The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made (...) about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals. (shrink)

Life saving or life sustaining treatment may not be instigated in the clinical setting when such treatment is deemed to be futile and therefore not in the patient’s best interests. The concept of futility, however, is related to many assumptions about quality and quantity of life, and may be relied upon in a manner that is ethically unjustifiable. It is argued that the concept of futility will remain of limited practical use in making decisions based on the best interests principle (...) because it places such high demands on the individual responsible for decision making. This article provides a critical analysis of futility (in the context of the best interests decision-making principle), and proposes an ethically defensible notion of futility. (shrink)

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a judgement about the future (...) quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components - pain and suffering, body functioning, and autonomy - and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations. (shrink)

Recent years have seen educationalists turning to Emmanuel Levinas when considering the relationship between ethics and education. While it is true that Levinas never speaks of ethics in relation to the practice of classroom education, nonetheless, for Levinas, ethics is a teaching, and learning can only take place in the presence of the Other. This book considers how, within the constraints of the Irish primary school education system, teachers can develop a Levinasian approach to teaching, that affords both them and (...) the children they teach multiple opportunities throughout the school day to take up their ethical responsibility for each other as Other. Beginning from a Levinasian understanding of learning and teaching as constituting primordially relational and ethical events, and weaving the philosophies of Levinas, and the educationalists he inspires, into the approaches of philosophy with children, restorative practice, and PAX, this book suggests a unique approach to ethics in Irish primary school classrooms. The focus of this thesis, then, is on both the philosophical underpinnings that anchor teaching as a Levinasian, and a consideration of what practical approaches could be employed by the Levinasian teacher. (shrink)