The pessimistic hypothesis is the hypothesis that life is bad for us, in the sense that we are worse off for having come into existence. Suppose this hypothesis turns out to be correct — existence turns out to be more of a burden than a gift. A natural next thought is that we should stop having children. But I contend that this is a mistake; procreation would often be permissible even if the pessimistic hypothesis turned out to be correct. Roughly, (...) this is because we are often in a position to know that future people will approve of having been created, and their approval will not be inappropriate even if they are worse off for having been created. And our respect for the attitudes of future people can permit us to create them. (shrink)

I argue that, insofar as we endorse the general idea that desires play an important role in well-being, we ought to believe that their significance for well-being is derived from a pair of more fundamental attitudes: attraction and aversion. Attraction has wholly positive significance for well-being, and aversion has wholly negative significance for well-being. Desire satisfaction and frustration have significance for well-being insofar as the relevant desires involve some combination of attraction and aversion. I defend these claims by illustrating how (...) our desires can be asymmetrical. They can have greater positive than negative significance for well-being, or vice versa. (shrink)

What makes it the case that a given experience is pleasurable? According to the felt-quality theory, each pleasurable experience is pleasurable because of the way that it feels—its “qualitative character” or “felt-quality”. According to the attitudinal theory, each pleasurable experience is pleasurable because the experiencer takes certain attitudes towards it. These two theories of pleasure are typically framed as rivals, but it could be that they are both partly right. It could be that pleasure is partly a matter of felt-quality, (...) and partly a matter of attitudes. It could be that a hybrid theory is true. In this paper, I aim to advance the cause of hybrid theories of pleasure. I do this in two ways. I begin by examining the challenges which motivate the search for a hybrid theory. I call these the HONEST challenges: Heterogeneity, Oppositeness, Normativity, Euthyphro, Separateness, and Togetherness. The first three challenges—HON—are challenges for the felt-quality theory. The second three challenges—EST—are challenges for the attitudinal theory. Having established the HONEST challenges, I then describe and motivate a particular cluster of hybrid theories which I will call dispositional hybrid theories. According to these theories, pleasurable experiences are all and only those experiences which dispose us to desire them in virtue of feeling the way that they do. The dispositional theories deliver on the promise of hybrid theories: because they appeal to both felt-qualities and attitudes, they have the resources to avoid most, if not all, of the HONEST challenges. (shrink)

Some experiences—like the experience of eating cheesecake—are good experiences to have. But when we try to explain why they are good, we encounter a clash of intuitions. First, we have an objectivist intuition: plausibly, the experiences are good because they feel the way that they do. Second, we have a subjectivist intuition: if a person were indifferent to that kind of experience, then it might fail to be good for that person. Third, we have a possibility intuition: for any kind (...) of experience, possibly there is a subject who is indifferent to that kind of experience. The pleasure problem is the problem we face in reconciling these three claims. I explain the problem and argue for a solution. I argue that we ought to reject the most common solutions: rejecting the objectivist or subjectivist intuitions. Instead, we ought to follow Timothy Sprigge in rejecting the possibility claim. We should embrace the view that experiences bear necessary connections to our attitudes. (shrink)

According to a view that goes by “Humeanism,” causal facts supervene on patterns of worldly entities. The simplest form of Humeanism is the constant conjunction theory: a particular type-F thing causes a particular type-G thing iff (i) that type-Fis conjoined with that type-G thing and (ii) all F’s are conjoined with G’s. The constant conjunction theory implies that all causation is extrinsic, in the following sense: for all positive causal facts pertaining to each possible region,it’s extrinsic to that region that (...) those causal facts pertain to it. Actual Humeans don’t accept the constant conjunction theory; they accept more sophisticated versions of Humeanism. But I argue that they, too, are committed to the thesis that all causation is extrinsic. In arguing for this claim,I use a discussion from Brian Weatherson as a springboard. Weatherson argues that on a plausible Humean view, some regions are such that all of their possible duplicates have the same or similar natural laws. I show that this is false. If Humeanism is true, then for every possible region, there are possible duplicates of that region with utterly alien natural laws. As a consequence, no causal facts pertain intrinsically to any region. (shrink)

My partner loves the experiences she gets from eating olives. I, on the other hand, hate the experiences I get from eating olives. We differ in tastes. But how exactly do we differ? In particular: do our taste experiences differ phenomenologically—that is, do my olive-experiences feel different than my partner’s olive-experiences? Some philosophers have assumed that the answer is “no,” and have advanced important arguments which turn on this assumption. I argue that, contrary to what these philosophers assume, ordinary taste (...) differences do involve differences in phenomenology. My olive-experiences feel different than my partner’s olive-experiences. I argue for this phenomenal thesis in stages. First, I argue that there is a link between our attitudes and our pleasures; second, I argue that there is a link between our pleasures and our phenomenology. Together, my conclusions link our attitudes and phenomenology in a way that vindicates the phenomenal thesis. Along the way, I fend off various worries about what the phenomenal thesis might entail. I show that it does not entail any form if radical subjectivism, nor does it entail that there is a “distinctive feeling of pleasure.” I close by considering how opponents of the phenomenal thesis might retreat to a weaker thesis: one which concerns extraordinary taste differences, as opposed to ordinary taste differences. I argue that there are no obviously sound arguments for even this weaker thesis, which should make us all the more confident in the phenomenal thesis. (shrink)

The article examines the role of discourse in organisational sensemaking. By building links between the theorising undertaken within organisational studies and the empirical analysis of multimodal social interaction, it argues for a relational view of sensemaking and investigates how sense is made in and through social interaction in real organisational situations where language use intertwines with embodied actions and the manipulation of artefacts. In particular, the article studies the use of discourse technologies of textual artefacts in sensemaking processes. The data (...) come from training workshops of a Finnish workplace organisation, conducted in order for the employees to delineate the history and future of their organisation with the help of writable papers. The results show how the papers exert agency in the situation by facilitating three specific discursive practices and by enabling and restricting the actions employed in constructing a shared understanding of the organisational reality. (shrink)

In virtue of what do we enjoy episodes of pleasure? According to the phenomenological theory of pleasure, we enjoy pleasures in virtue of having certain kinds of phenomenal experiences. According to the attitude theory of pleasure, we enjoy pleasures in virtue of having a certain kind of pro-attitude. In this chapter, we show that the attitude theory faces a dilemma. The attitude that is relevant to pleasure—the desire, liking, or favoring—is either necessarily co-instantiated with certain phenomenology, or not. If the (...) attitude theorist denies that the relevant attitudes are phenomenologically enriched in this sense, then their theory has the problematic implication that pleasure can come radically apart from phenomenology. This leads to a *problem of hedonic inversion*. If the attitude theorist instead affirms that the relevant attitudes are phenomenologically enriched, then they undermine their main objection to the phenomenological theory of pleasure. This is the so-called *heterogeneity problem*, according to which pleasures do not feel alike. Either way, the attitudinal theorist faces a difficult challenge in their ongoing debate with phenomenological theorists. (shrink)

No discussion of when an individual is dead is meaningful in the absence of a definition of death. If human death is defined as the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe spontaneously (and hence to maintain a spontaneous heart beat) the death of the brainstem will be seen to be the necessary and sufficient condition for the death of the individual. Such a definition of death is not something radically (...) new. It is merely the reformulation -- in the language of the neurophysiologist -- of much older concepts such as the 'departure of the (conscious) soul from the body' and the 'loss of the breath of life'. All death -- in this perspective -- is, and always has been, brainstem death... (shrink)

This first part of a two‐part article illustrates how research in evolutionary biology and psychology illuminates questions arising in philosophy—specifically questions about the origins of severe, systemic aggression that arise in the mimetic theory of René Girard. Part I looks at: (i) how old the systemic practice of severe aggression is, (ii) how much results from humanity's mimetic/social and competitive nature and how much from ecological, resource, and cultural conditions, and (iii) if ecological and cultural conditions are important, might we (...) adapt them toward greater cooperativity today? After briefly reviewing mimetic theory, the article looks at evolutionary psychology and biology, including fossil and archeological evidence. Findings suggest that severe, systemic aggression might be relatively recent and that its occurrence depends on ecological/resource/socioeconomic conditions additional to our mimetic/social nature. Thus, distinguishing the conditions that prod aggression from those that support pro‐social behavior might aid us in structuring society today. (shrink)

This Part II of a two‐part article illustrates how research in evolutionary biology, anthropology, archeology, and psychology illuminates questions arising in philosophy—specifically questions about René Girard's theory of aggression. Part I looked at: (i) how old the systemic practice of severe aggression is; (ii) how much of it results from humanity's mimetic/social and competitive nature and how much from ecological, resource, and cultural conditions; and (iii) if ecological, resource, and cultural conditions are important, might we adapt this information toward greater (...) cooperativity today? Part II investigates Girard's theory of ritual sacrifice—especially human sacrifice—as a societal steam valve for the systemic aggression explored in Part I. It draws on theories of play, theater, and art to examine the role and function of such ritual sacrifice. (shrink)

ExcerptIn light of the 2008 global financial crisis and its underlying causes, a reassessment of our global market system seems to be afoot, at least in some quarters. If neoliberalism (too much market) yields the Great Recession, if socialist planned markets (not enough market) produce the failed economies of the former Soviet bloc, and if social-market combinations (too much centralization of the market) progress toward the high-cost, centralized programs and slow growth of Western Europe, what are better options? One line (...) of questioning asks, can the dynamism and inventiveness of the market be harnessed not only for corporate and individual…. (shrink)

In his edition of this author Buecheler translates the words of Mim. III. 72 πρός σΣ Τñς κοΤΤίδος ψυχñς by ‘per capitale tuum ingenium,’ but affords no explanation as to how he arrived at this sense. May I suggest another interpretation to which Modern Greek seems to me to lead? The equivalent of κοΤΤίς is now πουλί or πουλάκπουλί μου or πουλάκι or simply πουλάκ‘my little birdie,’ i.e. ‘my darling,’ is the most frequent endearing term of the Greeks. See Vlachos's (...) Λεξικòν ‘Eλληογλλικòν ν πουλί 'πουλί μουmon chéri, mon amour, ma poulette.’ Therefore, πρóς σε Τñς κοΤΤíδος ψυχñς I fancy, means, ‘I implore thee by thy darling soul.’ The expression seems to have come down to us intact in sense, and only altered in so far as new words have been substituted for the obsolete ones. Of such a phenomenon I have given several curious examplesin my Notes tn the Gospels. (shrink)

Despite the acknowledged importance of strategic planning in business and other organizations, there are few studies focusing on strategy texts and the related processes of their production and consumption. In this article, we attempt to partially fill this research gap by examining the institutionalized aspects of strategy discourse: what strategy is as genre. Combining textual analysis and analysis of conversation, the article focuses on the official strategy of the City of Lahti in Finland. Our analysis shows how specific communicative purposes (...) and lexico-grammatical features characterize the genre of strategy and how the actual negotiations over strategy text involve particular kinds of intersubjectivity and intertextuality. (shrink)

This Handbook contains forty essays by an international team of experts on the antecedents, the content, and the reception of the Dionysian corpus, a body of writings falsely ascribed to Dionysius the Areopagite, a convert of St Paul, but actually written about 500 AD. The first section contains discussions of the genesis of the corpus, its Christian antecedents, and its Neoplatonic influences. In the second section, studies on the Syriac reception, the relation of the Syriac to the original Greek, and (...) the editing of the Greek by John of Scythopolis are followed by contributions on the use of the corpus in such Byzantine authors as Maximus the Confessor, John of Damascus, Theodore the Studite, Niketas Stethatos, Gregory Palamas, and Gemistus Pletho. In the third section attention turns to the Western tradition, represented first by the translators John Scotus Eriugena, John Sarracenus, and Robert Grosseteste and then by such readers as the Victorines, the early Franciscans, Albert the Great, Aquinas, Bonaventure, Dante, the English mystics, Nicholas of Cusa, and Marsilio Ficino. The contributors to the final section survey the effect on Western readers of Lorenzo Valla's proof of the inauthenticity of the corpus and the subsequent exposure of its dependence on Proclus by Koch and Stiglmayr. The authors studied in this section include Erasmus, Luther and his followers, Vladimir Lossky, Hans Urs von Balthasar, and Jacques Derrida, as well as modern thinkers of the Greek Church. Essays on Dionysius as a mystic and a political theologian conclude the volume. (shrink)

Multiprofessional teams have become in recent years one of the distinguishing features of services, where professionals with different competences work together. The core of our interest is addressed to the équipe of a palliative care ward; in particular, to that series of working activities that consists of communicative acts, as équipe meetings, for instance. Our research focuses on the analysis of the process by which the development of knowledge in multiprofessional practice is built to establish more information on recurrent patterns (...) in the interaction and connect them to the specific context that these are shaped by. In this sense we will underline how components of knowing are shared among team members in constructing medical prognosis and we will analyse the connection among language processes, cognitive activities and social structures. More specifically, we will study the role of language and the context in the definition of linguistic acts in cognitive activities and in hierarchies involved in decision-making processes by exploring and pointing out how it is organised and structured. In particular through the study of talk-in-interaction where interchange of information is realised, we will emphasise how, in the multiprofessional équipe meeting, the realisation of practices and the knowledge useful to collaborative management of ward working life are established. To reach this aim, we adopted an ethnographic approach connected to the analysis of the situated interaction. (shrink)

In nursing ethics the role of narratives and dialogue has become more prominent in recent years. The purpose of this article is to illuminate a relational-narrative approach to ethics in the context of palliative nursing. The case study presented concerns a difficult relationship between oncology nurses and a husband whose wife was hospitalized with cancer. The husband’s narrative is an expression of depression, social isolation and the loss of hope. He found no meaning in the process of dying and death. (...) The oncology nurses were not able to recognize his emotional and existential problems. A narrative perspective inspired by relational ethics indicates that participants may develop a relational narrative that seeks good for all involved in a situation. In palliative nursing this entails open communication about the fragility of life and approaching death. In relational narratives, answers to these ethical dilemmas are co-authored, contingent and contextual. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

Good medical practice requires evidence of effectiveness to address deficits in care, strive for further improvements, and justly apportion finite resources. Nevertheless, the potential of palliative care is still held back by a paucity of good evidence. These circumstances are largely attributable to perceived ethical challenges that allegedly distinguish dying patients as a special client class. In addition, practical limitations compromise the quality of evidence that can be obtained from empirical research on terminally ill subjects.This critique aims to appraise the (...) need for focused research, in order to develop clinical and policy decisions that will guide health care professionals in their care of dying patients. Weighted against this need are tenets that value the practical and ethical challenges of palliative care research as unique and insurmountable. The review concludes that, provided investigators compassionately apply ethical principles to their work, there is no justification for not endeavouring to improve the quality of palliative care through research. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 41-42, June 2011.

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, (...) to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes physician-assisted suicide (...) and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not. (shrink)

Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, (...) poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of ‘plugged in’ as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care. (shrink)

Clarifying and analysing moral problems arising in the practice of palliative care was the objective of participatory observations in five palliative care settings. The results of these observations will be described in this contribution. The moral problems palliative caregivers have to deal with in their daily routines will be explained by comparison with the findings of a previously performed literature study. The specific differences in the manifestation of moral problems in the different palliative care settings will be highlighted as well.

It is often claimed that the intentions of physicians are multiple, ambiguous, and uncertain—at least with respect to end-of-life care. This claim provides support for the conclusion that the principle of double effect is of little or no value as a guide to end-of-life pain management. This paper critically discusses this claim. It argues that proponents of the claim fail to distinguish two different senses of “intention,” and that, as a result, they are led to exaggerate the extent to which (...) clinical intentions in end-of-life contexts are ambiguous and uncertain. It argues further that physicians, like others who make life and death decisions, have a duty to get clear on what their intentions are. Finally, it argues that even if the principle of double effect should be rejected, clinical intentions remain ethically significant because they condition the meaning of extraordinary clinical interventions, such as that of palliative sedation. (shrink)

As a patient approaches death, family members often are asked about their loved one’s preferences regarding treatment at the end of life. Advance care directives may provide information for families and surrogate decision makers; however, less than one-third of Americans have completed such documents. As the U.S. population continues to age, many surrogate decision makers likely will rely on other means to discern or interpret a loved one’s preferences. While many surrogates indicate that they have some knowledge of their loved (...) one’s preferences, how surrogates obtain such knowledge is not well understood. Additionally, although research indicates that the emotional burden of end-of-life decision making is diminished when surrogates have knowledge that a loved one’s preferences are honored, it remains unclear how surrogates come to know these preferences were carried out. The current study examined the ways that next of kin knew veterans’ end-of-life preferences, and their ways of knowing whether those preferences were honored in Veteran Affairs Medical Center inpatient settings. (shrink)

Taking steps to build a more dementia‐friendly society is essential for addressing the needs of people experiencing dementia. Initiatives that improve the quality of life for those living with dementia are needed to lessen controllable factors that can negatively influence how people envision a future trajectory of dementia for themselves. Programs that provide better funding and better coordination for care support would lessen caregiver burden and make it more possible to imagine more people being able to live what they might (...) consider a “good life” with dementia. Specific proposals, such as payment for dementia care managers and new systems to support high‐quality, symptom‐based palliative care beyond the hospice benefit of only six months, would improve and reframe how many people in the United States experience a dementia illness. Such changes should be incorporated into discussions about improving and respecting preferences in the later stages of dementia. (shrink)

The concept of ‘geneticization’ has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to (...) disease, health and the body. This article analyses the thesis of ‘geneticization’. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that ‘geneticization’ primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights. (shrink)

The vast majority of contributions to the literature on spirituality in nursing make extravagant claims about transcendence, eternity, the numinous, higher powers, higher levels of existence, invisible forces, cosmic unity, the essence of humanity, or other supernatural concepts. Typically, these assertions are made without the support of argument or evidence; and, as a consequence, alternative ways of theorizing ‘spirituality’ have been closed off, while the lack of consistent scholarship has turned the topic into a metaphysical backwater. In this paper, I (...) adopt a different premise, rejecting unsupported claims, and surveying the ‘spirituality’ terrain from a naturalistic and reductionist perspective. I argue that, if we rid ourselves of non‐naturalistic assumptions, we will discover theoretical and clinical resources in health psychology, social psychology, neuropsychology, and pharmacopsychology – resources which confirm that it is possible to conceptualize the study of existential concerns, and how health professionals might respond to them, in a properly scientific manner. In order to illustrate the potential usefulness of these resources, I will take palliative care as an example. (shrink)

This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but (...) together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

Palliation is a relatively new concept that is used in connection with the integral care provided to those who are unable to recover from their illness. The specific meaning of the concept has not been clearly defined. This article explores the possibilities offered by a responsive approach to evaluation that can facilitate a reflexive dialogue on this ambiguous concept. In doing so it draws on a case study of a palliative care project in a Dutch health care authority. The article (...) begins with an overview of the characteristics of a responsive approach to evaluation and addresses interpretative, representational and practical dilemmas. It goes on to present a series of dialogues between health professionals, informal caregivers, patients and evaluators. These dialogues take the form of juxtaposed stories, transcribed conversations and interpretations. Finally, the learning experiences are summarised and the appropriateness of the responsive approach to evaluate palliative care is discussed. (shrink)

In the history of palliative care, all roads lead back to Dame Cicely Saunders, a remarkable social worker/nurse/physician who promoted the concept of total pain and founded the first modern hospic...

Quality of care is a prominent discourse in modern health‐care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse–patient–carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi‐structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural (...) discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health‐care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. (shrink)

Τ τε 'Ομρον ξ ποβολς γγραφε [σόλων] αψδεσθαι, οον που ό πρτος ληξεν κεθεν ρχεσθαι τòν χ;óμεν㦿ν . It would be tedious to trace the course of the controversy about this phrase. Since Hermann showed that ύποβάλλειν means ‘subiicere alteri quod recordetur uel dicat’ , the many conflicting interpretations have been obliged to resort to some device, more or less strained, in order to reconcile the natural sense of ύποβολή with what at least appears to be the explanatory clause added (...) in the text of Diogenes, and with the parallel phrase in the Hipparchus, 228d: ήνάγκασε τούς αΨδος Παναθηναίοις ξ ύπολψεως φεξης ατδιιναι. We should expect some term meaning performance by turns, and sufficiently technical to need the explanation given by Diogenes. Mr. Pallis has cut the knot in the Classical Quarterly by suggesting ξ ποβς on the model of the pseudo-Platonic passage. There is, however, no classical authority for this word, and a change as small will restore a known technical word with the required sense. (shrink)

Τ⋯ τε 'Ομ⋯ρον ⋯ξ ὑποβολ⋯ς γ⋯γραφε [σόλων] ῥαψῳδεῖσθαι, οἷον ὅπου ό πρ⋯τος ἒληξεν ⋯κεῖθεν ἂρχεσθαι τòν ⋯χ;óμεν㦿ν.It would be tedious to trace the course of the controversy about this phrase. Since Hermann showed that ύποβάλλειν means ‘subiicere alteri quod recordetur uel dicat’, the many conflicting interpretations have been obliged to resort to some device, more or less strained, in order to reconcile the natural sense of ύποβολή with what at least appears to be the explanatory clause added in the text (...) of Diogenes, and with the parallel phrase in the Hipparchus, 228d: ήνάγκασε τούς ῥαΨῳδοὺς Παναθηναίοις ⋯ξ ύπολ⋯ψεως ⋯φεξης α⋯τ⋯ διι⋯ναι. We should expect some term meaning performance by turns, and sufficiently technical to need the explanation given by Diogenes. Mr. Pallis has cut the knot in the Classical Quarterly by suggesting ⋯ξ ὺποβ⋯ς on the model of the pseudo-Platonic passage. There is, however, no classical authority for this word, and a change as small will restore a known technical word with the required sense. (shrink)

Until quite recently bioethicists have had little of depth and probity to say about the duty of healthcare professionals in general and physicians in particular to relieve pain and suffering associated with disease and/or its treatment.

The moral importance of the ‘intention–foresight’ distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating ‘slow euthanasia’. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The (...) majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some ‘mental gymnastics,’ the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of ‘terminal’ sedation – cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles. (shrink)