Context In some cases, physicians estimate that continuous sedation until death may have a life-shortening effect. The accuracy of these estimations can be questioned.Aim The aim of this study is to compare two approaches to estimate the potential life-shortening effect of continuous sedation until death.Methods In 2008, 370 Dutch physicians filled out a questionnaire and reported on their last patient who received continuous sedation until death. The potential life-shortening effect of continuous sedation was estimated through a direct approach and an (...) indirect approach . The intrarater agreement between both approaches was determined with a weighted κ.Results According to the direct approach, sedation might have had a life-shortening effect in 51% of the cases and according to the indirect approach in 84%. The intrarater agreement between both approaches was fair . In 10% of all cases, the direct approach yielded higher estimates of the extent to which life had been shortened; in 58% of the cases, the indirect approach yielded higher estimates.Conclusions The results show a discrepancy between different approaches to estimate the potential life-shortening effect of continuous sedation until death. (shrink)

Since the emergence of the innovative field of artificial intelligence in the 1960s, the late Hubert Dreyfus insisted on the ontological distinction between man and machine, human and artificial intelligence. In the different editions of his classic and influential book What computers can’t do, he posits that an algorithmic machine can never fully simulate the complex functioning of the human mind—not now, nor in the future. Dreyfus’ categorical distinctions between man and machine are still relevant today, but their relation has (...) become more complex in our increasingly data-driven society. We, humans, are continuously immersed within a technological universe, while at the same time ubiquitous computing, in the words of computer scientist Mark Weiser, “forces computers to live out here in the world with people” The cell phone reader. Peter Lang Publishing, New York, 2006, p 20). Dreyfus’ ideas are therefore challenged by thinkers such as Weiser, Kevin Kelly, Bruno Latour, Philip Agre, and Peter Paul Verbeek, who all argue that humans are much more intrinsically linked to machines than the original dichotomy suggests—they have evolved in concert. Through a discussion of the classical concepts of individuum and ‘authenticity’ within Western civilization, this paper argues that within the ever-expanding data-sphere of the twenty-first century, a new concept of man as ‘aggregate of data’ has emerged, which further erodes and undermines the categorical distinction between man and machine. This raises political and ethical questions beyond the confines of technology and artificial intelligence. Moreover, this seemingly never-ending debate on what computers should do provokes the philosophical necessity to once again define the concept of what it is to be ‘human.’. (shrink)

Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.