Cambridge Quarterly of Healthcare Ethics最新文献

Research suggests that caregivers of patients with disorders of consciousness such as minimally conscious states (MCS) believe they suffer in some way. How so, if they cannot experience sensations or feelings? What is the nature of their suffering? This paper explores non-experiential suffering (NES). It argues that concerns about NES are really concerns about harms (e.g., dignity-based harms), but still face problems. Second, it addresses the moral importance of bearing witness to suffering. It explores several possible accounts: epistemic (bearing witness generates important knowledge), consequentialist (witnesses' interests also matter), and deontological (there is a duty to bear witness). It argues that witnessing suffering creates epistemic advantages and disadvantages for determining a patient's interests; that clinicians' interests to not bear witness may have considerable moral weight; and that the obligation to bear witness to NES is unclear.

This essay argues that what distinguishes a negatively valenced phenomenal experience from suffering is an ability to make meaning of the experience. In this sense, intellectual ability influences the extent and nature of suffering. But this connection is not a straightforward one, since intellectual ability cuts both ways. On the one hand, those with higher levels of intellectual functioning are better able to make meaning of negative experiences, thereby reducing their suffering. On the other, intellectual ability can influence the depth and breadth of one's negative experiences, thereby increasing suffering. This means that we cannot make any assumptions about a person's susceptibility to suffering based on their level of intellectual functioning alone.

This essay argues that suffering in persons with dementia is more than a matter of personal experience. It is knowable by others and does not need to rely on the reports of the patient to affirm it. It is even possible for a person to claim not to be suffering-"I'm doing fine"-but for others to conclude to the contrary-"You are suffering." A key property of this objective account is the caregiver observes the suffering. This observation is a product of the work of caregiving and this work relies on perceiving and supporting the mind of the person living with dementia. When that work of mind support is successful, it creates a feeling of being at home. When it is not, suffering ensues.

Based on the case report of Nathan Goldstein et al., "But I have a pacer…there is no point in engaging in hypothetical scenarios": A Non-imminently Dying Patient's Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient's request to deactivate her pacemaker. Philosophically, and as a clinical ethicist, I support the team's decision to honor the patient's request for pacemaker deactivation. However, it is worth exploring a bit further whether the distress on the part of the outside hospital's ethics committee and providers-who declined to honor the patient's request for pacemaker deactivation-may actually track something of moral significance. In this commentary, I argue that there are reasonable grounds for holding that deactivation of a 'biofixture' such as a pacemaker may be more analogous in moral terms to medical aid in dying than it is to standard cases of withdrawal of life support at the end of a patient's life.

In leaning forward to better see the details of a Breughel wedding scene, an elderly man with thick glasses bumped his head on the wooden frame. He saw stars. "Careful, that painting is irreplaceable," the guard said. "Please stand back a few feet."

Within bioethics, two issues dominate the discourse on suffering: its nature (who can suffer and how) and whether suffering is ever grounds for providing, withholding, or discontinuing interventions. The discussion has focused on the subjective experience of suffering in acute settings or persistent suffering that is the result of terminal, chronic illness. The bioethics literature on suffering, then, is silent about a crucial piece of the moral picture: agents' intersubjectivity. This paper argues that an account of the intersubjective effects of suffering on caregivers could enrich theories of suffering in two ways: first, by clarifying the scope of suffering beyond the individual at the epicenter, i.e., by providing a fuller account of the effects of suffering (good or bad). Second, by drawing attention to how and why, in clinical contexts, the intersubjective dimensions of suffering are sometimes as important, if not more important, than whether an individual is suffering or not.

The terminology of "lives not worth living," "worthwhile lives," and "unworthwhile lives," used by John Harris and many others, has become an accepted linguistic convention in bioethical discussions. These terms are used to distinguish lives of overwhelming negative experience from lives that are or are expected to be of overall positive value. As such, this terminology seems helpful in discussions around resource allocation, end-of-life decision making and questions of when it might be acceptable (and unacceptable) to reproduce. This paper argues that there is, however, a problematic ambiguity inherent in these general terms that is particularly evident when it comes to discussing reproductive choices. It is suggested that in this context, this ambiguity can conceal authoritarian eugenic motivations that are difficult to justify and that many using these terms would not adhere to. As a result, it is argued that we should replace these terms with the terms "intrinsically valuable" and "intrinsically harmful." This would make it more explicit what exactly is meant and would allow these matters to be debated with greater clarity.

Neurorights are widely discussed as a means of protecting phenomena like cognitive liberty and freedom of thought. This article is especially interested in example cases where these protections are sought in light of fast-paced developments in neurotechnologies that appear capable of reading the mind in some significant sense. While it is prudent to take care and seek to protect the mind from prying, questions remain over the kinds of claims that prompt concerns over mind reading. The nature of these claims should influence how exactly rights may or may not offer justifiable solutions. Overall, the exploration of neurotechnological mind reading questions here will come in terms of philosophical accounts of mental content and neuroreductionism. The contribution will be to present a contextualization of questions arising from 'mind-reading' neurotechnology, and appraisal of if or how neurorights respond to them.