Introduction Death is an inevitable part of clinical practice and affects, in its very own way, not only next of kin and friends but also the members of the clinical team, in particular physicians and nurses, as those who take care of a patient in the very last moments of his or her life. Nevertheless, in clinical everyday life, it is no matter of course to meet the end of human life not only on a physical but also metaphysical level. (...) Definition of the problem In Western sociocultural contexts, silence is commonly regarded as an adequate expression of respect in the context of death. Considering that time is a more than limited resource in Western healthcare systems, it can, however, be challenging for the clinical team to pause and pay respect to the life that has passed and to generally deal with the unfathomability of human finiteness. Instead, death tends to become drowned out by a strident clinging to the common routines of patient care, in the course of which everyday clinical noises can turn into a roaring, almost inhuman cacophony—a cacophony that may not do justice to the dignity of the deceased, the relatives, or the clinic team. Objective With that said, this article focuses on forms of bidding farewell in clinical patient care, with an emphasis on post-mortem silence. Drawing on examples from literature, medical ethics, and the law, I will plead for a moment of silence in everyday clinical practice as a possible means to interrupt the noise of medicine in the immediate aftermath of death to honor the dignity of both the dead and the living. (shrink)

Zusammenfassung Angesichts des fortgesetzten Rückgangs des Organspendeaufkommens in Deutschland werden Forderungen nach Einführung der Widerspruchsregelung bei der Organübertragung post mortem seit längerem nicht mehr nur von der Ärzteschaft, sondern verstärkt auch von politischer Seite erhoben. Gegenstand des Beitrags ist die Prüfung der Vereinbarkeit der gegenwärtig diskutierten Vorschläge zu einer Erhöhung des Organaufkommens mit dem individuellen Selbstbestimmungsrecht, ohne damit eine gesamthafte ethische Nutzen-Kosten-Bilanz dieser Strategien zu präjudizieren. Der Beitrag geht davon aus, dass hauptsächlich drei Faktoren für die Beurteilung relevant (...) sind: 1. ob der Eingriff in die körperliche Integrität zu Lebzeiten oder post mortem erfolgt; 2. die Intensität des Wunsches, nach dem Tod vor solchen Eingriffen geschützt zu sein; 3. das Ausmaß des sozialen Drucks, einen solchen Eingriff zuzulassen. Es ergibt sich, dass eine Widerspruchsregelung unter dem Gesichtspunkt des Selbstbestimmungsrechts einerseits nicht optimal, andererseits aber auch nicht schlechthin inakzeptabel und jedenfalls der Alternative einer Zwangserklärungsregelung vorzuziehen ist. (shrink)

Demonstrates the fertility of the phenomenological tradition of philosophy for intergenerational justice and climate ethics.

Purpose The search for cause of death is important to improve knowledge and provide answers for the relatives of the deceased. Medical autopsy following unexplained death in hospital is one way to identify cause of death but is difficult to carry out routinely. Post mortem sampling (PMS) of tissues via thin biopsy needle or ‘mini incisions’ in the skin may be a useful alternative. A study was undertaken to assess how this approach is perceived by intensive care doctors (...) and also to evaluate how this practice is considered in ethical terms in France. Methods A study of PMS practices immediately after death in 10 intensive care departments was performed. The medical director of each centre was interviewed by telephone and asked to describe practices in their unit and to outline the questions raised by this practice. Results PMS is routinely performed in 70% of the units which responded, without systematically obtaining formal consent and without precise rules for communicating results. Approaches to PMS differed between centres, but all physicians felt that PMS is useful for the scientific information it gives and also for the information it provides for relatives. All physicians regret the lack of standards to structure PMS practices. Conclusion Information from post mortem examinations is important for society to inform about causes of death, for doctors to improve practices and for decision-makers responsible for organising care. Debate persists regarding the balance between individual rights and community interests. It is suggested that an approach for identifying cause of death could easily be integrated into the relationship between carers and relatives, provided full transparency is maintained. (shrink)

BackgroundOrgan transplantation represents the most effective and acceptable therapy for end-stage organ failure. However, its frequent practice often leads to a shortage of organs worldwide. To solve this dilemma, some countries, such as Portugal, have switched from an opt-in to an opt-out system, which has raised concerns about respect for individual autonomy. We aimed to evaluate whether young university students are aware of this opt-out system so that they can make informed, autonomous and conscious decisions, as well as to identify (...) the factors that determine a positive attitude toward post-mortem organ donation.MethodsAn observational, cross-sectional study was developed and a questionnaire was administered to first-year students from six faculties of the University of Porto.ResultsOf the 841 participants, 60% were unaware that Portugal had adopted an opt-out system. Among the informed individuals, their main sources of information included social media, internet, and family. Furthermore, only 48% of all participants agreed with the current opt-out system. Female sex (p = 0.049; OR 1.393), knowledge of the law (p < 0.001; OR 4.749) and family being the primary source of information (p < 0.001; OR 2.855) were independent factors associated with a positive attitude toward post-mortem organ donation law.ConclusionsThere is a significant lack of knowledge among young university students regarding the presumed post-mortem organ donation law and how it works. Female sex, having family as a primary source of information and being aware of the presumed post-mortem organ donation law are the strongest independent factors that determine a positive attitude toward the opt-out system. (shrink)

The purpose of this article is not to affirm or deny particular philosophical positions, but to explore the limits of intelligibility about what post-mortem harm means, especially in the light of improper post-mortem procedures at Bristol and Alder Hey hospitals in the late 1990s. The parental claims of post-mortem harm to dead children at Alder Hey Hospital are reviewed from five different philosophical perspectives, eventually settling on a crucial difference of perspective about how we (...) understand harm to the dead. On the one hand there is the broadly 'analytical' tradition1 of thinking that predicates the notion of harm on the basis of an existing subject. Since the dead are non-existent persons, it makes little sense to view the dead as being harmed. On the other hand, there is a phenomenological perspective, where the dead, in respect to the experience of grief, are existentially absent. This forms the basis that it is possible to harm grieving parent's experiences of how their dead are treated. The article ends with a short examination of what harming the dead implies for traditional bioethical concerns, namely, obtaining informed consent from significant others when planning medical research on the newly dead. (shrink)

Traditionally, Christians have hold the two following beliefs: the belief that God is omniscient, omnipotent, and perfectly good on the one hand and the belief that God has actualized a possible world in which some people freely reject Christ and are damned eternally, while others freely accept Him and are saved on the other. The combination of these two beliefs seems to result in a contradiction. This serious and well-known problem is called the soteriological problem of evil. In this article (...) the author, on the basis of William Lane Craig's Molinist theory, argues that there is no contradiction between these beliefs and that, therefore, there is no soteriological problem of evil, unless one adds two premises. The theory of middle knowledge shows that there is no good reason to accept the second of these. Therefore, there is no contradiction between belief in a perfectly good, omniscient, and omnipotent God and the eternal damnation of some people in this world. This Molinist account is defended against some philosophical and theological objections that have been raised against it. Finally, the author tries to show that, although Craig's concept of transworld damnation is helpful to offer a defense of the compatibility of the two traditional Christian beliefs mentioned above, it does not help us to offer a theodicy of post-mortem evil.ZusammenfassungIn der christlichen Tradition finden wir die folgenden beiden Überzeugungen: einerseits, dass Gott allwissend, allmächtig und vollkommen gut ist und anderseits, dass er eine mögliche Welt aktualisiert hat, in der einige Menschen Christus freiwillig ablehnen und ewig verloren gehen, während andere ihn freiwillig annehmen und gerettet werden. Es hat den Anschein, dass die Kombination dieser beiden Überzeugungen in einen Widerspruch mündet. Aufgrund der Molinistischen Theorie William Lane Craigs sucht Verfasser zu erweisen, dass diese beiden Überzeugungen sich nicht widersprechen – es sei denn, dass zwei fragwürdige Prämissen hinzugefügt würden. Die Theorie der scientia media zeigt, dass es keine guten Gründe gibt, um die zweite dieser Prämissen zu akzeptieren. Es besteht also kein Widerspruch zwischen der Überzeugung, dass Gott allwissend, allmächtig und vollkommen gut ist, und der Überzeugung, dass einige Menschen ewig verloren gehen. Diese Molinistische Theorie wird gegenüber einigen philosophischen und theologischen Einsprüchen verteidigt. Schliesslich versucht der Verfasser nachzuweisen, dass, obwohl Craigs Konzept der transworld damnation für eine Verteidigung des christlichen Glaubens gebraucht werden kann, es nicht gebraucht werden kann für eine Theodizee hinsichtlich postmortalem Übel. (shrink)

Why would we ever take a picture of a dead person? This practice began as a way to perpetuate the image of the deceased, rendering their memory eternal – Victorians thought that it could be useful to have portraits of their dead loved ones. Certainly, subjects in post-mortem photos will be remembered forever. However, we must ask two more questions. Are they people portrayed as if they were still alive? Or on the other hand, are they bodies that (...) represent death? Our paper takes an in-depth look at different iconographical styles as well as photographic techniques and religious and ethical reasons behind memento mori photos during the Victorian Age. (shrink)

Recent advances in medical technology have provided healthcare staff with the possibility of maintaining the life of a brain-dead pregnant woman on life-support in order to achieve a successful delivery of the foetus. Management of Post-Mortem Pregnancy examines the legal and ethical difficulties surrounding such post-mortem management.

The current state of British sociology of education is reviewed; noting its decline, but suggesting that its influence has been dispersed throughout educational research in Britain. It is argued that its fate is not simply a product of external attack but also derives from internal problems. Against this background, it is suggested that postmodernism can be treated as a stimulus for a fundamental reconsideration of the proper nature and role of academic research on education.

Parents of children who died following complex heart surgery have recently discovered that organs were removed and retained in post-m.

BackgroundCollecting post-mortem brain tissue is essential, especially from healthy “control” individuals, to advance knowledge on increasingly common neurological and mental disorders. Yet, healthy individuals, on which this study is focused, are still understudied. The aim of the study was to explore, among healthy potential brain donors and/or donors’ relatives, attitude, concerns and opinion about post-mortem brain donation (PMBD).MethodsA convenience sampling of the general population (twins and their non-twin contacts) was adopted. From June 2018 to February 2019, (...) 12 focus groups were conducted in four Italian cities: Milan, Turin, Rome and Naples, stratified according to twin and non-twin status. A qualitative content analysis was performed with both deductive and inductive approaches. Emotional interactions analysis corroborated results.ResultsOne hundred and three individuals (49–91 yrs of age) participated. Female were 60%. Participants had scarse knowledge regarding PMBD. Factors affecting attitude towards donation were: concerns, emotions, and misconceptions about donation and research. Religion, spirituality and secular attitude were implied, as well as trust towards research and medical institutions and a high degree of uncertainty about brain death ascertainment. Family had a very multifaceted central role in decision making. A previous experience with neurodegenerative diseases seems among factors able to favour brain donation.ConclusionsThe study sheds light on healthy individuals’ attitudes about PMBD. Brain had a special significance for participants, and the ascertainment of brain death was a source of debate and doubt. Our findings emphasise the importance of targeted communication and thorough information to promote this kind of donation, within an ethical framework of conduct. Trust in research and health professionals emerged as an essential factor for a collaborative attitude towards donation and informed decision making in PMBD. (shrink)

Can a materialist look for the resurrection of the dead and the life of the world to come? Dean Zimmerman’s Falling Elevator Model is a speculative account of how persons, understood as material beings, might survive in a post-mortem resurrected state—a just-so story. It assumes endurantism, the doctrine that persons and other ordinary objects are three-dimensional beings which are wholly present at every time they exist. I argue that neither endurantism, nor purdurantism, according to which persons are four-dimensional (...) ‘worms’ who have proper temporal parts at every time that they exist, provides a plausible account of personal survival. If you want to be a Christian materialist you should embrace exdurantism, the ‘stage theory’, according which persons are instantaneous stages and are not identical to their temporal successors either in this world or in any world to come. Exdurantism provides a plausible account of survival in ordinary cases and extraordinary cases of this-worldly fission, and of post-mortem survival. (shrink)

Background: Post-mortem needle biopsies have been used in resource-poor settings to determine cause of death and there is interest in using them in Bangladesh. However, we did not know how families and communities would perceive this procedure or how they would decide whether or not to consent to a post-mortem needle biopsy. The goal of this study was to better understand family and community concerns and decision-making about post-mortem needle biopsies in this low-income, predominantly (...) Muslim country in order to design an informed consent process. Methods: We conducted 16 group discussions with family members of persons who died during an outbreak of Nipah virus illness during 2004-2008 and 11 key informant interviews with their community and religious leaders. Qualitative researchers first described the post-mortem needle biopsy procedure and asked participants whether they would have agreed to this procedure during the outbreak. Researchers probed participants about the circumstances under which the procedure would be acceptable, if any, their concerns about the procedure, and how they would decide whether or not to consent to the procedure. Results: Overall, most participants agreed that post-mortem needle biopsies would be acceptable in some situations, particularly if they benefitted society. This procedure was deemed more acceptable than full autopsy because it would not require major delays in burial or remove organs, and did not require cutting or stitching of the body. It could be performed before the ritual bathing of the body in either the community or hospital setting. However, before consent would be granted for such a procedure, the research team must gain the trust of the family and community which could be difficult. Although consent may only be provided by the guardians of the body, decisions about consent for the procedure would involve extended family and community and religious leaders. Conclusions: The possible acceptability of this procedure during outbreaks represents an important opportunity to better characterize cause of death in Bangladesh which could lead to improved public health interventions to prevent these deaths. Obstacles for research teams will include engaging all major stakeholders in decision-making and quickly building a trusting relationship with the family and community, which will be difficult given the short window of time prior to the ritual bathing of the body. (shrink)

Background Voluntary post-mortem donation to science (PDS) is the most appropriate source for body dissection in medical education and training, and highly useful for biomedical research. In Mexico, unclaimed bodies are no longer a legal source, but PDS is legally possible, although scarcely facilitated, and mostly ignored by the general population. Therefore, we aimed to evaluate the attitude and willingness for PDS and to identify a sociodemographic profile of people with willingness toward PDS. Methods A validated on-line survey (...) was distributed by the convenience method via the social networks of a Catholicism-inspired, private university in northern Mexico. Frequency analyses of all variables and coded free comments were complemented with association studies. Results Although the responder cohort (n = 143) was too small and biased to be representative of the university community (n = 13,500), willingness to post-mortem organ donation was 90.7% and to PDS 70.7%. In this cohort, PDS willingness had the strongest association with mature age (> 40 years old; P, 0.0008). Among young adults, willingness to PDS was the lowest among volunteers from technical and business schools and the highest among those from the social sciences (P, 0.009). Respondents from the social sciences were also the most consistent between attitude and behavior with respect to organ donation. A free comment option revealed respondents were interested in the unusual taboo topic. Conclusions A small, but sufficiently large proportion expressed willingness toward PDS. In our university cohort, which was biased in higher education and altruism, mature age and social interest were associated with PDS willingness. (shrink)

Background The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. Main body This article discusses some of the ethical challenges that were encountered in (...) these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. Conclusion It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa. (shrink)

This essay considers the question of conversion unto repentance, as an act of cognition and volition, by the separated soul in the post‐mortem state. It primarily explicates and interrogates Thomas Aquinas's various attempts to rule out this possibility for the damned. Since Thomas's arguments for such impossibility feature his commitment to the radical immateriality of the human soul—and, like it, the angelic spirit—the essay highlights the ontological and moral tensions within that account. The case is thus made for (...) the ontological, logical, and moral inconsistencies of his position, in pursuit of a more holistic anthropology across the soul's various states and a more rationally and coherent eschatology—namely, an affirmation of the irreducible mutability of the created soul on its way towards likeness to God, perhaps, if not certainly, towards universal salvation. (shrink)

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract (...) for health research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

This paper is devoted to the deliberations on the vision of communist society as the phase of modernity. Author argues that the modern communism was nothing more than dusted offset of ideas inapplicable to the current circumstances. But there is something more important than disparagement of communism in itself. In critical analysis of modernity as some kind of „response to inefficiency of ancien régime” the author presents evidence to social reforms bounded up with the appearance of capitalism. Modernity in Bauman’s (...) paper is presented as an inevitable confrontation between Marxist prophesy about revolution of the proletariat and socio-political aspects of capitalist order which undermined theoretical principles of socialism and its strategy. Despite the critical commentaries on the communist regime, author ponders on the substantial promise of communism in itself, which realized its potential in the past and in the globalized world is one of the most significant aspects to discussion and the crux of the contemporary reflection.Key words COMUNISM. (shrink)

Faithful persons tend to relate to their religious beliefs as truth claims, particularly inasmuch as their beliefs have soteriological implications for those of different religions. For Christians the particular claims which matter most in this regard are those made by Jesus of Nazareth and his claims are primarily relational in nature. I propose a model in which we understand divine grace from Jesus as being mediated through relational knowledge of him on a compassionately exclusivist basis, including post-mortem. Supporting (...) this model, I draw from Eleonore Stump’s hypothesis in her 2018 Atonement that the crucifixion of Jesus opens the divine psyche to all human psyches sufficiently for salvific mutual indwelling to occur, and from Gavin D’Costa’s conception of the descensus Christi ad inferos as the mechanism for grace’s accessibility post-mortem presented in his 2009 Christianity and World Religions. This model seeks to address ongoing, justified pastoral concern for the soteriological status of non-Christians while still treating Christianity as objectively true. (shrink)

I develop an exploratory analysis of “post-mortem photography”, a social practice existing in different cultures. The study, part of a larger project in Denmark, “The culture of grief”, combines Dialogical Self Theory, mainly concerning verbal and textual objects, with the iconic framework of affective semiosis to discuss the function of taking and keeping pictures of dead persons as if they were still alive or just sleeping. How can this practice and artifact culturally mediate the experience of death and (...) the elaboration of grief? What kind of inner dialogue is developed through the internalization of this specific kind of presence/absence? These are some of the preliminary questions I will try to answer by discussing some examples of post-mortem photography from the 19th and 20th centuries in different countries. (shrink)

Die Art-House-Ästhetik der Fernsehserie Hannibal entfacht eine düstere Bilderwelt, die von verschiedenen Symbolen der Vanitas erfüllt ist. Jedoch erweist sich nicht nur die Symbolik, sondern vielmehr die Gestaltung eines eigenen Zeitparadigmas, das durch die formende Kraft des Seriellen erzeugt wird, als zentraler Bezug zur barocken Denkfigur: Die ästhetische Modellierung von Zeit entfaltet eigene Formen der Zeitenthobenheit sowie der simultanen Präsenz und versucht zugleich das Vergängliche medial zu überwinden. Dabei lotet die Serie einerseits die Schönheit des Vergehens wie die des Verfalls (...) aus, andererseits setzt sie die eigene Medialität mit der Vanitas in Beziehung, indem die Wiederholungstruktur das Vergessen als Erkenntnisprozess instituiert und so Verwandlung und Neubeginn im Zeichen der Vergänglichkeit konstituiert. (shrink)

About a decade ago, the Netherlands Environmental Assessment Agency unwittingly embarked on a transition from a technocratic model of science advising to the paradigm of ‘‘post-normal science’’. In response to a scandal around uncertainty management in 1999, a Guidance for ‘‘Uncertainty Assessment and Communication’’ was developed with advice from the initiators of the PNS concept and was introduced in 2003. This was followed in 2007 by a ‘‘Stakeholder Participation’’ Guidance. In this article, the authors provide a combined insider/outsider perspective (...) on the transition process. The authors assess the extent to which the PNS paradigm has delivered new approaches in the agency’s practice and analyze two projects—on long-term options for Dutch sustainable development policy and for urban development policy—the latter in somewhat more detail. The authors identify several paradoxes PBL encounters when putting the PNS concept into practice. It is concluded that an openness to other styles of work than the technocratic model has become visible, but that the introduction of the PNS paradigm is still in its early stage. (shrink)

Paul Cilliers has developed a novel post-structural approach to complexity that has influenced several writers contributing to the current complexity literature. Concomitantly however, Cilliers advocates for modelling complex systems using connectionist neural networks (rather than analytic, rule-based models). In this paper, I argue that it is dilemmic to simultaneously hold these two positions. Cilliers’ post-structural interpretation of complexity states that models of complex systems are always contextual and provisional; there is no exclusive model of complex systems. This sentiment (...) however appears at odds with Cilliers’ promotion of connectionist neural networks as the best way to model complex systems. The lesson is that those who currently follow Cilliers’ post-structural approach to complexity cannot also develop a preferred model of complex systems, and those who currently advocate for some preferred model of complex systems cannot adopt the post-structural approach to complexity without giving up the purported objectivity and/or superiority of their preferred model. (shrink)

Discussions of the sources for Levinas’s philosophy have tended to focus on Greece and the Bible to the neglect of his Russo-Lithuanian cultural heritage. Almost no work has been done examining the impact of Russian literature on Levinas’s thinking. The present essay seeks to overcome this neglect by examining the influence that Dostoyevsky in particular exerted on the development of Levinas’s philosophy. I am aware that the notion of “influence” is philosophically vague, and not something whose truth can easily be (...) ascertained. Might there be nothing more than simply a confluence between the thinking of Dostoyevsky and that of Levinas? Could it be that Levinas was attracted to the work of Dostoyevsky because he found there what he was already looking for? Although Levinas credits Dostoyevsky with introducing him to philosophy, it would be facile to draw the conclusion that St. Petersburg occupies as important a place in Levinas’s intellectual itinerary as Athens or Jerusalem. Dostoyevsky provided neither an ontology nor any of the “pre-philosophical experiences” (EI 24) on which, according to Levinas, all philosophical thought rests. But he did give Levinas a way to think about art, religion, and, most importantly of all, ethics after the Holocaust, an event that more than any other, according to Levinas, demonstrated the absolute failure of philosophical theodicy. It was Dostoyevsky, I submit, rather than the Bible, the Greeks, or Kant who taught Levinas that the moral imperative, addressed to the singular existing individual, supersedes the religious imperative, whose validity is placed in question by the suffering of innocents and the absence of the all-powerful and providential God of theism. (shrink)

The emergence of Thanabots —artificial intelligence systems designed to simulate deceased individuals—presents unprecedented challenges at the intersection of artificial intelligence, legal rights, and societal configuration. This short policy recommendations report examines the legal, social and psychological implications of these posthumous simulations and argues for their prohibition on ethical, sociological, and legal grounds.