hence, the cognitive exercises of the Meditations, modeled not on the sense- and imagination-based exercises of Ignatius of Loyola, but on the Augustinian procedure of turning away from the senses and imagination to perceive the unpicturable with the fleshless eye of the mind. In accordance with this reading, the function of Descartes' skeptical arguments is not to introduce skepticism so that it can be defeated but to aid the meditator in withdrawing the mind from the senses in order to attend to truths of the pure intellect. These truths then offer the basis for a new natural philosophy, including a new theory of the senses. (shrink)

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)

How can Christian ethics make a significant contribution to health care ethics in today's Western, pluralistic society? Robin Gill examines the 'moral gaps' in secular accounts of health care ethics and the tensions within specifically theological accounts. He explores the healing stories in the Synoptic Gospels, identifying four core virtues present within them - compassion, care, faith and humility - that might bring greater depth to a purely secular interpretation of health care ethics. Each of these virtues is examined in (...) turn, using a range of topical issues including health care rationing, genetics, HIV/AIDS, withholding/withdrawing nutrition from PVS patients, and the empirical evidence which suggests a connection between religion and health. Professor Gill also argues that these four virtues are shared by other major religious and humanistic traditions and that, together with secular principles, they can enrich health care ethics even in a pluralistic society. (shrink)

This article enumerates and critically examines the potential grounds on which we might treat the case of a patient with an advance directive who attempted suicide, differently from one whose injuries were the result of an accident. Grounds for differentiation are distilled into two potential justifications. The first addresses the concern that withholding or withdrawing care from a patient with self-inflicted injuries would be aiding and abetting suicide. The second examines concerns about the patient’s decisionmaking capacity. Ultimately, it is (...) argued that while there might be legitimate reasons to hold the advance directive of a suicidal patient to a different standard of scrutiny, the fact that the patient’s medical state was self-inflicted should not, in and of itself, necessarily invalidate the guidance of the directive. Finally, four practical recommendations are offered for negotiating similar cases. (shrink)

The United States has long been a model for accessible, affordable education, as exemplified by the country's public universities. And yet less than 60 percent of the students entering American universities today are graduating. Why is this happening, and what can be done? Crossing the Finish Line provides the most detailed exploration ever of college completion at America's public universities. This groundbreaking book sheds light on such serious issues as dropout rates linked to race, gender, and socioeconomic status. Probing graduation (...) rates at twenty-one flagship public universities and four statewide systems of public higher education, the authors focus on the progress of students in the entering class of 1999--from entry to graduation, transfer, or withdrawal. They examine the effects of parental education, family income, race and gender, high school grades, test scores, financial aid, and characteristics of universities attended. The conclusions are compelling: minority students and students from poor families have markedly lower graduation rates--and take longer to earn degrees--even when other variables are taken into account. Noting the strong performance of transfer students and the effects of financial constraints on student retention, the authors call for improved transfer and financial aid policies, and suggest ways of improving the sorting processes that match students to institutions. An outstanding combination of evidence and analysis, Crossing the Finish Line should be read by everyone who cares about the nation's higher education system. (shrink)

Listening effort helps explain why people who are hard of hearing are prone to fatigue and social withdrawal. However, a one-factor model that cites only effort due to hardness of hearing is insufficient as there are many who lead happy lives despite their disability. This paper explores other contributory factors, in particular motivational arousal and pleasure. The theory of rational motivational arousal predicts that some people forego listening comprehension because they believe it to be impossible and hence worth no effort (...) at all. This is problematic. Why should the listening task be rated this way, given the availability of aids that reduce its difficulty? Two additional factors narrow the explanatory gap. First, we separate the listening task from the benefit derived as a consequence. The latter is temporally more distant, and is discounted as a result. The second factor is displeasure attributed to the listening task, which increases listening cost. Many who are hard of hearing enjoy social interaction. In such cases, the actual activity of listening is a benefit, not a cost. These people also reap the benefits of listening, but do not have to balance these against the displeasure of the task. It is suggested that if motivational harmony can be induced by training in somebody who is hard of hearing, then the obstacle to motivational arousal would be removed. This suggests a modified goal for health care professionals. Don’t just teach those who are hard of hearing how to use hearing assistance devices. Teach them how to do so with pleasure and enjoyment . (shrink)

The ethical issues around decision making on behalf of infants have been illuminated by two empirical research studies carried out in Scotland. In-depth interviews with 176 medical and nursing staff and with 108 parents of babies for whom there was discussion of treatment withholding/withdrawal, generated a wealth of data on both the decision making process and the management of cases. Both staff and parents believe that parents should be involved in treatment limitation decisions on behalf of their babies. However, whilst (...) many doctors and nurses consider the ultimate responsibility too great for families to carry, the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception found in the two groups. The results of these empirical studies provide both aids to ethical reflection and guidance for clinicians dealing with these vulnerable families. They demonstrate the value of empirical data in the philosophical debate. (shrink)

Much controversy has existed over the claims of Native Americans and other indigenous peoples that they have a right—based on original occupancy of land, historical transfers of sovereignty, and principles of self-determination—to a political status separate from the states in which they now find themselves embedded. How valid are these claims on moral grounds? -/- Burke Hendrix tackles these thorny questions in this book. Rather than focusing on the legal and constitutional status of indigenous nations within the states now ruling (...) them, he starts at a more basic level, interrogating fundamental justifications for political authority itself. He shows that historical claims of land ownership and prior sovereignty cannot provide a sufficient basis for challenging the authority of existing states, but that our natural moral duties to aid other persons in danger can justify rights to political separation from states that fail to protect their citizens as they should. -/- Actual attempts at political separation must be carefully managed through well-defined procedural mechanisms, however, to foster extensive democratic deliberation about the nature of the political changes at stake. Using such procedures, Hendrix argues, indigenous peoples should be able to withdraw politically from the states currently ruling them, even to the point of choosing full independence. (shrink)

Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions.In this paper, we first systematically review existing guidelines relating to (...) the treatment and resuscitation of newborns in humanitarian crises, finding little substantive ethical guidance for those providing humanitarian healthcare. We next draw on paradigm cases and published literature to identify and describe some of the major ethical questions common to these settings. We divide these questions into quality of life considerations, allocation of limited resources, and conflicting cultural norms and values. We finally suggest some preliminary recommendations to guide ethical decision‐making around resuscitation of newborns and withdrawal of treatment in humanitarian settings. (shrink)

Cambodia’s GDP contributed 0.03 percent of the world economy. Cambodia economy has grown around seven percent. Cambodia’s economy was led by growth in garment exports. Cambodia’s economy was related with other countries through exports and imports. The Trump administration has imposed visa sanctions against Cambodia and likely to make economic sanction on Cambodia. To understand the potential impact of the sanction, a research into “Potential Impact of Foreign Sanction on Cambodia’s Economy” has been proposed. Two research objectives were (1) to (...) analyze potential impacts of foreign investment in Cambodia and (2) to analyze potential impacts on employment of Cambodians. This research focuses only trade sanction that limits or potential restriction of textile, clothing and footwear export from Cambodia to EU and US as independent that would potentially impact on seven independent variables including garment and footwear valued added to GDP, Cambodia’s exports, products exported to US and EU, worth of textile, clothing and footwear exports, garment and footwear investment factories, employments in garment and footwear, workers’ wages in garment factories and footwear factories. The secondary data was collected. The data was collected from varied sources. After the data and information collected, data entry was done into MS excel. The descriptive statistics like table and bar-charts were used for this research. The research found out that Cambodia’s economy was likely to be negatively impact from EU’s and US’s sanctions on Cambodia. The impacts included reduction of GDP value, potential loss of Cambodia export of textile, closure of garments and footwear factories, unemployment and loss of workers’ incomes in textile, clothing factories and footwear factories. There are some recommends: maintaining good relation with EU and US, exploring new markets of garments and footwear products, exploring impact of the close of visa of some top government officials to US on Cambodia’s economy, the impacts of products imported from EU on Cambodia. The more studies on other scenario of sanction on Cambodia and indirect impact and impacts of foreign aid reduction or withdrawal on Cambodia’s economy should be done. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to (...) ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

Written for non-specialists, this concise and accessible work by moral philosopher Kevin L. Flannery engages in a careful reflection of the moral issues of greatest importance in the lives of Christians today. After introductory chapters on the relationship between ethics and church teaching, and on the relevance of action theory--the study of the nature and structure of human actions--Flannery applies Aristotle's and Thomas Aquinas's theory of human action to the following topics: sexual morality, reproduction, killing and keeping alive, cooperation in (...) the evil acts of others, and conscience. The book treats a number of controversial issues, not so much because they are controversial, but because they usefully explain the philosophical principles underlying church teaching. Flannery considers, for example, whether it is moral for a spouse who has contracted a disease such as HIV or AIDS to make use of a prophylactic during sexual intercourse. Flannery also addresses whether it is moral for a politician to vote in favor of legislation that permits same-sex marriage, or for a family or doctor to withdraw nutrition and hydration from a patient in a vegetative state. A major theme discussed throughout the book is intention and its effect on the moral character of human acts. ABOUT THE AUTHOR: Kevin L. Flannery, S.J., professor of philosophy at the Pontifical Gregorian University in Rome, is author of many works on ethics and on the history of logic, including Acts Amid Precepts: The Aristotelian Logical Structure of Thomas Aquinas's Moral Theory (CUA Press). (shrink)

continent. 1.3 (2011): 201-207. “Poetry is experience, linked to a vital approach, to a movement which is accomplished in the serious, purposeful course of life. In order to write a single line, one must have exhausted life.” —Maurice Blanchot (1982, 89) Nikos Karouzos had a communist teacher for a father and an orthodox priest for a grandfather. From his four years up to his high school graduation he was incessantly educated, reading the entire private library of his granddad, comprising mainly (...) the Orthodox Church Fathers and the ancient classics. Later on in his life he sold the library for money, only to buy a little more time before he went broke again: “I carry sorrow like a cage/ I got no birds/ as I come back from her hair/ I see the profit emptied/ cool from terror.” (1993, Ι, 101) Nowadays—and ridiculously recently—we are more than apt to speak of a certain insouciance pertaining to the Greek form of expenditure: expenditure without any type of investment, sometimes not (even) symbolic. In the vaults of the European unconscious, this imprudent stance still conjures a “capital punishment” in the form of de-capitation, reflecting back the fear of excess and the terror of its consequences.1 Thus the Greek way of living is very close to what a stranger could have termed as “the Greek way of dying.” Yet, what is not often understood is that the Greek esprit , the same one that invented the maxim μηδ?ν ?γαν (“nothing in excess”), does not experience death solely as an imminent fear of bankruptcy. For it miraculously combines its unconditional acceptance with the promise of a resurrection that is always there in the scents of Spring, from Dionysus to the orthodox Christ: “Everyone resurrects himself through dying [….] Resurrection is the switching of mortalities.” (2002, 94) Hence, if an entire library was imprudently traded for a plate with seven olives, a sliced tomato and some fresh goat cheese, let us not be fooled: this is not the meal of the pauper, but that of “an aristocrat from God” (1993, II, 491) feeding his eloquent loudmouth, ridiculously cut open in an otherwise rock-solid caput . *** To speak of the Greek experience is to speak about a half-dead language that still utters in life what is seemingly excluded from it and thus forbidden to be talked about: death. Death as anything that is out of this world, as something that will never return . Still, along with an experience of death that recently waned as a worn-out academic fashion, the Greek experience is dead too. Nearly 2300 years of written words separating Homer from the fall of Byzantium equal 500 books on a library traded for money: “I am with the killed. Hence my deepest solitude. I do not feel this tremendous macho society, beyond from the fact that it is a ruthlessly consuming one. It is me who pays all the time .” (2002, 57) Let us do the math and see how much this dealing with the Greek experience is costing the poet and how much dealing with the Greek experience might cost us today. *** “I do not guarantee a single word.” (Karouzos, 1993, II, 454) Through its various dialects and forms, the Greek language speaks through an incessant historical dissemination. Anyone who is aware of this terrifying polymorphy and still calls himself a poet, must stand against a white sheet of paper, pen-in-hand, with a very particular duty: to be as fully inconsistent as possible. In the formally ironic uniqueness of the poem, the poet functions as “a band-aid for lesser and greater antinomies.” (1993, I, 251) Of course these antinomies are not exhausted in language—they are historical, political and, alas, existential. Yet, beyond appearances , it is language that ruthlessly encodes them through history, submitting the poet to the temptation of placing them one next to the other on a single white sheet. The closer their neighboring, the greater the scattering of the writer in the ironic uniqueness of the paper. In a work where poetic license is described as a “freedom-impasse” (2002, 51), this task is undertaken in full conscience of its personal consequences: “what I am interested in is to escape my individuality (envisioning the non-ego) […] Nevertheless, my dissociations never achieve duration.” (2002, 74-75) Hence, though poetry is the “deserted direction of will,” (1998, 62) the stance of the poet is not that of a Nietzschean “great man.”2 Whereas drunkenness provides a thread between the poem and the excess it both presupposes and infuses (“Poetry always enlarges. ‘Drunkenness’ is nothing more than that,” (2002, 85)), whereas language flashes in loudmouth spurts of déraison (“When I am alone I do something else. I utter words. For example, while having my ouzo and listening to music I am most likely capable of randomly shouting ‘Electricity!’” (2002, 138)), the poet never gives in to the double affirmation that would eventually risk the “element of pleasure in discourse.” (2002, 80)” It is exactly because the gap of the antinomies is so vast that poetry is not meant to be written with a hammer. Neither does writing consist in a reevaluation of those elements. In short, poetry is not an affirmation of difference, but the surprising beauty of chiming antinomies. We might never transcend them, but it is up to us to put them together. Yet again, this voisinage is not to be identified with the necessity of chance as an eternal return.4 On the contrary it is a return from that very return : Let us treat Yes as a No to No and No as a Yes […] And let us not forget that this pissed affirmation crumbled down Nietzsche’s intellect in the dark paths of this world. (2002, 88) This return from the “vicious circle” should in no way be taken as a form of artistic prudence. Rather it can be seen as a dribble of demonic inconsistency as Dionysus transforms himself into a Christ that is in turn de-theologized: “Who can forbid that? Every man is capable of his own theology, nothing can stop him.” (2002, 73-74) This is a turn towards an existential vision of the world, historically coinciding with a particular political defeat of the Left, to which the poet devoted all his life: after the defeat of the popular front I raised the question “why do we exist?” while others were asking “why we failed.” (2002, 57)5 But most of all it is a return to poetry that exceeds the existential question itself, going beyond the issue of faith. Poetry comes in as a question of return after a defeat that is confessed in full profanity. Though it accepts the necessity of the defeat, it does not affirm it. Though it negates it, the negation is not in the name of a promise to be delivered in the kingdom of heavens. Following a historical and existential defeat, poetry is born post mortem . It signals a return to Christ as “groundless religiousness in the surprise of the real as such” (2002, 72) which is at once a return to the refuge of childhood. It is not a question of endurance towards an eternal return. Rather it is a question on the possibility of an existential return. Returning in a world as someone who cannot enjoy any returns exactly because he is averse to guarantees. A return without returns. *** PHOTOCOPY OF HAPPINESS When I was young I used to pin down cicadas and step on ant nests. I used to stand there silent for hours. With threads I decapitated bees. Now I am a dead man breathing. (Karouzos, 1993, II, 336.) The return to the “paradise of childhood” (2002, 68) constitutes the devouring refuge of its own memory when defeat becomes the synonym of adulthood. The political struggles of a young communist in a country torn up by a civil war right after World War II fraught with incarcerations and exiles. Historically they resulted in the defeat of the communist movement in Greece and opened up a long turbulent road that would peak in the dictatorship of 1967. Existentially they led to a series of disillusionments: mental breakdown, divorce, abandonment of studies in law school. To the question “why do we exist” the answer was poetry. Still this exposé should not be read as a sweeping chronography of a man. For it actually happens to coincide with the historical fate of a nation that after its modern constitution never stopped dreaming of the glories of its past youth, in a present that was (and is) sweepingly disappointing. But isn’t this return to youth finally a way of compensating for a loss of youth that necessarily results in a losing adulthood? Will Greeks, the eternal children of Plato and Nietzsche, ever learn? How to return without dying, how to remember without wasting time? WE ARE IN THE OPEN MEANING Living the coldest mauve night right across Parthenon I went to take a piss on some foliage and I was enjoying the foliage as it was steaming. (Karouzos, 1993, II, 340) Beyond the historical tragedies of modern Greece and away from any personal disappointments, the relation that this land holds with language and history is mediated through the Greek light—whose omnipresence is the very condition of its transcendence. All historical contradictions from Dionysus to Christ took place under this light; all those disseminated dialects were spoken beneath its warmth. To paraphrase Lévinas,6 light is both the condition of the world and of our withdrawal from it—a withdrawal towards the invisibility of God, of the dead, of meta-physics, resulting from the temptation that all is still here, behind this light the visibility of which they once evaded: “birds, the allurement of God.” (1993, I, 17) Under that luminous sky, if Greeks can do anything at all, it is to envision a return that will never come. All they can do is write poetry—which is doing nothing; other than lending an ear to a disseminated language whispering a unity that cannot be promised, as an adulthood in defeat is ready to recognize. Trying “to trap the invisible in visibility” (1993, II, 483) they forget that they have grown up and one day they die—with the promise of return. Hence an additional meaning must be given to this return to childhood. It does not signal salvation but rather its promise. To the ears of an aged continent it means that the return to/of poetry is a losing game, a return without returns. “Europe, Europe… you are nothing more than the continuation of Barabbas.” (1993, I, 295) *** “Life is not there to verify theories.”7 The records show that Karouzos was finally given a second-class pension from the Greek government, at the time when he was being recognized by the literary press as one of Greece’s major contemporary poets. Being neither a bourgeois nor a nobelist, he proclaimed himself to be an anarcho-communist, unconditionally faithful to the utopia of a classless society. He also drank, heavily. “Capitalism made an animal out of man/ Marxism made an animal out of truth/ Shut up.” (1993, II, 369) Perhaps one of the most scandalous divides of our times has been the one between the living and the dead, the latent prohibition that the living should not be concerned with the dead based on the mere impossibility of the dead to be concerned with the living in the first place. What adds to this scandal is that this divide abuses anything that cannot return to us by subsuming it under the same futility. Hence death is no longer “loss” in the usual sense. It no more refers to the things we lost but to our “loss” (of time, money and well-being) as we insist to dwell on them. Death is a waste —of time. It is this waste that we find in the insouciance of Greek expenditure; the waste in dealing with a language that most of its historical part is no longer spoken (a dead language); the waste in translating a poet who is ex definitio untranslatable; the waste of his vision, his money, his life. The waste of dealing with anything that cannot return and that cannot bring in any returns . But it is also the waste of life that poetry itself presupposes, the waste of dealing with invisibility, with anything that is out of this world and thus invokes the fear of death that is in turn—and surprisingly— nowhere to be found. Instead of death, what is there, beyond the light, is the being without us (to recall the Lévinasian il y a ), the mumble of our own nothingness which constitutes the price to be paid for writing poetry under an evergreek light. To understand this to-and-fro, is to realize that poetry is something out of this world that nevertheless takes place in this world, by virtue of this world. But to ridiculously equate this to-and-fro with death as non-existence, is to exile poetry along with its own possibility from this same old world: I do not believe that poetry will ever disappear from this world. […] But I am also sure that it does not have many chances of playing, as you say, a redemptive role in our vertiginous technological future. Without being endangered as a creative need, it will be placed on the side of history. (2002, 32) It is mainly there that we would like to locate the meaning of Nikos Karouzos’s poetry today. If we are willing to include the Greek original it is because we consider that it will be both a waste of time for us to do so (since most of you cannot read Greek) and because it might induce you to the even larger waste of learning it. We would additionally be glad if this small introduction served as an equally wasteful, academically useless piece of reading, gesturing towards a taboo of investing in anything Greek—that is in anything dead among the living, in anything that will never come back and maybe was never here in the first place. This is the only way to reserve for ourselves the possibility of poetry and preserve the light of its promise. “To return: that is the miracle.” (1993, I, 17) Athens, Greece July 10, 2011 NOTES 1 “ Capitale (a Late Latin word based on caput “head”) emerged in the twelfth to thirteenth centuries in the sense of funds, stock of merchandise, sum of money or money carrying interest.[…] The word and the reality it stood for appear in the sermons of St. Bernardino of Siena (1380-1444) ‘… quamdam seminalem rationem lucrosi quam communiter capitale vocamus ’, ‘that prolific cause of wealth that we commonly call capital’” (Braudel, 1992, 232-233). 2 “A great man – a man whom nature has constructed and invented in the grand style – what is he? First : there is a long logic in all of his activity, hard to survey because of its length, and consequently misleading; he has the ability to extend his will across great stretches of his life and to despise and reject everything petty about him, including even the fairest, ‘divinest’ things in the world.” (Nietzsche, 1968, 505, §962) 3 Cf. Deleuze, 1986, 186-9. 4 “Return is the being of becoming, the unity of multiplicity, the necessity of chance: the being of difference as such or the eternal return.” (Deleuze, 189)5 In this 1982 interview Karouzos refers to the defeat of the communist movement in Greece after the civil war of 1946-1949 between the Governmental Army and the Democratic Army of Greece, the military division of the Greek communist party. Karouzos’s father was a member of the communist National Liberation front (EAM) members of which formed the mainl resistance movement (ELAS) in Greece during WWII. The poet was a member of the United Panhellenic Organization of Youth (EPON), which was a youth division of EAM. After the end of the war, ELAS was called to disarmament in view of the formation of a National Army. The members of EAM resigned from the government of national unity and a series of protests led to a 3 year civil war between ELAS and the Government Army. After the defeat of ELAS the Communist party was outlawed and many communists were exiled in deserted Greek islands. Karouzos, who took action in the Greek resistance and was active during the Greek civil war, was exiled in Icaria on 1947 and in Makronisos on 1953 where he was called two years earlier to do his military service. 6 “Existence in the world qua light, which makes desire possible, is then, in the midst of being, the possibility of detaching oneself from being. To enter into being is to link up with objects; it is in effect a bond that is already tainted with nullity. It is already to escape anonymity. In this world where everything seems to affirm our solidarity with the totality of existence, where we are caught up in the gears of a universal mechanism, our first feeling, our ineradicable illusion, is a feeling or illusion of freedom. To be in the world is this hesitation, this interval in existing, which we have seen in the analyses of fatigue and the present.” (Lévinas, 1988,43-4) 7from a TV interview. THE POETRY OF NIKOS KAROUZOS From Redwriter [ Ερυθρογρ?φος ], in Collected Works, Vol . II, Athens: Ikaros. 1993, 463-4. [Athens: Apopeira, 1990, 9-10.] JESUS ANTI-OEDIPUS* Why were we once saving till the fifth day the Paschal lamb? The scriptures say: with this victim’s meat we ought to cleanse all of our senses. To give life to the whitest wave miraculous odors in the extension of the chest. Ideals to death. For us to witness the illustrious dawns of Absinthe and for the soul to be a deeply carved ornament on the fore we named will. Then many deer running amidst the evergreen growth with watery hymns, then, the unintended angels descending with heights spiraling in their momentum offer themselves to the luminous Adventure. Whence the need for speech and our sufferings covered with flags like the glorified dead. An incorporeal finger pointing at the flamboyant and fragrant holocausts within the tired horizons and the exhausted breadths with joys of the mistletoe on fire and shivering all of the green-leaved love. Something would have chirped again had we not driven it away— maybe the ewe’s grass. Something would have called us to the eternal resurrection— maybe the grace of spring. But now our heart is fiercely blinded, withdrawn to the appearances of Hades. Silence and ice incessantly cover the Infant Spirit in thatched times. While the cherry trees are dreaming faintly glowing in absolute darkness there’s nothing the Babylonians can contemplate in labs with automatic colored lights. How to rejoice now in the fifth day of the lamb? We have forked the stars. We’ve gradually become supposedly sublime with plucked chimeras in our hands. Avenged relentlessly by science. *Though the poem appears in a 1990 collection, it was actually written in 1968. Hence the reader must be aware in not associating Karouzos’ Anti-Oedipus with the famous 1972 work of Deleuze and Guattari, given that the former precedes the latter. ΙΗΣΟΥΣ ΑΝΤΙ-ΟΙΔΙΠΟΥΣ Γιατ? κρατο?σαμε κ?ποτε ?ς την π?μπτη μ?ρα το πασχαλιν? πρ?βατο; Τα κε?μενα λ?νε: μ’ αυτο? του θ?ματος το κρ?ας ?πρεπε να καθαρ?σουμε ?λες τις αισθ?σεις. Για να δ?σουμε κ?μα στη ζω? λευκ?τατο θαυμ?σιες ευωδι?ς στην ?κταση του στ?θους. Ιδανικ? στο χ?ρο. Για να βλ?πουμε τα λαμπρ? χαρ?ματα του ?ψινθου και να ’ναι η ψυχ? στ?λισμα βαθυχ?ρακτο της πλ?ρης που την ε?παμε θ?ληση. Τ?τε πολλ?ς δορκ?δες τρ?χοντας αν?μεσα στην καταπρ?σινη φ?ση με τους υδ?τινους ?μνους, τ?τε, κατεβα?νοντας οι αθ?λητοι ?γγελοι με κυλινδο?μενο το ?ψος στην ορμ? τους χαρ?ζονται της αστραφτερ?ς Περιπ?τειας. ?θεν η μιλι? γι’ αυτ? χρει?ζεται και τα δειν? σκεπ?ζονται ωσ?ν τους τιμημ?νους νεκρο?ς με σημα?ες. Ασ?ματο δ?χτυλο δε?χνει τα φλογ?δη και μοσχοβ?λα ολοκαυτ?ματα στους κουρασμ?νους ορ?ζοντες στα εξουθενωμ?να πλ?τη καθ?ς αν?βουν οι χαρ?ς του νερα?δ?ξυλου και τρ?μει ολ?κληρη η πρασιν?φυλλη αγ?πη. Κ?τι θα κελαηδο?σε π?λι αν δεν το δι?χναμε— μπορε? της προβατ?νας το χορτ?ρι. Κ?τι θα μας καλο?σε στην απ?ραντη αν?σταση— μπορε? του ?αρος η χ?ρη. Μα η καρδι? μας ?γρια τυφλ?θηκε π?ρασε στα φαιν?μενα του ?δη. Σιγ? και π?γος αδι?κοπα σκεπ?ζει στους αχυρ?νιους καιρο?ς το Ν?πιο Πνε?μα. Την ?ρα που ονειρε?ονται οι βυσσινι?ς και λ?μπουν αμυδρ? μεσ’ στο απλ?τατο σκοτ?δι τ?ποτα δε στοχ?ζονται οι βαβυλ?νιοι στα εργαστ?ρια με τ’ αυτ?ματα χρωματιστ? φ?τα. Π?ς να χαρο?με πια την π?μπτη μ?ρα του προβ?του; Φουρκ?σαμε τ’ αστ?ρια. Γ?ναμε σιγ?-σιγ? δ?θεν υπ?ροχοι με μαδημ?νες χ?μαιρες στα χ?ρια. Μας ν?μεται σκληρ? η επιστ?μη. From: Redwriter [Ερυθρογρ?φος], in Collected Works, Vol. II, Athens: Ikaros. 1993, 472. [Athens: Apopeira, 1990, 18.] DIALECTΙCS OF SPRING Christ the straight angle; Christ the Pythagorean theorem. Christ the infinitesimal calculus from above the blessed Sets Christ. Christ the tessellation of massive particles Christ the zero mass. Hence we spray numbers and fields of lust. We are carabineers of diseased logic plus something— Observed means observer and Hekate The darkness luminous and light in the dark Astarte banqueters demons from today. ΔΙΑΛΕΚΤΙΚΗ ΤΟΥ ΕΑΡΟΣ Χριστ?ς η ορθ? γων?α· Χριστ?ς το πυθαγ?ριο θε?ρημα. Χριστ?ς ο απειροστικ?ς λογισμ?ς ?νωθεν ?λβια Χριστ?ς τα Σ?νολα. Χριστ?ς η ψηφιδογραφ?α στα μαζικ? σωμ?τια Χριστ?ς η μ?ζα μηδ?ν. ?ρα ψεκ?ζουμε αριθμο?ς και πεδ?α λαγνε?ας. Ε?μαστε τυφεκιοφ?ροι νοσο?σης λογικ?ς και κ?τι-- παρατηρο?μενο σημα?νει παρατηρητ?ς και Εκ?τη σκ?τος το π?μφωτο και φως εν τ? σκοτ?? η Αστ?ρτη συνδαιτημ?νες δα?μονες απ’ ?ρτι. From: Redwriter [Ερυθρογρ?φος], Athens: Apopeira, 1990, 18. [1993, II, 472]. CREDO (as we are used to say in Latin) Α I believe in one Poet expelled from heavens / fugitive from the god and vagabond, Empedocles / and here on earth / exile on the earth etc. of Baudelaire /. Β I believe in one Computer inside thunder and through matter. Γ Suffering undefiled / substantive / the Poet uplifts himself slow-burning suicidal implying lengthy sleeps. Δ Cutting down on prospective mistakes. Ε Of all things visible and invisible officiating the onion-peelings. Ζ The Poet has nothing / see the departed /. Η I believe in one Poet that says: madness I enjoy; he ridicules existence; let me light up from my mana. Θ Syntax he doesn’t care about when musicality commands him. Along with still more licenses, and Ts are played according to the concept sound anywhere. E.g. the winters here, he winters there; it will not come—I will not rest, etc. etc. Ι The Poet exercises thought until it’s stripped down. Κ And if he’s Greek he must always study the fineness of Attica, in light, mountains, fields and sea. For this fineness teaches language. Λ And if he’s deeply destined the Poet expresses the unexplainable of the explained; he happens to be a rightful heir to the scientist and his predecessor. Μ On the froth he does not last; the Poet blusters at the bottom of the pot. Ν Flamebred and never redeemed. Ξ The Poet must sometimes say: what a consumption of presence — be a bit lonely for a change! Ο The Poet is twilit. Π He is susceptible of deaths and resurrections. Ρ He looks from the corner of his eye and exists in a glance. Σ He follows behind the mother. Τ Eveningless when it comes to age. Υ I believe in one Poet who says: let the purities coincide. Until the Corinth of the Universe or even further. Φ In a higher despair. Χ In a brighter quintessence. Ψ In one sensation that lifts off. Ω Forgiving everyone. CREDO (ως ε?θισται να λ?με λατινιστ?) Α Πιστε?ω εις ?να Ποιητ?ν εκτ?ς ουρανο? / φυγ?ς θε?θεν και αλ?της, Εμπεδοκλ?ς / και επ? της γης / εξ?ριστος π?νω στη γη κ.λπ. του Βωδελα?ρου /. Β Πιστε?ω εις ?να Υπολογιστ?ν εντ?ς κεραυνο? και δια της ?λης. Γ Υποφ?ροντας ?χραντα / ουσιαστικ?ν / ο Ποιητ?ς ανατε?νεται βραδυφλεγ?ς αυτ?χειρας εξυπακο?οντας πολ?ωρους ?πνους. Δ Τα υποψ?φια λ?θη λιγοστε?οντας. Ε Ορατ?ν τε π?ντων και αορ?των ιερουργ?ντας την αποκρομμ?ωση. Ζ Ο Ποιτ?ς ?χει τ?ποτα / βλ?πε τους αναχωρ?σαντες /. Η Πιστε?ω εις ?να Ποιητ?ν που λ?ει: η τρ?λα μ’ αρ?σει· γελοιοποιε? την ?παρξη· ας αν?ψω απ’ τη μ?να μου. Θ Συνταχτικ? δεν το γνοι?ζεται στην προσταγ? της μουσικ?τητας. Μαζ? και μ’ ?λλες ακ?μη λευτερι?ς, και τα νυ πα?ζονται κατ? την ?ννοια ?χος οπουδ?ποτε. Π.χ. τον χειμ?να εδ?, το χειμ?να εκε?· δε θ? ’ρθει – δεν θα καταλαγι?σουμε, κ. λπ. κ.λπ. Ι Ο Ποιητ?ς γυμν?ζει τη σκ?ψη σε απογ?μνωση. Κ Κι αν ε?ναι ?λληνας οφε?λει να σπουδ?ζει π?ντοτε της Αττικ?ς τη λεπτ?τητα, σε φως, βουν?, χωρ?φια και θ?λασσα. Διδ?σκει γλ?σσα η λεπτ?τητα το?τη. Λ Κι αν ε?ναι βαθι? πεπρωμ?νος ο Ποιητ?ς εκφρ?ζει το ανεξ?γητο του εξηγητο?· τυγχ?νει ν?μιμος δι?δοχος του επιστ?μονα και προκ?τοχ?ς του. Μ Στον αφρ? δεν ?χει δι?ρκεια· στο πατοκ?ζανο μα?νεται ο Ποιητ?ς. Ν Φλογοδ?αιτος και ποτ? ξελυτρωμ?νος. Ξ Ο Ποιητ?ς κ?ποτε πρ?πει να λ?ει: μεγ?λη καταν?λωση παρουσ?ας – γενε?τε και λ?γο μοναξι?ρηδες! Ο Ο Ποιητ?ς ε?ναι αμφ?φλοξ. Π Επιδ?χεται θαν?τους και αναστ?σεις. Ρ Ακροθωρ?ζει και υπ?ρχει σε ξαφνοκο?ταγμα. Σ Ε?ναι ουραγ?ς της μητ?ρας. Τ Αν?σπερος απ? ηλικ?α. Υ Πιστε?ω εις ?να Ποιητ?ν που λ?ει: να συμπ?σουν οι αγν?τητες. Μ?χρι την Κ?ρινθο του Σ?μπαντος ? μακρ?τερα. Φ Σε αν?τερη απελπισ?α. Χ Σε φαειν?τερη πεμπτουσ?α. Ψ Σε μια α?σθηση που πτηνο?ται. Ω Συγχωρ?ντας τους π?ντες. From Large Sized Logic [ Λογικ? μεγ?λου σχ?ματος ], Athens: Erato, 1989, n.p. [1993, II, 521-3]. (shrink)

Philosophers disagree about the moral status of harm-enabling, or behavior by which an agent removes an obstacle to the completion of a threatening sequence. I argue that enabling harm is equivalent to doing harm, at least when an agent withdraws a resource to which neither she nor the victim has any prior moral claim. This conclusion reinforces the common objection that deontological appeals to the doing/allowing distinction cannot easily handle cases involving the withdrawal of aid. I argue that the existing (...) literature on this issue overlooks a more fundamental problem concerning the moral relevance of an agent’s past behavior. (shrink)

Marketing researchers have proposed various conceptual models of ethical decision-making to better clarify the steps in the decision-making process. However, lacking in the literature is comprehensive empirical validation of these models. This manuscript examines the ethical decision-making model proposed by␣Ferrell et al. [1989, Journal of Macromarketing56(Fall), 55–64] in the context of a real-world marketing situation. This model is a comprehensive synthesis of previously developed models in the literature. The events surrounding the withdrawal from the market of the pain reliever Vioxx, (...) manufactured by Merck & Co., are detailed. The analysis provides insights into the decision-making process faced by Merck executives and sheds light onto the real-world applicability of the conceptual model. Furthermore, this study demonstrates how potential modifications to existing models can be developed by their examination in the context of real world events. It is hoped that this analysis, along with future examinations, aids marketing researchers in developing a better understanding of the ethical decision-making process in a business context. (shrink)

Queer cinema takes shape between experimental film, the intimate diary form, art video, documentary, dream fiction, recording and militant video-tracts. In the introductory article, we address several dimensions of this creation : one reflects a practice in queer art according to localized experience, as in the films of Hervé Guibert, David Wojnarowicz, and Raphaël Vincent or the photographic work of Del LaGrace Volcano, based on the experience of AIDS or trans-identities. Another dimension is the attempt to constitute a sexual cinema, (...) with Hans Scheirl or Maria Beatty : these are explorations of an exploded, « de-gendered » body, which directly connects moving images to chemical and bodily transformations, inner mental sensations, jouissance and deterritorialized sexual practices. Lastly, we discuss in more general terms the emergence of a queer cinema which serves as a site for the elaboration of a counter-cinema, a withdrawal from cinema which casts a hegemonic gaze on subaltern political subjects. The documentary genre is then hollowed out from within by this decolonizing gesture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive listing of (...) those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

Of great importance to many non-consequentialists is a claimed moral difference between doing and allowing harm. I argue that non-consequentialism is best understood, however, as consisting in three morally distinct categories where commentators typically identify two: standard doings of harm, standard allowings of harm, and denials of resources. Furthermore, the moral distinctness of denials of resources is independent of whether denials are doings or allowings of harm, I argue. I argue by way of matched examples, as well as by way (...) of two widely accepted features of non-consequentialism: stringent rights of persons, and the susceptibility of resources to distribution within political society. (shrink)

This paper argues that it is morally wrong for the affluent not to contribute money or time to famine relief. It begins by endorsing an important methodological line of objection against the most prominent philosophical advocate of this claim, Peter Singer. This objection attacks his strategy of invoking a principle the acceptability of which is apparently based upon its conformity with "intuitive" moral judgements in order to defend a strongly counterintuitive conclusion. However, what follows is an argument for that counterintuitive (...) conclusion which claims to circumvent the methodological objection, and moreover without having to resort to a justificational ethical theory. How can this be done? Merely by appealing, it is maintained, to the simple practical considerations which are characteristic of the virtues of kindness and justice. Accordingly, an account of those virtues, outlining the structure of the practical reasoning of their possessors, occupies a central place in the argument. The paper displays the resources for normative argument of a "virtue ethics;" but it claims also that its conclusion cannot be escaped by the adherents of any plausible moral outlook. And this yields a further conclusion. All moral outlooks, and not only those which equate the moral point of view with the impartial point of view, face a "problem of demandingness" - for it seems to be a corollary of the argument that if one is to be living a life which is not immoral, one is precluded from pursuing practically any source of personal satisfaction. (shrink)

While agreeing with the main conclusion of Dominic Wilkinson and colleagues (Wilkinson, Butcherine, and Savulescu 2019), namely, that there is no moral difference between treatment withholding and withdrawal as such, we wish to criticize their approach on the basis that it treats the widespread acceptance of withdrawal aversion (WA) as a cognitive bias. Wilkinson and colleagues understand WA as “a nonrational preference for withholding (WH) treatment over withdrawal (WD) of treatment” (22). They treat WA as a manifestation of loss aversion (...) and refer to Kahneman and colleagues (1991), which defined this effect as follows: “the disutility of giving up an object is greater that the utility associated with acquiring it” (194). In a previous work, Wilkinson and Savulescu understood nonequivalence between treatment withholding and withdrawal as a reflection of slightly different, although related, phenomena: status quo bias or omission bias (Wilkinson and Savulescu 2012, 130–131). In neither of these two papers do they describe precisely the relation between these well-known psychological effects and WA, nor do they explain why they treat these effects as examples of nonrational preferences, despite the fact that these issues have been the subject of wide-ranging discussions on the intersection of psychology, economy, and philosophy. (shrink)

In a recent paper, Charles Foster argued that the epistemic uncertainties surrounding prolonged disorders of consciousness make it impossible to prove that the withdrawal of life-sustaining treatment can be in a patient’s best interests and, therefore, the presumption in favour of the maintenance of life cannot be rebutted. In the present response, I argue that, from a legal perspective, Foster has reached the wrong conclusion because he is asking the wrong question. According to the reasoning in two leading cases —Bland (...) and James —the principle of respect for autonomy creates a persuasive presumption against treatment without consent. Therefore, it is the continuation of treatment that requires justification, rather than its withdrawal. This presumption also works as the tiebreaker determining that treatment should stop if there is no persuasive evidence that its continuation is in the best interests of the patient. The presumption in favour of the maintenance of life, on the other hand, should be understood as an evidential presumption on a factual issue that is assumed to be true if unchallenged. However, the uncertainties regarding PDOC actually give reasons for displacing this evidential presumption. Consequently, decision-makers will have to weigh up the pros and cons of treatment having the presumption against treatment without consent as the tiebreaker if the evidence is inconclusive. In conclusion, when the right question is asked, Foster’s argument can be turned on its head and uncertainties surrounding PDOC weigh in to justify the interruption of treatment in the absence of compelling contrary evidence. (shrink)

When can or should citizenship be granted to prospective members of states? When can or should states withdraw citizenship from their existing members? In recent decades, political philosophers have paid considerable attention to the first question, but have generally neglected the second. There are of course good practical reasons for prioritizing the question of when citizenship should be granted—many individuals have a strong interest in acquiring citizenship in particular political communities, while many fewer are at risk of denationalization. Still, loss (...) of membership in a political community is a practice with a long history that continues to take place today. -/- Concerns about national security have recently led several liberal democratic states to pass, strengthen or consider legislation that would empower their governments to denationalize certain persons.] At the international level, formal norms governing denationalization are vague and generally toothless, and there are no international legal norms that restrict denationalization to citizens who hold another citizenship or wish to take up citizenship elsewhere (Worster, 2009). So it is important to determine whether there are conditions under which denationalization can be morally justified and, if so, what those conditions are. We shall argue that while denationalization is ordinarily impermissible, there is a class of crime committed by citizens that may render it not only permissible, but a fitting response on the part of the state. (shrink)

The problem of how to remove information from an agent's stock of beliefs is of paramount concern in the belief change literature. An inquiring agent may remove beliefs for a variety of reasons: a belief may be called into doubt or the agent may simply wish to entertain other possibilities. In the prominent AGM framework for belief change, upon which the work here is based, one of the three central operations, contraction, addresses this concern (the other two deal with the (...) incorporation of new information). Makinson has generalised this work by introducing the notion of a withdrawal operation. Underlying the account proffered by AGM is the idea of rational belief change. A belief change operation should be guided by certain principles or integrity constraints in order to characterise change by a rational agent. One of the most noted principles within the context of AGM is the Principle of Informational Economy. However, adoption of this principle in its purest form has been rejected by AGM leading to a more relaxed interpretation. In this paper, we argue that this weakening of the Principle of Informational Economy suggests that it is only one of a number of principles which should be taken into account. Furthermore, this weakening points toward a Principle of Indifference. This motivates the introduction of a belief removal operation that we call severe withdrawal. We provide rationality postulates for severe withdrawal and explore its relationship with AGM contraction. Moreover, we furnish possible worlds and epistemic entrenchment semantics for severe withdrawals. (shrink)

Many countries have adopted new triage recommendations for use in the event that intensive care beds become scarce during the COVID‐19 pandemic. In addition to establishing the exact criteria regarding whether treatment for a newly arriving patient shows a sufficient likelihood of success, it is also necessary to ask whether patients already undergoing treatment whose prospects are low should be moved into palliative care if new patients with better prospects arrive. This question has led to divergent ethical guidelines. This paper (...) explores the distinction between withholding and withdrawing medical treatment during times of scarcity. As a first central point, the paper argues that a revival of the ethical distinction between doing and allowing would have a revisionary impact on cases of voluntary treatment withdrawal. A second systematic focus lies in the concern that withdrawal due to scarcity might be considered a physical transgression and therefore more problematic than not treating someone in the first place. In light of the persistent disagreement, especially concerning the second issue, the paper concludes with two pragmatic proposals for how to handle the ethical uncertainty: (1) triage protocols should explicitly require that intensive care attempts are designed as time‐limited trials based on specified treatment goals, and this intent should be documented very clearly at the beginning of each treatment; and (2) lower survival prospects can be accepted for treatments that have already begun, compared with the respective triage rules for the initial access of patients to intensive care. (shrink)

If a doctor is trying to decide whether or not to provide a medical treatment, does it matter ethically whether that treatment has already been started? Health professionals sometimes find it harder to stop a treatment (withdraw) than to refrain from starting the treatment (withhold). But does that feeling correspond to an ethical difference? In this article, we defend equivalence—the view that withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. We argue that preference for (...) withholding over withdrawal could represent a form of cognitive bias—withdrawal aversion. Nevertheless, we consider whether there could be circumstances in which there is a moral difference. We identify four examples of conditional nonequivalence. Finally, we reflect on the moral significance of diverging intuitions and the implications for policy. We propose a set of practical strategies for helping to reduce bias in end-of-life decision making, including the equivalence test. (shrink)

The Zhuangzi, a 4th century BCE Daoist text, is sceptical about the political culture of its time. Those who debated conceptions of a good life were hostile to the views of others. They were intolerant and at times contemptuous of others who did not embody their values. In contrast to such negativity, the Zhuangzi promotes equanimity. The equanimity of the sagely person is grounded in a balance she maintains between engagement and withdrawal. Engaging critically, she problematises the lack of diversity (...) in their options for a good life. By withdrawing, she refuses to be party to the squabbles that perpetuate intolerance. The paper aims to show how equanimity is possible, thereby articulating a new angle on emotions in the Zhuangzi. (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)

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

I reject the traditional picture of philosophical withdrawal in the Hellenistic Age by showing how both Epicureans and Stoics oppose, in different ways, the Platonic and Aristotelian assumption that contemplative activity is the greatest good for a human being. Chrysippus the Stoic agrees with Plato and Aristotle that the greatest good for a human being is virtuous activity, but he denies that contemplation exercises virtue. Epicurus more thoroughly rejects the assumption that the greatest good for a human being is virtuous (...) activity. He maintains that the greatest good for a human being is the tranquility that virtuous activity always and contemplative activity sometimes brings about. (shrink)

Withdrawal of artificially delivered nutrition and hydration (ANH) from patients in a permanent vegetative state (PVS) requires judicial approval in England and Wales, even when families and healthcare professionals agree that withdrawal is in the patient9s best interests. Part of the rationale underpinning the original recommendation for such court approval was the reassurance of patients’ families, but there has been no research as to whether or not family members are reassured by the requirement for court proceedings or how they experience (...) the process. The research reported here draws on in-depth narrative interviews with 10 family members (from five different families) of PVS patients who have been the subject of court proceedings for ANH-withdrawal. We analyse the empirical evidence to understand how family members perceive and experience the process of applying to the courts for ANH-withdrawal and consider the ethical and practice implications of our findings. Our analysis of family experience supports arguments grounded in economic and legal analysis that court approval should no longer be required. We conclude with some suggestions for how we might develop other more efficient, just and humane mechanisms for reviewing best interests decisions about ANH-withdrawal from these patients. (shrink)