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)

Background: Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. Objectives: (1) To identify and compare the five ethical issues considered most important by surveyed expert panellists in non-genetic and genetic AD research and (2) to compare our empirical findings with ethical issues in genetic research in general as described in the literature. (...) Method: A modified Delphi study in two rounds Results: Genetic and non-genetic research into AD generated an approximately equal number of topics with a considerable overlap. Different priorities in the ethics of both types of research were found. Genetic research raised new topics such as “confidentiality of genetic information” and “implications of research for relatives” which changes the impact and application of existing ethical topics such as “informed consent” and is judged to have more impact on both individuals and society. A difference with the results of more theoretical approaches on ethical aspects related to AD research was also found. Conclusions: Different priorities are given to ethical issues in genetic and non-genetic research. These arise partly because genetic research causes unique and new questions, mostly related to the position of family members and the status of and access to genetic information. Differences found between the results of our empirical study and the more theoretical literature, suggest an additional value for empirical research in medical ethics. (shrink)

BackgroundThis article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives.MethodsA content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision.ResultsThree themes were identified: ‘conditions’, ‘ethical considerations’ (...) and ‘look back’. Conditions were: ‘sense of urgency’, ‘incompetence to decide’ and ‘agreement between relatives’. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased’s body, especially when they do not know his/her preference. Donor families respect the deceased’s last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments. Some non-donor families would like to be supported during decision-making.DiscussionThe discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased’s wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families.ConclusionDiscrepancies between willingness to consent to donate and refusal at the bedside can be attributed to an unresolved dilemma: aiding people or protect the body of the deceased. Non-donor families felt incompetent to decide. They refused consent for donation, since their deceased had not given any directive. When ethical considerations do not lead to an unambiguous answer, situational factors were pivotal. Relatives of unregistered eligible donors are more prone to unstable decisions. To overcome ambivalence, coaching during decision-making is worth investigation. (shrink)

In the Netherlands, consent from relatives is obligatory for post mortal donation. This study explored the perspectives of relatives regarding the request for consent for donation in cases without donor registration. A content analysis of narratives of 24 bereaved relatives of unregistered, eligible, brain-dead donors was performed. Relatives of unregistered, brain-dead patients usually refuse consent for donation, even if they harbour pro-donation attitudes themselves, or knew that the deceased favoured organ donation. Half of those who refused consent for donation mentioned (...) afterwards that it could have been an option. The decision not to consent to donation is attributed to contextual factors, such as feeling overwhelmed by the notification of death immediately followed by the request; not being accustomed to speaking about death; inadequate support from other relatives or healthcare professionals, and lengthy procedures. Healthcare professionals could provide better support to relatives prior to donation requests, address their informational needs and adapt their message to individual circumstances. It is anticipated that the number of consenting families could be enlarged by examining the experience of decoupling and offering the possibility of consent for donation after circulatory death if families refuse consent for donation after brain-death. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

This long-awaited book replaces Hughes and Cresswell's two classic studies of modal logic: _An Introduction to Modal Logic_ and _A Companion to Modal Logic_. _A New Introduction to Modal Logic_ is an entirely new work, completely re-written by the authors. They have incorporated all the new developments that have taken place since 1968 in both modal propositional logic and modal predicate logic, without sacrificing tha clarity of exposition and approachability that were essential features of their earlier works. The book takes (...) readers from the most basic systems of modal propositional logic right up to systems of modal predicate with identity. It covers both technical developments such as completeness and incompleteness, and finite and infinite models, and their philosophical applications, especially in the area of modal predicate logic. (shrink)

In this article I will evaluate the popular view that we acquire most of our concepts by means of learning. I will do this through an examination of Jerry Fodor’s dissenting views and those of some of his most persistent and significant critics. Although I will be critical of Fodor’s central claim that it is impossible to learn a concept, I will ultimately conclude that we should be more sceptical than is normal about the power of learning when it comes (...) to concept acquisition, particularly with respect to natural kind concepts. Central to my argument for this conclusion will be an examination of the bearings of psychological essentialism on concept acquisition. (shrink)

Expressions in a language, whether words, phrases, or sentences, have meanings. So it seems reasonable to suppose that there are meanings that expressions have. Of course, it is fashionable in some philosophical circles to deny this.

The second highest level of the divided line in Plato’s Republic (510b-511a) appears to be about the entities of mathematics—entities such as particular (though non-physical) triangles. It differs from the highest level in two respects. It involves reasoning from hypotheses, and it uses visible images. This article defends the traditional view that the passage is indeed about these mathematical ‘intermediates’; and tries to show how the apparently different features of the second level are related, by focussing on Plato’s need to (...) give an account of how we can speak of many particulars of the same kind, without assuming that they are imperfect copies, in the way sensible things can be imperfect copies, of forms. (shrink)

Martin Heidegger (1889-1976) is probably the most divisive philosopher of the twentieth century. He is considered by some to be greatest charlatan ever to claim the title of philosopher, an apologist for Nazism by others, and an acknowledged leader and central figure to many philosophers. Michael Inwood's lucid introduction steers a clear path through Heidegger's complex language and thought. This short, accessible guide to the existentialist thought of Heidegger focuses on his most important work, Being and Time, and its major (...) themes of existence in the world, inauthenticity, guilt, destiny, truth, and the nature of time. These themes are then reassessed in the light of Heideggers later work, together with the extent of his philosophical importance and influence. For anyone interested in philosophy, theology and literary theory, Heidegger is an invaluable guide to the complex and voluminous thought of a major twentieth-century existentialist philosopher. (shrink)

Liturgy and ritual -- Structure -- Curriculum.

' I heartily recommend it to any philosopher of language interested in the issues. [] Logicians, of course, will want to savour the whole thing.' Australian Journal of Philosophy, 71:3 (1993).

Semantic Indexicality shows how a simple syntax can be combined with a propositional language at the level of logical analysis. It is the adoption of such a base language which has not been attempted before, and it is this which constitutes the originality of the book. Cresswell's simple and direct style makes this book accessible to a wider audience than the somewhat specialized subject matter might initially suggest.

Adverbial modification is probably one of the least understood areas of linguistics. The essays in this volume all address the problem of how to give an analysis of adverbial modifiers within truth-conditional semantics. Chapters I-VI provide analyses of particular modifiers within a possible worlds framework, and were written between 1974 and 1981. Original publication details of these chapters may be found on p. vi. Of these, all but Chapter I make essential use of the idea that the time reference involved (...) in tensed sentences should be a time interval rather than a single instant. The final chapter (Chapter VII) was written especially for this volume and investigates the question of how the 'situation semantics' recently devised by Jon Barwise and John Perry, as a rival to possible-worlds semantics, might deal with adverbs. In addition I have included an appendix to Chapter III and an introduction which links all the chapters together. (shrink)

Over a longer period than I sometimes care to contemplate I have worked on possible-worlds semantics. The earliest work was in modal logic, to which I keep returning, but a sabbatical in 1970 took me to UCLA, there to discover the work of Richard Montague in applying possible-worlds semantics to natural lan guage. My own version of this appeared in Cresswell (1973) and was followed up in a number of articles, most of which were collected in Cresswell (1985b). A central (...) problem for possible worlds semantics is how to accommodate propositional attitudes. This problem was addressed in Cresswell (1985a), and the three books mentioned so far represent a reasonably complete picture of my positive views on formal semantics. I have regarded the presentation of a positive view as more important than the criticism of alternatives, although the works referred to do contain many passages in which I have tried to defend my own views against those of others. But such criticism is important in that a crucial element in establishing the content of a theory is that we be able to evaluate it in relation to its com petitors. It is for that reason that I have collected in this volume a number of articles in which I attempt to defend the positive semantical picture I favour against objections and competing theories. (shrink)

The paper considers the question of when the operator L of necessity in modal logic can be expressed in terms of the operator meaning it is non-contingent that.

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

Despite the end of the Cold War and the ascendancy of liberal democracy celebrated by Francis Fukuyama as “the end of history”, a growing number of scholars and political activists point to its inherent shortcomings. However, they have tended to dismiss it on the basis of one or two of its salient weaknesses. While this is a justifiable way to proceed, it denies the searching reader an opportunity to see the broad basis for the growing rejection of liberal democracy among (...) African political theorists. Consequently, in this article, I argue that from an African perspective, the almost hegemonic status of liberal democracy can be challenged on at least five grounds, namely, logical inconsistency, impracticability due to the largely communalistic outlook of many africans, inconsistency between affirmation and action, violation of the right to ethnic identity, and the moral imperative to assert the right to cultural emancipation. -/- I conclude by calling upon African and Africanist political theorists to utilise indigenous African political thought, coupled with emancipatory aspects of political thought from other parts of the world, to design practicable models of democracy for contemporary African states. I further conclude that in order to promote genuine inter-cultural dialogue on democratisation, people from Western cultures ought to acknowledge the equality of all cultures, and to recognise that systems of governance are part and parcel of those cultures. (shrink)

In this paper, I offer a view beyond that which would narrowly reduce the role of parents in medical decision making to acting as custodians of the best interests of children and toward an account of family authority and family autonomy. As a fundamental social unit, the good of the family is usually appreciated, at least in part, in terms of its ability successfully to instantiate its core moral and cultural understandings as well as to pass on such commitments to (...) future generations. The putative rights of children to expression, information, freedom of thought, conscience, religion, and to freedom of association with others are, in this essay, assessed from the perspective of those conditions necessary for the family to function as a moral community. In so doing, I respond to the move to liberate children from parental authority and to effect the transformation of the family as implied by the United Nations’ "Convention on the Rights of the Child" and the pediatric bioethics it supports. (shrink)