The high predictive accuracy of contemporary machine learning-based AI systems has led some scholars to argue that, in certain cases, we should grant them epistemic expertise and authority over humans. This approach suggests that humans would have the epistemic obligation of relying on the predictions of a highly accurate AI system. Contrary to this view, in this work we claim that it is not possible to endow AI systems with a genuine account of epistemic expertise. In fact, relying on accounts (...) of expertise and authority from virtue epistemology, we show that epistemic expertise requires a relation with understanding that AI systems do not satisfy and intellectual abilities that these systems do not manifest. However, recent developments of large language models make us argue that in the future AI systems may endowed with a form of epistemic authority. Further, following the Distributed Cognition theory and adapting an account by Croce on the virtues of collective epistemic agents to the case of human-AI interactions we show that, if an AI system is successfully appropriated by a human agent, a hybrid epistemic agent emerges, which can become both an epistemic expert and an authority. Consequently, we claim that the aforementioned hybrid agent is the appropriate object of a discourse around trust in AI and the epistemic obligations that stem from its epistemic superiority. (shrink)

Human-centered explainable AI (HCXAI) advocates for the integration of social aspects into AI explanations. Central to the HCXAI discourse is the Social Transparency (ST) framework, which aims to make the socio-organizational context of AI systems accessible to their users. In this work, we suggest extending the ST framework to address the risks of social misattributions in Large Language Models (LLMs), particularly in sensitive areas like mental health. In fact LLMs, which are remarkably capable of simulating roles and personas, may lead (...) to mismatches between designers' intentions and users' perceptions of social attributes, risking to promote emotional manipulation and dangerous behaviors, cases of epistemic injustice, and unwarranted trust. To address these issues, we propose enhancing the ST framework with a fifth 'W-question' to clarify the specific social attributions assigned to LLMs by its designers and users. This addition aims to bridge the gap between LLM capabilities and user perceptions, promoting the ethically responsible development and use of LLM-based technology. (shrink)

Current research in Explainable AI includes post-hoc explanation methods that focus on building transparent explaining agents able to emulate opaque ones. Such agents are naturally required to be accurate and trustworthy. However, what it means for an explaining agent to be accurate and trustworthy is far from being clear. We characterize accuracy and trustworthiness as measures of the distance between the formal properties of a given opaque system and those of its transparent explanantes. To this aim, we extend Probabilistic Computation (...) Tree Logic with operators to specify degrees of accuracy and trustworthiness of explaining agents. We also provide a semantics for this logic, based on a multi-agent structure and relative model-checking algorithms. The paper concludes with a simple example of a possible application. (shrink)

One of the most commonly referenced ethical principles when it comes to the management of dying patients is the doctrine of double effect (DDE). The DDE affirms that it is acceptable to cause side effects (e.g. respiratory depression) as a consequence of symptom‐focused treatment. Much discussion of the ethics of end of life care focuses on the question of whether actions (or omissions) would hasten (or cause) death, and whether that is permissible. However, there is a separate question about the (...) permissibility of hastening or causing unconsciousness in dying patients. Some authors have argued that the DDE would not permit end of life care that directly aims to render the patient unconscious. The claim is that consciousness is an objective human good and therefore doctors should not intentionally (and permanently) suppress it. Three types of end of life care (EOLC) practices will be explored in this article. The first is symptom‐based management (e.g. analgesia); the second is proportional terminal sedation as a means of relieving suffering (also referred to as palliative sedation or continuous deep sedation); and finally, deliberate and rapid sedation to unconsciousness until death (a practice we call terminal anaesthesia in this paper). After examining the common arguments for the various types of symptom‐based management and sedation, we apply the DDE to the latter two types of EOLC practices. We argue that aiming at unconsciousness, contrary to some claims, can be morally good or at least morally neutral in some dying patients. (shrink)

Different anesthetics are known to modulate different types of membrane-bound receptors. Their common mechanism of action is expected to alter the mechanism for consciousness. Consciousness is hypothesized as the integral of all the units of internal sensations induced by reactivation of inter-postsynaptic membrane functional LINKs during mechanisms that lead to oscillating potentials. The thermodynamics of the spontaneous lateral curvature of lipid membranes induced by lipophilic anesthetics can lead to the formation of non-specific inter-postsynaptic membrane functional LINKs by different mechanisms. These (...) include direct membrane contact by excluding the inter-membrane hydrophilic region and readily reversible partial membrane hemifusion. The constant reorganization of the lipid membranes at the lateral edges of the postsynaptic terminals (dendritic spines) resulting from AMPA receptor-subunit vesicle exocytosis and endocytosis can favor the effect of anesthetic molecules on lipid membranes at this location. Induction of a large number of non-specific LINKs can alter the conformation of the integral of the units of internal sensations that maintain consciousness. Anesthetic requirement is reduced in the presence of dopamine that causes enlargement of dendritic spines. Externally applied pressure can transduce from the middle ear through the perilymph, cerebrospinal fluid, and the recently discovered glymphatic pathway to the extracellular matrix space, and finally to the paravenular space. The pressure gradient reduce solubility and displace anesthetic molecules from the membranes into the paravenular space, explaining the pressure reversal of anesthesia. Changes in membrane composition and the conversion of membrane hemifusion to fusion due to defects in the checkpoint mechanisms can lead to cytoplasmic content mixing between neurons and cause neurodegenerative changes. The common mechanism of anesthetics presented here can operate along with the known specific actions of different anesthetics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryMichael Robertson, Senior Research FellowThe French philosopher Michel Foucault once recounted the story of the English King, George III, being restrained by his guards at the direction of his physician Dr. Willis. King George, presumably deranged by a psychotic mania consequent upon porphyria, was incapable of self-rule and his power was usurped by the medical profession in an act of coercion tantamount to treason. This for Foucault was (...) a profound metaphor of psychiatric power.1The plight of Mdm. W yokes the two most emotive issues in psychiatry — involuntary treatment and the administration of ECT. Whilst only utilised at an extremity of clinical practice, both of these are the most misunderstood of actions performed by the psychiatric profession. Yet, in many circumstances, they are life-saving.In essence, we are confronted with a profoundly depressed woman, whose illness is seemingly resistant to first line treatment and poses a serious, credible risk of harm. Most psychiatrists would regard this as somewhat of a psychiatric emergency. We are informed that Mdm. W’s family has transcended any cultural taboos about mental illness and is engaged in her care, has an extensive lived experience of her severe mood disorder and accepts, indeed welcomes, the use of ECT to terminate a severe episode of depression. In the course of a psychotic depression, Mdm. W is suffering profound distress and presents a risk of either suicide or serious medical complications if the episode persists. Despite the minimal discomfort during the actual administration of ECT, Mdm. W’s distress will be compounded by the further restraint needed to prevent from her eating and drinking prior to anaesthesia.It is difficult to know what Mdm. W’s experience of this situation would [End Page 230] be. Through the prism of her disturbed mental state, with its derangements in thinking, cognitive functioning and apprehension of reality, she would likely experience the situation as one of fear or terror; she would likely interpret ECT and the enforced restriction of oral intake prior to the procedure as punitive — further evidence of her “sins”, reinforcing her delusional guilt and nihilism. Yet to speak to Mdm. W in circumstances of euthymia or normal mood, where such derangements no longer occur, might reveal an utterly different perspective on the situation. Like many people with episodic mental illnesses, Mdm. W might, when such a scenario was put to her, consent to future treatment with ECT without equivocation. Indeed, many patients with bipolar disorder formulate advance directives in regard to the specific management of their possible future episodes of illness.If the clinical and legal aspects of this situation are so clear, why is there a sense of a dilemma in the realm of clinical ethics? Beyond the emotive nature of the situation, we see a deeply distressed woman being provided potentially life-saving treatment, which is being denied to her by the profound impairments of insight and judgement consequent upon her illness.In Singapore, such detention and enforced treatment under the Mental Capacity Act (2010) applies to a person with a mental illness or disorder who lacks capacity to make decisions in their own best interests based upon impairment of mind or brain. This would be considered a “capacity” based mental health law. In other jurisdictions, the legal test and evidentiary justification for such care may be predicated upon risk of harm to self or others. In either setting, Mdm. W’s clinical situation provides adequate legal justification for such enforced care.The moral justification of such laws falls into two general categories — the “risk” argument and the “capacity” argument. In mental health legislation, the “harm principle”, as first elaborated in John Stuart Mill’s On Liberty,2 is usually defined in terms of the construct of “risk”. Risk is a term that has multiple meanings in different disciplinary contexts, although all approaches to “risk” attempt to apply knowledge to an area of uncertainty.3 The notion of “risk assessment” is usually considered as the process of categorising individuals by their perceived likelihood of causing serious harm to themselves or harm to others. In the insurance industry, actuarial assessment is a mathematical discipline aimed at computing a probability of adversity... (shrink)

Is a painful experience less bad for you if you will not remember it? Do you have less reason to fear it? These questions bear on how we think about medical procedures and surgeries that use an anesthesia regimen that leaves patients conscious – and potentially in pain – but results in complete ‘drug-induced amnesia’ after the fact. I argue that drug-induced amnesia does not render a painful medical procedure a less fitting object of fear, and thus the prospect of (...) amnesia does not give patients a reason not to fear it. I expose three mistakes in reasoning that might explain our tendency to view pain or discomfort as less fearful in virtue of expected amnesia: a mistaken view of personal identity; a mistaken view of the target of anticipation; and a mistaken method of incorporating past evidence into calculations about future experiences. Ultimately my argument has implications for whether particular procedures are justified and how medical professionals should speak with anxious patients about the prospect of drug-induced amnesia. (shrink)

This article engages two fundamentally different kinds of so-called natural law arguments in favor of specific moral absolutes: Elizabeth Anscombe's claim that certain actions are known to be intrinsically wrong through intuition, and John Finnis's claim that such actions are known to be wrong because they involve acting directly against a basic human good. Both authors maintain, for example, that murder and contraceptive sexual acts are known to be wrong, always and everywhere, through their respective epistemological lens. This article uses (...) the counter-example of anesthesia to challenge these two approaches to substantiating natural law claims. The paper concludes by rejecting the view shared by Professors Finnis and Anscombe that once one rejects these foundations for moral absolutes, one is left with moral subjectivism. In fact, one is left with moral absolutes of a more restricted nature, which are known philosophically, and with more robust moral absolutes held on religious grounds. Virtues are needed in the moral life, among other reasons, because such norms require discernment and integrity for their correct application. (shrink)

Possible systemic effects of general anesthetic agents on neural information processing are discussed in the context of the thalamocortical suppression hypothesis presented by Drs. Alkire, Haier, and Fallon (this issue) in their PET study of the anesthetized state. Accounts of the neural requisites of consciousness fall into two broad categories. Neuronal-specificity theories postulate that activity in particular neural populations is sufficient for conscious awareness, while process-coherence theories postulate that particular organizations of neural activity are sufficient. Accounts of anesthetic narcosis, on (...) the other hand, explain losses of consciousness in terms of neural signal-suppressions, transmission blocks, and the disruptions of signal interpretation. While signal-suppression may account for the actions of some anesthetic agents, the existence of anesthetics, such as choralose, that cause both loss of consciousness and elevated discharge rates, is problematic for a general theory of narcosis that is based purely on signal suppression and transmission-block. However, anesthetic agents also alter relative firing rates and temporal discharge patterns that may disrupt the coherence of neural signals and the functioning of the neural networks that interpret them. It is difficult at present, solely on the basis of regional brain metabolic rates, to test process-coherence hypotheses regarding organizational requisites for conscious awareness. While these pioneering PET studies have great merit as panoramic windows of mind-brain correlates, wider ranges of theory and empirical evidence need to be brought into the formulation of truly comprehensive theories of consciousness and anesthesia. (shrink)

For patients under anesthesia, it is extremely important to be able to ascertain from a scientific, third person point of view to what extent consciousness is correlated with specific areas of brain activity. Errors in accurately determining when a patient is having conscious states, such as conscious perceptions or pains, can have catastrophic results. Here, I argue that the effects of (at least some kinds of) anesthesia lend support to the notion that neither basic sensory areas nor the prefrontal cortex (...) (PFC) is sufficient to produce conscious states. I also argue that it this is consistent with and supportive of the higher-order thought (HOT) theory of consciousness. I therefore disagree in some ways with Mehta and Mashour (2013), who argue that evidence from anesthesia mainly favors a first-order representational (FOR) theory, as opposed to HOT theory (and many other theories, for that matter). (shrink)

In general anesthesia, a “cocktail” of drugs renders a patient unconscious, in what has been called a “controlled coma”. Various measures of patient awareness involve overt behavior, autonomic nervous system activity, processed EEG, and event‐related potentials. The incidence of intraoperative awareness is very low, but anecdotal reports suggest that patients might process surgical events unconsciously, leading to unconscious postoperative memories. Careful experimental studies show that priming effects, similar to those observed in implicit memory, can be spared even in the absence (...) of conscious recollection, an outcome which indicates that unconscious perception can occur even in clinically adequate general anesthesia. Deeper planes of amnesia, however, appear to abolish both explicit and implicit perception. (shrink)

This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner’s interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses’ experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly (...) demanding when involving older patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one’s legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced. (shrink)

Empirical work is reviewed which correlates the presence or absence of various parts of the auditory evoked potential with the disappearance and reemergence of auditory sensation during induction of and recovery from anesthesia. As a result, the hypothesis is generated that the electrophysiological correlate of auditory sensation is whatever neural activity generates the middle latency waves of the auditory evoked potential. This activity occurs from 20 to 80 ms poststimulus in the primary and secondary areas of the auditory cortex. Evidence (...) is presented suggesting that earlier or later waves in the auditory evoked potential do not covary with auditory sensation (as opposed to auditory perception) and it is therefore suggested that they are possibly not the electrophysiological correlates of sensation. (shrink)

General anesthesia provides an alternative to typical laboratory paradigms for investigating implicit learning. We assess the evidence that a simple type of learning—priming—can occur without consciousness. Although priming has been shown to be a small but persistent phenomenon in surgical patients there is reason to question whether it occurs implicitly due to problems in detecting awareness using typical clinical signs. This paper reviews the published studies on priming during anesthesia that have included a measure of awareness or of anesthetic depth. (...) We conclude that perceptual priming, but not conceptual priming, takes place in the absence of conscious awareness. (shrink)

Research on learning under anesthesia has focused on showing that learning is possible in the absence of awareness. However, a simple dissociation between learning and awareness is conclusive only under strong additional assumptions, and the actual state of consciousness of an anesthetized person is difficult to determine. Instead of trying to establish complete unconsciousness, one might employ gradual anesthesia to experimentally vary the level of consciousness in a controlled fashion, checking whether cognitive processes exist that can change in opposite direction (...) to measures of awareness. (shrink)

This paper presents research regarding the monitoring of the brain and the adequacy of anesthesia during surgery. Particular variables are derived from EEG and ECG signals and are correlated to anesthetic gas (sevoflurane) concentration, in pediatric anesthesia. The methods used for parameter extraction are based on change detection theory and time-frequency representation. Preliminary results show that the expired anesthetic gas concentration modulates both the heart rate variability and the duration of the burst suppression. Monitors of the central nervous system and (...) autonomic nervous system activities can be expected to be based on these variables. (shrink)

It has frequently been suggested that science and religion are innately in conflict. One example from the history of medicine is the introduction of anaesthesia into obstetrics in 1847, which is commonly said to have stimulated massive religious opposition. Historians have almost unanimously averred that such opposition arose from the belief that obstetric anaesthesia interfered with the primeval curse— ‘In sorrow thou shalt bring forth children’ . Despite considerable opposition to obstetric anaesthesia upon medical, physiological, and general (...) moral grounds, evidence of genuine religious opposition in contemporary sources has proved to be virtually non-existent. On examination, this particular ‘conflict’ appears to be an artifact of historiography based upon a contemporary defence prepared against an attack which never materialized. (shrink)

Grossi, Antonio This article discusses anaesthesia, the role of the anaesthetist and its ethical challenges. In the current political climate of task substitution and de-professionalisation, it is worth considering the role of the anaesthetist and the relevant ethical issues pertaining to this endeavour.

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. -/- Popular and academic discourse about assisted suicide paradigmatically focuses on (...) individuals with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)

It is no accident that white privilege designed to be both be invisible and weightless to white people. Alison Bailey’s “On White Privilege and Anesthesia: Why Does Peggy McIntosh’s Knapsack Feel Weightless?” extends a weighty invitation white readers to complete the unpacking task McIntosh (1988) began when she compared white privilege to an “invisible and weightless knapsack.” McIntosh focuses primarily making white privilege visible to white people. Bailey’s project continues the conversation by extending a ‘weighty invitation’ to white readers to (...) explore why the metaphorical knapsack, despite the weight of its contents, feels weightless. Here’s the short answer. The knapsack only feels weightless because white people have become anesthetized us to our own brokenness. We are more comfortable considering what white privilege does for us than what it does to us. People of color feel the weight of whiteness every day. The weighty invitation invites white readers to become sensitive to our own insensitivity. To do this Bailey (1) explores white resistance to unpacking the weight; (2) people of color’s testimonies to the daily impact of the weight on their bodies; and (3) how the anesthesia of white privilege distorts our humanity. The article concludes with a McIntosh style list of that the anesthesia of privilege distorts white people’s humanity. (shrink)

Philip Reed (2023) argues that discrimination against (non-acutely) dying patients constitutes a unique kind—which he calls terminalism—because their status as persons with terminal illness marks them with a socially salient identity which, by means of direct and indirect discrimination, limits their sets of choices and resources, such as in hospice care or organ transplant policies. 1 Importantly, Reed also argues that while terminalism is an increasingly prevalent normative phenomenon, it has been overlooked in the literature, ‘hiding in plain sight’ (...) as even though we are ‘aware of it at some level’." 1 What could explain this paradox? Drawing from Jeffrey Bishop, Giorgio Agamben, and T. Kenny Fountain, I argue that an institutional episteme and operating assumption of medicine, from the training of medical students, discursively disciplines terminally ill persons as bare life, between medicine’s dichotomy of bodies: neither ‘biovaluable’ (the surplus value of separated human bodily material... (shrink)

Anesthetic gas molecules are recognized to act by van der Waals (London dispersion) forces in hydrophobic pockets of select brain proteins to ablate consciousness. Enigmatic features of consciousness have defied conventional neurophysiological exp lanations and prompted suggestions for supplemental occurrence of macroscopic quantum coherent states and quantum computation in the brain. Are these feasible? During conscious (non-anesthetic) conditions, endogenous Van der Waals London dispersion forces occur among non-polar amino acid groups in hydrophobic pockets of neural proteins and help regulate their (...) conformation/function. London forces are weak instantaneous couplings between pairs of electron induced dipoles (e.g. between adjacent non-polar amino acid groups), and are quantum mechanical effects capable of supporting quantum superposition/computation and macroscopic quantum coherence. Quantum effects mediated by endogenous London forces in hydrophobic pockets of select neural proteins may be necessary for consciousness. The mechanism of anesthetics may be to inhibit (by exogenous London forces) the necessary quantum states. (shrink)

Evil should be characterised as a specific constellation, which results from destructive connections between individual activities and systemic influences. The article shows some important aspects of the structure of evil and prefers the terms of wickedness and obscene coincidences to describe its own character. Therefore, also the division between rationality and affectivity appears as inadequate, because evil has on the one side an intrinsic attractiveness for individuals and is on the other side in modern societies more and more a product (...) of a rationality, which is free from passion. Especially the emotional impoverishment is responsible for the increase of evil, which is demonstrated by two examples. Based on Paul Ricoeur, the evolution of malum can be developed by a short analyse of the relationship between Ethics and Emotions. (shrink)

The Termination Thesis (or “TT”) is the view that people go out of existence when they die. Lots of philosophers seem to believe it. Epicurus, for example, apparently makes use of TT in his efforts to show that it is irrational to fear death. He says, “as long as we exist, death is not with us; but when death comes, then we do not exist.”1 Lucretius says pretty much the same thing, but in many more words and more poetically: “Death (...) therefore to us is nothing, concerns us not a jot, since the nature of the mind is proved to be mortal; . . . when we shall be no more, when there shall have been a separation of body and soul, out of both of which we are each formed into a single being, to us, you may be sure, who then shall be no more, nothing whatever can happen to excite sensation.”. (shrink)

Philosophical (p-) zombies are constructs that possess all of the behavioral features and responses of a sentient human being, yet are not conscious. P-zombies are intimately linked to the hard problem of consciousness and have been invoked as arguments against physicalist approaches. But what if we were to invert the characteristics of p-zombies? Such an inverse (i-) zombie would possess all of the behavioral features and responses of an insensate being yet would nonetheless be conscious. While p-zombies are logically possible (...) but naturally improbable, an approximation of i-zombies actually exists: individuals experiencing what is referred to as “anesthesia awareness.” Patients under general anesthesia may be intubated (preventing speech), paralyzed (preventing movement), and narcotized (minimizing response to nociceptive stimuli). Thus, they appear—and typically are—unconscious. In 1-2 cases/1000, however, patients may be aware of intraoperative events, sometimes without any objective indices. Furthermore, a much higher percentage of patients (22% in a recent study) may have the subjective experience of dreaming during general anesthesia. P-zombies confront us with the hard problem of consciousness—how do we explain the presence of qualia? I-zombies present a more practical problem—how do we detect the presence of qualia? The current investigation compares p-zombies to i-zombies and explores the “hard problem” of unconsciousness with a focus on anesthesia awareness. (shrink)

Slow euthanasia or a good palliative intervention?There are many ways in which doctors influence the circumstances and/or the timing of a patient’s death. Some of these are accepted as normal medical practice—for instance, when a disproportional treatment is forgone, others are considered tolerable only under strict conditions or even intolerable, such as non-voluntary active euthanasia. A relatively new phenomenon in the ethical discussion on end-of-life decisions is terminal sedation. Terminal sedation is used in patients with terminal illnesses (...) where normal medical treatments cannot relieve severe symptoms such as pain and agitation, and no option is left but to take away the perception of these symptoms. Often, the decision to start terminal sedation is accompanied by the decision to forgo the provision of artificial nutrition and hydration in these patients. In The Netherlands, terminal sedation was estimated to be applied in 4–10% of all deaths in 2001.1 The combination of these two decisions have made the moral status of terminal sedation the subject of fierce ethical debates. Is it slow euthanasia2,3 or is it a good palliative intervention that should be sharply distinguished from euthanasia?4,5 One of the characteristics of this debate is that it is a very confused one: people disagree about the meaning of the term, the appropriateness of it and, of course, about the conditions under which it would be morally justified. As a matter of fact, these three discussions are deeply connected: as is often the case, a discussion about terms is a discussion about norms in disguise.The first observation to be made is that many seemingly descriptive definitions of terminal sedation contain normative claims. Examples of this are definitions of terminal sedation in which only …. (shrink)

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one (...) or more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

Professional directives are unwavering: educational intimate exams should only ever occur with patients’ explicit consent. This article describes the current clinical, educational, and ethical landscape of educational pelvic examinations under anesthesia, underscores the imperative that these exams only ever occur with patients’ explicit consent, and offers accessible modifications to students’ involvement in these exams.

What kind of symbiosis between archaeon and bacterium gave rise to their eventual merger at the origin of the eukaryotes? I hypothesize that conditions favouring bacterial uptake were based on exchange of intermediate carbohydrate metabolites required by recurring changes in availability and use of the two different terminal electron chain acceptors, the bacterial one being oxygen. Oxygen won, and definitive loss of the archaeal membrane potential allowed permanent establishment of the bacterial partner as the proto‐mitochondrion, further metabolic integration and (...) highly efficient ATP production. This represents initial symbiogenesis, when crucial eukaryotic traits arose in response to the archaeon‐bacterium merger. The attendant generation of internal reactive oxygen species (ROS) gave rise to a myriad of further eukaryotic adaptations, such as extreme mitochondrial genome reduction, nuclei, peroxisomes and meiotic sex. Eukaryotic origins could have started with shuffling intermediate metabolites as is still essential today. (shrink)

When a terminally ill patient kills herself, using a drug prescribed by a physician for this purpose, in bioethical literature this would be described as a case of physician-assisted suicide. This would also be a case of suicide according to the standard account of suicide in the philosophical literature. However, in recent years, some authors have argued that terminally ill self-killing in fact should not be considered suicide. In this paper, we don’t try to address the philosophical merits of such (...) arguments. Instead, we ask whether these considerations align with the way non-philosophers think about suicide. We present empirical evidence from four studies that address different concerns raised about terminally ill self-killing being a suicide. We conclude that the raised concerns cannot be supported by the folk understanding of suicide. (shrink)

The theoretical aspects and practical application of the termination of an employment contract upon an employee’s notice are analyzed in the paper. An employee can terminate an employment contract by his/her notice either without specifying any reason or due to some serious reasons. The problems of the regulation of the grounds for the exipiry of an employment contract are discussed and analyzed by comparison with the corresponding regulations in other European countries. Rulings of the Supreme Court of the Republic of (...) Lithuania are discussed to reveal the problems existing in practice. Conclusions and suggestions for the improvement of laws providing conditions for homogeneous interpretation of legal provisions are presented. (shrink)

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)