Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

There is a remarkable trend in contemporary environmentalism that emphasizes ‘accepting responsibility’ for the natural world in contrast to outdated preservationist thinking that shirks such responsibility. This approach is often explained and justified by reference to the anthropocene: this fundamentally new epoch—defined by human domination—requires active human intervention to avert planetary catastrophe. However, in this paper, I suggest this rhetoric encourages a flight from history. This often jubilant, sometimes anxious, yearning for unprecedented human innovation and—ultimately—control in our new millennia mirrors (...) the Futurist movement that took off near the beginning of the last century. Despite the significant differences in the details of how academics have defended this twenty-first-century environmental outlook, they all represent the true flight from history; they too quickly jettison the ideas of historical environmentalists and so misunderstand the environmental values at the heart of preservation that are more salient than ever. (shrink)

Childress and coauthors present a case considering ECMO withdrawal over the objection of the conscious patient who is no longer a candidate for transplantation or other definitive therapeutic inter...

What term is most appropriate in describing the limits of medicine? That depends on who determines the limits and the bases on which those limits are delineated and communicated. Schneiderman, Jecker, and Jonsen critique two recent policy statements by critical care providers—Bosslet et al. and Nates et al. —for their rejection of the use of the term futile for treatment. Both statements recommend using the adjective inappropriate for the problematic treatment, rather than futile, based on the lack of consensus of (...) just what constitutes futility. Schneiderman, Jecker, and Jonsen also assert that, despite a lack of consensus about the determination of futility, the definitions they have... (shrink)

In this issue, Raphael Cohen-Almagor reviews some of the terms used in the discussion of bioethical issues at the end of a patient's life; he argues that they are “valueladen” and serve “primarily the physicians, at times at the expense of the patients’ best interest.” Each of the following terms comes under scrutiny: “death with dignity,” “persistent vegetative state,” “futility,” “double effect,” and “brain death.” He argues that these concepts, developed in recent decades, “have generated an unhealthy atmosphere for patients, (...) which might lead to undesirable actions at the end of patients’ lives.” He issues a plea to discontinue the use of the term “persistent vegetative state” because it is dehumanizing, to explain “double effect” and “futility” in detail and with sincerity, and to clarify the motivation for using these terms and others. He warns physicians not to use terminology that is offensive to patients and loved ones or that weakens their patients’ will to live. (shrink)

In this issue, Raphael Cohen-Almagor reviews some of the terms used in the discussion of bioethical issues at the end of a patient's life; he argues that they are “valueladen” and serve “primarily the physicians, at times at the expense of the patients’ best interest.” Each of the following terms comes under scrutiny: “death with dignity,” “persistent vegetative state,” “futility,” “double effect,” and “brain death.” He argues that these concepts, developed in recent decades, “have generated an unhealthy atmosphere for patients, (...) which might lead to undesirable actions at the end of patients’ lives.” He issues a plea to discontinue the use of the term “persistent vegetative state” because it is dehumanizing, to explain “double effect” and “futility” in detail and with sincerity, and to clarify the motivation for using these terms and others. He warns physicians not to use terminology that is offensive to patients and loved ones or that weakens their patients’ will to live. (shrink)

It is now a default obligation to provide cardiopulmonary resuscitation (CPR), in the absence of knowledge of a patient’s or surrogate’s wishes to the contrary. We submit that it is time to reevaluate this position. Attempting CPR should be subject to the same scrutiny demanded of other medical interventions that involve balancing a great benefit against grievous harms.

The Wisconsin Supreme Court, after adopting the doctrine of the objective patient standard, expanded it in bold and innovative ways over nearly four decades, until the Wisconsin legislative and executive branches drastically reversed this course. The saga has implications for other jurisdictions considering adoption or expansion of the objective patient standard doctrine.

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.

From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by patients (...) and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)

This paper is a critical analysis of David Rayfield's attempt to distinguish true from correct descriptions of human actions (Inquiry, Vol. 13 [1970], Nos. 1?2). It is argued that the analysis fails to do the job required of it for two reasons. First, the analysis of true descriptions is circular insofar as it turns on the notion of an ?unbound action?. Secondly, and independent of the charge of circularity, it is shown that the basis upon which Rayfield draws the true?correct (...) distinction leads to certain unacceptable consequences for action theory. (shrink)

This book presents Robert S. Hartman’s formal theory of value and critically examines many other twentieth century value theorists in its light, including A.J. Ayer, Kurt Baier, Brand Blanshard, Paul Edwards, Albert Einstein, William K. Frankena, R.M. Hare, Nicolai Hartmann, Martin Heidegger, G.E. Moore, P.H. Nowell-Smith, Jose Ortega y Gasset, Charles Stevenson, Paul W. Taylor, Stephen E. Toulmin, and J.O. Urmson.

INTRODUCTION Max Scheler's Wesen und Formen der Sympathie, which appeared in 1923, is an essentially altered and extended second edition of a book published ...

This article substantiates the common intuition that it is wrong to contribute to dangerous climate change for no significant reason. To advance this claim, I first propose a basic principle that one has the moral obligation to act in accordance with the weight of moral reasons. I further claim that there are significant moral reasons for individuals not to emit greenhouse gases, as many other climate ethicists have already argued. Then, I assert that there are often no significant moral (or (...) excusing) reasons to emit greenhouse gases. In any such trivial-cost – but not necessarily trivial-impact – cases, the individual then has an obligation to refrain. Finally, I apply the moral weighing principle to everyday situations of emitting and establish two surprisingly substantial implications: the relevance of virtues to the interpersonal assessment of environmentally harmful actions and the extensive individual ethical obligations that exist short of moral purity. (shrink)

In the 1999 Galton Lecture for the annual conference of The Galton Institute, the author summarizes the main elements of Galtongenerals original and largely intuitive ideas, which still inspire mainstream scientific research on intelligence.