It has been demonstrated that death certificates do not accurately record the actual cause of death in up to one-fourth of cases, as determined from subsequent autopsy findings. The purpose of this study was to explore the use of natural language autopsy data bases as an automated quality assurance mechanism. We translated the account of the major process leading to death, or the primary diagnosis, from all 45,564 narrative autopsy reports obtained at The Johns Hopkins Hospital (...) between May 28, 1889, and June 30, 1987, into the hierarchical system of Medical Subject Heading (MeSH) titles. We obtained a total of 125,772 MeSH title translations, 1,563 of them distinct (average 2.8 per case), ranging in frequency from 6,029 occurrences of LUNG to 1 occurrence apiece of 357 MeSH titles. The natural-language-to-MeSH translations showed expected trends over the past century: fewer infectious diseases; more cardiovascular and neoplastic disease among adults; and more respiratory diseases and congenital malformations in the pediatric age group. The greater availability of autopsy documents in electronic form should increase the value of this resource for quality assurance. (shrink)

In the ongoing pandemic, death statistics influence people’s feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization’s rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts and values.

Brain death certification can be a clinically and ethically challenging affair. Healthcare workers are expected to refer patients for brain death certification to identify potential organ donors, but family members may be ill-prepared for this turn of events. Already distraught families may not appreciate delays in brain death certification, but such delays are common because of the need to manage the patient’s altered physiological state to allow testing. Opportunities for donation are sometimes lost because (...) of the unnecessary delay. With focus on an opt-out organ donation law, we discuss causes of delays in brain death certification, and the ethical issues faced by clinicians in using tests to certify patients. To resolve the issues, we argue for the use of supplementary confirmatory tests as part of a more protocol-driven approach to brain death certification to avoid delays. Such tests should be regarded as part of the donation process funded by the state. (shrink)

The World Health Organization has issued international instructions for certification and classification (coding) of the coronavirus disease (COVID-19) as cause of death. Central to these instructions is the selection of the underlying cause of death for a public health preventive purpose. This article focuses on two rules for this selection: (1) that a death due to COVID-19 should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19 and (...) (2) that COVID-19 should not be considered as due to anything else. The article argues that observance of the first rule may not always lead to an optimal selection from a preventive point of view and that in the future the ascertainment of an animal source of the coronavirus (SARS-CoV-2) would make it possible to reconceptualize ‘COVID-19‘ and create a zoonotic classification code by means of which a factor of a greater preventive value could be selected than what is currently possible. (shrink)

Some opponents of abortion claim that fetuses are persons from the moment of conception. Following Berg (2017), let us call these individuals “Personhood-At-Conception” (or PAC), opponents of abortion. Berg argues that if fetuses are persons from the moment of conception, then miscarriage kills far more people than abortion. As such, PAC opponents of abortion face the following dilemma: They must “immediately” and “substantially” shift their attention, resources, etc., toward preventing miscarriage or they must admit that they do not actually believe (...) that fetuses are persons from the moment of conception (or, at least, they must recognize that they are not acting in ways that are consistent with this belief). In this essay, I show that Berg’s argument fails at each step. Specifically, after outlining her argument (in section 1), I consider the central claim of Berg’s style of argument: That “miscarriage…is much deadlier than abortion.” In section 2, I argue that this claim is false (when taken literally) and misleading otherwise. In section 3, I show that Berg’s style of argument is identical in structure to a criticism that is sometimes levied against the recent “Black Lives Matter” movement. In the latter context, the argument has been vehemently rejected. I argue that Berg’s style of argument should be rejected for the same reasons. Finally, in section 4, I show that Berg’s suggestion that opponents of abortion should divert “substantial” amounts of money and attention to miscarriage prevention faces two problems. First, these claims are made without any evidence regarding the actual priorities and spending habits of PAC opponents of abortion. If we are told “not enough is being done,” one wonders: What is being done and how much counts as “enough”? Berg gives no answer to either question. Second, even if it is true that opponents of abortion do not pay substantial attention to miscarriage prevention, Berg fails to notice that this may be for good reason. I conclude that PAC opponents of abortion do not face the dilemma that Berg presents. (shrink)

The cut and thrust of this paper is the re-examination of an age long belief and practice among the Ika people of Delta State and the Obolo of Rivers State which is aimed at discouraging the practice of witchcraft and sorcery. The study critically evaluates the phenomenon which includes necromancy, divination and poison ordeal and concludes that caution is needed as the act which involves human life is not without imperfection. The discourse is comparative as it examines the methods of (...) ascertaining death among the Ika and Obolo. It employs moral, social and philosophical springboards for the analysis. Some of the findings includes: belief in witchcraft is very strong among the people and age long practices to eradicate same will endure, if nothing is done to discourage it. A major constraint is that matters relating to witchcraft and sorcery are metaphysical and so difficult to verify.Keywords: Death, Ascertain, Cosmology, Necromancy, Divination and Ordeal by poison. (shrink)

COVID-19 has caused far-reaching humanitarian challenges. Amongst the emerging impacts of the pandemic is on the dynamics of human trafficking. This paper presents findings from a multi-methods study interrogating the impacts of COVID-19 on human trafficking in Sudan—a critical source, destination, and transit country. The analysis combines a systematic evidence review, semi-structured interviews, and a focus group with survivors, conducted between January and May of 2021. We find key risks have been exacerbated, and simultaneously, critical infrastructure for identifying victims, providing (...) support, and ensuring accountability of perpetrators has been impeded. Centrally, the co-occurrence of the pandemic and the democratic transition undercut the institutional and governance capacity, limiting the anti-trafficking response and exposing already vulnerable groups to increased risks of human trafficking. Findings point to increased vulnerabilities for individuals with one or more of the following identities: migrants, refugees, females, and informal labourers. (shrink)

In their manuscript, Nielsen Busch and Mjaaland (2023) argue that controlled donation after circulatory death (cDCD) is compatible with the dead donor rule (DDR) by describing the DDR and the incor...

This paper examines mortality by cause of death in a rural area of Machakos district in Kenya. The cause-of-death data collected between 1975 and 1978 were likely to be of fairly good quality. The number of deaths was higher among infants and children. Infectious diseases and diseases of the respiratory system were the leading causes of death among children below 5 years of age. Next in prominence were the causes ascribed to congenital anomalies and perinatal (...) conditions.Among adolescents and young adults, injury and poisoning, together with tuberculosis and other infectious and parasitic diseases, were the leading causes of death. Degenerative diseases, especially diseases of the circulatory system and neoplasms and respiratory illness, were responsible for the majority of deaths among the older population. (shrink)

The COVID-19 pandemic has made it especially visible that mortality data are a key component of epidemiological models, being a single indicator that provides information about various health aspects, such as disease prevalence and effectiveness of interventions, and thus enabling predictions on many fronts. In this paper we illustrate the interrelation between facts and values in death statistics, by analyzing the rules for death certification issued by the World Health Organization. We show how the notion of the (...) underlying cause of death can change in view of public health goals. This brings us to a general point about how non-epistemic factors, such as values and goals, are reflected in the choice of different measures in epidemiological models. We finally argue that this analysis is not only relevant from a theoretical point of view but also has important practical consequences. (shrink)

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that (...) the practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

Neonatal mortality during the first week of life, corresponding to the years 19750·023 per year. This decline cannot be explained by an increase in the mean birth weight (MBW=23440·835−10·107 g per year). From the most frequent of the causes of death to the least were: congenital anomalies, preterm born or low birth weight, respiratory problems, pregnancy difficulties, hypoxaemia/asphyxia, delivery difficulties and infectious diseases. This sequence changed when the specific age at death was considered. The NMR descended evenly for (...) both sexes for the causes indicated above, except for preterm born or low birth weight, in which the male mortality decrease was greater since its rate was more elevated at the beginning of the period studied. For all the causes listed, NMR was more elevated both in urban areas and for males. Early neonatal mortality (first 24 hours) was higher for pregnancy difficulties, preterm born or low birth weight, congenital anomalies and hypoxaemia/asphyxia. (shrink)

Purpose The search for cause of death is important to improve knowledge and provide answers for the relatives of the deceased. Medical autopsy following unexplained death in hospital is one way to identify cause of death but is difficult to carry out routinely. Post mortem sampling (PMS) of tissues via thin biopsy needle or ‘mini incisions’ in the skin may be a useful alternative. A study was undertaken to assess how this approach is perceived by (...) intensive care doctors and also to evaluate how this practice is considered in ethical terms in France. Methods A study of PMS practices immediately after death in 10 intensive care departments was performed. The medical director of each centre was interviewed by telephone and asked to describe practices in their unit and to outline the questions raised by this practice. Results PMS is routinely performed in 70% of the units which responded, without systematically obtaining formal consent and without precise rules for communicating results. Approaches to PMS differed between centres, but all physicians felt that PMS is useful for the scientific information it gives and also for the information it provides for relatives. All physicians regret the lack of standards to structure PMS practices. Conclusion Information from post mortem examinations is important for society to inform about causes of death, for doctors to improve practices and for decision-makers responsible for organising care. Debate persists regarding the balance between individual rights and community interests. It is suggested that an approach for identifying cause of death could easily be integrated into the relationship between carers and relatives, provided full transparency is maintained. (shrink)

Verbal autopsy presents the opportunity to understand the disease burden in many low-income countries where vital registration systems are underdeveloped and most deaths occur in the community. Advances in technology have led to the development of software that can provide probable cause of death information in real time, and research considering the ethical implications of these advances is necessary to inform policy. Our research explores these ethical issues in rural Nepal using a public health ethics framework. We considered (...) the burdens and benefits of VA and giving cause of death information to families of the deceased through qualitative research with VA interviewers, community members, national policy stakeholders and international academics. Burdens can be experienced differently, and it is important to balance the emotional burden of VA with utilization of the data to inform planning and increased access to health services. The training, support and supervision of VA interviewers should be prioritized if VA is taken to scale. Initial and ongoing community engagement is recommended in addition to engaging ethical, legal, health and policy personnel in developing protocols and systems. Integrating rigorous research while cautiously moving forward is recommended to ensure systems and responses to concerns are relevant to contexts. (shrink)

The purpose of the study was to analyse the level and the trends of Potential Years of Life Lost due to the main causes of death in Poland in the years 2002-2011. The material for the study was the information from the Central Statistical Office on the number of deaths due to the main causes of death in Poland in the years 2002-2011. The premature mortality analysis was conducted with the use of the PYLL indicator. PYLL rate was (...) calculated following the method proposed by J. Romeder, according to which premature mortality was defined as death before the age of 70. Time trends of PYLL rate and the average annual percent change were assessed using jointpoint models and the Joinpoint Regression Program. In the years 2002-2011, PYLL rate for all-cause deaths decreased by 7.0% among men and 8.1% among women. In 2011, the main reasons for PYLL among men were: external causes, cardiovascular diseases and cancers. Among women the leading causes were: cancers, cardiovascular diseases and external causes. PYLL rate increased among men for colorectal cancer, and among women for colorectal and lung cancer. The presented epidemiological situation for premature mortality in Poland shows that in the majority of cases it is caused by preventable deaths, which highlights a need to intensify measures in primary and secondary prevention. (shrink)

‘The tale of the Argonauts was among the most popular myths in Greek and Roman literature of all periods.’ There was, however, not inconsiderable variation in certain aspects of the narrative: in the inclusion or exclusion of entire episodes; in (un)expected divergences from more authoritative versions of the story; and in the details of minutiae. In the Argonautic choral odes of Seneca'sMedea(301–79 and 579–669), and in Valerius Flaccus’ incomplete epic, there is a conspicuous, learned engagement with much of the earlier (...) tradition that hints at versions of the myth which are divergent from those that the two poets privilege in their respective narratives. Such moments serve to assert the playwright's and the epicist's status asdocti poetae, and to engage the learned reader in a (re)negotiation of the tradition; at times, an awareness of a literary past seems to be given to particular characters too so as to heighten the reader's experience of the narrative—by a sort of prolepsis—as it unfolds. (shrink)

AbstractWhen considering the manner of death, two categories can be distinguished, namely natural death and unnatural death. Though most physicians think that the distinction between the two is evident, this is not the case.When comparing the Netherlands, Belgium, England and Germany it is noticed that the terms natural and unnatural might be used in law but are not defined by law. In practice, the term unnatural death is used when there is an external cause of (...) death, but even that turns out to not be sufficient in making an obvious difference between the two terms. Different countries may even label the same death differently. A, at times philosophical and semantic, discussion shows that when it comes to causes of death a very large grey area exists between natural and unnatural causes of death. The Netherlands, Belgium and Germany even have the possibility to label a death as natural without actually knowing the cause of death.In conclusion, we recommend a new system in which the circumstances surrounding a death are properly investigated. This should lead to a report to an independent legal expert, who is able to decide if and what conclusion can be drawn, from a judicial and a public point of view, thereby, making the distinction and the use of the terms natural and unnatural/nonnatural obsolete. (shrink)

The deceased's prior consent to posthumous reproduction is a common requirement in many common law jurisdictions. This paper critically evaluates four arguments advanced to justify the presumption against consent. It is argued that, in situations where death is caused by sudden trauma, not only is there inadequate justification for the presumption against consent, but there are good reasons to reverse the presumption. The article concludes that the precondition of prior consent may be inappropriate in these situations.

Rousseau is considered to be at once the most modern political thinker of the 18th century and the most ancient in his allegiance to classical republicanism. These essays address the place of liberty in his moral and political philosophy, and the origins, meaning, strength, weakness and significance of his argument.

Hobbesian war primarily arises not because material resources are scarce; or because humans ruthlessly seek survival before all else; or because we are naturally selfish, competitive, or aggressive brutes. Rather, it arises because we are fragile, fearful, impressionable, and psychologically prickly creatures susceptible to ideological manipulation, whose anger can become irrationally inflamed by even trivial slights to our glory. The primary source of war, according to Hobbes, is disagreement, because we read into it the most inflammatory signs of contempt. Both (...) cause and remedy are therefore primarily ideological: The Leviathan's primary function is to settle the meaning of the most controversial words implicated in social life, minimize public disagreement, neutralize glory, magnify the fear of death, and root out subversive doctrines. Managing interstate conflict, in turn, requires not only coercive power, but also the soft power required to shape characters and defuse the effects of status competition. (shrink)

BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among (...) diverse populations have not been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death. (shrink)

With no statutory definition of death, the accepted medical definition relies on brain stem death criteria as a definitive measure of diagnosing death. However, the use of brain stem death criteria in this way is precarious and causes widespread confusion amongst both medical and lay communities. Through critical analysis, this paper considers the insufficiencies of brain stem death. It concludes that brain stem death cannot be successfully equated with either biological death or the (...) loss of integrated bodily function. The overemphasis of the brain-stem and its consequences leaves the criteria open to significant philosophical critique. Further, in some circumstances, the use of brain stem death criteria causes substantial emotional conflict for families and relatives. Accordingly, a more holistic and comprehensive definition of death is required. (shrink)

BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation (...) between the academic fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities.DiscussionTwo questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die.ConclusionsDeprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease. (shrink)

The theories of cultural anthropologist Ernest Becker arise from an existential and psychological analysis of the death terror/anxiety deep in the unconscious of every human. Becker details how this anxiety governs the ideologies and behaviors of our species—something now confirmed by thousands of experiments performed by psychologists engaged in contemporary terror management theory (TMT). Humans manage their anxiety through what Becker terms “hero systems”—concepts, beliefs, and myths we create to give us a sense of significance and meaning during, and (...) even beyond our mortal lives. Today, many dominant economic, technological, and religious hero systems seek to confirm our significance by denying that we are—like all other species—animals who must exist in a decaying, mortal body. Becker shows how this attempt to deny our “creatureliness” (basic biological nature) causes humans to stand against the natural world we are embedded in, leading to an assault on the planet and nonhuman animals. As a result, Becker believed pacifism was the only hero system capable of keeping humankind from destroying itself and the earth. Pacifism is the precursor to the more encompassing ethical concept of “reverence for life,” advocated by Dr. Albert Schweitzer. By respecting the will-to-live in all sentient beings, reverence for life transcends concern for humans alone and extends moral and physical safeguards to life as such. Confronting the fact that humans are increasingly alienated from their commodified world and their own being, reverence for life stands as a vital solution to many of our modern problems. And following contemporary TMT research, reverencing life can also expand one’s self-esteem, which research shows lowers death anxiety, reduces aggression, and offers authentic meaning to life itself. (shrink)

This paper examines the evolution of Jacques Lacan’s concept of mourning from his treatment of Hamlet in Seminar 6, “Desire and Its Interpretation,” to its transformation in the tenth Seminar on “Anxiety.” It is a transformation that occurs in tandem with Lacan’s reconception of anxiety as lack of the lack and his reshaped conception of the objet a as object/cause of desire. The key point is the way that Lacan’s renovated conception upends the common sense notion of mourning, that (...) which assumes that suffering the death of a loved one means accommodating oneself to an absence where there was previously a presence. On the contrary, says Lacan, part of what is most deeply to be mourned is the lack in the Other around which the love relation was constructed. The paper concludes by asking to what extent Lacan’s account of mourning should be distinguished from those of both Hegel and Freud. (shrink)

Michael Nair-Collins and Franklin G. Miller argue in an extended essay that the dominant view in medical ethics of patients who are brain dead but sustained on mechanical ventilation is false. According to this view, these unfortunate patients are biologically dead, yet appear to be alive as a result of the fact that mechanical ventilation ensures that their heart continues to beat, that their skin remains warm, that their wounds continue to heal, that their body does not decay, and that (...) they continue to breathe. This view was defended by the U.S. President’s Commission in 1981, and again by the President’s Council in 2008. That brain-dead, mechanically ventilated patients are biologically dead—rather than dead merely in a social or legal sense—is seen by defenders of this view as important. The President’s Council explicitly rejected the idea that death is anything other than a fact of biology. The significance of this move is explained by Nair-Collins and Miller as follows: > Getting this biological conception right is critically important: responsible moral and policy deliberation begins with an unbiased assessment of relevant factual questions. One cannot address the difficult normative questions surrounding organ retrieval, just use of resources, withdrawal of mechanical support and so on, without first addressing the biological question: what is the vital status of this organism? Essentially, working with a biological conception of death makes certain decisions much less ethically murky than they would be in the absence of such a conception. The ‘dead donor rule’, for example, prohibits causing death to a patient by removing their organs. If it is a fact of biology that brain-dead, mechanically ventilated patients are dead, then removing their organs for donation clearly does not fall foul of the dead donor rule. If, on the other hand, the …. (shrink)

There is a close relationship between Ashʿarism and Ḥanbalism since the emergence of Ashʿarism. However, they often conflicted with each other as they approached to religious matters from different perspectives. These conflicts were not only limited to theological discussions but also turned into social conflicts, which occasionally resulted with deaths. First massive events occurred in 429/1038 in Baghdād between Ashʿarites and Ḥanbalities. When Niẓām al-Mulk was appointed as vizier, the conflicts reached a peak. The apparent reason of the conflicts was (...) the theological controversy between these two sects. However, the rise of Ashʿarism, which was usually against Ḥanbalism, was the main reason of the social conflicts. Supports of the Ashʿarite thought by the leading statesmen of the era such as Niẓām al-Mulk and Ayyūbid sultans, and accusations of some Ashʿarite preachers about Ḥanbalities relying on this political support were also among the factors that led to these conflicts. Nevertheless, even if any accusation was not made, it occurred that the members of both sects resorted to violence in case of criticisms about their beliefs. This shows that the most important reason of the conflicts was sectarian fanaticism.Summary: Ashʿarism is the name of the sect that was formed around the ideas of Abū al-Ḥasan al-Ashʿarī. It is a continuation of Kullābism in terms of general thought system. Ashʿarism replaced Kullābism by the end of the 5th century of the Hijrah, and started to be called as an independent sect. It spread mostly among the Shāfiʿites and Mālikites in Iraq, Khurāsān, Damascus, Maghreb, and Yemen. When it was arrived to the last quarter of the 5th century, it became the common theological sect of most of Shāfiʿites and Mālikites. Bāqillānī (d. 403/1013), Ibn Fūrāk (d. 406/1015), and Abū Isḥāq al-Isfarāyīnī’s (d. 418/1027) efforts played an important role in rising of Ashʿarism in this period. In the following periods, contribution of the Seljuk vizier Niẓām al-Mulk (d. 485/1092) to Ashʿarism was massive by establishing the Niẓāmiyah Colleges to strengthen the Ashʿarites against the Hanafites in Khurāsān and against the Ḥanbalites in Baghdād. The Niẓāmiyah Colleges were donated by Niẓām al-Mulk to Shāfiʿite scholars for the mission of primarily limiting the influence Shīʿī thought. The condition of belonging to Shāfiʿites in waqfiyyah (endowment certificate) of the colleges provided some important advantages for Shāfiʿites and Ashʿarites. On the other hand, the Ayyūbids provided important contributions to Ashʿarites in the regions of Egypt, Damascus and Yemen. They worked for strengthening Ashʿarism during their ruling for two centuries. It was a state policy for the Ayyūbids to support Ashʿarism starting from the founder of the state, Ṣalāḥ al-Dīn al-Ayyūbī (d. 589/1193).This rapid rise of Ashʿarism led to a tense relationship between the Ashʿarites and the Ḥanbalites who became the most important representative of Aṣḥāb al-ḥadīth (people of the traditions of the Prophet) after the period of Miḥnah (period of religious persecution). Undoubtedly, the first respondents of these tense relations were Kullābite scholars. At the beginning of the 4th century of the Hijrah, Abū al-Ḥasan al-Ashʿarī became the natural inheritor of the Ḥanbalite reaction to the Kullābites. He conflicted with the Ḥanbalites because of his different approach on the debate regarding creation of the Qur’ān. Ḥanbalite reactions to Imam al-Ashʿarī continued after his death. When he died in Baghdād in 324/935, officials buried him secretly as they worried about Ḥanbalite attacks against his funeral. Hence, after his burial some Ḥanbalites tried to destroy his tomb several times. After Ashʿarī died, the first social events between the Ashʿarites and the Ḥanbalites took place in Iṣfahān, one of the most important cities of West Khurāsān, in the end of the 4th century of the Hijrah. The debate started around the question of whether the letters of the Qur’ān were created or uncreated between the Ḥanbalite scholar Ibn Mandah (d. 395/1005) and Ashʿarite scholar Abū Nuʿaym al-Iṣfahānī (d. 430/1038). This debate led to prolonged events between the supporters of these scholars. Abū Nuʿaym, saved his life from various attacks and finally he had to leave Iṣfahān.The tense relationships between the Ashʿarites and the Ḥanbalites reached the peak in the 5th century of the Hijrah. Many events occurred in Baghdād during this century. The discussion on interpretation of the revealed attributes of Allah turned into conflict between the two sides from time to time. The Ashʿarite scholars accused the Ḥanbalites with tashbih (affirming Allah’s similarity to humanity) and tajseem (anthropomorphism) by pointing at Abū Yaʿlā al-Farrā’s work titled Ibṭāl al-taʾwīl al-ṣifāt. The ʿAbbāsid caliphs generally supported the Ḥanbalites in this debate. For example, when al-Qāim bi-Amr Allāh re-published the famous declaration known as the Qādirī Creed in 433/1042, he proclaimed that rejection of the Ḥanbalite approach on the issue of the revealed attributes of Allah would be regarded as a cause of blasphemy. The paper was read in a meeting where several scholars from various sects were present. It was signed firstly by Ashʿarite scholar Abū al-Ḥasan ʿAli ibn ʿUmar al-Qazwīnī (d. 442/1051). However, he was one who had criticized Ibṭāl al-taʾwīl al-ṣifāt in 429/1038, which caused conflicts in society at that time. This shift in his position is remarkable as it shows that the declaration was primarily response to him.In the middle of the 5th century of the Hijrah, Ashʿarite scholar al-Khatīb al-Baghdādī (d. 463/1071) became a victim of the tension between the Ashʿarites and Ḥanbalites. Khatīb had protection of vizier Ibn al-Muslima and under his protection he lectured on Hadith in the Mansur Mosque. However, after the death of the vizier, he was subjected to harassment of the Ḥanbalites because of some expressions in his work titled Tarīkh Baghdād. So much so that he began to worry about his life, thus he had to leave Baghdād and went to Damascus in 451/1059.The tense relations between the Ashʿarites and the Ḥanbalites reached the summit in the period of Niẓām al-Mulk who was the vizier of Seljuk Empire. In fact, some events resulted with deaths. For example, in the events of 469/1076, which lasted years, the Ḥanbalites attacked Ashʿarite scholar Abū Naṣr ibn ʿAbd al-Karīm al-Qushayrī (d. 514/1120) who accused them with tashbeeh and tajseem. As a result, around twenty people died during these events. The gradual rise of the Ashʿarite thought with the support of Niẓām al-Mulk and abusive discourses of some Ashʿarite scholars who relied on this support can be mentioned among the basic reasons of the events at that time.After the death of Niẓām al-Mulk in 485/1092, for a long time there was no serious event between the Ashʿarites and the Ḥanbalites. In the middle of the 6th/12th century, the relations started to become tense again in the regions of Egypt, Damascus, and Yemen under the Ayyūbid dynasty. In addition to these places, various events occurred in Khurāsān region, in cities such as Marw. Nevertheless, unlike some previous events, the current tensions were not against a whole sect but only targeted some individual scholars. Moreover, unlike the previous periods, oppressed and victimized people were mostly Ḥanbalite scholars this time. No serious events took place between two sects after this period. Therefore, it can be said that their struggle to dominate society led to the above-mentioned events. (shrink)

A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2–5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain (...) arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2–5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that paents in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2–5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently. (shrink)

In this work, I explore and critically evaluate Aristotle’s views on the naturalness of dying from old age. His views are not straightforward, because Aristotle regards old age as a kind of decay and he talks about decay sometimes as natural and sometimes as unnatural. Nature, according to Aristotle, has two aspects, matter and form. I argue that, in Aristotle’s system, decay is always materially natural but formally unnatural. Likewise, natural death is death caused by old age and (...) although getting old is never formally natural, it is, in a particular sense, materially natural. In Aristotle’s view, getting old does not have the same mechanism as inorganic decay such as wine’s turning into vinegar, but it is a result of the materially natural decay of lungs, which leads to the exhaustion of the vital heat in the heart. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the provider-patient (...) relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

: Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead and that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be (...) to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law—such as authorizing procuring surgeons to end the lives of patients by means of organ procurement—and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained. (shrink)

Refusal of organ donation is common, and becoming more frequent. In Australia refusal by families occurred in 56% of cases in 1995 in New South Wales, and had risen to 82% in 1999, becoming the most important determinant of the country's very low organ donation rate .Leading causes of refusal, identified in many studies, include the lack of understanding by families of brain death and its implications, and subsequent reluctance to relegate the body to purely instrumental status. It is (...) an interesting paradox that surveys of the public continue to show considerable support for organ donation programmes—in theory we will, in practice we won't .In this paper we propose that the Australian community may, for good reason, distrust the concept of and criteria for “whole brain death”, and the equation of this new concept with death of the human being. We suggest that irreversible loss of circulation should be reinstated as the major defining characteristic of death, but that brain-dead, heart-beating entities remain suitable organ donors despite being alive by this criterion. This presents a major challenge to the “dead donor rule”, and would require review of current transplantation legislation. Brain dead entities are suitable donors because of irreversible loss of personhood, accurately and robustly defined by the current brain stem criteria."Even the dead are not terminally ill any more.". (shrink)

Two experiments investigated whether moral evaluations of organ transplantation influence judgments of death and causation. Participants’ beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette varied depending on the moral valence of the vignette. Those who were randomly assigned to the good condition were more likely to believe that the donor was dead prior to organ removal and that organ removal did not cause death. Furthermore, attitudes (...) toward euthanasia and organ donation independently predicted judgments of death and causation, regardless of experimental condition. The results are discussed in light of the framework of motivated reasoning, in which motivation influences the selection of cognitive processes and representations applied to a given domain, as well as Knobe’s person-as-moralist model, in which many basic concepts are appropriately imbued with moral features. On either explanatory framework, these data cast doubt on the psychological legitimacy of the mainstream justification for vital organ procurement from heart-beating donors, which holds that neurological criteria for death are scientifically justified, independently of concerns about organ transplantation. These data suggest that, rather than concluding that organ removal is permissible because the donor is dead, people may believe that the donor is dead because they believe organ removal to be permissible. (shrink)

This is the earliest critical discussion in the context of modern/contemporary philosophy in the analytical tradition arguing that somebody with a reasonably stable character and the company of the right people would be able to enjoy eternity.

The Hanafi Sect was the first among the fiqh sects that completed its formation and codification. Abu Hanifa, the founding imam of the sect, raised many students. His most prominent students were Abu Yusuf, Muhammed al-Shaybani and Zufar. While teaching his students, Abu Hanifa created a free environment and was pleased that his students adopted opposing views to his. Accordingly, different views emerged among the imams in question for reasons such as interpreting the texts, taking into account the changes in (...) customs and time, and approaching the issues from different perspectives. After the death of Abu Hanifa, Abu Yusuf served as a kadi, i.e. a judge. Muhammad al-Shaybani played an important role in the formation of the sect. Zakat is one of the subjects where different opinions and disagreements occurred among the imams of the madhhab, or sect. Hanafi books exhibited different approaches in revealing these differences of opinion. For example, there were jurists who mentioned and discussed their differences of opinion in detail, as in Ka-sana’s work Bedai al-sanai fi tertib al-sharai, as well as in Mawsili’s work el-Ihtiyar li-talil al-Muhtar. There were also jurists who took a middle way on the subject. In this study, the differences of opinion of the sect imams Abu Hanifa, Abu Yusuf, Muhammed al-Shaybani and Zufar on zakat will be explained based on the book al-Hidaye by Burhaneddin al-Merginani, which is one of the most popular books of the Hanafi sect. However, the commentaries of al-Hidaye and the books of the sect on fiqh will also be consulted occasionally. In this study, the subjects that are considered more important than the others in regard to the fiqh of zakat will be analyzed. (shrink)

This chapter begins with a discussion of the “Epicurean view” — the view stating that death cannot intelligibly be regarded as an evil for the person who dies because the alleged evil lacks a subject or “recipient.” An argument is then presented in opposition to this view that possesses two key components. The first is an account of the “Values Connect with Feelings” requirement, according to which the connection need not be actual, but merely possible and that the requirement (...) is satisfied provided that the relevant object, state, or event is a possible object, even if it is not a possible cause, of the relevant feelings. The second key component is the employment of a four-dimensional framework that makes it possible to claim that temporally distant events or states, like spatially distant events, exist, and thus are possible objects of relevant feelings. (shrink)

ABSTRACT If a doctor kills a severely handicapped infant, he commits an act of murder; if he deliberately allows such an infant to die, he is said to engage in the proper practice of medicine. This is the view that emerged at the recent trial of Dr Leonard Arthur over the death of the infant John Pearson. However, the distinction between murder on the one hand and what are regarded as permissible lettings die on the other rests on the (...) Moral Difference Myth, according to which deliberate lettings die in the practice of medicine are not instances of the intentional causation of death. I argue that a doctor who refrains from preventing a handicapped infant's death, causes that infant's death and does so intentionally. He commits an act of murder. But, I suggest, not all instances of the intentional causation of death are morally wrong. To the extent that they are not, killing rather than letting die will often be the preferable option because more economical of suffering. Hence what is required is the abolition of the Moral Difference Myth and legislation to the effect that those doctors who justifiably cause a patient's death—whether by an action or by an omission—commit no offence. (shrink)

I offer a principled objection to arguments in favour of legalizing non-voluntary euthanasia on the basis of the principle of beneficence. The objection is that the status of death as a benefit to people who cannot formulate a desire to die is more problematic than pain management care. I ground this objection on epistemic and political arguments. Namely, I argue that death is relatively more unknowable, and the benefits it confers more subjectively debatable, than pain management. I am (...) not primarily referring to the claim that it is difficult to make comparisons between live and post-mortem states, but rather to the fact that it is epistemically and metaphysically problematic to impute a “life-worse-than-death” or a state of “suffering-calling-for-death” to people who cannot subjectively wish to die, as though this kind of suffering were a medically observable fact rather than a belief- and value-laden notion. On the contrary, people enduring similar causes of pain may have different experiences of suffering and views on how it affects the worthwhileness of their existence or the desirability of death or of continuing their lives. The projection of a “suffering-calling-for-death” onto infants or people with severe intellectual disabilities may not be indefensible, but it is more controversial than judging that pain management will improve their well-being from the perspective of beneficence. My argument also relies on our society’s liberal endeavour to avoid endorsing unverifiable beliefs about life and death or controversial conceptions of the good life. My goal is not to suggest we should not attend the suffering of cognitively disabled people. On the contrary, I only cast doubt on too quick an assumption that ending their lives is the best way of caring for them, when robust palliative treatments are available. Moreover, I express the concern that a lack of attention to distinctions between “pain-calling-for-relief” and “suffering-calling-for-death” may be based on ableist projections and assumptions. I conclude that it is imperative to continue research into the nature of pain and suffering experienced by individuals with mental or cognitive impairments preventing them from expressing autonomous wishes about the kind of treatment that would most benefit them. (shrink)