BackgroundSome people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for (...) medical interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team.MethodsA three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process?ResultsDecision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: Risks, burdens and benefits; Treatment goals; Normative ethical values; Interested parties.ConclusionsDecision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of ‘who decides’ cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum. (shrink)

Refusal of lifesaving treatment, and such refusal by advance directive, are widely recognized as ethically and legally permissible. Voluntarily stopping eating and drinking is not. Ethically and legally, how does VSED compare with these two more established ways for patients to control the end of life? Is it more questionable because with VSED the patient intends to cause her death, or because those who assist it with palliative care could be assisting a suicide?In fact the ethical and legal (...) basis for VSED is virtually as strong as for refusing lifesaving treatment and less problematic than the basis for refusing treatment by advance directive. VSED should take its proper place among the accepted, permissible ways by which people can control the time and manner of death. (shrink)

Although voluntarily stopping eating and drinking as a way to hasten one’s death is not yet a widely recognized practice in the United States, it has received increasing attention in the medical and bioethics literature in recent years. After a brief review of the broader context of human death and dying, this article poses and examines 11 conceptual, personal, and public policy questions about VSED. The article identifies essential features of VSED and discusses whether VSED is a type (...) of suicide. It identifies reasons why people may or may not choose VSED, and it considers responses by family members and professional caregivers to people who have chosen VSED. It also considers how public policies may permit and regulate or restrict the practice of VSED. Examination of these questions is designed to increase understanding of VSED and to inform moral evaluation of this practice. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving voluntarily stopping eating and drinking (VSED). Over the past decade, clinicians and bioethicists have increasingly recognized VSED as a medically and ethically appropriate means to hasten death. Most recently, in September 2013, the National Hospice and Palliative Care Organization (NHPCO) called on its 2,000 member hospices to develop policies and guidelines addressing VSED. And VSED is getting more attention not only in healthcare communities, but also in the general (...) public. For example, VSED was recently highlighted on the front page of the New York Times and in other national and local media. Nevertheless, despite the growing interest in VSED, there remains little onpoint legal authority and only sparse bioethics literature analyzing its legality. This article aims to fill this gap. Specifically, we focus on new legislative, regulatory, and judicial acts that clarify the permissibility of VSED. We categorize these legal developments into the following seven categories: 1. Definition of VSED2. Uncertainty Whether Oral Nutrition and Hydration Are Medical Treatment3. Uncertainty Regarding Providers’ Obligations to Patients Who Choose VSED4. Judicial Guidance from Australia5. Judicial Guidance from the United Kingdom6. Judicial Guidance from Canada7. Case of Margot Bentley. (shrink)

In this paper I analyze Kant’s ideas about eating and drinking. First, I show that gluttony and drunkenness are considered ways to oppose to the duty to oneself as an animal being. Second, I claim that for Kant there is a healthy way of having meals, which consists in eating together with friends. Then I indicate that Kant accepts that one can drink at dinner parties but has to avoid drinks that lead to drunkenness and unsocial behavior. (...) In this sense, he draws a classification of the various kinds of alcoholic drinks, according to their potential harm. Afterwards, I illustrate how Kant’s own intimate life was a daily practice of his thoughts on dietetic conceptions and on what is better for digestion and health. To conclude, I mention the idea of a philosopher’s medicine of the body and why a strict diet should be avoided. (shrink)

In “On Avoiding Deep Dementia,” Norman Cantor astutely notes that, for some individuals, the concept of “protracted maintenance during progressive cognitive dysfunction and helplessness is an intolerably degrading prospect.” This cannot be argued with. Cantor's solution, however—that in the wake of a dementia diagnosis, patients should have the option to direct, in advance, instructions for voluntary stopping of eating and drinking should they develop a state of deep dementia—is more ethically challenging than it may first appear.Respect for autonomy (...) is one of the most fundamental principles of bioethics, and it requires that we allow patients with capacity to refuse life‐sustaining treatment, even when that treatment is something as seemingly innocuous as nutrition and hydration. If a capacitated person uses an advance directive to prospectively refuse artificial nutrition or hydration, then that treatment must be withheld if the person develops dementia and loses the ability or willingness to eat. Cantor is incorrect, however, in suggesting that an advance directive can require that nutrition and hydration be withheld from a patient with dementia who actively requests to eat or drink. Regardless of the language in an advance directive, caregivers cannot be compelled to abandon their duty to attend to the person's human dignity, nor can physicians be compelled to sedate a person with moderate or severe dementia because that person continues to be receptive to eating and drinking. (shrink)

Since the publication of Nikolas Rose’s ‘The Politics of Life Itself’ there has been vivid discussion about how biopolitical governance has changed over the last decades. This article uses what Rose terms ‘molecular politics’, a new socio-technical grip on the human body, as a contrasting background to ask anew his question ‘What, then, of biopolitics today?’ – albeit focusing not on advances in genetics, microbiology, and pharmaceutics, as he does, but on the rapid proliferation of wearables and other sensor-software gadgets. (...) In both cases, new technologies providing information about the individual body are the common ground for governance and optimization, yet for the latter, the target is habits of moving, eating and drinking, sleeping, working and relaxing. The resulting profound differences are carved out along four lines: ‘somatic identities’ and a modified understanding of the body; the role of ‘expert knowledge’ compared to that of networks of peers and self-experimentation; the ‘types of intervention’ by which new technologies become effective in our everyday life; and the ‘post-discipline character’ of molecular biopolitics. It is argued that, taken together, these differences indicate a remarkable shift which could be termed aretaic: its focus is not ‘life itself’ but ‘life as it is lived’, and its modality are new everyday socio-technical entanglements and their more-than-human rationalities of governance. (shrink)

This book presents and discusses some of the problems that are increasingly emerging today in our relationship with food as well as in our style of eating and drinking. The first three chapters focuses on issues concerning eating, and on our relationship with what we can eat. The fourth chapter deals with the act of drinking, with our relationship with water, and discusses justice aspects in the use of water. The main idea is that the acts (...) of eating and drinking are to be understood as relationships, i.e. as a way human beings relate to other beings. As such, they can be performed ethically well or badly. Therefore, an ethics of eating and of drinking should be developed. Not only the book highlights some key ethical problems associated with the act of eating and drinking, yet it also describes some ethically sustainable solutions to them. It ends with a list of reflections, which are intended to guide our choices in the relations with food and drinks with a normative approach. Mainly written for university students and researchers in the field of applied ethics, this book will also offer an inspiring reading to a wider audience of academics and professionals. (shrink)

A comprehensive and accessible introduction to the development of and current debates in the aesthetics of food and drink.

ZusammenfassungDas Verfahren des Sterbefastens ) hat eine lange Tradition, die, soweit wir wissen, bis in die Antike zurückreicht. Besonders in jüngster Zeit findet es Interesse bei älteren Menschen, die dem Tode nahe sind und über Zeitpunkt und Umstände ihres Todes ein gewisses Maß an Gestaltungsspielraum behalten wollen. Unter den Befürwortern dieses Verfahrens ist allerdings u. a. strittig, wieweit Sterbefasten als eine „passive“ Form von Suizid gelten kann. Auf dem Hintergrund der WHO-Definition des Suizids verteidigt der Beitrag eine affirmative Antwort und (...) diskutiert, wieweit sich daraus Konsequenzen für die ethische Beurteilung des Sterbefastens ergeben. (shrink)

Encouraging VSED (voluntarily stopping eating and drinking) to hasten a patient’s death is immoral. The practice results in an obvious conflict between the autonomy of the patient and the principles of beneficence and non-maleficence that must guide the physician and other health care workers. Because VSED is an act of passive euthanasia, it harms the patient and thus compromises the integrity of the physician–patient relationship. Health care providers must avoid any involvement in VSED, whether by providing information about (...) the practice or by administering palliative care while a patient is voluntarily starving and dehydrating himself to death. Instead of cooperating in the evil of euthanasia, health care providers need to advocate for the patient by refusing to do any harm and by addressing the reasons why the patient is requesting a hastened death. (shrink)

Voluntary stopping of eating and drinking (VSED) is an increasingly popular method by which patients are choosing to hasten death when life feels unbearable. This formal act of suicide often leads to distressing symptoms, for which patients then seek palliation by medical professionals. The intentional act of hastening death is always an evil act. A Catholic physician must understand the moral implications of participating in any phase of the patient’s planning and execution of the VSED process, including cooperation (...) in evil and scandal. The Catholic physician must strive to develop a well-formed conscience and then be prepared to exercise his or her right to conscientious objection while offering an example of true compassion for the sick, the suffering, and the dying. (shrink)

This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. We argue that sedation is ethically and legally (...) permissible not only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly. -/- ----- Dieser Beitrag befasst sich mit Sedierungen von Patienten am Lebensende. In der Regel werden Sedierungen nur als ultima ratio vorgenommen, wenn die Betroffenen dem Tod bereits nahe sind und Leidenssymptome aufweisen, die anders nicht zu lindern sind. Doch wie sind Fälle zu beurteilen, in denen Patienten sich selbstbestimmt für einen Behandlungs- oder einen Flüssigkeits‑/Nahrungsverzicht entscheiden, um zu sterben, und dafür eine „Begleitsedierung“ erbitten oder erwarten – auch wenn dies aus medizinischer Sicht über eine Anwendung von Sedierung als letztes Mittel hinausgeht? Wir argumentieren hier dafür, dass Zusage wie Anwendung einer Begleitsedierung ethisch und rechtlich nicht nur als ultima ratio, sondern grundsätzlich zulässig sind. Eine klare Verpflichtung zu sedieren sehen wir darüber hinaus bei akutem Leiden jeder Art, während in einigen anderen Konstellationen Vorbehalte individueller Ärzte gegenüber vermeintlich verfrühten oder unnötigen Sedierungen respektiert werden müssen. Vor dem Hintergrund des ethischen und juridischen Grundrechts auf ein selbstbestimmtes Sterben plädieren wir allerdings dafür, auch solche Vorbehalte zu überdenken. Die medizinischen Leitlinien sollten entsprechend überarbeitet werden. (shrink)

In recent years, a number of writers have proposed voluntary stopping of eating and drinking as an alternative to physician-assisted suicide. This paper calls attention to and discusses some of the ethical complications that surround the practice of voluntary stopping of eating and drinking. The paper argues that voluntary stopping of eating and drinking raises very difficult ethical questions. These questions center on the moral responsibility of clinicians who care for the terminally ill as (...) well as the nature and limits of the authority they exercise over them. (shrink)

L’assistance médicale à mourir (AMM) a reçu beaucoup d’attention de la part de nombreux acteurs dans le domaine de la bioéthique. Des philosophes, des théologiens, des avocats et des cliniciens de toutes sortes ont abordé de nombreux aspects difficiles de cette question. Le débat public, la politique publique et la loi ont été renforcés par des analyses disciplinaires variées. Avec la légalisation du AMM au Canada, on s’intéresse maintenant à des questions qui ont toujours été éclipsées par le débat sur (...) l’autorisation de l’AMM. Un de ces problèmes est l’arrêt volontaire de manger et boire (AVMB) comme une alternative à l’AMM. Dans cet article, je vais appliquer une perspective légale à la question. Une compréhension des aspects légaux de l’AVMB permet d'établir les fondements d'une réflexion éthique au sujet de son autorisation. Est-il permis pour ceux qui préfèrent l’AVMB à l’AMM? Est-il permis pour ceux qui ne sont pas admissibles à l’AMM en vertu de notre législation actuelle – pour ceux qui n’ont pas de maladie grave et irrémédiable, pour les mineurs matures, pour les personnes dont la seule condition médicale sous-jacente est un trouble mental et qui ne rencontrent pas les critères d’admissibilité, et pour les personnes ayant perdu leur capacité, mais ayant rempli une directive préalable? (shrink)

Christians all over the world celebrate the Eucharist as an important aspect of their faith. Arising from Paul's warning in 1 Corinthians 11:27-30 that persons who eat the Lord's Supper unworthily bring judgment upon themselves, some churches in Nigeria restrict the Communion to supposedly holy members. This article examined the text with a view to appraising this attitude towards the Communion. It applied the historical exegesis and the analytical approach. The article found that the restriction of the Eucharist to selected (...) members of the congregation is counter-productive and self-defeating in that many Christians are denied the opportunity to partake of it. Paul's view of judgment upon participants derived from his Jewish perception in which affliction was always seen as divine punishment. Furthermore, at its inception the celebration of the Communion does not reflect the idea that it was meant for only holy people. In view of this, and the fact that the Jewish perception need not apply in the modern and scientific world, the work concluded that the mainline churches in Nigeria have to review their attitude towards the Communion such that all Christians are encouraged to participate in it. While laying emphasis on reverent and loving behaviour at the Lord's Table, the idea of the Communion causing illness and death should be completely jettisoned. CONTRIBUTION: This article is a contribution to New Testament Theology and Christian ethics. The proposal to make the Eucharist more accommodating is significant for congregational harmony in the church in Nigeria. (shrink)

Some people will confront Alzheimer's with a measure of resignation, a determination to struggle against the progressive debilitation and to extract whatever comforts and benefits they can from their remaining existence. They are entitled to pursue that resolute path. For other people, like myself, protracted maintenance during progressive cognitive dysfunction and helplessness is an intolerably degrading prospect. The critical question for those of us seeking to avoid protracted dementia is how best to accomplish that objective.One strategy is to engineer one's (...) own death while still mentally competent to do so (even in the stage of mild dementia). If I were to use a preemptive strategy in the face of a dementia diagnosis, I would probably choose to stop eating and drinking, a process known as voluntarily stopping eating and drinking. An alternative tactic for avoiding prolonged dementia would be to allow oneself to decline into moderate dementia—thus losing capacity to perform self‐deliverance or even to make serious medical decisions—but before getting to that point to provide advance instructions rejecting prospective life‐sustaining medical interventions. These advance instructions would authorize palliative but not curative measures. My current personal instructions define the point of intolerable cognitive decline triggering medical nonintervention as “mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.” These instructions dictate allowing my demise at a point of moderate dementia when I may not be perceptibly suffering, when I may still be getting some rudimentary satisfaction from my debilitated life, and when I no longer recall the preoccupation with personally intolerable indignity that motivated my instructions. Can I expect that my advance instructions will be implemented in those circumstances? Is it lawful, and is it moral for a surrogate decision‐maker and associated caregivers to allow an uncomprehending, ostensibly content but demented individual to die? My analysis herein contends that it is not only lawful and moral but also legally required to implement clear, considered advance instructions even at a stage of moderate dementia. (shrink)

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a (...) terminally ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions. (shrink)

Disgust or horror is our natural attitude to eating human flesh and drinking human blood. How can this attitude not transfer itself to the Christian Eucharist, in which the bread is said to be Christ's body and the wine his blood? And if the aversion must transfer itself, then how can God have been, as Christians have to think, the founder of the rite? I discuss these questions with reference to several different theories of the Eucharist, one Calvinist, (...) the others of a would-be Roman Catholic kind. (shrink)

Medical assistance in dying has received considerable attention from many in the field of bioethics. Philosophers, theologians, lawyers, and clinicians of all sorts have engaged with many challenging aspects of this issue. Public debate, public policy, and the law have been enhanced by the varied disciplinary analyses. With the legalization of MAiD in Canada, some attention is now being turned to issues that have historically been overshadowed by the debate about whether to permit MAiD. One such issue is voluntary stopping (...) eating and drinking as an alternative to MAiD. In this paper, I will apply a legal lens to the issue. An understanding of whether VSED is legal provides a foundation for ethical reflection on whether it ought to be permitted. Is it permitted for those who prefer VSED to MAiD? Is it permitted for those who do not qualify for MAiD under our current legislation – for those who do not have a grievous and irremediable medical condition, for mature minors, for individuals whose sole underlying medical condition is a mental disorder and who do not otherwise meet the eligibility criteria, and for individuals who have lost capacity but had completed an advance directive? (shrink)

Ever since the 1960s, when medical science became capable of prolonging the dying process beyond bounds that many patients would find acceptable, people have sought “death with dignity,” or “a natural death,” or “a good death.” Once debilitation from a fatal affliction has reached a personally intolerable point, dying patients have sought to control the manner and timing of death via diverse techniques. Some sought the disconnection of life-sustaining medical interventions, such as respirators and dialysis machines. Beyond freedom from (...) unwelcome interventions, some patients intent on avoiding suffering sought access to pain relief medication—even in dosages posing some risk of hastening death. Other dying patients sought access to deep sedation, even knowing that they would never emerge from the resultant unconsciousness. Still other patients voluntarily refused to eat or drink or to accept artificial nutrition and hydration. (shrink)

食⋅酒는 인간의 생리적 요구를 충족시킬 뿐 아니라 인간의 문화적 정서를 내포하고 있어 일정부분 인간의 정서적 요구를 만족 시켜주기도 한다. 따라서 食, 즉 인간이 음식물을 먹고 마신다는 것은 생명의 유지는 물론 인간의 기본적인 욕구와 감성, 이성 등의 잠재된 능력을 균형적으로 발달하게 하여 인간이 인간으로서 주체적 삶을 지속적으로 가능하게 한다. 또한 인간은 먹고 마시는 행위를 통하여 사회생활에서 화합과 처세술을 펼칠 수 있는 좋은 수단으로 활용하기도 한다. 『주역』에 등장하는 성인들은 먹는 문제를 해결하기 위한 방편으로 다음과 같은 일을 시행했다. 복희는 ‘노끈을 매어서 그물을 만들어 (...) 사냥을 하고 물고기를 잡게 했다.’ 사냥할 때 쓰는 그물과 물고기를 잡을 때 쓰는 어망을 발명하여 먹거리를 해결하도록 했고, ‘신농은 논과 밭을 갈아 농사를 지을 수 있는 가래나 쟁기를 발명하여 나무를 깎아 보습을 만들고, 나무를 휘어 쟁기를 만들어 밭을 갈고 김매는 이로움을 천하에 알렸다.’ 이로써 곡류의 먹거리를 해결했다. 이는 백성의 먹거리를 안정적이고 지속적으로 해결할 방법을 알려 줌으로써 안정된 사회를 유지하도록 했다. 『주역』에서 ‘食’ 자는 27번 언급되는데 「잡괘전」의 “噬嗑食也”을 포함하여 12괘에서 언급하고 있다. ‘술(酒)字’는 8번 언급되는데 4괘에서 그 내용을 담고 있다. 그 4괘는 需卦, 坎卦, 困卦, 旣濟卦인데 여기에는 모두 坎卦(☵)가 들어있다. 본고에서는 ‘마시고 먹고 잔치하며 즐거워한다(飮食宴樂)’, ‘우물에 진흙이 있어 먹지 않는다(井泥不食)’, ‘머리를 적실 정도로 마신다(飮酒濡首)’.‘술과 음식을 먹는 것을 절제하다(節飮(酒)食)’ 등의 함의를 통하여 배우는 처세술에 관한 것이다. 따라서 본고는 『주역』에서 음식과 술에 부여된 의미와 그것을 다루는 인간의 태도를 분석하여, 이를 근거로 현대인이 먹고 마시는 행위를 할 때 교훈으로 삼을 수 있는 처세술을 제시하려는 논문이다. (shrink)

In discussions of arts and culture, food and drink are often relegated to the realms of mere decoration or mere necessity. However, like the term taste, which begins as one of the five senses but comes to be understood as the most sweeping term for human sensibility, eating and drinking can also be fundamental aesthetic experiences. In this book, author Leonard Barkan covers millennia of Western aesthetic and cultural activity, tracing the history of eating and drinking (...) across literature, art, philosophy, statecraft, religion, and historiography. Drawing on a myriad of historical and analytic perspectives, Barkan demonstrates how the materials of the dining table, the flavor and pleasure of food, and hunger and satiety are central to life and culture. He explores what it means to "read for the food" in works of art, literature, and philosophy, and demonstrates the central role that food played in Roman civilization. He examines the deeply culinary qualities of the Hebrew Bible and the New Testament, the relationship between food and drink and the culture of the Renaissance, and the literal acts of consumption that are endowed with sacred significance. By uncovering the gastronomic underplot in cultural and artistic works, Barkan proposes an interdisciplinary approach to the relation between sense experience and aesthetic experience, and considers what it means to move from the margins to the center in a study of culture. (shrink)

This paper sheds light on the significance of gastronomy as an emblem of cultural identity in Toni Morrison’s God Help the Child. It shows how Morrison imbues the narrative with instances of food and drinks which reflect certain racial stereotypes to which Lula Ann is prone during her struggle to reach self-definition. The colour, taste, diversity, quality and manners of food are all rigorously woven to portray Lula’s Journey. Onomastically, some characters and places are purposefully named after food such as (...) Sweetness, Whisky land, Raisin, and Mrs. Queen Olive; all of them represent an outstanding stage in Lula’s identity development. Finally, food takes a further dimension in the way it reflects the spiritual food that Lula receives throughout her journey. (shrink)

Although “you are what you eat” is a well-worn cliché, personal identity does not figure prominently in many debates about the ethics of eating interventions. This paper contributes to a growing philosophical literature theorizing the connection between eating and identity and exploring its implications for eating interventions. I explore how “identity-policing,” a key mechanism for the social constitution and maintenance of identity, applies to eating and trace its ethical implications for eating interventions. (...) I argue that identity policing can be harmful and that eating interventions can subject people to these harms by invoking identity policing qua intervention strategy or by encouraging people to eat in ways that subject them to policing from others. While these harms may be outweighed by the benefits of the intervention being promoted, they should nonetheless be acknowledged and accounted for. To aid in these evaluations, I consider factors that modulate the presence and severity of identity-policing and discuss strategies for developing less harmful eating interventions. I conclude by considering the relationship between identity-policing and identity loss caused by long-term diet change. This paper contributes to the centering of identity in food ethics and to a more comprehensive picture of identity’s ethical importance for eating interventions. (shrink)

The elaborated intrusion (EI) theory of desire (Kavanagh, Andrade, & May, 2005) attributes the motivational force of cravings to cognitive elaboration, including imagery, of apparently spontaneous thoughts that intrude into awareness. We report a questionnaire study in which respondents rated a craving for food or drink. Questionnaire items derived from EI theory formed a single factor alongside factors for anticipated reward/relief, resistance, and opportunity. In a multiple regression predicting strength of craving, the first three factors accounted for 36% of the (...) variance. Opportunity did not enter the model. In a second study, the difference between individuals' strong and weak cravings to take part in a sporting activity was shown to be related to visual, auditory, and general imagery, and to anticipated reward or relief from engaging in the activity. Implications for treatment of craving-related disorders are discussed in the light of these results and of other research indicating that interference with imagery can reduce the strength of craving. (shrink)

Introduction: The Binge Eating Scale (BES) is a widely-used self-report questionnaire to identify compulsive eaters. However, research on the dimensions and psychometric properties of the BES is limited. Objective: The aim of this study was to examine the properties of the Spanish version of the BES. Method: Confirmatory Factor Analyses (CFAs) were carried out to verify the BES factor structure in a sample of Spanish college students (N = 428, 75.7% women; age range = 18–30). An invariance measurement routine (...) was carried out across sexes, the latent means were compared, and estimates of reliability and convergent and discriminant validity were presented. Results: A one-factor model fit the data best and was also equivalent between sexes. The scalar invariance model showed statistically significant differences across sexes, with a higher prevalence in women. Regarding reliability, the results were excellent. Finally, high statistically significant correlations were obtained with other measures of binge eating (BE), food addiction, impulsivity, binge drinking, and body mass index (BMI). Conclusions: The Spanish 16-item BES is a valid and reliable scale to evaluate BE in the youth population. (shrink)

Understanding the relationship between obesity and fast food consumption encompasses a broad range of individual level and environmental factors. One theoretical approach, the health capability framework, focuses on the complex set of conditions allowing individuals to be healthy. This qualitative study aimed to identify factors that influence individual level health agency with respect to healthy eating choices in uniformly constrained environments. We used an inductive qualitative research design to develop an interview guide, conduct open-ended interviews with a purposive sample (...) of 14 student fast food workers, and analyze the data. Data analysis was conducted iteratively during the study with multiple coders to identify themes. Emergent themes included environmental influences on eating behaviors and internal psychological factors. A localized, embedded approach to analyzing the factors driving the obesity epidemic is needed. Addressing contextual interactions between internal psychological and external environmental factors responds to social justice and public health concerns, and may yield more relevant and effective interventions for vulnerable communities. (shrink)

This study explored how social representations of food and health fit into the development of masculinities. In what ways does the transition into Higher Education impact on students’ eating and drinking behaviours? And where do representations of food and health fit into the development of masculinities? A total of thirty-five students from two separate higher education establishments in Ireland took part. Fourteen semi-structured individual interviews (7 males, 7 females) and four focus groups (6 males in one, 5 males (...) in two and 6 females in another) were conducted. A thematic analysis indicated that increasing unhealthy behaviour among young people is not just about their disinclination to engage with an active comprehension of the implications of their behaviour for their future. Rather, their choice of food and drink, and the quantity of alcohol they consume has more to do with attaining and maintaining their gendered identities within a community of students. (shrink)

Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol’s involvement with hooking up behavior, the array of health consequences associated with this relationship, as (...) well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e. expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e. emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided. (shrink)

In recent years, the postulation that deception is necessary for placebos to have an effect on pain relief or increased well-being has come into question. Latest studies have shown that an openly administered mock drug works just as well as a deceptively administered placebo on certain complaints. This open-label placebo effect has primarily been used in the area of pain treatment so far. This study is the first to examine the effect of such placebos on healthy individuals with the use (...) of drinking water. In two experiments, participants were required to use certain specified water bottles for their daily drinking water consumption. At the beginning of Experiment 1, all participants received one bottle of water, which they were asked to refill themselves each day during a 2-week intervention period. In Experiment 2, participants received a new sealed water bottle every day. In both experiments, participants were randomly assigned to one of four groups: no treatment, open-label placebo without rationale, open-label placebo with rationale, and open-label placebo with additional rationale in a suggested relaxed state. We conducted baseline and post-treatment measurements of the subjective perceived physical and mental well-being of the participants. In Experiment 1, only the OPR++ group reported enhanced vitality at the post-treatment level compared to the other groups. In Experiment 2, post-treatment measurements showed improvements for the OPR++ group in the Physical Performance Capability, Mental Performance Capability, Emotional Balance, Overall Recovery, Negative Emotional State, and Overall Stress categories compared to the other groups. Our results support the idea that placebos with an additional rationale in a suggestive relaxed state are more effective than with just a rationale in a normal state. Furthermore, our study shows the tendency that OLP++ in the form of water with health claims may be more effective when the water is given in several sealed bottles separately than in one sealed but refillable bottle. (shrink)

The consumption of food and drink becomes a fully human activity only when it takes place within a realm of hospitality. When thus situated a meal gathers together not only families, friends and neighbors, but it is also brings together divine and mortal being and unites in common courtesy the living and the dead. Natural scientific insights into human food consumption make their greatest contribution to our understanding when we situate these within the larger context of intersubjective relations. Anorexia, bulimia, (...) alcoholism and other forms of compulsive and unhappy consumption of natural substances all can be understood as doomed attempts to eat and drink outside the humanizing sphere of reciprocity and hospitality. (shrink)

© British Society of Aesthetics 2017. Published by Oxford University Press on behalf of the British Society of Aesthetics. All rights reserved. For Permissions, please email: [email protected] two books contribute, each in a very different way, to the reflection on a timeless subject: eating. While Eat This Book deals with a polemic subject, Taste as Experience focuses on the general experience of the simple act of eating and drinking and how this contributes to philosophical reflection. These questions (...) are far from trivial and it is necessary to address these subjects in a context where each citizen is increasingly led to think about the environmental and ethical impacts of his food consumption. Furthermore, the pleasure that comes from the act of eating, far from being a hedonistic fantasy, allows us to reflect on our relationship to the world. In other words: What is the symbolic role that food... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"He Who Eats Me Will Live Because of Me":Eucharistic Indwelling and Aquinas's Johannine Theology of the Missions of the Divine PersonsDaniel M. Garland Jr.IntroductionIn the Bread of Life Discourse of John 6, Jesus begins his teaching by stating that he is the true bread from heaven sent from God to give life to the world. After "the Jews" (οἱ Ἰουδαῖοι)1 boast that Moses gave their fathers manna to eat (...) in the wilderness, Jesus makes a contrast between the manna in the wilderness and himself as the "bread of life" (6:35). While the title "Bread of Life" carries a metaphorical sense, Jesus climaxes his discourse by [End Page 1171] insisting that believers eat of (ἐσθίω) or gnaw on (τρώγω) his flesh and drink his blood. Then, in John 6:57, Jesus makes the startling claim: "As the living Father sent me, and I live because of the Father, so the one who eats [τρώγω] me will live because of me." Jesus, here, connects his mission with the giving of his flesh as food for eternal life. At the same time, Jesus declares in John 17:3 that eternal life is predicated on the knowledge of God the Father and Jesus Christ, whom he has sent. There seems to be a tension here in John's Gospel. Do we have eternal life by eating or by knowing?This article will explore the gift of eternal life communicated through the sacramental eating and drinking of Christ's body and blood and its relation to our coming to know the Father and the Son. It will be divided into two main parts. The first part will explore this as revealed in the text of the Gospel of John by examining what it means "to know God." Next, I will show that Jesus has the power to give eternal life because he is Life itself and that John points to the root of this power as being derived from Jesus's procession from the Father. Then, I will take up Jesus's mutual abiding/indwelling language in John 6 and elsewhere in the Gospel and how this contributes to bringing eternal life to believers. The second part will show how St. Thomas's teaching on the missions of the divine persons further clarifies Jesus's teaching in the Gospel of John that eternal life comes about through both eating Christ's flesh and coming to the knowledge of the Father and the Son and also gives greater theological insight into the Johannine theology of the Eucharist as the source of eternal life.Gospel of JohnJohn 17 and the Relational Name of the Father and the Son in Relation to Eternal LifeIn John 17, Jesus prays from the vantage point of already having completed (17:4; τελειώσας) the work that the Father has given him to do. The work that Jesus speaks of is both a past event, consisting of the signs that witness that the Father has sent him (see 5:36; τελειώσω), but also the future event of the Cross(see 19:30; τελειώσω),2 Here, Jesus requests glorification by the Father in order that he, as Son, may glorify the Father in return. This mutual glorification is rooted in the power (ἐξουσίαν) that the Father has given to the Son over all flesh—the power to grant eternal life (17:2). Jesus [End Page 1172] then defines eternal life in 17:3 as "to know the only true God and Jesus Christ whom he has sent." There is an intimate connection, here, between knowing the Father ("the only true God") and Jesus. Eternal life is not merely knowledge of the Father, but knowledge of the Father as the one who sent the Son.3 How does one know the Father? John 17 suggests that it is through the revelation of his name. There is a repeated refrain in John 17 of Jesus making known the Father's name (17:6, 26) and keeping them in this name (17:11, 12). Looking back in the Gospel, we can recall that in John 5:43, Jesus associates the "Father's name" with his mission: "I have come in my Father's name." The same can... (shrink)

We argue that the occurrence of puritanical norms cannot simply be explained by appealing to the need for cooperation. Anthropological and archaeological studies suggest that across history and cultures self-indulgent behaviours, such as excessive drinking, eating, and feasting, have been used to enhance cooperation by enforcing social and group identities.

BackgroundMediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image intervention’s effect on eating disorder symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use.MethodsThis study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development (...) including 30 schools in Norway. A total of 1,713 participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators.ResultsIn girls, the reduction in ED symptomatology was mediated by positive changes in protective factors and reductions in risk factor scores. Comparable changes in protective and risk factors among boys played no mediating role.ConclusionInterventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys. (shrink)

Who gets to decide what it means to live a healthy lifestyle, and how important a healthy lifestyle is to a good life? As more governments make preventing obesity and diet-related illness a priority, it's become more important to consider the ethics and acceptability of their efforts. When it comes to laws and policies that promote healthy eating--such as special taxes on sugary drinks and the banning of food deemed unhealthy--critics argue that these policies are paternalistic, and that they (...) limit individual autonomy over food choices. In Healthy Eating Policy and Political Philosophy: A Public Reason Approach, Anne Barnhill and Matteo Bonotti show that both paternalistic justifications for healthy eating efforts and anti-paternalistic arguments against them can be grounded in perfectionist views that overly prioritize some values over others. The authors therefore propose a more inclusive, public reason approach to healthy eating policy that will be appealing to those who take pluralism and cultural diversity seriously, by providing a framework through which different kinds of values, including but not limited to autonomy and health, can be factored into the public justification for healthy eating efforts. Additionally, the book adopts a 'farm to fork' approach to the ethics of healthy eating efforts: it engages with theories and debates in political philosophy, considers the implications of different theoretical positions for healthy eating efforts, and then develops a concrete tool for assessing policies that will be of interest to both scholars and policymakers. As well as offering a novel normative analysis of healthy eating policy, the authors offer a new theoretical framework that will be applicable to a wide range of public policy scenarios. (shrink)