台湾地区姑息医学制度的建立及法律实践

姑息治疗在提高晚期癌症患者生活质量、实施临终关怀、给予病人及其家属全面周到的照顾诸方面起着重要作用。在台湾,已为姑息治疗立法并实施了10年,积累了丰富的经验。这项法律本身及其细则、附件等配套文件使姑息治疗更加规范可行。研究规范的姑息治疗及台湾的相关法律可以帮助我们更好的理解姑息治疗的理念,帮助发展大陆同道构建有效实用的...     

The Question of Questions: What is a Gene? Comments on Rolston and Griffths & Stotz

If the question “What is a gene?” proves to be worth asking it must be able to elicit an answer which both recognizes and address the reasons why the concept of the gene ever seemed to be something worth getting excited about in the first place as well analyzing and evaluating the latest develops in the molecular biology of DNA. Each of the preceding papers fails to do one of these and sufferrs the consequences. Where Rolston responds to the apparent failure of molecular biology to make good on the desideratum of the classical gene by veering off into fanciful talk about “cybernetic genes,” Griffiths and Stotz lose themselves in the molecular fine print and forget to ask themselves why “genes” should be of any special interst anyway.     

A Semantics for Means-end Relations

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). “They were in conversation without speaking. They didn’t need to speak. They just changed reality so that they had spoken.” Terry Pratchett, Reaper Man     

Whole Lives and Good Deaths

This article discusses two views associated with narrative conceptions of the self. The first view asserts that our whole life is reasonably regarded as a single unit of meaning. A prominent strand of the philosophical narrative account of the self is the representative of this view. The second view—which has currency beyond the confines of the philosophical narrative account—is that the meaning of a life story is dependent on what happens at the end of it. The article argues that the connection between these two views is more tentative than often supposed: philosophical narrativists that see life as a single unit of value and meaning nonetheless provide grounds for arguing that the end of life is not the best and may be a particularly bad time to approach and intervene in the matter of how well one's life as a whole has gone.     

L’affaire Lambert

In the case Lambert, the Council of State (high court of the Public law) finished a long trial. The question concerned the power of medical decision: family? doctor? judge? The European Court of Human Rights disputes its solution.     

Affaire Vincent L. : les maux de la fin

As called back it June 24th, Council of State in its press release, the Vincent L.’s case “raise scientific, ethical and human questions”. At first, to decide on the fate of this 38-year-old man, the administrative jurisdiction recovered from it in expert opinions asked to establish the existence or not of an unreasonable stubbornness. But the objectivity of the medical science cannot solve only this litigation where the outcome is the life or the death of a patient. That is why the court opened its doors to the ethical speech too. If in this case, the science could not exist without consciousness, if the legal word could not exist without the ethical word, it's because of the human dimension which fills this media and legal affair. So behind this patient's case, called now “the Vincent L.’s affair”, it's a question about the death, that of a young man in the incapacity to express its will. It's also a question of a family disagreement on the future of their son, brother, or husband. In this context, “politically and mediatically charged”, the administrative jurisdiction pronounced four times on the decision of the stop of Vincent L.’s treatment. The educational position of the French judges allowed to clear up statutory provisions of the Leonetti's act.     

Palliative-care professionals' experiences of unusual spiritual phenomena at the end of life

Research literature has highlighted unusual phenomena occurring at the end of life. Palliative-care professionals often feel ill-prepared in managing these and in talking to patients and family members about them. This study aimed to explore the meanings and interpretations ascribed to these phenomena by palliative-care professionals. Eight participants were interviewed, and interpretative phenomenological analysis used to identify themes within their accounts. Four themes emerged from the analysis: (1) Who are we to say what's out there?: a connection with something beyond what can be seen; (2) It opened up conversations: the experience of talking about unusual experiences; (3) It knocked me sideways: managing the emotional impact of these experiences; and (4) The fact that she was so accepting made it easier: the value of acceptance in relation to unusual experiences. These findings are discussed within the context of existing literature and implications for palliative-care professionals are discussed.     

A new look at time and eternity

In his Systematic Theology, Vol. III, Wolfhart Pannenberg argues that God as eternal comprehends the different moments of time simultaneously and orders them to constitute a whole or totality. The author contends that this approach to time and eternity might solve the logical tension between the classical notion of divine sovereignty and the common sense belief in creaturely spontaneity/human freedom. For, if the existence of the events constituting a temporal sequence is primarily due to the spontaneous decisions of creatures, and if their being ordered into a totality or meaningful whole is primarily due to the superordinate activity of God, then both God and creatures play indispensable but nevertheless distinct roles in the cosmic process.     

Spiritual Inquiry and Well-Being in Life-Limiting Illness

ABSTRACT

Introduction: End of life, as a developmental phase, is accompanied by inner resources as well as losses. Spirituality is a potential inner resource for integrating illness that often occurs during this time. Despite the increase in spirituality research, how spiritual perspectives are used in life-limiting illness remains under-investigated. Better knowledge about this process may be useful for health care providers, family caregivers and patients themselves to enhance well-being at end of life. This study describes the process of how patients and family care-givers use their spiritual resources to facilitate well-being at the end of life.

Method: A qualitative study was designed, based upon the grounded theory method, that entails theoretical sampling of concepts (not sampling of people as in quantitative designs), and the analytic technique of constant comparison of the data until conceptual categories are saturated with supporting data and a theory can be identified. The sample consisted of 12 respondents: 6 dyads of elderly patients with a life-limiting illness and family caregivers. Interviews occurred over a 2-year period.

Results: Data analysis generated a theory about a process called “transcending life-limiting illness,” which derived from two related themes: spiritual inquiry and end-of-life dimensions.

Conclusion: The results expand existing knowledge about how people, either as patients or as family caregivers of persons facing end of life, live with life-limiting illness. The process of transcending life-limiting illness goes beyond merely coping to tap resources for well-being. This resource is expressed through an ongoing dialectic process of spiritual inquiry about life and death as supported by six critical life dimensions.     

The Astounding Assumption of Infinite Life

The multimillennial philosophical discussion about life after death has received a recent boost in the prospect of immortality attained via technologies. In this newer version, humans generally are considered mortal but may develop means of making themselves immortal. If “immortal” means not mortal, thus existing for infinity, and if the proposed infinite‐existing entity is material, it must inhabit an infinite material universe. If the proposed entity is not material, there must be means by which it can shed its material substance and exist nonmaterially. The article examines arguments for how an infinite life would be possible given current physical understanding. The paper considers a Pascalian‐style wager weighing the likelihood of adjusting to existence wholly within a finite universe versus betting on there being some way to construe the universe(s) as a viable medium for infinite beings. Conclusion: the case for a finite being to exist infinitely has little viable support.