In teasing out the diverse origins of our “modern, ecological understanding of epidemic disease” Greater than the parts: holism in biomedicine, 1920–1950, Oxford University Press, Oxford, 1998), historians have downplayed the importance of parasitology in the development of a natural history perspective on disease. The present article reassesses the significance of parasitology for the “invention” of medical ecology in post-war France. Focussing on the works of microbiologist Charles Nicolle and on that of physician and zoologist Hervé Harant, I argue that (...) French “medical ecology” was not professionally insulated from some major trends in parasitology, especially in Tunis where disciplinary borders in the medical sciences collapsed. This argument supports the claim that ecological perspectives of disease developed in colonial context but I show that parasitologists such as Harant built on the works of medical geographers who had called attention to the dynamic and complex biological relations between health and environment in fashioning the field of medical ecology in the mid-1950s. As the network of scientists who contributed to the global emergence of “disease ecology” is widening, both medical geography and parasitology stand out as relevant sites of inquiries for a broader historical understanding of the multiple “ecological visions” in twentieth-century biomedical sciences. (shrink)

According to standard comparativist views, death is bad insofar as it deprives someone of goods she would otherwise have had. In The Ethics of Killing, Jeff McMahan argues against such views and in favor of a gradualist account according to which how bad it is to die is a function of both the future goods of which the decedent is deprived and her cognitive development when she dies. Comparativists and gradualists therefore disagree about how bad it is to die (...) at different ages. In this paper I examine two prominent criticisms of gradualism and show that both misconstrue McMahan. I develop a related criticism that seems to show that a gradualist cannot coherently relate morbidity and mortality. This criticism also fails, but has an instructive implication for how policy-makers setting priorities for health care investments should regard choices between life-saving interventions and interventions against non-fatal diseases in the very young. (shrink)

As previous pandemics, the coronavirus disease 2019 (COVID-19) has direct and indirect effects on mental health and well-being. The purpose of the current study was to examine whether meaning in life mediated the association between coronavirus suffering and satisfaction with life and whether stress-related growth moderated the mediating effect of meaning in life on the association between these variables. Stress-Related Growth Measure (SGM) was also conducted for the purpose of this study. The participants were 402 (66% women) young adults (...) who completed the Suffering Measure During COVID-19, Meaningful Living Measure, Satisfaction With Life Scale, and SGM. The results indicated that the SGM has adequate psychometric properties with unidimensional structure of stress-related growth in the face of adversity. Moderated mediation analysis revealed that coronavirus suffering directly influenced satisfaction with life as well as indirectly by its effect on meaning in life. Additionally, stress-related growth was found as a moderator in the relationship between coronavirus suffering–meaning in life and coronavirus suffering–satisfaction with life. These results suggest that meaning in life mitigates the effect of coronavirus suffering on satisfaction with life, and this mediating effect is moderated by stress-related growth in young adults. While meaning in life helps explain the relationship between coronavirus suffering and satisfaction with life, the stress-related growth functions as a protective factor against the adverse effect of coronavirus experiences. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

Abstract: I argue that Orientalism continues to construct Arabs as subjects that cannot suffer violence, particularly the violence of torture. Beginning with Edward Said’s observation that Orientalists constructed ‘Arabs’ in the nineteenth -century as inorganic, metallic, and mineralized beings, I trace these themes through various sites in and around Guantanamo Bay. One finds the tropes of Orientalism in the Bybee memo as well as in the diary of Mohamedou Ould Slahi. Through these three distinct but related moments, one finds that (...) Orientalism continues to produce Arabs as inorganic entities beyond death and thereby immune to violence and specifically the violence of torture. Insofar as imperialism has co-opted the language of non-violence by constructing its enemies as inviolable, one must recognize the Orientalized Arab as a receptor of limitless ‘non - violent’ hostilities. (shrink)

"Get a behind-the-scenes glimpse of what it takes to change the world in this comprehensive biography that tells the complete life story of internationally renowned peacemaker Nelson Mandela. Civil rights activist. World leader. Writer. Throughout his life, Nelson Mandela took on many roles, all in the pursuit of peace. Born in 1918 in South Africa, he grew up in a culture of government-enforced racism and became involved in the anti-apartheid movement at a young age. Deeply committed to nonviolent activism, Mandela (...) directed a peaceful campaign against the racist policies of his South African government, and spent twenty-seven years in prison as a result. In the years following his emergence as a free man, he continued his efforts to dismantle the country's apartheid system and was awarded the Nobel Peace Prize alongside South African President F.W. de Klerk. In 1994 he was inaugurated as South Africa's first black president and served until his retirement from active politics in 1999 at the age of eighty-one. He continued to promote global peace until his death in 2013, and his legacy lives on. From Nelson Mandela's childhood to his monumental impact on race relations and nonviolent activism, this comprehensive biography shares the truth about the man behind the iconic smile: his struggles, his triumphs, and the sacrifices along the way"--. (shrink)

The suffering of non-human animals is great and omnipresent. This is because animals are vulnerable to disease, disfigurement, injury, predation, age-related physical decline and death, and—today—it is also because human beings are subjecting animals to unprecedented violence in two different domains. Human activities and their byproducts are devastating wild animal habitats at such a fantastic rate that we are obliged to speak of a “sixth mass extinction”, and, while the crisis is typically measured in terms of the loss (...) of entire species, it plays itself out concretely on the bodies ofindividuals. At the same time, industrialized societies now objectify and “process” animals on a massive scale in a variety of settings, for instance—to mention but the numerically most significant—in CAFOs, industrial slaughterhouses and aquafarms, where each year the whole lifecycles of hundreds of billions of land and sea creatures are controlled without any consideration for their pain or terror except insofar as it threatens the economically efficient growth and harvesting of their edible tissues. How should we best respond to the awfulness, and the enormity, of animal suffering? (shrink)

It is often accepted that we may legitimately speak about voluntary euthanasia only in cases of persons who are suffering because they are incurably injured or have an incurable disease. This article argues that when we consider the moral acceptability of voluntary euthanasia, we have no good reason to concentrate only on persons who are ill or injured and suffering.

This chapter contains sections titled: Introduction Doubts About Libertarianism Obligations Conclusions References Further reading.

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood (...) as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)

Barbarism was by no means unique to the past 100 years, Jonathan Glover tells us, but ''it is still right that much of 20th-century history has been a very unpleasant surprise.'' This was the century of Passchendaele, Dresden, Nanking, Nagasaki and Rwanda; of the Final Solution, the gulag, the Great Leap Forward, Year Zero and ethnic cleansing -- names that stand for killings in the six and seven figures and for suffering beyond comprehension. The technological progress that inspired the (...) optimism of the Victorians turned out also to multiply the effects of old-fashioned evil and criminal stupidity. (shrink)

Patients with Wilson’s disease suffer from prospective memory impairment, and some of patients develop cognitive impairment. However, very little is known about how brain structure and function changes effect PM in WD. Here, we employed multimodal neuroimaging data acquired from 22 WD patients and 26 healthy controls who underwent three-dimensional T1-weighted, diffusion tensor imaging, and resting state functional magnetic resonance imaging. We investigated gray matter volumes with voxel-based morphometry, DTI metrics using the fiber tractography method, and RS-fMRI using the seed-based (...) functional connectivity method. Compared with HC, WD patients showed GM volume reductions in the basal ganglia and occipital fusiform gyrus, as well as volume increase in the visual association cortex. Moreover, whiter matter tracks of WD were widely impaired in association and limbic fibers. WM tracks in association fibers are significant related to PM in WD patients. Relative to HC, WD patients showed that the visual association cortex functionally connects to the thalamus and hippocampus, which is associated with global cognitive function in patients with WD. Together, these findings suggested that PM impairment in WD may be modulated by aberrant WM in association fibers, and that GM volume changes in the association cortex has no direct effect on cognitive status, but indirectly affect global cognitive function by its aberrant functional connectivity in patients with WD. Our findings may provide a new window to further study how WD develops into cognitive impairment, and deepen our understanding of the cognitive status and neuropathology of WD. (shrink)

A life-threatening illness such as cancer can bring about much existential suffering and a disconnect to self in spite of surviving cancer. In my recent research project, I interviewed 14 long-term cancer survivors on being post cancer. Contrary to common assumptions about long-term survivorship, my interviewees reported grave existential difficulties in finding a firm footing in their sense of self, fostering a variety of stories of despair. This article examines long-term cancer survivors’ suffering from the vantage point of (...) selfhood and provides a philosophical interpretation of the reintegration of the self by illuminating their stories of despair through the Danish philosopher Søren Kierkegaard’s seminal work The Sickness Unto Death. The participating survivors described how the cancer experience had quaked old perceptions of self, instigating them to question the depth of their self-understanding before the cancer and who they really were. In relating to themselves, they realized the dynamic process of becoming who they are by continuing to balance opposing poles within the self. This act of relating to self revealed the limit of the autonomous self in the creation of selfhood. The article intends to illustrate how a philosophical reading of selfhood and suffering in survivorship can inform medicine and inspire models for follow-up cancer care for long-term survivors. (shrink)

This chapter first analyses pessimism about the human condition, arguing that it has both an evaluative and a psychological component. As an evaluative thesis, the chapter proposes a standard by which human lives are to be assessed, and says that a human life is worth living if and only if it has certain features. Its psychological component asserts that something inheres in all or nearly all human beings that will always prevent their lives from having those valuable features. The discussion (...) then turns to happiness, the best form of consciousness, eudaimonia, Schopenhauer's and Plato's complaints about the human situation, and life's brevity. (shrink)

An argument is advanced to show that affluent and moderately affluent people, like you and me, are morally obligated: (O1) To provide modest financial support for famine relief organizations and/or other humanitanan organizations working to reduce the amount of unnecessary suffering and death in the world, and (O2) To refrain from squandering food that could be fed to humans in situations of food scarcity. Unlike other ethical arguments for the obligation to assist the world’s absolutely poor, my argument (...) is not predicated on any highly contentious ethical theory that you likely reject. Rather, it is predicated on your beliefs. The argument shows that the things you currently believe already commit you to the obligatoriness of helping to reduce malnutrition and famine-related diseases by sending a nominal percentage of your income to famine relief organizations and by not squandering food that could be fed to them. Consistency with your own beliefs implies that to do any less is to be profoundly immoral. (shrink)

The aim of this study was to gain a deeper understanding of the experience of time when living with severe incurable disease. A phenomenological and philosophical approach of description and deciphering were used. In our modern health care system there is an on-going focus on utilizing and recording the use of time, but less focus on the patient’s experience of time, which highlights the need to explore the patients’ experiences, particularly when life is vulnerable and time is limited. The empirical (...) data consisted of 26 open-ended interviews with 23 participants receiving palliative care at home, in hospital or in a nursing home in Norway. The theoretical frameworks used are mainly based upon K. Martinsens philosophy of care, K. E. Løgstrup phenomenological philosophy, in addition to C. Saunders’ hospice philosophy, L. Feigenberg’s thanatology and U. Qvarnström’s research exploring patient’s reactions to impending death. Experience of time is described as being a movement that moves the individual towards death in the field of opposites, and deciphered to be a universal, but a typical and unique experience emerging through three integrated levels: Sense of time; where time is described as a movement that is proceeding at varying speeds. Relate totime; where the awareness of limited life changes the understanding of time to be more existential. Being in time; where limited time seems to clarify the basic living conditions and phenomena of life. The existence of life when the prospect of death is present is characterized by emotional swings that move within polarizing dimensions which is reflected in the experience of time illustrated as the moves of the pendulum in a grandfather clock. The diversity of the experience of time is oscillating between going fast or slow, being busy or calm, being unpredictable but predictable, safe or unsafe and between being good or bad, depending on the embodied situation of the individual. (shrink)

What is the relationship between harm and disease? Discussions of the relationship between harm and disease typically suffer from two shortcomings. First, they offer relatively little analysis of the concept of harm itself, focusing instead on examples of clear cases of harm such as death and dismemberment. This makes it difficult to evaluate such accounts in borderline cases, where the putative harms are less severe. Second, they assume that harm-based accounts of disease must be understood normatively rather than naturalistically, (...) in the sense that they are inherently value based. This makes such accounts vulnerable to more general objections of normative accounts of disease. Here we draw on an influential account of harm from the philosophy of law to develop a harm-based account of disease that overcomes both of these shortcomings. (shrink)

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease (...) as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization. (shrink)

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as clinical phronesis, i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of virtue ethics, yet one that is informed by the exigencies of (...) moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their disengaged form (reflecting the malaise of modern medicine). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the silent world of doctor and patient — provides may deny or refuse any given connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of calculative reasoning only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can save the life of medical ethics — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can prevent the death of medical ethics. (shrink)

Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. (...) The author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don’t, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, “reciprocity” is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making. (shrink)

For nearly five years, bioethicists and neurologists debated whether Jahi McMath, an African American teenager, was alive or dead. While Jahi's condition provides a compelling study for analyzing brain death, circumscribing her life status to a question of brain death fails to acknowledge and respond to a chronic, if uncomfortable, bioethics problem in American health care—namely, racial bias and unequal treatment, both real and perceived. Bioethicists should examine the underlying, arguably broader social implications of what Jahi's medical treatment (...) and experience represented. On any given day, disparities in the quality of health care and health outcomes for people of color in comparison to whites are evidenced in American hospitals and clinics. These disparities are not entirely explained by differences in patient education, insurance status, employment, income, expressed preference for treatments, and severity of disease. Instead, research indicates that, even for African Americans able to gain access to health care services and navigate institutional nuances, disparities persist across a broad range of services, including diagnostic screening and general medical care, mental health diagnosis and treatment, pain management, HIV‐related care, and treatments for cancer, heart disease, diabetes, and kidney disease. (shrink)

The ability to convert human somatic cells into induced pluripotent stem cells (iPSCs) is allowing the production of custom‐tailored cells for drug discovery and for the study of disease phenotypes at the cellular and molecular level. IPSCs have been derived from patients suffering from a large variety of disorders with different severities. In many cases, disease related phenotypes have been observed in iPSCs or their lineage‐specific progeny. Several proof of concept studies have demonstrated that these phenotypes can be reversed (...) in vitro using approved drugs. However, several challenges must be overcome to take full advantage of this technology. Here, we highlight recent advances in the field and discuss the main challenges associated with this technology as it applies to disease modelling. (shrink)

The author encountered evocations of suffering and death in all the studies and research he devoted, over 40 or so years, to the intellectual, social and religious life of western Muslim Judaism, and indeed the whole of traditional Jewish thought and its varied modes of expression: rabbinical law, Hebrew poetry, the literature of homily and preaching, mystical writings and the kabbala, dialect and popular literatures in Judeo-Arabic and Judeo-Berber. Some passages are taken from the Zohar (‘The town the (...) angel of death cannot enter’, for instance). The author also refers to the Talmud and magic therapeutics, the power of sacred names, Jewish and Muslim miracle workers, hunting down and casting out demons, etc. Agony, refusal to die, joyous commemoration of death, the cemetery and the cult of the dead, Judeo-Muslim pilgrimages, the wealth of the customs, beliefs and rites of the past lead the author to reflect on the question of death in the present-day world. (shrink)

Schuklenk and van de Vathorst's paper is a very welcome addition to the literature on the assisted dying debate and will be of great interest to clinicians working in the field of mental health.1 Many psychiatrists will have had patients who have asked them to allow them to die, to desist in their efforts to prevent their suicide, and one of us has had personal experience, outside of professional life, of being asked to aid in someone's attempt to end their (...) life in the context of an episode of mood disorder. The person with depression asking professionals, friends and family members to aid them in ending their life is a very real phenomenon. In their discussion, Schuklenk and van de Vathorst's paper uses two principles that we endorse and add weight to their argument: namely, the reality of suffering in depression and the parity of mental and physical illness. Indeed, the case Schuklenk and van de Vathorst make is a strong one and our commentary will focus on the premise of the argument around choosing death and some empirical clarification about competence in depression and the nature of treatment-resistant depression (TRD) and its prognosis. The conceptual concern we wish to discuss in relation to assisted dying, endorsed by the state and legislature, is not linked to any moral or religious concern, or even on grounds related to ‘slippery slope’ or ‘abuse’ arguments. Rather the worry is how one could operationalise decisions around assisted dying as based on competence and capacity and view such decisions as rational. I think this concern is not limited to depressive illness, but to all decisions regarding choosing non-existence. Schuklenk and van de Vathorst offer the following useful criteria to regulate assisted suicide:1. (shrink)

Animal production, especially pork production, is facing growing international criticism. The greatest concerns relate to the environment, the animals’ living conditions, and the occupational diseases. But human and animal conditions are rarely considered together. Yet the living conditions at work and the emotional bond that inevitably forms bring the farm workers and the animals to live very close, which leads to shared suffering. Suffering does spread from animals to human beings and can cause workers physical, mental, and also (...) moral suffering, which is all the more harmful due to the fact that it is concealed. The conceptual tools used to conceal suffering ( animal welfare, stress, pain) suggest that the industrial system can be improved, whereas for farmers it is by definition incompatible with animal husbandry. (shrink)

COVID-19 pandemic-related perceived risk of infection, illness fears, acute stress, emotional anxiety, exhaustion, and fatigue, psychological trauma and depressive symptoms, and sustained psychological distress can cause smartphone addiction risk and lead to technology-related cognitive, emotional, and behavioral disorders, thus impacting psychological well-being. Behavioral addiction of smartphone users can result in anxiety symptom severity, psychiatric symptoms, and depressive stress. We carried out a quantitative literature review of the Web of Science, Scopus, and ProQuest throughout June 2022, with search terms including “smartphone (...) addiction + COVID-19” + “stress,” “anxiety,” “depression,” “psychological distress,” “screen time,” and “fear.” As we analyzed only articles published between 2020 and 2022, 288 papers met the eligibility criteria. By excluding sources with similar titles, having unclear findings or unsupported by replication, or displaying inconsistent content, we selected 64, mainly empirical, sources. We used layout algorithms and bibliometric mapping as data visualization tools. Assessing the Methodological Quality of Systematic Reviews, a systematic review and literature review software, Mixed Methods Appraisal Tool, and Systematic Review Data Repository were employed as methodological quality assessment tools. As limitations, we analyzed only articles published between 2020 and 2022 in scholarly outlets indexed in the Web of Science, Scopus, and ProQuest databases. The scope of our study also does not advance the inspection of sources covering vulnerable individuals suffering from certain diseases or specific generations. Subsequent analyses should develop on smartphone use and addiction among children and adolescents. Future research should thus investigate problematic smartphone use and addiction across generations Z and Alpha. Attention should be directed to their personality traits and psychopathological symptoms. (shrink)

The problem of animal suffering is the atheistic argument that an all-knowing, all-powerful, and all-good God would not use millions of years of animal suffering, disease, and death to form a planet for human beings. This argument has not received as much attention in the philosophical literature as other forms of the problem of evil, yet it has been increasingly touted by atheists since the time of Charles Darwin. While several theists have attempted to provide answers to (...) the problem, they disagree with each other as to which answer is correct. Also, some of these theists have given in to the problem and believe it entails that God is limited in certain ways. B. Kyle Keltz seeks to provide a classical answer to the problem of animal suffering inspired by the medieval philosopher/theologian Thomas Aquinas. In doing so, Keltz not only utilizes the wisdom of Aquinas, but also contemporary insights into non-human animal minds from contemporary philosophy and science. Keltz provides a compelling neo-Thomistic answer to the problem of animal suffering and explains why the classical God of theism would create a world that includes animal death. (shrink)

The one thing that is at once most predictable and unpredictable about life is death. Yet, man lives, forgetting death as if he were immortal. Between these two -- a visible manifestation of death and an innate sense of immortality -- hangs the balance of life, a paradox which we do not easily understand. What if death is not an end, but a passage to another life? What if rebirth is not about retribution, but is a (...) form of evolution? What if life and death are not opposites but work towards a common goal? There must be a larger picture, a missing piece of the puzzle to complete the story and make our understanding whole. How should we deal with trauma and loss, suffering and pain and other ethical and existential issues? This is an attempt to find answers to these and many other related issues, theoretically and practically, supported by anecdotes and experiences arising from brushes with death. (shrink)

There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option (...) was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns. (shrink)

To comprehend pain, disease, death and suffering as being meaningful - beyond the firing of synapses, the collapse of human abilities, and the mere end of life - requires a context in which to evaluate essential connotations, as well as to place and integrate understandings. If pain and suffering are to have enduring significance, they must be situated within a nest of ontological background assumptions, standards of inquiry, and epistemological foundations. Where secular bioethics fails to give deep (...) meaning to suffering, Christian bioethics succeeds. This essay analyzes the divergent meanings of suffering endorsed by the various Christian religions as conceptualized through the different metaphysical, epistemological, and sociological assumptions of each religion. (shrink)

This work examines contemporary views on medical ethics, such as preventing death, defining family relations, and reproductive and disabled issues.

In this paper I will briefly discuss flourishing and freedom, relating them to health and disease; discuss the tensions between flourishing and freedom; and exemplify how those discussions are relevant to chronic disease suffering. The concept of freedom has significant connections with the concepts of health, disability and disease. Understanding disease and disability in terms of the loss of aspects of freedom may help our understanding of the suffering that arises from chronic disease. On the other hand, flourishing (...) may require a degree of adversity. Therefore disability and disease may be conducive to flourishing. Flourishing may be understood as subordinated to freedom, as a path to freedom, or as transcending freedom. It is suggested that freedom and flourishing are expressed as mutually enhancing cycles, actualized according to the personal circumstances that will ground their expression. In a distant horizon of innocent spontaneous self-expression, flourishing and freedom may become coincident. Regarding chronic disease as a constraint on ‘species-typical’ abilities to fulfill one’s significant life interests, as well as an unwanted intrusion into the patient’s life, presents chronic disease suffering as a loss of both positive and negative freedom. The conceptual relation between flourishing and freedom will thus organise the possibilities the sufferer sees as open to their self. (shrink)

Abortion and euthanasia are among the most controversial topics in society today. Abortion is simply any action that intentionally causes the death and removal from the womb of an unborn child. Likewise, Euthanasia is the act of intentionally ending the life of a person who is elderly, terminally ill, or suffering from some incurable injury or disease. In this book, Dr. Wayne Grudem attempts to give an accurate summary of biblical teachings related to abortion and euthanasia, and also (...) to represent fairly the arguments of people who disagree with his positions. (shrink)

It is not uncommon for patients with advanced disease to express a wish to hasten death. Qualitative studies of the WTHD have found that such a wish may have different meanings, none of which can be understood outside of the patient’s personal and sociocultural background, or which necessarily imply taking concrete steps to ending one’s life. The starting point for the present study was a previous systematic review of qualitative studies of the WTHD in advanced patients. Here we analyse (...) in greater detail the statements made by patients included in that review in order to examine their moral understandings and representations of illness, the dying process and death. We identify and discuss four classes of assumptions: assumptions related to patients’ moral understandings in terms of dignity, autonomy and authenticity; assumptions related to social interactions; assumptions related to the value of life; and assumptions related to medicalisation as an overarching context within which the WTHD is expressed. Our analysis shows how a philosophical perspective can add to an understanding of the WTHD by taking into account cultural and anthropological aspects of the phenomenon. We conclude that the knowledge gained through exploring patients’ experience and moral understandings in the end-of-life context may serve as the basis for care plans and interventions that can help them experience their final days as a meaningful period of life, restoring some sense of personal dignity in those patients who feel this has been lost. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death and Dying in JapanRihito Kimura (bio)A majority of Japanese, at present, feel that the modern biomedical and technological innovations pertaining to human life and death have been forcing a change in our common understanding of what, historically, was simply the natural event and process of death and dying. The meaning of death and the dying process in our lives is changing as have the (...) traditional criteria for determining death, namely, cessation of heartbeat and respiration.An individual’s death should be a personal and private matter as well as a familial, communal, and social matter. It has been regarded as such for many thousands of years in our Japanese society and culture. It is well understood that our traditional socio-cultural understanding of human life positively admits the natural process of death as the final event of life. The ideas expressed in Zen-Buddhist phrases such as “accept death as it is” and “life-death as one phenomenon” have been key motifs totally integrated into our traditional understanding of life (Tomomatsu 1939).However, the traditional perception of death as an acceptable process has [End Page 374] been vanishing as the Japanese have applied modern biomedical technologies more frequently in well-equipped hospital settings. Although the involvement of family members in the process of dying and particularly in the death event continues in a variety of ways, the care of dying patients in Japan is becoming much more similar to that delivered in advanced hospital settings in many countries of the world, than it is different. Now, in Japan, a majority of people end their lives in the hospital, surrounded by high-technology machines. Yet, in a survey by the Yomiuri Shimbun of 15 June 1991, half of the respondents said they would prefer to die at home.In addition, there has been a tradition of not explaining to terminally ill people the true nature of their condition, on the ground that this is most appropriate way to proceed (Kashiwagi 1994, pp. 78–85). However, views on this matter are changing. There is a gradual move toward telling patients the truth, and the notion of informed consent has been widely publicized in the clinical setting (Leflar 1996, pp. 96–107). In the 1991 nationwide opinion poll by the Yomiuri Shimbun, 65 percent of the participants said that they would like to be given full diagnostic information about themselves even if they were terminally ill. Nevertheless, only 22 percent of the people questioned said they themselves would definitely be prepared to disclose such information to a family member.The same survey indicated that 78 percent of people considered palliative care desirable, even though it might shorten life, while 16 percent thought life should be sustained as long as possible, irrespective of the pain that patients might be suffering.Challenges of Care for the DyingA special task force on terminal care, set up by the Ministry of Health and Welfare, issued a report in 1989 that encouraged the disclosure of diagnostic information to patients, provided that consideration was given to patients’ life histories, personalities, relationships with family members, and other factors. The report favored the use of drugs for pain control; it also dealt with matters such as spiritual requirements and the care of the family members.Traditionally, the physician-patient relationship in Japan is based on a complete and unquestioning trust of the physician by the patient, such that the physician acts to make health care decisions on behalf of the patient (Kimura 1991). However, increasingly it is believed that people should not have to accept without question the authority of doctors in the treatment of disease. Responsibility for the care of the dying should be shared between family members and all health professionals, not only physicians. Changes are needed in the mentalities of health care providers, patients, and family members, and it must be recognized that the medical system and institutions are not immutable (Annas and Miller 1994, pp. 374–76). [End Page 375]To complicate matters even further, although a patient’s family is informed of the incurable nature of the disease affecting their family member, the patient, as noted above, usually is not told of... (shrink)

The global reality of suffering and death has always demanded an authentic theological response and impelled debate concerning Gods relationship to suffering, as well as the conceivability of the suffering of God. The scope and impact of this suffering in the last century have driven this debate to an acute pitch, demanding to know how one can speak rightly of God in view of the suffering that is inherent and inflicted in the cosmos. While (...) in former ages, some looked to an omnipotent and impassible deus ex machina in answer to this question, many contemporary theologians have revised their understanding of God in relation to the world. With these theologians, Gloria Schaab proposes that a viable response to cosmic suffering is the recognition that the triune Christian God participates in the very sufferings of the cosmos itself. She sets her argument within theology and science dialogue and specifically within the work of scientist-theologian Arthur Peacocke. Informed by the understandings of evolutionary science, grounded within a panentheistic paradigm of the God-world relationship, and rooted within the Christian theological tradition, this work contends that the understanding of the Triune God as intimately involved with the suffering of the cosmos is viable and efficacious in view of the suffering of the cosmos and its creatures. It develops a female procreative model of the creative suffering of the Triune God, an ecological ethics based on the midwife model of care, and a pastoral model of threefold differentiation of suffering in God as steps toward Christian praxis in response to the mystery of God within the pain, suffering, and death of cosmic existence and human experience. (shrink)

Ubiquitin is the most phylogenetically conserved protein known. This 8,500 Da polypeptide can be covalently attached to cellular proteins as a posttranslational modification. In most cases, the addition of multiple ubiquitin adducts to a protein targets it for rapid degradation by a multisubunit protease known as the 26S proteasome. While the ubiquitin/26S proteasome pathway is responsible for the degradation of the bulk of cellular proteins during homeostasis, it may also be responsible for the rapid loss of protein during the programmed (...) death of certain cells, such as skeletal muscle during insect metamorphosis. In addition, alterations in the expression and regulation of ubiquitin may play significant roles in pathological disorders. For example, dramatic increases in ubiquitin and ubiquitin‐protein conjugates are observed in a wide variety of neurodegenerative disorders, including Alzheimer's disease. Patients suffering from the autoimmune disease systemic lupus erythematosus generate antibodies reacting with ubiquitin and ubiquitinated histones. At present, it is not known whether these changes in ubiquitin expression and regulation initiate pathological changes in these diseases or if they are altered as a consequence of these disorders. (shrink)

Rare diseases are a heterogenic group of disorders with a little in common except of their rarity affecting by less than 5 : 10.000 people. In the world is registered about 6000-8000 rare diseases with 6-8% suffering population only in the European Union. In spite of rarity, they represent an important medical and social problem due to their incidence. For many rare diseases have no treatment, but if it exists and if started on time as being available to patients, (...) there is a good prognosis for them to be able for normal life. The problems of patients affected by rare diseases are related to the lack of diagnosis and timely undergoing as well as their treatment or prevention. Orphan drugs are products intended for treatment, diagnosis or prevention of rare diseases, but for their development and marketing the industry has not been interested in yet because of their marketing reasons. Patients suffering from a rare disease although belonging to the vulnerable group for their specific health needs, is becoming invisible in the health care system due to their additional needs un properly recognized. Ethical problems faced by patients, but also health care professionals are related to the allocation of medical diagnostics, unequal approach to health care, inappropriately specialized social services as well as therapy and rare orphan drugs unavailability. Ethical questions related to clinical trails on orphan drugs, population screening and epidemiology testing on rare diseases will also be discussed in this paper. [Projekat Ministarstva nauke Republike Srbije, br. 41004: Rare diseases: Molecular pathophysiology, the diagnostic and therapeutical modalities, social, ethical and legal aspects] Retke bolesti su veoma heterogena grupa poremecaja i imaju malo toga zajednickog osim retkosti, posto pogadjaju manje od pet osoba na 10.000 ljudi. U svetu je evidentirano izmedju 6.000 i 8.000 retkih bolesti koje pogadjaju sest do osam procenata stanovnistva samo u Evropskoj uniji. Dakle, iako retke, one predstavljaju vazan medicinski i socijalni problem s obzirom na broj obolelih. Za mnoge retke bolesti nema terapije, a ukoliko ona postoji i ako se na vreme zapocne i bude dostupna pacijentima, postoje dobri izgledi da ce oboleli moci da zive normalnim zivotom. Problemi s kojima se susrecu pacijenti sa retkim bolestima vezani su za dijagnostikovanje u smislu nemogucnosti ili nepravovremenog postavljanja dijagnoze, kao i same terapije ili prevencije pojave bolesti. Orphan lekovi su proizvodi koji su namenjeni za lecenje, dijagnozu ili prevenciju retkih bolesti, za ciji razvoj i marketing industrija nije zainteresovana iz trzisnih razloga. Pacijenti s retkim bolestima, iako pripadaju osetljivoj grupi, jer imaju specificne zdravstvene potrebe, ostaju nevidljivi u zdravstvenom sistemu, jer se njihove dodatne specificne potrebe ne prepoznaju. Eticki problemi s kojima se susrecu pacijenti, ali i zdravstveni radnici, ticu se alokacije zdravstvene dijagnostike, nejednakog pristupa zdravstvenoj zastiti i nezi, nedostatka specijalizovanih socijalnih usluga, kao i nepostojanja i nedostupnosti terapije orphan lekovima. Eticka pitanja retkih klinickih ispitivanja orphan lekova i populacionih i skrining ispitivanja u vezi sa retkim bolestima takodje su razmatrani u ovom radu. PR Projekat Ministarstva nauke Republike Srbije, br. 41004: Rare diseases: Molecular pathophysiology, the diagnostic and therapeutical modalities, social, ethical and legal aspects. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Zen and the Art of DeathMaja Milcinski*When reflecting on immortality, longevity, death, and suicide, or taking into consideration some of the central concepts of the Sino-Japanese philosophical tradition, such as impermanence (Chinese: wuchang; Japanese: mujo), we see that the philosophical methods developed in the Graeco-Judeo-Christian tradition might not be very suitable. On the other hand it is instructive to contrast them with the similar themes developed in the (...) Graeco-Judeo-Christian tradition, since these problems present a challenge for a redefinition of philosophy, which has traditionally regarded itself as a European (and in an even less acceptable variation as a Western) phenomenon. As such the very borders of philosophical discourse known in European history as philosophia are today being reconsidered. Although the notion of philosophy (love of wisdom) is distinctly Greek in origin, this does not mean that Asia failed to cultivate activities similar to that. The absence of this notion in China and Japan does not necessarily imply a lack of the cultivation of wisdom within their traditions. Could this mean that, paradoxically, the “philo-“ limits this complex activity primarily to rationally mastered undertakings?By rethinking the history of philosophy as a single narrative, one might come closer to the movements related to the levels of consciousness that were activated in philosophical undertakings in various Asian philosophical schools. In this regard Japanese and Chinese Buddhist philosophical traditions might be instructive since, through the various stages of their development, they have attempted to put the inexpressible into words. The awareness of the insufficiency of words resulted in many original solutions. In the Song dynasty, for instance, China produced a variety of diagrams (tu), by which philosophers and practitioners represented their theories. These formulations, often arose on the basis of meditation techniques and could not therefore be fully transmitted by means of language alone. The illustration of the nine-step process (known in [End Page 385] Japan as kuso) is one such representation, and it is taken here as a point of departure for approaching the concept of impermanence and death in the Japanese philosophical context.One possible means of approaching the discussed topic is to contrast it with the ways in which impermanence, particularly with the phenomenon of death as one of its aspects, has been perceived in the European tradition. It would be naive to generalize and stress the impression that fear of death is much more central and influential in the Euro-American life style than in the Asian one, since it is rooted in human biological and subconscious mechanisms. This paper, however, tries to point at the subtle difference which exists in the spiritual realm.Europe and ImpermanenceThe European Middle Ages developed the so-called ars moriendi, the art of dying. It was this tradition which produced sayings such as “My Lord, it is a great art to die well, and one to be learned by men in health” 1 and the many variations of the dance of death (danse macabre). This awareness of human mortality was also spread by texts, of which the following inspired thought is characteristic: “The one who has not learned how to die, will die against his will. Learn how to die and you will know how to live, since nobody will learn how to live, who has not learned how to die. He shall be y-cleped a wretch that cannot live and dare not die.” 2 These undertakings, however, did not succeed in building any kind of permanent discipline in Europeans connected with the idea of impermanence and death. Rather, it left them caught up in the dizziness of everyday life. The ars moriendi vanished from their consciousness and only became manifest when actual circumstances provoked it, if indeed at all, since often at the moment of impending death people are completely terrified in the light of the prospect of losing their Ego. Although in Christianity there is a tradition of seeing death as a new beginning, some Christians remain skeptical of this “new beginning.” Beginning of what? Is it an illusion of “heaven,” a reflection of this world without suffering and frustrations? In this respect the ars moriendi was cultivating something else: impermanence... (shrink)

There is a massive amount of severe suffering and death in the world, and much of this suffering and death is out of our control. The amount and severity of suffering and death in the world can be used to make an argument for (or elicit a reaction against) the existence of God: if God—an all-powerful, all-knowing, and all-good being—exists, God would not allow such massive amounts of suffering and death. I'll propose (...) a line of response that begins by exploring what would be involved in taking a new perspective on the suffering and death in the world. I then argue that there is no good reason not to take that new perspective. If this is correct, the argument from (or reaction to) suffering and death to the conclusion that God doesn't exist has lost much of its force; an argument that seems forceful from one perspective is weak from a different perspective that is just as reasonable, or more reasonable, to take. (shrink)

The basic challenge that readers of the New Testament face is not only about what Jesus Christ teaches but who he is. Functional Christology has developed at the expense of ontological Christology. This challenge centres on Jesus Christ’s relevance, in terms of his identity, not only for Christians in particular but also for creation as a whole. The question ‘who is Jesus Christ in relation to creation?’ is thus of special interest to this study. Various authors such as Gunton, Gregersen, (...) Peacocke and others have approached this question from different perspectives. The PhD study by Rabie-Boshoff was completed to shed light into the context of dialogue between Christian theology and the science of linguistics in an effort to understand the Genesis 1 creation story. This article refers to part of the study in an effort to make sense of who Jesus Christ is in relation to creation. This provides consolation in a time of worldwide lockdown because of the Coronavirus Disease 2019 virus. The human struggle of making sense of the world is brought into sharp focus in times like these, more so in terms of making sense of their creatureliness and mortality. Although science as a valid knowledge base may provide some answers to this human dilemma, Christians in particular appeal to the Bible and their belief in Jesus Christ. This turn to Jesus, and who he is, provides human beings with enduring and satisfying answers to their suffering and pain.Contribution: This article is an attempt to contribute to the ongoing discussion on creation in terms of how human beings make sense of creation, considering who Jesus Christ is in relation to creation. Human beings have always been engaged in a process of making sense of the world they live in. Ancient cultures provide such a window, allowing a glimpse into how those cultures perceived their world. (shrink)

Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often (...) asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate. (shrink)

La relación de discrepancia y coincidencia de las causas de muerte entre el diagnóstico clínico y anatomopatológico constituye de forma indirecta un indicador de calidad de la atención médica. Son múltiples los ejemplos de enfermedades descubiertas o esclarecidas gracias a la autopsia, que tiene en la correlación clinicopatológica un basamento fundamental. Se estableció como objetivo de investigación describir los principales vínculos históricos entre las especialidades de medicina interna y anatomía patológica, que tienen como enlace esencial la correlación clínico patológica, atendiendo (...) a que no puede existir contradicción antagónica entre enfermo y enfermedad; la medicina interna y la anatomía patológica no pueden verse aisladas ni separadas. The difference and similarity relationship of death causes between the clinical and anatomy-pathological diagnosis is, indirectly, a medical care quality indicator. Thanks to autopsy, which has the clinical-pathological correlation as a main basis, numerous diseases have been discovered or clarified. Discovering the main historical relations between Internal Medicine and Pathological Anatomy specialties was established as the objective of the research. These specialties have the clinical-pathological correlation as a main link, taking into account that there cannot be a conflicting contradiction between the sick and the disease; Internal Medicine and Pathological Anatomy cannot be seen in an isolated or separate way. (shrink)

In the context of animal experimentation, laboratory workers fluctuate between seeing animals used in research as tools or objects and seeing them as sentient living beings. Most laboratory workers do not wholly lose their empathy and their ability to connect with other living beings. To deal with the fact that their job involves harming and killing animals on a regular basis, they employ various coping strategies, such as rationalizing the use of animals in research and minimizing their emotional attachment to (...) the animals. The evidence compiled in this article suggests that researchers, technicians, and caregivers who are involved in animal experimentation experience stress, anxiety, guilt, and trauma. I conclude that inflicting pain and death on nonhuman animals causes laboratory workers to suffer as well. Thus, in animal research, the suffering of nonhuman animals and humans is directly linked. The consideration of human suffering adds another dimension to ethical discussions of animal research, namely the relation between the suffering of human and nonhuman animals. A comprehensive ethical discussion of animal experiments should therefore include the suffering of nonhuman animals, the suffering of humans, and the relation between the two. (shrink)

Animal Suffering and Public Relations conducts an ethical assessment of public relations, mainly persuasive communication and lobbying, as deployed by some of the main businesses involved in the animal industrial complex - the industries participating in the systematic and institutionalized exploitation of animals. Society has been experiencing a growing ethical concern regarding humans' (ab)use of other animals. This is a trend first promoted by the development of animal ethics - which claims any sentient being, because of sentience, deserves moral (...) consideration - and more recently by other approaches from the social sciences, including critical animal studies. In this volume, we aim to start an entirely unaddressed discussion within the field of public relations: the need to problematize the ethics of persuasion when nonhuman animal suffering is involved, particularly the impact of persuasion and lobbying on compassion towards other animals in the cases of food, experimentation, entertainment and environment management. The books provides an interdisciplinary, theoretical discussion illustrated with international case studies from experts in strategic communication, public relations, lobbying and advocacy, animal ethics, philosophy of law, political philosophy and social psychology. This unique book merges the fields of critical public relations, animal ethics and critical animal studies and will be of direct appeal to a wide range of researchers, academics and doctoral students across related fields. (shrink)