The discourse on death and many indigenous African mortuary practices have received critical attention and scholarship. However, little attention has been paid to indigenous African burial practices in relation to public health, disease and crime control. This article explores how forms and causes of death determine social control systems and medical philosophies of interment in Cameroon. The paper focuses on the philosophical foundations birthing the _PfenəMbvɨmə_ (_the bottomless burial site_) in Kedjom-Keku. Using critical analysis of (...) oral interviews, archival records and extant literature, we unveil how burial practices have contributed to the philosophy of medicine and history of social change in Cameroon. (shrink)

In this original and compelling book, Jeffrey P. Bishop, a philosopher, ethicist, and physician, argues that something has gone sadly amiss in the care of the dying by contemporary medicine and in our social and political views of death, as shaped by our scientific successes and ongoing debates about euthanasia and the "right to die"--or to live. __The Anticipatory Corpse: Medicine, Power, and the Care of the Dying__, informed by Foucault's genealogy of medicine and power as well as by (...) a thorough grasp of current medical practices and medical ethics, argues that a view of people as machines in motion--people as, in effect, temporarily animated corpses with interchangeable parts--has become epistemologically normative for medicine. The dead body is subtly anticipated in our practices of exercising control over the suffering person, whether through technological mastery in the intensive care unit or through the impersonal, quasi-scientific assessments of psychological and spiritual "medicine." The result is a kind of nihilistic attitude toward the dying, and troubling contradictions and absurdities in our practices. Wide-ranging in its examples, from organ donation rules in the United States, to ICU medicine, to "spiritual surveys," to presidential bioethics commissions attempting to define death, and to high-profile cases such as Terri Schiavo's, __The Anticipatory Corpse__ explores the historical, political, and philosophical underpinnings of our care of the dying and, finally, the possibilities of change. A ground-breaking work in bioethics, this book will provoke thought and argument for all those engaged in medicine, philosophy, theology, and health policy. "With extraordinary philosophical sophistication as well as knowledge of modern medicine, Bishop argues that the body that shapes the work of modern medicine is a dead body. He defends this claim decisively with with urgency. I know of no book that is at once more challenging and informative as __The Anticipatory Corpse. __To say this book is the most important one written in the philosophy of medicine in the last twenty-five years would not do it justice. This book is destined to change the way we think and, hopefully, practice medicine." --_Stanley Hauerwas, Duke Divinity School _ "Jeffrey Bishop carefully builds a detailed, scholarly case that medicine is shaped by its attitudes toward death. Clinicians, ethicists, medical educators, policy makers, and administrators need to understand the fraught relationship between clinical practices and death, and __The Anticipatory Corpse __is an essential text. Bishop's use of the writings of Michel Foucault is especially provocative and significant. This book is the closest we have to a genealogy of death." --_Arthur W. Frank, University of Calgary _ "Jeffrey Bishop has produced a masterful study of how the living body has been placed within medicine's metaphysics of efficient causality and within its commitment to a totalizing control of life and death, which control has only been strengthened by medicine's taking on the mantle of a bio-psycho-socio-spiritual model. This volume's treatment of medicine's care of the dying will surely be recognized as a cardinal text in the philosophy of medicine." --_H. Tristram Engelhardt, Jr., Rice University, Baylor College of Medicine_. (shrink)

We investigated whether (a) people positively reevaluate the characters of recently dead others and (b) supernatural primes concerning an ambient dead agent serve to curb selfish intentions. In Study 1, participants made trait attributions to three strangers depicted in photographs; one week later, they returned to do the same but were informed that one of the strangers had died over the weekend. Participants rated the decedent target more favorably after learning of his death whereas ratings for the control targets remained (...) unchanged between sessions. This effect was especially pronounced for traits dealing with the decedent’s prosocial tendencies (e.g., ethical, kind). In Study 2, a content analysis of obituaries revealed a similar emphasis on decedents’ prosocial attributes over other personality dimensions (e.g., achievement-relatedness, social skills). Finally, in Study 3, participants who were told of an alleged ghost in the laboratory were less likely to cheat on a competitive task than those who did not receive this supernatural prime. The findings are interpreted as evidence suggestive of adaptive design. (shrink)

This study examined health professionals’ (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)—controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios—BD, uncontrolled DCD and controlled DCD—were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the (...) context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors’ loss of circulatory function could be reversed, and raises questions about “death” as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs’ discomfort must be further identified and addressed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of Medicine’s Report on Non-Heart-Beating Organ TransplantationRoger Herdman (bio), Tom L. Beauchamp (bio), and John T. Potts Jr. (bio)In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis of the IOM (...) report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.Transplantation BackgroundAs a first step, some background in the relevant aspects of organ transplantation will prove useful. For the purposes of this analysis, “transplantation” involves the transfer of cells, tissues, or solid organs from one human to another to replace the structure or function of comparable body components that, through injury or disease, are defective or of inadequate function. The IOM report deals with solid organs, primarily kidneys and livers, whose blood supply is reconnected in the organ recipient, in contrast to cells, like bone marrow, and tissues, like corneas. A variety of donor types exists for organ transplantation, each with particular medical and scientific conditions.Living donors are healthy (and usually genetically related) individuals who volunteer to provide either a whole, paired organ such as a kidney or a section of an organ such as a liver. Cadaver donors are individuals who have died and from whom a full array of organs can be taken. “Heart-beating” cadaver donors are individuals who have suffered “brain death,” that is, irreversible cessation of function of the whole brain including the brain stem; and “non-heart-beating” donors (NHBDs) are individuals who are ill or injured, but not “brain dead,” and who have suffered cardiopulmonary death, that is, irreversible cessation of cardiac and respiratory function. NHBDs can be “controlled,” which means that [End Page 83] they can be sustained by artificial life support systems until a medical and family decision is made to terminate futile life support. This can be done at a scheduled time and in a controlled manner, and organs can then be recovered for transplantation. NHBDs can also be “uncontrolled,” which means that their hearts and breathing have stopped through disease or injury at an unexpected time or in an uncontrolled manner, and they cannot be resuscitated; the organs of some individuals of this description can be recovered for transplantation. The IOM report focused on both controlled and uncontrolled NHBDs and on problems specific to them.The questions that were asked and addressed in the IOM report became current and salient beginning in 1992 with the establishment of the University of Pittsburgh “Policy for the Management of Terminally Ill Patients Who May Become Organ Donors After Death.” This policy addressed controlled NHBDs and the ethical questions raised by their use; much of the discussion was reported in the June 1993 special issue of the Kennedy Institute of Ethics Journal. Public notice and anxiety about some of these concerns were sharpened and refocused by national and local media allegations of improper treatment of donors at the Cleveland Clinic in 1997, specifically premature—i.e., antemortem—recovery of organs and administration of drugs that allegedly might hasten donor death.The DHHS Request for StudyIt is not surprising that several federal actions would be taken in response to these events. Some, such as the results of a transplantation task force, remain largely internal to DHHS at this writing. Others are public, such as the IOM study of the NHBD situation. In May 1997, the DHHS initiated contacts with the IOM with the goal of exploring federal concerns about the medical and ethical treatment of NHBDs, in particular the allegations directed at the Cleveland Clinic.The DHHS response should be understood in at least three contexts. First, living donors and uncontrolled NHBDs were essentially the only donor types in the early days of transplantation in the United States. The technologies, ethics, and social acceptance of controlling and terminating life support for... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:(P)rescription Narratives: Feminist Medical Fiction and the Failure of American Censorship. by Stephanie Peebles TaveraEtta M. MaddenStephanie Peebles Tavera. (P)rescription Narratives: Feminist Medical Fiction and the Failure of American Censorship. Edinburgh: Edinburgh University Press, 2022. Hardback, xii + 220 pp. ISBN 978-1-4744-9319-2.Utopian Studies readers first saw Stephanie Peebles Tavera’s work in print in her 2018 essay on reproductive health in Charlotte Perkins Gilman’s Herland. More recently, in (P)rescription (...) Narratives, she gives readers a view of the much broader historical scope of her scholarship in literary and cultural studies. Tavera’s analysis of what she labels “feminist medical fiction” considers not only novels and short stories but also literary reviews, dramas, and documentary films, many of which will be unfamiliar to readers of utopian and dystopian literature. Yet the book contextualizes the ways in which these works capture the “utopian possibilities” of women writers who pushed for breaking the boundaries of the dystopian strictures of embodied life. The literary works “rescript” what had been prescribed by others as “normalized behavior,” from the latter-nineteenth century through the Progressive Era (5, 37). As Tavera illustrates through her detailed analysis, these women’s narratives provide “interventions that... interrupt the dissemination of false [End Page 612] narratives of the female body” and “alter the course of cultural development toward greater inclusivity” (5).To establish the temporal boundaries for the project, Tavera emphasizes the Comstock Law, established in 1873, and the death of its author Anthony Comstock in 1915. While Comstock’s work often has been understood as restricting pornography, she explains the Comstock Law as more than merely that. Comstock sought to control what he and others saw as sexual deviation, which included birth control in any form. Tavera also bookends the project with lawsuits associated with Victoria Woodhull and Margaret Sanger, both women who advocated for abortion and birth control as means of allowing women to avoid the strictures over their bodies. Additionally, she explains, Comstock’s racism caused him to completely overlook Black women, ironically allowing a space in which Black women’s feminist medical fiction especially rescripts “normalized behavior” (37)—a topic she pursues in two parts of the book.The book follows a roughly chronological path as it examines four topics related to women’s health, brilliantly organized into “(p)rescriptions,” indicated by Rx, rather than chapters with numbers. Rx1, “Crip Medicine,” illustrates how authors such as Charlotte Perkins Gilman pointed to the socially constructed status of “hysteria” in a patriarchal culture that saw women as deviant by nature. Instead, these authors advocated for a more holistic examination of women’s health, impacted by the environments in which they lived. Drawing from Lyman Tower Sargent’s widely accepted view of utopianism as dreaming of a place “considerably better than the society in which the author lived,” she underscores “the utopian impulse underlies much of the work of feminist medical fiction” (39). In particular, writers of feminist medical fiction were “driven by failure.”Perhaps most familiar to illustrate this point is Gilman’s work, such as “The Yellow Wallpaper,” which illustrated how the culture failed certain characters. The narrator of that story suffers postpartum depression and is made worse by Dr. S. Weir Mitchell’s rest cure. Consequently, Gilman proceeded to write other works, such as Moving the Mountain (1911) and then Herland (1915), which push readers to envision “alternative societies” without such destructive patriarchal medical practices (39). But Tavera also explains how Louisa May Alcott’s Eight Cousins, or the Aunt-Hill (1875) critiques contemporary culture by providing a “domestic utopia” in the female domain of Aunt-Hill, wherein the male Dr. Alec Campbell demonstrates “a better way... of caring for the female body” (55). And another key example is Rebecca Harding [End Page 613] Davis’s Kitty’s Choice: A Story of Berrytown (1875). Berrytown is described as “the Utopia in actual laths, orchards, and bushel-measures of the advance guard of the reform party in the United States” (qtd. in Tavera 55). Through its two physicians, Dr. Muller and Dr. McCall, who represent homeopathic and allopathic practitioners, readers see that the society... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 124.2 (2003) 317-320 [Access article in PDF] Julia T. Dyson. King of the Wood: The Sacrificial Victor in Virgil's Aeneid. Oklahoma Series in Classical Culture 27. Norman: University of Oklahoma Press, 2001. xii + 264 pp. Paper, $19.95. In this interesting study, Julia Dyson argues that the cult of Diana Nemorensis constitutes a crucial intertext for the interpretation of Aeneas' killing of Turnus at the (...) end of Virgil's Aeneidand the politico-religious order his action founds, namely, the Roman Empire. The project takes its bearings from the current renewal of scholarly interest in religion and sacrifice in Roman literature (e.g., Denis Feeney, Literature and Religion at Rome: Cultures, Contexts, and Beliefs [Cambridge, 1998] and Philip Hardie, The Epic Successors of Virgil[Cambridge, 1993]). In the first part of the book, "Sacrificial Victory," Dyson revisits the much-discussed scenes in which sacrifice, both literal (Laocoön's rites in Troy, Aeneas' in Thrace) and symbolic (the deaths of Laocoön, Palinurus, Misenus, etc.), are described. In the second part, "The Ghastly Priest," Dyson breaks new ground by focusing on specific details of the ritual in Diana's Arician grove and their evocation in the Aeneid, rather than appealing to an abstract concept of "sacrifice," to document a systematic pattern of allusion to the cult throughout the poem. The resulting work advances our understanding of Virgil's use of an important cult in Roman religion to give thematic coherence to his poem.Each part comprises six chapters. Part 1 examines the poem's various sacrifice-scenes, which have received considerable attention in the scholarly literature—e.g., C. Bandera, "Sacrificial Levels in Virgil's Aeneid" (Arethusa14, 1981, 217-39) and J. J. O'Hara, Death and the Optimistic Prophecy in Vergil's Aeneid(Princeton, 1990). Dyson is particularly concerned, however, to demonstrate that sacrifice fails consistently in the poem in order to develop the argument that Aeneas' death is demanded as the final sacrifice in the sequence. In her first chapter, "The Piaculaof Aeneas," she shows that Aeneas repeatedly fails to conduct sacrificial rites correctly, a failure that necessarily entails the gods' unceasing demand for further sacrifices. Chapter 2, "Tiber and Numicus," explores Virgil's allusions to the sacrificial fate of Aeneas—implied in the two divergent traditions of his end (either drowned or translated to heaven and deified while offering sacrifice on the banks of the river Numicus)—through the association, on the one hand, of Tiber with Numicus and, on the other, of Aeneas with Palinurus and other "sacrificial" victims.In chapter 3, "The Unburied Dead," Dyson develops her thesis further by demonstrating that such sacrificial deaths—often at sea and involving lack of burial—proliferate in the poem (Palinurus, Orontes, Leucaspis, Misenus, Caieta, Priam, Tarquitus) and thereby, she argues, prefigure the ultimate fate of Aeneas. Chapter 4, "Victor and Victim," examines instances of role-reversal in which sacrificer is transformed into sacrificial victim, not only in overtly religious contexts (as, e.g., Laocoön) but also, indeed primarily, on the battlefield in combat scenes which Virgil frequently invests with sacrificial detail. The diverse themes of rivers, sacrifice, and victory come together [End Page 317] in chapter 5, "Aeneas and Turnus," where Dyson analyses Aeneas' killing of Turnus (who is characterized, she argues, by association with the Tiber) in the final duel as a sacrifice that "both foreshadows and necessitates the sacrifice of Aeneas" (112). The last chapter in Part 1, "Juno's Honores," argues that Jupiter's promise to his consort that the Romans will outdo other nations in honoring her (Aen. 12.838-40) must be interpreted against Juno's demand for proper honors (i.e., sacrifices) at the poem's outset (1.46-49), a demand that can only be satisfied by further sacrifices—including that of Aeneas himself.Part 1 contains much interesting and innovative discussion of sacrifice along with some inevitable rehearsal of well-trodden ground, but it certainly establishes Dyson's thesis that Virgil alludes throughout the Aeneidto Aeneas' sacrificial... (shrink)

In 1882 Koch discovered the tubercle bacillus and transformed both the medical and the social history of tuberculosis and the experiences of those who contracted it. For the first time, the absence or presence of the bacillus made it possible to define, in Koch’s terms, “the boundaries of the diseases to be understood as tuberculosis.” And for the first time the sick became subject to oversight and discrimination.Prior to Koch’s discovery, tuberculosis, or as it was then called, consumption, was (...) considered a hereditary and non-contagious disease, albeit a very deadly and persistent one. Over the first half of the nineteenth century, it was responsible for one out of every five deaths. It crossed all boundaries of geography, social class, age, and sex affecting residents in rural as well as urban areas, the prosperous as well as the poor, the young even more notably than the old, females more often than males. Physicians assumed a familial predisposition existed ; following the precepts of humoral medicine, they postulated that the disease originated in “irritations” whose sources were to be found in the interaction of an inherited constitution with a particular lifestyle and environment. (shrink)

This study explores and analyses funerary rite struggles in a nation where Christianity is a comparatively recent phenomenon, and many families have Christian and Hindu, Buddhist and Traditionalist members, who go through traumatic experiences at the death of their family members. The context of mixed affiliation raises questions of social, psychological and religious identity for Christian converts, which are particularly acute after a death in their family. Using empirical research, this thesis focuses on the question of adaptation and identity (...) in relation to church life, within the familial and social sphere of individual Christians and within the wider society in which they live, particularly with reference to death and disposal. This research has used an applied theology approach to explore and analyse the findings in order to address the issue of funerary rites with which the Nepalese church is struggling. For the need of adaptation, this study seeks to understand the funerary rites of the host culture alongside Jewish-Christian characteristics of adaptation, especially in terms of the Nepalese Evangelical Christian context. It also poses the challenge of finding an identity in a wider cultural and societal milieu. The case studies and interviews have portrayed tripartite relationships and tensions between an individual, family and church or community at the death in a ‘split’ family where a Christian convert’s loyalty to the deceased and the family is tested. Participation and non-participation in the last rites create problems for both the church and the family, and some solution needs to be found. The study has discovered that adaptation of the technique of the funerary rites, rather than of their content, could ease this tension in a ‘split’ family, and enhance a family and community’s reconciliation and solidarity. The mode of disposal, whether burial or cremation, could be used and a theology of cremation be developed in order to provide a theological framework. (shrink)

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

Traditionally, people were recognized as being dead using cardio-respiratory criteria: individuals who had permanently stopped breathing and whose heart had permanently stopped beating were dead. Technological developments in the middle of the twentieth century and the advent of the intensive care unit made it possible to sustain cardio-respiratory and other functions in patients with severe brain injury who previously would have lost such functions permanently shortly after sustaining a brain injury. What could and should physicians caring for such patients do? (...) Significant advances in human organ transplantation also played direct and indirect roles in discussions regarding the care of such patients. Because successful transplantation requires that organs be removed from cadavers shortly after death to avoid organ damage due to loss of oxygen, there has been keen interest in knowing precisely when people are dead so that organs could be removed. Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized by all 50 states in the United States as an acceptable way to determine death. We explore the ongoing debate over definitions of death, particularly over brain death or death determined using neurological criteria, and the relationship between definitions of death and organ transplantation. (shrink)

A friend once told me I was wasting my time writing about cross-cultural perspectives on the beginnings of life. “Your work is interesting for its curiosity value,” he said, “but fundamentally worthless. What happens in other cultures is totally irrelevant to what is happening here.” Those were discouraging words, but as I followed the American debates about the beginnings and ends of life, it seemed he was right. Anthropologists have written a great deal about birth and death rites in other (...) societies and about non-western notions of personhood, but to date our findings have had little impact on American policy, ethics, or law. The recognized experts on contentious topics such as abortion and euthanasia tend to come from the fields of philosophy, bioethics, theology, law, and biology, but rarely from the social sciences. I was a bit surprised, therefore, to be invited to address the Thomas A. Pitts Memorial Lectureship on “Defining the Beginning and the End of Human Life.”. (shrink)

Epidemics, the medical historian Charles Rosenberg argued, typically have four Acts, as in a play. In Act I, which he termed ‘Progressive revelation’, ‘merchants’, ‘municipal authorities’ and ‘the complacency of ordinary men and women’, alike are reluctant to acknowledge an epidemic because of its threat to their ‘economic and institutional interests’ and to ‘their accustomed way of doing things’: gradually however, ‘inexorably accumulating deaths and sicknesses’ bring ‘ultimate, if unwilling, recognition’. In Act II, ‘Managing randomness’, ‘collective agreement’ is sought on (...) an ‘explanatory framework’ to manage the epidemic’s ‘dismaying arbitrariness’. Such frameworks, in previous centuries mainly religious, are now more ‘secular and mechanistic’, but again also moral and social: explanation for example of the ‘differential susceptibility of particular individuals’ is sought in terms of ‘risk-enhancing behaviour’ and ‘style of life’, but also of environmental and social factors, such as ‘residence and occupation’, providing ‘a vehicle for social criticism as well as a rationale for social control’. In Act III, ‘Negotiating public response’, pressure is generated for ‘decisive and visible community response’, often taking the form of ‘collective rites integrating cognitive and emotional elements’. Such rites, including not only ‘the imposition of a quarantine’ and ‘procedures to cleanse and disinfect’, but also religious, or now more often moral or social rituals, afford ‘the reassurance of familiar frames of explanation and logically consequent policies that provide both meaning and the promise of efficacy’. Finally, In Act IV, ‘Subsidence and retrospection’, ‘incidence of the disease gradually declines’, and questions are raised ‘for retrospective moral judgement’ about ‘what “lasting impact” particular incidents have had and what “lessons” have been learnt. Have the dead died in vain? Has a heedless society reverted to its accustomed ways of doing things as soon as denial became once more a …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Helping a Muslim Family to Make a Life–and–Death Decision for Their Beloved Terminally Ill FatherBahar BastaniI live in a city in the Midwest with a population of around two million people. There are an estimated 2,000 Iranians living in this city, the vast majority of which belong to Shia sect of Islam. [End Page 190] However, the vast majority is also not very religious. Over the past two decades (...) that I have been living in this city, professionally in the capacity of a physician and university faculty at a school of medicine, and socially as one of the community leaders with a particular role in religious matters, I have acquired the trust of my community. Following one of my yearly routine travels to my homeland, Iran, I had just returned to work when I received a phone call from one of the Iranian community members. He informed me that his father was very ill and was hospitalized, and that the physicians had introduced the idea of stopping life support. The family was experiencing a significant emotional, moral and religious dilemma as to whether they could consent to this. I was requested by the patient’s children to help them make the right decision.I requested that the oldest son, who had called me, to ask the three other siblings and their mother to be present at the bedside of the patient that night, so that we could discuss the matters face–to–face. That same night, all requisite family members and myself gathered at the bedside of this 88–year–old husband and father, who had developed multi–organ failure, which commenced with an infection following a heart valve replacement, followed by bacteremia and sepsis. Moreover, the patient was hypotensive, had developed respiratory failure requiring intubation and artificial ventilation, and had also developed hematologic coagulation abnormalities secondary to sepsis. Because of the sepsis, hypotension, and multiple drugs, including antibiotics and vasopressors, his kidneys had also failed, and there was a need to start hemodialysis if his life was to be maintained. After speaking with the intensive care physicians who were taking care of this elderly gentleman, it became clear to me that further care was futile, and there was absolutely no hope for him to recover from his multiple organ failure. I presented all the facts that I had acquired to the family members, and expressed my own viewpoint that I agreed with those physicians and that further care of their beloved, terminally ill husband and father was futile and only extended his dying. My assurances made it easier for the family members, particularly for his four sons who were present, to come to the decision to withdraw life support. After I informed the intensive care physicians of the family’s decision, the patient was heavily sedated with morphine, and the intravenous fluids, antibiotics, vasopressors, and the ventilator machine were all stopped. Over the next several minutes, the patient developed agonal breathing, his blood pressure dropped to zero, and his heart stopped. During the last few minutes of his life, I held the hands of the family members, we all prayed Islamic prayers to bless his soul while departing from his body. The next day, I supported the family with funeral services that included the Islamic prayers for the dead, the ceremonial religious washing of the body of the deceased, and the ceremonial religious burial.The dilemma that this family faced was multi-factorial: (1) the children had spent all of their adult life in America, and were unfamiliar with Islamic end of life and funeral traditions; (2) they had been asked by their father’s physicians to make a decision regarding the withdrawal of life support, which posed a moral and ethical dilemma; (3) they did not know whether it was religiously acceptable to withdraw life support; and (4) they did not know what type of funeral service would be acceptable to the religious beliefs of their deceased father.My presence as a trusted community leader, physician and religious leader was reassuring to the family members that the decision to stop life support for their loved one with a terminal illness and multiple organ... (shrink)

The present article examines how people’s belief in an afterlife, as well as closely related supernatural beliefs, may open an empirical backdoor to our understanding of the evolution of human social cognition. Recent findings and logic from the cognitive sciences contribute to a novel theory of existential psychology, one that is grounded in the tenets of Darwinian natural selection. Many of the predominant questions of existential psychology strike at the heart of cognitive science. They involve: causal attribution (why is (...) mortal behavior represented as being causally related to one’s afterlife? how are dead agents envisaged as communicating messages to the living?), moral judgment (why are certain social behaviors, i.e., transgressions, believed to have ultimate repercussions after death or to reap the punishment of disgruntled ancestors?), theory of mind (how can we know what it is “like” to be dead? what social-cognitive strategies do people use to reason about the minds of the dead?), concept acquisition (how does a common-sense dualism interact with a formalized socio-religious indoctrination in childhood? how are supernatural properties of the dead conceptualized by young minds?), and teleological reasoning (why do people so often see their lives as being designed for a purpose that must be accomplished before they perish? how do various life events affect people’s interpretation of this purpose?), among others. The central thesis of the present article is that an organized cognitive “system” dedicated to forming illusory representations of (1) psychological immortality, (2) the intelligent design of the self, and (3) the symbolic meaning of natural events evolved in response to the unique selective pressures of the human social environment. (shrink)

There is a general sense that the philosophy of Descartes was a dominant force in early modern thought. Since the work in the nineteenth century of French historians of Cartesian philosophy, however, there has been no fully contextualized comparative examination of the various receptions of Descartes in different portions of early modern Europe. This study addresses the need for a more current understanding of these receptions by considering the different constructions of Descartes's thought that emerged in the Calvinist United Provinces (...) and Catholic France, the two main centers for early modern Cartesianism, during the period dating from the last decades of his life to the century or so following his death in 1650. It turns out that we must speak not of a single early modern Cartesianism rigidly defined in terms of Descartes's own authorial intentions, but rather of a loose collection of early modern Cartesianisms that involve a range of different positions on various sets of issues. Though more or less rooted in Descartes's somewhat open-ended views, these Cartesianisms evolved in different ways over time in response to different intellectual and social pressures. Chapters of this study are devoted to: the early modern Catholic and Calvinist condemnations of Descartes and the incompatible Cartesian responses to these; conflicting attitudes among early modern Cartesians toward ancient thought and modernity; competing early modern attempts to combine Descartes's views with those of Augustine; the different occasionalist accounts of causation within early modern Cartesianism; and the impact of various forms of early modern Cartesianism on both Dutch medicine and French physics. (shrink)

Concepts. Health ; Disease ; Death -- Models and kinds. Causation and kinds ; Holism and reductionism ; Controversial diseases -- Evidence and inference. Evidence in medicine ; Objectivity and the social structure of science ; Inference ; Effectiveness, skepticism, and alternatives ; Diagnosis and screening -- Values and policy. Psychiatry: care or control? ; Policy ; Public health.

When a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the brain, whether standard (...) criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated. These controversies leave little hope of consensus on how to define death for social and public policy purposes. Rather, there is persistent disagreement among proponents of three major groups of definitions of death: whole-brain, cardiocirculatory or somatic, and higher-brain. Given the persistence and reasonableness of each of these groups of definitions, public policy should permit individuals and their valid surrogates to choose among them. (shrink)

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction (...) between appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule. (shrink)

The dead donor rule (DDR) governs procuring life-prolonging organs. They should be taken only from deceased donors. Miller and Truog have proposed abandoning the rule when patients have decided to forgo life-sustaining treatment and have consented to procurement. Organs could then be procured from living patients, thus killing them by organ procurement. This proposal warrants careful examination. They convincingly argue that current brain or circulatory death pronouncement misidentifies the biologically dead. After arguing convincingly that physicians already cause death by withdrawing (...) treatment, they claim no bright-line differences preclude organ removal from the living. The argument fails for those who accept the double effect doctrine or other grounds for distinguishing forgoing life support from active, intentional killing. If the goal is determining irreversible loss of somatic function, they correctly label current death pronouncement a “legal fiction.” Recognizing a second, public policy meaning of the term death provides grounds for maintaining the DDR without jeopardizing procurement. (shrink)

The interpretation of the dead donor rule (DDR) has been central to recent debates regarding normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD). Proponents...

In a representative vignette study in Germany with 1,653 respondents, we investigated laypeople’s attribution of moral responsibility in collaborative medical diagnosis. Specifically, we compare people’s judgments in a setting in which physicians are supported by an AI-based recommender system to a setting in which they are supported by a human colleague. It turns out that people tend to attribute moral responsibility to the artificial agent, although this is traditionally considered a category mistake in normative ethics. This tendency is stronger when (...) people believe that AI may become conscious at some point. In consequence, less responsibility is attributed to human agents in settings with hybrid diagnostic teams than in settings with human-only diagnostic teams. Our findings may have implications for behavior exhibited in contexts of collaborative medical decision making with AI-based as opposed to human recommenders because less responsibility is attributed to agents who have the mental capacity to care about outcomes. (shrink)

The current definition of death used for donation after cardiac death relies on a determination of the irreversible cessation of the cardiac function. Although this criterion can be compatible with transplantation of most organs, it is not compatible with heart transplantation since heart transplants by definition involve the resuscitation of the supposedly "irreversibly" stopped heart. Subsequently, the definition of "irreversible" has been altered so as to permit heart transplantation in some circumstances, but this is unsatisfactory. There are three available strategies (...) for solving this "irreversibility problem": altering the definition of death so as to rely on circulatory irreversibility, rather than cardiac; defining death strictly on the basis of brain death (either whole-brain or more pragmatically some higher brain criteria); or redefining death in traditional terms and simultaneously legalizing some limited instances of medical killing to procure viable hearts. The first two strategies are the most ethically justifiable and practical. (shrink)

The dead donor rule (DDR) has facilitated the saving of hundreds of thousands of lives. Recent advances in heart donation, however, have exposed how DDR has limited donation of all organs. We propose advancing the moment in the dying process at which death can be determined to increase substantially the supply of organs for transplantation. We justify this approach by identifying certain flaws in the Uniform Determination of Death Act and proposing a modification of that law that permits earlier procurement (...) of healthier organs in greater numbers. (shrink)

Burial rites are very common among many Africa communities. In the African context, burials are not the end of life but rather the beginning of another life in the land of the ancestors. In spite of the importance of the African funeral rites, the missional role of the church in mourning and the burial of the dead in the African communities, the COVID-19 pandemic led protocols and restrictions placed a huge challenge on the African religious and cultural practices. (...) Contribution: In the light of the above-named challenges, the article discusses the religious-cultural effect of the pandemic with special focus on the African liturgical and missiological challenges in the context of the COVID-19 restrictions on funerals and burial rites. (shrink)

Expressing doubts about death criteria can serve healthy purposes, but can also cause a number of harms, including decreased organ donation rates and distress for donor families and health care staff. This paper explores the various causes of doubts about death criteria—including religious beliefs, misinformation, mistrust, and intellectual questions—and recommends responses to each of these. Some recommended responses are relatively simple and noncontroversial, such as providing accurate information. However, other responses would require significant changes to the way we currently do (...) business. Policymakers should establish minimum national standards for determining death to foster a trustworthy system; academics and publishers have a duty to publish only materials that substantially engage and advance the debate to minimize the harm caused by divided expert opinion; and opposition to the dead donor rule should be conceptually separated from doubts about death criteria. (shrink)

BackgroundSystems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology ; “big data” statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems (...) medicine knowledge and clinicians working to apply it.DiscussionThis article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through “big data” approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the “death computer,” to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their “quantified self.”SummaryThis paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care. (shrink)

Purpose. The aim of this article is an analysis of the main versions of the biodeterminist tradition of re­solving the issue of the nature of gender identity, as well as identification of the advantages of the new version of biodeterminism, which involves elements of social constructivism. Theoretical basis. Social norms determine the extent to which a person has the right to independently determine his or her gender identity, and even more so, to change his or her body according (...) to such gender concepts. Social norms regulate gender relations in society and direct the gender behavior of individuals. However, social norms do not create either the human body, or those biological laws, according to which it functions. Originality. The biodetermist theories of the gender were analyzed from the position of "week" social constructivism. The role of social norms as a factor of gender self-certification, as well as a factor of control over social interference in the functioning of human corporeality is considered. The role of modern medicine as an increasingly influential institutional means of control over the functioning of human corporeality, and therefore, indirectly, and for the implementation of gender identity self-identification is revealed. Conclusions. According to the "week" social constructivism the gender emerges as an integral result of biological, psychological and social construction. The role of personality in the design of the gender has historically grown, but this role can never exclude the influence of biological and social factors that are increasingly becoming the nature of biological and social technologies. Personality can become a victim of these technologies, but he/she can program them, or at any rate selectively use, combine, or to some extent adjust existing biological and social technologies. (shrink)

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life support perpetuated (...) body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of “defining” these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant.My mentors’ discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions. (shrink)

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it (...) is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved.Many people now consider such cases of non-heart-beating organ donation to be ethically permissible. However, widespread disagreement persists as to how such practices are to be justified and whether such practices are compatible with the Uniform Declaration of Death Act. In this paper, I argue that non-heart-beating organ donation can be ethically justified, that in the justified cases the patients are in fact dead, and that the early declarations of death required for such donation do comply with the UDDA. (shrink)

Objectives: To investigate why physicians label end-of-life acts as either ‘euthanasia/ending of life’ or ‘alleviation of symptoms/palliative or terminal sedation’, and to study the association of such labelling with intended reporting of these acts. Methods: Questionnaires were sent to a random, stratified sample of 2100 Dutch physicians. They were asked to label six hypothetical end-of-life cases: three ‘standard’ cases and three cases randomly selected, that varied according to type of medication, physician’s intention, type of patient request, patient’s life expectancy and (...) time until death. We identified the extent to which characteristics of cases are associated with physician’s labelling, with multilevel multivariable logistic regression. Results: The characteristics that contributed most to labelling cases as ‘euthanasia/ending of life’ were the administration of muscle relaxants or disproportional morphine. Other important factors were an intention to hasten death and a life expectancy of several months. Physicians were much more willing to report cases labelled as ‘euthanasia’ or ‘ending of life’ than other cases. Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not. (shrink)

Jeffrey Bishop’s The Anticipatory Corpse demonstrates how death is present in and cloaked by contemporary practices of end-of-life care. A key to Bishop’s argument is that for modern medicine the cadaver has become epistemologically normative and that a metaphysics shorn of formal and final causes now shapes contemporary healthcare practices. The essays of this symposium laud and interrogate Bishop’s argument in three ways. First, they raise critical methodological challenges from the perspectives of human rights, Charles Taylor’s concept of social (...) imaginaries, and economics. Second, they demonstrate the analytical power of his argument by detailing how it might be extended to additional issues beyond simply end-of-life care and how it might be brought into conversation with sociology. Third, they engage the constructive turn Bishop takes at the end of the book. Bishop himself also updates readers on the reception of The Anticipatory Corpse, as well as the way his thinking has evolved over the past 5 years since its publication. He also engages the questions, challenges, and openings provided by our authors. (shrink)

This article reflects on the ‘Woman, Life, Freedom’ uprising in Iran (2022/23) in light of the politicisation of mourning. It argues that this uprising represented a singular afterlife of Antigone’s impediment of burial. In other words, the initial event of the murder of a Kurdish woman that sparked this uprising should not be reduced to the tension between one woman and the clerical class over the compulsory dress code, the clash between two value systems or worldviews, nor to the (...) saga of a heroic individual fighting abstract institutions as the liberal narrative would have it. Rather, at stake is the Marxian problem of the exposure of contradictions and cracks in the social reality itself, the unveiling of deep-rooted antagonisms of a power structure grounded on the simultaneous acknowledgment and disavowal of a great portion of the population. The article shows how the very bodies of the dead protesters became the sites of relentless struggle and subversion. The excessive violence of the state in this uprising manifested itself in the denial of proper burial rites and blockage of funerals, a deprivation and violation that came back to haunt the state and challenge its symbolic power. Just like the unburied corpse of Polyneices, the mistreated dead bodies of the demonstrators bring to light what remains unconcealable and uncontainable in the desperate, brute force of the power-structure to prolong its own lifespan and buy legitimacy for its reign. (shrink)

Comparing mortuary rituals across 57 representative cultures extracted from the Human Relations Area Files, this paper demonstrates that kin of the deceased engage in behaviours to prepare the deceased for disposal that entail close and often prolonged contact with the contaminating corpse. At first glance, such practices are costly and lack obvious payoffs. Building on prior functionalist approaches, we present an explanation of corpse treatment that takes account of the unique adaptive challenges entailed by the death of a loved one. (...) We propose that intimate contact with the corpse provides the bereaved with extensive veridical cues of death, thereby facilitating acceleration of a grieving process that serves to recategorize the deceased as no longer a relationship partner, opening the door to relationship replacement and a return to social functioning. The benefits of exposure to such cues are tempered by the costs of exposure to cues of disease risk, a balance that in part explains the relative rarity of highly invasive mortuary practices that exacerbate the latter factor. We conclude by discussing implications of our model for contemporary mortuary practices in the developed world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increased by about 55 percent, while the number of donors (...) increased only about 16 percent.1 By the end of March 1993, more than 30,000 potential recipients awaited transplantation (United Network for Organ Sharing Database (UNOS) 1993). Every day six of these patients die prior to receiving a heart or liver transplant, while patients needing kidney transplants must tolerate a lower quality of life on dialysis (Grenvik 1992; Evans, Orians, and Ascher 1992).This scarcity is likely to get worse. As transplantation becomes more successful, it is being offered to sicker and older patients. Attempts to transplant other solid organs, such as small bowel and pancreas, will only fuel the demand for donors. However, the current source of organs is unlikely to grow. Most organs come from patients who have been declared dead by neurologic criteria (commonly referred to as "brain dead" or heart-beating cadaver donors (HBCDs) because their hearts are beating at the time of procurement). Estimates of the potential pool of HBCDs have been revised downward from 20,000-27,000 to roughly 10,000-12,000 (Nathan et al. 1991). Improvements in automobile safety and handgun legislation will likely lead to further reductions. Moreover, the rate of procurement from HBCDs has remained relatively flat despite extensive public awareness campaigns and legislation requiring hospitals to routinely request donation from families of dead patients (Caplan et al. 1992).If organ transplantation is going to continue to flourish, alternative [End Page 103] sources of organs must be found. Recently the University of Pittsburgh Medical Center (UPMC) proposed procuring organs from patients who have been declared dead by traditional cardiopulmonary rather than brain-oriented criteria after they or their families have decided to forgo life-sustaining treatment—hereafter referred to as the Pittsburgh protocol (UPMC Policy 1993). These patients are typically referred to as non-heart-beating cadaver donors (NHBCDs) because their hearts are no longer beating at the time of organ procurement.Although NHBCDs were a major source of transplantable kidneys prior to the institution of death by neurologic criteria, their usefulness was limited by "warm ischemia time." This term refers to the injury to tissues that occurs when the blood supply is interrupted and before the organs are cooled and reperfused. Under the Pittsburgh protocol, therapy is withdrawn in the operating room where a waiting surgical team removes organs immediately after death is declared. By controlling the place and time of death, it has been possible to minimize warm ischemia time and thus solve the technical problems previously associated with procurement from NHBCDs.The potential contribution of NHBCD organs is significant. Nathan (1992), using data from Delaware Valley Transplant Program, concludes that the use of severely brain injured, but not "brain dead" patients, would increase the donor pool by 20-25 percent. Moreover, unpublished data from the Pittsburgh organ procurement organization, the Center for Organ Recovery and Education (CORE), suggests that these organs, particularly kidneys, function as well as those procured from HBCDs (Broznick 1993).This volume is devoted to the ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors after a discussion to forgo life-sustaining treatment. The genesis of this volume was a project in which we invited leading experts in transplantation, ethics, and public policy to use the Pittsburgh protocol as a starting point for exploring a broad range of issues associated with attempts to procure organs from NHBCDs. The issues raised by NHBCDs turned out to have important implications about the fundamental conceptual and moral assumptions underlying organ procurement.Although each of the papers in this volume can be read separately, we intend the volume to be read as a whole. Many of the latter pieces on the ethical implications of the policy are best understood in light of the earlier background papers... (shrink)

Intergenerational transfers are a core feature of the practice of private philanthropy. A substantial portion of the resources committed to charitable causes comes from transfers (either during life or at death) that continue to pay out after death. Indeed, much of the power of the charitable foundation lies in its ability to extend the life of an enterprise beyond the mortal existence of its initiating agents. Despite their prevalence, whether and in what way the instruments of intergenerational philanthropy can be (...) justified is controversial. Many have argued that these instruments unfairly privilege the interests of the dead at the expense of the living and unborn. More recently, others have argued that intergenerational charitable transfers comport with the demands of distributive justice and are therefore legitimate. This paper contends that both of these perspectives fail to see the problem for what it is. Intergenerational charitable transfers may indeed promote justice in certain respects, but they do so at the cost of imposing the judgments of the dead onto the living. Respecting the wishes of the past conflicts with an interest in “generational sovereignty.” The paper concludes that properly accounting for this interest in generational sovereignty doesn’t require the abolition of intergenerational philanthropy. But it does tell in favor of a different regulatory orientation than most legal systems currently adopt. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Echoes of Grief:Tales from an Emergency Medicine and Critical Care NurseMarcia KingWell, I have 42 years of stories from working in ICU and Emergency Medicine as a registered nurse. The first situation that comes to mind on the subject of grieving on the job in healthcare happened about 37 years ago. I had a nice lady in ICU for several days in a row as a patient. She had (...) a bad myocardial infarction (MI) and was critical. We tried all the medications and pain meds, and nothing took her chest pain away. Meanwhile, her husband stayed with her all day, and all night. He doted after her 24/7. He slept in a chair and never went home for about three days, even though they lived just a few blocks from the hospital. I was amazed at what an awesome husband he was.Finally, after about three days, she fell asleep for more than 10 minutes. She had said her pain was gone. Her husband didn't want to leave her, but he asked me "if it would be okay" to go home and take a shower, eat a sandwich, and get the mail. He explained that he would be right back.I said, "Sure, now is a good time since her pain is gone and she's sleeping. You must take care of yourself too."The husband ran out in a hurry. About 10 minutes after he left, his wife suddenly had pain again and a run of ventricular tachycardia, (V-tach), which is a type of abnormal heart rhythm, or arrhythmia. Even though the V-tach stopped on its own, I called the husband and told him to come back because he wanted to be there if anything happened. A few minutes later, she had another run of V-tach, but this time, she coded and died. About two minutes after she died, the husband came running into the room—panicked and crying and talking to her dead body.He was saying, "I'm so sorry I left you! I shouldn't have left you!" I felt awful because I was the one who told him it was okay to go. Then I was crying with him and for the poor man.He then left for home, and their doctor (who was a well-known grouch-ass) appeared and saw that I was upset, and he asked me what my problem was. Why was I so sad about it? I thought, "Jerk, you are in the wrong career."Thinking about that doctor's reaction at the time, I wondered, "WTF is wrong with him!" I had known the doctor for several years because his mom was the head nurse of the surgical floor. I thought for a moment and then said to him, "How could you be a decent doctor if that death didn't bother you?" I was [End Page 74] in my 20s at the time—a fairly new nurse—and was just starting to be able to feel comfortable speaking up and being assertive.I just felt so bad for that poor man. I felt terrible that I told him it was okay to run home. He really wanted to be there if something happened to her, and from what I saw, he was an amazing husband to her. Looking back, she probably was waiting for the minute he stepped out to go.Another time, while working in the emergency department, a trauma alert was called on a patient who came in by ambulance. We were told the woman had fallen off a hayloft while pushing hay onto the floor in her barn. She hit her head bad in the fall. She wasn't my patient, but I ran into the room to help when she arrived. There was a bunch of staff around blocking my view. Without even looking at her, I grabbed her arm to put in an IV as I had done thousands of times before. Suddenly, I noticed it was weirdly quiet. I looked up, and the ER Doc and tech were looking at me funny. Then the Doc said, "Marcia, you know who this is, don't... (shrink)

For hundreds of years, death had been defined by cardiopulmonary criteria. When heart and respiratory functions were permanently absent, doctors declared their patients dead. Three developments in intensive care medicine called into question these widely-accepted criteria, however: the advent of positive pressure ventilation and the promotion of cardiopulmonary resuscitation, both in the early 1950s, and the first successful heart transplantation in 1967. What had previously been diagnosed as the permanent absence of vital functions, suddenly became reversible. Not only could doctors (...) replace a defective heart with a functioning transplant; patients could also be kept oxygenated in the total absence of spontaneous respiratory function. The traditional boundaries between life and death became blurred. Patients for whom there was not the remotest possibility of regaining consciousness following massive brain damage continued to consume valuable medical resources. Moreover, their organs could not be procured for transplantation. Were those patients still alive or could the ventilators be switched off? A criterion suited to indicate a patient’s death despite the provision of external life support was needed. In 1968 an ad hoc committee of the Harvard Medical School published the first comprehensive definition of what would soon become the new clinical standard: brain death. The brain bears a special relation to other organs; it directs bodily functions without carrying them out. When the brain is destroyed, it was argued, this control mechanism is irreversibly dysfunctional, so that the organism becomes unable to maintain its vital functions, loses its somatic unity and, consequently, ceases to exist. This neurological criterion has been controversial ever since its introduction. Whether brain death is indeed death is what I shall be investigating in this thesis. I will be asking three main questions: What are we? Is brain death the death of an organism? Is brain death the death of a psychological being? The question of personal identity and the question of the appropriate definition of death are intimately related. Only when we have determined what kind of entity we essentially are can we specify what conditions must apply for this entity to persist or to cease to exist. I shall argue that we are essentially psychological beings, which entails that our death is distinct from the death of our organisms. Hence, we need two different criteria – one for the death of each entity. I shall try to establish whether brainstem death and whole-brain death correspond to the irreversible cessation of organismic functioning. I will then determine by which criterion the death of a psychological being can be diagnosed. (shrink)

Generative AI has captured the public imagination as a tool that promises access to expertise beyond the technical jargon and expense that traditionally characterize such infospheres as those of medicine and law. Largely absent from the current literature, however, are interrogations of generative AI’s abilities to deal in culturally responsive communication, or the expertise interwoven with culturally aware, socially responsible, and personally sensitive communication best practices. To interrogate the possibilities of cultural responsiveness in generative AI, we examine the patterns of (...) response that characterize ChatGPT-3.5’s advice for coming out. Specifically, we submitted 100 prompts soliciting coming out advice to GPT-3.5, variegating each of those prompts slightly to account for intersectional identities. From the analysis, we find that, while the responses are largely in-line with best practices, there are also instances that might represent problematics concerning the interpellation of the user or the persons to whom one is coming out. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Contemporary IlluminationsReading Donne's "A Nocturnall upon S. Lucies Day through Three Twenty-First-Century PoemsTheresa M. DipasqualeIn his contribution to the 2017 volume John Donne and Contemporary Poetry, edited by Judith Scherer Herz, Jonathan F. S. Post explores "a nearly endless landscape of comparisons and contrasts" that unfolds between Stephen Edgar's 2008 poem "Nocturnal" and Donne's "A nocturnall upon S. Lucies day, Being the shortest day."1 Post's essay illuminates what Calvin (...) Bedient, in the same volume, calls the "great glacier-gloom" of Donne's "Nocturnall," its devastated "solemnity."2 In doing so, Post renders largely moot many questions that have preoccupied critics of Donne's poem: whether or how this poem reflects Donne's experience; whether the woman lamented by the speaker is a fiction or a historical person lamented by the poet; and if the latter, whether the poem mourns the 1617 death of John Donne's wife, Anne More Donne; the 1627 death of Donne's patroness Lucy, Countess of Bedford; or the Countess' near-fatal illness in 1612–13.3 These biographical and historical questions are not without value, but they draw the critic's attention away from more compelling questions regarding the "I" of the poem—a persona who claims not to be a person at all, but an inscription, a grave, "A quintessence" derived or "expresse[d]/... even from nothingnesse."4In this article, I widen and intensify the pool of light cast on Donne's "Nocturnall" by Post's presentist and intertextual analysis of Edgar's poem, examining three of the many other twenty-first-century poems that tap into Donne's poem, allude to it, quote it, adopt its structure, or respond to the anguish it expresses.5 Each of the three I discuss is [End Page 1] luminous in its own right but also a potent critical response to Donne's five-stanza poem. Each teaches something different about Donne's lyric. The poets whose work I consider—Liz Lochhead, Jay Wright, and Meena Alexander—all address twenty-first-century concerns; they grapple with questions and sorrows beyond the scope of Donne's conscious imagining yet latent in his poem. Each picks up where critics leave off when they "assume," as Alison R. Rieke notes, "that the speaker... is a husband or lover, possibly Donne, who experiences grief upon his wife's or mistress' death."6 Each takes up the challenge that Donne's persona issues when it denies that it is either "a man" (30) or any other living thing.In the first stanza of "A Nocturnall upon S. Lucies Day," this anti-persona observes that "all" other things around it are "Dead and enterr'd" and "yet" that "all these seeme to laugh, / Compar'd with mee, who am their Epitaph" (8–9). If it is an incised text rather than a human being, the poem's "mee" can no more speak than laugh; it is as silent as the grave it marks or as the dead flesh interred there. Indeed, it goes on to claim that it is "every dead thing" and that love's alchemical "art" has "expresse[d] / A quintessence even from" this mass of nonliving objects, this "nothingnesse" (12, 14–15). Struggling to define its anti-essential essence, it declares itself a mass burial site: "I, by loves limbecke, am the grave / Of all, that's nothing" (21–22). An epitaph, dead things, nothingness, a grave: all these are silent. And yet, in Donne's poem, they strenuously assert their nonbeing; they pulse with a paradoxically audible sense of self. After "Compar'd with mee" in the final line of the opening stanza, the reader encounters sixteen additional instances of the first-person singular in the poem's forty-five lines: "my" appears once, "mee" five times, and "I" eleven times. And the "I" issues a directive to readers: commanding, in the opening line of stanza 2, "Study me then, you who shall lovers bee" (10). But those who obey this order, making themselves students of the poem's inscribed nothingness, find themselves dismissed in the poem's final stanza. Having insisted that its "Sunne" will never "renew... (shrink)

Books reviewed:James D. G. Dunn and John W. Rogerson, Eerdmans Commentary on the BibleYairah Amit, Reading Biblical Narratives. Literary Criticism and the Hebrew BibleThomas L. Leclerc, Yahweh is Exalted in Justice: Solidarity and Conflict in IsaiahNuria Calduch‐Benages, Joan Ferrer, and Jan Liesen, La sabiduría del Escriba/Wisdom of the Scribe: Diplomatic Edition of the Syriac Version of the Book of Ben Sira according to Codex Ambrosianus, with Translations in Spanish and EnglishSidnie White Crawford and Leonard J. Greenspoon, The Book of Esther (...) in Modern ResearchPaolo Sacchi, The History of the Second Temple PeriodMary E. Mills, Biblical Morality. Moral Perspectives in Old Testament NarrativesRichard Swinburne, The Resurrection of God IncarnateH. Benedict Green, Matthew, Poet of the BeatitudesC. K. Barrett, On Paul. Essays on His Life, Work and Influence in the Early ChurchMichael D. Goulder, Paul and the Competing Mission in CorinthByron R. McCane, Roll Back the Stone: Death and Burial in the World of JesusMagnus Zetterholm, The Formation of Christianity in Antioch: A Social‐Scientific Approach to the Separation between Judaism and ChristianityDale V. Irvin and Scott W. Sunquist, History of the World Christian Movement, Volume I: Earliest Christianity to 1453Francis Clark, The ‘Gregorian’ Dialogues and the Origins of Benedictine MonasticismMichael Frassetto, The Year 1000: Religious and Social Response to the Turning of the First MillenniumPatrick Nold, Pope John XXII and his Franciscan Cardinal: Bertrand de la Tour and the Apostolic Poverty ControversyTeresa P. Reed, Shadows of Mary: Reading the Virgin Mary in Medieval TextsMichael D. Bailey, Battling Demons: Witchcraft, Heresy, and Reforma in the Late Middle AgesColm Lennon, An Irish Prisoner of Conscience of the Tudor Era: Archbishop Richard Creagh of Armagh, 1523–86Judith S. Graham, Puritan Family Life: The Diary of Samuel SewallCrawford Gribben, The Puritan Millennium. Literature and Theology, 1550‐1682M. Feingold, Jesuit Science And The Republic of LettersRobert Bireley, The Jesuits And The Thirty Years War: Kings, Courts, and ConfessorsTorkel Brekke, Makers of Modern Indian Religion in the Late Nineteenth CenturyP. Koslowski, The Concept of God, the Origin of the World, and the Image of the Human in the World ReligionsPeter Koslowski, The Origin and the Overcoming of Evil and Suffering in the World ReligionsJ. H. Laenen, Jewish Mysticism: An IntroductionBarbara Bowe, Biblical Foundations of Spirituality: Touching a Finger to the FlameThomas G. Weinandy and Daniel A. Keating, The Theology of St Cyril of Alexandria. A Critical AppreciationJames D. G. Dunn, Jesus Remembered: Christianity in the Making, Volume 1Daniel W. Hardy, Finding the Church: The Dynamic Truth of AnglicanismS. Mark Heim, The Depth of the Riches: A Trinitarian Theology of Religious EndsJohn Webster, Word and Church. Essays in Christian DogmaticsAlister E. McGrath, A Scientific Theology. Volume 1: NatureJames Alison, On Being LikedMichael J. Langford, A Liberal Theology for the Twenty‐First Century: A Passion for ReasonGuy Mansini and James G. Hart, Ethics and Theological Disclosures:The Thought of Robert SokolowskiMark A. Wrathall, Religion After MetaphysicsGerd Van Riel, Pleasure and the Good Life: Plato, Aristotle, and the NeoplatonistsNomy Arpaly, Unprincipled Virtue: An Inquiry into Moral AgencyGernot Böhme, Ethics in Context: The Art of Dealing with Serious QuestionsErica Appelros, God in the Act of Reference: Debating Religious Realism and Non‐RealismMark C. Murphy, Natural Law and Practical RationalityRichard Brian Davis, The Metaphysics of Theism and ModalityJ. Brower and K. Guilfoy, The Cambridge Companion to AbelardBrian Davies, Thomas Aquinas: Contemporary Philosophical PerspectivesStephen J. Pope, The Ethics of AquinasKevin White and Romanus Cessario, On The Virtues John CapreolusSteven Shakespeare, Kierkegaard, Language and the Reality of GodSusan M. Felch and Paul J. Contino, Bakhtin and Religion: A Feeling for FaithRuth Coates, Christianity in Bakhtin: God and the Exiled AuthorDavid Michael Levin, The Philosopher's Gaze: Modernity in the Shadows of EnlightenmentCharles Guignon and David R. Hiley, Richard RortyCelia E. Deane‐Drummond, Biology and Theology TodayOswaldo de Rivero, The Myth of Development: The Non‐Viable Economies of the 21st Century. (shrink)

Samuel H. LiPuma and Joseph P. DeMarco argue for a positive right to continuous sedation until death (CSD) for any patient with a life expectancy less than six months. They reject any requirement of proportionality. Their proposed guideline makes CSD an option for a decisional adult patient with an appropriate terminal diagnosis regardless of whether suffering (physical or existential) is present. This guideline purports to “empower” the patient with the ability to control the timing and manner of her death. This (...) extends even to the option to “opt out” of the awareness and experience of dying and to avoid suffering altogether, even if one’s symptoms and suffering could be effectively treated.We respond first with a critique of their terminology. We then turn to some purely practical considerations of how this guideline might be enacted in the current atmosphere of American hospice and palliative care medicine. We close with a consideration of one philosophical concern that might ground the discussion of risks, benefits, and alternatives necessary for informed consent. (shrink)

Organ donation after a circulatory determination of death is possible in selected patients where consent is given to support donation and the patient has been legally declared dead by two doctors. The National Health Act (61 of 2003) and regulations provide strict controls for the certification of death and the donation of organs and tissues after death. Although the National Health Act expressly recognises that brain death is death, it does not prescribe the medical standards of testing for the determination (...) of brain death (neurological determination of death), circulatory death (circulatory determination of death) or for determination of death based on somatic criteria. However, in all cases of organ donation, including after circulatory death, the National Health Act mandates that two doctors certify the death, with one doctor possessing more than 5 years of experience. Additionally, both doctors must be independent from the transplant team. The standard for such determination, as for brain death, aligns with accepted medical standards. The Critical Care Society of Southern Africa has published South African (SA) Guidelines on Death Determination that outline rigorous standards for death determination in hospital settings by either a neurological or circulatory method. Legislation and the Health Professions Council of SA’s (HPCSA) professional guidance direct clinicians on obtaining informed consent for donation either from the patient or in cases of incapacity from their surrogate decision maker. Collectively, the legislation, regulations and professional guidelines in SA provide a robust ethical framework that supports organ donation after circulatory death. (shrink)

The social and cultural changes of the last century have transformed death from an everyday fact to something hidden from view. Shifting between the practical and the theoretical, the professional and the intimate, the real and the fictitious, this collection of essays explores the continued power of death over our lives. It examines the idea and experience of death from an interdisciplinary perspective, including studies of changing burial customs throughout Europe; an account of a"dying party" in the Netherlands; (...) examinations of the fascination with violent death in crime fiction and the phenomenon of serial killer art; analyses of death and bereavement in poetry, fiction, and autobiography; and a look at audience reactions to depictions of death on screen. By studying and considering how death is thought about in the contemporary era, we might restore the natural place it has in our lives. (shrink)

Recent events, such as the widespread acceptance of the book, Final Exit, show that the very foundation upon which all humane medical practice is ba sed is in danger of being replaced with ethical relativism. Cameron's book could very well be a rallying point for those in the profession who know something is wrong. Endorsed by C. Everett Koop.

Book Reviews in this article Baptism and Resurrection: Studies in Pauline Theology against its Graeco‐Roman Background. By A.J.M. Wedderburn. Meaning and Truth in 2 Corinthians. By Frances Young and David Ford. Jesus and God in Paul's Eschatology. By L. Joseph Kreitzer. The Acts of the Apostles : By Hans Conzelmann. The Genesis of Christology: Foundations for a Theology of the New Testament. By Petr Pokorny. The Incarnation of God: An Introduction to Hegel's Theological Thought as Prolegomena to a Future Christology. (...) By Hans Küng, translated by J.R. Stephenson. The Incarnation: Collected Essays in Christology. By Brian Hebblethwaite. Models for God: Theology for an Ecological, Nuclear Age. By Sallie McFague. Pp. xv, 224, London, SCM Press, 1987, £8.50 Symbol and Sacrament: A Contemporary Sacramental Theology. By Michael G. Lawler. The Sacrifice We Offer: The Tridentine Dogma and its Reinterpretation. By David N. Power. New Eucharistic Prayers: An Ecumenical Study of their Development and Structure. Edited by Frank C. Senn. To Join Together: The Rite of Marriage. By Kenneth W. Stevenson. Company of Voices: Daily Prayer and the People of God. By George Guiver. The Long‐Legged Fly. By Don Cupitt. Approaches to Auschwitz. By Richard L. Rubenstein and John K. Roth. Natural Law and Justice. By Lloyd L. Weinreb. Christian Morality: The Word Becomes Flesh. By Josef Fuchs S.J., translated by Brian McNeil. Medicine in Contemporary Society: King's College Studies 1986–87. Edited by Peter Byrne. Military Ethics: Guidelines for Peace and War. By N. Fotion and G. Elfstrom. Choice: The Essential Element in Human Action. By Alan Donagan. Persons and Personality: A Contemporary Inquiry. Edited by Arthur Peacocke and Grant Gillet. The Rationality of Emotion. By Ronald de Sousa. The Psychology of Personality: An Epistemological Inquiry. By James T. Lamiell. Aesthetics: An Introduction to the Philosophy of Art. By Anne Sheppard. The Ascetic Element in Culture and Criticism. By Geoffrey Gait Harpham. Electric Language: A Philosophical Study of Word Processing. By Michael Heim. Education and Philosophical Anthropology: Toward a New View of Man for the Humanities and English. By David Holbrook. Evolution and the Humanities. By David Holbrook. Further Studies in Philosophical Anthropology. By David Holbrook. Women in Western Political Philosophy. Edited by Ellen Kennedy and Susan Mendus. The Light of the Soul: Theories of Ideas in Leibniz, Malebranche and Descartes. By Nicholas Jolley. Arnauld and the Cartesian Philosophy of Ideas. By Stephen M. Nadler. Later Medieval Philosophy : An Introduction. By John Marenbon. Either/Or. By Søren Kierkegaard, translated by Howard and Edna Hong, Princeton University Press, 1987: Vol. One, Wittgenstein. By A.C. Grayling. Questions on Wittgenstein. By Rudolf Haller. The False Prison: A Study of the Development of Wittgenstein's Philosophy. By David Pears, Oxford, Clarendon Press. Vol. One, The Later Wittgenstein: The Emergence of a New Philosophical Method. By S. Stephen Hilmy. Knowledge of God: Calvin, Einstein and Polanyi. By Iain Paul. Conceptual Change and Religious Practice with Special Reference to Jews in Britain and Israel. By Janice Williams. The World's Religions. Edited by Stewart Sutherland, Leslie Houlden, Peter Clarke and Friedhelm Hardy. Religions in Conversation: Christian Identity and Religious Pluralism. By Michael Barnes. Theravāda Buddhism, A Social History from Ancient Benares to Modem Colombo. By Richard Gombrich. Mahāyāna Buddhism, The Doctrinal Foundations. By Paul Williams. Hinduism in Great Britain: The Perpetuation of Religion in an Alien Cultural Milieu. Edited by Richard Burghart. The Way of the Black Messiah. By Theo Witvliet. The Meaning of Religious Conversion in Africa. By Cyril C. Okorocha. Common Ground: Christianity, African Religion and Philosophy. By Emmanuel K. Twesigye. Islamic Spirituality I: Foundations. Edited by Seyyed Hossein Nasr. The Great Cosmic Mother: Rediscovering the Religion of the Earth. By Monica Sjöö and Barbara Mor. Judaism and Christianity in the Age of Constantine. By J. Neusner. Language and the Worship of the Church. Edited by David Jasper and R.C.D. Jasper. The Urban Character of Christian Worship: The Origins, Development and Meaning of Stational Liturgy. By John E. Baldovin. Leontii Presbyteri Constantinopolitani Homiliae. Edited by Cornells Datema and Pauline Allen. Law, Sex and Christian Society in Medieval Europe. By James A. Brundage. Melchior Hoffman: Social Unrest and Apocalyptic Visions in the Age of Reformation. By Klaus D Alonso de Zorita: RoyalJudge and Christian Humanist, 1512–1585. By Ralph H. Vigil. Pedro Moya de Contreras: Catholic Reform and Royal Power in New Spain, 1571–1591. By Stafford Poole. Archbishop William Laud. By Charles Carlton. The Social History of Religion in Scotland since 1730. By Callum G. Brown. Pastors and Pluralism in Württemberg, 1918–1933. By David J. Diephouse. The Churches and the Third Reich, Vol. One: Preliminary History and the Time of Illusions, 1918–1934. By Klaus Scholder. Reforming Fundamentalism. Fuller Seminary and the New Evangelicalism. By George M. Marsden. The Hellenistic Philosophers Vol. II: Greek and Latin Texts with Notes and Bibliography. By A.A. Long and D.N. Sedley. Prayers of the Eucharist: Early and Reformed. Edited by R.C.D. Jasper and G. J. Cuming. The Way of Paradox: Spiritual Life as Taught by Meister Eckhart. By Cyprian Smith. Meister Eckhart: The Man from whom God Hid Nothing. Edited by Ursula Fleming. The Spiritual Exercises of St Ignatius Loyola: A New Translation. Translated by Elisabeth Meier Tetlow. Courtfield and the Vaughans: An English Catholic Inheritance. By Mary Vaughan. Trinity College, Washington D.C.: The First Eighty Years, 1897–1977. By Columba Mullaly. John Henry Newman on the Idea of Church. By Edward Jeremy Miller. Journey from Paradise: Aft Athos and the Interior Life. By Ralph Harper. (shrink)

This article gives brief results of a Norwegian empirical project where the main purpose has been to study the burial rite versus bereavement and the role of religiousness in relation to the disposing of the dead. The theoretical perspective is that loss of a significant close, as well as religiousness are primary life experiences which flow together in the bereaved person's grieving conduct during the burial rite. 70 bereaved persons who had lost a close relative during a certain (...) time period have filled in questionnaires with information about the death, the funeral, religiousness and bereavement. The sample is treated statistically by means of indexes for grieving conduct during the burial week, religiousness, and grief. The sample is coherent and unambiguous, and shows that those who let the burial rite be a time to mourn experienced more benefit from the funeral service and had less anxiety, depression and intrusive experiences during the first year of bereavement. But sadness was independent of the grieving conduct during the burial rite, a result which makes sadness an aspect of mourning which qualitatively differs from the other aspects described. External conditions as urbanity and institutionalizing, as well as internal matters as the dramatical character of the loss, and personal religiousness affected the bereaved person's grieving conduct during the burial rite. (shrink)

This article gives brief results of a Norwegian empirical project where the main purpose has been to study the burial rite versus bereavement and the role of religiousness in relation to the disposing of the dead. The theoretical perspective is that loss of a significant close, as well as religiousness are primary life experiences which flow together in the bereaved person's grieving conduct during the burial rite. 70 bereaved persons who had lost a close relative during a certain (...) time period have filled in questionnaires with information about the death, the funeral, religiousness and bereavement. The sample is treated statistically by means of indexes for grieving conduct during the burial week, religiousness, and grief. The sample is coherent and unambiguous, and shows that those who let the burial rite be a time to mourn experienced more benefit from the funeral service and had less anxiety, depression and intrusive experiences during the first year of bereavement. But sadness was independent of the grieving conduct during the burial rite, a result which makes sadness an aspect of mourning which qualitatively differs from the other aspects described. External conditions as urbanity and institutionalizing, as well as internal matters as the dramatical character of the loss, and personal religiousness affected the bereaved person's grieving conduct during the burial rite. (shrink)