Propositional dynamic logic (PDL) provides a natural setting for semantics of means-end relations involving non-determinism, but such models do not include probabilistic features common to much practical reasoning involving means and ends. We alter the semantics for PDL by adding probabilities to the transition systems and interpreting dynamic formulas 〈α〉 ϕ as fuzzy predicates about the reliability of α as a means to ϕ. This gives our semantics a measure of efficacy for means-end relations.

Stephen Finlay analyses ‘ought’ in terms of probability. According to him, normative ‘ought's are statements about the likelihood that an act will realize some (contextually supplied) end. I raise a problem for this theory. It concerns the relation between ‘ought’ and the balance of reasons. ‘A ought to Φ’ seems to entail that the balance of reasons favours that A Φ-es, and vice versa. Given Finlay's semantics for ‘ought’, it also makes sense to think of reasons and their weight in (...) terms of probability. In this paper, I develop such a theory of weight. It turns out, however, that it cannot explain the entailments. This leaves Finlay with a challenge: to explain these entailments in some other way consistent with his theory, or to show why the appearances deceive and there are no such entailments. (shrink)

There has been considerable work on practical reasoning in artificial intelligence and also in philosophy. Typically, such reasoning includes premises regarding means–end relations. A clear semantics for such relations is needed in order to evaluate proposed syllogisms. In this paper, we provide a formal semantics for means–end relations, in particular for necessary and sufficient means–end relations. Our semantics includes a non-monotonic conditional operator, so that related practical reasoning is naturally defeasible. This work is primarily an exercise in conceptual analysis, aimed (...) at clarifying and eventually evaluating existing theories of practical reasoning (pending a similar analysis regarding desires, intentions and other relevant concepts). (shrink)

What is it exactly that we are attributing to a thing when we judge it to be good? According to the orthodox answer, at least in some cases when we judge that something is good we are attributing to it a monadic property. That is, good things are “just plain good.” I reject the orthodox view. In arguing against it, I begin with the idea that a plausible account of goodness must take seriously the intuitive claim that there is something (...) in common between moral and non-moral goodness—something in virtue of which it makes sense to call ‘good’ both the things that are morally good and the things that are non-morally good. However, it is implausible that all judgments about the goodness of things attribute a monadic property to those things, as this does not capture what we mean when we judge something to be non-morally good. Instead, I propose and defend my own relational theory of goodness according to which goodness is a relation that holds between things and ends (or goals). That is, goodness is a relational property such that to be good is to be related in the relevant way to some goal or another. This is true in both the mundane everyday cases and in loftier cases concerned with moral goodness. (shrink)

Radical ethical relativism as presented in Ruth Benedict's Patterns of Culture not only denies absolute values, its thesis of the incommensurability of cultural configurations precludes possibility of any agreement on values by individuals of different cultures. This fact provides the proper perspective from which to judge the current controversy between radical and “modified” ethical relativists. A double error is committed, therefore, by those who contend that there has been no reduction of the “area of indeterminacy” existing between the ethical principles (...) of different cultures since, despite the newer developments in the social sciences, there are still no absolutely valid ethical values. Not only is the term “validity” vague and in need of reinterpretation, but, in assuming the denial of absolute values to be the distinguishing characteristic of radical relativism, they actually identify this theory with modified relativism. This brief paper attempts to prove the untenability of the denial of cross cultural agreement on ends and means by treating the question first, from the point of view of C. L. Stevenson's Dewey-inspired notion of the derivation of ends from means, and, second, from that of Stevenson's more original idea, complex ethical agreement. (shrink)

Analytic reductivism in metaethics has long been out of philosophical vogue. In Confusion of Tongues: A Theory of Normativity (2014), Stephen Finlay tries to resuscitate it by developing an analytic metaethical reductive naturalistic semantics for ‘good.’ He argues that an end-relational semantics is the simplest account that can explain all of the data concerning the term, and hence the most plausible theory of it. I argue that there are several assumptions that a reductive naturalist would need to make about (...) contextual parameter completion to derive reductive naturalism from an end-relational semantics—assumptions that nonnaturalists might forcefully resist. I also argue for the claim that an end-relational semantics could provide surprising resources for nonnaturalists to address semantic worries about their views—the upshot of which paints the way for a new and sophisticated nonnaturalism about the semantics of moral discourse. Nonnaturalists have long suspected that they need not worry about semantics and this paper lends support to that suspicion. (shrink)

In her paper, “The Doctrine of Double Effect: Problems of Interpretation,” Nancy Davis attempts to find an interpretation of the means-end relationship that would provide a foundation for the Doctrine of Double Effect (DDE) and its reliance on the distinction between what an agent intends or brings about intentionally and what that agent merely foresees will result from his/her action, but does not intend (or bring about intentionally). Davis’s inability to find such an interpretation lessens the plausibility of the view (...) that theDDE is an acceptable moral doctrine. In the present paper, it is suggested that Davis’s inability to find an interpretation of the means-end relationship that will support the DDE results from her assumption that an agent must intend to produce whatever he/she produces intentionally. Borrowing an argument from Michael Bratman, this article shows that Davis’s assumption is false. Thatrealization paves the way toward a defense of the DDE. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion (...) of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

This article indicates a new direction for business ethics, which Lon Fuller pioneered with his work on social architecture. “Eunomics”, as Fuller called it, is “the theory or study of good order and workable arrangements”. How should we appraise the effects of the various ways of organizing and running a corporation, for example, with regard to the different structures and basic plans it can espouse? We should reject the “doctrine of the infinite pliability of social arrangements”, as some forms of (...) organization are unsound. They cannot be implemented in a proper fashion given the boundaries and the rules of the market established. A theory of business eunomics explains why each kind of legal process, including managerial direction, is better suited for the pursuit of a limited number of ends, and thus why we should not force a single institution to solve all ethical problems. (shrink)

This article proposes the use of temporal logic for an analysis of instrumentality inspired by the work of G.H. von Wright. The first part of the article contains the philosophical foundations. We discuss von Wright’s general theory of agency and his account of instrumentality. Moreover, we propose several refinements to this framework via rigorous definitions of the core notions involved. In the second part, we develop a logical system called Temporal Logic of Action and Expectations (TLAE). The logic is inspired (...) by a fragment of propositional dynamic logic based on indeterministic time. The system is proven to be weakly complete relative to its given semantics. We then employ TLAE to formalise and analyse the instrumentality relations defined in the first part of the paper. Last, we point out philosophical implications and possible extensions of our work. (shrink)

This article is a longitudinal analysis of the relation between gendered labour divisions and new data processing technologies at the Dutch Central Bureau of Statistics. Following social-constructivist and evolutionary economic approaches, the authors hold that the relation between technology and work organization is a two-way process. This means that technology does not only affect the relations between men and women at work, but that these relations also influence technological choices. The proportional numbers of men and women on the labour market (...) and changing conceptions of which work is deemed appropriate for women have been important factors in the strongly varying extent to which women participated in office work. They have also been important factors in determining the course of technological development. Shortages of women on the labour market have even determined search heuristics for new technological solutions in specific directions. (shrink)

Human personality influences the way people interact with dogs. This study investigated the associations between the personality of animal shelter volunteers and behavior during on-leash walks with shelter dogs. Video recording and a canine leash tension meter were used to monitor the on-leash walking. Personality was measured in five dimensions with the NEO Five-Factor Inventory. Neurotic volunteers pulled the leash harder and tended to interact with dogs using more body language; dogs being walked by neurotic volunteers in turn displayed more (...) lip-licking and body shaking and were more likely to be rated as well-behaved. Extroverted volunteers were associated with stronger maximal leash tension at both the human and dog ends of the leash, and they praised the dog more, often in a high pitched voice. These volunteers eliciting more tail-wagging and body shaking by the dog. Extroverted volunteers were also more tolerant of different dog behaviors. Volunteers with personalities characterized by “openness to experiences” were less likely to verbally attract the attention of dogs, praise dogs and talk to them in a high-pitched voice; however, dogs walked by these volunteers were more likely to pull on the leash, and engaged in more lip-licking but less sniffing. “Agreeable” volunteers liked to verbally attract the attention of the dogs and more commonly initiated hand gestures and physical contact, causing the dogs to pull less frequently; dogs in these dyads displayed more gazing and lip-licking behaviors. Conscientious volunteers were less likely to pull the leash and tended to have more physical contact with the dogs but did not favor verbal communication and did not use a high pitched voice. (shrink)

ABSTRACT This article considers three kinds of relations: being-there-alongside, waiting, and staying, that come into focus at or after the end of life. The first relation is explored in light of Heidegger’s and Levinas’s contrasting accounts of responsibility, the second in terms of Bergson’s notion of hesitation, and the third in relation to Winnicott’s description of a “holding environment.” The work serves as a plea for spaces and practices that support more generous, open-ended, and nuanced relations among those who are (...) dying and those who attend to and survive them. (shrink)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order (...) to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

The aim of the present paper is to show that a particular interpretation of the end in itself, which is widely accepted in research on Kant’s critical philosophy, is at least worth dis­cussing. I refer to the interpretation of the end in itself as a so-called existing end, i.e., something for the sake of which we perform an action but which we do not realize – sim­ply because it already exists. As I will argue, this interpretation does not take into (...) account a crucial aspect of the end in itself, i.e., its property of being an end. Being an end, the end in itself must fit into the Kantian general definition of a practical end and must therefore be something to be realized. (shrink)

_Psychoanalysis Beyond the End of Metaphysics_ offers a new paradigm approach which advocates reengaging the importance of metaphysics in psychoanalytic theorizing. The emergence of the relational trend has witnessed a revitalizing influx of new ideas, reflecting a fundamental commitment to the principle of dialogue. However, the transition towards a more pluralistic discourse remains a work in progress, and those schools of thought not directly associated with the relational shift continue to play only a marginal role. In this book, (...) Robin S. Brown argues that for contemporary psychoanalysis to more adequately reflect a clinical ethos of pluralism, the field must examine the extent to which a theoretical commitment to the notion of relationship can grow restrictive. Suggesting that in the very effort to negotiate theoretical biases, psychoanalytic practice may occlude a more adequate recognition of its own evolving assumptions, Brown proposes that the profession’s advance requires a return to first principles. Arguing for the fundamental role played by faith in supporting the emergence of consciousness, this work situates itself at the crossroads of relational, Jungian, and transpersonal approaches to the psyche. Psychoanalysis Beyond the End of Metaphysics will be of significant interest to all psychodynamically oriented clinicians, alongside scholars of depth psychology and the philosophy of mind. It will also be helpful to advanced and postgraduate students of psychoanalysis seeking to orient themselves in the field at present. (shrink)

Background End-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians’ profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in Neonatal Intensive Care Units and correlate them with self-reported practices of end-of-life decisions and with their background data. Methods A structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and (...) sixty two out of 260 eligible physicians answered anonymously the questionnaire. Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians’ attitude and views ranging from value of life to quality of life approach. Results Continuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score were more likely to limit, while those with a low score were more likely for continuation of intensive care. Physicians’ educational level, involvement in research, religion and position on the existing legal framework were factors that affected the attitude score. Conclusions Physicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform. (shrink)

Definition of the Problem: One of the main ethical arguments against the therapeutic transplantation of fetal tissue in severe cases of Parkinson’s disease is the allegation that the relationship between the abortion and the transplantation is a (bad)-means-to-a-(good)-end-relation.Arguments: This paper differentiates between the actual experimental single-case treatment and a potential mass treatment. In the former case, ethical guidelines seem to guarantee that abortion and transplantation are two distinct actions and therefore abortion is not a means to the end transplantation on (...) principle. However, in the latter case – the potential mass treatment of patients with more severe cases of Parkinson’s disease – there seem to be several technical, logistical and psychological reasons for the impossibility to distinguish between abortion and transplantation.Conclusion: Although abortion is not a means to the end transplantation as a matter of principle the ethical problems of a mass treatment would be immense. (shrink)

Augustine posed two questions that go to the heart of the nature of law. Firstly, what is the difference between a kingdom and a band of robbers? Secondly, is an unjust law a law at all? These two questions force us to consider whether law is simply a means of social control, distinguished from a band of robbers only by its size, or whether law is a social institution justified by its orientation towards justice. The End of Law applies Augustine’s (...) questions to modern legal philosophy as well as offering a critical theory of natural law that draws on Augustine’s ideas. McIlroy argues that such a critical natural law theory is realistic but not cynical about law’s relationship to justice and to violence, can diagnose ways in which law becomes deformed and pathological, and indicates that law is a necessary but insufficient instrument for the pursuit of justice. Positioning an examination of Augustine’s reflections on law in the context of his broader thought, McIlroy presents an alternative approach to natural law theory, drawing from critical theory, postmodern thought, and political theologies in conversation with Augustine. (shrink)

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients’ true wishes, meaningfully engaging patients’ significant others, balancing interests among patients and significant others, and determining clinicians’ obligations to change patients’ unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy must incorporate patients’ competence (...) (apart from decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman’s procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman’s account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician–patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care. (shrink)

In the relational literature, the subject of termination - the ending of an analysis - has received scant attention, and traditional Freudian or ego-psychological criteria are not always enough to assess the readiness to terminate therapy in the coconstructed, intersubjective analytic relationship. _Good Enough Endings _seeks to remedy this gap, bringing together contributions from contemporary relational thinkers, while at the same time engaging with ideas from other psychoanalytic perspectives. Topics given consideration include: Can there be a relational (...) criteria or paradigm for termination, and what would it include? How do treatment goals of the analyst and/or that of the patient affect the decision to terminate? How do recent developments in attachment theory and research influence the preparation to end analysis? What occurs for the patient after termination, and how do we assess the need for follow-up? Integrating elements of existing psychoanalytic theory with the fruits of the relational turn, _Good Enough Endings _expands and expounds upon the relational considerations in ending analysis, providing a resource for reflection and insight into the final - and perhaps most difficult - aspect of psychoanalytic treatment. (shrink)

AbstractDeveloped from meaningful work and business ethics, we investigate the motivational effect of meaningful work on paid staff (not volunteers) with a “shortage” of ethical employment practices situated in the Not-for-Profit sector. We tested the traditional notion of meaningful work by nature and by line manager support (under its business-like practices) to compensate for the “sacrifice” (low pay and job stress caused by poor employment terms) of front line staff working alongside professional managers paid the market rate. Using a mixed-method (...) case study, we employed SEM modelling to analyse a staff survey of 125 valid responses and administrative records of staff resignation, alongside interviews. The results show that meaningful work by nature and by line manager support are positively and significantly associated with job satisfaction but neither has a significant effect on staff resignation action. There is no empirical evidence to support the compensating effect of meaningful work by nature; meaningful work by line manager support has a stronger effect only through reduced job stress, rather than compensating for the low pay, in preventing resignation. The qualitative analysis reveals that continued low pay and using precarious employment contracts have evoked the questioning of ethics of employment practices in this sector. We discuss the implications and suggest further areas of research. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue (...) our analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

This paper advances a reductive semantics for ‘ought’ and a naturalistic theory of normativity. It gives a unified analysis of predictive, instrumental, and categorical uses of ‘ought’: the predictive ‘ought’ is basic, and is interpreted in terms of probability. Instrumental ‘oughts’ are analyzed as predictive ‘oughts’ occurring under an ‘in order that’ modifer (the end-relational theory). The theory is then extended to categorical uses of ‘ought’: it is argued that they are special rhetorical uses of the instrumental ‘ought’. Plausible (...) conversational principles explain how this end-relational ‘ought’ can perform the expressive functions of the moral ‘ought’. The notion of an ‘ought-simpliciter’ is also discussed. (shrink)

BackgroundOne of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it.MethodsWe conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the (...) United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable.ResultsAll four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants’ comfort and needs at the EOL.ConclusionBecause of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research’s impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings. (shrink)

Decisions regarding the end-of-life of minor patients are amongst the most difficult areas of decision-making in pediatric health care. In this field of medicine, such decisions inevitably occur early in human life, which makes one aware of the fact that any life—young or old—cannot escape its temporal nature. Belgium and the Netherlands have adopted domestic regulations, which conditionally permit euthanasia and physician-assisted suicide in minors who experience hopeless and unbearable suffering. One of these conditions states that the minor involved must (...) be legally competent and able to express an authentic and lasting wish to die. This contribution is different from other legal texts on end-of-life decisions in modern health care. Foremost, it deals with the role time-bound components play in our views on the permissibility of such decisions with regard to minor patients. While other disciplines provide profound reflections on this issue, from a legal point of view this side has hardly been explored, let alone examined with regard to its relevance for the legal permissibility of end-of-life decisions in pediatrics. Therefore, the manuscript inquires whether there are legal lessons to be learned if we look more closely to temporality-related aspects of these end-of-life decisions, particularly in connection to a minor patient’s assumable ability to choose death over an agonizing existence. (shrink)

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...) condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations. (shrink)

Many philosophical discussions of the narrative self touch upon the end of life. End-related terms and concepts that occur in these discussions include finitude, completion, closure, telos, retroactive meaning-conferral, life shape, and a closed beginning-middle-and-end structure. Those who emphasise life’s end in non-philosophical narrative contexts are perhaps clearer on its significance. The end is thought to play a key role in the story of a life, securing or enhancing the life narrative’s meaning or value, and thereby warranting special treatment and (...) attention. Call this thought ‘the special-ends hypothesis’. In this paper, I test the applicability of the special-ends hypothesis within philosophical narrativist accounts of the self. I examine narrativist claims pertaining to the end of life, taking seriously the specific terms they deploy, and considering the contexts in which they occur. Superficially it seems that narrativists endorse the special-ends hypothesis, overtly or by implication. But as perspective is gained on the broader theoretical context in which the concepts are situated, this apparent support diminishes. Ultimately, for most narrativists, the end of life has no special role to play in securing or enhancing the meaning or value of life as a whole. (shrink)

End-of-life decision making frequently involves a complex balancing of clinical, cultural, social, ethical, religious and economic considerations. Achieving a happy balance of these sometimes-competing interests, however, can be particularly fraught in a family-centric society like Singapore where the family unit often retains significant involvement in care determinations necessitating careful consideration of the family’s position during the decision-making process. While various decision-making tools such as relational autonomy, best interests principle and welfare-based models have been proposed to help navigate such difficult (...) decision-making processes, their application in practical terms, however, is dubious at best. This case report is presented to highlight these issues and explore the utility of these frameworks within the Singapore end-of-life care context when the interests of the family may be dissonant from those of the patient. (shrink)

Experiencing Endings and Beginnings highlights the emotional turmoil which, to a greater or lesser extent, accompanies the changes we experience throughout life. It considers the nature of the anxieties aroused by a new situation, changes in our circumstances, beginnings, and endings of relationships, gains and losses and the ending of a previous state throughout the lifespan. Endings and beginnings are shown to be closely related, for every new situation entered into, more often than not, involves having to let go of (...) some of the advantages of the previous one as well as losing what is familiar and facing fear of the unknown. Isca Wittenberg shows how all these aspects of change evoke primitive anxieties, stemming from our earliest experiences of coming into this world. The book considers life changes including birth and weaning, going to nursery and school, beginning work, marriage, parenthood, and retirement, with reference to clinical examples. This revised edition includes a new chapter by the author examining advanced old age. Experiencing Endings and Beginnings will be essential reading for psychoanalysts and psychotherapists in practice and in training. It will also be of great interest to other professionals and to readers interested in understanding change across the lifespan. (shrink)

Explainable artificial intelligence (XAI) seeks to produce explanations for those machine learning methods which are deemed opaque. However, there is considerable disagreement about what this means and how to achieve it. Authors disagree on what should be explained (topic), to whom something should be explained (stakeholder), how something should be explained (instrument), and why something should be explained (goal). In this paper, I employ insights from means-end epistemology to structure the field. According to means-end epistemology, different means ought to be (...) rationally adopted to achieve different epistemic ends. Applied to XAI, different topics, stakeholders, and goals thus require different instruments. I call this the means-end account of XAI. The means-end account has a descriptive and a normative component: on the one hand, I show how the specific means-end relations give rise to a taxonomy of existing contributions to the field of XAI; on the other hand, I argue that the suitability of XAI methods can be assessed by analyzing whether they are prescribed by a given topic, stakeholder, and goal. (shrink)

Despite increasing interests and urgent needs for quality end-of-life care, there is no exact definition of what is the interval referred to as end of life or what end-of-life care is. The purpose of this article is to report our examination of terms related to end-of-life care and define end-of-life care from nursing ethics perspectives. Current terms related to end-of-life care, such as terminal care, hospice care, and palliative care, are based on a medical model and are restrictive in terms (...) of diagnosis and prognosis. Using codes of ethics for nurses as a framework, we attempt to identify people to whom nurses are responsible to provide end-of-life care and develop a definition of end-of-life care that is more inclusive and applicable to a broader range of people who would benefit from end-of-life care by nurses and other health-care providers. (shrink)

Families and clinicians approaching a child’s death in the paediatric intensive care unit (PICU) frequently encounter questions surrounding medical decision-making at the end of life (EOL), including defining what is in the child’s best interest, finding an optimal balance of benefit over harm, and sometimes addressing potential futility and moral distress. The best interest standard (BIS) is often marshalled by clinicians to help navigate these dilemmas and focuses on a clinician’s primary ethical duty to the paediatric patient. This approach does (...) not consider a clinician’s potential duty to the patient’s family. This paper argues that when a child is dying in the PICU, the physician has a duty to serve both the patient and the family, and that in some circumstances, the duty to serve the family becomes as important as that owed to the child. We detail the limitations of the BIS in paediatric EOL care and propose the relational potential standard as an additional ethical framework to guide our decisions. (shrink)

Patients with advanced dementia suffer from severe cognitive and functional impairment, including eating disorders. The focus of our research is on the issue of life-sustaining treatment, specifically on the social and ethical implications of tube feeding. The treatment decision, based on values of life and dignity, involves sustaining lives that many people consider not worth living. We explore the moral approach to caring for these patients and review the history of the debate on artificial nutrition and hydration showing the impact (...) of the varying perceptions of the value of these patients' lives on changing norms. We argue that in light of the value of solidarity, decisions about life-sustaining treatment for patients with advanced dementia should be made on a case by case basis, as with any other patient, in consideration of the medical implications of the intervention which might best serve the goals of care for the individual patient. (shrink)

Relational inferences are a well-known problem for Aristotelian logic. This book charts the development of thinking about this problem by logicians writing in Arabic from the ninth to the nineteenth century. It shows that that the development of Arabic logic did not - as is often supposed - come to an end in the fourteenth century.

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

This paper addresses a set-theoretic completeness based on a relational semantics for fuzzy extensions of two versions Rt and R T of R (Relevance logic). To this end, two fuzzy logics FRt and FRT as extensions of Rt and R T, respectively, and the relational semantics, so called Routley-Meyer semantics, for them are first recalled. Next, on the semantics completeness results are provided for them using a set-theoretic way.

Like others who work in philosophy, I asked myself from time to time what I was trying to do in my philosophizing. The natural answer seemed to be that I was trying to understand the world, and to do so by taking any thing or event that puzzled me and pressing the question Why? till I arrived at the understanding I sought. And what does understanding anything mean? It means to explain it or to render it intelligible. And when does (...) it become intelligible? Only when it is seen in context, and seen as required by that context. This requirement is of various kinds. Sometimes it is causal, as when an attack of malaria is explained by the bite of the anopheles mosquito. Sometimes it is a means-end relation, as when the presence of a rudder is explained as a means of guiding a ship. Sometimes it is logical, as when the Pythagorean theorem is explained by showing that it follows necessarily from other accepted propositions of geometry. (shrink)

This book follows hard upon Korsgaard's The Sources of Normativity. Both present the author's influential version of a Kantian theory of normative ethics and metaethics. Whereas The Sources of Normativity was a systematic investigation of "normativity" written as a single unit, the present volume is a collection of previously published papers, some of them already well known and much discussed, dating between 1983 and 1993. By the nature of the case, one might expect less thematic unity in this book than (...) in the other one, but the present book is a deeper and more wide ranging presentation of the author's views. Korsgaard's historical focus in The Sources of Normativity is less on Kant and more on the British moralists. Creating the Kingdom of Ends deals quite explicitly with the interpretation of Kant's moral philosophy. The papers in this book contain, in my judgment, the heart of Korsgaard's work: a variety of fresh and illuminating insights into Kant's moral theory and its relation to contemporary ethical theory which have helped to reshape the image of Kant's ethics and to refocus the issues dealt with in current moral philosophy. Or to make claims less grand but of more immediate relevance to this review, there is no question that some of the papers in this book have helped to reshape both the present writer's image of Kant's ethics and his conception of the way questions of ethical theory should be addressed. I hope below to say something both about where I think Korsgaard has gotten these matters right, and where I find her position either unclear or dubious. (shrink)

In this dissertation I address three philosophical problems in the philosophy of biology united by the underlying, and interlocking, issues of the explanatory role of teleological, normative, and representational concepts in biology. In the first chapter, I argue that extant accounts of functions have foundered on a problem I dub the Dysfunction Dilemma, and I offer a way to move forward. Functions are of philosophical interest because the concept plays an important explanatory role in biology, and other sciences, but is (...) apparently teleological and normative –an item’s function is its end, purpose, or goal, and a dysfunctional item is one that fails to realize a particular norm, performance of its proper function. Extant accounts of function do not successfully capture both its explanatory import and its normative and teleological character, either painting dysfunction as conceptually incoherent or painting functions as epiphenomenal. I diagnose the source of the dilemma and offer an account of functional explanation which avoids it. In the second chapter, I defend the idea that genes, like words or concepts, have intentionality or representational/semantic content. First, I argue that while the standard motivation for this idea is mechanistic analogies between molecular mechanisms and digital computation, Ernst Mayr, one of the architects of the modern synthesis in biology, has provided an alternative and more defensible justification for taking the idea seriously. Parallel to the standard case for representational and computational theories of cognition, Mayr’s justification rests on the need to invoke representations to explain end-directed processes. I then put Mayr’s argument to work answering three kinds of objection to the idea that genes are representational: 1) Genetic representations are causally or explanatorily inert, 2) Genetic processes are too complex and context sensitive to be captured by representational concepts, and 3) Details of molecular biology undermine representational conceptions of genes. In the final chapter, I develop a historical and philosophical interpretation of Ernst Mayr’s distinction between proximate and ultimate causes and its relation to Niko Tinbergen’s "four questions." Both frameworks have been influential in the biological study of behavior and are typically presented as a single framework, with Mayr’s proximate-ultimate distinction corresponding to one of two axes dividing Tinbergen’s four questions. I argue that this interpretation misrepresents Mayr’s and Tinbergen’s philosophical positions. I offer a positive account of both frameworks and their relation to one another, and I argue that contrary to many critics, Mayr’s proximate-ultimate distinction, when properly interpreted, does not present a barrier to the project of integrating biological work on Tinbergen’s four questions. (shrink)

The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw (...) conclusions about what we do (or do not) owe them. This paper argues that at best the concept of “personhood” is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood. (shrink)

There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option was (...) proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns. (shrink)

All we have left of the millenarian dateline is the countdown to it. The digital clock at the Beaubourg Centre, which shows the countdown in millions of seconds, is the perfect symbol for this century as it illustrates perfectly the reversal of modernity's relation to time. Time is no longer counted progressively from an origin but by subtraction, as with rocket launches or time bombs. This is a perspective of entropy. We no longer live with a vision of a world (...) of progress and production. When you count the seconds separating you from the end, it means that everything is already at an end; we are already beyond the end. (shrink)

Healthcare professionals working in intensive care units are often involved in end-of-life decision-making. No research has been done so far about these processes taking place in Croatian ICUs. The aim of this study was to investigate the perceptions, experiences, and challenges healthcare professionals face when dealing with end-of-life decisions in ICUs in Croatia. A qualitative study was performed using professionally homogenous focus groups of ICU nurses and physicians of diverse professional and clinical backgrounds at three research sites. In total, six (...) institutions at the tertiary level of healthcare were included. The constant comparative analysis method was used in the analysis of the data. Differences were found between the perceptions and experiences of nurses and physicians in relation to end-of-life decisions. Nurses’ perceptions were more focused on the context and features of immediate care, while physicians’ perceptions also included the wider sociocultural context. However, the critical issues these specific professional groups face when dealing with end-of-life decisions seem to overlap. A high variability of practices, both between individual practitioners and between different organizational units, was omnipresent. The lack of adequate legal, professional, and clinical guidelines was commonly expressed as one of the most critical source of difficulties. (shrink)