Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

I ask you to X. You now have a reason to X. My request gave you a reason. How? One unpopular theory is the epistemic account, according to which requests do not create any new reasons but instead simply reveal information. For instance, my request that you X reveals that I desire that you X, and my desire gives you a reason to X. Peter Schaber has recently attacked both the epistemic account and other theories of the reason-giving (...) force of requests. Schaber defends a new theory of the reason-giving force of requests according to which request give reasons because it is valuable for requesters and requestees that requests have this power. In this paper I argue that Schaber's attack on the epistemic account fails, and that his own theory ought to be rejected because it faces compelling objections. (shrink)

In The Alchemy of Race and Rights Patricia Williams notes that when people of color are asked to understand such practices as racial profiling by putting themselves in the shoes of white people, they are, in effect, being asked to, ‘look into the mirror of frightened white faces for the reality of their undesirability’ (1992, 46). While we often see understanding another as ethically and epistemically virtuous, in this paper I argue that it is wrong in some cases to ask (...) another to attempt to understand certain positions or lines of thought. In developing my argument I draw on the work of María Lugones to argue for a view of agency that is epistemically interdependent. I examine the case described by Patricia Williams to demonstrate specifically how the understanding requested in this case unfairly undermines both epistemic and non-epistemic agency. I distinguish appropriate requests for understanding from inappropriate requests so as to make clear that I am not suggesting that it is wrong to make such requests when the understanding sought after is difficult, painful, or even when it forces one to reconsider the meaning of one’s actions. Finally, I examine an example from Susan Brison to show how strategic refusals to understand may provide a pathway toward new ways of knowing and being in resistance to oppressive regimes. (shrink)

Although requests constitute a type of action that have been widely discussed within conversation analysis-oriented work, they have only recently begun to be explored in relation to the situated and multimodal dimensions in which they occur. The contribution of this paper resides in the integration of bodily-visual conduct (gaze and facial expression, gesture and locomotion, object manipulation) into a more grammatical account of requesting. Drawing on video recordings collected in two different hair salons located in the French-speaking part of Switzerland (...) and in France (23 h in total), this paper analyzes clients’ negative requests by exploring how they interface with the participants’ embodied conducts. Contrary to what the literature describes for positively formulated requests, with negative requests clients challenge an expectable next action (or ongoing action) by the hairdresser. One linguistic format constitutes the focus of this article, roughly glossable as ‘You don’t do [action X] too much (huh)’. Our analysis of a consistent collection of such formatted turns will show that clients present them (and hairdressers tend to treat them) in different ways, depending on how they relate to embodied conduct: When these turns are used by the client as instructions, they are accompanied by manipulations of the client’s own hair and tend to occur toward the initial phase of the encounter, at a stage when hairdressers and clients collaboratively negotiate the service in prospect. When uttered as directives, these turns are not accompanied by any touching practices from the client and are typically observable in subsequent phases of the encounter, making relevant an immediate linguistic or/and bodily response from the professional, as shown by the client who is actively pursuing mutual gaze with him/her. Therefore, an action cannot be distinguished from another on the basis of the turn format alone: Its sequential placement and the participants’ co-occurring embodied conduct contribute to its situated and shared understanding. By analyzing the clients’ use of a specific linguistic format conjointly with the deployment of specific embodied resources, this study will advance our understanding of how verbal resources and embodiment operate in concert with each other in the formation and understanding of actions, thereby feeding into new areas of research on the grammar-body interface. (shrink)

In the Netherlands, consent from relatives is obligatory for post mortal donation. This study explored the perspectives of relatives regarding the request for consent for donation in cases without donor registration. A content analysis of narratives of 24 bereaved relatives of unregistered, eligible, brain-dead donors was performed. Relatives of unregistered, brain-dead patients usually refuse consent for donation, even if they harbour pro-donation attitudes themselves, or knew that the deceased favoured organ donation. Half of those who refused consent for donation (...) mentioned afterwards that it could have been an option. The decision not to consent to donation is attributed to contextual factors, such as feeling overwhelmed by the notification of death immediately followed by the request; not being accustomed to speaking about death; inadequate support from other relatives or healthcare professionals, and lengthy procedures. Healthcare professionals could provide better support to relatives prior to donation requests, address their informational needs and adapt their message to individual circumstances. It is anticipated that the number of consenting families could be enlarged by examining the experience of decoupling and offering the possibility of consent for donation after circulatory death if families refuse consent for donation after brain-death. (shrink)

It has recently been reported that some hospitals in the UK have placed a blanket restriction on the provision of maternal request caesarean sections as a result of the COVID-19 pandemic. Pregnancy and birthing services are obviously facing challenges during the current emergency, but we argue that a blanket ban on MRCS is both inappropriate and disproportionate. In this paper, we highlight the importance of MRCS for pregnant people’s health and autonomy in childbirth and argue that this remains crucial (...) during the current emergency. We consider some potential arguments—based on pregnant people’s health and resource allocation—that might be considered justification for the limitation of such services. We demonstrate, however, that these arguments are not as persuasive as they might appear because there is limited evidence to indicate either that provision of MRCS is always dangerous for pregnant people in the circumstances or would be a substantial burden on a hospital’s ability to respond to the pandemic. Furthermore, we argue that even if MRCS was not a service that hospitals are equipped to offer to all pregnant persons who seek it, the current circumstances cannot justify a blanket ban on an important service and due attention must be paid to individual circumstances. (shrink)

On 23 September 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world to have an Act on euthanasia. Even though there is currently legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia.

Requests belong to a family of forms of social influence on action that appear problematic when employed in the attempt to directly influence belief. Explaining why this is so is more difficult than it might at first appear. The fact that belief is not directly subject to the will can only be part of the explanation. It must also be the case that requests are incapable of providing epistemic reasons in a way that parallels that in which they provide practical (...) reasons. I propose an account of the nature of requests that is in a position to explain why requests are incapable of doing this. (shrink)

A request to admit a hospital inpatient with motor neurone disease to the hospice generated unusual unease. Significantly, withdrawal of ventilation had already been planned. The presumption that ventilation would be withdrawn after transfer presented a dilemma. Should the hospice accept the admission? If so, should the hospice staff stop the ventilation, and then when and how? Debate centred on the continuity of best interests and the logistics of withdrawing ventilation. The factors making the request contentious identified competing (...) interests within hospice admission decision making that could detrimentally impact on patient care. (shrink)

Upon doing something generous for someone with whom you are close, some kind of reciprocity may be appropriate. But it often seems wrong to actually request reciprocity. This chapter explores the wrongness in making these requests, and why they can nevertheless appear appropriate. After considering several explanations for the wrongness at issue (involving, e.g. distinguishing oughts from obligation, the suberogatory, imperfect duties, and gift-giving norms), a novel proposal is advanced. The requests are disrespectful; they express that their agent insufficiently (...) trusts the hearer to recognize their own reasons to reciprocate, and the close relationship between them morally requires this kind of trust. This proposal is articulated and situated in the recent discussion of the normativity of requests. The chapter concludes by explaining how these requests may appear appropriate. Agents in these relationships often have standing to make requests, though the standing is lacking in these particular cases. (shrink)

This book addresses the relevance of Timaeus’s cosmology to Socrates’ request for a speech about war. Charles Ives finds relevance in the dialogue’s concern for education apropos of the medical dimensions of Timaeus’ physics, the project of becoming like god, and the philosophical soul responsible for success on the battlefield.

In the Laura Ashworth case in 2008, the Human Tissue Authority considered itself bound to overturn a deceased daughter's alleged wish that one of her kidneys should go to her mother, who at the time had end stage kidney failure and was on dialysis. 12 This was so even though Laura's earlier wish to be a living donor would most likely have been authorised, had the formal assessment process begun. The decision provoked much criticism. The recent Department of Health document (...) Requested Allocation of a Deceased Donor Organ, published 29 March 2010, developed by the UK health administrations together with the HTA and NHS Blood and Transplant , which is the main organ allocation body in the UK, seeks to resolve this ethical dilemma by setting out the circumstances in which requests for such deceased donations may be acceptable. 3 The most important conditions appear to be:a. the donation must be unconditional in nature;b. there must be …. (shrink)

In the Netherlands, in 2002, euthanasia became a legitimate medical act, only allowed when the due care criteria and procedural requirements are met. Legally, an Advanced Euthanasia Directive can replace direct communication if a patient can no longer express his own wishes. In the past decade, an exponential number of persons with dementia share a euthanasia request with their physician. The impact this on physicians, and the consequent support needs, remained unknown. Our objective was to gain more insight into (...) the experiences and needs of Dutch general practitioners and elderly care physicians when handling a euthanasia request from a person with dementia. We performed a qualitative interview study. Participants were recruited via purposive sampling. The interviews were transcribed verbatim, and analyzed using the conventional thematic content analysis. Eleven general practitioners and elderly care physicians with a variety of experience and different attitudes towards euthanasia for PWD were included. Euthanasia requests appeared to have a major impact on physicians. Difficulties they experienced were related to timing, workload, pressure from and expectations of relatives, society’s negative view of dementia in combination with the ‘right to die’ view, the interpretation of the law and AEDs, ethical considerations, and communication with PWD and relatives. To deal with these difficulties, participants need support from colleagues and other professionals. Although elderly care physicians appreciated moral deliberation and support by chaplains, this was hardly mentioned by GPs. Euthanasia requests in dementia seem to place an ethically and emotionally heavy burden on Dutch GPs and elderly care physicians. The awareness of, and access to, existing and new support mechanisms needs further exploration. (shrink)

Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS (...) arise in the context of what are called ‘Maternal Request Caesarean Sections’ (MRCS) and there is a good deal of support for the position that women who request PCS without clinical indication should be provided with them. Our argument goes further than support for acceding to requests for MRCS: we submit that healthcare practitioners caring for women with uncomplicated pregnancies have a positive duty to inform them of the option of PCS as opposed to assuming vaginal delivery as a default, and to provide (or arrange for the provision of) PCS if that is the woman's preferred manner of delivery. (shrink)

This paper defends the epistemic account of the normativity of requests. The epistemic account says that a request does not create any reasons and thus does not have any special normative power. Rather, a request gives reasons by revealing information which is normatively relevant. I argue that compared to competing accounts of request normativity, especially those of David Enoch and James H.P. Lewis, the epistemic account gives better answers to cases of insincere requests, is simpler, and does (...) a better job incorporating the importance of relationships. I also defend the epistemic account from three objections: that requests are important because they constitute consent, that requests and wishes must be normatively different, and that some requests do not provide any new information. (shrink)

Research in the fields of pragmatics has highlighted important differences in speech act realisation strategies and the perception of contextual variables across lingua-cultures. This particularly applies for requests, which are potentially face-threating acts and important expressions of cultural behaviour, as their performance is influenced by culturally-embedded perspectives on rights and obligations. Although some languages have been widely investigated in terms of request realisation, such as English, little research has been done on Italian. This study examines request realisation strategies (...) in Italian, in terms of Head Acts and request perspective, and the impact of the sociopragmatic factors of social distance and weight of imposition of the request on strategy choice amongst eight Italian speakers, by means of open-ended roleplays. The data was analysed by using a coding scheme based on Blum-Kulka and Olshtain and revealed that the Italian speakers where more influenced by social distance, which in turn impacted on the choice of request perspective. They were shown to prefer using hearer-orientation, which reflected in the verb conjugation of the Head Acts, since this perspective allows them to do relational work with the hearer, by either addressing the recipient with the familiar tu or with the formal lei. (shrink)

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia (...) or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

BackgroundMedical aid in dying was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two (...) Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend. (shrink)

Being able to ask others to do things, and thereby giving them reasons to do those things, is a prominent feature of our interpersonal lives. In this paper, I discuss the distinctive normative status of requests – what makes them different from commands and demands. I argue for a theory of this normative phenomenon which explains the sense in which the reasons presented in requests are a matter of discretion. This discretionary quality, I argue, is something that other theories cannot (...) accommodate, though it is a significant aspect of the relations that people stand in to one another, and the kinds of practical reasons that flow from those relations. (shrink)

This study examines the characteristics of request sequences in Chinese public service calls. The data analysis indicates that a prominent characteristic of Chinese public service calls is the frequent appearance of insert expansions and non-minimal post-expansions, with the latter occurring after both preferred response and dispreferred response. This is closely related to participants’ institutional identities and epistemic asymmetry; operators handling such service calls should pay due attention to this asymmetry to ensure mutual understanding in conversation.

This paper analyses video recorded interactions between police officers and drivers in traffic stops in Russia. The interactions were recorded via cameras installed on the drivers’ car dashboards, and subsequently uploaded to YouTube; a practice to which over one million Russian motorists have resorted to counterbalance perceived high levels of bribery and corruption. The analysis focuses on responses to opening requests for identification in five different encounters. These show that the drivers repeatedly engage in potentially interpersonally sensitive activities in which (...) the vulnerability of face, especially that of the police officer, is interactionally manifested by launching counter requests in return. The organisation of the request–counter request sequences highlights how face and identity related concerns are interwoven in the participants’ attempts to contest each other’s authority. (shrink)

In this paper, I examine connections between the speech acts of assertion, denial, polar questions and justification requests, and the common ground. When we pay attention to the structure of norms governing polar questions, we can clarify the distinction between strong and weak denial, together with the parallel distinction between strong and weak assertion, and the distinct way that these speech acts interact with the common ground. In addition, once we pay attention to the distinct norms concerning justification requests, we (...) can give a distinctive answer to Carroll’s puzzle concerning the force of the logical _must_ and the sense in which certain rules for logical concepts can indeed count as definitions. (shrink)

This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals (...) and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses. (shrink)

Background Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians’ attitudes toward assisted death vary across the globe, but little is known about physicians’ actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients’ requests for assisted death in countries where these actions are not legal. Methods A survey including statements concerning euthanasia (...) and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. Results Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. Conclusions Finnish physicians’ actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal. (shrink)

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must give (...) “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation passed by Parliament in March 2021 open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios. (shrink)

Objectives—While clinical practice is complicated by many ethical dilemmas, clinicians do not often request ethics consultations. We therefore investigated what triggers clinicians' requests for ethics consultation. Design—Cross-sectional telephone survey.Setting—Internal medicine practices throughout the United States.Participants—Randomly selected physicians practising in internal medicine, oncology and critical care.Main measurements—Socio-demographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results—One hundred and ninety of 344 responding physicians (55%) reported requesting (...) ethics consultations. Physicians most commonly reported requesting ethics consultations for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were: 1) wanting help resolving a conflict; 2) wanting assistance interacting with a difficult family, patient, or surrogate; 3) wanting help making a decision or planning care, and 4) emotional triggers. Physicians who were ethnically in the minority, practised in communities under 500,000 population, or who were trained in the US were more likely to request consultations prompted by conflict. Conclusions—Conflicts and other emotionally charged concerns trigger consultation requests more commonly than other cognitively based concerns. Ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations when consulting. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills. (shrink)

Use of normothermic regional perfusion (NRP) for organ recovery in donation after circulatory death (DCD) raises two crucial, and intertwined, ethical questions. The first is whether the use of NRP...

Several recent articles raise an issue long unaddressed in the medical literature: physician compliance with patient or family requests for futile or ineffectice therapy. Although they agree philosophically that such treatment ought not be given, most physicians have followed the course described by Stanley Fiel, in which a young patient dying of cystic fibrosis was accepted “for evaluation” by a transplant center even though he has already passed the threshold of viability as a candidate for a heart-lung transplant. Dr. Fiel (...) reported this action was taken not in the hope of doing the transplant but so that the family could assure themselves they had done “everything possible.” The patient, after a long and stressful cross-country flight, arrived at the hospital in respiratory failure. He died soon thereafter far from home and familiar surroundings. (shrink)

Background: An ongoing challenge for clinical ethics consultation is learning how colleagues in other healthcare professions understand, make use of, and evaluate clinical ethics consultation services. Aim: In pursuing such knowledge as part of clinical ethics consultation service quality assessment, clinical ethics consultation services can learn important information about the issues and concerns that prompt colleagues to request ethics consultation. Such knowledge allows for greater outreach, education, and responsiveness by clinical ethics consultation services to the concerns of clinician colleagues. (...) Design: This quality assessment project explores consultation requests and follow-up questionnaire responses voluntarily submitted from nurses who requested clinical ethics consultation. We present qualitative data analyzed using content analysis and constant comparison methods to identify key concerns that prompted requests as well as common themes among nurse requestors’ evaluations of what was most important in clinical ethics consultations. Participants and context: A total of 41 nurses requesting clinical ethics consultation and 15 who returned the follow-up questionnaire. Ethical considerations: Our Office of Research Compliance and Quality Improvement determined that our project was not considered human subjects research and so did not require institutional review board approval or exemption. However, efforts were made to avoid any sense of coercion and all data were de-identified prior to analysis. Findings: Our analysis revealed six main categories of issues that prompted nurses’ requests for ethics consultation, as well as unifying themes around nurses’ experiences, advocacy, and family support while caring for patients in the intersections of patients, families, and physicians. Discussion: The insights gained from analyzing nurses’ requests for and responses to clinical ethics consultation may serve as a resource for clinical ethics consultation services seeking to identify, respond to, and educate regarding issues of importance to nurse colleagues and may be a resource for nursing administrators and leadership seeking to identify and address common ethical issues nurses face. Conclusion: Ongoing work on clinical ethics consultation service quality improvement and engagement with our nursing colleagues about their concerns prompting—and their evaluations of—clinical ethics consultation are necessary. (shrink)

Reasons play an important role in social interaction. We study reasons-giving in the context of request sequences in Russian. By contrasting request sequences with and without reasons, we are able to shed light on the interactional work people do when they provide reasons or ask for them. In a systematic collection of request sequences in everyday conversation, we find reasons in a variety of sequential positions, showing the various points at which participants may orient to the need (...) for a reason. Reasons may be left implicit, or they can be made explicit. Participants may make reasons explicit either as part of the initial formulation of a request or in an interactionally contingent way. Across sequential positions, we show that reasons for requests recurrently deal with three possible issues: providing information when a request is underspecified, managing relationships between the requester and requestee and explicating ancillary actions implemented by a request. By spelling out information normally left to presuppositions and implicatures, reasons make requests more understandable and help participants to navigate the social landscape of asking assistance from others. (shrink)

Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. The argument of futility has often been used to justify unilateral decisions made by physicians to withhold or withdraw life-sustaining treatment. However, (...) we argue that neither the concept of futility nor that of patient autonomy alone is apt for resolving situations in which physicians are confronted with patients' requests for active treatment. Instead, we integrate the relevant arguments that have been put forward in the academic discussion about ‘futile’ treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families. (shrink)

Objective Having failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why. Methods Content analysis of applications for religious exemptions from influenza vaccination at a free-standing children’s hospital in Cincinnati, Ohio, USA during the 2014–2015 influenza season. Results Twelve of 15 260 employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical employees. All requestors (...) voluntarily identified their religious affiliation, and most were Christian. Content analysis identified six categories of reasons used to justify an exemption: risks/benefits, ethical/political, lack of direct patient contact, providence, purity and sanctity of life. Individuals articulated reasons in 1–5 categories. The most frequently cited category was purity; the vaccine and/or its mode of administration were impure, or receiving the vaccine would make the individual impure. Two individuals asserted that the vaccine contained cells derived from aborted human fetuses. Individuals also volunteered information supporting the sincerity of their beliefs including distress over previous vaccination and examples of behaviour consistent with their specific objection or their general religious commitment. All requests were approved. Conclusions Less than 0.1% of employees requested religious exemptions. Partnering with religious leaders and carefully correcting erroneous information may help address requestors’ concerns. (shrink)

In April 2002 a new law regarding euthanasia came into effect in the Netherlands. This law holds that euthanasia remains a criminal offence unless it is performed by a physician who acts according to six specified rules of due care and reports the case to a review committee. The six rules of due care are similar to those of the previous regulation and are largely based on jurisprudence. Completely new, however, is the article concerning a competent patient who has written (...) an advance directive requesting euthanasia under certain circumstances. The law stipulates that a physician may act according to that written request, as long as he or she fulfils all other rules of due care. The author defends the view that these requests are neither feasible nor ethically justifiable, and presents both moral and practical arguments for this, claiming that for consistency reasons one cannot act on the basis of a written statement and fulfil the other rules of due care at the same time. The author also examines a difficult case of a demented, severely depressed woman who had written a living will requesting euthanasia before she became demented. (shrink)

In this article we study the work and communication practices of two highly connected organizations, the members of which have all access to instant messaging on a professional basis. We document the development of a communicational genre, that of ‘quick questions’, and analyze the sequence organization of such IM conversation threads. We show how ‘quick questions’ enable the collaborative accomplishment of complex, knowledge-intensive tasks by recruiting colleagues constituted as experts capable of quickly answering information requests related to ongoing tasks. ‘Quick (...) questions’ articulate communicative practices, ‘strong’ distribution of tasks and ‘organizing’ in highly connected organizations. We argue that they enact a distinctive cognitive and moral economy based on minimal forms of interaction and exchanges, constituting a more general phenomenon. (shrink)

Although the topic has been extensively studied, many issues about understanding of indirect requests in children are still unsolved. Our contribution is to distinguish genuine and ironic hints, focusing on the latter. We examined the understanding of ironic hints and ironic imperatives in 5- to 9-year-old children and in adults, in various situational contexts. The main result of this study was that ironic hints were more difficult to understand than ironic imperatives only when the context was neutral. When the context (...) was ironic, there was no significant difference. Discussion highlights how context enables young children to understand very indirect requests like ironic hints. (shrink)