Objective: Cognitive impairment is a common neurological complication in patients with end-stage renal disease undergoing maintenance hemodialysis. Brain network analysis based on graph theory is a promising tool for studying CI. Therefore, the purpose of this study was to analyze the changes of functional brain networks in patients on MHD with and without CI by using graph theory and further explore the underlying neuropathological mechanism of CI in these patients.Methods: A total of 39 patients on MHD and 25 healthy controls (...) matched for age, sex, and years of education were enrolled in the study. Resting-state functional magnetic resonance imaging and T1-weighted high-resolution anatomical data were obtained, and functional brain networks for each subject were constructed. The brain network parameters at the global and regional levels were calculated, and a one-way analysis of covariance was used to compare the differences across the three groups. The associations between the changed graph-theory parameters and cognitive function scores in patients on MHD were evaluated using Spearman correlation analysis.Results: Compared with HCs, the global parameters [sigma, gamma, and local efficiency ] in both patient groups decreased significantly. The clustering coefficient in patients with CI was significantly lower than that in the other two groups. The regional parameters were significantly lower in the right superior frontal gyrus, dorsolateral and gyrus rectus of patients with CI than those of patients without CI; however the nodal local efficiency in the left amygdala was significantly increased. The global Cp and regional parameters in the three brain regions were significantly correlated with the cognitive function scores.Conclusion: This study confirmed that the topology of the functional brain network was disrupted in patients on MHD with and without CI and the disruption of brain network was more severe in patients with CI. The abnormal brain network parameters are closely related to cognitive function in patients on MHD. (shrink)

"Dying in the City of Blues: Sickle Cell Anemia and the Politics of Race and Health" by Keith Wailoo is reviewed.

The one thing that is at once most predictable and unpredictable about life is death. Yet, man lives, forgetting death as if he were immortal. Between these two -- a visible manifestation of death and an innate sense of immortality -- hangs the balance of life, a paradox which we do not easily understand. What if death is not an end, but a passage to another life? What if rebirth is not about retribution, but is a form of evolution? What (...) if life and death are not opposites but work towards a common goal? There must be a larger picture, a missing piece of the puzzle to complete the story and make our understanding whole. How should we deal with trauma and loss, suffering and pain and other ethical and existential issues? This is an attempt to find answers to these and many other related issues, theoretically and practically, supported by anecdotes and experiences arising from brushes with death. (shrink)

Explores the moral struggles, political intrigues and violent vendettas that enmeshed Seneca, the ancient Roman writer and philosopher, in the brutal daily lives of the imperial family and the regime of his student, Nero.

Maung argues that an externalist understanding of mental disorder exposes how, if society was more just for the most deprived, patterns of access to assisted dying might be different. I counter that reducing inequality lacks relevance to the immediate permissibility of assisted dying for mental disorder, owing to the need for solutions for those in distress. I suggest that the question of assistance in death for mental disorders is one of pragmatic politics, not for obfuscatory philosophy.

The question of what might constitute “good dying” is a sensitive subject that is being discussed and is socially and politically controversial. My contribution discusses whether a reference to concepts such as autonomy and dignity in the debate over suicide and euthanasia is in fact convincing. Important impulses for the train of thought stem from Kantian philosophy. I will argue that suicide, as presented by Kant, is not an expression of autonomy, but exactly the opposite: an expression of heteronomy.

This introduction to the Queer Death Studies special issue explores an emerging transdisciplinary field of research. This field critically, reflexively and affirmatively investigates and challenges conventional normativities, assumptions, expectations, and regimes of truths that are brought to life and made evident by current planetary scale necropolitics and its framing of death, dying and mourning in the contemporary world. It is set against the background of traditional engagements with the question of death, often grounded in Western hegemonic and normative ideas (...) of dying, dead and mourning subjects and bodies, on the one hand; and on the other contemporary discourses on human and nonhuman death and extinction, directly linked to the environmental crisis, capitalist and post/colonial extractivist necropolitics, material and symbolic violence, oppression and inequalities, and socio-economic, political and ecological unsustainabilities. By bringing together conceptual and analytical tools grounded in feminist materialisms and feminist theorising broadly speaking, queer theory and decolonial critique, the contributions in this special issue strive to advance queerfeminist methodologies and ontological, ethical and political understandings that critically and creatively attend to the problem of death, dying and mourning in the current environmental, cultural, and socio-political contexts. (shrink)

Shavelson and colleagues (2023) describe how medical aid-in-dying laws in the United States prohibit assistance in administering aid-in-dying medication. This prohibition distinguishes aid in dying...

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify (...) ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

The purpose of this paper is to identify a kind of discrimination that has hitherto gone unrecognised. ‘Terminalism’ is discrimination against the dying, or treating the terminally ill worse than they would expect to be treated if they were not dying. I provide four examples from healthcare settings of this kind of discrimination: hospice eligibility requirements, allocation protocols for scarce medical resources, right to try laws and right to die laws. I conclude by offering some reflections on why (...) discrimination against the dying has been hard to identify, how it differs from ageism and ableism, and its significance for end-of-life care. (shrink)

The claim that the Resurrection of Jesus is historical fact is often justified on the basis that the disciples died for the belief. I analyze the argument, and show that three key premises cannot be accepted. The first is the claim that the disciples died for their beliefs. I give a detailed analysis of what is involved in dying for a belief in this context, and show that we have no assurance that the disciples died for their beliefs in (...) that sense at all. The second is that the disciples could not have been sincerely mistaken, and the third is that the beliefs of the disciples were those attributed to them by apologists. I suggest that neither of these premises can be established with any certainty. (shrink)

Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late‐stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. (...) The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day‐to‐day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms. (shrink)

La revolución darwiniana, lejos de ser algo ya superado, como a veces se pretende, aún no ha concluido del todo. Y no ha concluido porque todavía nos falta una adecuada explicación darwinista de uno de los aspectos fundamentales de los seres vivos. Tenemos explicaciones darwinistas de cientos, quizás de miles de rasgos adaptativos, pero aún no contamos con una explicación bien establecida del origen y desarrollo evolutivo de las capacidades cognitivas en aquellos seres vivos que las poseen, y muy en (...) particular del origen y desarrollo evolutivo de la mente humana. Este libro analiza las principales hipótesis que han elaborado los científicos al respecto e intenta obtener algunas conclusiones filosóficas relevantes a partir ellas y de los datos sobre las que se sustentan. Antonio Diéguez es catedrático de Lógica y Filosofía de la Ciencia en la Universidad de Málaga. Sus líneas principales de investigación son la epistemología evolucionista y el realismo científico. Entre sus publicaciones destacan los siguientes libros: la teoría de las ciencias morales en John Stuart Mill (1988), Realismo científico (1998) y Filosofía de la Ciencia (2005), publicado este último por Biblioteca Nueva. (shrink)

Architectural experience and creation is studied through a selection of projects, each driven by an obsessive creator towards particular levels of architectural experience, both physical and virtual. The article investigates the processes of turning dreams into physical space, exemplified by four extraordinary creators and collectors of space, each one a pursuer of obsessive architectural activities, all haunted by transitive dreams: Baron Des Esseintes, Joris-Karl Huysmans’ fictional character in the novel À Rebours (Against Nature) from 1884; Kurt Schwitters, the dadaist painter (...) and constructor of the Merzbau created in Hannover between 1919 and 1937; Sir John Soane, the architect and collector, who arranged his home as a museum from 1790 until 1837; and the German artist Gregor Schneider, whose home in Rheydt since 1985 is slowly folding in on itself under the name Haus Ur. Whereas Des Esseintes is a fictional builder of dreams in physical form; Schwitters, Soane and Schneider are real builders of dreams in physical form - the author Huysmans is a real builder of dreams in fictional form. Three of the four selected projects introduce layers of hybrid existence into ordinary building shells, and one represents the virtual architecture of narrative space. Their creators are driving architectural space into different ontological states, providing a field of perceptional and representational problems. The architects of parallel realities are subsequently challenging our basic understanding of architectural organization, aesthetics and methods. This erratic field of subjective and obsessive architecture serves my purposes of investigating architectural imagination as the main asset of virtual space. (shrink)

In 2017, Victoria became the first state in Australia to pass legislation permitting voluntary assisted dying. Under this law, only those people who are near the end of their lives may access voluntary assisted dying, and because many of these people require nursing care to manage the progression of their illness or their symptoms, it will invariably have an impact on nursing practice. The Victorian law includes a series of procedural steps as safeguards to ensure that the law (...) operates as intended. To support people who choose voluntary assisted dying and to practice safely within boundaries of the law, nurses must be aware of these requirements and how they operate. However, there are often gaps in nurses’ legal knowledge. This was demonstrated in an article that aimed to inform nurses about the operation of Voluntary Assisted Dying Act 2017 (Vic) but contained several errors and misstatements of the law. Our article corrects these errors and discusses how the law is intended to be applied by revisiting the fictional case of Chloe – a woman with a terminal illness who is seeking voluntary assisted dying. As the Voluntary Assisted Dying Act 2017 (Vic) also protects nurses from liability if they act in accordance with its provisions, we conclude that sound knowledge and understanding of its operation support nurses to provide the safe, comprehensive and compassionate care their patients deserve at the end of life. (shrink)

Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grass-roots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely (...) know. Unfortunately, some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians’ rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve? (shrink)

It might seem counterintuitive to think transhumanists, who are typically characterized by extreme techno-optimism and hope for radical life-extension, would be interested in assisted dying. Because the technological enhancements they long for will probably not be available during their natural lifetimes, many transhumanists at least entertain the idea of having themselves cryonically preserved to buy some additional time for real-world technology to catch up to their dreams. However, since an ideal preservation would take place before serious cellular deterioration sets (...) in, controlling the time and manner of death would be very attractive for transhumanist cryonicists. This chapter identifies some circumstances under which they might be justified in seeking assistance in dying (even though they would describe it as something more akin to hibernating). After providing a fundamental overview of both transhumanism and cryonics, and then making my case for what some scholars have called “cryothanasia” (i.e. assisted dying for the purpose of improved preservation quality), I proceed to consider some scenarios meant to test the limits of this justification. While things are admittedly murkier when considering the possibility of cryothanasia outside the context of imminent medical collapse, I can see no insurmountable criticisms of cryothanasia as a last resort in cases of (currently) terminal and irreparable neurodegeneration or other forms of progressive brain damage. (shrink)