Current research in Explainable AI includes post-hoc explanation methods that focus on building transparent explaining agents able to emulate opaque ones. Such agents are naturally required to be accurate and trustworthy. However, what it means for an explaining agent to be accurate and trustworthy is far from being clear. We characterize accuracy and trustworthiness as measures of the distance between the formal properties of a given opaque system and those of its transparent explanantes. To this aim, we extend Probabilistic Computation (...) Tree Logic with operators to specify degrees of accuracy and trustworthiness of explaining agents. We also provide a semantics for this logic, based on a multi-agent structure and relative model-checking algorithms. The paper concludes with a simple example of a possible application. (shrink)

The high predictive accuracy of contemporary machine learning-based AI systems has led some scholars to argue that, in certain cases, we should grant them epistemic expertise and authority over humans. This approach suggests that humans would have the epistemic obligation of relying on the predictions of a highly accurate AI system. Contrary to this view, in this work we claim that it is not possible to endow AI systems with a genuine account of epistemic expertise. In fact, relying on accounts (...) of expertise and authority from virtue epistemology, we show that epistemic expertise requires a relation with understanding that AI systems do not satisfy and intellectual abilities that these systems do not manifest. However, recent developments of large language models make us argue that in the future AI systems may endowed with a form of epistemic authority. Further, following the Distributed Cognition theory and adapting an account by Croce on the virtues of collective epistemic agents to the case of human-AI interactions we show that, if an AI system is successfully appropriated by a human agent, a hybrid epistemic agent emerges, which can become both an epistemic expert and an authority. Consequently, we claim that the aforementioned hybrid agent is the appropriate object of a discourse around trust in AI and the epistemic obligations that stem from its epistemic superiority. (shrink)

Human-centered explainable AI (HCXAI) advocates for the integration of social aspects into AI explanations. Central to the HCXAI discourse is the Social Transparency (ST) framework, which aims to make the socio-organizational context of AI systems accessible to their users. In this work, we suggest extending the ST framework to address the risks of social misattributions in Large Language Models (LLMs), particularly in sensitive areas like mental health. In fact LLMs, which are remarkably capable of simulating roles and personas, may lead (...) to mismatches between designers' intentions and users' perceptions of social attributes, risking to promote emotional manipulation and dangerous behaviors, cases of epistemic injustice, and unwarranted trust. To address these issues, we propose enhancing the ST framework with a fifth 'W-question' to clarify the specific social attributions assigned to LLMs by its designers and users. This addition aims to bridge the gap between LLM capabilities and user perceptions, promoting the ethically responsible development and use of LLM-based technology. (shrink)

Many enzymes are inhibited by their own substrates, leading to velocity curves that rise to a maximum and then descend as the substrate concentration increases. Substrate inhibition is often regarded as a biochemical oddity and experimental annoyance. We show, using several case studies, that substrate inhibition often has important biological functions. In each case we discuss, the biological significance is different. Substrate inhibition of tyrosine hydroxylase results in a steady synthesis of dopamine despite large fluctuations in tyrosine due to (...) meals. Substrate inhibition of acetylcholinesterase enhances the neural signal and allows rapid signal termination. Substrate inhibition of phosphofructokinase ensures that resources are not devoted to manufacturing ATP when it is plentiful. In folate metabolism, substrate inhibition maintains reactions rates in the face of substantial folate deprivation. Substrate inhibition of DNA methyltransferase serves to faithfully copy DNA methylation patterns when cells divide while preventing de novo methylation of methyl‐free promoter regions. (shrink)

The dynamics-from-permutations of classical Ising spins is generalized here for an arbitrarily long chain. This serves as an ontological model with discrete dynamics generated by pairwise exchange interactions defining the unitary update operator. The model incorporates a finite signal velocity and resembles in many aspects a discrete free field theory. We deduce the corresponding Hamiltonian operator and show that it generates an exact terminating Baker–Campbell–Hausdorff formula. Motivation for this study is provided by the Cellular Automaton Interpretation of Quantum Mechanics. (...) We find that our ontological model, which is classical and deterministic, appears as if of quantum mechanical kind in an appropriate formal description. However, it is striking that small deformations of the model turn it into a genuine quantum theory. This supports the view that quantum mechanics stems from an epistemic approach handling physical phenomena. (shrink)

A new theory for basic function in the nervous system has recently been proposed (Dempsher, J., 1979a, 1979b; 1980, 1981). The major basic themes of the new theory are as follows: (1) There are two fundamental units of structure and function, the fibre or conducting mechanism, and the neurocentre, where nervous system function as we know it takes place. (2) The nerve impulse is regarded as a mathematical event. The mathematics is the result of a prescribed fusion of energy and (...) matter. (3) Nervous system function everywhere in the nervous system is mathematical. In the fibre, the prescribed fusion of energy and matter results in a number. In the neurocentre, the prescribed fusion of energy and matter results in a mathematical function. Basic function in the nervous system everywhere requires a transformation of a nerve impulse in the fibre into a nerve impulse in the neurocentre with opposing properties: The nerve impulse in the fibre is confined to the fibre; cannot sum with another nerve impulse; can travel long distances with constant form and velocity; curvature in space and time are not significant features; and it is regarded as a number. On the other hand, the nerve impulse in the neurocentre is confined to the neurocentre; can sum with other nerve impulses; cannot travel long distances - even in a very short distance, it changes form; curvature in space and time is a very significant feature; and it is regarded as a mathematical function.The approach to determine how one form of the nerve impulse is transformed into the other at the input region is based on two of the differences listed above: (1) The nerve impulse in the fibre cannot sum with another nerve impulse in the fibre, whereas in the neurocentre, several nerve impulses sum to form a larger nerve impulse. (2) The nerve impulse in the fibre is regarded as a number, in the neurocentre, it is regarded as a mathematical function. The commonality of (1) and (2) is that the properties defining the nerve impulse in the fibre are associated with the property ofdiscreteness, whereas, the properties defining the nerve impulse in the neurocentre are associated with the property ofcontinuousness. Thus, the basic theme of unification of function at the input region of the neurocentre is the transformation of a phenomenon with the property of discreteness into a phenomenon with the property of continuousness. The solution to this transformation is approached from two directions:biologic andmathematical. In the biologic approach, the unit element of the nerve impulse in the fibre terminations (as.u. as a wave of energy, a spike in the classical theory) fuses with a. calcium-binding protein causing the release of Ca++. The calcium ions then combine with another protein. Associated with the second reaction is a conformational change in the Ca++-protein complex and the unit element in the neurocentre, bs.u., is emitted. Individual bs.u. then fuse with acetylcholine; summation occurs andwave b is emitted. In the mathematical approach, the nerve impulse as a number, is partitioned into two numbers with a precise rule relating these two numbers. One possibility suggested is that the number can be regarded as the value of a trigonometric function. This value then gives rise to an angle with sides related in a ratio or proportionality fashion — a relationship with the property of continuousness, as contrasted with that of a single number, discreteness. Both biologic and mathematical approaches are united so as to suggest that the mathematical (trigonometric) function arose as the result of a fusion of energy (as.u. as a wave of energy) and the calcium-binding protein as matter; following this reaction, bs.u., with opposing properties, is emitted. (shrink)

An analytical investigation into compressible gas flow with slight rarefactions through the insect trachea and tracheoles during the closed spiracle phase is undertaken, and a complete set of asymptotic analytical solutions is presented. We first obtain estimates of the Reynolds and Mach numbers at the channel terminal ends where the tracheoles directly deliver respiratory gases to the cells, by comparing the magnitude of the different forces in the compressible gas flow. The 2D Navier–Stokes equations with a slip boundary condition (...) are used to investigate compressibility and rarefied effects in the trachea and tracheoles. Expressions for the velocity components, pressure gradients and net flow inside the trachea are then presented. Numerical simulations of the tracheal compressible flow are performed to validate the analytical results from this study. This work extends previous work of Arkilic et al. :167–178, 1997) on compressible flows through a microchannel. Novel devices for microfluidic compressible flow transport may be invented from results obtained in this study. (shrink)

ABSTRACT In this journal, Middleton and Murgueitio Ramírez argue that absolute velocity is measurable, contrary to the received wisdom. Specifically, they claim that ‘there exists at least one reasonable analysis of measurement according to which the speedometer in [a world called “the Basic World”] measures the absolute velocity of the car.’ In this note, I critically respond to that claim: the analysis of measurement that Middleton and Murgueitio Ramírez propose is not reasonable; nor does it entail that absolute (...) velocities are measurable. (shrink)

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. -/- Popular and academic discourse about assisted suicide paradigmatically focuses on (...) individuals with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)

ABSTRACT There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called ‘early terminal sedation’. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and (...) nutrition, even if these are life‐sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase. Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine. (shrink)

Movement, Velocity, and Rhythm from a Psychoanalytic Perspective: Variable Speed(s) explores philosophical and psychoanalytic theories, as well as artworks, that show sensible bodily rituals for reviving our social and subjective lives. With a wide range of contributors from interdisciplinary backgrounds, it informs readers on how to find rituals for syncing ourselves with others and world rhythms. It will be essential reading for Lacanian psychoanalysts in practice and in training, as well as anyone interested in rhythm at the intersection of (...) Lacanian psychoanalysis and continental philosophy. (shrink)

Starting from the formal expressions of the hydrodynamical (or “local”) quantities employed in the applications of Clifford algebras to quantum mechanics, we introduce—in terms of the ordinary tensorial language—a new definition for the field of a generic quantity. By translating from Clifford into tensor algebra, we also propose a new (nonrelativistic) velocity operator for a spin- ${\frac{1}{2}}$ particle. This operator appears as the sum of the ordinary part p/m describing the mean motion (the motion of the center-of-mass), and of (...) a second part associated with the so-called Zitterbewegung, which is the spin “internal” motion observed in the center-of-mass frame (CMF). This spin component of the velocity operator is nonzero not only in the Pauli theoretical framework, i.e., in the presence of external electromagnetic fields with a nonconstant spin function, but also in the Schrödinger case, when the wavefunction is a spin eigenstate. Thus, one gets even in the latter case a decomposition of the velocity field for the Madelung fluid into two distinct parts, which constitutes the nonrelativistic analogue of the Gordon decomposition for the Dirac current. Explicit calculations are presented for the velocity field in the particular cases of the hydrogen atom, of a spherical well potential, and of an electron in a uniform magnetic field. We find, furthermore, that the Zitterbewegung motion involves a velocity field which is solenoidal, and that the local angular velocity is parallel to the spin vector. In the presence of a nonuniform spin vector (Pauli case) we have, besides the component of the local velocity normal to the spin (present even in the Schrödinger theory), also a component which is parallel to the curl of the spin vector. (shrink)

Highly malignant neuroepithelial tumors are known for their extensive tissue invasion. Investigating the relationship between their spatial behavior and temporal patterns by employing detrended fluctuation analysis (DFA), we report here that faster glioma cell motility is accompanied by both greater predictability of the cells' migration velocity and concomitantly, more directionality in the cells' migration paths. Implications of this finding for both experimental and clinical cancer research are discussed.

The Termination Thesis (or “TT”) is the view that people go out of existence when they die. Lots of philosophers seem to believe it. Epicurus, for example, apparently makes use of TT in his efforts to show that it is irrational to fear death. He says, “as long as we exist, death is not with us; but when death comes, then we do not exist.”1 Lucretius says pretty much the same thing, but in many more words and more poetically: “Death (...) therefore to us is nothing, concerns us not a jot, since the nature of the mind is proved to be mortal; . . . when we shall be no more, when there shall have been a separation of body and soul, out of both of which we are each formed into a single being, to us, you may be sure, who then shall be no more, nothing whatever can happen to excite sensation.”. (shrink)

The theoretical aspects and practical application of the termination of an employment contract upon an employee’s notice are analyzed in the paper. An employee can terminate an employment contract by his/her notice either without specifying any reason or due to some serious reasons. The problems of the regulation of the grounds for the exipiry of an employment contract are discussed and analyzed by comparison with the corresponding regulations in other European countries. Rulings of the Supreme Court of the Republic of (...) Lithuania are discussed to reveal the problems existing in practice. Conclusions and suggestions for the improvement of laws providing conditions for homogeneous interpretation of legal provisions are presented. (shrink)

Zeno argued that since at any instant an arrow does not change its location, the arrow does not move at any time, and hence motion is impossible. I discuss the following three views that one could take in view of Zeno's argument:(i) the "at-at" theory, according to which there is no such thing as instantaneous velocity, while motion in the sense of the occupation of different locations at different times is possible,(ii) the "impetus" theory, according to which instantaneous velocities (...) do exist but these are only contingently and causally related to the temporal developments of positions,(iii) the "no instants" theory, according to which instants in time do not exist, and hence instantaneous velocities do not exist, while motion, in the sense of different areas occupied during different time intervals, is possible.I argue that, despite the fact that there have been interesting and relevant developments in mathematics and physics since the time of Zeno, each of these views still has serious drawbacks. (shrink)

The movie, The terminal, is used to illustrate Mac Intyre's description of virtue ethics. The terminal is a mythical tale about a traveler, Viktor Navorski, who is stranded by circumstances in a New York airport. Viktor is a person who, without a strict reliance on duty or rules, has developed the disposition to act well despite variation in his circumstances. His character is revealed in contrast to that of three other characters: a cleaner, a flight attendant and the (...) airport manager. Stories like this one may be a good way to open dialogue among clinicians about being virtuous as a practitioner. Such dialogue may make striving to be virtuous an acceptable goal for practitioners and less like an idealistic, pseudo-goal for those aiming for sainthood. (shrink)

ABSTRACT We argue that Roberts’s argument for the thesis that absolute velocity is not measurable in a Newtonian world is unsound, because it depends on an analysis of measurement that is not extensionally adequate. We propose an alternative analysis of measurement, one that is extensionally adequate and entails that absolute velocity is measured in at least one Newtonian world. If our analysis is correct, then this Newtonian world is a counterexample to the widely endorsed thesis that if a (...) property varies under the symmetries of a theory then, according to that theory, the property could not be measured. Thus, our paper shows that the debate over the measurability of symmetry-variant properties is more unsettled than previously supposed. (shrink)

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one (...) or more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

Terminale Sedierung ist unter bestimmten Umständen ethisch rechtfertigbar: Mit dem Wissen um die Begrenztheit des eigenen Lebens ist auch der Sterbeprozess ein bewusst zu gestaltender, dem eigenen Willen unterworfener Bestandteil des Lebens. Das schließt auch die (paradoxe) Möglichkeit ein, bewusst auf das Bewusstsein beim eigenen Sterben zu verzichten. Anhand eigener Studien kann der Autor zeigen, dass sich der Wunsch nach Sterbehilfe bei terminal kranken Menschen als die Folge einer konsequenten Einordnung in das System der Medizin deuten lässt. Infolgedessen begreifen (...) Patienten auch das Sterben als eine Aufgabe des Medizinsystems, so dass sie ärztliche Sterbehilfe als Ausdruck für ein menschenwürdiges Sterben, paradoxerweise sogar als natürlichen Tod auffassen können. In dieser Situation ermöglicht die terminale Sedierung einen Fortschritt: Das Medizinsystem kann der von ihm erwarteten Zuständigkeit für den Prozess des Sterbens nachkommen, ohne direkt und intentional zu töten. Trotzdem bleiben bezüglich der Missbrauchsmöglichkeiten, der Rollenkonfusion der Ärzte und der Grenzen menschlicher Handlungsräume Zweifel. Vor der „Illusion der glatten Lösungen“ (H. Thielicke) wird gewarnt und für den Versuch geworben, das jeweils Beste für die einzelnen Betroffenen zu erreichen. (shrink)

Historically, the hypothesis that our world is a computer simulation has struck many as just another improbable-but-possible “skeptical hypothesis” about the nature of reality. Recently, however, the simulation hypothesis has received significant attention from philosophers, physicists, and the popular press. This is due to the discovery of an epistemic dependency: If we believe that our civilization will one day run many simulations concerning its ancestry, then we should believe that we are probably in an ancestor simulation right now. This essay (...) examines a troubling but underexplored feature of the ancestor-simulation hypothesis: the termination risk posed by both ancestor-simulation technology and experimental probes into whether our world is an ancestor simulation. This essay evaluates the termination risk by using extrapolations from current computing practices and simulation technology. The conclusions, while provisional, have great implications for debates concerning the fundamental nature of reality and the safety of contemporary physics. (shrink)

A null 4-vector ε°σμε, based on Dirac's relativistic electron equation, is shown explicitly for a plane wave and various Coulomb states. This 4-vector constitutes a mechanical “model” for the electron in those states, and expresses the important spinor quantities represented conventionally byn, f, g, m, j, κ,1, ands. The model for a plane wave agrees precisely with the relation between velocity and phase gradient customarily used in quantum theory, but the models for Coulomb states contradict that relation.

Slow euthanasia or a good palliative intervention?There are many ways in which doctors influence the circumstances and/or the timing of a patient’s death. Some of these are accepted as normal medical practice—for instance, when a disproportional treatment is forgone, others are considered tolerable only under strict conditions or even intolerable, such as non-voluntary active euthanasia. A relatively new phenomenon in the ethical discussion on end-of-life decisions is terminal sedation. Terminal sedation is used in patients with terminal illnesses (...) where normal medical treatments cannot relieve severe symptoms such as pain and agitation, and no option is left but to take away the perception of these symptoms. Often, the decision to start terminal sedation is accompanied by the decision to forgo the provision of artificial nutrition and hydration in these patients. In The Netherlands, terminal sedation was estimated to be applied in 4–10% of all deaths in 2001.1 The combination of these two decisions have made the moral status of terminal sedation the subject of fierce ethical debates. Is it slow euthanasia2,3 or is it a good palliative intervention that should be sharply distinguished from euthanasia?4,5 One of the characteristics of this debate is that it is a very confused one: people disagree about the meaning of the term, the appropriateness of it and, of course, about the conditions under which it would be morally justified. As a matter of fact, these three discussions are deeply connected: as is often the case, a discussion about terms is a discussion about norms in disguise.The first observation to be made is that many seemingly descriptive definitions of terminal sedation contain normative claims. Examples of this are definitions of terminal sedation in which only …. (shrink)

“Terminal sedation” refers to the use of sedation as palliation in dying patients with a terminal diagnosis. Although terminal sedation has received widespread legal and ethical justification, the practice remains ethically contentious, particularly as some hold that it foreseeably hastens death. It has been proposed that empirical studies show that terminal sedation does not hasten death, or that even if it may hasten death it does not do so in a foreseeable way. Nonetheless, it is clear (...) that providing terminal sedation in combination with the withholding or withdrawing of life-prolonging treatments such as fluid and nutrition can foreseeably hasten death significantly—what is here called early terminal sedation . There are ethical justifications for the use of sedation in palliative care and thus it would seem that ETS is an ethically and legally acceptable practice. However, what emerges from the literature is the repeated assertion that terminal sedation must be restricted to use in imminently dying patients—the “imminence condition”—and that therefore ETS is unacceptable. This restriction has taken on greater significance with the trend of palliative care to include the care of patients who are not imminently dying. This paper proposes to show that although there is widespread intuitive support for the imminence condition, it does not follow from the justifications for sedation as palliation, and that explicit arguments for the imminence condition are needed. (shrink)

Absolute velocities in Newtonian mechanics are commonly regarded as unmeasurable. Roberts (Br J Philos Sci 59(2):143–168, 2008) provides a justification for this thesis which appeals to the observational indistinguishability of boost-related models of Newtonian mechanics. Middleton and Murgueitio Ramírez (Australas J Philos, 2020) criticise his argumentation by pointing out that his analysis of the notion of measurement is too restrictive, and that, under a weaker analysis (based on counterfactuals), absolute velocities are measurable. Jacobs (Australas J Philos, 2020) opposes their view, (...) arguing that, on a properly formulated counterfactual-based account of measurement, absolute velocities are unmeasurable. However, in his argument, observational indistinguishability plays no role, even though, intuitively, it is very relevant for the issue of (un)measurability. This paper’s aim is to bring observational indistinguishability back to this discussion. I build upon the observation that there is an analogy between possible views on knowledge and justification on the one hand, and on measurement on the other. In particular, I explore the distinction between externalist and internalist approaches. Counterfactual-based accounts are all externalist, whereas the observational indistinguishability of boost-related models becomes relevant if we are interested in an internalist concept of measurement. (shrink)

We will examine Kepler's use of a relation between velocity and distance from a centre of circular motion. This relation plays an essential role, through a derivation in chapter 40 of the Astronomia Nova, in the presentation of the Area Law of planetary motion. Kepler transcends ancient and contemporary applications of the distance-velocity relation by connecting it with his metaphysical commitment to the causal role of the Sun. His second main innovation is to replace the astronomical models of (...) his predecessors with an account that derives trajectories from physical principles. In this paper we restrict our attention primarily to the first 40 chapters of Kepler's Astronomia Nova. Hence, we do not discuss Kepler's discovery of elliptical planetary orbits. (shrink)

Gilbertson et al should be commended for their insightful exploration of expanded terminal sedation (ETS)1; however, there are a number of concerns that I will address in this response. I will first better characterise the currently accepted and commonplace ‘standard’ TS (STS), and then argue that the advocated forms of ETS draw very close to—and at times clearly constitute a subtype of—euthanasia, as opposed to representing a similar but separate practice. I will then conclude with concerns regarding the inappropriate (...) application of ETS, particularly in the non-voluntary context. Gilbertson et al distinguish ‘gradual’ TS, which they state is the currently accepted form of TS, from ‘rapid’ TS, which is then argued to be a justifiable form of ETS. However, in my experience working in multiple large public teaching hospitals in New South Wales, Australia and consistent with local clinical practice guidelines,2 3 STS falls somewhere in the middle between ‘gradual’ and ‘rapid’ TS. STS explicitly aims to achieve permanent unconsciousness so as to eliminate the potential for (and therefore relieve) suffering; conversely, lighter or more intermittent forms of sedation, or administering sedatives with aims other than to achieve unconsciousness (eg, anxiolysis), do not constitute TS proper. STS uses doses proportionate to the extent of symptoms so as to avoid ‘overshooting’ and inadvertently administering excessive doses which actually hasten/cause death, in order to distinguish STS from euthanasia in this respect. This is achieved by gradually uptitrating doses when the patient appears distressed, and is therefore by definition …. (shrink)

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)

Abstract:Recent contributions to the medical literature have raised yet again the issue of whether the term “terminal” is an intelligible one and whether there is a consensus view of its meaning that is sufficient to justify or even require its use in discussing end-of-life care and treatment options with patients. Following a review of the history and development of informed consent, persistent problems with the communication of prognosis and the breaking of bad news are analyzed. The author argues that (...) candid but compassionate communication between physicians and patients about prognosis is essential to informed decisions about both disease-directed (curative) and palliative therapies. (shrink)

Background: The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended-at the time-on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Sources of data: Existing ethics and health policy literature on the (...) topic of access to experimental drugs. Areas of agreement: The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. Areas of controversy: At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients-the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to Phase 1 agents for terminally ill patients. Growing points: Finding a compromise between providing free or no access to Phase 1 drugs for terminally ill patients. Areas timely for developing research: We ought to investigate means to increase access to experimental drugs for terminally ill patients without sacrificing necessary clinical trials' sounds scientific methods. (shrink)

People are often involuntarily laid off from their jobs through no fault of their own. Employees who are dismissed in this manner cannot always legitimately hold employers accountable for these miserable situations because the decision to implement layoffs is often the best possible outcome given the context—that is, layoffs in and of themselves may be “necessary evils.” Yet, even in circumstances in which layoffs qualify as “necessary evils,” morality demands that employers respect the dignity of those whose employment is involuntarily (...) terminated. In this paper I argue that to preserve the dignity of employees who are involuntarily terminated, in most cases employers have a substantial reason to offer a special kind of unemployment benefit, “severance pay.” To support my claim I draw and expand upon Bernard Williams’s analysis of “agent-regret,” which I believe greatly helps to address and articulate employers’ obligations in the context of involuntary termination. (shrink)

Maybe they should never have called the first movie The Terminator. After all, there’s more than one Terminator. That may seem like a picky point, but, believe it or not, philosophers have long been obsessed with trying to determine the meaning of the word “the.†Indeed, much controversy swirls around this seemingly innocuous definite article. Specifically, the controversy focuses on whether or not definite descriptions are ambiguous.

Gilbertson et al present a considered analysis of the abstract problem of ‘sedation’ at the end of life,1 and it is reassuring to see the separation of multiple practises that are often grouped under the heading terminal sedation. In their work, the authors attempt to introduce and justify a new practice in the care of those dying with significant suffering—expanded terminal sedation (ETS). This analysis will not, however, help our colleagues at the bedside. Here, we will focus on (...) the flaws which are most relevant to clinicians: jurisdiction, uncertainty and reversibility. The authors’ focus on a jurisdiction that does already allow medically assisted in dying confuses their analysis. For example, either an instance of their proposed ETS does amount to intentionally hastening death, in which case it should be treated as a means of euthanasia and practised only where that is permitted, subject to its limits and regulations; or it does not amount to intentionally hastening death, in which case there is no reason to specify such jurisdictions. To explain that the most controversial elements of terminal sedation have been tacitly ‘accepted’ by the society in question does not invalidate the concerns. It is beyond the scope of this response to explore these, but to us, …. (shrink)

Medical research involving human subjects can be risky and burdensome. Therefore, such research must be reviewed and approved by a Research Ethics Committee (REC). To guarantee the safety of the subjects, it is very important that these studies be conducted in accordance with the approved protocol. An important issue in this respect is whether studies include the requisite number of subjects based on the research question. The research question is unlikely to be answered reliably if the requisite number of subjects (...) is not met. In such cases, subjects are exposed to unnecessary risks and burdens. In this descriptive study, the authors evaluated how frequently studies are completed with the required number of subjects. Moreover, the authors identified the characteristics of research that does and does not include the required number of subjects. The results of this study show that a considerable proportion of studies (41/107) were terminated although they failed to recruit a sufficient number of subjects. Furthermore, the authors found that investigator-initiated studies have significantly (p=0.028) more problems in recruiting the requisite number of subjects than studies initiated by pharmaceutical companies. Potential solutions are discussed to reduce the number of studies that do not include a sufficient number of subjects. (shrink)