Notwithstanding fears of overly permissive approaches and related pleas to refuse euthanasia for psychological suffering, some Belgian hospitals have declared that such requests could be admissible. However, some of these hospitals have decided that such requests have to be managed and carried out outside their walls. Ghent University Hospital has developed a written policy regarding requests for euthanasia for psychological suffering coming from patients from outside the hospital. The protocol stipulates several due care criteria that go beyond the requirements of (...) the Belgian Euthanasia Law. For instance, the legally required first and second consulted physicians should all be psychiatrists and be affiliated with a psychiatry department of a Flemish university hospital. Moreover, euthanasia for psychological suffering can only be performed if the advices of these consulted physicians are positive. Importantly, preliminary reflection by the multidisciplinary Hospital Ethics Committee was introduced to discuss every request for euthanasia for psychological suffering coming from outside the hospital. In this way, the protocol supports psychiatrists faced with the complexities of assessing such requests, improves the quality of euthanasia practice by ensuring transparency and uniformity, and offers patients specialised support and guidance during their euthanasia procedure. Nevertheless, some concerns still remain. (shrink)

Objectives To examine the frequency and characteristics of decisions to forgo artificial nutrition and/or hydration at the end of life.Design Postal questionnaire survey regarding end-of-life decisions to physicians certifying a large representative sample of Belgian death certificates in 2007.Setting Flanders, Belgium, 2007.Participants Treating physicians of deceased patients.Results Response rate was 58.4%. A decision to forgo ANH occurred in 6.6% of all deaths . Being female, dying in a care home or hospital and suffering from nervous system diseases or malignancies were (...) the most important patient-related factors positively associated with a decision to forgo ANH. Physicians indicated that the decision to forgo ANH had had some life-shortening effects in 77% of cases. There had been no consultation with the patient in 81%, mostly due to incapacity . The family, colleague physicians and nurses were involved in decision making in 76%, 41% and 62%, respectively.Conclusions A substantial number of deaths are preceded by a decision to forgo ANH in Belgium. These decisions, ethically laden and involving a considerable chance of life shortening, are mostly not preceded by discussion with the patient despite existing patient rights legislation. It is recommended that physicians and patients and their families alike dedicate ample time to the discussion of treatment options and communication about the possibility of forgoing ANH and that this discussion takes place earlier as part of overall end-of-life care planning rather than at the very end of life. (shrink)

Assisted dying is a divisive and controversial topic and it is therefore desirable that a broad range of interests inform any proposed policy changes. The purpose of this study is to collect and synthesize the views of an important stakeholder group—namely people with disabilities —as expressed by disability rights organisations in Great Britain. Parliamentary consultations were reviewed, together with an examination of the contemporary positions of a wide range of DROs. Our analysis revealed that the vast majority do not have (...) a clear public stance; those that do exhibit a significant diversity of opinion. DROs opposing legislation on assisted dying have argued that it would be premature, misguided, inequitable and culturally undesirable. Some specify conditions that would have to be satisfied before they could support legalisation, such as radical improvements in health and social care services and the elimination of discrimination against PwD. DROs supporting assisted dying maintain that a change in the law would promote autonomy, end intense suffering, can be delivered safely and is supported by the DRO’s membership. The discussion considers the reasons why several DROs adopt a neutral stance and the argument is made that, whatever their overarching stance on the issue, DROs need to be involved in the policy debate so that the crucial perspectives of PwD are heard and addressed. This is an important message for countries around the world that permit, or are considering legalising, assisted dying. (shrink)

A historical investigation of the exclusion of Africa and Asia from modern histories of philosophy.

Objectives Potentially life-shortening medical end-of-life practices ) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices they label as euthanasia or sedation.Methods We conducted a large stratified random sample of death certificates from 2007 . The physicians named on the death certificate were approached by means of a postal questionnaire asking about ELDs made in each case and asked to choose the most appropriate label to describe the ELD. Response (...) rate was 58.4%.Results In the vast majority of practices labelled as euthanasia, the self-reported actions of the physicians corresponded with the definition in the Belgian euthanasia legislation; practices labelled as palliative or terminal sedation lack clear correspondence with definitions of sedation as presented in existing guidelines. In these cases, an explicit life-shortening intention by means of drug administration was present in 21.6%, life shortening was estimated at more than 24 h in 51% and an explicit patient request was absent in 79.7%.Discussion Our results suggest that, unlike euthanasia, the concept of palliative or terminal sedation covers a broad range of practices in the minds of physicians. This ambiguity can be a barrier to appropriate sedation practice and indicates a need for better knowledge of the practice of palliative sedation by physicians. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying. The practice is generally considered to be legal as a form of symptom control, although this is mostly only assumed. France has passed an amendment to the Public Health Act that would grant certain terminally ill patients an explicit right to continuous deep sedation until they pass away. Such a (...) framework would be unique in the world. In this paper we will highlight and reflect on four relevant aspects and shortcomings of the proposed bill. First, that the bill suggests that continuous deeps sedation should be considered as a sui generis practice. Second, that it requires that sedation should always be accompanied by the withholding of all artificial nutrition and hydration. In the most recently amended version of the legal proposal it is stated that life sustaining treatments are withheld unless the patient objects. Third, that the French bill would not require that the suffering for which continuous deep sedation is initiated is unbearable. Fourth, the question as to whether the proposal should be considered as a way to avoid having to decriminalise euthanasia and/or PAS or, on the contrary, as a veiled way to decriminalise these practices. The French proposal to amend the Public Health Act to include a right to continuous deep sedation for some patients is a unique opportunity to clarify the legality of continuous deep sedation as an end-of-life practice. Moreover, it would recognize that the practice of continuous deep sedation raises ethical and legal issues that are different from those raised by symptom control on the one hand and assisted dying on the other hand. Nevertheless, there are still various issues of significant ethical concern in the French legislative proposal. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying...

How (Not) to Be Secular is what Jamie Smith calls "your hitchhiker's guide to the present" -- it is both a reading guide to Charles Taylor's monumental work A Secular Age and philosophical guidance on how we might learn to live in our times. Taylor's landmark book A Secular Age (2007) provides a monumental, incisive analysis of what it means to live in the post-Christian present -- a pluralist world of competing beliefs and growing unbelief. Jamie Smith's book is a (...) compact field guide to Taylor's insightful study of the secular, making that very significant but daunting work accessible to a wide array of readers. Even more, though, Smith's How (Not) to Be Secular is a practical philosophical guidebook, a kind of how-to manual on how to live in our secular age. It ultimately offers us an adventure in self-understanding and maps out a way to get our bearings in today's secular culture, no matter who "we" are -- whether believers or skeptics, devout or doubting, self-assured or puzzled and confused. This is a book for any thinking person to chew on. (shrink)

This chapter provides an introduction to higher-order metaphysics as well as to the contributions to this volume. We discuss five topics, corresponding to the five parts of this volume, and summarize the contributions to each part. First, we motivate the usefulness of higher-order quantification in metaphysics using a number of examples, and discuss the question of how such quantifiers should be interpreted. We provide a brief introduction to the most common forms of higher-order logics used in metaphysics, and indicate a (...) number of questions which can be raised in such systems using logical vocabulary alone. Using a further example, we return to applications of higher-order logics in metaphysics. We also mention key developments in the history of higher-order logic as it pertains to metaphysics. Finally, we mention certain arguments which have been raised against the use of higher-order logic, and some ways of responding to them. (shrink)

Practical deliberation often involves conditional judgements about what will (likely) happen if certain alternatives are pursued. It is widely assumed that the conditionals useful in deliberation are counterfactual or subjunctive conditionals. Against this, I argue that the conditionals of deliberation are indicatives. Key to the argument is an account of the relation between 'straightforward' future-directed conditionals like ' If the house is not painted, it will soon look quite shabby' and * "w e r e ' ' e d F (...) D C s like ' If the house were not to be painted, it would soon look quite shabby': an account on which both of these types of FDCs are grouped with the indicatives for semantic treatment and on which, while conditionals of both types are properly used in means/ends deliberations, those of the ' were'ed-up variety are especially well suited for that purpose. (shrink)

In the traditional form of canonical quantization, certain field components (not having “conjugate” momenta) must be regarded as noncanonical. This long-known distinction enters modern gauge theories, when they are canonically quantized as by Kugo and Ojima. We avoid that peculiarity by not using any conjugate “momenta” at all. In our formulation, canonical quantization can be related to Feynman's path integral.

Aggregating individuals’ consistent attitudes might produce inconsistent collective attitudes. Some groups therefore need the capacity to form attitudes that are irreducible to those of their members. Such groups, group-agent realists argue, are agents in control of their own attitude formation. In this paper, however, I show how group-agent realism overlooks the important fact that groups consist of strategically interacting agents. Only by eliminating group agency from our social explanations can we see how individuals vote strategically to gain control of their (...) groups and produce collective attitudes we cannot make sense of if we treat groups as agents. (shrink)

'Pataphysics: The Poetics of an Imaginary Science is a survey that attempts to describe a hypothetic philosophy--the avant-garde pseudo-science imagined by Alfred Jarry. 'Pataphysics is a supplement to metaphysics, accenting it, then replacing it, in order to create a philosophic alternative, whose discipline can study cases, not of conception, but of exception: variance , alliance , and deviance . 'Pataphysics synthesizes the romantic schism between a literal, scientized discourse and a figural, poeticized discourse, and my thesis suggests that this revision (...) of the signifier "science" by 'pataphysics is symptomatic of a postmodern transition in science from a paradigm of absolutism to a paralogy of relativism. Structured as a descriptive explication, which emphasizes a theoretical perspective, this survey is divided into five chapters: the first chapter recounts the history of the conflict between science and poetry ; the second chapter examines the avant-garde pseudo-science of 'pataphysics itself ; and finally, the last three chapters discuss the influence of 'pataphysics upon the poetics of its subsequent successors . While my thesis focuses upon theories of textual poetics rather than poetry itself , my thesis does nevertheless strive to be as conceptually encyclopedic as 'pataphysics itself: instead of normalizing 'pataphysics within one theoretical perspective, this survey alludes intermittently to 'pataphysical enterprises that constitute exceptions to such a genealogy of Jarryites. What is at stake is the status of poetry in a world of science. How might poetry reclaim its own viable truth? How might science benefit from its own poetic irony? For the postmodern condition, such questions have already opened up a novel space for speculative imagination; hence, this survey presents itself as a kind of primer for a future of possible research. (shrink)

In this short but meaty book, Peter Unger questions the objective answers that have been given to central problems in philosophy. As Unger hypothesizes, many of these problems are unanswerable, including the problems of knowledge and scepticism, the problems of free will, and problems of causation and explanation. In each case, he argues, we arrive at one answer only relative to an assumption about the meaning of key terms, terms like "know" and like "cause," even while we arrive at an (...) opposite answer relative to quite different assumptions, but equally arbitrary assumptions, about what the key terms mean. (shrink)

This article explores the enduring mysteries of consciousness and the afterlife, two enigmatic topics that have fascinated humanity for ages. Despite extensive scientific efforts, the existence of an afterlife remains unproven, and understanding consciousness remains a significant challenge. The research introduces innovative hypotheses through simple thought experiments with empirical evidence and robust theoretical foundations. It delves into the complexities of consciousness, its relationship with the brain, and the need for interdisciplinary approaches encompassing physics, psychology, and philosophy. Boldly contemplating the probability (...) of a continuous consciousness after death, the study argues that existing evidence strongly supports this idea. Beyond theoretical implications, it envisions practical outcomes, suggesting that insights into these mysteries could enhance human well-being and contribute to a more harmonious world. In summary, this article embarks on a quest to shed light on age-old questions about consciousness and the afterlife. Through fresh methodologies, it aims to provide new perspectives that could reshape our understanding of existence and inspire intellectuals to positive individual and societal advancements. -/- . (shrink)

Neoplatonic allegorical interpretation expounds how literary texts present philosophical ideas in an enigmatic and coded form, offering an alternative path to the divine truths. The Neoplatonist Porphyry’s _On the Cave of the Nymphs_ is one of the most significant allegorical interpretation handed down to us from Antiquity. This monograph, exclusively dedicated to the analysis of _On the Cave of Nymphs_, demonstrates that Porphyry interprets Homer’s verse from Odyssey 13.102-112 to convey his philosophical thoughts, particularly on the material world, relationship between (...) soul and body and the salvation of the soul through the doctrines of Plato and Plotinus. The Homeric cave of the nymphs with two gates is a station where the souls descend into genesis and ascend to the intelligible realm. Porphyry associates Odysseus’ long wanderings with the journey of the soul and its salvation from the irrational to rational through escape from all toils of the material world. (shrink)

are ambiguous. In the mouth of someone who cannot remember whether it was Michael, or rather someone else, who was top scorer, can express the epistemic possibility that Michael led the league in scoring. But from someone who knows that Michael did not even play last season, but is wondering what would have happened if he had, means something quite different. Now where it has this quite different meaning, may still turn out to be the expression of some epistemic possibility. (...) Perhaps where does not express the epistemic possibility of ‘Michael led the league in scoring’, it expresses the epistemic possibility of ‘Michael would have led the league in scoring’. Analysis of this ‘would have’ statement, together with an exploration of the suspicion that the ‘might have’ statement is ambiguous between these two epistemic possibilities, will have to await another occasion. The important point for present purposes is that is ambiguous between an expression of the epistemic possibility of ‘Michael led the league in scoring’ and some quite different reading. (shrink)

What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of (...) responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist in reasonable clinical decision-making, practical implications of all these requirements are also suggested. (3) Challenges concerning the framework are discussed. First, a crucial presumption that the framework relies upon is considered—namely, clinicians’ willingness to justify their decisions as requested. Then how public deliberation may influence clinical decision-making is discussed. Next is a consideration of how clinicians’ need to have confidence in their own judgements in order to perform in a manner worthy of trust would be compatible with adherence to the framework supported by public deliberation. It is concluded that fair distribution in the interplay between macro- and micro-level considerations can be secured by legitimising procedures on each level, by ensuring well-organised and continuing public debate and by basing individual clinical judgements upon well-justified and principled normative bases. (shrink)

It is only when mixing two or more pure substances along a reversible path that the entropy of the mixing can be made physically manifest. It is not, in this case, a mere mathematical artifact. This mixing requires a process of successive stages. In any finite number of stages, the external manifestation of the entropy change, as a definite and measurable quantity of heat, isa fully continuous function of the relevant variables. It is only at an infinite and unattainable limit (...) thata non-uniform convergence occurs. And this occurs when considered in terms of the number of stages together with a distinguishability parameter appropriate to the particular device which is used to achieve reversibility. These considerations, which are of technological interest to chemical engineers, resolve a paradox derived in chemical theory called Gibbs'' Paradox. (shrink)

University human research ethics application procedures can be complicated and daunting, especially for international students unfamiliar with the process and the language. We conducted focus groups and interviews with four research higher degree and 21 Master’s coursework international students at an Australian university to gain their views on the human ethics application process. We found the most important influences on their experience were: the time it took to do an application; support from supervisors, peers and others; their own language skills; (...) and their lack of familiarity with research ethics procedures. To improve the experience of international students undertaking research involving human research ethics applications, we recommend universities provide guidance on institutional ethics review processes, concepts and terminology, with translations in a range of languages, together with guidance on how to conduct research ethically within and outside the students’ own countries. We also recommend curricula be developed to further students’ understanding of the importance of ethical research practice, and that these curricula be embedded in undergraduate and postgraduate degree programs and reflected in course learning outcomes. (shrink)