Feeding difficulties in older patients who are suffering from dementia present problems with balancing conflicting ethical principles. They have been considered by several writers in recent years, and the views of nursing and care staff have been studied in different contexts. The present study used focus groups to explore the way in which nursing and care staff in a National Health Service trust deal with conflict between ethical principles in this area. Three focus groups were convened, one each from (...) the staff of three wards caring for patients with dementia. Case histories were discussed and transcripts analysed. It emerged that staff were aware of making fine judgements of utility concerning the spectrum of feeding methods available. Informants gave some weight to the principle of autonomy, but sought to balance that against their commitment to care. In explaining their perspectives, informants gave more weight to personal attitudes and trust culture than to professional ethics. (shrink)

The key focus in ethics should be on victims. Victims are those that suffer from unnecessary and preventable pain and misery. Non-human animals can also suffer and should therefore be included in the moral circle. Ethical living is striving to avoid harm to others and striving to help alleviate or prevent suffering. Being good isn't easy.Export citation.

Animal ethics has received a lot of attention over the last four decades. Its focus, however, has almost exclusively been on the welfare of captive animals, ignoring the vast majority of animals: those living in the wild. I suggest that this one-sided focus is unwarranted. On the empirical side, I argue that wild animals overwhelmingly outnumber captive animals, and that billions of wild animals are likely to have lives that are even more painful and distressing than those of their (...) captive counterparts. On the normative side, I argue that as long as we have duties of assistance towards humans suffering from natural causes, and we reject anthropocentrism, we also have duties of assistance towards animals suffering in the wild.Article first published online: 22 MARCH 2016. (shrink)

This chapter explores critically ethical concerns arising from forms of suffering to which domesticated nonhuman animals are subjected in scientific instruction and research and within the industrial-factory-farm-food complex, as well as other contexts. Consideration is given to the views of Arthur Schopenhauer on suffering, René Descartes’s designation of ontological differences between human and non-human animals, and Donna Haraway’s reconfiguration of the relationship between human and nonhuman animals in scientific laboratory settings. Proceeding from a discussion of David Benatar’s “antinatalist” (...) views the focus of analysis is on the forms of suffering imposed on domesticated nonhuman animals by humans. In response to ethical concerns raised about the suffering inflicted on nonhuman animals in the course of scientific research, scientists have sought a “solution” in the form of genetically engineered nonhuman animals whose responses to painful stimuli are presented as modulated to reduce pain. This reductive conceptualization of suffering reduces the complexity of suffering to physical sensation alone and does not engage with the ethical issues involved. Drawing on the work of Emmanuel Levinas and Albert Schweitzer the chapter concludes that an ethical solution to the complex issues explored lies in refraining from exposing nonhuman animals to pain and suffering. (shrink)

Contrary to the ecumenical spirit of our time, the differences among the Christian religions bring into question what one can say or do in common with fellow Christians. This issue, echoing the program of this journal, accentuates those differences, specifically when we focus on the Christian who is ill and suffering. At the bedside, it is the specifics of a religion, including not only its doctrines, but its informing and sustaining narratives, that must particularly be brought into play for (...) the sake of the patient. Given this, our focus in this article regards what such a view implies for the clinician who is caring for a Christian patient whose religion he mayor may not share, in general or in its specifics. Our basic conclusion is that the tendency for the clinician to act as both the patient's spiritual counselor, as well as his clinician, is generally neither prudent nor appropriate. Both hats should not be worn concurrently. This view is advanced not only because of concerns regarding patient vulnerability and the possible abuse of power, but also because the two roles may collide with or undermine each other. (shrink)

Drawing chiefly on recent sources, in Part One I sketch an untraditional way of articulating what I claim to be central elements of traditional Catholic morality, treating it as based in virtues, focused on the recipients (“patients”) of our attention and concern, and centered in certain person-to-person role-relationships. I show the limited and derivative places of “natural law,” and therefore of sin, within that framework. I also sketch out some possible implications for medical ethics of this approach to (...) moral theory, and briefly contrast these with the influential alternative offered by the “principlism” of Beauchamp and Childress. In Part Two, I turn to a Catholic understanding of the nature and meaning of human suffering, drawing especially on writings and addresses of the late Pope John Paul II. He reminds us that physical and mental suffering can provide an opportunity to share in Christ's salvific sacrifice, better to see the nature of our earthly vocation, and to reflect on the dependence that inheres in human existence. At various places, and especially in my conclusion, I suggest a few ways in which this can inform bioethical reflection on morally appropriate responses to those afflicted by physical or mental pain, disability, mental impairment, disease, illness, and poor health prospects. My general point is that mercy must be informed by appreciation of the person's dignity and status. Throughout, my approach is philosophical rather than theological. (shrink)

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an (...) class='Hi'>ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties ‘medicalised’. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims’ narrative and their lived experiences. We will use Paul Ricoeur’s phenomenological reflections from ‘Suffering is not the same as pain’ for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering. (shrink)

The ethical concerns of Japanese nurses are compared with those of previously described nurses from the USA. Patient comfort was a primary concern of nurses from both countries. Participants described an ethical imperative to provide adequate pain medication for patients and prevent unnecessary and uncomfortable invasive tests and procedures, especially at the end of life as the focus changed from ‘cure’ to ‘care’. The notion of regard for personhood varied, based on the communication styles and definition of the self inherent (...) in the different cultures of the nurses. A common meaning centred around knowing patients as persons, listening to their needs and preferences, supporting their everyday choices through advocacy, and maintaining their dignity. Despite background cultural differences, there are common ethical concerns between nurses in Japan and the USA. This article invites readers to reflect on everyday nursing practices that exemplify ethical expertise, and the significance of this expertise in uncovering and articulating nursing ethics across cultures. (shrink)

Miranda Fricker explains that hermeneutical injustice occurs when an area of one’s social experience is obscured from collective understanding. However, Fricker focuses only on the injustice suffered by those who cannot render intelligible their own oppression. I argue that there is another side to hermeneutical injustice that is other-oriented; an injustice that occurs when one cannot understand, to a basic extent, the oppression of others. Specifically, I discuss the hermeneutical injustice suffered by nonhuman animals made possible by objectifying concepts available (...) in the collective hermeneutical resource. (shrink)

In the years just prior to the COVID-19 pandemic, American clinicians and health care systems were focused on another life-threatening disease: opioid use disorder and the epidemic of deaths...

Despite the central place of suffering in medical care, suffering in infants and nonverbal children remains poorly defined. There are epistemic problems in the detection and treatment of suffering in infants and normative problems in determining what is in their best interests. A lack of agreement on definitions of infant suffering leads to misunderstanding, mistrust, and even conflict amongst clinicians and parents. It also allows biases around intensive care and disability to affect medical decision-making on behalf (...) of infants. In this paper, I propose the concept of suffering pluralism, which is a novel multidimensional view of infant suffering based on subjective and objective components. The concept of suffering pluralism is more inclusive of the multiple ways in which infant suffering can occur. It acknowledges and defines a subjective component to infant suffering, while also focusing moral attention on objective well-being by describing it using the language of suffering. This concept allows us to better weigh up subjective and objective components of well-being. It also encourages clarity and consistency in claiming suffering, which is likely to improve communication and reduce conflict in medical decision-making for unwell infants and children. I will end by exploring possible critiques and limitations of this concept. (shrink)

Background The interaction of health personnel with relatives is linked to the quality of care results in nursing homes. However, there is limited knowledge of how relatives perceive being an integral part of the nursing home context. This secondary analysis has its starting point in an ethical concern about relatives’ experiences in a previous study. Aim To critically discuss relatives’ experiences of suffering when their next of kin live in a nursing home in a rural arctic context. Research Design, (...) Participants and Context The critical hermeneutic stance is informed by Habermas. The secondary analysis is conducted on original data from five semi-structured focus groups with 18 relatives of residents of two nursing homes in a rural part of Norway. The theoretical framework concerning dignity, well-being, and suffering, as developed by Galvin and Todres, contrasts the analysis. Ethical Considerations The study followed the principles of the Helsinki Declaration. It was approved by the Norwegian Center for Research Data (NSD) (reg. no. 993360). Findings The main theme of this study is: suffering while resigning to an unacceptable violation of dignity. This theme is deepened by two subthemes: (a) suffering while adapting to a relationship of dependence and (b) suffering while accepting the unacceptable. Conclusions Relatives experience suffering as a cross-pressure in their struggle to interact responsibly with health personnel in nursing homes. This may have a negative outcome, where relatives end up adapting to being silent witnesses to missed care and a violation of dignity. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, (...) the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Jon Sobrino and Jean-Marc Éla provide unique contributions for theological ethics in reflecting suffering as mystery of evil (mysterium iniquitatis) and suffering as the driving force for liberation (mysterium salutis). As a proponent of liberation theology, Sobrino focuses on structural problem of evil. In this regard, Éla gives his unique voice by analyzing suffering from its socio-cultural perspectives. Putting Sobrino and Éla in dialog shows the need for interdisciplinary approach in doing theological ethics. This interdisciplinary (...) reflection on suffering on the one hand will bring a more holistic view on the complexity of the problem of suffering. On the other hand, it brings a more contextual understanding on the meaning of discipleship in a violent world. Keywords: Saffering, evil, liberation, resocialization, structural & socio- cultural approach, discipleship. Abstrak: Jon Sobrino dan Jean-Marc Éla memberikan sumbangan yang khas bagi refleksi teologis etis tentang kompleksitas problem penderitaan sebagai misteri kejahatan (mysterium iniquitatis) namun sekaligus menawarkan daya dorong bagi kesetiaan menapaki jalan pembebasan (mysterium salutis). Sobrino yang menekankan analisa struktural atas kejahatan membutuhkan analisa sosio-kultural dari Éla sehingga aneka upaya “memberi nama” dan melawan problem kejahatan mendapatkan pijakannya pada praktik-praktik kultural dalam komunitas lokal. Dialog Sobrino dan Éla juga menunjukkan bahwa teologi mesti membuka diri pada kajian interdisipliner dengan ilmu lain sehingga, di satu sisi, misteri penderitaan dapat didekati secara lebih utuh dan, di sisi lain, jalan kemuridan yang muncul karena tanggapan atasnya menjadi lebih kontekstual. Kata-kata kunci: Penderitaan, kejahatan, pembebasan, resosialisasi, pendekatan struktural, pendekatan sosio-kultural, kemuridan. (shrink)

The problem of suffering crucially focuses on meaninglessness. Meaningful suffering—suffering having some “point” or function—is not as problematic as absurd suffering that cannot be rendered purposeful. This issue is more specific than the problem of the “meaning of life” (or “meaning in life”). Human lives are often full of suffering experienced as serving no purpose whatsoever – indeed, suffering that may threaten to make life itself meaningless. Some philosophers—e.g., D.Z. Phillips and John Cottingham—have persuasively (...) argued that the standard analytic methods of philosophy of religion in particular ought to be enriched by literary reading and interpretation, especially when dealing with issues such as this. The problem of evil and suffering can also be explored from a perspective entangling literary and philosophical approaches (Kivistö & Pihlström, 2016). This double methodology is in this paper applied to the problem of evil and suffering by considering an example drawn from Holocaust literature: Primo Levi’s work is analyzed as developing an essentially ethical argument, with a philosophical-cum-literary structure, against theodicies seeking to render suffering meaningful. By means of such a case study, I hope to shed light on the problem of meaningless suffering, especially regarding the moral critique of “theodicist” attempts to interpret all suffering as meaningful. (shrink)

Outside Ethics brings together some of the most important and provocative works by one of the most creative philosophers writing today. Seeking to expand the scope of contemporary moral and political philosophy, Raymond Geuss here presents essays bound by a shared skepticism about a particular way of thinking about what is important in human life--a way of thinking that, in his view, is characteristic of contemporary Western societies and isolates three broad categories of things as important: subjective individual preferences, (...) knowledge, and restrictions on actions that affect other people. He sets these categories in a wider context and explores various human phenomena--including poetry, art, religion, and certain kinds of history and social criticism--that do not fit easily into these categories. As its title suggests, this book seeks a place outside conventional ethics.Following a brief introduction, Geuss sets out his main concerns with a focus on ethics and politics. He then expands these themes by discussing freedom, virtue, the good life, and happiness. Next he examines Theodor Adorno's views on the relation between suffering and knowledge, the nature of religion, and the role of history in giving us critical distances from existing identities. From here he moves to aesthetic concerns. The volume closes by looking at what it is for a human life to have "gaps"--to be incomplete, radically unsatisfactory, or a failure. (shrink)

Outside Ethics brings together some of the most important and provocative works by one of the most creative philosophers writing today. Seeking to expand the scope of contemporary moral and political philosophy, Raymond Geuss here presents essays bound by a shared skepticism about a particular way of thinking about what is important in human life--a way of thinking that, in his view, is characteristic of contemporary Western societies and isolates three broad categories of things as important: subjective individual preferences, (...) knowledge, and restrictions on actions that affect other people. He sets these categories in a wider context and explores various human phenomena--including poetry, art, religion, and certain kinds of history and social criticism--that do not fit easily into these categories. As its title suggests, this book seeks a place outside conventional ethics. Following a brief introduction, Geuss sets out his main concerns with a focus on ethics and politics. He then expands these themes by discussing freedom, virtue, the good life, and happiness. Next he examines Theodor Adorno's views on the relation between suffering and knowledge, the nature of religion, and the role of history in giving us critical distances from existing identities. From here he moves to aesthetic concerns. The volume closes by looking at what it is for a human life to have "gaps"--to be incomplete, radically unsatisfactory, or a failure. (shrink)

Florijn analyzes the ruling of the Court of Appeal in the Heringa case, focusing on the role of patient autonomy in physician assisted death (Florijn 2022). His analysis of the case shows that in Dutch euthanasia law patient autonomy as self-determination is limited by the reciprocal physician-patient relationship. Yet, it also gives an unbalanced view of the Dutch euthanasia regulation and its ethical foundation. By focusing on patient autonomy, the importance of unbearable and irremediable suffering as a prerequisite for (...) euthanasia becomes less visible. The requirement of irremediable suffering means that only a physician is allowed to perform euthanasia, since medical expertise is needed to establish whether there are still treatment options to alleviate suffering. We will discuss the importance of suffering, and its consequences for the “tired of life” debate. (shrink)

BackgroundHumanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care—a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance was available. In 2018, (...) the WHO released a guide on‘Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises’—the first guidance on the topic by an international body.AimsThis paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances.ImplicationsIn parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance. (shrink)

While the idea of philosophy as conceptual analysis has attracted many adherents and undergone a number of variations, in general it suffers from an authority problem with two dimensions. First, it is unclear why the analysis of a concept should have objective authority: why explicating what we mean should express how things are. Second, conceptual analysis seems to lack intersubjective authority: why philosophical analysis should apply to more than a parochial group of individuals. I argue that Hegel’s conception of social (...) ontology, focused on his concept of “ethical life” (Sittlichkeit), helps to explain how concepts (and their explication) have both objective and intersubjective authority in the social domain. Hegel claims that modern institutions are the product of self-conscious purposes, so that they are conceptually constituted. Concepts do not just represent these objects and so depend on a contingent relation to them. As many contemporary social ontologists agree, this means that our concepts of these institutions are uniquely epistemically “transparent.” They have objective authority. Concepts have intersubjective authority in the modern world as well, according to Hegel. However, I show that this feature of Hegel’s account does not rely on the solution to a philosophical problem. Rather, since the concepts of modern ethical life are “essentially contested,” their content depends on the practical and political agreement of modern subjects. This means that concepts can only have objective authority if some prior intersubjective agreement has been reached. The role of philosophy as conceptual analysis is thus importantly dependent on political developments. (shrink)

This chapter examines the ethical case that can be mounted for veganism. Because there has been comparatively little discussion in ethics focused directly on veganism, the central aim of this chapter is threefold: to orient readers to (some of) the most important philosophical literature relevant to the topic, to provide a clear explanation of the current state of the ethical case for veganism, and to focus attention on the most important outstanding or underexplored questions in this domain. The (...) chapter examines the range of positions that deserve to be called ethical veganism, and some of the types of reasons that philosophers can potentially appeal to in arguing for veganism. It then spells out the core of the most promising case for veganism, which argues directly for the wrongness of making animals suffer and die. The chapter then considers three ways of arguing from this conclusion to an ethical defense of the vegan lifestyle, which appeal respectively to the ethical significance of the effects of individual use of animal products, of group efficacy, and of complicity with wrongdoing. The chapter concludes by examining several neglected complications facing the ethical case for veganism. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy (...) between Cassell’s distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

A signal challenge of twenty-first century psychiatry is the effective treatment of existential/spiritual suffering in palliative care. This chapter will concentrate on research to assess the therapeutic potential of psilocybin to assuage that suffering. If a “psychedelic experience” can facilitate an acceptance of impending death, and reduce the existential suffering of those who endure it, it could prove to be a valuable intervention where one is sorely needed. The therapeutic use of psilocybin with dying patients (hereinafter patients) (...) raises numerous questions about research trial design, the model of psychiatry that might accommodate it, and the kind of experience it induces. Are these the sorts of experience that psychiatric treatment should effect on troubled patients? Is spiritual care within the ambit of psychiatry? There are epistemological questions as to the veridicality of the psychedelic experience. How much credence should we give it? I will argue in cautious support of ongoing research to evaluate the therapeutic use of psilocybin in palliative care. This argument can be extended to research on its therapeutic use in psychotherapy. The chapter will focus on four questions: (1) what is the ethical justification for this research on patients? (2) What types of research trial design are best used to assess the purported benefits of a psychedelic drug experience? (3) What is the epistemic warrant of the “mystical” and “noetic” facets of this experience? (4) What models of (a) psychiatry and (b) drug action could accommodate the therapeutic use of psilocybin in palliative care? (shrink)

A major argument for vegetarianism is that eating animals causes unjustified suffering. While this argument has been articulated by several people, it has received surprisingly little attention. Here I restate it in a way that I believe is most convincing, considering and rejecting the two main justifications for causing suffering in order to eat animals. I compare it to some other prominent arguments for vegetarianism, and discuss a major objection to the argument which focuses on whether the animals (...) would not exist if not bred to be eaten. (shrink)

Recent developments in AI programming allow for new applications: individualized chatbots which mimic the speaking and writing behaviour of one specific living or dead person. ‘Deathbots’, chatbots of the dead, have already been implemented and are currently under development by the first start-up companies. Thus, it is an urgent issue to consider the ethical implications of deathbots. While previous ethical theories of deathbots have always been based on considerations of the dignity of the deceased, I propose to shift the focus (...) on the dignity and autonomy of the bereaved users of deathbots. Drawing on theories of internet-scaffolded affectivity and on theories of grief, I argue that deathbots may have a negative impact on the grief process of bereaved users and therefore have the potential to limit the emotional and psychological wellbeing of their users. Deathbot users are likely to become dependent on their bots which may make them susceptible to surreptitious advertising by deathbot providing companies and may limit their autonomy. At the same time, deathbots may prove to be helpful for people who suffer from prolonged, severe grief processes. I caution against the unrestricted usage of deathbots and suggest that they should be classified as medical devices. This classification would not the least mean that their non-harm, as well as their helpfulness for people suffering from prolonged grief needs to be proven and that their potential for autonomy infringements is reduced. (shrink)

Each year millions of nonhuman animals are exposed to suffering in universities as they are routinely used in teaching and research in the natural sciences. Drawing on the work of Giroux and Derrida, we make the case for a critical pedagogy of nonhuman animal suffering. We discuss critical pedagogy as an underrepresented form of teaching in universities, consider suffering as a concept, and explore the pedagogy of suffering. The discussion focuses on the use of nonhuman animal (...) subjects in universities, in particular in teaching, scientific research, and associated experiments. We conclude that a critical pedagogy of nonhuman animal suffering has the capacity to contribute to the establishment of a practical animal ethics conducive to the constitution of a radically different form of social life able to promote a more just and non-speciesist future in which nonhuman animals are not used as resources in scientific research in universities. (shrink)

This paper has two aims. The first is to defend a recent critique of the leading medical theory of suffering, which alleges too narrow a focus on violent experiences of suffering. Although sympathetic to this critique, I claim that it lacks a counterexample of the kinds of experiences the leading theory is said to neglect. Drawing on recent clinical cases and the longer intellectual history of suffering, my paper provides this missing counterexample. I then answer some possible (...) objections to my defence, before turning to my second aim: an expansion of my counterexample into a spectrum of suffering that varies according to the selves and purposes that suffering affects. Next, I connect this spectrum to the tolerability of suffering, which I distinguish from its affective intensity. I conclude by outlining some applications of this distinction for the psychometric reliability of assessment instruments that measure suffering in clinical contexts. (shrink)

Background With the huge number of patients who suffer from chronic and incurable diseases, medical scientists continue to search for new curative methods for patients in dire need of treatment. Interest in stem cells is growing, generating high expectations in terms of the possible benefits that could be derived from stem cell research and therapy. However, regardless of the hope of stem cells changing and improving lives, there are many ethical, religious, and political challenges and controversies that affect the research, (...) and mandated to establish ethical guidelines and regulations. In Saudi Arabia, key stakeholders play an active role in discussing the ethics of stem cell research and therapy. The focus of the study was to explore professionals’ perceptions related to the ethical challenges of using stem cells in research and treatment in Saudi Arabia. Results A qualitative research study was conducted to explore and describe the perceptions of 25 professionals employed at different tertiary hospitals in the various regions of Saudi. A thematic analysis was performed to search for and identify the most significant perceptions shared by the participants. Four themes were generated based on the ethical challenges of four areas related to stem cell use, including forbidden and permitted sources of stem cells, informed consent, beneficence, and ethical regulations and guidelines. Conclusion The study identified that there is a growing need to advance the knowledge, education, and awareness related to stem cell research and treatment in Saudi Arabia. (shrink)

This paper focuses on Nietzsche’s claim that suffering is closely related to the realization of certain perfectionist values, such as artistic excellence. According to Bernard Reginster, creative achievement consists in overcoming suffering, and therefore, suffering is an essential ingredient of creative achievement. Because suffering forms an essential part of a valuable whole in this way, Reginster argues that we must in turn value suffering ‘for its own sake’. This paper argues that Reginster’s position is open (...) to the following objection: from the fact that suffering is an essential part of a valuable whole, it does not follow that suffering is itself valuable. Rather, by taking advantage of the principle of organic unities, it would have to form an essential part of a valuable whole in a particular way. The author considers two ways the principle might be attributed to Nietzsche’s views on suffering: first, as an ‘enabling condition’, in which suffering allows for a whole that outweighs its disvalue; and second, as ‘a contributor’, in which suffering positively contributes value to the whole. The paper explores how Nietzsche’s ethics turns out to be crucially informed by this conceptual distinction. (shrink)

Many people think that the amount of evil and suffering we observe provides important and perhaps decisive evidence against the claim that a loving God created our world. Yet almost nobody worries about the ethics of human procreation. Can these attitudes be consistently maintained? This chapter argues that the most obvious attempts to justify a positive answer fail. The upshot is not that procreation is impermissible, but rather that we should either revise our beliefs about the severity of (...) global arguments from evil or develop new and better defenses of human procreation. Although both possibilities are worthy of pursuit, this chapter focuses on the latter possibility. (shrink)

Background Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups with (...) persons with lived experience of mental illness.Methods We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team.Results A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide.Conclusions Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk. (shrink)

Patients with advanced dementia suffer from severe cognitive and functional impairment, including eating disorders. The focus of our research is on the issue of life-sustaining treatment, specifically on the social and ethical implications of tube feeding. The treatment decision, based on values of life and dignity, involves sustaining lives that many people consider not worth living. We explore the moral approach to caring for these patients and review the history of the debate on artificial nutrition and hydration showing the impact (...) of the varying perceptions of the value of these patients' lives on changing norms. We argue that in light of the value of solidarity, decisions about life-sustaining treatment for patients with advanced dementia should be made on a case by case basis, as with any other patient, in consideration of the medical implications of the intervention which might best serve the goals of care for the individual patient. (shrink)

Emerging markets are a growing force, and the resulting increase in wealth—especially among the middle class—promotes conspicuous consumption with potentially negative impacts for societal and environmental well-being. Efforts to encourage ethical consumer behavior in emerging markets often meet various forms of consumer resistance. One reason that ethical consumption may suffer in emerging markets is because consumers have difficulty considering ethical other-focused attributes, such as Fair Trade or eco-friendly options, especially if those attributes do not directly benefit the self. Our (...) research demonstrates a simple way to encourage more ethical consumption in emerging markets, without economic incentives. In particular, when consumers see narrow (vs. broad) product categories, they are more likely to incorporate both salient (self-focused) and non-salient (other-focused) attributes into their decision. Thus, narrow product categories encourage consumers to consider ethical attributes to a greater extent than they normally would. This finding holds in private settings, across various product categories (i.e., coffee, tea, juice) and contexts (i.e., online and in the field), and in different emerging markets (e.g., India, South Africa, and Iran). (shrink)

It is commonly understood that in its focus on rights and obligations law is centrally concerned with organising responsibility. In defining how obligations are created, in contract or property law, say, or imposed, as in tort, public, or criminal law, law and legal institutions are usually seen as society’s key mode of asserting and defining the content and scope of responsibilities. This book takes the converse view: legal institutions are centrally involved in organising irresponsibility. Particularly with respect to the production (...) of large-scale harms – including extensive human rights violations, forms of colonialism, or environmental or nuclear devastation – and in opposition to conventional understandings of responsibility in law, morality and politics, the book provides a detailed analysis of the ways in which legal institutions – their practices, concepts, and categories – themselves operate as much to deflect responsibility for harms suffered as they do to acknowledge them. Drawing on a series of case studies from local, national, and global concerns the book analyses how law facilitates dispersals and disavowals of responsibility, and it shows how it does so in consistent and patterned ways. In assessing how this ‘organised irresponsibility’ operates, and what its consequences are for both legal analysis and society generally, a thoroughgoing re-evaluation of law’s methods, operation, and consequences is required. At stake is nothing less than a fundamental re-assessment of the role of modern law in the production and legitimation of human suffering. This innovative and interdisciplinary book provides a sustained challenge to conventional thinking about law and legal institutions. It will be of major interest to those working in law, political and legal theory, sociology and moral philosophy. (shrink)

Featuring the work of leading contemporary Muslim philosophers and theologians, this book grapples with various forms of evil and suffering in the world today, from COVID-19 and issues in climate change to problems in palliative care and human vulnerability. Rather than walking down well-trodden paths in philosophy of religion which often address questions of evil and suffering by focusing on divine attributes and the God-world relationship, this volume offers another path of inquiry by focusing on human vulnerability, potential, (...) and resilience. Addressing both the theoretical and practical dimensions of the question of evil, topics range from the transformative power of love, virtue ethics in Sufism and the necessity of suffering, to the spiritual significance of the body and Islamic perspectives on embodiment. In doing so, the contributors propose new perspectives based on various pre-modern and contemporary materials that can enrich the emerging field of the global philosophy of religion, thereby radically transforming contemporary debates on the nature of evil and suffering. The book will appeal to researchers in a variety of disciplines, including Islamic philosophy, religious studies, Sufism and theology. (shrink)

This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to (...) demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored. (shrink)

This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to (...) demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative (...) interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants attended a 1-year (...) educational programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability. (shrink)

Human beings have a moral duty to intervene to prevent or to mitigate the suffering of free-living animals. This article focuses on that duty, particularly as it exists when an animal asks for help and when animals who need help are within the zone of a person’s ability and willingness to help. As such, people should be free to help if they choose to do so, unencumbered by legal restrictions that outlaw such conduct. However, federal and state laws in (...) the United States remain an obstacle, because they designate some activities that are necessary to help free-living animals as unlawful. Laws should not interfere with human beings’ benign interactions with nature and, in particular, people should be legally permitted to help free-living animals. People should actually assist the individual animals who want or need help, rather than trading individual assistance in favor of ecosystem “management,” policy concerns that favor expediency and budget limitations, or any other tangential issues. (shrink)

The interdisciplinary group of authors featured in this focus issue contribute to conversations at the intersection of anthropology and ethics by exploring ethical self‐making and moral experimentation among faith‐based actors in a range of humanitarian settings. Kari Henquinet describes the genealogies of American evangelical humanitarianism by focusing on the ethical self‐formation of early World Vision leaders. Rachel Schneider and Sara Williams each explore practices by which relatively privileged individuals seek to cultivate virtue by engaging with those on the margins, (...) in poor, urban neighborhoods in South Africa, and through packaged tours in Israel/palestine, respectively. Sarah Tobin describes projects of Islamic self‐making among displaced refugee women in Jordan. Although they examine a wide range of subjects and settings, they explore a common set of themes, two of which I discuss here: moral experimentation, and engagements with suffering, poverty, and inequality. (shrink)

With the increasing focus on globalization of the economy, ethical issues are often submerged by the goal of increasing profitability. This article explores the implications of globalization and its effects on both the Earth’s poor and the Earth itself. It illustrates how poverty goes hand in hand with environmental degradation. The economic and moral impacts of international financial and regulatory organizations are analyzed and discussed. The article demonstrates how the economically marginalized suffer not only from the obvious lack of food, (...) clothing, and shelter but also from polluted air, an unpotable water supply, and macro issues such as global warming. It concludes with the recommendation of looking to the economy of the Beatitudes of the New Testament for solutions. (shrink)

Since the terrorist attacks of September 11, 2001, the concept of 'evil' has enjoyed renewed popularity in both international political rhetoric and scholarly writing. World leaders, politicians, and intellectuals have increasingly turned to 'evil' to describe the very worst humanitarian atrocities that continue to mark international affairs. However, precisely what 'evil' actually entails is not well understood. Little consensus exists as to what 'evil' is, how it is manifested in the international sphere, and what we ought to do about it. (...) With this in mind, this work seeks to ascertain precisely what is meant by 'evil' when it is used to describe actors and events in international politics. Focusing on the history of evil in western secular and religious thought, it reintroduces a classical understanding of evil as the means according to which we seek to understand otherwise meaningless human suffering. (shrink)

The aim of this article is to analyse and discuss the ethically problematic conflict raised by patients with stroke who refuse nutritional treatment. In analysing this conflict, the focus is on four different aspects: (1) Is nutritional treatment biologically necessary? (2) If necessary, is the reason for refusal a functional disability, lack of appetite or motivation, misunderstanding of the situation or a genuine conflict of values? (3) If the latter, what values are involved in the conflict? (4) How should we (...) deal with the different kinds of refusal of nutritional treatment? We argue that patients' autonomy should be respected as far as possible, while also considering that those who have suffered a stroke might re-evaluate their life as a result of a beneficial prognosis. However, if patients persist with their refusal, health care professionals should force nutritional treatment only when it is clear that the patients will re-evaluate their future life. (shrink)

Background:Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals.Aim:To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations.Methods:Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group.Ethical considerations:Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research.Result/conclusion:Two categories emerged: one in ‘ethical issues’ and one in ‘emotions and feelings in caring’. The (...) four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse’s ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients’ care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with ‘end-of-life’ care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient’s ‘previous wishes’ in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient’s advocate. The nurses express feelings of distress, suffering, anger and helplessness. (shrink)

Little is known about whether followers who perceive ethical leadership are more easily moved to act compassionately with peers. This study hypothesizes four compassionate feelings as mediators of the relationship between ethical leadership and interpersonal citizenship behavior directed at peers: empathic concern or an other-oriented emotional response elicited by and congruent with the perceived welfare of a peer in need; mindfulness, a state of consciousness in which attention is focused on present-moment phenomena; kindness, understanding the pain or suffering (...) of peers; and common humanity, viewing peers’ experiences as part of the larger human experience. Data were obtained from 300 followers working in three-member groups with a common leader in each of 100 investment banks in the city of London. Results indicated that: ethical leadership was significantly and positively linked to compassion and peer-focused citizenship and common humanity is the only compassionate feeling that mediates the link between ethical leadership and peer-focused citizenship. Findings suggest that supervisors who act morally more easily move their followers to become sensitized to peers’ setbacks and misfortunes and take action in the form of interpersonal OCBs to lessen or relieve their suffering. (shrink)

Since the birth of the first test-tube baby, Louise Brown, in 1977, we have seen truly remarkable advances in biotechnology. We can now screen the fetus for Down Syndrome, Spina Bifida, and a wide range of genetic disorders. We can rearrange genes in DNA chains and redirect the evolution of species. We can record an individual's genetic fingerprint. And we can potentially insert genes into human DNA that will produce physical warning signs of cancer, allowing early detection. In fact, biotechnology (...) has progressed to such a point that virtually any kind of genetic manipulation, if not already possible, is just around the corner. But these breakthroughs also raise serious ethical and moral dilemmas that we are only now beginning to confront. In Wonderwoman and Superman, noted medical ethicist John Harris offers the first thorough analysis of the moral dilemmas created by the revolution in molecular biology. Covering a wide array of recent innovations, Harris discusses, for example, the moral decisions involved and the consequences of creating egg and embryo banks. Who should be allowed to use such resources? Should recipients be screened? Should such banks be open for public or private use? And does it cheapen life to make embryos available for sale? In another chapter, Harris examines the question of conceiving children chiefly for organ donation, focusing on the recent case of a woman who wanted to have a second child to provide a bone marrow donor for her first child sick with leukemia (she intended to abort the fetus if its bone marrow did not genetically match that of her living child). In this case, the medical staff had to decide whether they should perform in-vitro fertilization, knowing that the mother did not satisfy the clinic's criteria (there was no father), and also knowing the potential for abortion. Discussing the ethics of the mother's choice and the clinic's choice, Harris asks whether it is morally correct to create a child as an organ donor, whether the future child would suffer, whether it is worth any suffering to be born, and who has the right to weigh the various factors (both moral and physiological) involved in making these decisions. Delving into a multitude of issues such as when life begins, when suffering is needless, and whether we should play God, Wonderwoman and Superman provides not only a thought-provoking inquiry into the potential and actual ethical dilemmas created by the many advances in biotechnology, but challenges us to learn to choose responsibly and to face the moral implications of the choices that confront us. (shrink)

This chapter deals with the following myths: without God there is no morality; atheists are moral relativists; atheists don't give to charity; atheists deny the sanctity of human life; and if there is no god we are soulless creatures. Atheists, informed by secular approaches to ethics, are more likely to be focused on what will cause, or prolong, or conversely, ameliorate, suffering, rather than taking the view that human life possesses some kind of transcendent or supernatural value. (...) Many thinkers in the Eastern philosophical tradition have put forward arguments for the existence of something much like the concept of the soul, without depending on theistic arguments. (shrink)

Veterinarians serve on the front lines working to prevent animal suffering and abuse. For centuries, their compassion and expertise have improved the quality of life and death for animals in their care. However, modern interest in animal rights has led more and more people to ask questions about the ethical considerations that lie behind common veterinary practices. This Common Threads volume, drawn from articles originally published in the Journal of Animal Ethics (JAE), offers veterinarians and other interested readers (...) a primer on key issues in the field. Essays in the first section discuss aspects of veterinary oaths, how advances in animal cognition science factor into current ethical debates, and the rise of complementary and alternative veterinary medicine and its relationship to traditional veterinary medicine. The second section continues with an essay that addresses why veterinarians have an obligation to educate animal caregivers to look past "cuteness" in order to treat all animals with dignity. The collection closes with three short sections focusing on animals in farming, trade, and research ”areas where veterinarians encounter conflicts between their job and their duty to advocate and care for animals. Contributors: Judith Benz-Schwarzburg, Vanessa Carli Bones, Grace Clement, Simon Coghlan, Priscilla N. Cohn, Mark J. Estren, Elisa Galgut, Eleonora Gullone, Matthew C. Halteman, Andrew Knight, Drew Leder, Andrew Linzey, Clair Linzey, Kay Peggs, Megan Schommer, Clifford Warwick, and James W. Yeates. (shrink)

End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: if the (...) patient requested it, and if it relieved the patient’s suffering. They considered that the doctor’s orders, the family’s request, or the patient’s advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed. (shrink)