In this article, we illuminate the affective phenomenon of loneliness by exploring the question of how it relates to love and other forms of friendship. We reflect in particular on the question of how different forms of loneliness are relevant to human existence. Distinguishing three forms of loneliness, we first introduce two border cases of loneliness: unfelt loneliness in which one’s individuality is denied and one therefore cannot feel lonely; and existential loneliness in which the possibility of intimacy and existential (...) communication are denied and one therefore cannot but feel lonely. We then turn to loneliness that occurs within intimate friendships—even the most intimate ones. In our analysis, we pay attention especially to the role of communication. In order to do so, we repeatedly turn to poetic expressions of loneliness. We argue that loneliness cannot reflect only the absence or partial failure of communication but also the inherent limits of communication. These limits in turn point back to the nature of human existence and love itself. (shrink)

There is growing interest in political phenomenology in the role that affectivity and emotions play in the political realm. Broadly speaking, it has been suggested that political emotions fall into two sub-categories: political emotions of allegiance and political emotions of antagonism. However, what makes an emotion one of allegiance or one of antagonism has yet to be explored. In this chapter, we show how work done on the phenomenology of emotions, the phenomenology of sociality, and critical phenomenology, can inform our (...) understanding of political emotions. Inspired by frameworks from each of these fields respectively, we introduce three ‘levels’ of phenomenological analysis with regards antagonistic political emotions: (i) the antagonistic character of the emotion, (ii) the antagonistic role in group dynamics, and (iii) a critical reflection on the very notion of antagonistic. Through this three-pronged phenomenological analysis we show how we can better understand, and critique, the conceptualisation of political emotions of antagonism and allegiance as well as show that whether an emotion is considered one of allegiance or antagonism depends on what level of analysis is employed. (shrink)

In this article, we investigate the relationship between loneliness and misogyny amongst the online movement of “involuntary celibates” (incels) that has become widely known through several violent attacks. While loneliness plays a prominent role in the incels’ self-descriptions, we lack a comprehensive analysis of their experience of loneliness and its role in their radicalization. Our article offers such an analysis. We analyze how loneliness is felt, described, and implicitly understood by incels, investigate the normative presumptions underlying their experiences, and critically (...) reflect on the political function of their discourse of loneliness. We claim that it is the affective mechanism of ressentiment that transforms loneliness into antagonistic emotions and show how loneliness is exacerbated rather than alleviated through the incel community. Finally, we point to the relevance of our analysis for contemporary philosophical and feminist loneliness studies. (shrink)

In this article, I provide a philosophical analysis of the nature and role of perceived identity threats in the genesis and maintenance of fanaticism. First, I offer a preliminary definition of fanaticism as the social identity-defining devotion to a sacred value that demands universal recognition and is complemented by a hostile antagonism toward people who dissent from one’s group’s values. The fanatic’s hostility toward dissent thereby takes the threefold form of outgroup hostility, ingroup hostility, and self-hostility. Second, I provide a (...) detailed analysis of the fears of fanaticism, arguing that each of the three aforementioned forms of hostile antagonism corresponds to one form of fear or anxiety: the fanatic’s fear of the outgroup, renegade members of the ingroup, and problematic aspects of themselves. In each of these three forms of fear, the fanatic experiences both their sacred values and their individual and social identity as being threatened. Finally, I turn to a fourth form of fear or anxiety connected to fanaticism, namely the fanatic’s anxiety of and flight from the existential condition of uncertainty itself, which, at least in some cases, ground the fanatic’s fearfulness. (shrink)

What kind of affective phenomenon is religious zeal and how does it relate to other affective phenomena, such as moral anger, hatred, and love? In this paper, I argue that religious zeal can be both, and be presented and interpreted as both, a love-like passion and an anger-like emotion. As a passion, religious zeal consists of the loving devotion to a transcendent religious object or idea such as God. It is a relatively enduring attachment that is constitutive of who the (...) zealot is, and it expresses itself in a distinctive set of mental and behavioral dispositions. Most importantly, it motivates uncompromising actions and involves intense, hot, and deep emotions. As an anger-like emotion, religious zeal is an occurrent affective state of mind that is intentionally directed towards a specific object, characteristically a person or group of persons. It condemns the violation of a religious norm that is taken to be of absolute validity and general applicability. It motivates an action aiming at vengeance and retaliation, and it involves intense and hot feelings of hostility towards its object. I argue that rather than reducing the complex phenomenon of religious zeal to one of these two manifestations, we should reflect upon the question of how the two distinct conceptualizations relate to each other. (shrink)

In this article, I provide an analysis of the widespread, intellectually fascinating, and existentially challenging phenomenon of self-reflexive anxiety in which we feel threatened by what or who we are. I focus on those cases in which we take an event or action whose possible occurrence we attribute to ourselves to be expressive or constitutive of our identity. As I argue, depending on the kind of event we are dealing with, our descriptive self-conception, our self-esteem, or our evaluative self-conception are (...) at stake. In all cases, we are confronted with a dialectic between self and other, activity and passivity inherent in our personhood or even in our agency. I demonstrate how my analysis is not only of intrinsic value, but it can also help us in achieving a better understanding of self-reflexive emotions in general and ‘traditional’ self-reflexive emotions like shame in particular. (shrink)

The current rise of populism is often associated with affects. However, the exact relationship between populism and affects is unclear. This article addresses the question of what is distinctive about populist (appeals to) affects. It does so against the backdrop of a Laclauian conception of populism as a political logic that appeals to a morally laden frontier between two homogenous groups, ‘the people’ and ‘those in power’, in order to establish a new hegemonic order. I argue that it is distinctive (...) of populism that it breaks with the dominating feeling rules by overtly appealing to affects and reclaiming them for the realm of the political. The article explores three groups of affective phenomena: discontent, anger, and fear; empathetic, sympathetic, group-based, and shared emotions; and collective passions of enthusiasm and love. It shows how an appeal to these affects relates to the political logic of populism itself by contributing to the concretization, collectivization, and unification of affects. (shrink)

Today, in a Western secular context, the affective phenomenon of religious zeal is often associated, or even identified, with religious intolerance, violence, and fanaticism. Even if the zealots’ devotion remains restricted to their private lives, “we” as Western secularists still suspect them of a lack of reason, rationality, and autonomy. However, closer consideration reveals that religious zeal is an ethically and politically ambiguous phenomenon. In this article, I explore the question of how this ambiguity can be explained. I do so (...) by drawing on Paul Ricœur’s theory of affective fragility and tracing back the ambiguity of religious zeal to a dialectic inherent to human affectivity and existence itself. According to Ricœur, human affectivity is constituted by the two poles of vital and spiritual desires which are mediated by the thymos. As I show, this theory helps us to understand that religious zeal as a spiritual desire is neither plainly good nor plainly bad, but ambiguous. Moreover, it enables us to acknowledge the entanglement of abstraction and concretion that is inherent to the phenomenon of religious zeal. Finally, this theory helps us to understand why religious zeal, as one possible expression of the human quest for the infinite, is both a promise and a threat. In conclusion, human existence is tragic not in that we necessarily fail, but in that no matter which path we take with regard to our spiritual desires—that of affirmation, rejection, or moderation—we are and remain fallible. (shrink)

How does it feel to be in a crisis? Is the idea of the crisis itself bound to our affectivity in the sense that without the occurrence of specific emotions or a change in our affective lives at large we cannot even talk about a crisis properly speaking? In this paper, I explore these questions by analyzing the exemplary case of the corona crisis. In order to do so, I first explore the affective phenomenology of crises in general and the (...) corona crisis in particular, thereby paying attention to both individual (personal) and collective (socio-political) crises and crisis experiences. Then, I turn to the limits of the analogy between individual and collective crises. I reflect on how socio-political crises are not simply there but performed and procedurally constructed and show how, in the context of the corona pandemic, fears and hopes, feelings of solidarity and antagonistic emotions mirror political interests and values. While the phenomenological reflections in the first part help us to account for the fact that crises are not just objective facts but also subjective forms of experience, the political reflections in the second part help us to do justice to the inherently political nature of the language and experiences of (collective) crises. I conclude by pointing out a twofold relationship between (socio-political) crisis and critique. Thanks to their characteristic affective phenomenology, crises are tools of criticism; but due to their inherently political character, they also themselves have to be subjected to critique. (shrink)

What is the feeling of religious longing and how, if at all, can religious longing justify religious beliefs? Starting with an analogy between religious longing and basic physical needs and an analogy between religious longing and musical longing, I argue that the feeling of religious longing is characterized by four features: its generality, its indeterminate transcendent object which by its nature is not capable of empirical verification or falsification, its mode of being infinitely interested in passion and its ambiguity with (...) regard to our own power and powerlessness. Religious longing can neither epistemically nor pragmatically justify religious beliefs. If we want to account for the rationality of religious beliefs motivated by religious longing, we have to consider passionate rationality as a third kind of rationality. We wholeheartedly take as true what we experience as a condition of the possibility of life. (shrink)

There is a need for inner recollection opposed to our everyday distraction. Our distraction is partly based on anthropological features and partly on social and cultural features. As well as feelings of distraction, we know experiences of being focussed from everyday life. As feelings in which distraction is absent, and as feelings in which we are partly and temporarily released from our own egocentric perspective, they remind us that a different kind of relation to ourselves and the world is possible. (...) Therefore, they can motivate a process of self-transformation aiming at a mystical state of mind, which is of a more profound and enduring kind than ordinary experiences of being focussed. The mystical state of mind is a state in which we transcend ourselves in the face of the universe and thereby relativize our own affective involvement. It is a feeling of an all-encompassing unity which ultimately concerns us; and it is a feeling of love, joy, and peace of mind. Mystical feelings thus shape and restrict spaces of possibilities, and they comprise an altered sense of what it means to be real. Therefore, they can be classified as existential feelings. Still, the mystical state of mind differs from prototypical existential feelings because it is a positive feeling, necessarily comprises active as well as passive moments, and presupposes an explicit way of attending to the world as world. (shrink)

Was ist Angst? Was sagt die Tatsache, dass wir bestimmte Ängste empfinden, über unser Selbstverständnis als Personen aus? Das Buch bietet eine differenzierte philosophische Analyse des Gefühls der Angst, die Einsichten der zeitgenössischen Debatte ebenso aufgreift wie Gedanken der existenzphilosophischen Tradition. Im Zentrum stehen die ebenso alltäglichen wie faszinierenden Phänomene selbstreflexiver und stimmungsmäßiger Angst. In Sprache und Stil ist das Buch analytisch, in Inhalt und Geist jedoch existenziell. Es versteht sich selbst als Übung in philosophischer Freiheit, in der es wesentlich (...) auch darum geht, Klarheit über das jeweils eigene Philosophieverständnis zu erlangen. (shrink)

Recent studies have suggested that while both adults and children hold past-future hedonic preferences – preferring painful experiences to be in the past and pleasurable experiences to lie in the future – these preferences are abandoned when the quantity of pain or pleasure under consideration is greater in the past than in the future. We examined whether such preferences might be affected by the utility people assign to experiential memories, since the recollection of events can itself be pleasurable or aversive, (...) and we examined the developmental trajectory of the value that people assign to experiential memories of past painful experiences. Using a task in which we manipulated hypothetical memory loss in a series of brief vignettes, we found that for some adults, but not for children, the disutility attached to the recollection of painful past events outweighed the disutility of living through future painful events. Between middle childhood and adulthood, experiential memory appears to assume a more important role in determining the value that people assign to past experiences and in mitigating bias toward the future. (shrink)

Among the most persuasive arguments against hate speech bans was made by Ronald Dworkin, who warned of the threat to political legitimacy posed by laws that deny those subject to them adequ...

In February 2020, the British Medical Association will be surveying members for their views on what the BMA’s position on physician-assisted dying should be. The BMA is currently opposed to physician-assisted dying in all its forms, a position that was agreed in 2006 at the annual representative meeting, the Association’s policy-making conference.1 As previously reported in Ethics briefing,2 the decision to survey members follows a motion passed at last year’s ARM which called on the BMA to “carry out a poll (...) of members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results from the survey will not determine BMA policy. Rather, the results be published ahead of this year’s ARM and provided to those attending to inform a debate and discussion on the BMA’s policy position. More information about the survey, including a briefing pack of useful information, and information for BMA members on how to participate can be found online at www.bma.org.uk/PAD. ### High Court rejects Judicial reviews on assisted suicide The High Court has refused permission for two separate challenges to the law on assisted suicide in the UK to proceed to a full hearing. In the first case, Phil Newby, who has motor neuron disease, applied for judicial review of the law on assisted suicide and asked for the court to carry out a detailed examination of what he termed “legislative facts” – that is, an examination of the existing evidence on the “costs, risks and benefits” of regulating assisted suicide – including a cross-examination of relevant expert witnesses.1 Handing down the judgement, Lord Justice Irwin and Mrs Justice May, held that assisted dying …. (shrink)

Healthcare professionals are currently working under extreme pressure as they respond to the pandemic outbreak of COVID-19. At the time of writing, there is currently no effective vaccine or anti-viral treatment. The pandemic is fast-moving, relatively unpredictable and of uncertain duration. In many countries, it is placing an enormous stress on healthcare resources and providing care to existing standards is proving difficult. Unfortunately, in some countries, health services have been overwhelmed. The impact of the pandemic on resource-poor countries is of (...) particular concern. This extraordinary situation is raising, or has the potential to raise, many ethical challenges for doctors delivering care to patients. It is possible, for example, that there may be points in this pandemic where decisions need to be made about who should have access to finite specialised intensive care beds, drugs and equipment. This has happened in some countries and, despite efforts by the UK Government to reduce demand and increase supply, it is still possible that this could happen in the UK. Some hospital trusts in the UK are already reporting concerningly low supplies of oxygen and vital medicines such as propofol and alfentanil.1 In these circumstances, where not everyone can be treated, difficult ethical decisions will have to made. For example, can some patients be prioritised over others? How should a doctor decide on which patients to treat? Can treatment be withdrawn from patients who are currently being treated, but are not responding, in order to offer treatment to those who may have a better chance of benefiting? The UK is also reporting concerningly low supplies of vital personal protective equipment for frontline workers, raising the question - what are a doctor’s obligations to treat patients, in circumstances that present a high …. (shrink)

Previous Ethics briefings have charted the unprecedented developments in relation to the law on abortion in Northern Ireland this year,1 resulting in legislation being passed by the UK government that ‘decriminalised’ abortion in Northern Ireland, up to the point at which a fetus ‘is capable of being born alive’, from 22 October 2019. A new legal framework and supporting guidelines on abortion are now set to be introduced by 31 March 2020—which should reflect the recommendations in the 2018 United Nations’ (...) Committee on the Elimination of Discrimination against Women report on abortion in Northern Ireland.2 ### Interim guidance In anticipation of this period between decriminalisation and the introduction of a new legal framework, on 7 October 2019 the UK government’s Northern Ireland Office published interim factual guidance for healthcare professionals on their responsibilities to patients in light of these changes.3 Among other things, the guidance notes that there are no plans for additional services to be routinely available in Northern Ireland before 31 March 2020. There will, however, be fewer restrictions on which women in Northern Ireland can access funded abortion services in England via the Central Booking Service—doctors should direct women to this service.4 If healthcare professionals do offer additional abortion services in Northern Ireland itself ‘they should do so in line with their professional competence and guidance from their professional body’. The guidance recognises that some women may still purchase drugs that cause abortions online during this interim period. The difference now is that should a woman require medical assistance as a result, there is no obligation on healthcare professionals to report the woman to the police as abortion, in these circumstances, is not a crime. Previously, under section 5 of the Criminal Law Act 1967 a legal duty, unique to Northern Ireland, was placed …. (shrink)

### British Medical association survey on physician-assisted dying closes Previous Ethics briefings have highlighted the survey of members on physician-assisted dying being carried out by the British Medical Association.1 This survey closed at midnight on Thursday 27 February. In total, 29 011 members responded – 20.1% of all members who received an invitation to participate – making this one of the largest surveys of medical opinion carried out on this issue, ever. The results of the survey will not make BMA (...) policy, but will inform a debate and discussion at the organisation’s main policy-making conference, the annual representative meeting in June this year. You can find out more about the survey and how it was carried out at www.bma.org.uk/PAD This page will continue to be updated when more information about the survey results is available. ### Royal College of General Practitioners remains opposed to a change in the law on assisted dying In October 2019, the Royal College of General Practitioners began surveying its members on the College’s position on physician-assisted dying. The College published its results on 21 February. Of the 49 539 members invited to participated, 6674 responded – a response rate of 13.47%.2 In response to a question about what the College’s position on the law on assisted dying should be: Following the results of the survey, the RCGP Council decided that the College should continue to oppose a change in the law on assisted dying. ### Belgian doctors acquitted in country’s first criminal euthanasia case As noted in previous Ethics briefings, three Belgian doctors faced criminal charges of “unlawfully poisoning” a …. (shrink)

In April, the UK House of Commons Science and Technology committee published a report evaluating the readiness of the National Health Service to incorporate genomic testing into mainstream service provision.1 The committee also examined some of the research and regulatory considerations in relation to the ongoing development of genome editing. ### Genomics in the NHS The main focus of the report is the 100,000 Genomes Project and the various practical and ethical challenges associated with the planned roll-out of the Genomics (...) Medicine Service in the NHS. The 1 00 000 Genomes Project was launched in 2012 and is the first large-scale whole genome sequencing research study of its kind in the world. The overall objective is to sequence genomes from NHS patients with a rare disease and their families, and from patients with specific cancers. The study seeks to benefit patients by potentially providing a diagnosis, gain new scientific insights, increase public knowledge of genomic medicine, encourage investment, and accelerate the uptake of genomic medicine in the NHS. At the time of writing the project had sequenced over 55 000 genomes and it is expected that the full 1 00 000 will be completed by the end of 2018. Building on the success of the project NHS England announced the establishment of a national NHS Genomic Medicine Service to provide ‘comprehensive and equitable access to the latest in genomic testing and management for the whole country, regardless of condition and where people live.’2 The service is set to be operational this year. The committee acknowledged the range of potential benefits that whole genome sequencing could have for patient care, however it also highlighted that there was a currently a lack of ‘sufficiently unambiguous evidence’ for its …. (shrink)

The Supreme Court has ruled in the case of Y that there is no requirement to seek the approval of the Court of Protection in decisions to withdraw clinically assisted nutrition and hydration from patients in a prolonged disorder of consciousness.1 Mr Y was 52-year-old man who suffered a cardiac arrest after a myocardial infarction as a result of coronary artery disease. It was not possible to resuscitate him for well over 10 min, resulting in severe cerebral hypoxia which caused (...) extensive brain damage. Mr Y’s family and the NHS Trust treating him agreed that Mr Y would not want to be kept alive through the provision of CANH given his poor prognosis. They sought a declaration that it was not mandatory for applications of withdrawal of CANH to come before the court, which was granted by Mrs Justice O’Farrell in the first instance.2 Permission was granted for the appeal to ‘leapfrog’ the Court of Appeal and to proceed to the Supreme Court for consideration. In the interim, Mr Y died after contracting acute respiratory sepsis, but the Supreme Court determined that the appeal should go ahead in light of the general importance of the issues raised. In delivering the opinion of the Supreme Court on 30 July 2018, Lady Justice Black rejected the historical distinction that had been drawn between patients in PDOC and non-PDOC patients, in a way that had justified judicial involvement for patients in PDOC but not for others.3 She was clear that the correct approach to all cases involving CANH was to make a decision based on what was in the best interests of the patient. She further outlined that: > The documentation supplied to us shows that the difficulty that there is in assessing the patient and in …. (shrink)

The British Medical Association has published a new report on health and human rights in immigration detention in the UK. Locked up, locked out outlines how aspects of current detention policies and practices are detrimental to the health of those detained and the challenges doctors face in providing healthcare in the immigration detention setting. It makes a number of recommendations aimed at addressing policy and practice which impact on health and well-being, including calling for an end to the routine use (...) of detention as a means of monitoring those facing removal from the UK and for the introduction of a time limit on the length of time individuals can be detained. It also provides guidance for doctors working in these settings on some of the common ethical and professional dilemmas they may face. The report can be accessed and downloaded at www.bma.org.uk/immigrationdetention. The Government has announced its intention to review mental health legislation for England and, in relation to non-devolved issues, for Wales.1 The Government states that it is ‘committed to delivering parity of esteem between mental and physical health’, although it does not clarify the meaning of ‘parity of esteem’. Similarly, the Government states that it wants to ensure that people with mental health problems ‘are treated with dignity, and that their liberty and autonomy is respected as far as possible’. Again, the Government has not indicated the meaning of ‘as far as possible’. Although not directly mentioned in the review’s terms of reference, it must be set against the background of changing legal and ethical expectations in relation to the rights of those with mental or cognitive disorders and disabilities. The UK is a signatory to the United Nations Convention on the Rights of People with …. (shrink)

Erdoğan intensifies assault on Turkish civil society Deeply worrying reports from the Turkish Medical Association suggest that the Turkish President Recep Erdoğan is hardening his attack on civil society in Turkey, using the legitimate activities of the TTB as the flimsiest of pretexts. In January 2018, the TTB issued a short statement raising concerns about the impact on public health of Turkey’s military operation in the Kurdish-controlled region of northern Syria. It denounced the operation saying ‘No to war, peace immediately’. (...) In response to the Association’s press release, the Turkish president publicly accused the 83 000 strong TTB of being terrorist sympathisers. ‘This institution has nothing to do with Turkishness and nothing about them is worthy of the notion of Turkishness’, he said. 1 Eleven of its senior doctors, including the Association’s chairman, were later detained following an order from a Turkish prosecutor. President Erdoğan made it... (shrink)

In February 2014, the Belgian Parliament passed legislation allowing euthanasia for terminally ill children of all ages by 86 votes to 44, with 12 abstentions. The Bill became law in early March after being signed by the King, making Belgium the first country in the world to abolish age restrictions for euthanasia. Previously, the youngest age at which euthanasia was permitted was 12 years old in The Netherlands.1Euthanasia was legalised in Belgium in 2002, and the new legislation introduces amendments to (...) the law extending euthanasia to minors in certain circumstances. Euthanasia is now permissible for children of all ages where the child has a “terminal and incurable illness”, experiences “constant and unbearable physical suffering”, and death is expected to occur within a “brief period”. The child must be deemed capable of making the decision, and have the agreement of their parents.Belgian law sets no timetable for euthanasia from the point at which the patient first expresses a wish to die. As with adults seeking euthanasia, any request must be made in writing. A physician and “outsider” brought in to give a second opinion must agree upon the diagnosis and prognosis, and a paediatric psychiatrist or psychologist must certify in writing that the child possesses “the capacity of discernment”. Following this, the child's physician must meet with the parents to inform them of the outcome of the consultation and ensure they are in agreement with the child's request. The child and the family must receive psychological care and support if so desired.The move provoked heated debate and divided the medical, legal and political professions in Belgium. A group of 160 of the country's paediatricians opposed a change in the law, citing concerns about the largely subjective assessment of the “capacity of discernment”, and drawing attention to advances in …. (shrink)

Doctors and medical students in the UK have voted in support of the decriminalisation of abortion for women who self-administer abortions and healthcare professionals who provide abortions within the context of their clinical practice. Abortion should be treated as a medical issue rather than a criminal one. ### Background to the vote The vote took place at the end of June during the British Medical Association’s Annual Representative Meeting, where representatives of doctors and medical students from across the British Isles (...) gathered to set BMA policy through democratic procedures. Representatives considered the issue of decriminalisation during a 2-hour debate, where diverse and opposing viewpoints were heard. The debate was informed by a neutral discussion paper that was published by the BMA in February, which provided a guide to some of the key legal and ethical issues raised by the debate around decriminalisation.1 The BMA’s new policy only relates to whether abortion should or should not be a criminal offence; the policy does not address the broader issue of when and how abortion should be available. The BMA has established policy on these issues which remains unchanged.2 ### The law on abortion Induced abortion is currently a crime throughout the British Isles. There are, however, a range of exceptions to the crime laid out in statute and/or common law, for example, in England, Scotland and Wales, under the Abortion Act 1967. Any healthcare professionals operating within those defined exceptions, which include grounds for authorising an abortion and procedural requirements, can lawfully carry out an abortion as a clinical procedure. Outside these defined exceptions, the criminal offences potentially apply both to those who participate in carrying out abortions for others, including doctors, nurses and midwives, and to women who carry out abortions on themselves. For example, healthcare professionals who do not follow procedural requirements can attract criminal sanctions …. (shrink)

Essex University, in association with Johns Hopkins Center for Public Health and Human Rights, has brought out a timely report highlighting the increasing global criminalisation of the provision of healthcare.1 The report, with a foreword by Professor Dainius Puras, United Nations Special Rapporteur on the right to health, explores the pressures on medical impartiality arising in large part from both global and national responses to the threat of terrorism. Both international humanitarian law, human rights law and long-established principles of medical (...) ethics—as set out in various declarations of the World Medical Association—establish an absolute principle that all people, regardless of their beliefs, affiliation or status, have rights of access to appropriate healthcare. And this right extends to wounded and sick combatants, as well as civilians, during times of armed conflict. One of the challenges in this area is that in recent years, many conflicts have become ‘asymmetric’. Contemporary conflicts seldom involve opposing state armies. Instead, they increasingly involve irregular combatants, often labelled ‘terrorists’ or ‘insurgents’ by the states they are opposing. In response to these threats, many states have developed sometimes draconian legislation outlawing terrorist groups and those offering support. The danger, outlined in some detail in the report, is that the vital distinction between the impartial provision of medical care and the criminal offence of materially aiding terrorism is lost. In 2016, largely in response to the deliberate targeting of healthcare personnel and facilities in the conflicts disfiguring the greater Middle …. (shrink)

In February 2014, the Belgian Parliament passed legislation allowing euthanasia for terminally ill children of all ages by 86 votes to 44, with 12 abstentions. The Bill became law in early March after being signed by the King, making Belgium the first country in the world to abolish age restrictions for euthanasia. Previously, the youngest age at which euthanasia was permitted was 12 years old in The Netherlands.1Euthanasia was legalised in Belgium in 2002, and the new legislation introduces amendments to (...) the law extending euthanasia to minors in certain circumstances. Euthanasia is now permissible for children of all ages where the child has a “terminal and incurable illness”, experiences “constant and unbearable physical suffering”, and death is expected to occur within a “brief period”. The child must be deemed capable of making the decision, and have the agreement of their parents.Belgian law sets no timetable for euthanasia from the point at which the patient first expresses a wish to die. As with adults seeking euthanasia, any request must be made in writing. A physician and “outsider” brought in to give a second opinion must agree upon the diagnosis and prognosis, and a paediatric psychiatrist or psychologist must certify in writing that the child possesses “the capacity of discernment”. Following this, the child's physician must meet with the parents to inform them of the outcome of the consultation and ensure they are in agreement with the child's request. The child and the family must receive psychological care and support if so desired.The move provoked heated debate and divided the medical, legal and political professions in Belgium. A group of 160 of the country's paediatricians opposed a change in the law, citing concerns about the largely subjective assessment of the “capacity of discernment”, and drawing attention to advances in …. (shrink)

In April 2014, the European Parliament agreed the final text on a new EU Clinical Trials Regulation.1 The Regulation replaces the EU Clinical Trials Directive, which has long been criticised by various stakeholders for creating unnecessary bureaucracy and blamed, at least in part, for increased costs, time delays and a drop in clinical trial applications. The new Regulation seeks to remedy the faults of the previous legislation and make the EU an attractive place to conduct clinical trials.The Regulation aims to (...) streamline and harmonise the administrative procedures for clinical trial approvals but without compromising the safety of participants. A particular focus is placed on the importance of enabling trials in multiple or all member states, recognising that there is an increasing need to target ever more specific patient populations and the challenge this represents in recruiting sufficient numbers of participants to research studies. A new, two-part application process, designed to avoid the multiple submission of identical data is therefore to be introduced. Member states cooperate on certain aspects of trial approval but issues which are subject to specific national regulations will continue to be approved by individual countries. All applications will be submitted through a new EU portal, which will be set up and managed by the European Medicines Agency. The new process also takes a risk-based approach to some types of research study. Trials to test medicinal products that already have a marketing authorisation are classed as ‘low intervention trials’ and are subject to less stringent requirements.The ethical safeguards in the new Regulation remain similar to those in the 2001 Directive. A positive appraisal from a research ethics committee remains a prerequisite for a trial to be approved. Member …. (shrink)

### Royal College of Physicians adopts neutral position on assisted dying In March 2019, the RCP announced that it would adopt a neutral position on assisted dying, following a survey of its UK fellows and members.1 The College had previously polled members and fellows on what the RCP position should be in 2014, at that time 44.4% of respondents thought the RCP should be opposed to assisted dying; 31% thought it should be neutral or have no position; and 24.6% thought (...) it should be in favour. On the basis of these figures, the College reaffirmed its position opposing assisted dying.2 In announcing the 2019 survey, the College’s Council resolved that they would require a ‘supermajority’ of 60% to adopt a position either supporting or opposing a change in the law; if no such majority was received, the College would move to a position of neutrality. This approach was not without controversy, and a legal challenge to the Council’s decision is pending.3 In response to the question of what the RCP’s position should be, 43.4% thought the RCP should be opposed; 31.6% thought the RCP should be supportive; and 25% thought the RCP should adopt a neutral position. Without a supermajority of 60% either way, the College’s position became one of neutrality.1 ### New Jersey legalises assisted suicide for the terminally ill New Jersey has become the ninth jurisdiction in the USA to legalise physician-assisted suicide after legislation was passed by the State senate in April 2019.4 The Medical Aid in Dying for the Terminally Ill Act will permit terminally ill adults, with 6 months or less to live, to request physician assistance in ending their life. Two doctors must confirm the patient’s diagnosis, prognosis, decision-making capacity and the voluntariness of their request, and if satisfied, can prescribe lethal medication, which the patient must self-administer. …. (shrink)

Re AA and Re P : the ‘forced caesarean’ caseOn 30 November 2013 The Telegraph reported that Essex County Council Social Services had obtained a High Court Order against a woman that allowed her to be forcibly sedated and her child removed by caesarean section and taken into care.1 The original story reported that the woman, an Italian national who had been in the UK on a short-term basis for work, had experienced ‘something of a panic attack’ and, after calling (...) the police, was compulsorily detained under the Mental Health Act 1983. Five weeks later, the report said, she was restrained, forcibly sedated and awoke hours later to find that, pursuant to a court order obtained by Essex County Council Social Services, her baby had been removed by caesarean section and taken into care by social workers.The story was subsequently reported in a number of other media outlets and prompted such widespread outrage that the presiding judge, Mr Justice Mostyn, took the unprecedented step of releasing both the judgement of the initial application to the Court of Protection and the verbatim transcript of proceedings. It became apparent that the facts of the case had been drastically misreported by the media and that coverage had conflated two very separate issues: the medical procedure of the caesarean section and the taking of the child into local authority care.The initial case heard in the Court of Protection on 23 August 2012, Re AA,2 was the result of an application made not by the local authority or social workers seeking to remove the child but by Mid-Essex National Health Service Trust seeking a declaration and an order, on the basis of medical evidence, that the patient lacked capacity and that it would be in her best interests to undergo a caesarean section. Mr Justice Mostyn found in …. (shrink)

Aim: Streamlining consent for low-risk comparative effectiveness research (CER) could facilitate research, while safeguarding patients' rights. Materials & methods: 2618 adults were randomized to one of seven consent approaches (six streamlined and one traditional) for a hypothetical, low-risk CER study. A survey measured understanding, voluntariness, and feelings of respect. Results: Participants in all arms had a high understanding of the trial and positive attitudes toward the consent interaction. Highest satisfaction was with a streamlined approach showing a video before the medical (...) appointment. Participants in streamlined were more likely to mistakenly think a signature was required. Conclusion: Streamlined consent was no less acceptable than traditional, signed consent. Streamlined and traditional approaches achieved similar levels of understanding, voluntariness and a feeling that the doctor–patient interaction was respectful. (shrink)

Music can reduce stress and anxiety, enhance positive mood, and facilitate social bonding. However, little is known about the role of music and related personal or cultural variables in maintaining wellbeing during times of stress and social isolation as imposed by the COVID-19 crisis. In an online questionnaire, administered in 11 countries, participants rated the relevance of wellbeing goals during the pandemic, and the effectiveness of different activities in obtaining these goals. Music was found to be the most effective activity (...) for three out of five wellbeing goals: enjoyment, venting negative emotions, and self-connection. For diversion, music was equally good as entertainment, while it was second best to create a sense of togetherness, after socialization. This result was evident across different countries and gender, with minor effects of age on specific goals, and a clear effect of the importance of music in people's lives. Cultural effects were generally small and surfaced mainly in the use of music to obtain a sense of togetherness. Interestingly, culture moderated the use of negatively valenced and nostalgic music for those higher in distress. (shrink)