Religion may be an influential factor for care of terminally ill patients. Since there was no information of how Japanese religions thought of terminal care, a questionnaire survey was conducted among a total of 388 religious corporations, including 143 Shinto, 157 Buddhist, 58 Christian and 30 miscellaneous religious groups. Respondents were asked to answer questions based on their religious faith regarding a living will, and the introduction or withdrawal of life-sustaining treatments at the terminal stage. Results (...) showed that Japanese religions accepted the concept of living will and "being natural" at terminal care. Many corporations were critical about introduction of life-sustaining measures to the terminally ill patient, though some Shinto corporations were favorable to such acts. The Catholic policy denying extraordinary treatment was approved of by about three fourths of Shinto and Buddhist corporations. The present survey indicated that Japanese religions hold esteem in medicine. They advocate "being natural," when medical treatment becomes futile. Thus, religionists' views may facilitate to deepen and to expand discussion on this important issue among the general public. (shrink)

Our research on the texts of the Byzantine historians and chroniclers revealed an apparently curious phenomenon, namely, the abandonment of terminally ill emperors by their physicians when the latter realised that they could not offer any further treatment. This attitude tallies with the mentality of the ancient Greek physicians, who even in Hippocratic times thought the treatment and care of the terminally ill to be a challenge to nature and hubris to the gods. Nevertheless, it is a very curious (...) attitude in the light of the concepts of the Christian Byzantine physicians who, according to the doctrines of the Christian religion, should have been imbued with the spirit of philanthropy and love for their fellowmen. The meticulous analysis of three examples of abandonment of Byzantine emperors, and especially that of Alexius I Comnenus, by their physicians reveals that this custom, following ancient pagan ethics, in those times took on a ritualised form without any significant or real content. (shrink)

Immer mehr Menschen in der Schweiz praktizieren Yoga, glauben an eine Wiedergeburt und lassen sich komplementärmedizinisch behandeln. Barbara Zeugin untersucht, wie sich dieser religiöse Wandel auf die Begleitung am Lebensende auswirkt. Insofern alternative Formen von Religion in der Schweiz zunehmen, ist es nicht erstaunlich, wenn in der Begleitung am Lebensende auch alternativ-religiöse Praktiken und alternative Heilverfahren sowie die entsprechenden Rationalisierungen immer mehr an Bedeutung gewinnen. Die Rekonstruktion einer solchen, als alternativ aufgefassten Sterbebegleitungspraxis führte die Religionswissenschaftlerin erstens in ein Hospiz für (...) schwer Kranke und Sterbende und zweitens in ein anthroposophisch-medizinisches Spital, wo sie beobachtend und fragend den folgenden Fragen nachging: Welche alternativ-religiösen Handlungsformen und Rationalisierungen spielen in der Begleitung am Lebensende eine Rolle? Welche Bedeutung wird alternativen Heilpraktiken zugeschrieben? Wie sieht die konkrete Begleitungspraxis aus? Und worin besteht letztlich die Alternativität dieser Praxis resp. wie verhält sich diese zum Selbstanspruch der Palliative Care, die schwer Kranken und Sterbenden auch spirituell zu begleiten?"-- Back cover. (shrink)

The primary purpose of this study is to understand if/how patients of hospice healthcare require ‘Spiritual’ or/and ‘Religious’ assistance and if its involvement in palliative care helps greatly. We have built a correlative of two scales and administrated them on the same sample, along with complete demographics questions to a group of people under palliative care and several people directly connected with patients, relatives- families. This methodological study is designed to assess the reliability and validity of two scales (...) simultaneously for the same terminally ill patients (TIP): Paloutzian and Ellison’s (1982) Spiritual Well-being Scale. The scale was administered to 49 individuals, of which 45 are patients and 4 family members caring for a terminally ill relative. Background: Coping is a multifactorial and individual process related to responding to stressful situations, such as being a caregiver of a person with health conditions or terminal illness [such as in hospice]. Spiritual [S] / religious [R] coping is an essential internal resource used by individuals enduring stressful situations or, in this particular case, confronting imminent death. Instruments: The 14-item Brief RCOPE is widely used to assess religious coping. The other instrument we have used for S/R assessment is the Spiritual Well-Being (SWB) Scale, a general measure of the subjective quality of life. Neither one is available in the Romanian version Ciocan Tudor-Cosmin (2023) developed following Romanian culture. He worked with Professor Ray Paloutzian - author of the latter scale - to translate and validate the use of the translated scales. Objective: To investigate the S/RWB among palliative care patients in Romania and to identify the correlates of Spiritual and Religious Well-Being. Secondary: To translate, adapt and validate both the 14-item Brief RCOPE and SWBS in Romanian for caregivers of palliative patients facing death. Method: The methodological guideline provided by Ray Paloutzian and Craig W. Ellison was used to examine the psychometric properties of SWBS, while the manual provided by Kenneth Pargament on his website helped us accommodate the Brief RCOPE to Romanian culture and understanding. Results: The linguistic and conceptual equivalence of the scales was determined. The internal consistency was acceptable (Cronbach’s a = 0.891 for SWBS and a = 0.798 for RCOPE). The Principal Axis Factor (PAF) analysis with varimax rotation identified two factors comprising 13 items, and one item was excluded from the scale (14/RCOPE). The faith subscale (SWBS) showed similar distributions. Christians engaged in religious activities reported higher SWB in the meaning and peace subscale than patients without religious attendance. In the multivariate analysis, religious Frequency (P < 0.001), and individual spiritual activities (P < 0.003) were significantly related to a greater SWB. Conclusion: The Romanian versions of the SWBS and Brief RCOPE are reliable and valid measures for assessing both the spiritual and religious coping of patients in hospice, their families, and their caregivers. Although faith practices may be beneficial to improve spiritual well-being among Orthodox Christians (the majority in Romania), further research is needed to determine what individual spiritual activities can be supported by Orthodox Christians positively engaged – since they are very skeptical about practices other than religious ones, introduced by the traditional Church. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Seventh International Buddhist-Christian Conference:"Hear the Cries of the World"Darnise C. MartinThe SBCS Seventh International Conference honoring the ongoing Buddhist-Christian dialogue was hosted by Loyola Marymount University, June 3–8, 2005. The campus provided a picturesque and temperate backdrop to conversations, workshops, worship experiences, musical performances, and academic sessions inspired by the theme, "Hear the Cries of the World." This focus shaped our time together as we discussed issues, both (...) old and new, that continue to polarize our world and ways in which we might heal and grow into more holistic ways of being.Loyola Marymount University was pleased to welcome more than 120 participants from close to home and around the world. In addition to representation from many parts of the United States, we also had guests from Japan, Belgium, Germany, Korea, and Sweden. With such a diverse group having a range of needs and concerns, I was heartened to receive positive feedback from all of our attendees, who expressed their satisfaction with the programming and events as well as the general logistics, organization, and staff accessibility throughout the conference.The conference got underway with bittersweet opening ceremonies. We began with words of welcome to our international group, as well as expressions of sadness at the loss of David Chappell, founding member of the Society for Buddhist-Christian Studies. David's memory was lifted up in the presence of his family, dear friends, and colleagues. The Society will carry on his work of dialogue, healing, and reconciliation.The conference had many highlights. One of the most notable features of the conference was the visually and musically stunning dance performance by Viji Prakash, [End Page 185] acclaimed international choreographer and dancer. Her dance troupe, Shakti Dance Company, performed "From Prince to Buddha: A Journey to Enlightenment," an energetic production based on the life of the Buddha. The audience was thoroughly enchanted and entertained by this performance.The academic sessions offered many and varied expressions of the theme, "Hear the Cries of the World." Scholars, activists, and clergy came together to present papers and personal experiences around issues of ecological healing, prison ministry, youth outreach, women's responses to poverty and injustice, as well as the traditional figures of compassion, the Virgin Mary, Kuan Yin, and the way of the Bodhisattva.In particular, our group was intensely moved through an evening presentation on prison ministry presented by two people working intimately in the area of bringing compassion to this field. One presenter was Fleet Maull, founder of the Prison Dharma Network and the National Prison Hospice Association, who has been in the prison system as an inmate himself. He shared the experiences that led to his incarceration as well as the dehumanizing ways in which people are treated as inmates. He spoke of meditation as a tool by which prisoners may develop awareness and regain their humanity, even if for only brief moments. These moments can maintain hope for people who otherwise would have none. Maull, who was ordained a Buddhist priest while in prison, began a ministry to provide hospice care to terminally ill inmates, a ministry that has continued after his release through a growing network of participating prisons.The second presenter, Beth Ross of First African Methodist Episcopal (FAME) Church in Los Angeles, also discussed her work as part of the church's prison ministry outreach. Ross spoke about ministering not only to the person in prison, but also to the family of the inmate. Each has particular needs. The church has responded to prisoners' needs to not feel abandoned and isolated by instituting a letter-writing campaign. She said this helps people stay connected to a community and begin to heal. The church also provides re-entry support as prisoners are released and need to find housing and employment. Ross advocates for these former inmates needing a second chance. Without help, she notes, they are destined to commit further crimes against society and return to prison. FAME hopes to be a beacon of hope to these former prisoners.This was a powerful session for everyone. Speaking for myself, I had often thought about how society permanently demonizes former inmates. What chance do... (shrink)

Syme, Rodney Palliative care, founded by Cicely Saunders, a devout Christian, has grown from a single London hospice to a world-wide specialty with strong government support. It is one of the most important developments in modern medicine. It aims to provide compassionate and holistic care for the terminally ill. Nevertheless opposition on religious grounds to assisted-dying or hastening of death has been a core principle of palliative care from its origin, and persists today.

End-of-life debates in medical ethics often centre around several interrelated issues: improving care, avoiding coercion, and recognising the dignity and rights of the terminally ill. Care ethics advocates relational autonomy and non-abandonment. These commitments, however, face system pressures—economic, social and legal—that can be coercive. This article takes up two related aspects in this domain of ethics. Firstly, that competence and communication are core clinical ethics principles that can sidestep the overplayed dichotomies in end-of-life care. And secondly, it (...) questions the assumption that advance directives are universally benevolent—comparing the provisions of the Council of Europe’s 1999 recommendations on protection of human rights and dignity of the dying within the framework of the Irish context. The article also registers the unintended impacts of changing legal frameworks in relation to euthanasia and assisted suicide in Europe, including recent proposals in the Netherlands. A focus on human dignity can provide a theologically and philosophically shared normative orientation that argues for present directives rather than only advance directives, and a presumption in favour of ‘living up to death’. Dignity approaches not only grant rights but secure them by supporting ongoing initiatives that honour, rather than erode, the ‘longevity dividend’. (shrink)

When thinking about the intersection of care and Christian bioethics, it is helpful to follow closely the account of Ruth, who turned away from security and walked alongside her grieving mother-in-law to Bethlehem. Remembering Ruth may help one to heed Professor Kaveny?s summoning of Christians to remember ?the Order of Widows? and the church?s historic calling to bring ?the almanahinto its center rather than pushing her to its margins.? Disabled, elderly and terminally ill people often seem, at least implicitly, (...) expendable. By hearing the scriptural account of Jesus? steadfast great-grandmother, readers may recall another way. One may read Ruth?s care for Naomi as a performative, prophetic act of faith. Ruth?s faithful resolve, when set next to Orpah?s prudent way, challenges the notion that a bioethic of care is innately feminine, and may further call women and men corporately to participate in a kind of care that is strenuous work. My thanks to Cathleen Kaveny for allowing me to play off the title of her insightful essay. Thanks also to Willie James Jennings, whose 1998 baccalaureate sermon on Ruth inspired and much informed this essay. I wish also to thank Ellen Davis, who taught me to read Hebrew, and to read Ruth. (shrink)

A theology of accompaniment offers insights on how to journey with and be present to those who suffer from terminal illness. In order to sustain acts of accompaniment, the companion must cultivate specific virtues through prayer and the practices of the Christian community. This ethic of accompaniment is based on a Thomistic conceptualization of the virtues of charity and fortitude. These virtues enable the companion to engage in four types of practices with and on behalf of the dying patient. (...) Ethical accompaniment offers the following contributions to end-of-life care, the companion can function as a healthcare proxy, offers a viable alternative to physician-assisted suicide, and overcomes the loss of meaning associated with death through the Christian narrative. (shrink)

Medicine often views hospice care as “giving up,” which results in a reduced quality of end-of-life care for many patients. By integrating a theology of the Sabbath with modern medicine, hospice becomes a sacred and valuable way to honor the dying patient in a comprehensive and holistic way. A theology of Sabbath as “Sacredness in Time” can provide the foundation for a shift in understanding hospice as a legitimate care plan, which shifts the focus from controlling and (...) manipulating space for the body, to rest and enjoyment of time for the whole person. First, I explore vitalism and its negative effects on the institution of hospice. Second, I address the main misconceptions and biases surrounding hospice in order to establish hospice as an appropriate option for the terminally ill. Finally, I argue for a shift away from sacredness in space (as seen in vitalism) to sacredness in time. (shrink)

A lot of medical procedures can be justified in terms of the number of quality-adjusted life-years (QALYs) they can be expected to generate; that is, the number of extra years that the procedure will provide, with the quality of life during those extra years factored in. QALYs are a crude tool, but good enough for many decisions. Notoriously, however, they cannot justify spending any money on terminal care (and indeed on older people in general). In this paper I (...) suggest a different way of construing ‘quality’ (as meaningfulness rather than physical comfort) and ‘life’ (as both backward-looking and forward-looking), so that the terminal patient's efforts to find meaning in his life could in principle generate plenty of ‘retrospective QALYs’ to justify funding. (shrink)

In this paper, a personalist ethical perspective on end-of-life care of severely ill newborns is presented by posing two questions. (1) Is it ethically justified to decide not to start or to withdraw life-sustaining treatment in severely ill newborns? (2) Is it ethically justified, in exceptional cases, to actively terminate the life of severely ill newborns? Based on five values—respect for life and for the dignity of the human person, quality of life, respect for the process of dying, relational (...) autonomy, and justice—an ethical assessment is conducted that brings us answers to the two ethical questions. (1) Noninitiation or withdrawal of life-sustaining medical treatment in severely ill newborns is ethically acceptable, and might even be a moral duty, when initiation or continuation of medical treatment can be considered futile or even harmful. (2) However, according to the personalist approach, it is not ethically acceptable to actively terminate the life of a severely ill newborn. (shrink)

A Christian ethicist discusses such problems as organ transplants, caring for the terminally ill, and defining death.

The breaking of bad news in a hospital setting, particularly to patients in a terminal condition, highlights some complex and often emotive ethical issues for nurses. One theory that examines the way in which individuals react to bad news such as a terminal illness, is the theory of awareness contexts. However, this theory may be limited by failing to recognize the complexity of the situation and the ethical issues involved for nurses caring for terminally ill patients. Furthermore, contexts (...) of awareness are influenced to a much greater extent by relationships with nurses than simply by the delivery of medical information. Even when information is given to the client and the family, the nurse is involved in helping them to know the meaning of this information. In a hospital, the nurse is faced with emotional demands by clients, families and colleagues, complex issues of advocacy, and professional boundaries and responsibilities. It is the author’s wish to examine the reality of clinical practice for nurses, thus further extending the theory of awareness contexts. (shrink)

The nursing profession in Germany is facing a public debate on legal and ethical questions concerning euthanasia on request and physician-assisted suicide. However, it seems questionable if the profession itself, individual nurses or the professional associations are prepared to be involved in such a public debate. To understand this hesitation, the present situation is considered in the light of the tradition and history of professional care in Germany. Obedience to medical as well as to religious authorities was long part (...) of nurses' professional identity, but is no longer relevant. The lack of reflection and discussion on how to take a balanced view of ethical and political questions concerning nursing, and the role and responsibility of nurses in end-of-life decisions and situations of caring for dying people are discussed using the situation of nurses in the Netherlands as a comparison. (shrink)

Orthodox Christian ethics is grounded in the sacredness of life principle. Yet, it can accept a quality of life approach where “quality” refers not to capacities or states, but to the relationship between the patient's condition and the quest for transcendent life goals (Walter and Shannon, 1990). The true quality of human life derives from the vocation to stewardship, which enjoins an attitude of humble acceptance toward beneficial or “redemptive” suffering. The proper response to suffering in terminal cases is (...) not active euthanasia or physician-assisted suicide but appropriate pain management and personal care. In cases of PVS or deep coma, only the determination of higher brain death can warrant the withholding or withdrawing of food and hydration. Yet, artificial maintenance of biological existence is also immoral. Death is to be accepted and embraced as a transition to eternal life. (shrink)

Contemporary Christian ethics encounters the challenge to communicate genuinely Christian normative orientations within the scientific debate in such a way as to render these orientations comprehensible, and to maintain or enhance their plausibility even for non-Christians. This essay, therefore, proceeds from a biblical motif, takes up certain themes from the Christian tradition (in particular the idea of social justice), and connects both with a compelling contemporary approach to ethics by secular moral philosophy, i.e. with Axel Honneth's reception of Hegel, as (...) based on Hegel's theory of recognition. As a first step, elements of an ethics of recognition are developed on the basis of an anthropological recourse to the conditions of intersubjective encounters. These conditions are then brought to bear on the idea of social justice, as developed in the social-Catholic tradition, and as systematically explored in the Pastoral Letter of the United States Conference of Catholic Bishops, Economic Justice For All (1986). Proceeding from this basis, aspects of a Christian ethics of community service with regard to long-term care can be defined. (shrink)

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, (...) in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective. (shrink)

This article deals with making decisions about starting terminal care. The results are part of a larger survey on nurses’ conceptions of terminal care in community health centres in Finland. The importance, frequency and timing of decision making as well as communication and the number of investigations and procedures carried out are examined. The relationship between decision making and the size of a health centre’s catchment population is also discussed. The results make it possible to compare (...) the current situation in Finland with the national law on patients’ rights. The sample consisted of 328 nurses who worked on the wards of 32 community health centres. The data were collected by means of a structured questionnaire and processed with the Statistical Package for Social Sciences software. The nurses agreed that explicit decision making and documentation about starting terminal care were necessary, but it was highlighted that the practice had many shortcomings. Decisions were often made too late and the patients were not always aware of their situation; family members and the nursing staff were mostly better informed. It was noted that many investigations and other procedures were carried out on terminally ill patients, often at the request of family members. Decision making was found to have some relationship to the size of a health centre’s catchment area. (shrink)

The notion of the best interest of children figures prominently in family and reproductive policy discussions and there is a considerable body of empirical research attempting to connect the interests of children to how families and society interact. Most of this research regards the effects of societal responses to perceived problems in families, thus underlying policy on interventions such as adoption, foster care and temporary assumption of custodianship, but also support structures that help families cope with various challenges. However, (...) reference to the best interest of children can also be applied to a more basic issue in family policy, namely that of what is to be considered a family in the first place. This issue does not raise any questions regarding the proper conditions for when society should intervene in or change the family context of a child. Rather, it is about what social configurations should be recognized as a potentially fitting context for children to enter into and (if all goes well) eventually develop into adulthood within /.../ such that society’s default institutional arrangements allow it to have (by sexual and artificial reproduction, adoption, and combinations of these), care for and/or guard children. [This] will frame any further discussion of /.../ policies having further implications for, for example, the practices of adoption and reproductive technology, as well as regulation of custody in the event of separation or parental disagreement. (shrink)

Relational views of equality put forward a social and political ideal of equality that aims at being a better interpretation of what social justice requires than the prevailing distributive conceptions of equality, especially luck egalitarian views. Yet it is unclear what social justice as relational equality demands in distributive terms; Elizabeth Anderson's view seems to vacate a large part of the terrain of distributive justice in favor of a minimalist, sufficiency view. Against that, this paper argues that relational equality, properly (...) understood, requires setting stringent limits to distributive inequality, for both intrinsic and instrumental reasons. First, the relational egalitarian conception of society as a cooperative enterprise among equals gives rise to a presumption of equality in socially produced goods (and bads); inequalities in these goods have to be justified by justice-relevant reasons. Second, relational egalitarianism also delivers instrumental reasons to limit inequalities in income, wealth, and opportunities, because such inequalities may generate both opportunities for domination and inegalitarian status norms that threaten the social bases of self-respect of the worse off. (shrink)

In his important recent book, Aaron James has defended a principle ? Collective Due Care ? for determining when a form of economic integration is morally objectionable because it causes unjustified harm (including unemployment, wage suppression and diminished working conditions). This essay argues that Collective Due Care would yield implausible judgements about trade practices and would be too indeterminate to play the practical role for which it is intended.

Jennifer Nado has recently argued that conceptual engineers should focus on (re-)designing representations and may safely ignore issues of implementation. I make a general case for the methodological importance of implementation to conceptual engineering. Using the Social Norms Account as a foil, I argue for three claims. (1) Inquiring into methods of implementation is a theoretically challenging and philosophically worthwhile project in and of itself. (2) A sound theoretical understanding of implementation is imperative for theorists of conceptual engineering. It proves (...) vital for their assessment of the prospects for engineering interventions and the political risks inherent in them. (3) A sound theoretical understanding of implementation is imperative for practitioners of conceptual engineering. The usefulness of their representational (re-)designs depends on respecting broadly cognitive and social constraints on the part of the target population. I conclude that conceptual engineers have very good reasons to seriously engage with issues of implementation. (shrink)

Objectives: Treatment decisions in ethically complex situations are known to depend on a physician's personal characteristics and medical experience. We sought to study variability in decisions to withdraw or withhold specific life-supporting treatments in terminal care and to evaluate the association between decisions and such background factors.Design: Readiness to withdraw or withhold treatment options was studied using a terminal cancer patient scenario with alternatives. Physicians were asked about their attitudes, life values, experience, and training; sociodemographic data were (...) also collected.Setting: Finnish physicians, postal survey.Survey sample: Five hundred general practitioners, 300 surgeons, 300 internists, and 82 oncologists.Results: Treatments most often forgone were blood transfusion and thrombosis prophylaxis . Least willingly abandoned were intravenous hydration and supplementary oxygen . Female doctors were less likely to discontinue thrombosis prophylaxis and supplementary oxygen , but more readily x ray and laboratory examinations. Young doctors were more likely to continue antibiotics , thrombosis prophylaxis , supplementary oxygen and laboratory tests . Oncologists comprised the specialty most ready to forgo all studied treatments except antibiotics and blood transfusion. The family's wishes significantly increased treatment activity. Young and female practitioners and oncologists were most influenced by family appeal. Advance directives made decisions significantly more reserved and uniform. Different factors in the physician's background were found to predict decisions to withdraw antibiotics or IV hydration.Conclusion: The considerable variation observed in doctors' decisions to forgo specific life-sustaining treatments was seen to depend on their personal background factors. Experience, supervision, and postgraduate education seemed to be associated with more reserved treatment decisions. To increase the objectivity of end of life decisions, training, and research are of prime significance in this ethically complex area of medicine. (shrink)

Definition of the problemMedical and nursing care often takes place within complex organizational structures that comprise numerous facilities at numerous locations. We introduce an interactive ethical concept, designed in cooperation with the diaconal foundation BruderhausDiakonie Reutlingen and the International Centre for Ethics in Science, University of Tübingen, to address the particular needs of such organizations.ArgumentsTherefore we portray the interactive Nijmegen Model which combines an ethics committee located at the management level and situational ethical case deliberations on the ward in (...) order to bring together two indispensable ways of ethical reflection in organizations: “top-down”/“bottom-up”. We illustrate the challenges of implementing the said model into the organizational construction of the BruderhausDiakonie and how to address these by means of conception and implementation.ConclusionConsidering the implementational challenges that we encountered, the Nijmegen Model needs to be enhanced by introducing a link between the committee and the case deliberations. We delineate the basic elements and the requirements for such a position while reporting our initial practical experience with this model. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and (...) psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

Chaplains who serve in a clinical context often minister to patients representing a wide variety of faiths. In order to offer the best pastoral care possible, the chaplain should first possess a set of personal theological convictions as a foundation for ministry. Second, he or she needs to be sensitive to the beliefs and practices of the patients. Third, it is vital to develop a relationship of acceptance and trust not only with patients under their care, but also (...) with family members and caregivers as well. At times, situations will arise that are purely religious or theological. In a clinical setting, however, the questions and problems that arise more often are both theological and ethical. It is beneficial for the chaplain to be involved in an ethics committee, where the specifics of each case can be discussed, and staff can offer counsel to patients and their families. This study examines issues that chaplains face at the bedside, such as terminal care, life-prolonging treatments, dementia, persistent vegetative state, and euthanasia/assisted suicide. We will discover that those who are involved in clinical pastoral ministry will be called upon to be a comforter, mediator, educator, ethicist, and counselor. (shrink)

The aim of this article is to explore the spatial constitution of the university today, its relation to Bildung in the university, and the way that changes of the universities are conceptually articulated or even programmatically demanded. In the first part of the article, the concept of the so-called ‘non-places’ advanced by the French ethnologist Marc Augé is used in order to set a conceptual framework for reflecting on the place of the university. In the second part of the article, (...) it is demonstrated that the university is currently being reshaped as a non-place and more specifically, as a transit lounge. Using the example of Minerva University, it is shown how mobilization, optimization, and functionalization of learning become dominant at the expense of forming its own place. In the third part of the article, the relations between Bildung and place are reflected on following Ronald Barnett’s ecological approach of the university. In this approach, care and curation are central, as is shown in the final part of the article. (shrink)

Introduction -- Entering the world of medicine: contexts -- Why bioethics needs a philosophy (and theology) of medicien -- Perspectives on philosophy of medicine -- Perspectives on theology of medicine -- Finding the target: Messer's theology of health -- A philosophical-theological framework for medicine -- Human vulnerability and the goods of medicine -- Re-engaging the world of medicine: applying philosophy and theology of medicine.

In this paper it is argued that courts must, where appropriate, take into account the fact that National Health Service hospitals are under‐funded when they determine the standard of care owed by such hospitals and their professional staff to patients. Although this suggestion is inconsistent with the traditional view of the courts, its adoption would bring negligence cases into harmony with judicial review decisions. It would also cohere with a new understanding of accident causation within complex organisations, which suggests (...) that many of the injuries suffered by patients in under‐funded hospitals are the result of systemic failures that cannot necessarily be attributed to those who are the last actors in the causal chain leading to damage. (shrink)

The practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with “genomic medicine” nor with “precision medicine”, but with “data medicine”. The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors: biobanks, databases, bioinformatic platforms and genomic platforms. The “transformation” of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties has generated a new vision (...) of care. Molecular tumor boards are one response to these changes and are now providing better access to next-generation sequencing and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge: maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent documents at all academic medical centers and to introduce dynamic and electronic informed consent. (shrink)

Integrity, honesty, and truth seeking are important virtues that most people care about and want to see promoted in society. Yet surprisingly, there has been relatively little work among scholars today aimed at helping us better understand this cluster of virtues related to truth. This volume incorporates the insights and perspectives of experts working in a variety of disciplines, including philosophy, law, communication and rhetorical studies, theology, psychology, history, and education. For each virtue, there is a conceptual chapter, an (...) application chapter, and a developmental chapter. The resulting volume significantly deepens our knowledge about and appreciation for these central virtues. (shrink)

Christiane Bailey | : Distinguant deux sens de « communauté morale », cet article soutient que certains animaux appartiennent à la communauté morale dans les deux sens : ils sont des patients moraux dignes de considération morale directe et équivalente, mais également des agents moraux au sens où ils sont capables de reconnaître, d’assumer et d’adresser aux autres des exigences minimales de bonne conduite et de savoir-vivre. Au moyen de la notion d’« attitudes réactives » développée par Peter F. Strawson, (...) je soutiens que les animaux sociaux qui sont à la fois objets et sujets d’attitudes réactives forment des communautés morales au second sens, dans la mesure où ils se traitent mutuellement comme des individus ayant des obligations et tenus à des exigences de bonne volonté minimale dans leurs interactions interpersonnelles. Distinguant l’agentivité morale du raisonnement moral, je soutiens que la capacité de raisonner abstraitement sur les principes et les conséquences de nos actions nous imposent plus de responsabilités que n’en ont d’autres animaux, mais que cela ne fait pas nécessairement de nous des agents moraux plus compétents que d’autres animaux sociaux. Je termine en donnant un aperçu de quelques implications de ce changement de perspective en éthique animale. | : This article draws the distinction between two meanings of “moral community” and maintains that certain animals belong to moral communities in both senses of the term: these animals are moral patients worthy of direct and equivalent moral consideration, but also moral agents in the sense that they are capable of recognizing and respecting minimal requirements of good conduct and manners as well as expecting and demanding the same from other members of their community. By way of the notion of “reactive attitudes” developed by Peter F. Strawson, I maintain that social animals who are at once objects and subjects of reactive attitudes constitute moral communities in the second sense of the term, in that they treat each other as individuals who have obligations and who are bound by the demand for a minimum of good-will in their interpersonal interactions. Distinguishing between moral agency and moral reasoning, I maintain that the capacity to reason abstractly about the principles and consequences of our actions gives us more responsibilities than other animals have, but that this does not necessarily make us more competent moral agents than other social animals. I conclude with an overview of some of the implications that this change in perspective has for animal ethics. (shrink)

Critics sometimes claim that Catholic moral principles unreasonably oblige patients to adopt life-preserving medical treatments “at all costs,” even when the treatments are excessively burdensome or futile and when their adoption may badly disadvantage patients’ family members or caregivers. The author argues that this is a mischaracterization. Because of obligations arising from our relationships, not only is it sometimes licit to refuse lifesustaining medical care, but we sometimes have a duty to refuse it. This is the case when the (...) treatments are morally extraordinary and when adopting them would unfairly disadvantage someone for whom we have responsibility. The author argues that this conclusion is not inconsistent with the duty we have to properly care for our own lives or with moral principles prohibiting self-killing. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 621–630. (shrink)

Cases involving amoralists who no longer care about the institution of morality, together with cases of depression, listlessness, and exhaustion, have posed trouble in recent years for standard formulations of motivational internalism. In response, though, internalists have been willing to adopt narrower versions of the thesis which restrict it just to the motivational lives of those agents who are said to be in some way normal, practically rational, or virtuous. My goal in this paper is to offer a new (...) set of counterexamples to motivational internalism, examples which are effective both against traditional formulations of the thesis as well as against many of these more recent restricted proposals. (shrink)

This volume brings together a collection of essays on the philosophy of love by leading contributors to the discussion. Particular emphasis is placed upon the relation between love, its character and appropriateness and the objects towards which it is directed: romantic and erotic partners, persons, ourselves, strangers, non-human animals and art. It includes contributions by Aaron Ben Ze’ev (‘Ain’t Love Nothing but Sex Misspelled?’), by Angelika Krebs (‘Between I and Thou – On the Dialogical Nature of Love’), Aaron Smuts (‘Is (...) it Better to Love Better Things?’) and Jan Bransen (‘Loving a Stranger’). By focusing upon the different objects of love, and how the lover enters into a relation with them, the collection pushes beyond the recent debates on reasons for love and breaks new and important ground. (shrink)