This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded (...) as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context‐specific and culture‐specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end‐of‐life decision‐making. (shrink)

This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded (...) as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making. (shrink)

The article examines the possibilities of using the mechanisms of public-private partnership when implementing the projects on urban agglomerations development. Specific features of the urban agglomerations development are identified. They are based on combining the efforts of the territorial communities and aimed at implementing joint projects by attracting the appropriate resources, which allows to obtain an agglomeration effect and ensure the improvement of the quality of life of the population. It was proved that to implement joint projects on the (...) basis of using the mechanisms of public-private partnership it is necessary to attract private investors. The experience of using the mechanisms of public-private partnership in Ukraine is analyzed in two directions: by region and by type of activity. It was found that a significant part of projects with using public-private partnership mechanisms in the sphere of life support for large cities and agglomerations is carried out in the form of a concession. Concession allows to attract financial resources needed for the implementation of the development projects due to the ability to manage property over a long period of time, and also helps to prevent a monopolistic increase in the cost of services. The necessity of expanding the use of mechanisms of public-private partnership when implementing joint projects on the development of life support sphere for urban agglomerations was substantiated. Undoubtedly, it will be of great interest for private investors. In particular, it is the improvement of the tariff setting and tariff regulation policy, a strict control over the targeted use of funds, the transparency and economic certainty of costs, the balance of economic interests and the responsibility of those people who take part in the implementation of public-private partnership projects. Here, the scheme of the formation and implementation of joint projects on public-private partnership is presented that includes the observance of certain principles, the use of appropriate regulatory, economic and organizational methods, as well as the support of the economic security through risk management. Scientific approaches to improving the regulatory support for the use of public-private partnership mechanisms have been generalized, and the directions for making changes in the current legislation have been determined. The above measures will contribute to increased use of public-private partnership mechanisms when implementing joint projects aimed at developing the sphere of life support for urban agglomerations. (shrink)

The aim of the article is to examine differences in the quality of life as well as gratitude, meaning in life and positive orientation to life between diocesan and religious seminarians and secular students. The influence of religiosity on quality of life and subjective well-being is the subject of numerous studies, but seminarians have rarely been included in them. The present research was carried out for the first time with a group of diocesan and religious seminarians (...) in Poland and secular students. The study involved 296 participants—98 diocesan seminarians, 96 religious seminarians and 102 secular students in the control group. Results showed significant differences in the quality of life. Religious and diocesan seminarians scored higher than the control group members in the psychophysical, personal, psychosocial and metaphysical spheres. In addition, in terms of gratitude, and the presence of meaning in life, religious and diocesan seminarians achieved higher scores than the control group but lower scores in searching for the meaning in life. There were no significant differences between diocesan and religious seminarians except that only diocesan seminarians obtained significantly higher scores on positive orientation to life than the control group. Overall, results support the idea that seminarians have higher quality of life and subjective well-being than secular students. Research implications are discussed. (shrink)

In the present world, where the sphere of knowledge and social relations have become extremely complex, the problem of insufficient competency and inability to manage efficiently the accumulation and distribution process of various professional skills, has grown very urgent. Paradoxically, the insufficient knowledge,lacking skill or competence may be advantageous. To a certain extent, it reduces the threat of arrogant technocracy and meritocracy, while supporting innovation and creative search process, in which the burden of excessive erudition has often slowed down (...) progress. I will focus on some fallacies common in many countries undergoing modernization process, connected to the lack of clear awareness of the reasonably expected results of the medical university education(not quite professional if related to the background of the scientific state of the matter), to the dangerous “dissemination” of responsibility for a patient in the medical bureaucracy as well as to the overrepresentation of doctors among the managerial staff. To take advantage from some portion of ignorance in the medical life it needs to be acknowledged and reflected on. (shrink)

Extra-corporeal membrane oxygenation has been introduced to clinical practice for several decades. It is unclear how internet and newspapers portray the use of extra-corporeal membrane oxygenation. This study were: (1) to quantify the coverage of extra-corporeal membrane oxygenation use in newspapers and on the Internet; (2) to describe the characteristics of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those shown in extra-corporeal membrane oxygenation studies in Taiwan; and (3) to examine the (...) survival rates of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those in Taiwan and in the Extracorporeal Life Support Registry Report International Summary for January 2014. (shrink)

What are the relations among wisdom, virtue, and expertise? Wisdom can be defined broadly as knowledge about how to live well. At the least, the task of living well requires some conception of what it means for a life to be _good_ as well as the knowledge and skill needed to actualize the good in one’s spheres of life. While this idea is easy to assert, it is difficult to examine empirically. This is because the scientific study of (...) wisdom immediately runs up against the challenge of the fact/value dichotomy. While psychological science seeks to study “what is”, the “wisdom” of any given decision, act or person is something that can only be assessed against some conception of the good. Thus, the study of wisdom calls on us to seek ways to bridge the fact/value dichotomy. In this paper, we pursue this goal. We suggest that the study of wisdom requires the integration of at least two forms of inquiry: psychological-empirical analyses of the development of knowledge and skills, and philosophical-conceptual inquiries into what it means to live a good life. In elaborating this approach, we first differentiate the concepts of _wisdom_, _wise decision-making_, and _wisdom-supporting skills_. Then we describe conceptual and _empirical_ tools for assessing the development of wisdom-supporting skills as well as an _evaluative_ framework for assessing the “wisdom” of any given act of decision-making. To illustrate these ideas, we report the results of a study demonstrating how the capacity for wise decision-making can be cultivated through participation in a program devoted to fostering the development of wisdom-supported skills. (shrink)

The research is devoted to a discussion of social and humanitarian problems associated with tectonic changes in human life against the backdrop of total digitalization. The author's attention is focused on the uniqueness of the modern situation: never before have innovative technologies had the ability to penetrate so rapidly and deeply into the foundation of modern society, have they become so widespread and accessible to almost all peoples and cultures. At the same time, the undeniable public good and the (...) most serious threats to society that digital reality technologies bring with them are in a very close relationship. This is especially true for artificial intelligence systems. Innovations transform the entire world order, bringing radical changes not only to the material sphere of life, but also to the spiritual and moral state of a person. The research notes that the introduction of information and communication technologies into the life of modern society occurs without reliable support on the results of preliminary experimental research, without taking into account a deep professional and responsible assessment of the social and psychological consequences of their impact on the individual and on society as a whole. As a result, at this stage, society is constantly faced with many negative aspects of the impact of high-tech means. The work examines some of them: a decrease in cognitive and analytical abilities, the devaluation of human labor, the criminalization of cyberspace, the spread of Deepfake technology. Particular attention is paid to the problem associated with the possibility of using information technology as a tool of psychological influence. Information and psychological warfare is implemented on the basis of social networks and artificial intelligence technologies, which provides the enemy with the opportunity to achieve superiority without the use of military force. Information and humanitarian actions in cyberspace, carried out by Western countries in order to destabilize our society, destroy its value foundations, reformat the consciousness, worldview and spiritual and moral qualities of citizens, are becoming increasingly large-scale and aggressive. The work notes that digitalization is gaining momentum, plunging society deeper into new circumstances and requiring decisive action aimed at overcoming the many threats specific to the modern high-tech era. (shrink)

The article attempts to comprehend the phenomenon of an event in the religious dimension. An event is considered as a phenomenon characterized by a singularity, that is, an individual character of expression, belongs to the sphere of non everyday life, does not coincide with the usual framework of understanding of the world and does not correspond to empirical factual. The need for a more active philosophical and religious discourse of the correlation between everyday and non everyday life (...) in the realm of religion led to the necessity of address to this problem. Thus, the purpose of the article is to find out the ontological status of the event, the religious context of which manifests itself as an opposition to everyday life and leads to a transformation of the established way of life of the believer. Everyday being is characterized by features of sacredness, demonstrates the attraction to the transcendent. For this reason, the obvious and justified is the combination of the phenomena of everyday empirical world with the values ​​of another dimension of being. The presence of non everyday in everyday life is evidenced, in particular, by elements of cult practice, since they are an expression of sacral time and space, as well as a way of incarnation of eternal values. The sphere of non everyday life includes the relationship between human and God described in the Gospels, prophecies, revelation, and vision as non everyday manifestations of religious experience. Event is the opposition of the world of phenomena to beyond the exquisite world of being, the transformation, which leads to the emergence of new orders and structures. Implementation of the event contradicts the previous ideas, therefore meeting the event with standard reality is accompanied by a transformation of everyday life. Establishing the rootedness of an event into being or its transcendental origin allows us to determine the causes of an event. In a secularized world, human, for the most part, demonstrates his willingness to recognize as significant events, including those in the universe, which correspond to scientific knowledge. This happens even when the fact of the event calls into question the fundamental postulates of science. Given this discovery in science, situations in politics, art, personal life are perceived as large-scale events. Moreover, the moment of meeting with the event can be described, for example, with a poetic language that expresses certain symbols of human existence and appears as a means of objectivizing the event as an unexpected innovation. Instead, the believer perceives events of a supernatural nature as an interference of the otherworldly reality in the usual way of life. Thus, the reception of religious experience is accompanied by the transformation of the individual's everyday life. The basis of the mystical experience of the religious tradition is the experience of meeting with the Divine, which results in a change in the believer's self-consciousness, transformation of its values, senses and meanings. That is, the awareness of an event that does not belong to an established order implies the prospect of new reality emersion, which contradicts previous notions. One of the forms of gaining religious experience is the process of conversion, which results in the transformation of the ideological orientation of a person, which enables the knowledge of their own hidden depths of consciousness. Conversion, the acquisition of grace and faith express the sudden or gradual process by which the individual achieves internal harmony, awareness of his righteousness, a sense of happiness, finds support in believing in the reality of what he has discovered in religious experiences. (shrink)

ABSTRACT The concept of ‘intimate citizenship’ stresses the right of people to choose how they organize their personal lives and claim identities. Support and interest groups are seen as playing an important role in the pursuit of recognition for these intimate choices, by elaborating visible and positive cultures that invade broader public spheres. Most studies on intimate citizenship take into consideration the exclusions these groups encounter when negotiating their differences with society at large. However, much less attention is paid (...) to the ways in which these groups internalize the surrounding ideologies, identity categories and hierarchies that pervade society and constrain their recognition as full citizens. In contrast, this paper aims to emphasize the reproduction of otherness within alternative spheres of life, and to reveal the ambiguities and complexities involved in their dialectic relationship with society at large. To address this issue, the paper focuses on the role that ‘adoption cultures’ of Flemish adoptive parents with children from Ethiopia play in the pursuit of being recognized as ‘proper’ families and full citizens. The ethnographic research among adoptive parents and adoption professionals shows a defensive discourse and action that aims at empowering against potential problems, as well as a tendency to other the adoptive child by pathologizing its non‐normativity. By showing the strong embeddedness of adoptive families' practices of familial and cultural construction in larger cultural frames of selfing and othering, characterized by biologism and nativism, one begins to understand the limits of their capacity to realize full citizenship. (shrink)

This article argues that William James's thinking in The Varieties and elsewhere contains the view that social institutions, such as religious congregations and schools, are mediators between the private and public spheres of life, and are necessary for transforming personal feelings, ideals and beliefs into moral action. The Exercises of St Ignatius and the Just Community moral education approach serve as examples. Criticisms of the more commonly held view that James recognised only individual personal experiences as valid religious expressions (...) are marshalled. Furthermore, we argue that moral action or saintliness, the ultimate expression of religious faith according to James, is fundamentally social. The commonalities that the phenomenologies of moral action of St Ignatius and Lawrence Kohlberg have with William James's view are used to support the argument. (shrink)

Medical and nursing personnel have an obligation to provide the medication necessary for every patient’s pain relief. This includes patients whose life-supporting mechanical ventilation is being removed, who may not exhibit traditional signs of pain or dyspnea. The purpose of this paper is not to argue a position on withdrawing life support. Rather, it argues that nurses and physicians have an obligation to provide pain-relieving medication, such as opiates, when life support is removed, to ensure (...) that those entrusted to their care do not experience pain or significant distress. This is based on the principle of double effect, by which two actions, one intended and one unintended, may be permissible if there is a proportionate reason. The goal in these situations is never to hasten death intentionally but to make patients’ pain and suffering tolerable as a matter of compassionate and loving care. (shrink)

While many have suggested that to withdraw medical interventions is ethically equivalent to withholding them, the moral complexity of actually withdrawing life supportive interventions from a patient cannot be ignored. Utilizing interplay between expository and narrative styles, and drawing upon our experiences with patients, families, nurses, and physicians when life supports have been withdrawn, we explore the changeable character of boundaries in end-of-life situations. We consider ways in which boundaries imply differences – for example, between cognition and (...) performance – and how the encounter with boundaries can generate altered meanings important for understanding decisions and actions in these contexts. We conclude that the reliance on mere roles to support the moral weight of withdrawing medical interventions is inadequate. Roles that lead us to such moments are exceeded by the responsibility encountered in such moments. And here, we suggest, is the momentous character of withdrawal: it presents the grave astonishment, the trembling awe, in the not-being-there of the other in death. (shrink)

The demand for long working hours in leading positions is seen as a primary obstacle for women entering decision-making, leading to suggestions that public policy support better compatibility between work life and home. The paradox of high-level positions is that while leaders are said to have it all in terms of autonomy and self-determination, they are subject to significant temporal constraints. This article explores the character of the time of women and men pursuing high-level careers in business and (...) politics in Belgium, where state support for the domestic sphere is high, and yet women’s advance in management and politics has been relatively low. This research is based on a questionnaire survey and career history interviews. Women and men engaged in demanding careers organize their domestic worlds in segmented and rationalized ways, while their work has the character of more open and fluid time. This article suggests that assumptions about the character of time in different spheres of life need to be reviewed before further efforts are made to use family-friendly policies to increase women’s presence in decision-making. (shrink)

" Journal of the American Medical Association "Walton has made a successful attempt to write about medical concerns without ever leaving the layperson to ...

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Calvin's Political Theology and the Public Engagement of the Church: Calvin's Two Kingdoms by Matthew J. TuiningaGuenther ("Gene") HaasCalvin's Political Theology and the Public Engagement of the Church: Calvin's Two Kingdoms Matthew J. Tuininga CAMBRIDGE: CAMBRIDGE UNIVERSITY PRESS, 2017. 258 PP. £69.99 / £27.99In recent years, a vigorous debate has arisen within Reformed circles concerning the nature of the two kingdoms theology of John Calvin. Although all recognize (...) that Calvin articulated a distinction between the spiritual kingdom of the church and the political kingdom of the state, there is disagreement over [End Page 211] the nature of the engagement of Christians with the temporal kingdom and over what should guide the state in enacting civil justice and order.The Kuyperian Neo-Calvinist movement holds a transformationalist understanding of the engagement of members of the spiritual kingdom with all vocations and spheres of life. Alternatively, two kingdoms Reformed theologians, such as David VanDrunen and Michael Horton, argue that the Reign of Christ is confined to the spiritual kingdom and must not be brought to bear directly on the temporal kingdom. Matthew Tuininga's book supports the latter view in his exposition of Calvin's political theology. Tuininga argues that Calvin articulated a sharp distinction between church and political society, such that politics is seen not as "a means of transforming society into the kingdom of God according to the dictates of Christian scripture, but as an endeavour to secure temporal order and civil righteousness in accord with reason, natural law, and the virtues of charity and prudence" (1).Tuininga begins by situating Calvin and his two kingdoms theology in their historical and political context, indicating Calvin's concern for the autonomy of church contra government interference. The central chapters (3–6) present the eschatological basis for Calvin's two kingdoms doctrine and detail the development of this theme in Calvin's thought. The Kingdom of God is identified with the church and its spiritual authority. It is distinct from the state's temporal authority, whose role is to maintain civil righteousness and order. To support this distinction between the mandate of the two kingdoms, Tuininga presents in chapter 7 the novel, and debatable, claim that Calvin holds to two covenants of God with Israel: the covenant of grace made with Abraham and confirmed at Sinai and the narrower covenant of the law for Israel's national life, in which God's blessings and punishments were conditional on Israel's obedience and disobedience. Although this legal covenant—with its earthly and temporal character—is embedded in the broader covenant of grace, it is abolished with the fulfillment of the covenant of grace in the coming of Christ. Only the covenant of grace—with its heavenly, inward, and spiritual character—remains in force for God's people today.Chapter 8 argues that Calvin's views on the mandate of the magistrate to protect religion and enact public justice is based not on appeals to scripture but to reason, the evidence of national laws, and natural philosophy. In chapter 9 Tuininga unfolds the implications of Calvin's two kingdoms theology for Christian political involvement in society. And in his conclusion, Tuininga unfolds numerous ways that this two kingdoms theology can guide contemporary Christians' engagement with modern liberal democracies.This work is a welcome exposition of Calvin's political theology to support the two kingdoms theology. However, in addition to the novel, and debatable, claim that God made two covenants with Israel, this reviewer finds that Tuininga's exposition fails to incorporate key points in Calvin's thought: the failure of civil rulers' to enact natural law faithfully and consistently (2.2.13, 23; 3.14.2), [End Page 212] the description of the calling of civil authority as "holy and lawful before God … the most sacred and by far the most honorable of all callings" (4.20.4), and Calvin's claim that the best rulers are those governing according to both tables of the Decalogue (4.20.9–11). Nevertheless, this book is an important contribution to the ongoing debate and should be widely read.Guenther ("Gene") HaasRedeemer University CollegeCopyright © 2018... (shrink)

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding (...) these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. (shrink)

Quality-of-life policing, responsive to the concerns of urban communities, presents a profound paradox. On the one hand, the collateral effects of drug use, especially in public and in racially fragmented, low-income communities, result in levels of crime and fear of crime that renders the communities almost uninhabitable; on the other, the collateral effects of policing drug crime, for these same communities, destroy the community's human fabric. A "new" generation of legal scholars have embraced and transformed the Broken Windows model (...) of policing urban communities. These theorists share a "social norms"perspective: they suggest that law's direct threat of imposing sanctions is not the sole means of constraining conduct. A variety of other devices, including non-legal, "social" norms, may supplement the law's coercive power. The social norms "take" on the Broken Windows argument is that public low-level crime undermines the social structures of local communities. Inner city blight sends a distinct message: that community members reject or ignore norms supporting law-abiding behavior in favor of norms supporting law-breaking. Accordingly, social norms theorists advocate empowering police and local communities through a variety of traditional and newly minted public order offenses (such as anti-loitering statutes and youth curfews) as means of attacking high crime in urban and predominantly minority neighborhoods. In this article, I take up the challenge of public order policing. My claim is that the sort of preventative policing social norms theorists advocate can and should be separated from reactive "investigative" policing directed at apprehending criminals. Separating preventative and investigative policing means that the police, as currently constituted, are the wrong people to engage in preventative policing. Instead, the appropriate people include municipal officials with no power to engage in investigation but who have the authority to enforce norms of public order. My proposal is to radically restructure the manner in which we think about the legitimacy of various policing practices and the type of authority the police wield. Our current focus on constitutional remedies for low-level police abuses has failed to ameliorate the justified resentment expressed by individuals and local communities subject to heightened amounts of increasingly invasive policing.The attempt to limit police authority through prospective constitutional (and other) norms that control their ability to search, seize, and interrogate suspects is properly confined to the police's investigative role. Limits do not work to constrain their ability to police public order and engage in crime prevention. Yet even at the investigative stage, the Court has already replaced the rule-based due-process model of authority with a series of role-based exceptions to the Fourth, Fifth, and Sixth Amendments' constitutional requirements. Both role- and rule-based concepts of authority concern the proper scope of legitimate authority. Rule-based authority has its basis in adherence to the content of particular rules; role-based authority is based in the powers afforded individuals in particular roles of public authority. Whereas rule-based authority derives its legitimacy primarily from the government's right to promulgate norms, role-based authority gains legitimacy from the degree to which the official's role is matched to the circumstances triggering authority. (shrink)

This article describes a new theoretical, psychological model characterizing the concept, structure and functioning of spirituality in relation to the phenomenon of religiousness. The structural and processual approaches are indispensable when examining the spiritual sphere. The theory suggests that the psychological nature of spirituality can be considered from a threefold perspective: as a cognitive scheme, as a dimension of personality, as an attitude towards life. The Threefold Nature of Spirituality model binds these perspectives together and describes the phenomena (...) and processes inherent in spiritual functioning: looking for the sacred or a-sacred, for the meaning of life, and for personal fulfilment. Theoretical and empirical examples are presented here in support of the TNS, although further exploration is necessary. (shrink)

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} In order to see whether there is a common European model that gives a place to religion in the public sphere two issues have to be taken into account: first, if there is a theory of secularization that accurately describes the current situation of European societies and (...) second if, there is a European model on Church – State relationship. The first part is dedicated to the different accounts on secularization that may be applied to European countries: the classical Weber theory that view secularization as an “iron law” of any society, the institutional secularization, secularization as the decline and adequacy of religious practice, the continuation of the classical theory in the 60’s and beyond, the criticism of this theory and the particular argument of the increase of fundamentalist religious movements. The attempts to formulate new theories on secularization based on other assumptions than the classical one are also presented. The increased presence of religion in private life does not mean a decrease of religion in the public space but rather a new definition of it. Despite the different intensity of belief in national terms, some trends like “believing without belonging” are common, meaning that secularization could have a single meaning in Europe, apart from other continents. The second part starts with presenting the three types of Church - State relationship at the national level. All these have in common the fact that the state is neutral towards religious subjects, a religious subsection is singled out within the public sphere and the state has the right to intervene in this area only as an arbiter. There is already a European law on religion and this statement is supported by examples from the Lisbon Treaty, The Charter of Fundamental Rights, different Directives and decisions of the European Court of Justice. Common rules on religion agreed at the European level helps better to understand why there is a common European model on religions, different from the national models. After taking into account the two aspects described above, a common European model on religion in the public sphere emerges as a necessary conclusion. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of (...) well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: to examine the relationship between age and the extracorporeal membrane oxygenation use; to examine the relationship between age and the extracorporeal membrane oxygenation use; and to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal (...) membrane oxygenation. This is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use. The trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon. This study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved. (shrink)

Ethical questions surrounding withdrawal of life support can be complex. When life support therapies are the result of a suicide attempt, the potential ethical issues take on another dimension. Duties and principles that normally guide clinicians’ actions as caregivers may not apply as easily. We present a case of attempted suicide in which decisions surrounding withdrawal of life support provoked conflict between a patient’s family and the medical team caring for him. We highlight the (...) major unresolved philosophical questions and contradictory normative values about suicide that underlie this conflict. Finally, we show how these considerations were practically applied to this particular case. (shrink)

(2011). Standards, Norms, and Guidelines for Permissible Withdrawal of Life Support From Seriously Compromised Newborns. The American Journal of Bioethics: Vol. 11, No. 2, pp. 33-34.

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: (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)

Although healthcare workers play a crucial role in helping curb the hazardous health impact of coronavirus disease 2019, their lives and major functioning have been greatly affected by the pandemic. This study examined the effects of the COVID-19 pandemic on the quality of life of Malaysian healthcare workers and its predictive factors. An online sample of 389 university-based healthcare workers completed questionnaires on demographics, clinical features, COVID-19-related stressors, psychological experiences, and perceived social support after the movement lockdown was (...) lifted. All domains of QoL were within the norms of the general population except for social relationship QoL, which was lower than the norm. Multiple linear regression analysis indicated that COVID-19-related stressors and psychological sequelae predicted lower QoL. Conversely, greater perceived social support from friends and significant others predicted higher QoL. Clinical and demographic characteristics predicted QoL to a lesser extent: A history of pre-existing medical illness was associated only with lower physical health QoL, whereas older age and being single, divorced, or widowed were only predictive of higher environmental QoL. Efforts to enhance QoL among healthcare workers in response to the pandemic should focus on mitigating COVID-19-related stressors and psychological sequelae and facilitating social support. (shrink)

A number of influential reports on influenza pandemic preparedness include recommendations for extra-autonomous decisions to withdraw mechanical ventilation from some patients, who might still benefit from this technology, when demand for ventilators exceeds supply. An unintended implication of recommendations for nonvoluntary and involuntary termination of life support is that it make pandemic preparedness plans vulnerable to patients’ claims for assisted suicide and active euthanasia. Supporters of nonvoluntary passive euthanasia need to articulate why it is both morally different and (...) morally superior to voluntary active euthanasia if they do not wish to invite expansion of end-of-life options during health system catastrophe. (shrink)

The agricultural sector of production is a unique sphere of the national economy, which determines the level and quality of life of the country's population, but largely depends on the level of development and regional characteristics of economic entities, especially small forms of agricultural production – peasant farms. The article presents the features of the development of peasant farms in the regions of Russia. Based on the analysis of features of development of peasant farms of constituent entities of (...) the Russian Federation grouping the number and share of production data of the farmers identified areas that require a differentiated approach in the implementation of state support. (shrink)

Title: Medicine, Morals, and the LawPublisher: Gower Pub CoISBN: 0566005336Author: Sheila McLean and Gerry MaherTitle: Reproductive EthicsPublisher: Prentice HallISBN: 0137739044Author: Michael BaylesTitle: Ethics of Withdrawal of Life-Support SystemsPublisher: Praeger PaperbackISBN: 0275927105Author: Douglas N. Walton.

Recent research highlights the positive effects of organizational CSR engagement on employee outcomes, such as job and life satisfaction, performance, and trust. We argue that the current debate fails to recognize the potential risks associated with CSR. In this study, we focus on the risk of work addiction. We hypothesize that CSR has per se a positive effect on employees and can be classified as a resource. However, we also suggest the existence of an array of unintended negative effects (...) of CSR. Since CSR positively influences an employee’s organizational identification, as well as his or her perception of engaging in meaningful work, which in turn motivates them to work harder while neglecting other spheres of their lives such as private relationships or health, CSR indirectly increases work addiction. Accordingly, organizational identification and work meaningfulness both act as buffering variables in the relationship, thus suppressing the negative effect of CSR on work addiction, which weakens the positive role of CSR in the workplace. Drawing on a sample of 565 Swiss employees taken from the 2017 Swiss Public Value Atlas dataset, our results provide support for our rationale. Our results also provide evidence that the positive indirect effects of organizational CSR engagement on work addiction, via organizational identification and work meaningfulness, become even stronger when employees care for the welfare of the wider public. Implications for research and practice are discussed. (shrink)

The article aims to provide a standpoint from which to critically address two broad concerns. The first concern surrounds a naïve view of mindfulness, which takes it as a given that it is a good thing to cultivate mindfulness and attendant qualities like compassion because these virtues are key to improving the quality of life and bettering effective decisionmaking within business. Yet the virtue of mindfulness has roots in religious and spiritual traditions, and the virtue of compassion is complex (...) and contextual; neither of these virtues operate in a vacuum. Nor do they function independently from other virtues and values. Reasonable people of goodwill possessing the virtues of mindfulness and compassion in good measure, may nevertheless strongly disagree about what the compassionate, mindful thing to do is, particularly in a business setting. It is, moreover, conceivable that intensively cultivating mindfulness and compassion could lead one to reject altogether the “dog-eat dog” culture of competitive business that draws upon selective features of mindfulness meditation that lie in the corporate comfort zone yet which are not especially countercultural from a religious or spiritual vantage point. The second concern is that Western virtue-based business ethics is largely confined to academic philosophical theories. As such, virtue-driven business ethics is often more centered around developing theoretical wisdom than developing “hard core” practical wisdom earned through yoga asanas, meditation, chanting, and breathing, whereas for contemplative practices the reverse is the case, with practical wisdom emphasized over theoretical wisdom. Accordingly, the article examines prospects for cross-fertilization between, on the one hand, mindfulness and compassion interpreted as virtues in Eastern contemplative practices, and on the other hand, mindfulness and compassion as interpreted within Western virtue-oriented business ethics. Illuminating a pathway for such interpretative cross-pollination calls for an appropriate conceptual frame of reference that the article organizes around a set of interconnected themes. The first theme is that mindfulness and compassion represent key virtues within contemplative practices. This indicates a promising touchpoint between Eastern and Western traditions: their respective focus upon character, inner states, intrinsic motivation, and self-improvement toward ethicality in the world. The second theme is that such virtues in Eastern contemplative practices, as well as character traits integral to Western virtue-oriented approaches, denote contested “normative-interpretive” concepts that engage philosophical debate rather than indisputable empirical-criterial concepts that can be taken at face-value. The third theme advocates moving beyond behaviorist and neuropsychological accounts of virtue, approaching character traits of Eastern contemplative practice and Western virtue ethics through nonscientific inquiry into normative interpretive questions concerning such virtues. This supports debate over competing views of the nature, purpose, cultivation, and cultural context of mindfulness, compassion, and other virtues – issues arising as mindfulness enters the business management sphere -- to be conducted on normative grounds. With the background conceptual framework established, the article presents key points about the prospects for cross-fertilization between virtue ethics and contemplative practice, and why it matters, with reference to business ethics. (shrink)

Introduction. War as a social phenomenon has always been an object of philosophical reflection, since its results largely determine the further de- velopment of society and have a profound impact on all spheres of social life. In connection with the ongoing so-called special military operation which Russia is conducting in Ukraine and which is at the same time a proxy war of the collective West against our country, the modern philosophical discourse of war is clarified. One of the important (...) aspects of the ontology of war is considering its chronotopos. The space-time factor has a signifi- cant impact on the course and outcome of hostili- ties in modern warfare, which makes its study very relevant. The purpose of the study is to describe the chrono- topos of modern warfare, to show the influence of the space-time factor on the course and result of hostilities. Methods. Being supporters of the relational concept of space and time, the authors consider the chronotopos of war as its internal attributive property. In addition, they rely on the methodology of synergetics, which makes it possible, in addition to the external universal space-time, to single out the internal space-time of open complex non-equi- librium systems. The authors apply structural-func- tional analysis to study material and ideal objects that influence the characteristics of space and time in modern warfare. They also use general scientific methods: abstraction, comparison, description and explanation. Scientific novelty of the research. The authors give characteristics of the war chronotopos at the beginning of the 21st century, and consider the tendencies of its changes. The necessity of taking into account spatio-temporal changes in planning and conducting hostilities in modern warfare is substantiated. Results. New means of warfare, as well as the cor- responding changes in tactics, operational art and strategy, will significantly reformat the chronoto- pos of war. The space of modern warfare is being radically transformed due to the fact that the confrontation simultaneously takes place not only on the plane, but also in the air, in space, under water, and even in social networks. New capabili- ties of strike systems are changing the perception of such characteristics of the war space as the front and rear. What was previously considered a deep safe rear, in the era of using missiles and combat drones, is no longer such. The time of war is also changing. An increase in the flight speed of ammu- nition, aircraft, and missiles increases the dynamics of battles and intensifies all processes on the bat- tlefield. Hypersonic systems are changing the pace of war, space satellites, reconnaissance drones and new technologies make it possible for the com- mander officer of the battle to see everything that happens on the battlefield in real time, regard- less of the distance from objects. Each new war is fought in its own space-time continuum. To win the war, all this must be taken into account. Conclusions. The chronotopos of war within the framework of the relational concept of space and time prevailing in modern philosophy is changing due to the emergence of fundamentally new means of warfare with new capabilities, which requires a significant adjustment in combat management, ensuring the adequacy of human behavior in war, training troops, taking into account the character- istics of the space-time continuum of a particular war, understanding on the part of the command staff of the essence of changes in the space and time of modern war. Old stereotyped ideas about the chronotopos of war can cause disorientation of a person on the battlefield, which requires not only a philosophical reflection of the ongoing spatio- temporal changes, but also the practical consid- eration of new knowledge in training troops, in planning and conducting combat operations. (shrink)

The classic conception of human transcendental consciousness assumes its self-supporting existential status within the horizon of life-world, nature and earth. Yet this assumed absoluteness does not entail the nature of its powers, neither their constitutive force. This latter call for an existential source reaching beyond the generative life-world network. Transcendental consciousness, having lost its absolute status (its point of reference) it is the role of the logos to lay down the harmonious positioning in the cosmic sphere of (...) the all, establishing an original foundation of phenomenology in the primogenital ontopoiesis of life.​. (shrink)

Introduction Hundreds of thousands of premature neonates born in low-income countries are implicitly denied treatment each year. Studies from India show that treatment is rationed even for neonates born at 32 gestational age weeks (GAW), and multiple external factors influence treatment decisions. Is withholding of life-saving treatment for children born between 28 and 32 GAW acceptable from an ethical perspective? Method A seven-step impartial ethical analysis, including outcome analysis of four accepted priority criteria: severity of disease, treatment effect, cost (...) effectiveness and evidence for neonates born at 28 and 32 GAW. Results The ethical analysis sketches out two possibilities: (a) It is not ethically permissible to limit treatment to neonates below 32 GAW when assigning high weight to health maximisation and overall health equality. Neonates below 32 GAW score high on severity of disease and efficiency and cost-effectiveness of treatment if one gives full weight to early years of a newborn life. It is in the child's best interest to be treated. (b) It can be considered ethically permissible if high weight is assigned to reducing inequality of welfare and maximising overall welfare and/or not granting full weight to early years of newborns is considered acceptable. From an equity-motivated health and welfare perspective, we would not accept (b), as it relies on accepting the lack of proper welfare policies for the poor and disabled in India. Conclusion Explicit priority processes in India for financing neonatal care are needed. If premature neonates are perceived as worth less than other patient groups, the reasons should be explored among a broad range of stakeholders. (shrink)

I shall translate Kierkegaard's account of the dangers and opportunities of what he called the Press into a critique of the Internet so as to raise the question: what contribution -- for good or ill -- can the World Wide Web, with its ability to deliver vast amounts of information to users all over the world, make to educators trying to pass on knowledge and to develop skills and wisdom in their students? I will then use Kierkegaard's three-stage answer to (...) the problem of lack of involvement posed by the Press -- his claim that to have a meaningful life the learner must pass through the aesthetic, the ethical and the religious spheres of existence -- to suggest that only the first two stages -- the aesthetic and the ethical -- can be implemented with Information Technology, while the final stage, which alone makes meaningful learning possible, is undermined rather than supported by the tendencies of the desituated and anonymous Net. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should be developed, (...) used and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing (...) central decision problems. Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …. (shrink)

The article analyzes the basic principles of state policy in the sphere of culture. The specific mission of cultural awareness is determined in the national socio-cultural context. The study highlights the key concepts of contemporary cultural policy in Ukraine, including "management culture" and "cultural support". The article discloses their role in the national public identity. The authors conclude on the necessity of substantial organizational and managerial reform of cultural policy on the principle of consistency in maintaining spiritual achievements (...) of Ukrainian people and its traditions with simultaneous modernization of cultural life of society. (shrink)

Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body (...) are used for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Problem Statement. The process of global evolution has entered the Anthropocene. This fact has almost simultaneously generated two cardinal, inseparable imperatives in the rapidly changing ideological and outlook basis of modern civilization. Firstly, the feeling that the new geological epoch also requires fundamentally new algorithms guiding practical activity and its theoretical comprehension, justification in all spheres of political reality, with inevitable exit to the level of international relations and geopolitics. Secondly, the content of the categories of ANTHROPOCEN and (GLOBAL) CRISIS (...) overlap so diversely and widely that they form an almost inseparable logically and mentally amalgam. The purpose of this publication is to reveal the political aspects of the integration of new biopolitical issues into the life of modern society. The content of the term biopolitics is currently not formalized in a definitive form. In our concept, biopolitics is defined as the processes of implementing biopower, that is, the ability (direct or indirect) of the power structures of society to control and manipulate the performance of the biological functions of certain individuals. Based on a combination of methods of conceptual, discursive and evolutionary-anthropological analysis (the concepts of evolutionary strategy and cultural-ecological niche), possible scenarios for the future development of the political process at the domestic and international levels are identified. The mechanism of transbipolitical transition – the inclusion of civilizational and biological evolution in the political process – is investigated. The conclusion formulates the content of the category “transbiolitics” as the main element of rationalization of the global-evolutionary process in the globalizing world. Transbiolitics in our understanding is an international political problematic related to the rationalization of the global evolutionary process. Technologization of the global evolutionary process, the choice of implemented technological projects and forms of their institutional support is determined primarily by geo- and biopolitical motivation of local elites and humanitarian and other convergent technologies available to them. (shrink)

The University of Pittsburgh policy for procuring organs from non-heart-beating cadaver donors recognizes the potential for conflicts of interest between caring for a "hopelessly ill" patient who has forgone life-sustaining treatment and caring for a potential organ donor. The policy calls for a separation between those medical personnel who care for the gravely ill patient and those involved with the care of transplant recipients. While such a separation is possible in theory, it is difficult or impossible to attain in (...) practice. However, such a separation of duties would be unnecessary if an arbitrator were appointed to monitor the proceedings as they take place on a case-by-case basis. In this way, the biases—real or potential—of the individuals involved could be identified, and the harmful effects of the unavoidable conflicts of interest could be minimized. (shrink)