This chapter examines the relationship between pleasure and desire, with special attention to the possibility of reducing pleasure to desire, or desire to pleasure. There are plausible arguments for and against both reductive theories. Some of the arguments appeal to the normative roles of pleasure and desire, but there are also empirical findings from affective neuroscience that are relevant to both theories. One lesson from the discussion is that theorists of different backgrounds have different desiderata for a theory of pleasure (...) or desire, and these competing desiderata push theorists to develop their theories in different directions. (shrink)

I argue that, insofar as we endorse the general idea that desires play an important role in well-being, we ought to believe that their significance for well-being is derived from a pair of more fundamental attitudes: attraction and aversion. Attraction has wholly positive significance for well-being, and aversion has wholly negative significance for well-being. Desire satisfaction and frustration have significance for well-being insofar as the relevant desires involve some combination of attraction and aversion. I defend these claims by illustrating how (...) our desires can be asymmetrical. They can have greater positive than negative significance for well-being, or vice versa. (shrink)

What makes it the case that a given experience is pleasurable? According to the felt-quality theory, each pleasurable experience is pleasurable because of the way that it feels—its “qualitative character” or “felt-quality”. According to the attitudinal theory, each pleasurable experience is pleasurable because the experiencer takes certain attitudes towards it. These two theories of pleasure are typically framed as rivals, but it could be that they are both partly right. It could be that pleasure is partly a matter of felt-quality, (...) and partly a matter of attitudes. It could be that a hybrid theory is true. In this paper, I aim to advance the cause of hybrid theories of pleasure. I do this in two ways. I begin by examining the challenges which motivate the search for a hybrid theory. I call these the HONEST challenges: Heterogeneity, Oppositeness, Normativity, Euthyphro, Separateness, and Togetherness. The first three challenges—HON—are challenges for the felt-quality theory. The second three challenges—EST—are challenges for the attitudinal theory. Having established the HONEST challenges, I then describe and motivate a particular cluster of hybrid theories which I will call dispositional hybrid theories. According to these theories, pleasurable experiences are all and only those experiences which dispose us to desire them in virtue of feeling the way that they do. The dispositional theories deliver on the promise of hybrid theories: because they appeal to both felt-qualities and attitudes, they have the resources to avoid most, if not all, of the HONEST challenges. (shrink)

Some experiences—like the experience of eating cheesecake—are good experiences to have. But when we try to explain why they are good, we encounter a clash of intuitions. First, we have an objectivist intuition: plausibly, the experiences are good because they feel the way that they do. Second, we have a subjectivist intuition: if a person were indifferent to that kind of experience, then it might fail to be good for that person. Third, we have a possibility intuition: for any kind (...) of experience, possibly there is a subject who is indifferent to that kind of experience. The pleasure problem is the problem we face in reconciling these three claims. I explain the problem and argue for a solution. I argue that we ought to reject the most common solutions: rejecting the objectivist or subjectivist intuitions. Instead, we ought to follow Timothy Sprigge in rejecting the possibility claim. We should embrace the view that experiences bear necessary connections to our attitudes. (shrink)

The pessimistic hypothesis is the hypothesis that life is bad for us, in the sense that we are worse off for having come into existence. Suppose this hypothesis turns out to be correct — existence turns out to be more of a burden than a gift. A natural next thought is that we should stop having children. But I contend that this is a mistake; procreation would often be permissible even if the pessimistic hypothesis turned out to be correct. Roughly, (...) this is because we are often in a position to know that future people will approve of having been created, and their approval will not be inappropriate even if they are worse off for having been created. And our respect for the attitudes of future people can permit us to create them. (shrink)

A number of philosophers have argued that pleasure and pain are asymmetrical with respect to their contributions to well-being: the degree to which an episode of pain is bad for one is greater than the degree to which an equal quantity of pleasure is good for one. In this paper I defend an explanation of the asymmetry. I argue that pains, and some pleasures, are instrumentally bad for us in the short term. Notably, this is because pains and some pleasures (...) are partially self-defeating: they motivate us to pursue certain ends while at the same time distracting us from pursuing those ends. This may seem paradoxical, but I argue that being self-defeating is a nearly unavoidable feature of any system whose function is to alert us to problems and direct us to find solutions. (shrink)

According to a view that goes by “Humeanism,” causal facts supervene on patterns of worldly entities. The simplest form of Humeanism is the constant conjunction theory: a particular type-F thing causes a particular type-G thing iff (i) that type-Fis conjoined with that type-G thing and (ii) all F’s are conjoined with G’s. The constant conjunction theory implies that all causation is extrinsic, in the following sense: for all positive causal facts pertaining to each possible region,it’s extrinsic to that region that (...) those causal facts pertain to it. Actual Humeans don’t accept the constant conjunction theory; they accept more sophisticated versions of Humeanism. But I argue that they, too, are committed to the thesis that all causation is extrinsic. In arguing for this claim,I use a discussion from Brian Weatherson as a springboard. Weatherson argues that on a plausible Humean view, some regions are such that all of their possible duplicates have the same or similar natural laws. I show that this is false. If Humeanism is true, then for every possible region, there are possible duplicates of that region with utterly alien natural laws. As a consequence, no causal facts pertain intrinsically to any region. (shrink)

In recent years, a number of philosophers of well-being have given more attention to the topic of ill-being. In particular, increasing attention has been paid to the distinction between two kinds of attitudes: those whose objects are good for us and those whose objects are bad for us. I argue that the difference between positive and negative attitudes should be explained in terms of pleasure and displeasure. If one takes pleasure in something, then the object of one’s pleasure is good (...) for one. If one takes displeasure in something, then the object of one’s displeasure is bad for one. The resulting view is hedonic subjectivism. It is hedonic in the sense that it gives a central role to pleasure and displeasure in the theory of well-being; it is a form of subjectivism because it tells us that the objects of our pleasant and unpleasant attitudes are good or bad for us, respectively, in a way that goes beyond the goodness or badness of the pleasure and displeasure themselves. (shrink)

In virtue of what do we enjoy episodes of pleasure? According to the phenomenological theory of pleasure, we enjoy pleasures in virtue of having certain kinds of phenomenal experiences. According to the attitude theory of pleasure, we enjoy pleasures in virtue of having a certain kind of pro-attitude. In this chapter, we show that the attitude theory faces a dilemma. The attitude that is relevant to pleasure—the desire, liking, or favoring—is either necessarily co-instantiated with certain phenomenology, or not. If the (...) attitude theorist denies that the relevant attitudes are phenomenologically enriched in this sense, then their theory has the problematic implication that pleasure can come radically apart from phenomenology. This leads to a *problem of hedonic inversion*. If the attitude theorist instead affirms that the relevant attitudes are phenomenologically enriched, then they undermine their main objection to the phenomenological theory of pleasure. This is the so-called *heterogeneity problem*, according to which pleasures do not feel alike. Either way, the attitudinal theorist faces a difficult challenge in their ongoing debate with phenomenological theorists. (shrink)

My partner loves the experiences she gets from eating olives. I, on the other hand, hate the experiences I get from eating olives. We differ in tastes. But how exactly do we differ? In particular: do our taste experiences differ phenomenologically—that is, do my olive-experiences feel different than my partner’s olive-experiences? Some philosophers have assumed that the answer is “no,” and have advanced important arguments which turn on this assumption. I argue that, contrary to what these philosophers assume, ordinary taste (...) differences do involve differences in phenomenology. My olive-experiences feel different than my partner’s olive-experiences. I argue for this phenomenal thesis in stages. First, I argue that there is a link between our attitudes and our pleasures; second, I argue that there is a link between our pleasures and our phenomenology. Together, my conclusions link our attitudes and phenomenology in a way that vindicates the phenomenal thesis. Along the way, I fend off various worries about what the phenomenal thesis might entail. I show that it does not entail any form if radical subjectivism, nor does it entail that there is a “distinctive feeling of pleasure.” I close by considering how opponents of the phenomenal thesis might retreat to a weaker thesis: one which concerns extraordinary taste differences, as opposed to ordinary taste differences. I argue that there are no obviously sound arguments for even this weaker thesis, which should make us all the more confident in the phenomenal thesis. (shrink)

No discussion of when an individual is dead is meaningful in the absence of a definition of death. If human death is defined as the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe spontaneously (and hence to maintain a spontaneous heart beat) the death of the brainstem will be seen to be the necessary and sufficient condition for the death of the individual. Such a definition of death is not something radically (...) new. It is merely the reformulation -- in the language of the neurophysiologist -- of much older concepts such as the 'departure of the (conscious) soul from the body' and the 'loss of the breath of life'. All death -- in this perspective -- is, and always has been, brainstem death... (shrink)

Can something make your life go worse for you, even if you do not know about it? Many believe that facts unknown to us can indeed make our lives worse for us. But this raises an important practical problem: if we are ignorant of some important problems in our lives, then what can we do to ameliorate those problems? The Truth of Fact, The Truth of Feeling presents us with a dramatic illustration of the problem. And through the actions of (...) its two protagonists — the nameless journalist, and Jijingi — the story also illustrates some very different ways in which the problem might be solved. (shrink)

This Part II of a two‐part article illustrates how research in evolutionary biology, anthropology, archeology, and psychology illuminates questions arising in philosophy—specifically questions about René Girard's theory of aggression. Part I looked at: (i) how old the systemic practice of severe aggression is; (ii) how much of it results from humanity's mimetic/social and competitive nature and how much from ecological, resource, and cultural conditions; and (iii) if ecological, resource, and cultural conditions are important, might we adapt this information toward greater (...) cooperativity today? Part II investigates Girard's theory of ritual sacrifice—especially human sacrifice—as a societal steam valve for the systemic aggression explored in Part I. It draws on theories of play, theater, and art to examine the role and function of such ritual sacrifice. (shrink)

This first part of a two‐part article illustrates how research in evolutionary biology and psychology illuminates questions arising in philosophy—specifically questions about the origins of severe, systemic aggression that arise in the mimetic theory of René Girard. Part I looks at: (i) how old the systemic practice of severe aggression is, (ii) how much results from humanity's mimetic/social and competitive nature and how much from ecological, resource, and cultural conditions, and (iii) if ecological and cultural conditions are important, might we (...) adapt them toward greater cooperativity today? After briefly reviewing mimetic theory, the article looks at evolutionary psychology and biology, including fossil and archeological evidence. Findings suggest that severe, systemic aggression might be relatively recent and that its occurrence depends on ecological/resource/socioeconomic conditions additional to our mimetic/social nature. Thus, distinguishing the conditions that prod aggression from those that support pro‐social behavior might aid us in structuring society today. (shrink)

This article explores current right-wing populism as an ethical position from the perspective of many, though not all, White American evangelicals. The relevant ethics concern not only abortion or gay marriage (which, research finds, are not top vote-motivators) but views of society (who’s in, who’s not) and government (size and role). Building on ideational approaches to studying populism and incorporating historical and religio-cultural material, this article asks: What in White evangelical religious and political history and in present circumstances makes right-wing (...) populism look to be the most ethical stance? In answer, the article explores populism as proposed solutions to the complex intersectionality of economic, way-of-life, and status-loss duress. It investigates how evangelicals, drawing in mediated ways from their religio-political history and beliefs, understand right-populist views of society and government as an ethical solution to these duresses. (shrink)

The present article focuses on inscriptions carved on the marble templon screen of the Middle Byzantine era, an architectural and decorative element that played an important role in the liturgy, also dressed with multiple symbolic meanings. The study of the existing examples, dispersed in many regions of the Byzantine territory and dated from the 9th to the 12th c., provides us with evidence on matters of worship, language, art and patronage. The majority of the inscriptions consist of dedicatory texts that (...) commemorate acts of donation and express the donors’ concern for salvation. A smaller group reproduces quotations from the sacred scriptures or has references from the liturgy and the hymnography. The short number of the inscribed material of this kind, compared to the templon screens that were erected during the same period, corresponds to the general decline of epigraphy after the 7th c. and the gradual disability of the public to communicate through written texts. (shrink)

ExcerptIn light of the 2008 global financial crisis and its underlying causes, a reassessment of our global market system seems to be afoot, at least in some quarters. If neoliberalism (too much market) yields the Great Recession, if socialist planned markets (not enough market) produce the failed economies of the former Soviet bloc, and if social-market combinations (too much centralization of the market) progress toward the high-cost, centralized programs and slow growth of Western Europe, what are better options? One line (...) of questioning asks, can the dynamism and inventiveness of the market be harnessed not only for corporate and individual…. (shrink)

In his edition of this author Buecheler translates the words of Mim. III. 72 πρός σΣ Τñς κοΤΤίδος ψυχñς by ‘per capitale tuum ingenium,’ but affords no explanation as to how he arrived at this sense. May I suggest another interpretation to which Modern Greek seems to me to lead? The equivalent of κοΤΤίς is now πουλί or πουλάκπουλί μου or πουλάκι or simply πουλάκ‘my little birdie,’ i.e. ‘my darling,’ is the most frequent endearing term of the Greeks. See Vlachos's (...) Λεξικòν ‘Eλληογλλικòν ν πουλί 'πουλί μουmon chéri, mon amour, ma poulette.’ Therefore, πρóς σε Τñς κοΤΤíδος ψυχñς I fancy, means, ‘I implore thee by thy darling soul.’ The expression seems to have come down to us intact in sense, and only altered in so far as new words have been substituted for the obsolete ones. Of such a phenomenon I have given several curious examplesin my Notes tn the Gospels. (shrink)

This article explores humanity’s ontology of relationality and telos of the common good as not only inseparable but mutually constitutive, drawing on the work of Thomas Aquinas and looking into the debates between Charles De Koninck and Jacques Maritain.

This Handbook contains forty essays by an international team of experts on the antecedents, the content, and the reception of the Dionysian corpus, a body of writings falsely ascribed to Dionysius the Areopagite, a convert of St Paul, but actually written about 500 AD. The first section contains discussions of the genesis of the corpus, its Christian antecedents, and its Neoplatonic influences. In the second section, studies on the Syriac reception, the relation of the Syriac to the original Greek, and (...) the editing of the Greek by John of Scythopolis are followed by contributions on the use of the corpus in such Byzantine authors as Maximus the Confessor, John of Damascus, Theodore the Studite, Niketas Stethatos, Gregory Palamas, and Gemistus Pletho. In the third section attention turns to the Western tradition, represented first by the translators John Scotus Eriugena, John Sarracenus, and Robert Grosseteste and then by such readers as the Victorines, the early Franciscans, Albert the Great, Aquinas, Bonaventure, Dante, the English mystics, Nicholas of Cusa, and Marsilio Ficino. The contributors to the final section survey the effect on Western readers of Lorenzo Valla's proof of the inauthenticity of the corpus and the subsequent exposure of its dependence on Proclus by Koch and Stiglmayr. The authors studied in this section include Erasmus, Luther and his followers, Vladimir Lossky, Hans Urs von Balthasar, and Jacques Derrida, as well as modern thinkers of the Greek Church. Essays on Dionysius as a mystic and a political theologian conclude the volume. (shrink)

Four main areas generating confusion in discussion on brain death are identified as a) the relation of criteria of death to concepts of death, b) the argument about whether death is an event or a process, c) the inadequate differentiation of different neurological entities having different cardiac prognoses, and d) insufficient awareness of the separate issues of 'determining death' and 'allowing to die'. It is argued that if by death we mean the dissolution of the human 'organism as a whole', (...) then whole-brain death is death. Behavioural patterns, legitimate in the presence of a cadaver, should be legitimate from the time whole-brain death is diagnosed. (shrink)

Palliative care is a recent branch of health care. The doctors, nurses, and other professionals involved in it took their inspiration from the medieval idea of the hospice, but have now extended their expertise to every area of health care: surgeries, nursing homes, acute wards, and the community. This has happened during a period when patients wish to take more control over their own lives and deaths, resources have become scarce, and technology has created controversial life-prolonging treatments. Palliative (...) care is therefore faced with more ethical problems that other areas of health care. This book, by a clinician, teacher, and writer on health care ethics, has been written to provide all those who care for the terminally ill--doctors, nurses, social workers, clergymen, physiotherapists--with the concepts and principles which will assist them with difficult decisions. It challenges many received doctrines of palliative care, but its well-illustrated central theme is that technical expertise must be controlled by humane, non-technical judgments. (shrink)

Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end‐of‐life care; that legalising assisted dying doesn't expand patient choice in respect of (...) class='Hi'>palliative care; that growth in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims. (shrink)

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from (...) human experience, to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

Background Palliative care is an integral part of health care, which in term has become increasingly technologized in recent decades. Lately, innovative smart sensors combined with artificial intelligence promise better diagnosis and treatment. But to date, it is unclear: how are palliative care concepts and their underlying assumptions about humans challenged by smart sensor technologies (SST) and how can care benefit from SST? -/- Aims The paper aims to identify changes and challenges in palliative care due to (...) the use of SST. In addition, normative guiding criteria for the use of SST are developed. -/- Methods The principle of Total Care used by the European Association for Palliative Care (EAPC) forms the basis for the ethical analysis. Drawing on this, its underlying conceptions of the human and its socio-ethical aspects are examined with a phenomenological focus. In the second step, the advantages, limitations, and socio-ethical challenges of using SST with respect to the Total Care principle are explored. Finally, ethical-normative requirements for the application of SST are derived. -/- Results and Conclusion First, SST are limited in their measurement capabilities. Second, SST have an impact on human agency and autonomy. This concerns both the patient and the caregiver. Third, some aspects of the Total Care principle are likely to be marginalized due to the use of SST. The paper formulates normative requirements for using SST to serve human flourishing. It unfolds three criteria according to which SST must be aligned: (1) evidence and purposefulness, (2) autonomy, and (3) Total Care. (shrink)

Background Most patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one’s death can contribute to the loss of one’s sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide. Aim The aim of the study was to explore and describe nurses’ experiences of caring qualities alleviating suffering and preserving (...) the dignity of patients in need of palliative homecare. Research design A qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson’s caritative caring theory. Participants and research context A total of nine nurses with extensive work experience from a palliative homecare context participated in the study. Ethical considerations The study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study. Findings One main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge. Conclusions Certain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses’ ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity. (shrink)

Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes physician-assisted (...) suicide and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not. (shrink)

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but (...) it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers. (shrink)

Background: Palliative care is an important part of health services. The individualized care perceptions are is critical for supporting individuality during care and providing quality nursing care. Individualized care not only has, as well as having foundation of the philosophy of nursing but also, is also related to the nurses’ empathic tendencies and professional quality of life of nurses. Aim: This study was conducted to examine the relationships between the empathic tendencies, professional quality of life, and individualized care perceptions (...) of palliative care nurses. Research design: This is a cross-sectional study. Participants and research context: The study was conducted with 141 nurses working in palliative care between December 2023 and February 2024. The data of the study were collected using a “Participant Information Form,” the “Emphatic Tendency Scale (ETS),” the “Professional Quality of Life Scale (ProQOL R-IV),” and the “Individualized Care Scale-Nurse Version A (ICS-Nurse-A).” Ethical considerations: Ethics committee approval was obtained to conduct the study. Individuals who agreed to participate in the study were informed of the purpose of the study, and their written consent was obtained. Findings: The participants had moderate levels of empathic tendencies, compassion satisfaction, and burnout, while their compassion fatigue and individualized care perceptions were high. There was a positive correlation between empathic tendencies and individualized care perceptions ( p <.01). Empathic tendency and compassion satisfaction were significant positive predictors of the individualized care perceptions of the participants and respectively explained 13% and 20% of the total variance in their individualized care perceptions. On the other hand, burnout was a significant negative predictor of their individualized care perceptions and explained 5% of the total variance in their individualized care perceptions. Conclusions: High levels of empathic tendencies and compassion satisfaction had positive effects on the individualized care perceptions of palliative care nurses, whereas high levels of burnout had a negative effect on the same variable. (shrink)

The article explores the underlying reasons for patients’ self‐perception of being a burden (SPB) in family settings, including its impact on relationships when wishes to die (WTD) are expressed. In a prospective, interview‐based study of WTD in patients with advanced cancer and non‐cancer disease (organ failure, degenerative neurological disease, and frailty) SPB was an important emerging theme. In a sub‐analysis we examined (a) the facets of SPB, (b) correlations between SPB and WTD, and (c) SPB as a relational phenomenon. We (...) analyzed 248 interviews with 62 patients, their family caregivers, and professionals using grounded theory and interpretive phenomenological analysis. SPB appeared as important empathic concern in care situations. Patients expressed many sorts of concerns for others, but also perceived an altered self‐understanding that did not meet mutual expectations within relationships. In SPB associated with WTD three constellations were found: (a) WTD to unburden others; (b) patients decided against hastening death to prevent being a further burden to others (in these cases, the SPB counteracted the wish to die); and (c) both wishes for and against dying were sustained by SPB. These patients often felt paralyzed and suffered deeply. Family caregivers felt emotionally touched by SPB and tried to unburden patients by caring and compassion. We concluded that the impact of SPB on a WTD and the various meanings the facets of SPB have in balancing relationships need to be worked out individually. An early palliative and narrative approach is warranted. (shrink)

Palliative Care Nursing: Caring for Suffering Patients explores the concept of suffering as it relates to nursing practice. This text helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. In addition, it examines spiritual and ethical perspectives on suffering and discusses how witnessing suffering impacts nurses' ability to assume the professional role. Further, the authors discuss ways nurses as witnesses to suffering can (...) optimize their own coping skills and facilitate personal growth. Rich in case studies, pictures, and reflections on nursing practice and life experiences, Palliative Care Nursing: Caring for Suffering Patients delves into key topics such as how to identify when a patient is suffering, whether they are coping, sources of coping facades, what to do to ease suffering, and how to convey the extent of suffering to members of the health care team.Palliative Care Nursing: Caring for Suffering Patients helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. (shrink)

Background: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations” (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. Objectives: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate (...) if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses’ current end-of-life care practices. Design: Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. Findings: All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Discussion: Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients’ preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. Conclusion: While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses’ involvement and practices in end-of-life decision-making. (shrink)

After a review of terminology, I identify—in addition to Margaret Battin’s list of five primary arguments for and against aid-in-dying—the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan’s generalized empirical method. Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude that aid-in-dying must be (...) justified on its own merits and not on the basis of these well-established palliative care practices; and that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this part of their operative value structure. (shrink)

Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed (...) three characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses’ attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient (...) and considered it generally better not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units. (shrink)

This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does (...) not destroy capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation—for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons. (shrink)