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

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

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

I introduce a new version of Moral Error Theory, which I call Type-B Moral Error Theory. According to a Type-B theorist there are no facts of the kind required for there to be morality in stricto sensu, but there can be irreducible ‘normative’ properties which she deems, strictly speaking, to be morally irrelevant. She accepts that there are instrumental all things considered oughts, and categorical pro tanto oughts, but denies that there are categorical all things considered oughts on pain of (...) requiring ‘queer’ facts to obtain. I detail the most central motivation of this version of the theory against its more traditional rival, according to which there are no irreducible normative properties at all. The motivation is that it, unlike its rival, can successfully be defended against the notorious charge of self-defeat. (shrink)

If intense pain is “world-destroying,” as Elaine Scarry has argued, one of the ways nurses respond to that loss is by re-enacting the commonplace—both in practice and in writing—through daily, accumulating acts of care. Such care poses a critique of medicine’s emphasis on the exceptional moment and stresses forms of physical tending that are quotidian rather than heroic, ongoing rather than permanent or conclusive. I develop this view of care through the writings of nurses like Walt Whitman, Louisa May Alcott, (...) Cortney Davis and Joyce Renwick. (shrink)

I introduce a new version of Moral Error Theory, which I call Type-B Moral Error Theory. According to a Type-B theorist there are no facts of the kind required for there to be morality instricto sensu, but there can be irreducible ‘normative’ properties which she deems, strictly speaking, to be morally irrelevant. She accepts that there areinstrumentalall things considered oughts, andcategoricalpro tanto oughts (both of which she deems morally irrelevant), but denies that there arecategoricalall things considered oughts on pain of (...) requiring ‘queer’ facts to obtain. I detail the most central motivation of this version of the theory against its more traditional rival, according to which there are no irreducible normative properties at all. The motivation is that it, unlike its rival, can successfully be defended against the notorious charge of self-defeat. (shrink)

Here I discuss some theistic responses to the problem of animal pain and suffering with special attention to Michael Murray’s presentation in Nature Red in Tooth and Claw. The neo-Cartesian defenses he describes are reviewed, along with the appeal to nomic regularity and Murray’s emphasis on the progression of the universe from chaos to order. It is argued that despite these efforts to prove otherwise the problem of animal suffering remains a serious threat to the belief that an all-powerful, all-knowing, (...) and all-good creator exists. (shrink)

Self-Hypnosis: The Complete Manual for Health and Self-Change, 2nd ed offers a step-by step guide to using hypnosis to better well-being and stronger self-control. For over two decades renowned therapist and author Brian Alman showed thousands of individuals how to use self-inductive techniques for relief from pain, stress, and discomfort. Self-hypnosis assists in meditation and fosters positive self-regard. The exercises in Self-Hypnosis are clear, concise and easily attainable. As an effective therapy in alleviating the pain of childbirth, medical and dental (...) surgery, burns, and accidental injuries, hypnosis is practiced widely. Hypnosis in pain relief is a noninvasive and natural healing process. Self-Hypnosis makes this healing technique available to the lay reader. (shrink)

Thomas Paine often declared himself a citizen of the world. This Norton Critical Edition presents Paine and his writing within the transatlantic and global context of the revolutionary ideas and actions of his time. Thomas Paine's loyalties were with universal and self-evident principles rather than with a particular group or nation, and it is this dimension that informed his most important works. This Norton Critical Edition shows how Paine's fury at the British Empire, including its injustices (...) to South Asians and Africans, shaped his first best seller, Common Sense, and how his direct involvement with the French Revolution pushed his ideas toward a unique form of democratic radicalism. Together with his rejection of organized religion, Paine's radicalism resulted in his being one of the most hated men in both monarchial Britain and republican America. This volume includes J. M. Opal's introduction, "Thomas Paine and the Revolutionary Enlightenment, 1770s-90s," which provides essential biographical and historical details across three tumultuous decades. Paine's most important works-from Common Sense (1776) through Agrarian Justice (1796)-are reprinted and are accompanied by explanatory annotations. Supporting materials include a wide range of documents from the turbulent years following the publication of both Common Sense and the Declaration of Independence. These include Pennsylvania's gradual emancipation statute of the 1780s, an ex-slave's impassioned call for revolutionary violence against European imperialists and masters, and a British conservative's witty rejoinder to Paine's vision of a brave new world. Four major interpretations of Paine's work are provided by Nathan R. Perl-Rosenthal, Robert A. Ferguson, Gary Kates, and Gregory Claeys. A Selected Bibliography is also included. (shrink)

Pain management has improved in the past few decades. Opioid analgesics have become the mainstay in the treatment of cancer pain whilst inter-disciplinary pain management programmes are the generally accepted approach to chronic pain of non-malignant origin. Recently some pain specialists have advocated the use of opioids in the long-term management of non-cancer pain. This has raised some fundamental questions about the purpose of pain management. Is it best to opt for maximum pain relief and comfort, or should one emphasise (...) function and activity as higher priorities? Will the use of opioids create more autonomy for pain sufferers or will this add handicaps to lives which are already limited? Until more clinical outcome data are available we advocate caution in the use of opioid analgesia. Such caution can, and does, raise questions about the rights of the patient and the rights of the prescriber in a context where the facts do not point to a clear course of action. (shrink)

Thomas Paine is a legendary Anglo-American political icon: a passionate, plain-speaking, relentlessly controversial, revolutionary campaigner, whose writings captured the zeitgeist of the two most significant political events of the eighteenth century, the American and French Revolutions. Though widely acknowledged by historians as one of the most important and influential pamphleteers, rhetoricians, polemicists and political actors of his age, the philosophical content of his writing has nevertheless been almost entirely ignored. This book takes Paine's political philosophy seriously. It explores (...) his views concerning a number of perennial issues in modern political thought including the grounds for, and limits to, political obligation; the nature of representative democracy; the justification for private property ownership; international relations; and the relationship between secular liberalism and religion. It shows that Paine offers a historically and philosophically distinct account of liberalism and a theory of human rights that is a progenitor of our own. (shrink)

Aristotle does not explain why ordinary citizens who lack the virtue of justice nevertheless praise justice and the law. Indignation, defined as pain at the undeserved gains of others, is a promising candidate in the list of means regarding virtues and passions in Book 2 of the Nicomachean Ethics. However, as many scholars have noted, Aristotle’s description of indignation as a mean is flawed. Moreover, indignation is the only characteristic in the list that disappears from the inquiry thereafter. I argue (...) that Aristotle obliquely criticizes indignation for aligning envy, a base passion, with conventional justice. Aristotle’s subtle critique reveals that envy motivates ‘the many’ to support justice, an unsavory conclusion which he does not highlight. (shrink)

It’s a familiar fact that there is something it is like to see red, eat chocolate or feel pain. More recently philosophers have insisted that in addition to this objectual phenomenology there is something it is like for me to eat chocolate, and this for-me-ness is no less there than the chocolatishness. Recognizing this subjective feature of consciousness helps shape certain theories of consciousness, introspection and the self. Though it does this heavy philosophical work, and it is supposed to be (...) relatively obvious to anyone who introspects, it is rather difficult to see just what this phenomenal me-ness is supposed to be; indeed, many philosophers deny it exists. In this paper we try to provide a clear sense of what phenomenal me-ness involves, and then then consider some arguments for the existence of phenomenal me-ness experience as well as some accounts of what gives rise to it. In the end, we argue that the plausible senses of me-ness are a good deal thinner than what often seems to be claimed. (shrink)

How important is luck in economic success? No question more reliably divides conservatives from liberals. As conservatives correctly observe, people who amass great fortunes are almost always talented and hardworking. But liberals are also correct to note that countless others have those same qualities yet never earn much. In recent years, social scientists have discovered that chance plays a much larger role in important life outcomes than most people imagine. In Success and Luck, bestselling author and New York Times economics (...) columnist Robert Frank explores the surprising implications of those findings to show why the rich underestimate the importance of luck in success--and why that hurts everyone, even the wealthy. Frank describes how, in a world increasingly dominated by winner-take-all markets, chance opportunities and trivial initial advantages often translate into much larger ones--and enormous income differences--over time; how false beliefs about luck persist, despite compelling evidence against them; and how myths about personal success and luck shape individual and political choices in harmful ways. But, Frank argues, we could decrease the inequality driven by sheer luck by adopting simple, unintrusive policies that would free up trillions of dollars each year--more than enough to fix our crumbling infrastructure, expand healthcare coverage, fight global warming, and reduce poverty, all without requiring painful sacrifices from anyone. If this sounds implausible, you'll be surprised to discover that the solution requires only a few, uncontroversial steps. Compellingly readable, Success and Luck shows how a more accurate understanding of the role of chance in life could lead to better, richer, and fairer economies and societies. (shrink)

Every pharmacist, aware or not, is constantly making ethical choices. Sometimes these choices are dramatic, life-and-death decisions, but often they will be more subtle, less conspicuous choices that are nonetheless important. Assisted suicide, conscientious refusal, pain management, equitable and efficacious distribution of drug resources within institutions and managed care plans, confidentiality, and alternative and non-traditional therapies are among the issues that are of unique concern to pharmacists. One way of seeing the implications of such issues and the moral choices they (...) pose is to look at the experiences of practitioners and the kinds of choices they have had to make in situations typically faced by pharmacists. This book is a collection of those situations based on the real experiences of practicing pharmacists. The use of case studies in health care ethics is not new, but in pharmacy it is. This text is an important teaching tool that will help pharmacy students and pharmacists address the increasing number of ethical problems arising in their profession. It is not merely a compilation of cases, but rather is organized for the systematic study of applied ethics. Part I shows how to distinguish ethical problems from other kinds of evaluative judgments and examines the sources of values in pharmacy, posing basic questions about the meaning and justification of ethical claims. Part II explores the basic principles of ethics as they have an impact on pharmacy. Specific cases from clinical settings present in a systematic way the various questions raised by each of the major ethical principles -- benefiting the patient, distributing resources justly, respecting autonomy, dealing honestly with patients, keeping promises of confidentiality, and avoiding harm. Part II examines some of the special problems of contemporary pharmacy such as the linkages between pharmaceutical care and professional practice, human experimentation, reproductive issues, genetic technology, death and dying, and mental health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:26. IN DEFENSE OF SECTION V: A REPLY TO PROFESSOR YOLTON Professor Yolton's article is especially valuable for its opening paragraphs on the writing done in the eighteenth century on the physiological basis of cognition. These provide a much-needed background to Hume's own remarks on the nature of perceptions.. It is both correct and helpful, I think, to understand any philosopher as a man of his own century. Professor (...) Yolton offers this article, in part at least, to differ with my interpretation given in "The Location, Extension, Shape, and Size of Hume's Perceptions." It seems to me, however, that this opening part of his article serves instead to lend support to mine. I have not said, by the way, that Hume believes that ideas are "brain impressions," since Hume has not used that phrase himself. Instead, I have merely provided evidence that Hume believes some perceptions have location, extension, shape and size; and I have pointed out an inconsistency that arises in this connection. Professor Yolton warns against taking Hume to intend, in saying that an idea represents its impression, that the idea is an image of the impression. I find, however, that Hume does assert that ideas are images: Those perceptions, which enter with most force and violence, we may name impressions.... By ideas I mean the faint images of these in thinking and reasoning.... (Tl) Again, in explaining memory: For what is the memory but a faculty, by which we raise up the images of paet perceptions? And as an image necessarily resembles its object.... (T260) At the end of his Part I, Professor Yolton concludes: (1) Hume never mentions the brain and the physiological processes. It is the mind or the soul which considers, conceives, imagines, remembers, thinks It seems to me not at all clear that Hume distinguishes soul 27. or mind from the brain, for he says: Bodily pains and pleasures...arise Originally in the soul, or in the body, whichever you please to call it.... (T276) And Hume certainly does describe the brain and its physiological processes on T60-61 and T185, as Professor Yolton himself later recognizes explicitly on his pages 12 and 16. An ambiguity arises regarding 'representation', Professor Yolton concludes, because Hume is writing in two languages in his account of ideas as representations : The difficulties of interpretation arise from Hume's application of quantitative terms to ideas - size, parts, divisibility. We have to balance this quantitative language of ideas by Hume's ascription of logical properties to ideas - truth, contradiction, possibility. When he speaks of ideas 'representing' things, to which language does 'representation' belong: to the quantitative or to the logical language? (6) I gather that Professor Yolton finds some sort of incompatibility between the "quantitative" characteristics of ideas and their "logical" ones; yet he offers no explanation why he finds them incompatible. More to the point, of course, is whether Hume himself regarded them as incompatible. I find he does not. Rather, it appears that it is the "quantitative" aspects of some ideas that permit them to be adequate representations, having the same "logical" properties as do objects. On T28 Hume has concluded that some ideas are very small: This however is certain, that we can form ideas, which shall be no greater than the smallest atom of the animal spirits of an insect a thousand times less than a mite.... Then on the following page he makes use of this conclusion to argue that ideas have the same "logical" properties as the objects they represent: Wherever ideas are adequate representations of objects, the relations, contradictions and 28. agreements of the ideas are all applicable to the objects ; and this we may in general observe to be the foundation of all human knowledge. But our ideas are adequate representations of the most minute parts of extension; and thro' whatever divisions and subdivisions we may suppose these parts to be arriv'd at, they can never become inferior to some ideas, which we form. The plain consequence is, that whatever appca rn impossible and contradictory upon the comparison of these ideas, must be really impossible and contradictory, without any farther excuse or evasion. (T29), Thus I... (shrink)

It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With regard to the (...) qualia theory, we argue that it fails to capture the sense in which pain 's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain 's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain 's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)

In a recent article in this journal, Carl Knight and Andreas Albertsen argue that Rawlsian theories of distributive justice as applied to health and healthcare fail to accommodate both palliative care and the desirability of less painful treatments. The asserted Rawlsian focus on opportunities or capacities, as exemplified in Normal Daniels’ developments of John Rawls’ theory, results in a normative account of healthcare which is at best only indirectly sensitive to pain and so unable to account for the value of (...) efforts of which the sole purpose is pain reduction. I argue that, far from undermining the Rawlsian project and its application to problems of health, what the authors’ argument at most amounts to is a compelling case for the inclusion of freedom from physical pain within its index of primary goods. (shrink)

Schleiermacher’s theology of absolute dependence implies that absolutely everything, including evil, including even sin, is grounded in the divine causality. In addition to God’s general, creative causality, however, he thinks that Christian consciousness reveals a special, teleologically ordered divine causality which is at work in redemption but not in evil. He identifies good and evil, respectively, with what furthers and what obstructs the development of the religious consciousness in human beings. Mere pains and natural ills are not truly evil, in (...) his view, apart from a connection with some obstruction of the God-consciousness. These themes are explored in the present essay. (shrink)

For a long time, Daniel Dennett, like many philosophers, has been trying to understand how to make room for free will in a world of ordered causes. A core feature of Dennett's view on these matters is that the world is deterministic and his approach to this project has been to show how determinism really is our friend rather than our enemy . His most recent foray into this arena is the ambitious book, Freedom Evolves, where he once again seeks (...) to make clear that determinism does not threaten any of the freedoms worth wanting' that is, free will is compatible or consistent with determinism and that free will is a capacity that has evolved just as we as a species have evolved. My primary concern in this essay will not be on evolutionary theory and its role in the evolving capacity for free will. Rather, I will focus my attention on two features of Dennett's recent book that seem most closely related to understanding the nature of freedom. The first feature is his view, and accompanying arguments, that a deterministic world is no obstacle to free will. Here, he is at pains to argue two theses crucial to his project: that determinism does not imply inevitability, and that determinism does not imply that there are no genuine options. The second feature is his discussion of incompatibilism { the view that free will is inconsistent with determinism - through what many acknowledge as the best incompatibilist account of free will going these days, that of Robert Kane . Here, Dennett pursues three theses: that Kane's account does not need the indeterminism that inspired itscreation, that Kane cannot harness indeterminism in any way distinguishable from determinism, and that Kane's requirement that decisions be made by agents 'here and now' roughly up to them at the time of choice is unmotivated at best and incoherent at worst. If Dennett were to score a knockout on these three points against Kane, it would indeed look bad for any incompatibilist relying on indeterminism. In discussing Dennett's treatment of Kane, I also will raise some critical questions for Kane. Independent of Dennett's worries, incompatibilism is not home free. (shrink)

This paper explores the comparative dynamics of self-mutilation among young, contemporary, female self-cutters, and the holy stigmatics of the Middle Ages. It addresses the types of personalities that engage in self-mutilation and how some manipulate their self-inflicted pain into a method for healing and empowerment. The similarities between teenage cutters and female stigmatics are striking in their mutual psychoanalytical need for self-alteration as a means of escaping their own disassociative identities; and offers evidence of how their mutual bricolage of pain, (...) imagining, languaging, and subsequent self-mutilation often provide a transformation from bodies under siege to a resemblance of health and transformation. (shrink)

Background Because opioids can suppress respiratory drive, the principle of double effect (PDE) has been used to justify their use for terminally ill patients. Recent studies, however, suggest that the risk of respiratory depression in typical end-of-life (EOL) situations may be overstated and that heightened concern for this rare occurrence can lead to inadequate treatment of pain. The purpose of this study is to examine the role of the PDE in medical school ethics education, with specific reference to its potential (...) impact on pain management at EOL. Method After obtaining institutional review board approval, an electronic survey was sent to ethics educators at every allopathic medical school in the USA. Results One-third of ethics educators felt that opioids were ‘likely’ to cause significant respiratory depression that could hasten death. Educators' opinions of opioid effects did not influence their view of the relevance of the PDE, with approximately 70% deeming it relevant to EOL care. Only 15% of ethics educators believed that associating the PDE with opioid use might discourage clinicians from optimally treating pain, out of concern for respiratory depression. Conclusion This study demonstrates that a significant minority of ethics educators believe, contrary to current evidence, that opioids are ‘likely’ to cause significant respiratory depression that could hasten death in terminally ill patients. Yet, many of those who do not feel this is likely still rely on the PDE to justify this possibility, potentially (and unknowingly) contributing to clinical misperceptions and underutilisation of opioids at EOL. (shrink)

As the above quote clearly highlights, it is the responsibility of researchers and research supervisors to be certain that their research staff and students assistants are very familiar with all of the ethical principles and current standards relevant to the research they are conducting. Indeed, they must take an active role in being certain that their research staff and students complete appropriate training in these ethical principles and standards, and how they apply them to the research context in which they (...) are working. This is especially important in areas in which there may be physical harm such as chronic pain research. During the past decade, there has been a great increase in research of chronic pain, with breakthroughs in better understanding its etiology, assessment, and treatment (1,2). Obviously, much of this research was conducted using humans and animals as subjects. As a consequence, there were a number of ethical issues that investigators have to be cognizant of when conducting their studies. In this chapter, we will discuss such ethical issues in three major areas: (i) laboratory research with human subjects; (ii) laboratory research with animals; and (iii) translating these laboratory research ndings to ‘‘real world’’ applications in the clinical treatment arena. (shrink)

The Summa Theologiae is Thomas Aquinas' undisputed masterwork, and it includes his thoughts on the elemental forces in human life. Feelings such as love, hatred, pleasure, pain, hope and despair were described by Aquinas as 'passions', representing the different ways in which happiness could be affected. But what causes the passions? What impact do they have on the person who suffers them? Can they be shaped and reshaped in order to better promote human flourishing? The aim of this book is (...) to provide a better understanding of Aquinas' account of the passions. It identifies the Aristotelian influences that lie at the heart of the Summa Theologiae, and it enters into a dialogue with contemporary thinking about the nature of emotion. The study argues that Aquinas' work is still important today, and shows why for Aquinas both the understanding and attainment of happiness requires prolonged reflection on the passions. (shrink)

The special and unique attitudes that we take towards events in our futures/pasts—e.g., attitudes like the dread of an impeding pain—create a challenge for “Reductionist” accounts that reduce persons to aggregates of interconnected person stages: if the person stage currently dreading tomorrow’s pain is numerically distinct from the person stage that will actually suffer the pain, what reason could the current person stage have for thinking of that future pain as being his? One reason everyday subjects believe they have a (...) substantially extended temporal existence stems from introspection—they introspectively experience their selves as being temporally extended. In this paper, I examine whether a Reductionist about personal identity can co-opt this explanation. Using Galen Strawson’s recent work on self-experience as a resource, I reach both a negative and a positive conclusion about the prospects of such a position. First, the relevant kind of self-experience—i.e., the introspective experience of one’s self as being a substantially temporally extended entity—will not automatically arise within a person stage simply in virtue of that stage being psychologically connected to/continuous with other person stages. Second, the relevant kind of self-experience will arise, however, in virtue of person stages weaving together their respective experiences, actions, etc. via a narrative. This positive conclusion points towards a new Reductionist position that focuses upon a narrative, and not mere psychological continuity, in attempting to justify the special attitudes we take towards events in our futures/pasts. (shrink)

Pain is ubiquitous. It is also surprisingly complex. In this chapter, we first provide a truncated overview of the neuroscience of pain. This overview reveals four surprising empirical discoveries about the nature of pain with relevance for ethics. In particular, we discuss the ways in which these discoveries both inform putative normative ethical principles concerning pain and illuminate metaethical debates concerning a realist, naturalist moral metaphysics, moral epistemology, and moral motivation. Taken as a whole, the chapter supports the surprising conclusion (...) that the sciences have revealed that pain is less significant than one might have thought, while other neurological kinds may be more significance than has hitherto been recognised. (shrink)

Many contemporary thinkers seeking to integrate theistic belief and scientific thought reject what they regard as two extremes. They disavow deism in which God is understood simply to uphold the existence of the physical universe, and they exclude any view of divine influence that suggests the performance of physical work through an immaterial cause. Deism is viewed as theologically inadequate, and acceptance of direct immaterial causation of physical events is viewed as scientifically illegitimate. This desire to avoid both deism and (...) any positing of God as directly intervening in the physical order has led to models of divine agency that seek to defend the reality of divine causal power yet affirm the causal closure of the physical. I argue, negatively, that such models are unsuccessful in their attempts to affirm both the reality of divine causal power acting in the created world and the causal closure of the physical and, positively, that the assumption that underlies these models, namely that any genuine integration of theistic and scientific belief must posit the causal closure of the physical on pain of violating well-established conservation principles, is mistaken. (shrink)

Pain is not a single entity but is instead a collection of sensory experiences commonly associated with tissue damage. There is growing recognition that not all pains are equivalent, that pains and pathologies are not related in a simple manner, and that acute pains differ in many respects from persistent pains. Great strides have been made in improving our understanding of the neuronal mechanisms responsible for acute pain, but the studies leading to these advances have also led to the realization (...) that a bewildering array of processes are interposed between tissue damage and sensations of pain, especially in persistent pains. Persistent pains often seem unrelated or disproportionate to identifiable pathology, and they are modulated by a multitude of factors. This complexity in such a vital function serves as a challenge both to scientists seeking fundamental understanding and to clinicians faced with the immediate need to treat patients with painful disorders. (shrink)

Many philosophers have contended that (traditional) theism or supernaturalism suffers from what can properly be called the Problem of Divine Hiddenness (the PDH ). [See Howard-Snyder and Moser 2002]. Moreover, it is the contention of many proponents of the PDH that this “problem,” if, indeed, not just a component of the “problem of evil,” bears a striking similarity to the latter. Specifically, at the heart of this ostensible difficulty for theism is that Divine “Hiddenness,” like pain and suffering—or at least (...) pain and suffering in the amount that the world contains—is precisely the opposite of what one would expect if there existed a (maximally great) supernatural Person. Accordingly, it is maintained by proponents of the PDH that supernaturalism is disconfirmed by the relevant “problem.” The aim of this essay is to establish that there is more than ample metaphysical warrant (of a sort overlooked thus far) for maintaining that the “hiddenness” of God is exactly what should be expected if theism is true. Thus, the conclusion we hope to secure is that the PDH has considerably less to recommend it than its proponents have thought, and, accordingly, that it fails to constitute an effective threat to supernaturalism. (shrink)

Mary was angry. Youre going to take my pain medications away, aren't you? These were the first words she spoke as I walked into the examining room. Mary had a complex medical history, beginning with a back injury in 1988 that led to several surgical procedures, multiple injections of local anesthetic and corticosteroids, and placement of a dorsal column stimulator, none of which provided significant relief of her pain. Crippled by severe and sharp pain in her lower back and left (...) leg, she had sought help from several physicians, and had most recently been referred to me specifically, as she put it, to take away the pain medications.Not that the pain medications had afforded Mary a normal life by any stretch of imagination. She was taking eight to ten moderate strength opioid tablets per day in an effort to decrease her pain. She was not active, choosing to spend most of her time at home. She had quit her job shortly after the work-related accident. In fact, the workman's compensation board is still disputing her claim, and this dispute took a toll on Mary. (shrink)

Mary was angry. Youre going to take my pain medications away, aren't you? These were the first words she spoke as I walked into the examining room. Mary had a complex medical history, beginning with a back injury in 1988 that led to several surgical procedures, multiple injections of local anesthetic and corticosteroids, and placement of a dorsal column stimulator, none of which provided significant relief of her pain. Crippled by severe and sharp pain in her lower back and left (...) leg, she had sought help from several physicians, and had most recently been referred to me specifically, as she put it, to take away the pain medications.Not that the pain medications had afforded Mary a normal life by any stretch of imagination. She was taking eight to ten moderate strength opioid tablets per day in an effort to decrease her pain. She was not active, choosing to spend most of her time at home. She had quit her job shortly after the work-related accident. In fact, the workman's compensation board is still disputing her claim, and this dispute took a toll on Mary. (shrink)

Violence seems to be the central preoccupation in the work of Heiner Müller: from the early plays on the painful birth of a new socialist state, the German Democratic Republic (GDR), built on the ruins of one and overshadowed by the rise of another totalitarian system, to the political parables and allegories borrowed from Greek and Shakespearean tragedy; from his adaptations of some of the bloodiest episodes of the French, Russian, and German revolutions to the late dramatic experiments bent on (...) shattering the theatrical form itself. The concern with violence is indeed so pervasive as to appear obsessive. Violence is.. (shrink)