We provide an analysis of theory-ladenness in machine learning (ML) in science, where ‘theory’ (that we call ‘domain-theory’) refers to the domain knowledge of the scientific discipline where ML is used. By constructing an account of ML models based on a comparison with phenomenological models, we show (against recent trends in philosophy of science) that ML model-building is mostly indifferent to domain-theory, even if the model remains theory-laden in a weak sense, which we call theory-infection. These claims, we argue, have (...) far-reaching consequences for the transferability of ML across scientific disciplines, and shift the priorities of the debate on theory-ladenness in ML from descriptive to normative. (shrink)

Recent work in epistemology and philosophy of science conceptualizes explainable AI (XAI) tools as ‘models of models’, that is representations of opaque machine learning models whose value is assessed by their representation fidelity, and by the type of understanding they convey (e.g., explanatory, or objectual). In this work, we argue that this representation-centred view rests on a mistaken way of framing what XAI is. The problem XAI addresses, we claim, is not related to a lack of understanding, but of epistemic (...) incapacitation. Stated otherwise, XAI tackles the inability to use opaque models for all the scientific purposes their predictive accuracy should make possible in scientific contexts. Drawing on the literature on ‘models for’ and on models as epistemic artefacts, we propose an alternative account we name XAI-as-mediators. In doing so, we shift the question from “How faithful does the tool represent a model?” to “What does the tool enable the user to do with the model?”. We then distinguish between two forms of mediation: access mediation, which restores epistemic access to a model’s inner structure and behaviour, and semantic mediation, which aligns the model’s reasoning space with a given domain’s conceptual and inferential practices, and also specify the epistemic virtues proper to each type of mediation. Finally, we situate the proposed framework against Morgan and Morrison’s ‘models-as-mediators’ account, and show how it can answer Watson's challenge against XAI. (shrink)

Current research in Explainable AI includes post-hoc explanation methods that focus on building transparent explaining agents able to emulate opaque ones. Such agents are naturally required to be accurate and trustworthy. However, what it means for an explaining agent to be accurate and trustworthy is far from being clear. We characterize accuracy and trustworthiness as measures of the distance between the formal properties of a given opaque system and those of its transparent explanantes. To this aim, we extend Probabilistic Computation (...) Tree Logic with operators to specify degrees of accuracy and trustworthiness of explaining agents. We also provide a semantics for this logic, based on a multi-agent structure and relative model-checking algorithms. The paper concludes with a simple example of a possible application. (shrink)

The high predictive accuracy of contemporary machine learning-based AI systems has led some scholars to argue that, in certain cases, we should grant them epistemic expertise and authority over humans. This approach suggests that humans would have the epistemic obligation of relying on the predictions of a highly accurate AI system. Contrary to this view, in this work we claim that it is not possible to endow AI systems with a genuine account of epistemic expertise. In fact, relying on accounts (...) of expertise and authority from virtue epistemology, we show that epistemic expertise requires a relation with understanding that AI systems do not satisfy and intellectual abilities that these systems do not manifest. Further, following the Distribution Cognition theory and adapting an account by Croce on the virtues of collective epistemic agents to the case of human-AI interactions we show that, if an AI system is successfully appropriated by a human agent, a _hybrid_ epistemic agent emerges, which can become both an epistemic expert and an authority. Consequently, we claim that the aforementioned hybrid agent is the appropriate object of a discourse around trust in AI and the epistemic obligations that stem from its epistemic superiority. (shrink)

Human-centered explainable AI (HCXAI) advocates for the integration of social aspects into AI explanations. Central to the HCXAI discourse is the Social Transparency (ST) framework, which aims to make the socio-organizational context of AI systems accessible to their users. In this work, we suggest extending the ST framework to address the risks of social misattributions in Large Language Models (LLMs), particularly in sensitive areas like mental health. In fact LLMs, which are remarkably capable of simulating roles and personas, may lead (...) to mismatches between designers' intentions and users' perceptions of social attributes, risking to promote emotional manipulation and dangerous behaviors, cases of epistemic injustice, and unwarranted trust. To address these issues, we propose enhancing the ST framework with a fifth 'W-question' to clarify the specific social attributions assigned to LLMs by its designers and users. This addition aims to bridge the gap between LLM capabilities and user perceptions, promoting the ethically responsible development and use of LLM-based technology. (shrink)

We investigate a typology of socially and ethically risky phenomena emerging from the interaction between humans and large language model (LLM)-based conversational systems. As they relate to the way in which humans attribute social identity components, such as role and face, to LLM-based conversational systems, we term these phenomena 'social misattributions.' Drawing on classical theories of social identity and recent debates in the philosophy of technology, we argue that these social misattributions represent higher-order forms of anthropomorphisation of LLM-based conversational systems (...) that are not justified by their technical capabilities and follow from the social context of conversational interactions. We discuss the risks these misattributions pose to human users, including emotional manipulation and unwarranted trust, and propose mitigation strategies. Our recommendations emphasise the importance of fostering social transparency and exploring approaches, such as frictional design, that are currently promoted in the research domain of human-centred artificial intelligence. (shrink)

The research program of eXplainable AI (XAI) has been developed with the aim of providing tools and methods for reducing opacity and making AI systems more humanly understandable. Unfortunately, the majority of XAI scholars actually classify a system as more or less opaque by confronting it with traditional AI systems such as linear regression models or rules-based systems, which are usually assumed to be the prototype of transparent systems. In doing so, the concept of opacity remains unexplained. To overcome this (...) issue, we view opacity as a concept whose meaning depends on the context of application, and on the purposes and characteristics of its users. Based on this, in this work, we distinguish between access opacity, link opacity and semantic opacity, hence providing the groundwork for a taxonomy of the concept of opacity for AI systems. (shrink)

Background: The integration of artificial intelligence (AI) into health care has become a crucial element in the digital transformation of health systems worldwide. Despite the potential benefits across diverse medical domains, a significant barrier to the successful adoption of AI systems in health care applications remains the prevailing low user trust in these technologies. Crucially, this challenge is exacerbated by the lack of consensus among experts from different disciplines on the definition of trust in AI within the health care sector. (...) -/- Objective: We aimed to provide the first consensus-based analysis of trust in AI in health care based on an interdisciplinary panel of experts from different domains. Our findings can be used to address the problem of defining trust in AI in health care applications, fostering the discussion of concrete real-world health care scenarios in which humans interact with AI systems explicitly. -/- Methods: We used a combination of framework analysis and a 3-step consensus process involving 18 international experts from the fields of computer science, medicine, philosophy of technology, ethics, and social sciences. Our process consisted of a synchronous phase during an expert workshop where we discussed the notion of trust in AI in health care applications, defined an initial framework of important elements of trust to guide our analysis, and agreed on 5 case studies. This was followed by a 2-step iterative, asynchronous process in which the authors further developed, discussed, and refined notions of trust with respect to these specific cases. -/- Results: Our consensus process identified key contextual factors of trust, namely, an AI system’s environment, the actors involved, and framing factors, and analyzed causes and effects of trust in AI in health care. Our findings revealed that certain factors were applicable across all discussed cases yet also pointed to the need for a fine-grained, multidisciplinary analysis bridging human-centered and technology-centered approaches. While regulatory boundaries and technological design features are critical to successful AI implementation in health care, ultimately, communication and positive lived experiences with AI systems will be at the forefront of user trust. Our expert consensus allowed us to formulate concrete recommendations for future research on trust in AI in health care applications. -/- Conclusions: This paper advocates for a more refined and nuanced conceptual understanding of trust in the context of AI in health care. By synthesizing insights into commonalities and differences among specific case studies, this paper establishes a foundational basis for future debates and discussions on trusting AI in health care. (shrink)

This book provides a unified account of models and model-building practice in AI-based science, particularly machine learning (ML). It analyzes the relationship between ML model-building practices and scientific domain knowledge, develops an account of ML models as technical artifacts structured around five levels of abstraction that captures their representational capabilities, and shows how this framework can be used to reformulate contemporary debates in philosophy of science and AI in more fruitful ways. -/- .

The Termination Thesis (or “TT”) is the view that people go out of existence when they die. Lots of philosophers seem to believe it. Epicurus, for example, apparently makes use of TT in his efforts to show that it is irrational to fear death. He says, “as long as we exist, death is not with us; but when death comes, then we do not exist.”1 Lucretius says pretty much the same thing, but in many more words and more poetically: “Death (...) therefore to us is nothing, concerns us not a jot, since the nature of the mind is proved to be mortal; . . . when we shall be no more, when there shall have been a separation of body and soul, out of both of which we are each formed into a single being, to us, you may be sure, who then shall be no more, nothing whatever can happen to excite sensation.”. (shrink)

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. Popular and academic discourse about assisted suicide paradigmatically focuses on individuals with (...) ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)

Historically, the hypothesis that our world is a computer simulation has struck many as just another improbable-but-possible “skeptical hypothesis” about the nature of reality. Recently, however, the simulation hypothesis has received significant attention from philosophers, physicists, and the popular press. This is due to the discovery of an epistemic dependency: If we believe that our civilization will one day run many simulations concerning its ancestry, then we should believe that we are probably in an ancestor simulation right now. This essay (...) examines a troubling but underexplored feature of the ancestor-simulation hypothesis: the termination risk posed by both ancestor-simulation technology and experimental probes into whether our world is an ancestor simulation. This essay evaluates the termination risk by using extrapolations from current computing practices and simulation technology. The conclusions, while provisional, have great implications for debates concerning the fundamental nature of reality and the safety of contemporary physics. (shrink)

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...) more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

A terminating sequent calculus for intuitionistic propositional logic is obtained by modifying the R $\supset $ rule of the labelled sequent calculus $\mathbf {G3I}$. This is done by adding a variant of the principle of a fortiori in the left-hand side of the premiss of the rule. In the resulting calculus, called ${\mathbf {G3I}}_{\mathbf {t}}$, derivability of any given sequent is directly decidable by root-first proof search, without any extra device such as loop-checking. In the negative case, the failed proof (...) search gives a finite countermodel to the sequent on a reflexive, transitive, and Noetherian Kripke frame. As a byproduct, a direct proof of faithfulness of the embedding of intuitionistic logic into Grzegorcyk logic is obtained. (shrink)

.A term rewrite system is called simply terminating if its termination can be shown by means of a simplification ordering. According to a result of Weiermann, the derivation length function of any simply terminating finite rewrite system is eventually dominated by a Hardy function of ordinal less than the small Veblen ordinal. This bound had appeared to be of rather theoretical nature, because all known examples had had multiple recursive complexities, until recently Touzet constructed simply terminating examples with complexities beyond (...) multiple recursion. This was established by simulating the Hydra battle for all ordinal segments below the proof-theoretic ordinal of Peano arithmetic. By extending this result to the small Veblen ordinal we prove the huge bound of Weiermann to be sharp. As a spin-off we can show that total termination allows for complexities as high as those of simple termination. (shrink)

The aim of this article is a presentation of the problem of terminal sedation as a special medical procedure, an alternative to euthanasia and physician assisted death. Terminal sedation is consist in narcotizing the patient in the last stage of terminal disease, sometimes with discontinued nutrition and hydration until death. The goal of this procedure is to eliminate pain and suffering without causing death of the patient. The opponents of this method claim that terminal sedation is a form of euthanasia. (...) The supporters see the difference because the intention of physician must relieve unbearable suffering when the other procedures are useless. The terminal sedation has to be last resort in palliative care and the decision making process must be very careful. In case of applying this radical method the basis should be always the informed consent of the patient and the respect for the dying person. (shrink)

Abstract / 摘要 Relational Quantum Mechanics (RQM) posits that all physical properties are relative to the observer. However, Riedel (2024) identifies a critical logical challenge: the Unrestricted Iteration Principle (UIP), which leads to an infinite regress of relativization. This paper proposes a resolution by introducing the Universal Field of Intelligence (UFI) as the absolute substrate of information. We argue that while interaction outcomes are perspectival, the UFI functions as the Ultimate Observer or the "One True Realm" (一真法界), providing the foundational (...) phase-alignment mechanism that ensures global coherence. By terminating the iteration at the level of the foundational field, this model reconciles the flexibility of relational facts with the ontological necessity of a unified reality. -/- 關係量子力學 (RQM) 主張所有物理屬性皆相對於觀測者。然而，Riedel (2024) 指出了一個關鍵的邏輯挑戰：不限制疊代原則 (UIP)，這會導致相對化的無限回歸。本論文透過引入「宇宙智能場」 (UFI) 作為資訊的絕對基底，提出了一套解決方案。我們主張，雖然交互作用的結果是觀點性的 (perspectival)，但 UFI 作為「最終觀測者」或「一真法界」，提供了確保全域相干的基礎相位對齊機制。透過在基礎場層面終結這種疊代，本模型調和了關係性事實的靈活性與統一實相在學術本體論上的必要性。 . (shrink)

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of “terminal anorexia” suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is (...) in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected. (shrink)

“Terminal sedation” refers to the use of sedation as palliation in dying patients with a terminal diagnosis. Although terminal sedation has received widespread legal and ethical justification, the practice remains ethically contentious, particularly as some hold that it foreseeably hastens death. It has been proposed that empirical studies show that terminal sedation does not hasten death, or that even if it may hasten death it does not do so in a foreseeable way. Nonetheless, it is clear that providing terminal sedation (...) in combination with the withholding or withdrawing of life-prolonging treatments such as fluid and nutrition can foreseeably hasten death significantly—what is here called early terminal sedation . There are ethical justifications for the use of sedation in palliative care and thus it would seem that ETS is an ethically and legally acceptable practice. However, what emerges from the literature is the repeated assertion that terminal sedation must be restricted to use in imminently dying patients—the “imminence condition”—and that therefore ETS is unacceptable. This restriction has taken on greater significance with the trend of palliative care to include the care of patients who are not imminently dying. This paper proposes to show that although there is widespread intuitive support for the imminence condition, it does not follow from the justifications for sedation as palliation, and that explicit arguments for the imminence condition are needed. (shrink)

Slow euthanasia or a good palliative intervention?There are many ways in which doctors influence the circumstances and/or the timing of a patient’s death. Some of these are accepted as normal medical practice—for instance, when a disproportional treatment is forgone, others are considered tolerable only under strict conditions or even intolerable, such as non-voluntary active euthanasia. A relatively new phenomenon in the ethical discussion on end-of-life decisions is terminal sedation. Terminal sedation is used in patients with terminal illnesses where normal medical (...) treatments cannot relieve severe symptoms such as pain and agitation, and no option is left but to take away the perception of these symptoms. Often, the decision to start terminal sedation is accompanied by the decision to forgo the provision of artificial nutrition and hydration in these patients. In The Netherlands, terminal sedation was estimated to be applied in 4–10% of all deaths in 2001.1 The combination of these two decisions have made the moral status of terminal sedation the subject of fierce ethical debates. Is it slow euthanasia2,3 or is it a good palliative intervention that should be sharply distinguished from euthanasia?4,5 One of the characteristics of this debate is that it is a very confused one: people disagree about the meaning of the term, the appropriateness of it and, of course, about the conditions under which it would be morally justified. As a matter of fact, these three discussions are deeply connected: as is often the case, a discussion about terms is a discussion about norms in disguise.The first observation to be made is that many seemingly descriptive definitions of terminal sedation contain normative claims. Examples of this are definitions of terminal sedation in which only …. (shrink)

A theory of blameworthiness must answer two fundamental questions. First, what makes a person blameworthy when they act? Secondly, what makes a person blameworthy after the time of action? Two main answers have been given to the second question. According to interminability theorists, blameworthiness necessarily doesn't even diminish over time. Terminability theorists deny this. In this paper, I argue against interminability and in favour of terminability. After clarifying the debate about whether blameworthiness is interminable or terminable, I argue there's no (...) positive case for interminability. I then respond to three objections to terminability. In doing so, I clarify the nature of blame, self-blame, and posthumous blame. I also give theoretical reasons in favour of the view that a person's blameworthiness for a minor wrong can not only diminish but also cease completely. (shrink)

Termination in international contracts is considered a harsh sanction that harms international trade for each breach of contract or its provisions. The interest of international trade is fulfilled in maintaining and completing performance of contract, even if with a breach rectifiable by remedy. The termination destroys the contract and results in returning goods after their dispatch in addition to the accompanying new freight and insurance expenses and administrative and health procedures necessary for the entry and exit of goods and to (...) pay then refund the price. Moreover, the goods are exposed again to damage and perishing risks. Furthermore, the international sale contract is inherently associated with other international contracts such as goods transport contract, insurance contract and documentary credit through which the price is paid. If the sale contract is terminated, its effect will apply to all other associated contracts, if not performed, which produces many issues and hardships. (shrink)

Terminale Sedierung ist unter bestimmten Umständen ethisch rechtfertigbar: Mit dem Wissen um die Begrenztheit des eigenen Lebens ist auch der Sterbeprozess ein bewusst zu gestaltender, dem eigenen Willen unterworfener Bestandteil des Lebens. Das schließt auch die (paradoxe) Möglichkeit ein, bewusst auf das Bewusstsein beim eigenen Sterben zu verzichten. Anhand eigener Studien kann der Autor zeigen, dass sich der Wunsch nach Sterbehilfe bei terminal kranken Menschen als die Folge einer konsequenten Einordnung in das System der Medizin deuten lässt. Infolgedessen begreifen Patienten (...) auch das Sterben als eine Aufgabe des Medizinsystems, so dass sie ärztliche Sterbehilfe als Ausdruck für ein menschenwürdiges Sterben, paradoxerweise sogar als natürlichen Tod auffassen können. In dieser Situation ermöglicht die terminale Sedierung einen Fortschritt: Das Medizinsystem kann der von ihm erwarteten Zuständigkeit für den Prozess des Sterbens nachkommen, ohne direkt und intentional zu töten. Trotzdem bleiben bezüglich der Missbrauchsmöglichkeiten, der Rollenkonfusion der Ärzte und der Grenzen menschlicher Handlungsräume Zweifel. Vor der „Illusion der glatten Lösungen“ (H. Thielicke) wird gewarnt und für den Versuch geworben, das jeweils Beste für die einzelnen Betroffenen zu erreichen. (shrink)

The theoretical aspects and practical application of the termination of an employment contract upon an employee’s notice are analyzed in the paper. An employee can terminate an employment contract by his/her notice either without specifying any reason or due to some serious reasons. The problems of the regulation of the grounds for the exipiry of an employment contract are discussed and analyzed by comparison with the corresponding regulations in other European countries. Rulings of the Supreme Court of the Republic of (...) Lithuania are discussed to reveal the problems existing in practice. Conclusions and suggestions for the improvement of laws providing conditions for homogeneous interpretation of legal provisions are presented. (shrink)

The author of this paper, interested in the issues of values preference, meaning in life and altruism among university students has attempted to show a relation between them in the present period of clearly noticeable socio-cultural change. The study was conducted in 2009-2010 in Kraków among university students. The age of the respondents ranged from 21 to 25. 200 sets of correctly completed questionnaires were used for the results analysis. In order to show values preference among university students Rokeach’s ValueSurvey (...) (RVS) was used. The level of a sense of meaning in life was measured by means of Crumbaugh and Maholick’s Purpose in Life Test (PLT). Moreover, Śliwak’s Questionnaire of Altruism (A-N) was applied to measure the level of altruism. It was found that students with a high level of altruism are accompanied by a higher level of meaning in life than students with a low level thereof. Terminal values significantly correlate with meaning in life in groups of students with a high and low level of altruism. Among terminal values, values personal in character appear to be more strongly related to meaning in life than values social in character. (shrink)

People are often involuntarily laid off from their jobs through no fault of their own. Employees who are dismissed in this manner cannot always legitimately hold employers accountable for these miserable situations because the decision to implement layoffs is often the best possible outcome given the context—that is, layoffs in and of themselves may be “necessary evils.” Yet, even in circumstances in which layoffs qualify as “necessary evils,” morality demands that employers respect the dignity of those whose employment is involuntarily (...) terminated. In this paper I argue that to preserve the dignity of employees who are involuntarily terminated, in most cases employers have a substantial reason to offer a special kind of unemployment benefit, “severance pay.” To support my claim I draw and expand upon Bernard Williams’s analysis of “agent-regret,” which I believe greatly helps to address and articulate employers’ obligations in the context of involuntary termination. (shrink)

Gilbertson et al present a considered analysis of the abstract problem of ‘sedation’ at the end of life,1 and it is reassuring to see the separation of multiple practises that are often grouped under the heading terminal sedation. In their work, the authors attempt to introduce and justify a new practice in the care of those dying with significant suffering—expanded terminal sedation (ETS). This analysis will not, however, help our colleagues at the bedside. Here, we will focus on the flaws (...) which are most relevant to clinicians: jurisdiction, uncertainty and reversibility. The authors’ focus on a jurisdiction that does already allow medically assisted in dying confuses their analysis. For example, either an instance of their proposed ETS does amount to intentionally hastening death, in which case it should be treated as a means of euthanasia and practised only where that is permitted, subject to its limits and regulations; or it does not amount to intentionally hastening death, in which case there is no reason to specify such jurisdictions. To explain that the most controversial elements of terminal sedation have been tacitly ‘accepted’ by the society in question does not invalidate the concerns. It is beyond the scope of this response to explore these, but to us, …. (shrink)

Gilbertson et al should be commended for their insightful exploration of expanded terminal sedation (ETS)1; however, there are a number of concerns that I will address in this response. I will first better characterise the currently accepted and commonplace ‘standard’ TS (STS), and then argue that the advocated forms of ETS draw very close to—and at times clearly constitute a subtype of—euthanasia, as opposed to representing a similar but separate practice. I will then conclude with concerns regarding the inappropriate application (...) of ETS, particularly in the non-voluntary context. Gilbertson et al distinguish ‘gradual’ TS, which they state is the currently accepted form of TS, from ‘rapid’ TS, which is then argued to be a justifiable form of ETS. However, in my experience working in multiple large public teaching hospitals in New South Wales, Australia and consistent with local clinical practice guidelines,2 3 STS falls somewhere in the middle between ‘gradual’ and ‘rapid’ TS. STS explicitly aims to achieve permanent unconsciousness so as to eliminate the potential for (and therefore relieve) suffering; conversely, lighter or more intermittent forms of sedation, or administering sedatives with aims other than to achieve unconsciousness (eg, anxiolysis), do not constitute TS proper. STS uses doses proportionate to the extent of symptoms so as to avoid ‘overshooting’ and inadvertently administering excessive doses which actually hasten/cause death, in order to distinguish STS from euthanasia in this respect. This is achieved by gradually uptitrating doses when the patient appears distressed, and is therefore by definition …. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

Philip Reed (2023) argues that discrimination against (non-acutely) dying patients constitutes a unique kind—which he calls terminalism—because their status as persons with terminal illness marks them with a socially salient identity which, by means of direct and indirect discrimination, limits their sets of choices and resources, such as in hospice care or organ transplant policies. 1 Importantly, Reed also argues that while terminalism is an increasingly prevalent normative phenomenon, it has been overlooked in the literature, ‘hiding in plain sight’ as (...) even though we are ‘aware of it at some level’." 1 What could explain this paradox? Drawing from Jeffrey Bishop, Giorgio Agamben, and T. Kenny Fountain, I argue that an institutional episteme and operating assumption of medicine, from the training of medical students, discursively disciplines terminally ill persons as bare life, between medicine’s dichotomy of bodies: neither ‘biovaluable’ (the surplus value of separated human bodily material... (shrink)

Ackermann proved termination for a special order of reductions in Hilbert's epsilon substitution method for the first order arithmetic. We establish termination for arbitrary order of reductions.

Termination of pregnancy after a certain gestational age and following prenatal diagnosis, in many nations seem to be granted with a special status to the extent that they by law have to be discussed within a predominantly medical context and have physicians as third parties involved in the decision-making process (‘indication-based’ approach). The existing legal frameworks for indication-based approaches, however, do frequently fail to provide clear guidance for the involved physicians. Critics, therefore, asked for professional ethics and professional institutions in (...) order to provide normative guidance for the physicians in termination of pregnancy on medical grounds. After outlining the clinical pathway in an indication-based approach and the involved types of (clinical) judgements, this paper draws upon different understandings of professional ethics in order to explore their potential to provide normative guidance in termination of pregnancy on medical grounds. The analysis reveals that professional ethics will not suffice—neither as a set of established norms nor as internal morality—in order to determine the normative framework of indication-based approaches on termination of pregnancy. In addition, there seem to be considerable inconsistencies regarding the target and outcome between prenatal testing on the one hand and following termination of pregnancy on the other hand. A source of morality external to medicine has to be the basis of evaluation if a consistent and workable normative framework for termination of pregnancy and prenatal testing should be established. (shrink)

This paper contributes to the principled construction of tableau-based decision procedures for hybrid logic with global, difference, and converse modalities. We also consider reflexive and transitive relations. For converse-free formulas we present a terminating control that does not rely on the usual chain-based blocking scheme. Our tableau systems are based on a new model existence theorem.

Background: The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended-at the time-on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Sources of data: Existing ethics and health policy literature on the topic (...) of access to experimental drugs. Areas of agreement: The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. Areas of controversy: At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients-the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to Phase 1 agents for terminally ill patients. Growing points: Finding a compromise between providing free or no access to Phase 1 drugs for terminally ill patients. Areas timely for developing research: We ought to investigate means to increase access to experimental drugs for terminally ill patients without sacrificing necessary clinical trials' sounds scientific methods. (shrink)

Throughout the last decade, there has been an increased interest in various forms of dynamic epistemic logics to model the flow of information and the effect this flow has on knowledge in multi-agent systems. This enterprise, however, has mostly been applicationally and semantically driven. This results in a limited amount of proof theory for dynamic epistemic logics. In this paper, we try to compensate for a part of this by presenting terminating tableau systems for full dynamic epistemic logic with action (...) models and for a hybrid public announcement logic. The tableau systems are extensions of already existing tableau systems, in addition to which we have used the reduction axioms of dynamic epistemic logic to define rules for the dynamic part of the logics. Termination is shown using methods introduced by Braüner, Bolander, and Blackburn. (shrink)

ABSTRACT There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called ‘early terminal sedation’. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and nutrition, even (...) if these are life‐sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase. Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine. (shrink)

The “demand” for selective termination of pregnancy is a socially constructed response to prior medical interventions in women's reproductive processes, themselves dependent on cultural views of infertility.

The movie, The terminal, is used to illustrate Mac Intyre's description of virtue ethics. The terminal is a mythical tale about a traveler, Viktor Navorski, who is stranded by circumstances in a New York airport. Viktor is a person who, without a strict reliance on duty or rules, has developed the disposition to act well despite variation in his circumstances. His character is revealed in contrast to that of three other characters: a cleaner, a flight attendant and the airport manager. (...) Stories like this one may be a good way to open dialogue among clinicians about being virtuous as a practitioner. Such dialogue may make striving to be virtuous an acceptable goal for practitioners and less like an idealistic, pseudo-goal for those aiming for sainthood. (shrink)

One crucial issue that has historically received little attention within the assisted dying (AD) debate in the UK is what model of state involvement and provision should be implemented if AD becomes lawful. Limited attention has been paid to the question of whether AD should be positioned within existing end-of-life care provision, or whether it should occupy a separate space, with distinct provision. The question of the impact on the National Health Service (NHS) became an important point of concern in (...) debates about the Terminally Ill Adults (End of Life) Bill 2024–2025. These debates raised questions concerning how lawful AD ought to be established, the financial cost of provision for the service which the Bill states must be free, and how best to safeguard the interests of both patients and healthcare professionals. We consider the Government’s impact assessment, possible resource implications and ethical concerns over establishing a lawful AD service in England and Wales. The implications of a model of AD situated either within or alongside existing end-of-life NHS provision or, alternatively, established as a separate service outside existing end-of-life treatment provision are explored. We examine the key issues, including how AD should be funded, drawing on international experiences of different AD models. Our examination reveals that a clear volume/time/cost paradigm emerges, which must be recognised in planning a lawful AD service that avoids encouraging people towards AD. Whatever model of AD is implemented, maximising choice, safety, sustainability and equity of access are key concerns. Given the current NHS funding crisis, a variety of funding options to supplement state funding should be considered. (shrink)

Building on social network theory and incorporating insights from the literature on corporate misconduct, this study examined how a firm’s centrality within a social network influences terminations of its strategic alliances following public allegations of corporate misconduct. Utilizing a sample of 264 publicly listed companies operating within the global computer industry, the study found an inverted U-shaped relationship between an accused firm’s centrality and terminations of its strategic alliances following corporate misconduct. This relationship was found to be influenced as well (...) by media coverage and an accused firm’s brokering position. The findings underscore the multifaceted nature of centrality in the context of a corporate crisis, emphasizing its critical role in shaping the dynamics of inter-organizational partnerships. (shrink)

Medical research involving human subjects can be risky and burdensome. Therefore, such research must be reviewed and approved by a Research Ethics Committee (REC). To guarantee the safety of the subjects, it is very important that these studies be conducted in accordance with the approved protocol. An important issue in this respect is whether studies include the requisite number of subjects based on the research question. The research question is unlikely to be answered reliably if the requisite number of subjects (...) is not met. In such cases, subjects are exposed to unnecessary risks and burdens. In this descriptive study, the authors evaluated how frequently studies are completed with the required number of subjects. Moreover, the authors identified the characteristics of research that does and does not include the required number of subjects. The results of this study show that a considerable proportion of studies (41/107) were terminated although they failed to recruit a sufficient number of subjects. Furthermore, the authors found that investigator-initiated studies have significantly (p=0.028) more problems in recruiting the requisite number of subjects than studies initiated by pharmaceutical companies. Potential solutions are discussed to reduce the number of studies that do not include a sufficient number of subjects. (shrink)

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)

Essays examine various sides of medical ethics issues such as euthanasia, organ transplants, and living wills.

It is widely thought that abortion on the grounds of fetal abnormality is morally justified. More controversially, Peter Singer has argued that some infants with severe disabilities ought to be killed. Many disability rights activists object that such claims and practices express disrespect toward disabled persons, even if fetuses and infants are only potentially persons. This can seem puzzling. If disabled fetuses are not members of the community of disabled persons, how can our treatment of the former express disrespect toward (...) the latter? In what follows, I shall argue for two claims: first, the he puzzle is only apparent because whether we respect someone depends not only on how we do treat him but also on how we would treat him were circumstances different, and secondly, “substitutionary arguments” for selective terminations of disabled fetuses or infants do express disrespect toward disabled persons, even if fetuses and infants are only potentially persons. (shrink)