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Philosophy and Medicine
P&M136
Nathan Emmerich
Pierre Mallia
Bert Gordijn
Francesca Pistoia Editors
Contemporary
European
Perspectives
on the Ethics
of End of Life Care
Volume 136
Series Editors
Søren Holm, The University of Manchester, Manchester, UK
Lisa M. Rasmussen, UNC Charlotte, Charlotte, USA
Founding Editors
H. Tristram Engellhardt, Rice University, Houston, TX, USA †
Stuart F. Spicker, Renodo Beach, USA †
Editorial Board
George Agich, National University of Singapore, Singapore, Singapore
Bob Baker, Union College, Schenectady, NY, USA
Jeffrey Bishop, Saint Louis University, St. Louis, USA
Ana Borovecki, University of Zagreb, Zagreb, Croatia
Ruiping Fan, City University of Hong Kong, Kowloon, Hong Kong
Volnei Garrafa, International Center for Bioethics and Humanities,
University of Brasília, Brasília, Brazil
D. Micah Hester, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Bjørn Hofmann, Norwegian University of Science and Technology, Gjøvik, Norway
Ana Iltis, Wake Forest University, Winston-Salem, NC, USA
John Lantos, Childrens’ Mercy, Kansas City, MO, USA
Chris Tollefsen, University of South Carolina, Columbia, USA
Dr Teck Chuan Voo, Centre for Biomedical Ethics, Yong Loo Lin School
of Medicine, National University of Singapore, Singapore, Singapore
The Philosophy and Medicine series is dedicated to publishing monographs and
collections of essays that contribute importantly to scholarship in bioethics and the
philosophy of medicine. The series addresses the full scope of issues in bioethics
and philosophy of medicine, from euthanasia to justice and solidarity in health care,
and from the concept of disease to the phenomenology of illness. The Philosophy
and Medicine series places the scholarship of bioethics within studies of basic
problems in the epistemology, ethics, and metaphysics of medicine. The series
seeks to publish the best of philosophical work from around the world and from all
philosophical traditions directed to health care and the biomedical sciences. Since
its appearance in 1975, the series has created an intellectual and scholarly focal
point that frames the field of the philosophy of medicine and bioethics. From its
inception, the series has recognized the breadth of philosophical concerns made
salient by the biomedical sciences and the health care professions. With over one
hundred and twenty five volumes in print, no other series offers as substantial and
significant a resource for philosophical scholarship regarding issues raised by
medicine and the biomedical sciences.
More information about this series at http://www.springer.com/series/6414

Nathan Emmerich • Pierre Mallia
Bert Gordijn • Francesca Pistoia
Editors
Contemporary European
Perspectives on the Ethics
of End of Life Care
Editors
Nathan Emmerich Pierre Mallia
Australian National University The Faculty of Medicine and Surgery,
Canberra, Australia Bioethics Research Programme
University of Malta
Bert Gordijn Msida, Malta
The Institute of Ethics
Dublin City University Francesca Pistoia
Dublin, Ireland Department of Biotechnological and
Applied Clinical Sciences, Neurological
Institute
University of L’Aquila
Via Vetoio, L’Aquila, Italy
ISSN 0376-7418 ISSN 2215-0080 (electronic)

ISBN 978-3-030-40032-3 ISBN 978-3-030-40033-0 (eBook)
https://doi.org/10.1007/978-3-030-40033-0
© Springer Nature Switzerland AG 2020

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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Contents
1 Contemporary European Perspectives on the Ethics

of End of Life Care: An Introduction�� 1
Nathan Emmerich, Pierre Mallia, Bert Gordijn,
and Francesca Pistoia
Part I Philosophical and Theological Perspectives

on Care at the End of Life
2 Human Rights and Patient’s Rights �� 19
Benedetta Barbisan
3 Utilitarianism and Care at the End of Life�� 37
Nadine Mooren and Michael Quante
4 Virtue Ethics�� 55
Alastair V. Campbell
5 End of Life: Care Ethical Perspectives�� 75
Carlo Leget and Helen Kohlen
6 End of Life Issues: An Islamic Perspective�� 93
Alireza Bagheri
7 End-of-Life Medical Decisions in Israeli Law – How
Jewish Law Represents a Balance Between Principlist
and Situationist Approaches to Medical Law�� 105
Oren Asman and Yechiel Michael Barilan
8 The Catholic Position on End of Life:
Theological Foundations and Philosophical Reasoning �� 117
Pierre Mallia
9 Protestant Perspectives on End of Life Care �� 131
Michael Coors and Andrea Dörries
v
vi Contents
Part II Ethical Concepts in End of Life Care:

Definitions and Distinctions
10 Dignity�� 147
Roberto Andorno
11 Autonomy�� 157
John Lombard
12 Intentions and the Doctrine of Double Effect�� 169
Simon Woods and Vibeke Graven
13 Futile, Non-beneficial, Potentially Inappropriate
or ‘Disputed’ Treatment�� 181
Ben P. White, Lindy Willmott, and Eliana Close
14 The Distinction between Ordinary and Extraordinary
Treatment: Can It Be Maintained?�� 199
Alan J. Kearns, Nathan Emmerich, and Bert Gordijn
15 The Difference Between Withholding and Withdrawing
Life-Sustaining Treatment�� 213
Andrew McGee and Drew Carter
16 On Killing and Letting Die, Acts and Omissions:
For and Against the Distinctions�� 229
Richard Huxtable
Part III Moral Concerns and Ethical Problems

in the Clinical Practice of End of Life Care
17 The Ethics of Sedation at the End of Life�� 245
Søren Holm
18 Law, Public Debates and Professionals’ Attitudes:
A Comparative Study on the Use of Advance
Directives in England, France and Germany�� 259
Ruth Horn
19 Disorders of Consciousness: Ethical Implications
in Diagnosis, Prognosis and Management �� 277
Stephen Holland and Francesca Pistoia
20 When a Patient Refuses Life-Sustaining Treatments�� 297
Christoph Rehmann-Sutter
21 Intentions of Physicians and End of Life Care Team �� 315
Morten Magelssen and Joseph Shaw
22 Moral Distress in End-of-Life Care�� 335
Georgina Morley, Caroline Bradbury-Jones, and Jonathan Ives
Contents vii
23 Families and End of Life Care�� 355

Marian A. Verkerk
24 Ethics and Intercultural Issues in End of Life Care �� 367
Ayesha Ahmad
25 Postscript: Future Developments in Addressing
Ethics and Care at the End of Life �� 381
Nathan Emmerich, Pierre Mallia, Bert Gordijn,
and Francesca Pistoia
Contributors
Ayesha Ahmad St Georges, University of London, and the Institute for Global,
University College London, London, UK
Roberto Andorno School of Law and Institute of Biomedical Ethics and History
of Medicine, University of Zurich, Zurich, Switzerland
Oren Asman Nursing Department, Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
Department of Medical Law, First Moscow State Medical University, Moscow,
Russia
Alireza Bagheri The School of Medicine, Tehran University of Medical Sciences,
Tehran, Iran
The Centre for Health Care Ethics, Lakehead University, ON, Canada
Benedetta Barbisan University of Macerata, Macerata, Italy
Georgetown University Law Center, Washington, DC, USA
Yechiel Michael Barilan The Sackler School of Medicine, Tel Aviv University,
Tel Aviv, Israel
Caroline Bradbury-Jones University of Birmingham, Birmingham, UK
Alastair V. Campbell Centre for Biomedical Ethics Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore
Drew Carter Adelaide Health and Medical Sciences, University of Adelaide,
Adelaide, Australia
Eliana Close Australian Centre for Health Law Research, Faculty of Law,
Queensland University of Technology, Brisbane, Australia
Michael Coors Institute of Social Ethics, Faculty of Theology, University of
Zurich, Zurich, Switzerland
ix
x Contributors
Andrea Dörries Zentrum für Gesundheitsethik (ZfG), Hannover, Germany

Nathan Emmerich The Medical School, College of Health and Medicine,
Australian National University, Canberra, Australia
Bert Gordijn The Institute of Ethics at Dublin City University, Dublin, Ireland
Vibeke Graven The Danish Knowledge Center for Rehabilitation and Palliative
Care, Nyborg, Denmark
Stephen Holland Professor, Departments of Philosophy and Health Sciences,
University of York, York, UK
Søren Holm University of Manchester, Manchester, UK
University of Oslo, Oslo, Norway
Ruth Horn Ethox Centre and Wellcome Centre for Ethics and Humanities in the
Nuffield Department of Population Health, University of Oxford, Oxford, UK
Richard Huxtable Centre for Ethics in Medicine, Medical School at the University
of Bristol, Bristol, UK
Jonathan Ives Centre for Ethics in Medicine, University of Bristol, Bristol, UK
Alan J. Kearns School of Theology, Philosophy, and Music, Dublin City University
(DCU), Dublin, Ireland
Helen Kohlen The Philosophical-Theological University of Vallendar, Vallendar,
Germany
The University of Alberta (UoA) in Edmonton, Edmonton, Canada
Carlo Leget The University of Humanistic Studies in Utrecht, Utrecht, The
Netherlands
John Lombard School of Law, University of Limerick, Limerick, Ireland
Morten Magelssen Centre for Medical Ethics, Institute of Health and Society,
University of Oslo, Oslo, Norway
Pierre Mallia The Faculty of Medicine and Surgery, Bioethics Research
Programme, University of Malta, Msida, Malta
Andrew McGee Australian Centre for Health Law Research, Faculty of Law,
Queensland University of Technology, Brisbane, QLD, Australia
Nadine Mooren Department of Philosophy, University of Münster, Müenster,
Germany
Georgina Morley Center for Bioethics, and Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, USA
Francesca Pistoia Department of Biotechnological and Applied Clinical Sciences,
Neurological Institute, University of L’Aquila, Via Vetoio, L’Aquila, Italy
Contributors xi
Michael Quante Department of Philosophy, University of Münster, Münster,

Germany
Christoph Rehmann-Sutter University of Lübeck, Lübeck, Germany
Joseph Shaw Oxford University, Oxford, UK
Marian A. Verkerk The University Medical Centre, Groningen, Groningen, The
Netherlands
The University of Groningen, Groningen, The Netherlands
Ben P. White Australian Centre for Health Law Research, Faculty of Law,
Lindy Willmott Australian Centre for Health Law Research, Faculty of Law,
Simon Woods Policy Ethics and Life Sciences Research Centre (PEALS),
Newcastle University, Newcastle upon Tyne, UK
About the Contributors
Ayesha Ahmad PhD, is a Lecturer in Global Health at St George’s, University of

London, and Honorary Lecturer in Global Health at the University College London’s
Institute for Global Health, who specialises in mental health, trauma and
gender-based violence in conflict and during humanitarian crisis. She has a special
interest in culture and religion in clinical decision-making and has published work
in the Journal of Medical Ethics, Bioethics and American Journal of Bioethics. She
is a CI on the MRC-/AHRC-funded research project Storytelling for Health:
Acknowledgment, Expression and Recovery (SHAER), which is a collaboration
with Kashmir, Afghanistan, South Africa, Turkey and Tunisia. She is a coeditor of
Humanitarian Action and Ethics (2018) published by Zed Books and is a member
of the Clinical Ethics Committee at Great Ormond Street Hospital in London. She
has extensive experience in providing expert witness reports as cultural evidence for
asylum seeker cases.
Roberto Andorno is Associate Professor at the School of Law and Research

Fellow at the Institute of Biomedical Ethics both in the University of Zurich,
Switzerland. He holds doctoral degrees in law from the Universities of Buenos
Aires (1991) and Paris-Est (1994), both on topics related to the ethical and legal
aspects of assisted reproductive technologies. From 1998 to 2005, he served as a
member of the International Bioethics Committee (IBC) of the UNESCO. He has
published extensively on issues relating to bioethics and law, notably Principles of
International Biolaw: Seeking Common Ground at the Intersection of Bioethics and
Human Rights (Brussels, 2013).
Oren Asman is a Practicing Lawyer, Chair of District Psychiatric Review

Committees, Senior Academic Faculty in the Nursing Department of Tel Aviv
University and Professor in the Department of Medical Law, First Moscow State
Medical University. He is the Executive Director of the newly founded Initiative of
Bioethics and Law at the Sackler Faculty of Medicine in Tel Aviv University. His
research focuses on ethical and legal aspects of biomedicine and health professions.
xiii
xiv About the Contributors
He has authored peer-reviewed articles, chapters in academic books and short

reports in professional literature pertaining to religious bioethics and law, mental
health, law and ethics, professional comportment, ethics and medical law. His work
was utilised to formulate and subsequently update ethics codes and ethics teaching
programmes and has been cited in judicial decisions in Israel. He has served as
Executive Vice President of the World Association for Medical Law (2012–2018)
and Chair of the Scientific Committee of the 24th World Congress on Medical Law
and Bioethics (2018). He has also been a member and presenter at the Harvard
Medical School Program in Psychiatry and the Law (2012–2018) and a Visiting
Scholar at Harvard Law School Program in Disabilities (2013); at Kennedy Institute
of Ethics, Georgetown University (2013); and at the Nursing Department, Johns
Hopkins University (2016).
Alireza Bagheri MD, PhD, is Assistant Professor of Medicine and Medical Ethics
in the School of Medicine, Tehran University of Medical Sciences, Iran; a Research
Affiliate of the Centre for Health Care Ethics, Lakehead University, Canada; and an
Elected Fellow of The Hastings Center (USA). He has served as a member of the
UNESCO International Bioethics Committee (2010–2017) and of the board of
directors of the International Association of Bioethics (2009–2014). In 2010, Dr.
Bagheri received the Rhazes Medical Research Award for his work on medical futil-
ity and in 2018 the Bioethics Leadership Award in recognition of his contribution to
the discipline of bioethics scholarship at the international level. He has authored and
edited several books including Islamic Bioethics: Current Issues and Challenge
(2017) and Medical Futility: A Cross-national Study (2013).
Benedetta Barbisan is Professor of Comparative Constitutional Law at the

University of Macerata and Visiting Professor at Georgetown Law Center.
Previously, she has visited Boston College Law School, Harvard Law School,
Universidad de Oviedo, Yale Law School, King’s College London, Queen’s
University Belfast, Max Planck Institute for Comparative Public Law and
International Law in Heidelberg and Université Catholique de Lille. Alongside
recent articles on relevant topics of constitutional law in comparative perspective,
she has authored a book on Marbury v. Madison and the origin of the judicial review
in the United States (2008) and, with Giuliano Amato, a book on the dialogue
between the Italian Constitutional Court, the EU Court of Justice and the European
Court of Human Rights (2016). She is currently working on a book on constitution-
alism and the ‘right to die’, to be published with Springer.
Yechiel Michael Barilan (MD, MA) is a Practicing Physician, Expert in Internal

Medicine and Professor of Medical Education in the Sackler School of Medicine,
Tel Aviv University. He is the Academic Director of the newly founded Initiative of
Bioethics and Law at Tel Aviv University. His research focuses on moral theory,
especially the interaction between human rights and constitutional law, on one hand,
and medical ethics, on the other. He also focuses on the interactions between ethics,
the social history of the body and medical care. A significant part of his research is
About the Contributors xv
dedicated to Jewish law and the social history of health and disease in Judaism. A
Founding Senior Fellow of the Safra Center of Ethics, Buchman Faculty of Law, Tel
Aviv University (2012–2015), Barilan has authored more than hundred peer-
reviewed articles, chapters in academic books and encyclopaedia entries, as well as
three monographs: Human Dignity, Human Rights, and Responsibility: The New
Language of Global Bioethics and Biolaw (MIT Press, 2012), Jewish Bioethics:
Rabbinic Law and Theology in Their Social and Historical Contexts (Cambridge
University Press, 2014) and Medical Ethics in Judaism and Israeli Law (Hebrew,
Magness Press, forthcoming, 2018).
Caroline Bradbury-Jones is a Registered Nurse and midwife. She is Reader in

Nursing at the University of Birmingham, UK, where she leads the Risk, Abuse and
Violence Research Programme. Her research focuses primarily on violence against
women and girls. She has secured funding for a number of research projects rele-
vant to these areas. A significant part of her work is focused on health professionals’
responses to domestic abuse. Within this, she is interested in issues of emotional
labour, moral distress and vicarious trauma experienced by health professionals
when supporting patients and clients who are experiencing abuse.
Alastair V. Campbell is Visiting Professor of Medical Ethics and the Emeritus

Director of the Centre for Biomedical Ethics in the Yong Loo Lin School of
Medicine, National University of Singapore. Previously, he was Professor of
Biomedical Ethics at the University of Otago and then Professor of Ethics in
Medicine at the University of Bristol. A Former President of the International
Association of Bioethics, Campbell is a Recipient of the HK Beecher Award; a
Fellow of The Hastings Centre, New York, and of the Ethox Centre, University of
Oxford; and an elected Fellow of the Royal Society of Edinburgh. His recent books
include Health as Liberation: Medicine, Theology, and the Quest for Justice (1996),
Medical Ethics (with D.G. Jones and G. Gillet, third edition 2005), The Body in
Bioethics (2009) and Bioethics: the Basics (second edition 2017). For the past few
years, he has been an Advisor to the Bioethics Centre, Chinese University of Hong
Kong. In 2018, the Singapore Government recognised his service to Bioethics in
Singapore through the award of a Public Service Medal.
Drew Carter is a Moral Philosopher and Health Policy Researcher. He applies the
work of Ludwig Wittgenstein to illuminate bioethical issues, especially relating to
resource allocation. He has published on assisted reproductive technology and pain.
His current research focuses on intensive care triage and the managed entry of
health technologies.
Eliana Close is a PhD candidate with the Australian Centre for Health Law
Research in the School of Law, Queensland University of Technology. She gradu-
ated with first class honours in psychology from the University of Calgary and was
Rhodes Scholar at Oxford University where she completed her law degree with
honours. Prior to coming to Australia, she worked as a Business Associate at Google
xvi About the Contributors
and clerked at the Court of Appeal of Alberta. She also practised law as a Crown
Prosecutor. Eliana has long-standing interests in the intersection of law, technology
and bioethics. Her PhD research on the socio-legal implications of bedside rationing
at the end of life is supported by the National Health and Medical Research Council’s
Centre of Research Excellence in End of Life Care based at the Queensland
University of Technology.
Michael Coors (Prof. Dr.) is Extraordinary Professor for Theological Ethics in the
Faculty of Theology, University of Zurich. He is also the Director of the Institute of
Social Ethics in Zurich’s Center for Ethics. He has published on ethical issues at the
end of life, the ethics of aging and the ethics of intercultural encounters in health-
care as well as on conceptual questions of theological ethics. He is currently work-
ing on a research project focused on the moral significance of human vulnerability.
Andrea Dörries is a Medical Doctor and Clinical Ethicist, specialising in paediat-

rics and human genetics. From 1997 to 2018, she was the Director of the Zentrum
für Gesundheitsethik (ZfG) in Hannover (www.zfg-hannover.de). Her publications
focus on ethics committees, medical indications, paediatric ethics and organisa-
tional ethics. She is member of several national and international ethics c ommissions
and has participated in a dialogue on nanotechnology convened by the German
Federal Ministry for the Environment, Nature Conservation, and Nuclear Safety. At
present, she is part of a research project on the moral significance of the notion of
vulnerability (2018–2020).
Nathan Emmerich is currently a Research Fellow in Bioethics at the Australian

National University Medical School. Prior to this, he was a Research Fellow in the
Institute of Ethics at Dublin City University, where he was employed on the EndCare
research projects that, amongst other things, resulted in this collection. He can be
found on twitter @BioethicsAus.
Bert Gordijn is Professor and Director of the Institute of Ethics at Dublin City
University in Ireland. He has studied philosophy and history in Utrecht, Strasbourg,
and Freiburg im Breisgau. In 1995, he completed his Doctorate in Philosophy from
the Albert-Ludwigs-Universität Freiburg and his Doctorate in Bioethics from the
Radboud University Nijmegen in 2003. Bert has been Visiting Professor at Lancaster
University (UK), Georgetown University (USA), the National University of
Singapore, the Fondation Brocher (Switzerland), Yenepoya University (Mangalore,
Karnataka, India) and the University of Otago (New Zealand). He has served on
Advisory Panels and Expert Committees of the European Chemical Industry
Council, the European Patent Organisation, the Irish Department of Health and the
UNESCO. He is Editor-in-Chief of two book series, namely, The International
Library of Ethics, Law and Technology and Advances in Global Bioethics, as well
as of peer-reviewed journal Medicine, Health Care and Philosophy. He is Secretary
of the European Society for Philosophy of Medicine and Healthcare and President
of the International Association for Education in Ethics.
About the Contributors xvii
Vibeke Graven is a Postdoctoral Researcher at REHPA, the Danish Knowledge

Centre on Rehabilitation and Palliative Care. She completed her master’s degree in
Social Science and Philosophy and her PhD in ‘Humanistic Palliative Care’ from
Aalborg University, Denmark. Her research interests include spiritual and ethical
issues at the end of life with a particular focus on hospice palliative care.
Stephen Holland is a Reader in the Departments of Philosophy and Health

Sciences at the University of York. His work on disorders of consciousness started
when he was a member of the Coma and Disorders of Consciousness Research
Centre, an ongoing collaboration between the Universities of York and Cardiff. His
main research interest is in applied philosophy, especially as this relates to medicine
and healthcare, including bioethics and public health ethics. He is currently working
on a book defending the acquisition and use of health information for public health
purposes, to be published next year by Rowman & Littlefield International.
Søren Holm is a Danish Doctor and Philosopher. He holds first degrees in Medicine
and Philosophy and Religious Studies and a master’s degree in Healthcare Ethics
and Law as well as a PhD and a higher Danish doctorate. He is Professor of Bioethics
at the University of Manchester and Professor of Medical Ethics (part-time) at the
University of Oslo. He has been thinking and writing about end-of-life issues since
the early 1990s.
Ruth Horn is a Senior Researcher in Ethics and a University Research Lecturer at

the Ethox Centre and Wellcome Centre for Ethics and Humanities in the Nuffield
Department of Population Health at the University of Oxford. Ruth’s research
focuses on ethical questions raised by medical practices and new technologies at the
beginning and end of life. She has developed a comparative approach to understand
how ethical problems arise in different countries and how they are addressed in
clinical settings where ethically sensitive, and sometimes controversial, decisions
are made. Her approach, which combines literature review, conceptual analysis and
ethnographic research, allows the identification of country-specific, as well as
shared, ethical and social, problems. She has held grants from the European
Commission and the Wellcome Trust to conduct comparative research on advance
directives in the United Kingdom, France and Germany. She is presently a Senior
Researcher on the PAGE (Prenatal Assessment of Genomes and Exomes) Ethics
Research Programme.
Richard Huxtable is Professor of Medical Ethics and Law and Director of the
Centre for Ethics in Medicine in the Medical School, University of Bristol,
UK. Qualified in law and socio-legal studies, his research primarily concerns end-
of-life decision-making, surgical ethics and clinical ethics. He has published widely
in legal, bioethical and medical journals and edits the Ethics in Clinical Practice
section of BMC Medical Ethics. Richard is the author of Euthanasia, Ethics and the
Law: From Conflict to Compromise (2007, Routledge), Law, Ethics and Compromise
at the Limits of Life: To Treat or Not to Treat? (2012, Routledge) and Euthanasia:
xviii About the Contributors
All That Matters (2013, Hodder) and coauthor/editor of such volumes as The Voices
and Rooms of European Bioethics (2014, Routledge) and Ethical Judgments:
Re-writing Medical Law (2016, Hart). A long-standing participant in clinical ethics
support, he is a member of Bristol’s Clinical Ethics Advisory Group and also a
Trustee of the UK Clinical Ethics Network. He is also a member of the Ethics
Committees of the BMA and the Royal College of General Practitioners and PI on
a major Wellcome Trust collaborative project, Balancing Best Interests in Healthcare,
Ethics and Law (BABEL). He tweets at @DrRHuxtable.
Jonathan Ives is a Reader in Empirical Bioethics and Deputy Director of the

Centre for Ethics in Medicine at the University of Bristol. He completed his PhD in
Biomedical Ethics and Law from the University of Birmingham (UK). Trained in
both philosophical and social science research methods, he is an Interdisciplinary
Researcher with experience in mixed-methods research. He has published widely
on the theory and methodology of empirical bioethics as well as on more substan-
tive ethical issues including the ethics of fathers and families, reproductive ethics,
end-of-life ethics, research ethics, ethics and methodology in clinical trial design,
the ethics of medical education and mental health. His research has been funded by,
inter alia, the Wellcome Trust, ESRC, AHRC, Brocher Foundation and Brigstow
Foundation.
Alan J. Kearns is Assistant Professor of Ethics in the School of Theology,

Philosophy and Music at Dublin City University (DCU). He is also an Affiliated
Scholar at DCU’s Institute of Ethics. He lectures in the areas of philosophical and
theological ethics as well as applied ethics. His research interests include concepts
of person in bioethics and research ethics. His teaching and research are informed
and driven by his broad experience of providing ethics talks to healthcare profes-
sionals as well as by his work for various hospital committees in Ireland.
Helen Kohlen PhD, is Professor of Care Policy and Ethics at the Philosophical-
Theological University of Vallendar (PTHV), Germany, and Adjunct Professor at
the University of Alberta (UoA), Edmonton, Canada. A Sociologist working in the
field of healthcare ethics, her research focuses on the transformation of caring prac-
tices by including questions of inequality with regard to gender, social status and
ethnicity. Currently, she leads an empirical research project that investigates cultural
diversity and conflicts within healthcare organisations. She has previously con-
ducted transnational research on hospital ethics committees as well as end-of-
life care.
Carlo Leget is Full Professor of Care Ethics at the University of Humanistic

Studies, Utrecht, the Netherlands, where he also holds an endowed Chair in pallia-
tive care, established by the Netherlands Comprehensive Cancer Organisation
(IKNL) and the Association for Hospice Care Netherlands (AHzN). As Chair of the
Care Ethics Department in Utrecht, he is responsible for the master in care ethics
About the Contributors xix
and policy. His research focuses on the intersection of care, meaning and end-of-life
issues. He is a member of the Health Council of the Netherlands and Vice President
of the European Association of Palliative Care.
John Lombard PhD, is a Lecturer in the School of Law at University of Limerick

where he lectures on Medical Law and Intellectual Property Law at both under-
graduate and postgraduate levels. His research is focused on medical law. He has
published in national and international journals on a variety of issues. His mono-
graph Law, Palliative Care and Dying: Legal and Ethical Challenges was published
by Routledge in May 2018. He is currently completing a text titled ‘Nursing Law in
Ireland’, to be published 2020.
Morten Magelssen MD, PhD, is Associate Professor at the Centre for Medical
Ethics, University of Oslo, Norway. His main research interests are end-of-life eth-
ics, clinical ethics support, bedside rationing and other issues in clinical ethics and
conscientious objection in healthcare.
Pierre Mallia is Professor of Family Medicine, Patients’ Rights and Bioethics in

the Faculty of Medicine and Surgery, University of Malta, and Chairman of the
National Health Ethics Committee of the Ministry of Health, Malta. He teaches in
various faculties ranging from Medicine, Laws and Sciences. He is Ethics Advisor
to the Medical Council of Malta, Ethics Reviewer for the European Commission
Framework funding and Visiting Professor at Lyon University. He is the President
of the Malta College of Family Doctors and has received honorary membership of
the Royal College of Physicians of London and fellowship of the Royal College of
General Practitioners for his work on biomedical ethics and the ‘advancement of
medical education in Malta’. He chairs the Medicine and Law Programme of the
Faculty of Laws and coordinates the Bioethics Research Programme of the Faculty
of Medicine and Surgery. He has participated in several EU projects, is on several
editorial boards and has published over 100 papers. His most recent book is The
Nature of the Doctor-Patient Relationship: Health Care Principles Through the
Phenomenology of Relationships with Patients published by Springer. He appears
regularly on local media to discuss medical and ethical issues. His primary interests
are philosophy of medicine, patients’ rights and the advancement of palliative care,
care of the elderly, end-of-life issues and research ethics in medicine. He has an
interest in influencing clinical practice through such clinical ethics issues as futile
treatment at the end of life. He is currently coordinating the EndCare project – an
Erasmus+ project on end-of-life issues.
Andrew McGee is a Moral Philosopher and Legal Scholar with expertise in bio-
ethical controversies, especially at the end of life. He was admitted to practice as a
lawyer to the Supreme Court of Queensland and the High Court of Australia in
2006. He completed his PhD in Philosophy from the University of Essex and is cur-
rently Senior Lecturer in the Faculty of Law, QUT.
xx About the Contributors
Nadine Mooren has been a Postdoctoral Researcher in the Department of

Philosophy in Muenster since 2016. Her current research interest includes the phi-
losophy of aging and old age. She received her MA at the University of Cologne and
her PhD at the WWU, Muenster. She works mainly in the areas of practical philoso-
phy, ethics and philosophies of German idealism and Left Hegelianism. She has
published a book on Hegel’s conception of philosophy and religion titled Hegel und
die Religion (2018).
Georgina Morley is a Nursing Ethics Fellow at the Cleveland Clinic (Cleveland,

Ohio) where she is conducting research on moral distress, nursing ethics and bioeth-
ics as well as undertaking training in clinical ethics consultation. She is a Registered
Nurse in the United Kingdom and is passionate about advocating for her profession.
She has worked clinically in trauma and most recently in cardiac intensive care at
Barts Heart Centre, Barts Health NHS Trust, London. Georgina received her PhD
from the University of Bristol, Centre for Ethics in Medicine, supervised by Dr.
Jonathan Ives and Dr. Caroline Bradbury-Jones (University of Birmingham). Her
PhD was a feminist empirical bioethics project titled ‘What is “moral distress” in
nursing and how should we respond to it?’, funded by the Wellcome Trust Society
and Ethics Fellowship for Healthcare Professionals.
Francesca Pistoia is Assistant Professor of Neurorehabilitation at the University

of L’Aquila. She completed her degree summa cum laude in Medicine and Surgery
and thereafter specialised in Neurology summa cum laude at the University of
L’Aquila. She received her PhD in Internal Medicine and Applied Immunology at
the same university. She has contributed 95 papers (83 in peer-reviewed interna-
tional journals and 12 in Italian journals). She has presented her research at national
and international congresses (resulting in 71 abstracts and communications). Her
research is mainly focused on the diagnosis, prognosis and rehabilitation of patients
with severe brain injury with the aim of implementing validated assessment tools to
identify physical, cognitive and behavioural disabilities and quantify rehabilitation-
related outcomes. Research topics include the evaluation of patients with disorders
of consciousness (vegetative state and minimally conscious state) as a consequence
of severe brain injury; her studies in this area have been aimed at evaluating the
neurobiological and behavioral factors, which may influence the recovery of con-
sciousness, and the implementation of new therapeutical approaches, and on the
identification of disorders of motor imagery and the perception of emotions in
patients with locked-in syndrome. She also contributed to research addressing the
epidemiology of cerebrovascular diseases and of Parkinson’s disease in population-
based registries and the role of comorbidities in headache pathogenesis and of
behavioural therapies in patients with chronic headache. She serves as a member of
the Ethical Committee of the University of L’Aquila.
Michael Quante is Full Professor of Practical Philosophy in the Department of

Philosophy, Westfälische Wilhelms-Universität. He is Speaker of the Centrum für
Bioethik and coeditor of the Hegel Studien. His books include (in English) Hegel’s
About the Contributors xxi
Concept of Action (Cambridge University Press 2004, pbk. 2007), Enabling Social
Europe (Springer 2005, coauthored with Bernd v. Maydell et al.), Discovering,
Reflecting and Balancing Values: Ethical Management in Vocational Education
Training (Hampp 2014, coauthored with Martin Büscher), Interdisciplinary
Research and Trans-disciplinary Validity Claims (Berlin: Springer 2014, coauthored
with Carl F. Gethmann et al.), Personal Identity as a Principle of Biomedical Ethics
(Springer 2017), Pragmatistic Anthropology (Mentis 2018) and Spirit’s Actuality
(Mentis 2018).
Christoph Rehmann-Sutter is Professor of Theory and Ethics in the Biosciences

at the University of Lübeck, Germany. After studying molecular biology (diploma
degree 1984), he studied philosophy and sociology at the Universities of Basel and
Freiburg in Breisgau. His doctoral dissertation (1995), taken from the Technical
University of Darmstadt, focused on Aristotle’s theory of entelecheia and the links
between the philosophy of biology and bioethics. He established a research unit for
bioethics at the University of Basel, where much of the work has combined qualita-
tive sociological research methodology with philosophical analysis in order to
develop a fuller understanding of patient’s moral views in the context of their life-
world. In 2007–2008, he was a Research Fellow at the University of California
Berkeley. From 2001 till 2008, he was President of the official Swiss National
Advisory Commission on Biomedical Ethics. He has had visiting professorships at
Newcastle University, the London School of Economics (LSE) and King’s College,
London. His current research interests cover a broad range of bioethical topics,
including end-of-life issues, always adopting a phenomenological and hermeneuti-
cal approach that focuses on relationships and moral perspectives of patients and
professionals. He has published over 20 books, and 2 of his recent works have been
concerned with ethics at the end of life, these being The Patient's Wish to Die:
Research, Ethics, and Palliative Care (edited with Heike Gudat and Kathrin
Ohnsorge; Oxford University Press 2015) and Was uns der Tod bedeutet (Kadmos,
Berlin 2018).
Joseph Shaw is Senior Research Fellow at St Benet’s Hall, Oxford University,

having completed a DPhil in 2000. He has been Vice Chairman of the Anscombe
Bioethics Centre from 2013 to 2018. He has previously published on intention and
double effect and has been interested in ethical theory, medieval ethics and philoso-
phy of religion.
Marian A. Verkerk is Full Professor in the Ethics of Care at the University

Medical Center Groningen and the University of Groningen. She was the project
leader of the Network on Ethics of Families from 2011 till 2017 and is the author of
more than 150 academic (national and international) publications in the field of
bioethics, with particular interests in care ethics and palliative care. She has been a
member of the Health Council of the Netherlands (2004–2016) and of the Review
Committee on Euthanasia (1999–2012) and Chair of the Committee on Palliative
Sedation of the Royal Medical Association of the Netherlands. Currently, she is
xxii About the Contributors
leading a project on patient participation at the University Medical Center

Groningen.
Ben P. White is Professor in the Australian Centre for Health Law Research in the
School of Law, Queensland University of Technology. A Foundation Director of the
Centre, his research interest is health law, with a particular focus on end-of-life
decision-making. His work is interdisciplinary with publications in law, medicine,
bioethics and social science journals. He is undertaking a programme of research
funded by a series of Australian Research Council and National Health and Medical
Research Council grants examining the law, policy and practice of end-of-life
decision-making. He had carriage of the Queensland Law Reform Commission’s
Guardianship Review as a full-time Commissioner (and then later appointed as a
Part-Time Commissioner). He is a member of the editorial board of the Journal of
Law and Medicine.
Lindy Willmott is Professor in the Australian Centre for Health Law Research,
School of Law, Queensland University of Technology. She researches in the area of
health and guardianship law, particularly end-of-life issues. She served for many
years as a part-time member of the Queensland Civil and Administrative Tribunal
(formerly the Guardianship and Administration Tribunal). She has coauthored more
than ten texts in health law and contracts law and is a coauthor of the website ‘End
of Life Law in Australia.’ She has undertaken multiple empirical research projects
on end-of-life decision-making which have been funded by the Australian Research
Council and the National Health and Medical Research Council. Lindy was a
Foundation Director of the Australian Centre for Health Law Research and is a
member of the editorial board of the Journal of Law and Medicine.
Simon Woods PhD, is the Deputy Director of the Policy Ethics and Life Sciences
Research Centre (PEALS) at Newcastle University in the United Kingdom. He is a
philosopher focusing on the social and ethical implication of developments in medi-
cine and healthcare. He has a long-standing interest in end-of-life ethics and the
values of palliative care.
About the Editors
Nathan Emmerich is a Research Fellow in Bioethics in the Australian National

University Medical School. He was previously a Postdoctoral Research Fellow in
Ethics and End-of-Life Care at the Institute of Ethics, Dublin City University, and a
Visiting Research Fellow at Queen’s University Belfast. He has a background in
Philosophy and took his PhD, which concerned the connection between the infor-
mal moral socialisation of medical students and their formal medical ethics educa-
tion, under the supervision of medical sociologist. His work is interdisciplinary in
nature. He has published on ethical expertise, social science research ethics and
bioethics more generally.
Pierre Mallia is Professor of Family Medicine and Biomedical Ethics at the

University of Malta. He is attached to Malta’s Geriatric Karin Grech Rehabilitation
Hospital as a Clinical Ethicist and has published numerous papers and publications
in ethics, including on ethical issues with regard to aging. He is Chairman of the
Department of Health’s Health Ethics Committee and the Minister of Health’s
Bioethics Consultative Committee. He is also the Ethics Advisor to the Medical
Council of Malta and coordinates the University of Malta’s Bioethics Research
Programme at the Medical School and was Former Honourable Secretary to the
National Bioethics Consultative Committee and founded and coordinates the
Medical Law Unit in the Faculty of Laws. He is the President of the Malta College
of Family Doctors and was awarded a Fellowship of the Royal College of General
Practitioners (UK) for successfully introducing postgraduate training and the
MRCGP (INT) qualification in Malta. The Royal College of Physicians of London
has also awarded him an honorary membership for advancing medicine in Malta.
He is Visiting Professor at the Laennec University of Lyon and regularly visits
the Department of Health Sciences at the University of Maastricht and the Istituto
Universitario Sophia (Florence, Italy) with which he is collaborating to promote a
theory of dialogue in bioethics. He has been invited by the UNESCO to describe his
method of teaching and chosen as the ‘Regional Bioethics Expert’ in the
Mediterranean. He is frequently invited as a keynote speaker in international
meetings.
xxiii
xxiv About the Editors
He has participated in several FP projects including Euroscreen, Privireal,

Privileged, BioTEthed, Patient-Partner, EUPATI and others and has been invited by
the EC to give talks in Bratislava and Bucharest. He also lectured at the United
Nations International Institute on Ageing (INIA) in their diploma in Gerontology.
Bert Gordijn is Professor and Director of the Institute of Ethics at Dublin City
University in Ireland. He has studied philosophy and history in Utrecht, Strasbourg,
and Freiburg im Breisgau. In 1995, he completed his doctorate in Philosophy from
the Albert-Ludwigs-Universität Freiburg and his doctorate in Bioethics from the
Radboud University Nijmegen in 2003. He has been Visiting Professor at Lancaster
University (UK), Georgetown University (USA), the National University of
Singapore, the Fondation Brocher (Switzerland) and Yenepoya University
(Mangalore, Karnataka, India). He has served on Advisory Panels and Expert
Committees of the European Chemical Industry Council, the European Patent
Organisation, the Irish Department of Health and the UNESCO. He is Editor-in-
Chief of two book series, namely, The International Library of Ethics, Law and
Technology and Advances in Global Bioethics, as well as of peer-reviewed journal
Medicine, Health Care and Philosophy, all published by Springer. He is Secretary
of the European Society for Philosophy of Medicine and Healthcare and President
of the International Association for Education in Ethics.
Francesca Pistoia is Associate Professor of Neurology at the University of

L'Aquila. She completed her degree summa cum laude in Medicine and Surgery and
thereafter specialised in Neurology summa cum laude, at the University of L'Aquila.
She received her PhD in Internal Medicine and Applied Immunology at the same
university. She has contributed to 95 papers (83 in peer-reviewed international jour-
nals and 12 in Italian journals). She has presented her research at national and inter-
national congresses (resulting in 71 abstracts and communications). Her research is
mainly focused on the diagnosis, prognosis and rehabilitation of patients with severe
brain injury with the aim of implementing validated assessment tools to identify
physical, cognitive and behavioural disabilities and quantify rehabilitation-related
outcomes. Research topics include the evaluation of patients with disorders of con-
sciousness (vegetative state and minimally conscious state) as a consequence of
severe brain injury; her studies in this area have been aimed at evaluating the neuro-
biological and behavioural factors, which may influence the recovery of conscious-
ness, and the implementation of new therapeutical approaches, and on the
identification of disorders of motor imagery and the perception of emotions in
patients with locked-in syndrome. She also contributed to research addressing the
epidemiology of cerebrovascular diseases and of Parkinson’s disease in population-
based registries and the role of comorbidities in headache pathogenesis and of
behavioural therapies in patients with chronic headache. She serves as a member of
the Ethical Committee of the University of L’Aquila.
Abbreviations
AD Advance Directives
ACP Advance Care Planning
ANH Artificial Nutrition and Hydration
CEC Clinical Ethics Committee
CPCE Community of Protestant Churches in Europe
CPR Cardiopulmonary Resuscitation
CRS-R Coma Recovery Scale Revised
DALYs Disability-Adjusted Life Years
DDE Doctrine of Double Effect
DNAR Do Not Attempt Resuscitation
DOCs Disorders of Consciousness
EKD Evangelische Kirche in Deutschland (Evangelical Church in Germany).
EKÖ Evangelische Kirche Augsburgischen und Helvetischen Bekenntnisses
in Österreich (Evangelical Church of the Augsburg and Helvetic
Confession in Austria)
EMCS Emerging from a Minimally Conscious State
EoL End-of-Life
EPUF Église Protestante unie de France (the United Protestant Church of
France)
ESCR Economic, Social and Cultural Rights
ET Equivalence Thesis
fMRI Functional Magnetic Resonance Imaging
GCS Glasgow Coma Scale
GMC General Medical Council (UK)
HeaLYs Health-Adjusted Life Years
ICU Intensive Care Unit
LIS Locked-in Syndrome
LST Life-Sustaining Treatment
MCA Mental Capacity Act (UK) 2005
MCS Minimally Conscious State, including MCS (+/−)
MD Moral Distress
xxv
xxvi Abbreviations
MRI Magnetic Resonance Imaging

NTDs Non-treatment Decisions
PAS Physician-Assisted Suicide
PICU Paediatric Intensive Care Units
PVS Persistent Vegetative State
PKN Protestantse Kerk in Nederland (Protestant Church in the Netherlands)
QALY Quality-Adjusted Life Year
SCDF Sacred Congregation for the Doctrine of the Faith
SEK Schweizerischer Evangelischer Kirchenbund (Federation of Swiss
Protestant Churches)
UDHR Universal Declaration of Human Rights
UWS Unresponsive Wakefulness Syndrome
VS Vegetative State
WHO World Health Organisation
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softening party asperities and aiding very materially in the
restoration of better feeling between the North and South. Its
conservatism, always manifested save on extraordinary occasions,
did that much good at least.
The Campaign of 1880.
The Republican National Convention met June 5th, 1880, at

Chicago, in the Exposition building, capable of seating 20,000
people. The excitement in the ranks of the Republicans was very
high, because of the candidacy of General Grant for what was
popularly called a “third term,” though not a third consecutive term.
His three powerful Senatorial friends, in the face of bitter protests,
had secured the instructions of their respective State Conventions for
Grant. Conkling had done this in New York, Cameron in
Pennsylvania, Logan in Illinois, but in each of the three States the
opposition was so impressive that no serious attempts were made to
substitute other delegates for those which had previously been
selected by their Congressional districts. As a result there was a large
minority in the delegations of these States opposed to the
nomination of General Grant, and the votes of them could only be
controlled by the enforcement of the unit rule. Senator Hoar of
Massachusetts, the President of the Convention, decided against its
enforcement, and as a result all of the delegates were free to vote
upon either State or District instructions, or as they chose. The
Convention was in session three days. We present herewith the
BALLOTS.
Ballots. 1 2 3 4 5 6
Grant, 304 305 305 305 305 305
Blaine, 284 282 282 281 281 281
Sherman, 93 94 93 95 95 95
Edmunds, 34 32 32 32 32 31
Washburne, 30 32 31 31 31 31
Windom, 10 10 10 10 10 10
Garfield, 1 1 1 2 2
Harrison, 1
Ballots. 7 8 9 10 11 12
Grant, 305 306 308 305 305 304
Blaine, 281 284 282 282 281 283
Sherman, 94 91 90 91 62 93
Edmunds, 32 31 31 30 31 31
Washburne, 31 32 32 22 32 33
Windom, 10 10 10 10 10 10
Garfield, 1 1 1 2 2 1
Hayes, 1 2
Ballots, 13 14 15 16 17 18
Grant, 305 305 309 306 303 305
Blaine, 285 285 281 283 284 283
Sherman, 89 89 88 88 90 92
Edmunds, 31 31 31 31 31 31
Washburne, 33 35 36 36 34 35
Windom, 10 10 10 10 10 10
Garfield, 1
Hayes, 1 1
Davis, 1
McCrary, 1
Ballots, 19 20 21 22 23 24
Grant, 305 308 305 305 304 305
Blaine, 279 276 276 275 274 279
Sherman, 95 93 96 95 98 93
Edmunds, 31 31 31 31 31 31
Washburne, 31 35 35 35 36 35
Windom, 10 10 10 10 10 10
Garfield, 1 1 1 1 2 2
Hartranft, 1 1 1 1
Ballots, 25 26 27
Grant, 302 303 306
Blaine, 281 280 277
Sherman, 94 93 93
Edmunds, 31 31 31
Washburne, 36 35 36
Windom, 10 10 10
Garfield, 2 2 2
There was little change from the 27th ballot until the 36th and
final one, which resulted as follows:
Whole number of votes 755

Necessary to a choice 378
Grant 306
Blaine 42
Sherman 3
Washburne 5
Garfield 399
As shown, General James A. Garfield, of Ohio, was nominated on

the 36th ballot, the forces of General Grant alone remaining solid.
The result was due to a sudden union of the forces of Blaine and
Sherman, it is believed with the full consent of both, for both
employed the same wire leading from the same room in Washington
in telegraphing to their friends at Chicago. The object was to defeat
Grant. After Garfield’s nomination there was a temporary
adjournment, during which the friends of the nominee consulted
Conkling and his leading friends, and the result was the selection of
General Chester A. Arthur of New York, for Vice-President. The
object of this selection was to carry New York, the great State which
was then almost universally believed to hold the key to the
Presidential position.
The Democratic National Convention met at Cincinnati, June 22d.
Tilden had up to the holding of the Pennsylvania State Convention
been one of the most prominent candidates. In this Convention there
was a bitter struggle between the Wallace and Randall factions, the
former favoring Hancock, the latter Tilden. Wallace, after a contest
far sharper than he expected, won, and bound the delegation by the
unit rule. When the National Convention met, John Kelly, the
Tammany leader of New York, was again there, as at St. Louis four
years before, to oppose Tilden, but the latter sent a letter disclaiming
that he was a candidate, and yet really inviting a nomination on the
issue of “the fraudulent counting in of Hayes.” There were but two
ballots, as follows:
FIRST BALLOT.
Hancock 171
Bayard 153½
Payne 81
Thurman 63½
Field 66
Morrison 62
Hendricks 46½
Tilden 38
Ewing 10
Seymour 8
Randall 6
Loveland 5
McDonald 3
McClellan 3
English 1
Jewett 1
Black 1
Lothrop 1
Parker 1
SECOND BALLOT.
Hancock 705
Tilden 1
Bayard 2
Hendricks 30
Thus General Winfield S. Hancock, of New York, was nominated

on the second ballot. Wm. H. English, of Indiana, was nominated for
Vice-President.
The National Greenback-Labor Convention, held at Chicago, June
11, nominated General J. B. Weaver, of Iowa, for President, and
General E. J. Chambers, of Texas, for Vice-President.
In the canvass which followed, the Republicans were aided by such
orators as Conkling, Blaine, Grant, Logan, Curtis, Boutwell, while the
Camerons, father and son, visited the October States of Ohio and
Indiana, as it was believed that these would determine the result,
Maine having in September very unexpectedly defeated the
Republican State ticket by a small majority. The Democrats were
aided by Bayard, Voorhees, Randall, Wallace, Hill, Hampton, Lamar,
and hosts of their best orators. Every issue was recalled, but for the
first time in the history of the Republicans of the West, they accepted
the tariff issue, and made open war on Watterson’s plank in the
Democratic platform—“a tariff for revenue only.” Iowa, Ohio, and
Indiana, all elected the Republican State tickets with good margins;
West Virginia went Democratic, but the result was, notwithstanding
this, reasonably assured to the Republicans. The Democrats,
however, feeling the strong personal popularity of their leading
candidate, persisted with high courage to the end. In November all of
the Southern States, with New Jersey, California,[36] and Nevada in
the North, went Democratic; all of the others Republican. The
Greenbackers held only a balance of power, which they could not
exercise, in California, Indiana, and New Jersey. The electoral vote of
Garfield and Arthur was 214, that of Hancock and English 155. The
popular vote was Republican, 4,442,950; Democratic, 4,442,035;
Greenback or National, 306,867; scattering, 12,576. The
Congressional elections in the same canvass gave the Republicans
147 members; the Democrats, 136; Greenbackers, 9; Independents, 1.
Fifteen States elected Governors, nine of them Republicans and six
Democrats.
General Garfield, November 10, sent to Governor Foster, of Ohio,
his resignation as a Senator, and John Sherman, the Secretary of the
Treasury, was in the winter following elected as his successor.
The third session of the Forty-sixth Congress was begun December
6. The President’s Message was read in both Houses. Among its
recommendations to Congress were the following: To create the
office of Captain-General of the Army for General Grant; to defend
the inviolability of the constitutional amendments; to promote free
popular education by grants of public lands and appropriations from
the United States Treasury; to appropriate $25,000 annually for the
expenses of a Commission to be appointed by the President to devise
a just, uniform, and efficient system of competitive examinations,
and to supervise the application of the same throughout the entire
civil service of the government; to pass a law defining the relations of
Congressmen to appointments to office, so as to end Congressional
encroachment upon the appointing power; to repeal the Tenure-of-
office Act, and pass a law protecting office-holders in resistance to
political assessments; to abolish the present system of executive and
judicial government in Utah, and substitute for it a government by a
commission to be appointed by the President and confirmed by the
Senate, or, in case the present government is continued, to withhold
from all who practice polygamy the right to vote, hold office, and sit
on juries; to repeal the act authorizing the coinage of the silver dollar
of 412½ grains, and to authorize the coinage of a new silver dollar
equal in value as bullion with the gold dollar; to take favorable action
on the bill providing for the allotment of lands on the different
reservations.
Two treaties between this country and China were signed at Pekin,
November 17, 1881, one of commerce, and the other securing to the
United States the control and regulation of the Chinese immigration.
President Hayes, February 1, 1881, sent a message to Congress
sustaining in the main the findings of the Ponca Indian Commission,
and approving its recommendation that they remain on their
reservation in Indian Territory. The President suggested that the
general Indian policy for the future should embrace the following
ideas: First, the Indians should be prepared for citizenship by giving
to their young of both sexes that industrial and general education
which is requisite to enable them to be self-supporting and capable
of self-protection in civilized communities; second, lands should be
allotted to the Indians in severalty, inalienable for a certain period;
third, the Indians should have a fair compensation for their lands not
required for individual allotments, the amount to be invested, with
suitable safeguards, for their benefit; fourth, with these prerequisites
secured, the Indians should be made citizens, and invested with the
rights and charged with the responsibilities of citizenship.
The Senate, February 4, passed Mr. Morgan’s concurrent
resolution declaring that the President of the Senate is not invested
by the Constitution of the United States with the right to count the
votes of electors for President and Vice-President of the United
States, so as to determine what votes shall be received and counted,
or what votes shall be rejected. An amendment was added declaring
in effect that it is the duty of Congress to pass a law at once providing
for the orderly counting of the electoral vote. The House concurred
February 5, but no action by bill or otherwise has since been taken.
Senator Pendleton, of Ohio, December 15, 1881, introduced a bill
to regulate the civil service and to promote the efficiency thereof, and
also a bill to prohibit Federal officers, claimants, and contractors
from making or receiving assessments or contributions for political
purposes.
The Burnside Educational Bill passed the Senate December 17,
1881. It provides that the proceeds of the sale of public land and the
earnings of the Patent Office shall be funded at four per cent., and
the interest divided among the States in proportion to their illiteracy.
An amendment by Senator Morgan provides for the instruction of
women in the State agricultural colleges in such branches of
technical and industrial education as are suited to their sex. No
action has yet been taken by the House.
On the 9th of February the electoral votes were counted by the
Vice-President in the presence of both Houses, and Garfield and
Arthur were declared elected President and Vice-President of the
United States. There was no trouble as to the count, and the result
previously stated was formally announced.
The Three Per Cent. Funding Bill.
The 3 per cent. Funding Bill passed the House March 2, and was
on the following day vetoed by President Hayes on the ground that it
dealt unjustly with the National Banks in compelling them to accept
and employ this security for their circulation in lieu of the old bonds.
This feature of the bill caused several of the Banks to surrender their
circulation, conduct which for a time excited strong political
prejudices. The Republicans in Congress as a rule contended that the
debt could not be surely funded at 3 per cent.; that 3½ was a safer
figure, and to go below this might render the bill of no effect. The
same views were entertained by President Hayes and Secretary
Sherman. The Democrats insisted on 3 per cent., until the veto, when
the general desire to fund at more favorable rates broke party lines,
and a 3½ per cent. funding bill was passed, with the feature
objectionable to the National Banks omitted.
The Republicans were mistaken in their view, as the result proved.
The loan was floated so easily, that in the session of 1882 Secretary
Sherman, now a Senator, himself introduced a 3 per cent. bill, which
passed the Senate Feb. 2d, 1882, in this shape:—
Be it enacted, &c. That the Secretary of the Treasury is hereby
authorized to receive at the Treasury and at the office of any
Assistant Treasurer of the United States and at any postal money
order office, lawful money of the United States to the amount of fifty
dollars or any multiple of that sum or any bonds of the United States,
bearing three and a half per cent, interest, which are hereby declared
valid, and to issue in exchange therefore an equal amount of
registered or coupon bonds of the United States, of the denomination
of fifty, one hundred, five hundred, one thousand and ten thousand
dollars, of such form as he may prescribe, bearing interest at the rate
three per centum per annum, payable either quarterly or semi-
annually, at the Treasury of the United States. Such bonds shall be
exempt from all taxation by or under state authority, and be payable
at the pleasure of the United States. “Provided, That the bonds
herein authorized shall not be called in and paid so long as any bonds
of the United States heretofore issued bearing a higher rate of
interest than three per centum, and which shall be redeemable at the
pleasure of the United States, shall be outstanding and uncalled. The
last of the said bonds originally issued and their substitutes under
this act shall be first called in and this order of payment shall be
followed until all shall have been paid.”
The money deposited under this act shall be promptly applied

solely to the redemption of the bonds of the United States bearing
three and a half per centum interest, and the aggregate amount of
deposits made and bonds issued under this act shall not exceed the
sum of two hundred million dollars. The amount of lawful money so
received on deposit, as aforesaid, shall not exceed, at any time, the
sum of twenty-five million dollars. Before any deposits are received
at any postal money office under this act, the postmaster at such
office shall file with the Secretary of the Treasury his bond, with
satisfactory security, conditioned that he will promptly transmit to
the Treasury of the United States the money received by him in
conformity with regulations to be prescribed by such secretary; and
the deposit with any postmaster shall not at any time, exceed the
amount of his bond.
Section 2. Any national banking association now organized or
hereafter organized desiring to withdraw its circulating notes upon a
deposit of lawful money with the Treasury or the United States as
provided in section 4 of the Act of June 20, 1874, entitled “An act
fixing the amount of United States notes providing for a
redistribution of National bank currency and for other purposes,”
shall be required to give thirty days’ notice to the Controller of the
Currency of its intention to deposit lawful money and withdraw its
circulating notes; provided that not more than five million of dollars
of lawful money shall be deposited during any calendar month for
this purpose; and provided further, that the provisions of this section
shall not apply to bonds called for redemption by the Secretary of the
Treasury.
Section 3. That nothing in this act shall be so construed as to
authorize an increase of the public debt.
In the past few years opinions on the rates of interest have
undergone wonderful changes. Many supposed—indeed it was a
“standard” argument—that rates must ever be higher in new than old
countries, that these higher rates comported with and aided the
higher rates paid for commodities and labor. The funding operations
since the war have dissipated this belief, and so shaken political
theories that no party can now claim a monopoly of sound financial
doctrine. So high is the credit of the government, and so abundant
are the resources of our people after a comparatively short period of
general prosperity, that they seem to have plenty of surplus funds
with which to aid any funding operation, however low the rate of
interest, if the government—State or National—shows a willingness
to pay. As late as February, 1882, Pennsylvania funded seven
millions of her indebtedness at 3, 3½ and 4 per cent., the two larger
sums commanding premiums sufficient to cause the entire debt to be
floated at a little more than 3 per cent., and thus floating commands
an additional premium in the money exchanges.
History of the National Loans.
In Book VII of this volume devoted to Tabulated History, we try to

give the reader at a glance some idea of the history of our National
finances. An attempt to go into details would of itself fill volumes, for
no class of legislation has taken so much time or caused such a
diversity of opinion. Yet it is shown, by an admirable review of the
loans of the United States, by Rafael A. Bayley, of the Treasury
Department published in the February (1882) number of the
International Review, that the “financial system of the government
of the United States has continued the same from its organization to
the present time.” Mr. Bayley has completed a history of our National
Loans, which will be published in the Census volume on “Public
Debts.” From his article in the Review we condense the leading facts
bearing on the history of our national loans.
The financial system of the United States, in all its main features,
is simple and well defined, and its very simplicity may probably be
assigned as the reason why it appears so difficult of comprehension
by many people of intelligence and education. It is based upon the
principles laid down by Alexander Hamilton, and the practical
adoption of the fundamental maxim which he regarded as the true
secret for rendering public credit immortal, viz., “that the creation of
the debt should always be accompanied with the means of
extinguishment.” A faithful adherence to this system by his
successors has stood the test of nearly a century, with the nation at
peace or at war, in prosperity or adversity; so that, with all the
change that progress has entailed upon the people of the age, no
valid grounds exist for any change here.
“During the colonial period, and under the confederation, the
financial operations of the Government were based on the law of
necessity, and depended for success upon the patriotism of the
people, the co-operation of the several States, and the assistance of
foreign powers friendly to our cause.
“It was the willingness of the people to receive the various kinds of
paper money issued under authority of the Continental Congress,
and used in payment for services and supplies, together with the
issue of similar obligations by the different States, for the
redemption of which they assumed the responsibility; aided by the
munificent gift of money from Louis XVI. of France, followed by
loans for a large amount from both France and Holland, that made
victory possible, and laid the foundations for the republic of to-day,
with its credit unimpaired, and with securities commanding a ready
sale at a high premium in all the principal markets of the world.
“Authorities vary as to the amount of paper money issued and the
cost of the war for independence. On the 1st of September, 1779,
Congress resolved that it would ‘on no account whatever emit more
bills of credit than to make the whole amount of such bills two
hundred millions of dollars.’ Mr. Jefferson estimates the value of this
sum at the time of its emission at $36,367,719.83 in specie, and says;
‘If we estimate at the same value the like sum of $200,000,000
supposed to have been emitted by the States, and reckon the Federal
debt, foreign and domestic, at about $43,000,000, and the State
debt at $25,000,000, it will form an amount of $140,000,000, the
total sum which the war cost the United States. It continued eight
years, from the battle of Lexington to the cessation of hostilities in
America. The annual expense was, therefore, equal to about
$17,500,000 in specie.’
“The first substantial aid rendered the colonies by any foreign
power was a free gift of money and military supplies from Louis XVI.
of France, amounting in the aggregate to 10,000,000 livres,
equivalent to $1,815,000.
“These supplies were not furnished openly, for the reason that
France was not in a position to commence a war with Great Britain.
The celebrated Caron de Beaumarchais was employed as a secret
agent, between whom and Silas Deane, as the political and
commercial agent of the United States, a contract was entered into
whereby the former agreed to furnish a large amount of military
supplies from the arsenals of France, and to receive American
produce in payment therefor.
“Under this arrangement supplies were furnished by the French
Government to the amount of 2,000,000 livres. An additional
1,000,000 was contributed by the Government of Spain for the same
purpose, and through the same agency. The balance of the French
subsidy was paid through Benjamin Franklin. In 1777 a loan of
1,000,000 livres was obtained from the ‘Farmers General of France’
under a contract for its repayment in American tobacco at a
stipulated price. From 1778 to 1783, additional loans were obtained
from the French King, amounting to 34,000,000 livres. From 1782
to 1789, loans to the amount of 9,000,000 guilders were negotiated
in Holland, through the agency of John Adams, then the American
Minister to the Hague.
“The indebtedness of the United States at the organization of the
present form of government (including interest to December 31,
1790) may be briefly stated, as follows:
Foreign debt $11,883,315.96

Domestic debt 40,256,802.45
Debt due foreign officers 198,208.10
Arrears outstanding (since discharged) 450,395.52
Total $52,788,722.03
To this should be added the individual debts of the several States,

the precise amount and character of which was then unknown, but
estimated by Hamilton at that time to aggregate about $25,000,000.
“The payment of this vast indebtedness was virtually guarantied by
the provisions of Article VI. of the Constitution, which says: ‘All
debts contracted, and engagements entered into, before the adoption
of this Constitution shall be as valid against the United States under
this Constitution as under the confederation.’ On the 21st of
September, 1789, the House of Representatives adopted the
following resolutions:
Resolved, That this House consider an adequate provision for the
support of the public credit as a matter of high importance to the
national honor and prosperity.
Resolved, That the Secretary of the Treasury be directed to prepare
a plan for that purpose, and to report the same to this House at its
next meeting.
“In reply thereto Hamilton submitted his report on the 9th of
January, 1790, in which he gave many reasons for assuming the
debts of the old Government, and of the several States, and furnished
a plan for supporting the public credit. His recommendations were
adopted, and embodied in the act making provision for the payment
of the debt of the United States, approved August 4, 1790.
This act authorized a loan of $12,000,000, to be applied to the
payment of the foreign debt, principal and interest; a loan equal to
the full amount of the domestic debt, payable in certificates issued
for its amount according to their specie value, and computing the
interest to December 31, 1791, upon such as bore interest; and a
further loan of $21,500,000, payable in the principal and interest of
the certificates or notes which, prior to January 1, 1790, were issued
by the respective States as evidences of indebtedness incurred by
them for the expenses of the late war. ‘In the case of the debt of the
United States, interest upon two-thirds of the principal only, at 6 per
cent., was immediately paid; interest upon the remaining third was
deferred for ten years, and only three per cent. was allowed upon the
arrears of interest, making one-third of the whole debt. In the case of
the separate debts of the States, interest upon four-ninths only of the
entire sum was immediately paid; interest upon two-ninths was
deferred for ten years, and only 3 per cent. allowed on three-ninths.’
Under this authority 6 per cent. stock was issued to the amount of
$30,060,511, and deferred 6 per cent. stock, bearing interest from
January 1, 1800, amounting to $14,635,386. This stock was made
subject to redemption by payments not exceeding, in one year, on
account both of principal and interest, the proportion of eight dollars
upon a hundred of the sum mentioned in the certificates;
$19,719,237 was issued in 3 per cent. stock, subject to redemption
whenever provision should be made by law for that purpose.
“The money needed for the payment of the principal and interest
of the foreign debt was procured by new loans negotiated in Holland
and Antwerp to the amount of $9,400,000, and the issue of new
stock for the balance of $2,024,900 due on the French debt, this
stock bearing a rate of interest one-half of one per cent. in advance of
the rate previously paid, and redeemable at the pleasure of the
Government. Subsequent legislation provided for the establishment
of a sinking fund, under the management of a board of
commissioners, consisting of the President of the Senate, Chief
Justice of the Supreme Court, Secretary of State, Secretary of the
Treasury, and Attorney-General, for the time being, who, or any
three of whom, were authorized, under the direction of the President
of the United States, to make purchases of stock, and otherwise
provide for the gradual liquidation of the entire debt, from funds set
apart for this purpose. On assuming the position of Secretary of the
Treasury, Hamilton found himself entirely without funds to meet the
ordinary expenses of the Government, except by borrowing, until
such time as the revenues from duties on imports and tonnage began
to come into the Treasury. Under these circumstances, he was forced
to make arrangements with the Bank of New York and the Bank of
North America for temporary loans, and it was from the moneys
received from these banks that he paid the first installment of salary
due President Washington, Senators, Representatives and officers of
Congress, during the first session under the Constitution, which
began at the city of New York, March 4, 1789.
“The first ‘Bank of the United States’ appears to have been
proposed by Alexander Hamilton in December, 1790, and it was
incorporated by an act of Congress, approved February 25, 1791, with
a capital stock of $10,000,000 divided into 25,000 shares at $400
each. The government subscription of $2,000,000, under authority
of the act, was paid by giving to the bank bills of exchange on
Holland equivalent to gold, and borrowing from the bank a like sum
for ten years at 6 per cent. interest. The bank went into operation
very soon after its charter was obtained, and declared its first
dividend in July, 1792. It was evidently well managed, and was of
great benefit to the Government and the people at large, assisting the
Government by loans in cases of emergency, and forcing the ‘wildcat’
banks of the country to keep their issues ‘somewhere within
reasonable bounds.’ More than $100,000,000 of Government money
was received and disbursed by it without the loss of a single dollar. It
made semi-annual dividends, averaging about 8½ per cent., and its
stock rose to a high price. The stock belonging to the United States
was sold out at different times at a profit, 2,220 shares sold in 1802
bringing an advance of 45 per cent. The government subscription,
with ten years’ interest amounted to $3,200,600, while there was
received in dividends and for stock sold $3,773,580, a profit of nearly
28.7 per cent. In 1796 the credit of the Government was very low, as
shown by its utter failure to negotiate a loan for the purpose of
paying a debt to the Bank of the United States for moneys borrowed
and used, partly to pay the expenses of suppressing the whisky
insurrection in Pennsylvania and to buy a treaty with the pirates of
Algiers. On a loan authorized for $5,000,000, only $80,000 could be
obtained, and this at a discount of 12½ per cent.; and, there being no
other immediate resource, United States Bank stock to the amount of
$1,304,260 was sold at a premium of 25 per cent.
“Under an act approved June 30, 1798, the President was
authorized to accept such vessels as were suitable to be armed for the
public service, not exceeding twelve in number, and to issue
certificates, or other evidences of the public debt of the United
States, in payment. The ships George Washington, Merrimack,
Maryland and Patapsco, brig Richmond, and frigates Boston,
Philadelphia, John Adams, Essex and New York, were purchased,
and 6 per cent. stock, redeemable at the pleasure of Congress, was
issued in payment to the amount of $711,700.
“The idea of creating a navy by the purchase of vessels built by
private parties and issuing stock in payment therefor, seems to have
originated with Hamilton.
“In the years 1797 and 1798 the United States, though nominally at
peace with all the world, was actually at war with France—a war not
formally declared, but carried on upon the ocean with very great
virulence. John Marshall, Elbridge Gerry and Charles C. Pinckney
were appointed envoys extraordinary to the French Republic, with
power for terminating all differences and restoring harmony, good
understanding and commercial and friendly intercourse between the
two nations; but their efforts were in vain, and extensive
preparations were made to resist a French invasion. It was evident
that the ordinary revenues of the country would be inadequate for
the increased expenditure, and a loan of $5,000,000 was authorized
by an act approved July 16, 1798, redeemable at pleasure after fifteen
years. The rate of interest was not specified in the act, and the
market rate at the time being 8 per cent. this rate was paid, and it
was thought by a committee of Congress that the loan was negotiated
‘upon the best terms that could be procured, and with a laudable eye
to the public interest.’ A loan of $3,500,000 was authorized by an act
approved May 7, 1800, for the purpose of meeting a large deficit in
the revenues of the preceding year, caused by increased expenditures
rendered necessary on account of the difficulties with France, and
stock bearing 8 per cent. interest, reimbursable after fifteen years,
was issued to the amount of $1,481,700, on which a premium was
realized of nearly 5¾ per cent. These are the only two instances in
which the Government has paid 8 per cent. interest on its bonds.
“The province of Louisiana was ceded to the United States by a
treaty with France, April 30, 1803, in payment for which 6 per cent.
bonds, payable in fifteen years, were issued to the amount of
$11,250,000, and the balance which the Government agreed to pay
for the province, amounting to $3,750,000, was devoted to
reimbursing American citizens for French depredations on their
commerce. These claims were paid in money, and the stock
redeemed by purchases made under the direction of the
Commissioners of the Sinking Fund within twelve years. Under an
act approved February 11, 1807, a portion of the ‘old 6 per cent.’ and
‘deferred stocks’ was refunded into new stock, bearing the same rate
of interest, but redeemable at the pleasure of the United States. This
was done for the purpose of placing it within the power of the
Government to reimburse the amount refunded within a short time,
as under the old laws these stocks could only be redeemed at the rate
of 2 per cent. annually. Stock was issued amounting to $6,294,051,
nearly all of which was redeemed within four years. Under the same
act old ‘3 per cent. stock’ to the amount of $2,861,309 was converted
into 6 per cents., at sixty-five cents on the dollar, but this was not
reimbursable without the assent of the holder until after the whole of
certain other stocks named in the act was redeemed. The stock
issued under this authority amounted to $1,859,871. It would appear
that the great majority of the holders of the “old stock” preferred it to
the new. A loan equal to the amount of the principal of the public
debt reimbursable during the current year was authorized by an act
approved May 1, 1810, and $2,750,000 was borrowed at 6 per cent.
interest from the Bank of the United States, for the purpose of
meeting any deficiency arising from increased expenditures on
account of the military and naval establishments. This was merely a
temporary loan, which was repaid the following year.
“The ordinary expenses for the year 1812 were estimated by the
Committee of Ways and Means of the House of Representatives at
$1,200,000 more than the estimated receipts for the same period,
and the impending war with Great Britain made it absolutely
necessary that some measures should be adopted to maintain the
public credit, and provide the requisite funds for carrying on the
Government. Additional taxes were imposed upon the people, but as
these could not be made immediately available there was no other
resource but new loans and the issue of Treasury notes. This was the
first time since the formation of the new Government that the issue
of such notes had been proposed, and they were objected to as
engrafting on our system of finance a new and untried measure.
“Under various acts of Congress approved between March 4, 1812,
and February 24, 1815, 6 per cent. bonds were issued to the amount
of $50,792,674. These bonds were negotiated at rates varying from
20 per cent. discount to par, the net cash realized amounting to
$44,530,123. A further sum of $4,025,000 was obtained by
temporary loans at par, of which sum $225,000 was for the purpose
of repairing the public buildings in Washington, damaged by the
enemy on the night of August 24, 1814. These ‘war loans’ were all
made redeemable at the pleasure of the Government after a specified
date, and the faith of the United States was solemnly pledged to
provide sufficient revenues for this purpose. The ‘Treasury note
system’ was a new feature, and its success was regarded as somewhat
doubtful.
“Its subsequent popularity, however, was owing to a variety of
causes. The notes were made receivable everywhere for dues and
customs, and in payment for public lands. They were to bear interest
from the day of issue, at the rate of 5–⅖ per cent. per annum, and
their payment was guaranteed by the United States, principal and
interest, at maturity. They thus furnished a circulating medium to
the country, superior to the paper of the suspended and doubtful
State banks. These issues were therefore considered more desirable
than the issue of additional stock, which could be realized in cash
only by the payment of a ruinous discount. The whole amount of
Treasury notes issued during the war period was $36,680,794. The
Commissioners of the Sinking Fund were authorized to provide for
their redemption by purchase, in the same manner as for other

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More information about this series at http://www.springer.com/series/6414

ISSN 0376-7418 ISSN 2215-0080 (electronic)

© Springer Nature Switzerland AG 2020

1 Contemporary European Perspectives on the Ethics

Part I Philosophical and Theological Perspectives

Part II Ethical Concepts in End of Life Care:

Part III Moral Concerns and Ethical Problems

23 Families and End of Life Care���������������������������������������������������������������� 355

Andrea Dörries Zentrum für Gesundheitsethik (ZfG), Hannover, Germany

Michael Quante Department of Philosophy, University of Münster, Münster,

Ayesha Ahmad PhD, is a Lecturer in Global Health at St George’s, University of

Roberto Andorno is Associate Professor at the School of Law and Research

Oren Asman is a Practicing Lawyer, Chair of District Psychiatric Review

He has authored peer-reviewed articles, chapters in academic books and short

Benedetta Barbisan is Professor of Comparative Constitutional Law at the

Yechiel Michael Barilan (MD, MA) is a Practicing Physician, Expert in Internal

Caroline Bradbury-Jones is a Registered Nurse and midwife. She is Reader in

Alastair V. Campbell is Visiting Professor of Medical Ethics and the Emeritus

Andrea Dörries is a Medical Doctor and Clinical Ethicist, specialising in paediat-

Nathan Emmerich is currently a Research Fellow in Bioethics at the Australian

Vibeke Graven is a Postdoctoral Researcher at REHPA, the Danish Knowledge

Stephen Holland is a Reader in the Departments of Philosophy and Health

Ruth Horn is a Senior Researcher in Ethics and a University Research Lecturer at

Jonathan Ives is a Reader in Empirical Bioethics and Deputy Director of the

Alan J. Kearns is Assistant Professor of Ethics in the School of Theology,

Carlo Leget is Full Professor of Care Ethics at the University of Humanistic

John Lombard PhD, is a Lecturer in the School of Law at University of Limerick

Pierre Mallia is Professor of Family Medicine, Patients’ Rights and Bioethics in

Nadine Mooren has been a Postdoctoral Researcher in the Department of

Georgina Morley is a Nursing Ethics Fellow at the Cleveland Clinic (Cleveland,

Francesca Pistoia is Assistant Professor of Neurorehabilitation at the University

Michael Quante is Full Professor of Practical Philosophy in the Department of

Christoph Rehmann-Sutter is Professor of Theory and Ethics in the Biosciences

Joseph Shaw is Senior Research Fellow at St Benet’s Hall, Oxford University,

Marian A. Verkerk is Full Professor in the Ethics of Care at the University

leading a project on patient participation at the University Medical Center

Nathan Emmerich is a Research Fellow in Bioethics in the Australian National

Pierre Mallia is Professor of Family Medicine and Biomedical Ethics at the

He has participated in several FP projects including Euroscreen, Privireal,

Francesca Pistoia is Associate Professor of Neurology at the University of

MRI Magnetic Resonance Imaging

The Republican National Convention met June 5th, 1880, at

Whole number of votes 755

As shown, General James A. Garfield, of Ohio, was nominated on

Thus General Winfield S. Hancock, of New York, was nominated

The money deposited under this act shall be promptly applied

In Book VII of this volume devoted to Tabulated History, we try to

Foreign debt $11,883,315.96

1 Contemporary European Perspectives on the Ethics

Part I Philosophical and Theological Perspectives

Part II Ethical Concepts in End of Life Care:

Part III Moral Concerns and Ethical Problems

23 Families and End of Life Care�� 355