Aim To study the views of people in a largely Muslim country, Kuwait, of the acceptability of a life-ending action such as physician-assisted suicide (PAS). Method 330 Kuwaiti university students judged the acceptability of PAS in 36 scenarios composed of all combinations of four factors: the patient's age (35, 60 or 85 years); the level of incurability of the illness (completely incurable vs extremely difficult to cure); the type of suffering (extreme physical pain or complete dependence) and the extent to (...) which the patient requests a life-ending procedure, euthanasia or PAS (no request, some form of request, repeated requests). In all scenarios, the patients were women who were receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Results Five clusters were found. For 44%, PAS was always very unacceptable, no matter what the circumstances. For 23%, it was unacceptable, but less so if the patient was older or requested it repeatedly. For 16%, it was unacceptable if the patient was young but was acceptable if the patient was elderly. For 5%, it was unacceptable if the patient had extreme pain but was acceptable if completely dependent. For 11%, it was unacceptable if the patient did not request it but acceptable if she did. Conclusion The majority of the Kuwaiti university students opposed PAS either categorically or with a slight variation according to circumstances. Nonetheless, a minority approved of PAS in some cases, particularly when the patient was elderly. (shrink)

Basic disagreements about what makes human life valuable hinder use of the concept of futility to decide whether it is appropriate to continue life support for one in a permanent state of unconsciousness, or to provide intensive medical care to one in the last stages of a terminal illness (the “paradigm cases”). Triage planning (the process of establishing criteria for health care prioritization) is an attractive alternative framework for addressing the paradigm cases. Triage planning permits society to see the cases (...) in the context of diverse moral perspectives, limited resources, and competing health care demands. Furthermore, at least one essential question posed by the paradigm cases is whether treatment is wasteful, and triage planning is a useful model for identifying and eliminating wasteful medical care. The authors describe how triage planning can be implemented to address the paradigm cases, and conclude that it offers one way of moving debate about these cases beyond futility. (shrink)

The Health Protection Agency has recently attempted to create a postmortem tissue archive to determine the prevalence of abnormal prion protein. The success of this archive was prevented because the Health Protection Agency could not convince coroners to support the study’s methodology and participate on that basis. The findings of this paper detail and support the view that the Coroners’ Society of England and Wales’s refusal to participate was misguided and failed to appreciate that coroners have a moral obligation to (...) protect public health. Measures to assist coroners in fulfilling this role are proposed. (shrink)

The volume presents essays on the philosophical explanation of the relationship between body and soul in antiquity from the Presocratics to Galen. The title of the volume alludes to a phrase found in Plato, Aristotle and Plotinus, referring to aspects of living behaviour involving both body and soul, and is a commonplace in ancient philosophy, dealt with in very different ways by different authors.

Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. Objective: To identify and describe family caregivers’ experiences regarding care decisions for situations (...) that can lead to involuntary treatment use in persons living with dementia at home. Research design: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. Participants and research context: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. Ethical consideration: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. Findings: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad such as practical and emotional support, knowledge, and previous experiences. Discussion and conclusion: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations. (shrink)

Neuroscientists are searching for the engram within the conceptual framework established by John Locke's theory of mind. This framework was elaborated before the development of information theory, before the development of information processing machines and the science of computation, before the discovery that molecules carry hereditary information, before the discovery of the codon code and the molecular machinery for editing the messages written in this code and translating it into transcription factors that mark abstract features of organic structure such as (...) anterior and distal. The search for the engram needs to abandon Locke's conceptual framework and work within a framework informed by these developments. The engram is the medium by which information extracted from past experience is transmitted to the computations that inform future behavior. The information-conveying symbols in the engram are rapidly generated in the course of computations, which implies that they are molecules. (shrink)

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)

Papers presented at a symposium on philosophy and medicine at the Institute for the Medical Humanities at the University of Texas Medical Branch in 1974 were published in the inaugural volume of this series.

Comprehending the origin of marine invertebrate larvae remains a key domain of research for evolutionary biologists, including the repeated origin of direct developmental modes in echinoids. In order to address the latter question, we surveyed existing evidence on relationships of homology between the ectoderm territories of two closely related sea urchin species in the genus Heliocidaris that differ in their developmental mode. Additionally, we explored a recently articulated idea about homology called ‘organizational homology’ (Muller 2003. In: Muller GB, Newman SA, (...) editors. Origination of organismal form: beyond the gene in developmental and evolutionary biology. Cambridge, MA: A Bradford Book, The MIT Press. p 51–69. ) in the context of this specific empirical case study. Applying the perspective of organizational homology to our experimental system of congeneric echinoids has led us to a new hypothesis concerning the ectoderm evolution in these species. The extravestibular ectoderm of the direct developer Heliocidaris erythrogramma is a novel developmental territory that arose as a fusion of the oral and aboral ectoderm territories found in indirect developing echinoids such as Heliocidaris tuberculata. This hypothesis instantiates a theoretical principle concerning the origin of developmental modules, ‘integration’, which has been neglected because the opposite theoretical principle, ‘parcellation’, is more readily observable in events such as gene duplication and divergence (Wagner 1996. Am Zool 36:36–43). J. Exp. Zool. (Mol. Dev. Evol.) 306B:18– 34, 2006. (shrink)

This paper examines the identity of Asian swamp buffalo (Bubalus bubalis) from different value orientations. Buffalo were introduced into Northern (Top End) Australia in the early nineteenth century. A team of transdisciplinary researchers, including an ethicist, has been engaged in field research on feral buffalo in Arnhem Land over the past three years. Using historical documents, literature review, field observations, interviews with key informants, and interaction with the Indigenous land owners, an understanding of the diverse views on the scientific, cultural, (...) and economic significance of buffalo was obtained. While the diverse stakeholders in buffalo exploitation and management have historically delivered divergent value orientations on the nature of the human–buffalo relationship, we argue that over time there is the possibility of values and ethical convergence. Such convergence is possible via transdisciplinary and transcultural agreement on the value stances that constitute the construction of the being or identity of buffalo in the face of the overwhelming need to manage population density and gross numbers. (shrink)

The title may be understood in three ways. Firstly, the truth under study is the truth about freedom. We speak of the truth of something, in as much as we presume that there are many misconceptions about that something, and it stands in need of clarification. Thus, the many misconceptions about freedom will have to be divested, if freedom is to be rightly grasped. Secondly, in the sense that there is a truth in the core of freedom, indeed, truth is (...) the essence of freedom. If truth is to be rightly grasped, its core has to be penetrated. Thirdly, there is a deeper relation between truth and freedom. Freedom cannot be understood, much less rightly practised, if we do not comprehend the necessary relation that freedom bears to truth. This essay purports to study all three senses, not quite generally, but with special reference to Ratzinger, the German theologian-cum-phenomenologist of religion, who also happens to be the current pope Benedict XVI of the Catholic Christianity. The study proceeds in three stages. First of all, I will give the statement of the problem. Secondly, I will briefly dwell on the modern Western history of freedom. Thirdly, I will study the interface between freedom and truth, highlighting the nature of human freedom, the relation between freedom and responsibility, and the relation between freedom and the truth of human existence itself. The essay is more interpretive than evaluative, with an eye to be as close to the insightful thoughts of Ratzinger as possible. (shrink)