Bioethics for clinicians: 11. Euthanasia and assisted suicide

Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means.     

Dream Content and Political Ideology

This pilot study focuses on the relationship of dream content and political ideology in a contemporary U.S. context. The study involved 56 people, 28 (14 male and 14 female) who identified themselves as members of the political right and 28 (14 male and 14 female) who identified themselves as members of the political left. Most recent dream reports from these subjects were analyzed using Hall and Van de Castle content analysis categories. Following that quantitative analysis, each dream was analyzed in terms of its narrative qualities (themes, images, emotional patterns, etc.). Although the small size of the study makes it impossible to offer definitive interpretations, the findings are suggestive: people on the political right had more nightmares, more dreams in which they lacked personal power, and a greater frequency of lifelike dreams; people on the political left had fewer nightmares, more dreams in which they had personal power, and a greater frequency of good fortunes and bizarre elements in their dreams. These findings have plausible correlations to certain features of the political ideologies of people on the left and the right, and merit future investigation in larger-scale studies.     

Language, Ideology, and Political Economy

After sharply defining and contrasting an "analytic-scientific" and an "emotional-ethical" approach and their interrelations, this article goes on to explore some possible interconnections among the three main phenomena, before discussing each in more detail. The first is political economy in several important senses; germane problems are noted that deal with (ethno) quantification and the innovative individual. The second phenomenon is ideology, in three senses: (1) notional ideology, (2) ideology for maintaining or changing a sociopolitical order, and (3) ideology for masking a structure of domination. The third phenomenon is language, again in various senses, but particularly as (1) a symbolism with a structure analogous in some ways to that of economics, and (2) a mediator between ideology and political economy; considerable attention is given to the political-economic functions of language figures such as irony and synecdoche. A fourth, analytically crucial kind of ideology, "linguacultural ideology," fills in the foregoing structure. Alternative logics, alternative combinations of variables, and alternative complementary theories are suggested throughout, particularly in the final section.     

Language Ideology: The Case of Spanish in Departments of Foreign Languages

In this article we investigate language ideology in a department of Spanish. We are concerned with examining the acquisition and transmission of linguistic culture in departments of foreign languages within university settings and the ways in which views about non-English languages that are part of the American cultural dialogue are maintained and nurtured by educational institutions. Using long-term participant-observation data and focused interviews, we contend that foreign language departments in U.S. colleges and universities, although involved in a nonhegemonic practice—that is, in the teaching of non-English languages—are nevertheless working in concert with deeply held American ideologies about bilingualism and monolingualism.     

Political Regimes,Political Ideology,and Self-Rated Health in Europe: A Multilevel Analysis

Background

Studies on political ideology and health have found associations between individual ideology and health as well as between ecological measures of political ideology and health. Individual ideology and aggregate measures such as political regimes, however, were never examined simultaneously.

Methodology/Principal Findings

Using adjusted logistic multilevel models to analyze data on individuals from 29 European countries and Israel, we found that individual ideology and political regime are independently associated with self-rated health. Individuals with rightwing ideologies report better health than leftwing individuals. Respondents from Eastern Europe and former Soviet republics report poorer health than individuals from social democratic, liberal, Christian conservative, and former Mediterranean dictatorship countries. In contrast to individual ideology and political regimes, country level aggregations of individual ideology are not related to reporting poor health.

Conclusions/Significance

This study shows that although both individual political ideology and contextual political regime are independently associated with individuals'' self-rated health, individual political ideology appears to be more strongly associated with self-rated health than political regime.     

Meaning Matters: The Biosemiotic Basis of Bioethics

If the central problem in philosophical ethics is determining and defining the scope of moral value, our normative ethical theories must be able to explain on what basis and to what extent entities have value. The scientific foundation of contemporary biosemiotic theory grounds a theory of moral value capable of addressing this problem. Namely, it suggests that what is morally relevant is semiosis. Within this framework, semiosis is a morally relevant and natural property of all living things thereby offering us an ecological, as opposed to merely environmental, ethic. A consequence of this semiotic theory is that living things are accorded inherent moral value based on their natural relational properties—their ability to signify. This consequence establishes a hierarchy of inherent moral value based on the scope of signification: the larger the Umwelten, the greater the value. This paper argues that a robust semiotic moral theory can take into account a much wider scope of inherent value.. These consequences have positive ramifications for environmental ethics in their recognition of the natural ecological networks in which each organism is bound. This presentation of a biosemiotic model of value offers a justificatory strategy for our contemporary moral intuitions concerning our semiotic/moral relationships with living things while also productively pushing our normative ethical boundaries.     

Focus: Bioethics: The Emotions in Bioethical Decision-making

In an era of evidence-based medicine and an increasing use of technology the question is raised again as to what extent emotions should play in medical and ethical decision-making. While clearly the correct facts in each case are a sine qua non for ethical decision-making, and one should evaluate each situation rationally in accord with accepted ethical principles, the appropriate role of the emotions in decision-making is gaining increased attention in part as a result of newer research in neuroethics. In end-of-life care there often exists a disconnect between the “rational” analysis by many philosophers and ethicists and the emotional reactions of many physicians and nurses with respect to the comparison between withholding and withdrawal of life-sustaining therapy. It is suggested that these attitudes of many health care workers should not be ignored because they represent a critical, almost universal, and laudable value of reluctance to take human life, a value so strongly ingrained in the ethos of the medical profession.     

Australian Anthropology,Ideology and Political Repression: The Cold War Experience of Frederick G. G. Rose

It is more than half a century since Frederick G. G. Rose (1915–1991) published his classic text, The classification of kin, age structure and marriage amongst the Groote Eylandt Aborigines: A study in method and a theory of kinship (1960) in the former German Democratic Republic. Although the fieldwork for his thesis had been carried out in Australia on Groote Eylandt in 1938 and 1941, a conservative academic establishment and the political climate of the Cold War postponed its publication until 1960. Why were Rose's fieldwork findings suppressed by the powerful gate-keeper of Australian anthropology, Professor Adolphus Peter Elkin (1891–1979)? Moreover, why was Rose later denied a government permit to revisit Groote Eylandt and Central Australia to further his research? This paper examines the early work of the communist anthropologist, Frederick Rose, within the broad context of Western post-war anthropological developments, an expanding capitalist economy and the political tensions of the Cold War era. As a communist and public servant from 1938 to 1954, Rose was forced, after the Petrov Royal Commission cast him under a cloud of suspicion, to seek institutional support for his academic career in the German Democratic Republic.     

Implicit and Explicit Illusory Correlation as a Function of Political Ideology

Research has demonstrated that people who embrace different ideological orientations often show differences at the level of basic cognitive processes. For instance, conservatives (vs. liberals) display an automatic selective attention for negative (vs. positive) stimuli, and tend to more easily form illusory correlations between negative information and minority groups. In the present work, we further explored this latter effect by examining whether it only involves the formation of explicit attitudes or it extends to implicit attitudes. To this end, following the typical illusory correlation paradigm, participants were presented with members of two numerically different groups (majority and minority) each performing either a positive or negative behaviour. Negative behaviors were relatively infrequent, and the proportion of positive and negative behaviors within each group was the same. Next, explicit and implicit (i.e., IAT-measured) attitudes were assessed. Results showed that conservatives (vs. liberals) displayed stronger explicit as well as implicit illusory correlations effects, forming more negative attitudes toward the minority (vs. majority) group at both the explicit and implicit level.     

The Nature and Value of Bioethics Expertise

In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision‐making and policy‐formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non‐bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error.     

The Bioethics of Diagnosis: A Biocultural Critique of Certainty

This article argues that traditional models of diagnosis are incomplete in their reliance on a models of certainty that are no longer tenable in a postmodern world. Further, it argues that the current form of diagnosis, as applied to psychiatric and affective disorders, reduces patient agency and reinscribes the effects of biopower.     

Bioethics and culture: an African perspective

The project of Bioethics seems to me to require paying attention to the cultural realities and assumptive frame of reference of different peoples. I assume that this must be one of the views of the organizers of this conference too and that this is why the idea of country reports is taken seriously. If I am right about this, then it makes sense for me to start my discussion with a very brief discussion of some aspects of the cultural realities of Africa with particular reference to the Yoruba of Nigeria. Then I will discuss how this world view raises issues for bioethics. Two aspects of people's worldview relevant to bioethical issues are their conception of the human person and their conception of cause. What they consider themselves to be, and what they consider to be the principles of causation will normally influence their attitudes to health and illness and their choices regarding health care. I will briefly discuss these issues with regard to the Yoruba worldview.