Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

The idea that the world, not only of man but also of nature, was subject to a continuous process of change has taken strong root since the beginning of the nineteenth century. In 1859, Charles Darwin demonstrated that these changes were the result of immutable, eternal laws - although everything was subject to change, it was only in accordance with these laws. from the second half of the nineteenth century down to the First World War, this vision of change and (...) determination was interpreted in many different ways, both pessimistically and optimistically. It is striking that a fear of degeneration often went hand in hand with a belief in an upward evolutionary process and was not confined to any particular political spectrum. This volume, number XIV in the series, contains the papers presented at a workshop on the reception and interpretation of the theory of evolution, organised by the editors in April 2003. It covers the many, often irreconcilable faces, of the theory of evolution concerning not only the concrete substantive interpretation but also the many different fields of late nineteenth century thought by concentrating on cultural life in the broadest sense - political, social, scientific and artistic, both literature and the visual arts. This volume illustrates the versatility of the concept of evolution, and of degeneration as well, with the emphasis on the Netherlands. It not only presents the contradictions and many-sidedness of the post-Darwinian world, but also the continuity with the world before 1860. Moreover, it reveals one clear co-ordinating theme, namely that the theory of evolution was used as justification for many different ideologies and practices. (shrink)

En Russie, après 1917, « la question des femmes » et la « la question sexuelle » ont fait l’objet de politiques publiques qui se voulaient éclairées par les sciences sociales. Après avoir été décrétées résolues sous Staline, ces questions ont pu être partiellement réouvertes avec le Dégel. Cet article explique comment, sur le temps long, ces sciences sociales supposées « socialistes » se sont distinguées des sciences « bourgeoises » moins par leur épistémologie que par la priorisation ou l’exclusion (...) de certaines problématiques, au gré des évolutions politiques du régime. Ainsi, les recherches sur la sexualité et le contrôle des naissances, avant-gardistes dans les années 1920, sont devenues relativement illégitimes après le dégel. Dans les années 1960-1980, c’était surtout la baisse de la natalité et le « double fardeau » – domestique et professionnel – des femmes qui faisaient problème. Les comportements familiaux semblaient étrangers à la logique de la planification, et les sciences sociales étaient travaillées par la perspective d’un art de gouverner d’orientation plus libérale. Il s’est alors formé un clivage qui est toujours d’actualité, entre une conceptualisation du changement social en termes de « modernisation » – démographique, sexuelle... – à accompagner, ou de « crise » à enrayer. (shrink)

Este estudo abordará a tese dos três mundos, TTM, de Karl Popper. A TTM como pluralista e interacionista opõe-se ao monismo e a algumas concepções dualistas. Em uma segunda parte, pretendemos enfocar a crítica de Jürgen Habermas quando tenta aplicar a TTM e o M3 (mundo três) na obtençáo de uma justificaçáo da teoria da açáo para a sociologia. Nesta crítica Habermas acaba negligenciando muitos objetivos claros da TTM e do M3 descritos por Popper, principalmente quando náo considera a TTM (...) como uma tese metafísica e como resposta ao problema corpo-mente. (shrink)

Can God be the efficient cause of himself (causa sui,)? It is well known that Descartes answers this question in the affirmative, but it is considerably less clear why. The main contention of the essay is that Descartes advances the causa sui doctrine because he came to think that the ontological proof of Meditation V required it. We argue these contentions through a close analysis of Descartes' initial articulation of causa sui in response to Caterus, followed by attention to the (...) reformulation of the doctrine in response to the logical objections posed by Arnauld. Our understanding of causa sui as a move made within the horizon of the ontological proof not only illuminates why Descartes would have defended a doctrine as conceptually problematic as causa sui, but also provides an alternative to Jean-Luc Marion's view that causa sui constitutes a third, distinct proof for the existence of God. /// Pode Deus ser a causa eficiente de si mesmo (causa sui,)? É bem sabido que Descartes responde aflrmativamente a esta questão, mas é consideravelmente menos claro porquê. O principal conteúdo do ensaio é que Descartes apresenta a doutrina da causa sui porque pensou que a prova ontológica da Meditação V precisava dela. Demonstramos estas afirmações através de uma análise rigorosa da articulação inicial de Descartes da causa sui em resposta a Caterus, seguida de uma atenção à reformulação da doutrina em resposta às objecções logicas apresentadas por Arnauld. A nossa compreensão da causa sui como proposta feita no horizonte da prova ontológica não ilumina apenas porque é que Descartes teria defendido uma doutrina conceptualmente tão problemática como a causa sui, mas também providencia uma alternativa ao ponto de vista de Jean-Luc Marion de que a causa sui constitui a terceira, prova distintapara a existência de Deus. (shrink)

In this paper, some fundamental aspects of societal change processes are described, leading to proposals of how to cope with such changes through continuous learning within society. This change society is presently emerging worldwide. It is very much shaped by advanced networked information and communication technology. Correspondingly, certain trends are identified in this paper which indicate the change processes towards this new emerging society. Subsequently, different personal skills are described which are required for all members of society to cope with (...) these trends. The paper finishes with a case study which deals with regional development through open networked business processes. The aim of the project described was to develop a joint family vacation concept in the former socialist East German state of Saxonia. Thus, it illustrates the change and learning processes across society which have taken place in many countries after the socialist era. (shrink)

Ces trois ouvrages collectifs, qui se complètent et se prolongent mutuellement, sont des exemples révélateurs du dynamisme des études de genre en Russie. A. Temkina et E. Zdravomyslova ont joué depuis les années 1990 un rôle incontournable dans l’institutionnalisation de ce champ de recherches, à la marge du système universitaire russe, et se revendiquent d’une « sociologie publique ». A. Rotkirch (finlandaise) est professeure à l’Université d’Helsinski et directrice du Population Research In...

Dans le contexte du régime autoritaire soviétique des années Brejnev, on ne saurait retrouver des mobilisations féministes ou de patientes autour de la gynécologie similaires à celles qui ont pu se déployer à l’Ouest. Néanmoins, des dissidentes féministes se sont emparées de ce sujet dans des publications clandestines du début des années 1980 (les samizdats), restées très confidentielles en URSS. Ensuite, pendant la perestroïka, un abondant courrier de lectrices publié dans le magazine féminin grand public Rabotnitsa a véhiculé des témoignages (...) et des revendications extrêmement similaires à ceux des dissidentes féminines. L’article mobilise ces deux corpus. Les militantes et les lectrices ont notamment dénoncé le manque de contraceptifs menant à des avortements à répétition, l’absence d’anesthésie lors des avortements et des accouchements, l’indifférence et la « cruauté » d’un personnel soignant débordé, travaillant « à la chaîne ». Certaines ont même parlé de « tortures » gynécologiques. Ces critiques ordinaires et féministes ont porté, plus largement, sur le manque de moyens du système de santé. Après avoir examiné les politiques publiques soviétiques en matière de santé sexuelle et reproductive, l’article analyse les processus par lesquels des frustrations largement partagées par les patientes en gynécologie ont pu être mises en discours et politisées. Une mise en perspective sur la base de comparaisons internationales permet également d’interroger les impensés de ces discours critiques. (shrink)

Cet ouvrage, issu d’une thèse soutenue en 2006, est parmi les premiers à aborder l’histoire soviétique sous l’angle de la mode et de la culture vestimentaire, et il s’agit d’une contribution unique grâce aux sources nombreuses et variées – archives étatiques et privées, presse, entretiens... – sur lesquelles il s’appuie. L’ouvrage de Larissa Zakharova vise à faire se rejoindre l’histoire « d’en haut » et l’histoire « d’en bas » en analysant l’articulation entre les attitudes officielles vis-à...

Despite similar health problems, older persons show different care seeking behaviours for a variety of reasons. The aim of this study was to identify motives underlying the attitudes of older persons to seek nursing care and to develop a theoretical rationale which allows viewing their mutual interaction. Theory development according to Walker and Avant was used as a method to derive a model from the reviewed literature. Six categories were identified that may influence seeking of nursing care: perceived threat, disposition, (...) external options & barriers, current coping abilities, influence of significant others, and outcome value. Findings do not allow determination of factors that may predict care seeking attitude but provide a loosely structured conceptual model for culture specific investigations. Qualitative studies guided by the model should be conducted in order to develop testable theories of care seeking for different cultures and settings. (shrink)

An adequate theory of rights ought to forbid the harming of animals to promote trivial interests of humans, as is often done in the animal-user industries. But what should the rights view say about situations in which harming some animals is necessary to prevent intolerable injustices to other animals? I develop an account of respectful treatment on which, under certain conditions, it’s justified to intentionally harm some individuals to prevent serious harm to others. This can be compatible with recognizing the (...) inherent value of the ones who are harmed. My theory has important implications for contemporary moral issues in nonhuman animal ethics, such as the development of cultured meat and animal research. (shrink)

Value capture occurs when an agent’s values are rich and subtle; they enter a social environment that presents simplified — typically quantified — versions of those values; and those simplified articulations come to dominate their practical reasoning. Examples include becoming motivated by FitBit’s step counts, Twitter Likes and Re-tweets, citation rates, ranked lists of best schools, and Grade Point Averages. We are vulnerable to value capture because of the competitive advantage that such crisp and clear expressions of value have in (...) our private reasoning and our public justification. There is, however, a price. In value capture, we take a central component of our autonomy — our ongoing deliberation over the exact articulation of our values — and we outsource it. And the metrics to which we outsource usually engineered for the interests of some external force, like a large-scale institution’s interest in cross-contextual comprehensibility and quick aggregability. That outsourcing cuts off one of the key benefits to personal deliberation. In value capture, we no longer adjust our values and their articulations in light of own rich experience of the world. Our values should often be carefully tailored to our particular selves or our small-scale communities, but in value capture, we buy our values off the rack. In some cases – like decreasing CO2 emissions – the costs of non-tailored values are outweighed by the benefit of precise collective coordination. In other cases, like in our aesthetic lives, they are not. This suggests that we should want different values suited to different scales. We should want value federalism. Some values are perhaps best pursued at the largest-scale level, others at smaller scales. The problem occurs when we exhibit an excess preference for the largest-scale values – when we consistently let the universal metrics swamp our quieter interests. (shrink)

In The Case for Animal Rights, Tom Regan argues that although all subjects-of-a-life have equal inherent value, there are often differences in the value of lives. According to Regan, lives that have the highest value are lives which have more possible sources of satisfaction. Regan claims that the highest source of satisfaction, which is available to only rational beings, is the satisfaction associated with thinking impartially about moral choices. Since rational beings can bring impartial reasons to bear on decision making, (...) Regan maintains that they have an additional possible source of satisfaction that nonrational beings do not have and, consequently, the lives of rational beings turn out to have greater value.. (shrink)

Анотація. У статті проаналізовані досягнення Соціального Вчительства Католицької Церкви, репрезентовані працями Лева ХІІІ, Пія ХІ, Пія ХІІ, Івана Павла ІІ, що розкривають змістовні характеристики поняття «принцип субсидіарності», його роль і значення в системі християнських цінностей. Принцип субсидіарності робить можливими такі взаємовідносини в соціальному житті, коли спільнота вищого порядку не втручається у внутрішнє життя спільноти нижчого порядку, перебираючи на себе належні тій функції; заради спільного добра, спільного блага вона надає їй у разі потреби підтримку й допомогу, узгоджуючи у такий спосіб її (...) взаємодію з іншими соціальними структурами. Принцип субсидіарності скеровує соціальну практику на утвердження спільного блага в людському співтоваристві. Поширення і застосування принципу субсидіарності протистоїть небезпеці «одержавлення» суспільства та найзагрозливіших проявів колективізму, обмежує абсолютизацію влади, бюрократизацію державних і соціокультурних структур, стає одним із гарантів дотримання прав і свобод громадян своєї країни. (shrink)

In her BBC Reith Lectures on Trust, Onora O’Neill offers a short, but biting, criticism of transparency. People think that trust and transparency go together but in reality, says O'Neill, they are deeply opposed. Transparency forces people to conceal their actual reasons for action and invent different ones for public consumption. Transparency forces deception. I work out the details of her argument and worsen her conclusion. I focus on public transparency – that is, transparency to the public over expert domains. (...) I offer two versions of the criticism. First, the epistemic intrusion argument: The drive to transparency forces experts to explain their reasoning to non-experts. But expert reasons are, by their nature, often inaccessible to non-experts. So the demand for transparency can pressure experts to act only in those ways for which they can offer public justification. Second, the intimate reasons argument: In many cases of practical deliberation, the relevant reasons are intimate to a community and not easily explicable to those who lack a particular shared background. The demand for transparency, then, pressures community members to abandon the special understanding and sensitivity that arises from their particular experiences. Transparency, it turns out, is a form of surveillance. By forcing reasoning into the explicit and public sphere, transparency roots out corruption — but it also inhibits the full application of expert skill, sensitivity, and subtle shared understandings. The difficulty here arises from the basic fact that human knowledge vastly outstrips any individual’s capacities. We all depend on experts, which makes us vulnerable to their biases and corruption. But if we try to wholly secure our trust — if we leash groups of experts to pursuing only the goals and taking only the actions that can be justified to the non-expert public — then we will undermine their expertise. We need both trust and transparency, but they are in essential tension. This is a deep practical dilemma; it admits of no neat resolution, but only painful compromise. (shrink)

Recent discussions in the just war literature suggest that soldiers have a duty to assume certain risks in order to protect the lives of all innocent civilians. I challenge this principle of risk by arguing that it is justified neither as a principle that guides the conduct of combat soldiers, nor as a principle that guides commanders in the US military. I demonstrate that the principle of risk fails on the first account because it requires soldiers both to violate their (...) strict duty of obedience and loyalty and to exceed their special obligations to protect their fellow comrades, the state, the state's constituents and other protected civilians. I then illustrate that the principle of risk fails on the second account since it conflicts with the commander's primary obligation to protect and promote the welfare and lives of his or her soldiers. I conclude by arguing that we cannot reasonably expect soldiers and commanders to adhere to the principle of risk until there is a radical, institutional-level transformation of militaristic goals, values, strategies, policies, warrior codes and expectations of service members in the US Armed Forces. (shrink)

Монографія "Функціональність релігії: український контекст".

Este trabajo atiende a las interpelaciones parlamentarias en tanto que material de investigación educativa. Tras atender a la legislación y la función de control en este campo, se comentan las modalidades de análisis de discurso apropiadas para su tratamiento. A continuación se realiza un desglose cuantitativo de las interpelaciones registradas en la base de datos del Congreso de los Diputados a lo largo de las distintas legislaturas democráticas, indicando su contenido. Finalmente, se seleccionan tres de ellas a las que se (...) aplica un análisis de contenido basado en el enfoque discursivo expuesto. (shrink)