Theological engagement with quantum mechanics has been dominated by the Copenhagen interpretation, failing to reflect the fact that philosophers and physicists alike are increasingly moving away from the Copenhagen interpretation in favor of other approaches. One such approach, Hugh Everett's so-called Many Worlds Interpretation (MWI), is being taken increasingly seriously. As the MWI's credibility grows, it is imperative that metaphysicians, theologians, and philosophers of religion engage with its ideas and their implications. This article does just that, setting out some implications (...) of Everettian Quantum Mechanics that are particularly relevant to theism. It argues that taking seriously the radical consequences of the Everett interpretation means facing at least three major worries for theism pertaining to personal identity, the problem of evil, and salvation. The article concludes by calling on theologians and philosophers of religion to address these worries, in order that these matters of religious significance remain both coherent and credible if the MWI turns out to be correct. (shrink)

This philosophical investigation is motivated by the common association between happiness and self-transcendence, and a question posed by Freud: “Why is it so hard for men to be happy?” I consider the answers given in three key texts from the psychoanalytic tradition, Daniel Kahneman’s Thinking, Fast and Slow, Sigmund Freud’s Civilization and its Discontents, and Abraham Maslow’s The Farther Reaches of Human Nature. Based on a distinction between opposing forms of self-transcendence, ego-actualisation and ego-dissolution, the authors articulate the relation between (...) self-transcendence and happiness in different, but equally unsatisfactory, ways. In all three texts, a dominant ideological framing is discernible, which prioritises the present/positive and ignores the work of the absent/negative, ironically leaving us with a sense of futility concerning the pursuit of happiness. I propose that an approach influenced by Lacanian ideas, which acknowledges the role played by unhappiness in producing happiness, plausibly challenges the traditional conception of happiness that places it out of human reach as the effect of a perfectly self-transcendent state. Instead, understood as the effect of resistance to the notion of self-transcendence as self-perfection, happiness, while still difficult to achieve because it requires another kind of self-transcendence, becomes attainable here and now by ordinary individuals. (shrink)

In the spirit of the work edited by Michel Foucault (1975) on Pierre Rivière, I propose to put philosophy to work by tackling a case study in which I shall analyse certain court transcripts that pertain to the defence of serial killer, Stewart Wilken, in Die Staat Teen Stewart Wilken. My analysis of these documents is intended to uncover the practices and struggles of the discourses that come together, and into conflict, at this event. The analysis is divided into two (...) parts. In Part One, I thematize subjectivity in relation to the idea of enlightenment autonomy. Here I aim to show that the discourses in law, psychiatry and psychology that dominated at Wilken's trial, appear to have undergone “normalization.” In other words, what Foucault uncovered as early internecine struggles among discourses for supremacy have given way to a unanimous stance concerning the nature of the autonomous subject and its legal ramifications; effectively silencing alternatives. In Part Two, I shall skirt around the frayed edges of these dominant discourses, with the aim of showing in more detail how internal theoretical tensions, such as those evident in the expert testimony given at Wilken's trial, may open up spaces for other accounts of subject- formation. S. Afr. J. Philos. Vol.22(4) 2003: 289-305. (shrink)

Gadamer's project in Truth and Method is as much about truth in the human sciences as it is about human subjectivity, for, following Heidegger, he claims that truth is reducible to method (technical rationality) only if one is misled by old Enlightenment subject/object dualisms. Posing the question of the possibility and nature of truth in scientific thinking, where a strict division between subjective and objective has fallen away, Gadamer belongs, as one of its inaugural figures, to an alternative tradition of (...) philosophical complexity, which implicates environmental systems (culture, ideology, institutions), embedded in language, in the constitution of human subjectivity.With these theoretical shifts in mind, what caught my attention in a press report concerning the trial of (subsequently convicted) serial killer, Stewart Wilken (“Boetie Boer”), was the strangely anachronistic question that dominated the front page of a Port Elizabeth newspaper: “Boetie: Is he Sick or Evil?” This question, in my view, harks back to a questionable framework of Enlightenment autonomy, which depends upon the easy technical rationality of clear-cut dichotomies. In what follows I hope to show that in acknowledging the role of complex interrelations between cultural and other systems, a tradition of philosophical complexity justifiably claims a more adequate framework for understanding self- formation than that underpinning the discourses at work in Wilken's trial. I shall draw on Gadamer's hermeneutic model of an “embedded”subject, which is based on his speculative model of “play” out lined in Truth and Method, and supplement this with Lacan's psychoanalytic account of subject formation. S. Afr. J. Philos. Vol.21(4) 2002: 258-273. (shrink)

The "ruin" of the transcendental tradition -- Freud and the transcendental relation -- Derrida: Differance and the "plural logic of the aporia" -- The im-possibility of the psyche -- The death drive and the im-possibility of psychoanalysis -- Institutional psychoanalysis and the paradoxes of archivization -- The Lacanian real -- Sexual difference -- Feminine sexuality -- The transcendental relation in Lancanian psychoanalysis -- The death drive and ethical action -- The "talking cure": language and psychoanalysis.

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of ethics consultation are (...) not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

By technology, Martin Heidegger is referring to modern industrial technology, as opposed to older handicraft technology, or craft. Technology gives a way of viewing the world and everything in it as resources, the purpose of which is to serve further applications of technology. This is how the Borg views the universe, as raw material that they can assimilate into the Collective to feed their quest to continually assimilate more. The Borg also views the assimilation of species as an improvement, not (...) only of the Collective, but also of the species being assimilated. The Borg's assimilation of Picard shows how a shift in the perspective can help to change the relationship to technology, and might offer some hope that technology may not be able to sustain the challenging of all of nature. Society is being ordered on a global level so as to enable faster technological developments. (shrink)

Heaven falls into chaos during God's absence, and Hell becomes fairly democratic. With Lucifer caged up and out of the picture, demons build a relatively civil society through contracts. This is sovereignty by institution as opposed to acquisition. The leviathans are unlike the angels in that the angels lacked a unity of wills. Driven by their nature, people—and angels—cannot live in harmony without a central and absolute authority to keep them in order. Without the presence of God to command the (...) angels there can be no peace, only a natural state of war. The fact that even the heavenly host can fall into a Hobbesian state of nature does not bode well for humanity, but maybe that's why business has been so good for the King of the Crossroads. Each demon, after all, has willingly agreed to enter into the civil society of Hell. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Quantum mechanics has recently indicated that, at the fundamental level, temporal order is not fixed. This phenomenon, termed Indefinite Causal Order, is yet to receive metaphysical or theological engagement. We examine Indefinite Causal Order, particularly as it emerges in a 2018 photonic experiment. In this experiment, two operations A and B were shown to be in a superposition with regard to their causal order. Essentially, time, intuitively understood as fixed, flowing, and fundamental, becomes fuzzy. We argue that if Indefinite Causal (...) Order is true, this is good evidence in favor of a B‐theory of time, though such a B‐theory requires modification. We then turn to theology, suggesting that a B‐theoretic temporal ontology invites serious reconsideration of the doctrine of salvation. This paper concludes that the best explanation for salvation given a B‐theory is mind‐dependent salvific becoming, a type of psychological soteriological change that occurs through downward causation. (shrink)

This article applies Paul Tillich's existentialist analysis of the human predicament, particularly what it means to exist and to be fallen, to social media. I argue that social media heightens feelings of alienation and estrangement, supporting this claim with evidence from empirical research in psychiatry and communication studies. Thus, I offer an application of a Tillichian approach to an area of culture previously unexamined in this way. I identify three primary ways in which social media exacerbates existentialist emotional states: social (...) media allows us to construct artificial versions of ourselves through the use of filters and photo editing software; it provides the means to quantify social approval in groups the size of which the human brain has not evolved for; it extends the size of our social networks but decreases the quality of interactions. Social media is yet to receive significant philosophical or theological engagement despite its prevalence, particularly within younger generations. I argue that this is a mistake – philosophy has a duty to engage with such a ubiquitous feature of modern life. (shrink)

This article brings time and theology together constructively in response to a pressing problem for the doctrine of personal salvation. The problem arises within the physics and metaphysics of time, as these support a so-called temporal B-theory in which time does not pass and reality is comprised of a block universe. Within this static temporal metaphysic, objective change is highly problematized. Yet salvation requires an objective change from fallenness to redemption. So, how can we understand a salvation-transformation in the block (...) universe? In other words, can sinners really change? I argue that on a B-theory of time, a salvation-transformation is best understood as a form of qualitative, phenomenological, and subjective change, rather than a robust ontological change. I conclude that the individual's transformation from fallen to saved is one of mind-dependent becoming. So, sinners can change. But, in this lifetime, that change can only be subjective. (shrink)

Nipah virus is a priority pathogen that is receiving increasing attention among scientists and in work on epidemic preparedness. Despite this trend, there has been almost no bioethical work examining ethical considerations surrounding the epidemiology, prevention, and treatment of Nipah virus or research that has already begun into animal and human vaccines. In this paper, we advance the case for further work on Nipah virus disease in public health ethics due to the distinct issues it raises concerning communication about the (...) modes of transmission, the burdens of public health surveillance, the recent use of stringent public health measures during epidemics, and social or religious norms intersecting with preventive measures. We also advance the case for further work on Nipah virus disease in research ethics, given ethical issues surrounding potential vaccine trials for a high-fatality disease with sporadic spillover events, the different local contexts where trials may occur, and the potential use of unproven therapeutics during outbreaks. Further bioethics work may help to ensure that research and public health interventions for Nipah virus disease are ethically acceptable and more likely to be effective. (shrink)

Non‐Interventionist Objective Divine Action (NIODA), introduced by Robert John Russell, is a model of divine action drawing upon insights from quantum mechanics. It presents an intriguing and significant challenge to classical conceptions of divine action with far‐reaching consequences. When applying NIODA to theistic evolution, however, significant questions emerge that require attention. We identify and assess two sets of concerns. The first relates to quantum physics, particularly whether and how quantum occurrences influence mutations and evolution. We argue that the current empirical (...) evidence is ambiguous in its support of the kinds of quantum action that Russell proposes, though emerging data from quantum biology look promising. The second set of concerns is metaphysical, especially concerning the problem of evil. NIODA gives Godextensive agency over evolution and genetics, which has adverse consequences for theodicy. We propose potential solutions to the problems highlighted in our article, both metaphysical and physical, to improve the viability of NIODA's application to theistic evolution. (shrink)

Quantum mechanics has recently indicated that temporal order is not always fixed, a finding that has far-reaching philosophical and theological implications. The phenomena, termed “indefinite causal order,” shows that events can be in a superposition with regard to their order. In the experimental setting with which this article is concerned, two events, A and B, were shown to be in the ordering relations “A before B” and “B before A” at the same time. This article introduces an ongoing project that (...) seeks to make sense of this result, with a particular focus on the methodology by which this research will be undertaken. Specific research questions, particularly regarding what indefinite causal order might mean for the metaphysics of time and the doctrine of salvation, are introduced. The collaborative approach detailed brings together the disciplinary skills of a working scientist and a working theologian. What is offered is a collaborative methodology for interaction between science and religion that is more than the sum of its parts. Alister McGrath’s idea of multiple rationalities is employed as an epistemological framework within which this research takes place. Within an epistemologically pluralistic model, collaborative efforts are not only encouraged but necessary. Complex reality requires an equally complex, usually interdisciplinary, explanation. I argue that such dialogue is both theologically justified and culturally valuable and indicates the direction in which this research will be taken. (shrink)

Recently, significant research effort has focused on using Twitter to investigate mental health at the population-level. While there has been influential work in developing ethical guidelines for Internet discussion forum-based research in public health, there is currently limited work focused on addressing ethical problems in Twitter-based public health research, and less still that considers these issues from users’ own perspectives. In this work, we aim to investigate public attitudes towards utilizing public domain Twitter data for population-level mental health monitoring using (...) a qualitative methodology. The study explores user perspectives in a series of five, 2-h focus group interviews. Following a semi-structured protocol, 26 Twitter users with and without a diagnosed history of depression discussed general Twitter use, along with privacy expectations, and ethical issues in using social media for health monitoring, with a particular focus on mental health monitoring. Transcripts were then transcribed, redacted, and coded using a constant comparative approach. While participants expressed a wide range of opinions, there was an overall trend towards a relatively positive view of using public domain Twitter data as a resource for population level mental health monitoring, provided that results are appropriately aggregated. Results are divided into five sections: a profile of respondents’ Twitter use patterns and use variability; users’ privacy expectations, including expectations regarding data reach and permanence; attitudes towards social media based population-level health monitoring in general, and attitudes towards mental health monitoring in particular; attitudes towards individual versus population-level health monitoring; and users’ own recommendations for the appropriate regulation of population-level mental health monitoring. Focus group data reveal a wide range of attitudes towards the use of public-domain social media “big data” in population health research, from enthusiasm, through acceptance, to opposition. Study results highlight new perspectives in the discussion of ethical use of public data, particularly with respect to consent, privacy, and oversight. (shrink)

Special relativity has been understood by many as vindicating a tenseless conception of time, denying the existence of tensed facts and a fortiori objective temporal passage. The reason for this is straightforward: both passage and the obtaining of tensed facts require a universal knife-edge present moment—yet this structure is not easily reconcilable with the relativity of simultaneity. The above being said, the prospects for tense and passage are sometimes claimed to be improved on moving to cosmological solutions of general relativity. (...) In this paper, we evaluate in detail these arguments, finding that there remain several open questions to be addressed if the introduction of tensed facts into the relativistic context is to be compelling. Moreover, we argue that, even setting aside these issues, objective tense stands and falls in relativity for exactly the same reasons that it does in classical philosophical discussions on the matter. (shrink)

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were (...) examined to identify further eligible studies. Forty two articles were identified as eligible. Seventeen used an implicit measure, to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed. (shrink)

Background Implicit biases are present in the general population and among professionals in various domains, where they can lead to discrimination. Many interventions are used to reduce implicit bias. However, uncertainties remain as to their effectiveness. -/- Methods We conducted a systematic review by searching ERIC, PUBMED and PSYCHINFO for peer-reviewed studies conducted on adults between May 2005 and April 2015, testing interventions designed to reduce implicit bias, with results measured using the Implicit Association Test (IAT) or sufficiently similar methods. (...) -/- Results 30 articles were identified as eligible. Some techniques, such as engaging with others’ perspective, appear unfruitful, at least in short term implicit bias reduction, while other techniques, such as exposure to counterstereotypical exemplars, are more promising. Robust data is lacking for many of these interventions. -/- Conclusions Caution is thus advised when it comes to programs aiming at reducing biases. This does not weaken the case for implementing widespread structural and institutional changes that are multiply justified. (shrink)

Background Although it is the moral duty of physicians to protect vulnerable patients, there are no data on how vulnerability is perceived in clinical practice. This study explores how physicians classify someone as “vulnerable”. Method Thirty-three physicians were initially questioned about resource allocation problems in their work. The results of these interviews were examined with qualitative study software to identify characteristics associated with vulnerability in patients. Data were conceptualized, classified and cross-linked to highlight the major determinants of vulnerability. The findings (...) revealed the principal factors that make patients vulnerable in clinical practice, according to our definition of vulnerability: the likelihood of having one’s interests unjustly considered. Results Vulnerability can arise as a result of a mismatch between the characteristics of patients and physicians, the healthcare system, the treatment, or the communication between physicians and patients. Vulnerability appears as a gap between a patient’s needs and the means intended to meet them. Vulnerability can further be the result of doing too little or too much for patients. This result suggests that structures provided by healthcare systems are not as differentiated as they should be to cover all situations. Our initial definition of vulnerability was illustrated and supported by our results, showing that it encompasses all factors involved, not solely personal characteristics, indicating the need for a more pragmatic approach for use in clinical practice. Conclusion Vulnerability is not due to a single factor but appears under certain circumstances when there is a discrepancy between a patient’s interests and the care provided, despite existing compensation systems. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of (...) xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research. (shrink)

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics case consultation practices. The tool (...) was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...) present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

One of the most striking findings of the study by Foglia and colleagues (2009) was that clinicians and managers were most concerned with limited resources while ethics committee chairpersons focuse...

Which inequalities in longevity and health among individuals, groups, and nations are unfair? And what priority should health policy attach to narrowing them? These essays by philosophers, economists, epidemiologists, and physicians attempt to determine how health inequalities should be conceptualized, measured, ranked, and evaluated.

As highlighted by Pavarini et al., researchers in the field of bioethics have to remain critical and reflexive on the methodology and on the tools they use for their research purpose because...

Chapter 15: "'What you do hurts all of us!' When women confront women through pro-life rhetoric." -/- In this chapter, I articulate a specific problem in the way the rhetoric and ideology of pro-life politics operates as a form of confrontation between women. This is a dilemma that emerges when women engage in the appearance of concern and solicitude while passively coercing other women as they may be ambivalent and vulnerable in forcing anti-abortion outcomes. This in a reinvestment in the (...) problem I raise in my prior work, The Pregnancy ≠ Childbearing Project: A Phenomenology of Miscarriage (2017), a dilemma that I think is essential to grapple with if not also to urgently reconcile: where is the solidarity among women as they are pregnant, independent of the outcomes or expectations of childbearing? Alongside of the testimony of my own personal experience, I analyze the substance of the confrontation narrated in Maisie Crow’s documentary Jackson (2016), juxtaposing it with the fictional hypothesis of Margaret Atwood’s The Handmaid’s Tale (1998) to outline the character of harm in the confrontations between women through pro-life discourse. (shrink)

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person’s conduct is not selfishly motivated. No restrictions relating to the ground of suffering are mentioned in the act. Existential suffering as a reason for wanting to die, however, gives raise to controversial issues. Moreover, existential suffering lacks definition and no consensus exists on how to evaluate (...) and manage it. This study explores the perspectives of care professionals and volunteers from a “right-to-die organization” on existential suffering as a motive for assisted suicide requests. A qualitative study based on face-to-face interviews was conducted with twenty-six participants: palliative care and primary care providers as well as EXIT right-to-die organization volunteers. Elements from the grounded theory approach were used. The twenty-six participants described existential suffering in a multiplicity of individual ways. In total, sixty-three stories were recounted. Their representations were grouped into eight categories: physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden and loss of pleasurable activities. According to all participants, suffering coming from the loss of self-identity was always linked to physical decline, as if one’s image completely defined someone’s identity. Society’s perception of old people and vulnerable people were also often questioned. Another interesting point was that only four stories referring to a “pure” existential suffering were found. This suffering was related to a feeling that life has come to an end, without identification of any other related restriction or suffering. Existential suffering is multifaceted. Legislators and right-to-die organisations have to address the question of what make a AS acceptable. The plurality of existential suffering implies the need of a very personalized care. A better understanding of what it is made of could provide a “toolbox” to people concerned by these requests, helping them to explore it in order to offer suffering people a wider range of alternatives. (shrink)

Formal clinical trials of pig-to-human organ transplant—known as xenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there have (...) been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time. (shrink)

Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying assumptions may (...) be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner. (shrink)

In Switzerland, people can be granted access to assisted suicide on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person...