End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, an external reasonability standard is met, passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not ?futile.? Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, ?If this were not an attempted suicide, would a request to withdraw care be reasonable?? We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw (...) life support, regardless of the cause of the critical illness or disability, when the following criteria are met: Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, an external reasonability standard is met, passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. (shrink)

v. 1. Life of Thomas Paine, by W.M. Van der Weyde.--v. 2. Early essays. Common sense. The American crisis, I-IV.--v. 3. The American crisis, V-XIII. Patriotic papers.--v. 4. Political pamphlets.--v. 5. Open letters. Dissertations.--v. 6. Rights of man.--v. 7. Rights of man, concluded. Miscellaneous essays.--v. 8. The age of reason.--v. 9. Theological discussions.--v. 10. Miscellany. Songs and rhymes. Index.

Thomas Paine often declared himself a citizen of the world. This Norton Critical Edition presents Paine and his writing within the transatlantic and global context of the revolutionary ideas and actions of his time. Thomas Paine's loyalties were with universal and self-evident principles rather than with a particular group or nation, and it is this dimension that informed his most important works. This Norton Critical Edition shows how Paine's fury at the British Empire, including its injustices to South Asians and (...) Africans, shaped his first best seller, Common Sense, and how his direct involvement with the French Revolution pushed his ideas toward a unique form of democratic radicalism. Together with his rejection of organized religion, Paine's radicalism resulted in his being one of the most hated men in both monarchial Britain and republican America. This volume includes J. M. Opal's introduction, "Thomas Paine and the Revolutionary Enlightenment, 1770s-90s," which provides essential biographical and historical details across three tumultuous decades. Paine's most important works-from Common Sense (1776) through Agrarian Justice (1796)-are reprinted and are accompanied by explanatory annotations. Supporting materials include a wide range of documents from the turbulent years following the publication of both Common Sense and the Declaration of Independence. These include Pennsylvania's gradual emancipation statute of the 1780s, an ex-slave's impassioned call for revolutionary violence against European imperialists and masters, and a British conservative's witty rejoinder to Paine's vision of a brave new world. Four major interpretations of Paine's work are provided by Nathan R. Perl-Rosenthal, Robert A. Ferguson, Gary Kates, and Gregory Claeys. A Selected Bibliography is also included. (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.

I. Rights of man; being the first volume of an entirely new and unabridged issue. Ed. by Hypatia Bradlaugh Bonner, with a biographical and critical introduction by John M. Robertson. -- II. The age of reason; being the second volume of an entirely new and unabridged issue of the chief works of Thomas paine. Ed., with historical introduction, by Hypatia Bradlaugh Bonner.

Is consciousness a purely physical phenomenon? Most contemporary philosophers and theorists hold that it is, and take this to be supported by modern science. But a significant minority endorse non-physicalist theories such as dualism, idealism and panpsychism, among other reasons because it may seem impossible to fully explain consciousness, or capture what it's like to be in conscious states (such as seeing red, or being in pain), in physical terms. This Element will introduce the main non-physicalist theories of consciousness and (...) explain the most important arguments for them, and consider how they each respond to the scientific and other arguments in support of physicalism. This title is also available as Open Access on Cambridge Core. (shrink)

The phenomenal powers view claims that phenomenal properties metaphysically necessitate their effects in virtue of how they feel, and thereby constitute non-Humean causal powers. For example, pain necessitates that subjects who experience it try to avoid it in virtue of feeling bad. I argue for this view based on the inconceivability of certain phenomenal properties necessitating different effects than their actual ones, their ability to predict their effects without induction, and their ability to explain their effects without appeal to laws (...) or regularities. I also offer a harmony argument according to which the view offers the best explanation for otherwise seemingly fortunate psychophysical regularities. I then outline the view’s main implications for the metaphysics of causation and philosophy of mind. (shrink)

This paper focuses on the possibility of conceiving a form of ontological nihilism, starting from D. M. Armstrong’s combinatorialism. This possibility has been suggested by Efird and Stoneham, by means of proposing an alternative strategy to the ‘subtraction argument’. They claim that it is possible to sustain such nihilism trough the concepts of construction and totality state of affairs. However, this hypothesis will require the acceptance of non-instanciated universals, that is, platonic universals. Yet this is opposite to requirements that are (...) basic for a combinatorial theory, which should uphold that universals exist only in their instantiations. Then, the assumption of platonic universals results in high costs for a combinatorial naturalism, according to which only exists what is located in space and time. (shrink)

This paper focuses on the possibility of conceiving a form of ontological nihilism, starting from D. M. Armstrong’s combinatorialism. This possibility has been suggested by Efird and Stoneham, by means of proposing an alternative strategy to the ‘subtraction argument’. They claim that it is possible to sustain such nihilism trough the concepts of construction and totality state of affairs. However, this hypothesis will require the acceptance of non-instanciated universals, that is, platonic universals. Yet this is opposite to requirements that are (...) basic for a combinatorial theory, which should uphold that universals exist only in their instantiations. Then, the assumption of platonic universals results in high costs for a combinatorial naturalism, according to which only exists what is located in space and time. (shrink)

This paper focuses on the possibility of conceiving a form of ontological nihilism, starting from D. M. Armstrong’s combinatorialism. This possibility has been suggested by Efird and Stoneham, by means of proposing an alternative strategy to the ‘subtraction argument’. They claim that it is possible to sustain such nihilism trough the concepts of construction and totality state of affairs. However, this hypothesis will require the acceptance of non-instanciated universals, that is, platonic universals. Yet this is opposite to requirements that are (...) basic for a combinatorial theory, which should uphold that universals exist only in their instantiations. Then, the assumption of platonic universals results in high costs for a combinatorial naturalism, according to which only exists what is located in space and time. (shrink)

This edited volume represents a unique addition to the available literature on animal ethics, animal studies, and neuroethics. Its goal is to expand discussions on animal ethics and neuroethics by weaving together different threads: philosophy of mind and animal minds, neuroscientific study of animal minds, and animal ethics. Neuroethical questions concerning animals’ moral status, animal minds and consciousness, animal pain, and the adequacy of animal models for neuropsychiatric disease have long been topics of debate in philosophy and ethics, and more (...) recently also in neuroscientific research. The book presents a transdisciplinary blend of voices, underscoring different perspectives on the broad questions of how neuroscience can contribute to our understanding of nonhuman minds, and on debates over the moral status of nonhuman animals. All chapters were written by outstanding scholars in philosophy, neuroscience, animal behavior, biology, neuroethics, and bioethics, and cover a range of issues and species/taxa. Given its scope, the book will appeal to scientists and students interested in the debate on animal ethics, while also offering an important resource for future researchers. Chapter 13 of this book is available open access under a CC BY 4.0 license at link.springer.com. (shrink)

In the Eurowest pain is discursively framed as something that elides discourse and therefore is outside language. In this framing, pain, as outside language, is given asocial and ahistorical status understood to be beyond human construction. Indeed, played out in systems of belief and practice, pain acts as a medium for reciprocal relations with the metaphysical other since it too is understood as originating and sharing a part in the 'authentic' or 'real' from which the metaphysical, and therefore truth, is (...) understood to emerge. Understood as part of this domain, pain is linked to truth and therefore understood to be a means to truth; hence the use of torture to secure the truth. With this kind of discursive framing, this book works to make apparent the rhetorical play of pain demonstrating its social and political imperatives. (shrink)

Epiphenomenalism is the view that phenomenal properties – which characterize what it is like, or how it feels, for a subject to be in conscious states – have no physical effects. One of the earliest arguments against epiphenomenalism is the evolutionary argument (James 1890/1981; Eccles and Popper 1977; Popper 1978), which starts from the following problem: why is pain correlated with stimuli detrimental to survival and reproduction – such as suffocation, hunger and burning? And why is pleasure correlated with stimuli (...) beneficial to survival and reproduction – such as eating and breathing? According to the argument, the fact that we have these particular correlations and not other ones must have an evolutionary explanation. But given epiphenomenalism, differences in phenomenal properties could not cause differences in fitness, so natural selection would not be expected to favor these correlations over any other ones. Epiphenomenalism thus renders these correlations an inexplicable coincidence, and should therefore be rejected. The evolutionary argument has been widely criticized and few have deemed it cogent (Broad 1925; Jackson 1982; Robinson 2007; Corabi 2014). In this paper, I will consider previous and potential criticisms and conclude some of them are indeed fatal to the argument if it is understood, as it traditionally has been, as an argument for any standard version of non-epiphenomenalism such as physicalism and interactionism. I will then offer a new and improved version of the argument, as an argument for a particular non-epiphenomenalist view, which I will call the phenomenal powers view. This is the view that phenomenal properties produce and thereby (metaphysically) necessitate their effects in virtue of how they feel, or in virtue of their intrinsic, phenomenal character alone – along the lines of C. B. Martin and John Heil’s powerful qualities view (Martin and Heil 1999; Heil 2003). I will argue that the phenomenal powers view explains the correlations given natural selection far better than any other view. It follows that if (and only if) understood as an argument for the phenomenal powers view, the evolutionary argument is far stronger than it is usually thought to be. (shrink)

Kamm’s response to Tse’s comments deals with the following issues (among others): (1)the relevance of empirical facts to moral arguments about physician assisted suicide (PAS); (2) the moral relevance of the difference between foreseen risk and certainty of death as well as the difference between certain death and immediate death; (3) whether intention matters to the permissibility of giving morphine for pain relief (MPR) and whether objective factors can be the same whether one intends MPR or death in giving morphine; (...) (4) the relevance of the permissibility of MPR or terminating life-saving treatment for the permissibility of PAS. (shrink)

Phenomenal knowledge is knowledge of what it is like to be in conscious states, such as seeing red or being in pain. According to the knowledge argument (Jackson 1982, 1986), phenomenal knowledge is knowledge that, i.e., knowledge of phenomenal facts. According to the ability hypothesis (Nemirow 1979; Lewis 1983), phenomenal knowledge is mere practical knowledge how, i.e., the mere possession of abilities. However, some phenomenal knowledge also seems to be knowledge why, i.e., knowledge of explanatory facts. For example, someone who (...) has just experienced pain for the first time learns not only that this is what pain is like, but also why people tend to avoid it. Some philosophers have claimed that experiencing pain gives knowledge why in a normative sense: it tells us why pain is bad and why inflicting it is wrong (Kahane 2010). But phenomenal knowledge seems to explain not (only) why people should avoid pain, but why they in fact tend to do so. In this paper, I will explicate and defend a precise version of this claim and use it as a basis for a new version of the knowledge argument, which I call the explanatory knowledge argument. According to the argument, some phenomenal knowledge (1) explains regularities in a distinctive, ultimate or regress-ending way, and (2) predict them without induction. No physical knowledge explains and predicts regularities in the same way. This implies the existence of distinctive, phenomenal explanatory facts, which cannot be identified with physical facts. I will show that this argument can be defended against the main objections to the original knowledge argument, the ability hypothesis and the phenomenal concept strategy, even if it turns out that the original cannot. In this way, the explanatory knowledge argument further strengthens the case against physicalism. (shrink)

This paper is another of the papers presented at a conference on Pain organised under the auspices of the London Medical Group. Mark Swerdlow deals with the work of pain relief clinics and explores their value. He gives the background as to what these clinics are, describes who is treated, how they are staffed and finally offers his opinion as to their effectiveness.

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

The practice of humanity means that in every situation, one has the thought, 'How would I feel if this happened to me?' The moment someone swears at me, before swearing back at that person, in my mind I have the thought, 'If this has caused me so much pain, then if I swear at him, how much pain will he feel!' If one admits this and concedes, then a resolution will come about. This is the first sign of the practice (...) of humanity. The practice of humanity begins from this point. (shrink)

The management of an infant after a decision to withdraw active treatment creates dilemmas. Both lingering death and active killing are undesirable, but palliative interventions can hasten death. We investigated what staff on our neonatal unit thought were the limits of acceptable practice and why. We administered a structured interview to elucidate their views, and asked them to justify their answers. The interviews were analysed quantitatively and qualitatively. A total of 25 participants (15 nurses and 10 doctors) were recruited. 80% (...) emphasized the importance of pain relief following withdrawal, 60% mentioned meeting parental needs at that time. 76% agreed that death can be a desired consequence of withdrawal, yet 52% felt that death should never be hastened. 96% felt that morphine is acceptable after withdrawal, and 72% would give a higher than normal dose if necessary. 56% would stop paralysis at extubation but not reverse it, while 24% would continue paralysis. 16% would consider a drug that ended life instantly in some cases. A wide variety of views emerged, but there were two main positions, a cautious majority, and a more proactive minority. Apparent contradictions within the majority position could be explained using the doctrine of double effect and the acts and omissions distinction. (shrink)

Although activated spinal cord glia contribute importantly to neuropathic pain, how nerve injury activates glia remains controversial. It has recently been proposed, on the basis of genetic approaches, that toll-like receptor 4 may be a key receptor for initiating microglial activation following L5 spinal nerve injury. The present studies extend this idea pharmacologically by showing that TLR4 is key for maintaining neuropathic pain following sciatic nerve chronic constriction injury. Established neuropathic pain was reversed by intrathecally delivered TLR4 receptor antagonists derived (...) from lipopolysaccharide. Additionally, -naltrexone, -naloxone, and -naloxone, which we show here to be TLR4 antagonists in vitro on both stably transfected HEK293-TLR4 and microglial cell lines, suppressed neuropathic pain with complete reversal upon chronic infusion. Immunohistochemical analyses of spinal cords following chronic infusion revealed suppression of CCI-induced microglial activation by -naloxone and -naloxone, paralleling reversal of neuropathic pain. Together, these CCI data support the conclusion that neuron-to-glia signaling through TLR4 is important not only for initiating neuropathic pain, as suggested previously, but also for maintaining established neuropathic pain. Furthermore, these studies suggest that the novel TLR4 antagonists -naloxone and -naloxone can each fully reverse established neuropathic pain upon multi-day administration. This finding with -naloxone is of potential clinical relevance. This is because -naloxone is an antagonist that is inactive at the -opioid selective receptors on neurons that produce analgesia. Thus, these data suggest that -opioid antagonists such as -naloxone may be useful clinically to suppress glial activation, yet -opioid agonists suppress pain. (shrink)

Multidisciplinary models aggregating ‘lower-level’ biological and ‘higher-level’ psychological and social determinants of a phenomenon raise a puzzle. How is the interaction between the physical, the psychological and the social conceptualized and explained? Using biopsychosocial models of pain as an illustration, I argue that these models are in fact level-neutral compilations of empirical findings about correlated and causally relevant factors, and as such they neither assume, nor entail a conceptual or ontological stratification into levels of description, explanation or reality. If inter-level (...) causation is deemed problematic or if debates about the superiority of a particular level of description or explanation arise, these issues are fueled by considerations other than empirical findings. (shrink)

What if human joy went on endlessly? Suppose, for example, that each human generation were followed by another, or that the Western religions are right when they teach that each human being lives eternally after death. If any such possibility is true in the actual world, then an agent might sometimes be so situated that more than one course of action would produce an infinite amount of utility. Deciding whether to have a child born this year rather than next is (...) a situation wherein an agent may face several alternatives whose effects could well ramify endlessly on such suppositions, for the child born this year would be a different person—one who preferred different things, performed different actions, and had different descendants—from a child born next year. It has recently been suggested that traditional utilitarianism stumbles on such cases of infinite utility. Specifically, utilitarianism seems to require, for its application, that all experience of pleasure and pain cease at some time in the future or asymptotically approach zero.2 If neither of these conditions holds, then the utility produced by each of two alternative actions may turn out to be infinite, and utilitarianism thus loses its ability to discriminate morally between them. (shrink)

Background Paediatric clinical research faces unique challenges that compromise optimal recruitment of children into clinical trials. A main barrier to enrolment of children is parental misconceptions about the research process. In developing countries, there is a knowledge gap regarding parental perceptions of and attitudes towards their children's participation in clinical trials. Objective To explore such perceptions and attitudes in Lebanese parents. Study design 33 in-depth interviews were conducted with parents with and without previous research experience. Interviews were tape-recorded, transcribed in (...) colloquial Arabic, and later subjected to thematic analysis. Results Benefit/risk ratio assessment was a major determinant of parental consent. Fear of adverse events or painful procedures in research was a recurring theme in most interviews. Whereas perception of direct benefit to the child, trust in the physician or institution, financial gains or having a positive previous experience in research facilitated consent, a complex informed consent form and misunderstanding of the term ‘randomisation’ hindered parental approval of participation. Conclusion Lebanese parents have perceptions of and attitudes towards children's participation in clinical trials that are similar to those reported from the industrialised world. Improving communication with parents and building trust between researchers and parents is important for successful recruitment. Investigators planning to conduct paediatric trials in developing countries need to simplify consent forms and devise new ways to explain randomisation. (shrink)

Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of 1502 (...) French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

Local food systems are growing, and little is known about how the constellation of farms and markets change over time. We trace the evolution of two local food systems over six years, including a dataset of over 2690 market connections between 1520 locations. Longitudinal social network analysis reveals how the architecture, actor network centrality, magnitude, and spatiality of these supply chains shifted during the 2012–2018 time period. Our findings demonstrate that, despite growth in the number of farmers’ markets, grocery stores, (...) farms and restaurants in both counties, each local food system also experienced high turnover rates. Over 80% of the market connections changed during the study period. Farms, farmers’ markets, and grocery stores showed a 40–50% ‘survival’ rate, indicating their role in sustaining local food systems over longer time periods. Other actors, such as restaurants, had a much higher turnover rate within the network. Both food systems became more close-knit and consolidated as the center of gravity for both local food systems pulled away from urban areas toward rural farmland. Evidence of both growth and decay within local food systems provides a new understanding of the social networks behind local food markets. (shrink)

Two experiments, one on school-aged children and one on adults, explored the mechanisms underlying responses to an image prime followed by graspable objects that were, in certain cases, dangerous. Participants were presented with different primes and objects representing two risk levels . The task required that a natural/artifact categorization task be performed by pressing different keys. In both adults and children graspable objects activated a facilitating motor response, while dangerous objects evoked aversive affordances, generating an interference-effect. Both children and adults (...) were sensitive to the distinction between biological and non-biological hands, however detailed resonant mechanisms related to the hand-prime gender emerged only in adults. Implications for how the concept of “dangerous object” develops and the relationship between resonant mechanisms and perception of danger are discussed. (shrink)

In this paper, I explore how our experience of pain and suffering structure our experience over time. I argue that pain and suffering are not as easily dissociable, in living and in conceptual analysis, as philosophers have tended to think. Specifically, I do not think that there is only a contingent connection between physical pain and psychological suffering. Rather, physical pain is partially constitutive of existential suffering. My analysis is informed by contemporary thinking about pain and suffering as well as (...) Indian Buddhist philosophy. (shrink)