One of the tasks of Jean‐Paul Sartre's later work was to consider how an individual could live freely within a free community. This paper examines how Sartre describes the process of group formation and the implications of this discussion for education. The paper begins with his metaphor of a bus queue in order to describe a series. Then, by means of Sartre's analysis of the storming of the Bastille, the discussion expands to show how a series becomes a genuine group. (...) Finally, suggestions are offered, extrapolated from Sartre's theorizing about groups, as to how teachers might create and maintain genuine groups in and across schools rather than having them remain merely collections of individuals organized from outside. Throughout the paper, the implications of Sartre's insights into groups and educational settings are examined. (shrink)

Although higher education understands the need to develop critical thinkers, it has not lived up to the task consistently. Students are graduating deficient in these skills, unprepared to think critically once in the workforce. Limited development of cognitive processing skills leads to less effective leaders. Various definitions of critical thinking are examined to develop a general construct to guide the discussion as critical thinking is linked to constructivism, leadership, and education. Most pedagogy is content-based built on deep knowledge. Successful critical (...) thinking pedagogy is moving away from this paradigm, teaching students to think complexly. Some of the challenges faced by higher education moving to a critical thinking curricula are discussed, and recommendations are offered for improving outcomes. (shrink)

Although the genetic code is defined by a linear array of nucleotides, it is the three‐dimensional structure of the double helix that regulates most of its cellular functions. Over the past two decades, it has become increasingly clear that aspects of this three‐dimensionality which reflect topological relationships within the double helix (i.e., superhelical twisting, knotting, or tangling) influence virtually every facet of nucleic acid physiology. In vivo, DNA topology is modulated by ubiquitous enzymes known as topoisomerases. The type II enzyme (...) essential to the eukaryotic cell and is required for unlinking daughter chromosomes and maintaining chromosome structure. Moreover, topoisomerase II also has been identified as the primary cellular target for several widely used antineoplastic drugs. Before the physiological functions of topoisomerase II can be effectively dissected or its drug interactions fully exploited, it is imperative to understand the mechanism by which this important enzyme arries out its catalytic cycle. (shrink)

This book's importance is derived from three sources: careful conceptualization of teacher induction from historical, methodological, and international perspectives; systematic reviews of research literature relevant to various aspects of teacher induction including its social, cultural, and political contexts, program components and forms, and the range of its effects; substantial empirical studies on the important issues of teacher induction with different kinds of methodologies that exemplify future directions and approaches to the research in teacher induction.

Assessment in ethics education faces a challenge. From the perspectives of teachers, students, and third-party evaluators like the Accreditation Board for Engineering and Technology and the National Institutes of Health, assessment of student performance is essential. Because of the complexity of ethical case analysis, however, it is difficult to formulate assessment criteria, and to recognize when students fulfill them. Improvement in students’ moral reasoning skills can serve as the focus of assessment. In previous work, Rosa Lynn Pinkus and Claire (...) Gloeckner developed a novel instrument for assessing moral reasoning skills in bioengineering ethics. In this paper, we compare that approach to existing assessment techniques, and evaluate its validity and reliability. We find that it is sensitive to knowledge gain and that independent coders agree on how to apply it. (shrink)

A comprehensive treatment of the concept of causation in evolutionary biology that makes clear its central role in both historical and contemporary debates. Most scientific explanations are causal. This is certainly the case in evolutionary biology, which seeks to explain the diversity of life and the adaptive fit between organisms and their surroundings. The nature of causation in evolutionary biology, however, is contentious. How causation is understood shapes the structure of evolutionary theory, and historical and contemporary debates in evolutionary biology (...) have revolved around the nature of causation. Despite its centrality, and differing views on the subject, the major conceptual issues regarding the nature of causation in evolutionary biology are rarely addressed. This volume fills the gap, bringing together biologists and philosophers to offer a comprehensive, interdisciplinary treatment of evolutionary causation. Contributors first address biological motivations for rethinking evolutionary causation, considering the ways in which development, extra-genetic inheritance, and niche construction challenge notions of cause and process in evolution, and describing how alternative representations of evolutionary causation can shed light on a range of evolutionary problems. Contributors then analyze evolutionary causation from a philosophical perspective, considering such topics as causal entanglement, the commingling of organism and environment, and the relationship between causation and information. Contributors John A. Baker, Lynn Chiu, David I. Dayan, Renée A. Duckworth, Marcus W Feldman, Susan A. Foster, Melissa A. Graham, Heikki Helanterä, Kevin N. Laland, Armin P. Moczek, John Odling-Smee, Jun Otsuka, Massimo Pigliucci, Arnaud Pocheville, Arlin Stoltzfus, Karola Stotz, Sonia E. Sultan, Christoph Thies, Tobias Uller, Denis M. Walsh, Richard A. Watson. (shrink)

Lynne Baker was a trenchant critic of reductionist and physicalist conceptions of the universe, as well as the foremost defender of the constitution view of human persons. Baker was a staunch defender of a kind of practical realism, or what she sometimes called a metaphysics of everyday life. And it was this general “common sense” philosophical outlook that underwrote her non-reductionist, constitution view of reality. Whereas most of her contemporaries were given to metaphysical reductionism and eliminativism, born of a penchant (...) for so-called Quinean desert landscapes, Baker was unapologetic and philosophically deft in her defense of ontological pluralism. This volume honors Baker’s work by bringing together 16 critical essays by some of her students, colleagues, interlocutors, and friends. The essays fall into four areas, each an area to which Baker made unique and influential contributions: Practical Realism about the Mind, The Constitution View of Human Persons, The First Person Perspective, and God, Christianity and Naturalism. (shrink)

El presente trabajo se enfocó a profundizar sobre el tema de las economías verdes y la Responsabilidad Social Empresarial. A través de una investigación documental, se logró evidenciar que las economías verdes siguen estando muy poco desarrolladas en todas partes del mundo, donde Europa es la que más avances posee en dicho tema, quedándose Latinoamérica rezagada al respecto por problemas tecnológicos y de desarrollo. Sobre la responsabilidad social se pudo entender que la misma representa una piedra angular para el desarrollo (...) de las naciones y una de las vías más relevantes para alcanzar la sostenibilidad, reduciéndose problemas como la pobreza y el impacto medioambiental. Se concluyó que la importancia de estos trabajos de investigación radica en la amplitud del análisis que proponen, lo que sirve como un elemento referencial de gran calado desde el cual partir para otras investigaciones. Palabras Clave: Sostenibilidad, Responsabilidad, Sociedad, Desarrollo. Referencias [1]M. Mordt, «Soluciones ambientales sostenibles y economía verde e inclusiva: América Latina en la senda del cambio,» 2019. [2]A. Martínez y A. Porcelli, «Reflexiones sobre la economía verde. El New Deal Ecológico Mundial,» Revista LEX, vol. 15, nº 19, pp. 361-408, 2017. [3]Global Green Growth Institute, «Green Growth Index Concept,» 2019. [4]J. F. Cajiga Calderón, «El concepto de responsabilidad social empresarial,» Ciudad de México, 2007. [5]J. A. Cortés y E. Flores, Responsabilidad social, Centro de Investigación y Desarrollo Ecuador, 2017. [6]J. M. Araque Ramírez, «Responsabilidad Social del Ingeniero,» San José de Cúcuta, 2016. (shrink)

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common in (...) clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

Reprint of paper first published in Philosophy and Phenomenological Research in 1984.

_Philosophy and the Study of Religions: A Manifesto_ advocates a radical transformation of the discipline from its current, narrow focus on questions of God, to a fully global form of critical reflection on religions in all their variety and dimensions. Opens the discipline of philosophy of religion to the religious diversity that characterizes the world today Builds bridges between philosophy of religion and the other interpretative and explanatory approaches in the field of religious studies Provides a manifesto for a global (...) approach to the subject that is a practice-centred rather than a belief-centred activity Gives attention to reflexive critical studies of 'religion' as socially constructed and historically located. (shrink)

_Philosophy and the Study of Religions: A Manifesto_ advocates a radical transformation of the discipline from its current, narrow focus on questions of God, to a fully global form of critical reflection on religions in all their variety and dimensions. Opens the discipline of philosophy of religion to the religious diversity that characterizes the world today Builds bridges between philosophy of religion and the other interpretative and explanatory approaches in the field of religious studies Provides a manifesto for a global (...) approach to the subject that is a practice-centred rather than a belief-centred activity Gives attention to reflexive critical studies of 'religion' as socially constructed and historically located. (shrink)

People coordinate body postures and gaze patterns during conversation. We review literature showing that (1) action embodies cognition, (2) postural coordination emerges spontaneously when two people converse, (3) gaze patterns influence postural coordination, (4) gaze coordination is a function of common ground knowledge and visual information that conversants believe they share, and (5) gaze coordination is causally related to mutual understanding. We then consider how coordination, generally, can be understood as temporarily coupled neuromuscular components that function as a collective unit (...) known as a coordinative structure in the motor control literature. We speculate that the coordination of gaze and body sway found in conversation may be understood as a cross‐person coordinative structure that embodies the goals of the joint action system. (shrink)

In this paper, we put forward the view that emotions have a legitimate and important role in health professional ethics education. This paper draws upon our experience of running a narrative ethics education programme for ethics educators from a range of healthcare disciplines. It describes the way in which emotions may be elicited in narrative ethics teaching and considers the appropriate role of emotions in ethics education for health professionals. We argue there is a need for a pedagogical framework to (...) productively incorporate the role of emotions in health professional ethics teaching. We suggest a theoretical basis for an ethics pedagogy that integrates health professional emotions in both the experience and the analysis of ethical practice, and identify a range of strategies to support the educator to incorporate emotion within their ethics teaching. (shrink)

A distressing number of philosophers and classicists think that the deuteros plous or “second best” mentioned at Phaedo 99c9-dl is the hypothetical method. Many of them will even tell you that Plato says the hypothetical method is the deuteros plous, and that they are not merely interpreting his meaning. They usually back off, however, when challenged on this point, for there jus isn’t any such statement by Plato. Nor, I think, does Plato give us any justification at all for taking (...) the deuteros plous as the hypothetical method. I will argue in this paper that he is referring rather to the explanation of things in terms of their formal causes, and that this sort of explanation is “second best” when compared to a teleological explanation in terms of final causes. The hypothetical method of the dialectician is simply the logical device or apparatus by means of which the theory of ideas and the attendant notion of formal causation are introduced into the discussion; it is not a “second best” method and is not inferior to anything else. (shrink)

We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive (...) studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

We report on the simultaneous determination of complementary wave and particle aspects of light in a double-slit type “welcher-weg” experiment beyond the limitations set by Bohr’s Principle of Complementarity. Applying classical logic, we verify the presence of sharp interference in the single photon regime, while reliably maintaining the information about the particular pinhole through which each individual photon had passed. This experiment poses interesting questions on the validity of Complementarity in cases where measurements techniques that avoid Heisenberg’s uncertainty principle and (...) quantum entanglement are employed. We further argue that the application of classical concepts of waves and particles as embodied in Complementarity leads to a logical inconsistency in the interpretation of this experiment. (shrink)

Kevin M. Cahill reclaims one of Ludwig Wittgenstein's most passionately pursued endeavors: to reawaken a sense of wonder around human life and language and its mysterious place in the world. Following the philosopher's spiritual and cultural criticism and tying it more tightly to the overall evolution of his thought, Cahill frames an original interpretation of Wittgenstein's engagement with Western metaphysics and modernity, better contextualizing the force of his work. Cahill synthesizes several approaches to Wittgenstein's life and thought. He stresses (...) the nontheoretical aspirations of the philosopher's early and later writings, combining key elements from the so-called resolute readings of the _Tractatus_ with the "therapeutic" readings of _Philosophical Investigations_. Cahill shows how continuity in Wittgenstein's cultural and spiritual concerns informed if not guided his work between these texts, and in his reading of the _Tractatus_, Cahill identifies surprising affinities with Martin Heidegger's _Being and Time_--a text rarely associated with Wittgenstein's early formulations. In his effort to recapture wonder, Wittgenstein both avoided and undermined traditional philosophy's reliance on theory. As Cahill relates the steps of this bold endeavor, he forms his own innovative, analytical methods, joining historicist and contextualist approaches to text-based, immanent readings. The result is an original, sustained examination of Wittgenstein's thought. (shrink)

The "divided line" passage seems to compare the four states of the soul and their objects to the four segments of a line, somewhat as follows.

Drawing the line on physician assistance in physician-assisted death continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that (...) can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill. (shrink)

Both the commonsensical and leading theoretical accounts of entrepreneurship, democracy, and solidarity fail to describe adequately entrepreneurial, democratic, and solidarity?building practices. These accounts are inadequate because they assume a faulty description of human being. In this article we develop an interpretation of entrepreneurship, democratic action, and solidarity?building that relies on understanding human beings as neither primarily thinking nor desiring but as skillful beings. Western human beings are at their best when they are engaged in producing large?scale cultural or historical changes (...) in the way people and things are dealt with. The three domains of human activity where these historical changes are most clearly accomplished are entrepreneurship, democratic action, and solidarity. Section I, guided by a roughly Kuhnian notion of holding on to an anomaly until it re?gestalts the way we see things, offers a general interpretation of how skillful human beings open up new worlds by changing their shared background practices in three ways: reconfiguring, which makes a marginal practice central; cross?appropriation, in which one domain of practices takes over useful practices from another domain; and articulating, whereby dispersed or confused practices are brought into clearer focus. An entrepreneur creates a product which reconfigures the practices. This interpretation of entrepreneurial skills is contrasted with current accounts that overlook ehtrepreneurship to concentrate on instrumental or theoretical models of business activities. Section II claims that the most exemplary kind of political action in a liberal democracy is that of political action groups. Such groups produce a change in a nation's background practices through a kind of speaking that leads to massive cross?appropriation. We describe Mothers Against Drunk Driving (MADD) and suggest that it both satisfies the requirements for genuine democratic action that we have established in our examination of other views and lacks their disadvantages. We conclude that the relatively detached action suggested by current theories of liberal democracy fail to do justice to democratic practice. The final section argues that those who claim that a single highest value or procedure provides a source of solidarity that satisfies all the competing interests in a multi?cultural nation always arrive at a solidarity that is too thin to provide for the serious sort of commitments that one would be willing to die for. We propose that solidarity in multi?cultural states implies commitment to a set of thick values, and that when one realizes that these thick values construct one's identity one is willing to die for them. While political action concerns itself with ordering values, solidarity involves the cultivation of them in such a way that no ordering of them matters. But solidarity is not to be understood as a subjective feeling. It is rather the experience of a group identity, a ?we?, that sees things and deals with things in terms of shared concerns. This ?we? comes to recognize itself when the actions it engages in transform it. The paradigmatic action that transforms such a ?we? occurs when a culture figure articulates some forgotten concern or value. As in the cases of entrepreneurship and democratic action, a culture figure cultivates solidarity by changing the background practices in a historical manner. It is concluded that traditional theoretical accounts, by overlooking the primacy of involved skillful activities and the importance of background change, fail to capture the source, the function, and the point of entrepreneurship, liberal democracy, and solidarity. (shrink)

BackgroundFor children with life-limiting conditions who are unable to participate in decision-making, decisions are made for them by their parents and paediatricians. Shared decision-making is widely recommended in paediatric clinical care, with parents preferring a collaborative approach in the care of their child. Despite the increasing emphasis to adopt this approach, little is known about the roles and responsibilities taken by parents and paediatricians in this process. In this study, we describe how paediatricians approach decision-making for a child with a (...) life-limiting condition who is unable to participate in decision-making for his/herself.MethodsThis qualitative phenomenological study involved 25 purposively sampled paediatricians. Verbatim transcripts from individual semi-structured interviews, conducted between mid-2019 and mid-2020, underwent thematic analysis. Interviews were based around a case vignette matched to the clinical experience of each paediatrician.ResultsTwo key themes were identified in the exploration of paediatricians' approach to decision-making for children with life-limiting conditions: there is a spectrum of paediatricians’ roles and responsibilities in decision-making, and the specific influences on paediatricians’ choice of approach for end-of-life decisions. In relation to, analysis showed four distinct approaches: non-directed, joint, interpretative, and directed. In relation to, the common factors were: harm to the child, possible psychological harm to parents, parental preferences in decision-making, and resource allocation.ConclusionsDespite self-reporting shared decision-making practices, what paediatricians often described were physician-led decision-making approaches. Adopting these approaches was predominantly justified by paediatricians’ considerations of harm to the child and parents. Further research is needed to elucidate the issues identified in this study, particularly the communication within and parental responses to physician-led approaches. We also need to further study how parental needs are identified in family-led decision-making approaches. These nuances and complexities are needed for future practice guidance and training around paediatric decision-making.Trial registration: Not applicable. (shrink)

Bioethics, Volume 36, Issue 7, Page 765-773, September 2022.

The idea of “postponed withholding,” proposed by Syltern et al. (2022), is a provocative one, and like all good provocative ideas, provokes deeper thinking from fresh perspectives. Our attention wa...

I examine the positive and negative features of homeopathy from an ethical perspective. I consider: (a) several potentially beneficial features of homeopathy, including non-invasiveness, cost-effectiveness, holism, placebo benefits and agent autonomy; and (b) several potentially negative features of homeopathy, including failure to seek effective healthcare, wastage of resources, promulgation of false beliefs and a weakening of commitment to scientific medicine. A utilitarian analysis of the utilities and disutilities leads to the conclusion that homeopathy is ethically unacceptable and ought to be (...) actively rejected by healthcare professionals. (shrink)

If people sometimes participate in research because of altruism—because they want to help in the search for treatments—should we revise our views about what kinds of experiments are ethical? If participants act out of altruism, we might let them accept greater risks than we would if they are motivated only by a desire for personal gain. But how can we know when participants are genuinely altruistic?

In theory, HREC members should use the ethical guidelines in the National Statement on the Ethical Conduct of Research Involving Humans as the basis for their decisions, and researchers should design their research in accordance with these guidelines However, very little is known about what researchers and HREC members actually do in practice. In this paper, we report some of the key findings of the study “Human Research Ethics in Practice”, a qualitative interview-based study of health researchers and HREC members (...) in Victoria. The findings shed light on how researchers and HREC members conceptualise ethics, how they use the National Statement, and what deliberative strategies they employ to assess the ethical appropriateness of research studies. The findings also reveal differences and similarities between health researchers’ and HREC members’ perceptions of the roles of HRECs, and point to some sources of misunderstanding and tension. We examine the implications of some of these findings for the ways in which HRECs carry out their task, and research institutions support and promote ethical conduct in research amongst their staff and students. The focus of this study is on health research, but we suggest that the findings are highly relevant to all other research areas where human participants are involved. (shrink)

Recent work suggests that people predict how objects interact in a manner consistent with Newtonian physics, but with additional uncertainty. However, the sources of uncertainty have not been examined. In this study, we measure perceptual noise in initial conditions and stochasticity in the physical model used to make predictions. Participants predicted the trajectory of a moving object through occluded motion and bounces, and we compared their behavior to an ideal observer model. We found that human judgments cannot be captured by (...) simple heuristics and must incorporate noisy dynamics. Moreover, these judgments are biased consistently with a prior expectation on object destinations, suggesting that people use simple expectations about outcomes to compensate for uncertainty about their physical models. (shrink)

Usage-based linguistics postulates that multi-word expressions constitute a substantial part of language structure and use, and are formed through repeated chunking and stored as exemplar wholes. They are also re-used to produce new sequences by means of schematization. While there is extensive research on multi-word expressions in many spoken languages, little is known about the status of multi-word expressions in the mainstream U.S. variety of American Sign Language. This paper investigates recurring multi-word expressions, or sequences of multiple signs, that involve (...) a high-frequency sign of visual perception glossed as look and the family of ‘look’ signs. The look sign exhibits two broad functions: look/‘vision’ references literal or metaphorical vision and look/‘reaction’ signals a person’s reaction to a visual stimulus. Data analysis reveals that there are recurring sequences in distinct syntactic environments associated with the two functions of look, suggesting that look is in the process of grammaticalization from a verb of visual perception to a stance verb. The sequences demonstrate the emergence of linguistic structure from repeated use through the domain-general cognitive process of chunking in ASL. (shrink)

In this lively undergraduate textbook, Kevin Gibson explores the relationship between ethics and the world of business, and how we can serve the interests of both. He builds a philosophical groundwork that can be applied to a wide range of issues in ethics and business, and shows readers how to assess dilemmas critically and work to resolve them on a principled basis. Using case studies drawn from around the world, he examines topics including stakeholder responsibilities, sustainability, corporate social responsibility, (...) and women and business. Because business can no longer be isolated from its effects on communities and the environment, these concerns are brought to the forefront. The book also captures the dynamic nature of business ethics in the era of globalization where jobs can be outsourced, products are made of components from scores of countries and sweatshops often provide the cheap goods the public demands. (shrink)

In the debate over fetal tissue use, an analogy is often drawn between removing organs from the body of a person who has been murdered to use for transplantation, and collecting tissue from an aborted fetus to use for the same purpose. The murder victim analogy is taken by its proponents to show that even if abortion is the moral equivalent of murder, there is still no good reason to refrain from using the fetal tissue, since as a society we (...) do not see any problem about using organs from murder victims. However, I argue that the analogy between murder victims and aborted fetuses does not hold -- the two situations are not the same in all morally relevant respects. Thus the murder victim analogy does not provide an argument in favour of fetal tissue transplant. In conclusion, I point to some of the potential pitfalls of using analogies in ethical argument. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)