Death and Suffering

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Palliative Care, Suffering, Death Trajectory: A View of End of Life Care (EOL) Related Issues in Sub Saharan Africa (SSA)

Palliative Care, Suffering, Death Trajectory: A View of End of Life Care (EOL) Related Issues in Sub Saharan Africa (SSA)

Despite competing healthcare systems demands in SSA counties because of the “needs versus resource” tensions, health care policy makers/managers in SSA countries need to work on the issue of a dignified, death trajectory at EOL that is as free of pain and suffering as possible for its citizenry, whilst continuing to bat- tle the ravages of preventable and chronic illnesses known to contribute to high mortality and morbidity. In so doing they should be careful not to be caught up in setting up EOL or palliative care services that will assume a “business role”, as opposed to a value based palliative care system. In developing viable “develop- ment appropriate” palliative care services, SSA countries can seek assistance from organisations in developed economies with the appropriate experience and expertise in setting up appropriate cost saving palliative care systems, especially in the public health sector. For the citizens of SSA countries who are challenged day to day by existential difficulties the creation of a working, ably managed pal- liative care service may allow them find peace and dignity at EOL.

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Beyond the Suffering —Documenting Human Death and Dying

Beyond the Suffering —Documenting Human Death and Dying

The pulmonologist recounts his initial experiences with human death and dying and underscores suffering as being his principal challenge in the context of patient treatment. The hematologist and oncologist too relates his experiences and emphasizes that the practice of oncology is accompanied by countless situations where he wit- nesses suffering and death. He asserts that the suffering endured should always be a resource for him to use to help allay the suffering of others, and that everyone should be aware of their role in life: to help others. The third doctor, from the field of medical psychology, speaks not only about the suffering of someone who knows death is near, but about the richness of human character expressed at such moments. He stresses the importance of preparing students for such situations and mentions possible routes for educating them. As for the participation of the two people accompanying their family members, the musician recounts his experience dealing with the prolonged illness and death of his father, whom he says received excellent medical treatment. The other, a re- tired lady who accompanied her mother throughout what was also a prolonged illness, describes the anguish of being kept away from her dying mother by the doctors treating her on her deathbed. The nurse tells of her time working at an ICU and her first experiences treating dying patients: she was scared and suffered. She also speaks of the pleasure she feels working in such a stressful environment as the ICU and being able to care for patients in critical condition.

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Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life

Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life

A main condition for the initiation of sedation for psychological and existential suffering was for most physicians the presence of refractory symptoms. This con- forms with the sedation guideline recommendations [1 – 3]. There was often reluctance among physicians in the stud- ied countries to sedate for mainly psychological and exis- tential suffering. Another study also found physicians to be less in favor of or opposed to using sedation to uncon- sciousness for existential suffering [26]. Physicians in our study explained that they were reluctant to use sedation in these cases for personal reasons and that they would wait for the appearance of coexisting refractory physical symp- toms. It is also possible that physicians are reluctant to use sedation for psychological and existential suffering be- cause this suffering may fl uctuate as death approaches and is usually amenable to pharmacological and psycho- logical treatments such as the dignity model intervention designed for patients at the end of life [27,28]. This reluc- tance may heighten the risk of not exploiting enough the potential for interventions. Further, for the physicians in our study, the patient ’ s short life expectancy and an explicit request to be asleep and not to wake up again were deemed as important. No differences were found between the studied countries, except that the patient ’ s short life expectancy as a condition for the use of sedation seemed less important for Belgian physicians. This does not conform with sedation guideline recommendations [1 – 3]. Possibly, these physicians primarily focused on adequate symptom relief regardless of the patient’s short life expectancy.

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The Suffering Child: Claims of Suffering in Seminal Cases and What To Do About Them

The Suffering Child: Claims of Suffering in Seminal Cases and What To Do About Them

In August of 2016, Charlie Gard was born at term in the United Kingdom. Shortly after birth, his parents began to notice muscle weakness and breathing difficulties. He was admitted to intensive care and was eventually diagnosed with a severe mitochondrial disorder. Charlie ’ s speci fi c disorder had been previously reported in ∼ 15 infants, with typical clinical features including early onset, rapid progression, and death in infancy. 1 Charlie’s parents identified an experimental treatment that they hoped might benefit Charlie, but, given his deteriorating condition, Charlie’s physicians and care team thought this treatment would not be beneficial. They applied to the Family Division of the High Court for permission to withdraw life support and to provide palliative care. A lengthy court battle ensued between the hospital and Charlie ’ s parents, and several major media outlets around the world covered the story. Perhaps not surprisingly, both Charlie’s parents and his care team

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'Moltmann’s Crucified God'

'Moltmann’s Crucified God'

Only in this way can finite being stand against “the threatening nothingness of death, suffering and chaos”. “Death, suffering and mortality must therefore be excluded from the divine being.” It is a conflict between “the zone of the impossibility of death” and “the zone of the necessity of death”. Therefore, God cannot suffer and die. But “Christian theology must think of God’s being in suffering and dying and finally in the death of Jesus.” Moltmann chooses the God of the Bible, the God of the passion of Jesus Christ, over against the God of the philosophers. The theology of the cross liberates us from philosophical and political monotheism. The choice is for a God who makes all things new: “The metaphysical longing of all that is transitory for intransitoriness and of all that is finite for infinity undergoes an eschatological transformation and is taken up into the hope of the freedom of the sons of God and the freedom of the new creation that does not pass away.” 50

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THE PROBLEM OF HUMAN SUFFERING

THE PROBLEM OF HUMAN SUFFERING

Why do we suffer?Is a very big question that has perplexed the mind of human beings from time immemorial. Why are we born? And if we are born why this pain and suffering on this earth. We find suffering, pain, problems, old age and death.These to some extent can be said that there exists evil on this earth.Evil can be divided into two types.We find evil caused by nature like earthquakes, flood , storm etc. and evil created by man like fights, greed, insincerity,

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Game Birds: The Ethics of Shooting Birds for Sport

Game Birds: The Ethics of Shooting Birds for Sport

Also, hunting (for sport) with rifles appears clearly less problematic than hunting with traps (like snares or leg hold traps), if we assume that the former causes less suffering than the latter and the shooting does not involve animals bred in battery conditions. Hunting with traps often involves animals being trapped for days on end with horrific injuries. The animals often starve to death or die of exposure. Further, animals killed by traps are usually wild animals and may often be animals in which the harm caused by death is greater than the harm caused by death for animals bred specifically for blood sports. (Monkeys and large cats are just some of the animals hunted with snares. Wild cats, such as leopards and bobcats, are also victims of leg- hold traps.) Therefore, it is difficult to see how hunting with snares or traps is ever justifiable and appears to be a worse choice than shooting birds reared in free-range conditions or shooting animals in general.

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The Shelleys and the Art of Suffering

The Shelleys and the Art of Suffering

Seventeen years after she was widowed at the age of twenty-four, Mary Wollstonecraft Shelley published the first ‘complete’ edition of Percy Shelley’s poetry as a monument and eulogy to him. She justified her interventionist editorial presentation of his texts in part by reference to her lasting sorrow at his death. Her edition is marked by a burning sense of separation, but this posthumous collaboration has frequently been read as an impressive exercise in joint literary creativity. Literary collaboration is perhaps more readily associated with conviviality, good cheer, and mutual encouragement, and it is certainly the case that emphasising the camaraderie that fostered the writing of poems, novels and essays in the late eighteenth and early nineteenth centuries can distance us usefully from the spirit of serious intensity cultivated by high Romanticism. 1 Mary’s work, however, stands as a valuable reminder of

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Suffering in Romans

Suffering in Romans

Finally,  it  is  worth  exploring  Paul’s  understanding  of  suffering  in  relation  to  his   view   of   God’s   purpose   for   humanity   and   the   place   of   Christ’s   death   and   resurrection   in   his   theology.   In   our   study   we   set   out   to   explore   the   issues   concerning  suffering  from  the  audience’s  perspective.  This  approach  means  that   we   do   not   need   to   cross-­‐‑reference   what   Paul   says   elsewhere   concerning   suffering.  But  this  does  not  mean  that  Paul’s  other  letters  have  no  place  in  our   quest   for   a   theology   of   suffering.   For   example,   Philippians   3:10–11   clearly   speaks   of   Paul’s   desire   to   participate   in   Christ’s   suffering,   death   and   resurrection.  It  would  be  interesting  to  compare  and  contrast  Philippians  and   Romans  in  terms  of  the  interrelationships  between  suffering  and  participation   in   Christ.   Also,   Paul’s   use   of   εἰκώών,   µμεταµμορφόόω,   δόόξα   and   κτίίσις   in   2   Corinthians   3:18;   4:4;   5:17   echoes   the   corresponding   key   words   in   Romans   8.   Since   2   Corinthians   contains   numerous   references   to   suffering,   it   would   be   worthwhile   to   explore   the   relationship   between   affliction   and   God’s   purpose   for  humanity  and  creation  in  this  letter.  My  sense  is  that  participation  in  Christ   is  an  essential  element  of  —  if  not  central  to  —  Paul’s  theology,  and  that  sharing   in   his   suffering   is   an   integral   part   of   it. 7  It   would   be   a   fruitful   exercise   to  

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Cutting God in Half

Cutting God in Half

It is this cosmic It that is responsible for all our suffering. And precisely because It is an It, incapable of knowing and feeling, It can be forgiven the terrible things that It does. If It knew that the laws of nature, working themselves out as usual, meant, in this particular case, horrible suffering and death from cancer for this child, agonizing burns for this person, burial in rubble for that person, the It would at once bend a law of nature here and there, so that these ghastly tragedies can be avoided. But this cosmic It has no mind, no understanding, no awareness: it goes blindly on Its way, incapable of knowing anything, and therefore can be forgiven.

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Pediatric Suffering and the Burden of Proof

Pediatric Suffering and the Burden of Proof

The alleviation of suffering has always been central to the care of the sick. 1 Yet, although suffering is an ancient concern, Western medicine has taken a renewed interest in suffering over the past 50 years. A major reason for this renewal is the recognition that medicine can act as both a relief and a source of human suffering. As medical technology has advanced and life-sustaining treatments multiplied, medicine’s capacity to create suffering has also grown exponentially. In pediatric medicine for instance, the ability to stave off death with ventilators, dialysis, left ventricular assist devices, organ transplants, and extracorporeal membrane oxygenation allows children to survive but also to suffer and in ways that are diverse and unprecedented in human history. Western medicine’s increasing recognition of human suffering raises an important question for the practice of pediatrics: what exactly does it mean to say that a child is suffering? This question is critically important. Sick children’s lives literally hang in the balance, contingent on clinical evaluations of their suffering. This contingency is demonstrated by a recent analysis of the 651 occurrences of the term “ suffering ” in pediatric ethics articles over the past 10 years. 2 In the analyses, researchers found that 52% were used to support a specific medical decision. They also found that claims of patient suffering were 3 times more likely to support a life- ending decision as a life-extending decision (32% vs 10%). Reflecting on these findings, bioethicist Erica Salter3 worries that claims of child suffering can both consciously and unconsciously “ smuggle value judgements ” into ethical deliberation that would otherwise be considered even-handed and value neutral. Salter believes that suffering has become the new “qualitative futility” 4 for

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Harmony and beauty, disease and suffering

Harmony and beauty, disease and suffering

It is indeed comprehensible that the process of becoming and of being in time may already be a form of dying and suffering, but what is outrageous "is often the absurd way people die. Death does not always come about simply as a natural biological process, as when a ripe fruit drops from the bough, but often it occurs in circumstances which our sense of piety finds most repugnant" (Moschetti, 1989). It is this aspect of pain and suffering that we wish to address in this paper.

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Lev Shestov and the Crisis of Modernity

Lev Shestov and the Crisis of Modernity

Zenkovskii’s comment is helpful because it acknowledges that, for Shestov, everything flows from one’s understanding of God. But it is also misleading. A close examination of Shestov’s early career reveals that far from consistently being a religious philosopher, as he is usually portrayed, between 1897 and 1911 Shestov believed God to be dead, a belief that significantly impacted his anthropology, giving it a Stirnerian flavour, and which caused him to reject both the atheistic Russian Intelligentsia and the Russian religious philosophers, none of whom really appreciated the full implications of deicide. Influenced heavily by Nietzsche’s ideas about suffering and the death of God, during this period, Shestov’s mental world was close to that of European Modernism as both Shestov and the Modernists were attempting to revision a world of estranged individuals, cut off both from God and from each other. It was not until his works from 1911-14, when he began to meditate on the writings of Martin Luther and Lev Tolstoi that Shestov rediscovered religious faith, and began to articulate religious existentialism proper.

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AGAPE AS DEATH DRIVE Christian Soteriology and Sacrament as Vectors of the Traumatic

AGAPE AS DEATH DRIVE Christian Soteriology and Sacrament as Vectors of the Traumatic

Writing in the context of the oppression perpetuated by General Pinochet’s regime in Chile, William Cavanaugh takes the significance of brokenness even further by seeing the Eucharist’s role as competing against that of torture to establish social imaginaries (Cavanaugh 1998: 34-57). In contrast to state-sponsored torture and assassinations which embed fear into the desiring life-worlds of the people, Cavanaugh asserts that the Eucharist serves as the sacramental vehicle of imagination of the church, acting as a counter-discipline to state terror (ibid 253-281). The trauma of Jesus’ suffering and death is wielded as a redemptive weapon against the sufferings and deaths inflicted by the world. If torture is used to isolate bodies from each other, the feast of Christ can be mobilized to overcome isolation by opening up temporal horizons and connecting them with the present (ibid 278-281). The critical principle here is how local churches may wield their sacraments as a reminder cum call to embody the aggressive compassion Jesus had for the world by suffering for it, and in so doing personify Christ’s self-giving to their local communities. If the world’s powers inflict pain on the powerless, the church will endure pain on the latter’s behalf.

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Conceptualizing suffering and pain

Conceptualizing suffering and pain

Suffering, like pain, is unpleasant or even anguishing: Even if we do not accept an essentialist definition and we reject the understanding of suffering as a “loss of the self” or as a “reaffirmation of the self”, a definition is still neces- sary. “Unpleasantness” defines suffering and pain. Leknes and Bastian [48] propose “to move beyond a view of pain as simply unpleasant” because “it can also be experienced as pleasant, produce pleasant experiences or motivate us towards pleasant experiences”. They offer a number of ad- vantages and benefits of pain: it represents a possibility for redemption after a transgression, it can highlight bravery, motivate us, enhance sensation, offer temporary relief from other pain and offer “an effective contrast to many non- painful experiences, which can appear relatively pleasant if they occur after pain has ended.” However, such benefits or advantages exist only because pain is unpleasant (if it were not, it would no serve as a redemption, etc). The only con- vincing argument against the “unpleasantness” of pain is the “pain asymbolia” condition where patients feel pain but not unpleasantness. As I already mentioned, pain consists of a somatosensorial perception followed by a transitory mental image of the local change in the body (nociception) on the one hand, and an unpleasant emotion on the other hand. For Leknes and Bastian, a condition like “pain asym- bolia” proves that pain is not necessarily unpleasant. How- ever, I argue that people suffering from such a condition do not have a complete experience of pain, but only of one of its parts. In any case, pain asymbolia is a medical condition rather than a usual experience of pain. 12

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Time, fear and suffering in post-dualist modes of being

Time, fear and suffering in post-dualist modes of being

In contrast to the examples offered by Willmott (1994), Krishnamurti’s account of post- dualism does not suggest a sustained euphoric state in which the constraints of our current way of being are removed. There may well be emancipatory moments in which nihilation is absent and the ‘distraction’ of the journey metaphor is removed. Sustained post-dualist experience would, however, appear to be the exception rather than the rule. Consequently our attention here is directed towards the consequences of the removing the ‘distraction’ of self-becoming. While Krishnamurti promotes the removal of self- becoming to bring the individual fully into contact with what is, Sartre sees it as essential that this ordering be both controlled and progressive in order to avoid pain, uncertainty and fear of loss. Consequently, the process of dissolving the divisions that form the self does not necessarily result in a sustained state of emotional happiness and psychological wholeness implied by Willmott’s ‘glimpses of nonduality’. Rather, the pain and suffering that create the dualistic separation of self and world must be experienced and faced without analysis (Krishnamurti, 1972). This is a task that Krishnamurti acknowledges requires “an extraordinarily astute mind, an extraordinarily pliable heart” (Krishnamurti, 1954: 21).

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IRRIGATION AND AGRICULTURAL DEVELOPMENT: A SOCIO-ECONOMIC ANALYSIS OF UTTAR PRADESH

IRRIGATION AND AGRICULTURAL DEVELOPMENT: A SOCIO-ECONOMIC ANALYSIS OF UTTAR PRADESH

Agriculture sector plays an important role in the development state economy. Agriculture sector provides about 65 percent employment and accounted 29.6 percent share in the total state gross domestic product. The percentage of the agriculture, industry and service sector in the state income was 31.7percent, 22.2 percent and 46.1 percent in 2011(Census 2011). However, agriculture sector is suffering from various constraints such as lack of the capital, inadequate irrigation facilities, lack of agricultural machinery, lack of fertilizers & pesticides, high yielding varieties of seeds, lack of transportation facility, inadequate supply of power, lack of marketing facility, insignificant research & development, insufficient institutional credit, and fragmented land holdings. The government of state has implemented several programmes and policies to increase productivity as well as ensure food security. But, the growth of the agriculture is insignificant. The cropping pattern of agriculture is changing towards traditional crops commercial crops. Irrigation is most important agricultural input that facilitates significantly multiple cropping,increases cropproductivity, increases agricultural income, andprotecting plants from frost. According to Trevelyan, “Irrigation is everything in India, water is even more valuable than land because when water is applied to land, it increases its productivity at least six fold and renders it productive which otherwise would produce nothing or next to nothing.”It is noticed that lack of irrigation facility is the major problem face by farmers in Uttar Pradesh. Farmers are using traditional way of irrigation inputs, suffering from high irrigation input cost, lack of modern irrigation inputs, lack of regular supply, lack of coordination, regional disparities, and lack of finance. On the other hand, the state having very wide inter – regional and inter – district disparities. The Eastern, Central, Western and Bundelkhand regions have been tackling very tough situation since independence till now. These regions are facing several problems like as low productivity, floods, drought, and poor technology. The main agricultural crops in the state are wheat, rice, sugarcane, pulses and vegetables.

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Voicing suffering and commitment of the intellectual

Voicing suffering and commitment of the intellectual

Baxi believes the law is essential but not self-evident, and must, therefore, be ana- lyzed, critiqued, problematized and engaged with to identify its potential and lim- itations for alleviating suffering and rightlessness. Much of his thinking proceeds by identifying the contradictory, oxymoronic nature of law through his ironic and self-deprecating Baxi-morons. Thus he suggests that ‘State law provides ideologies, institutions, and structures which can be effectively used for domination as well as struggles against domination.’ 13 In a perspective reminiscent of E.P.Thompson, Baxi

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DISPOSSESSION, SOCIAL SUFFERING, AND SURVIVAL

DISPOSSESSION, SOCIAL SUFFERING, AND SURVIVAL

Captured as part of the Cultural Mapping and Community Governance project were stories from Sima Khan-White at Wandering Mission, and a compilation of Noongar Elders representing Gnaala Karla Booja, recorded at different sites including Lake Navarino in April 2011; some of the Elders interviewed had also participated in this cultural mapping. Sima’s story extended upon what some of the Elders, who had also been taken to missions including Wandering mission, had spoken about during interviews and the storytelling workshop, but had not necessarily elaborated upon. For example, Enid had spoken about being made to feel sinful, but had not gone into detail about this. In her story, Sima spoke about this in more detail. Sima’s story was recorded at Wandering Mission inside one of the buildings and is extremely powerful and emotional. Sima had expressed a pressing need to share her story as part of her own healing (CAN WA, 2012). Sima’s story added depth to my understanding of what it might have been like to grow up in Wandering Mission. Listening to Sima’s story and then returning to listen to the stories of Elders shared at the Chronicles workshops and in interviews, I was able to pick up on things that were left unsaid, things that were alluded to but were too difficult to communicate. Sima spoke about the occurrence of physical and sexual abuse that has been documented at Wandering mission (Laurie, 2017). Sima’s story was a story of dispossession and suffering but ultimately of resilience, resistance, and survival in the face of adversity.

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Cosmopolitanism: a Journey of Suffering and Forgiveness

Cosmopolitanism: a Journey of Suffering and Forgiveness

This has influenced my conception of cosmopolitanism. I struggle with the term cosmopolitanism itself. The notion of the universal, coupled with the polis suggest something about citizenship, ignoring the intimate relationship between us as living, breathing creatures. I prefer a conception of a dyad: cosmopassion and cosmocharis. Cosmopassion, as the word suggests, draw us into a world of compassion, suffering with, but recognizing also the universality of suffering. This notion immediately disables blame, and it carves room for empathy. It creates a space for the individual to “see the other person’s tears” (Pinar, 2007, p. 34). This is the wisdom, the thought, the ilm we require to become cosmopolitan. The hilm, the nobility of our soul, comes from the action of cosmocharis. This entails universal forgiveness. Charis itself is a Greek word that carries a similar meaning to hilm. It connotes grace, kindness, and graciousness of action (Oxford English Dictionary, 2015). Forgiveness; perhaps the most gracious act of all.

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