Do we need to decolonise bereavement studies?

At this re-launch of the journal Bereavement, we explore the question, ‘Do we need to decolonise bereavement studies?’ We do not offer definitive answers, but rather seek to open up conversations. We briefly explore some of the main debates and explanations of what ‘decolonising’ means. In its broader understandings, this entails questions about the nature of the knowledge that underpins claims to ‘expertise’, since knowledge inevitably reflects the socio-historic position and biography of those who produce it. This raises uncomfortable issues about the ‘universality’ of that knowledge, and how to understand what is shared between human beings, including how to understand experiences of pain and suffering. In addressing the nature of, ‘bereavement studies’, we first consider complexities of language and translation, before observing the heavy domination of the ‘psy’ disciplines in affluent minority worlds, oriented towards individualised, medicalised and interventionist perspectives. We indicate work that seeks to challenge these limitations, including the decolonising of psychiatry itself. We argue the need for such decolonising work to go beyond cross-cultural work originating in affluent minority worlds, beyond interdisciplinarity, and beyond crucial work on equality, diversity and inclusivity. Bereavement, as a field of study and a set of practices, needs to take account of the legacies of complex colonial histories of exploitation and harm that continue to shape the world in general, and in particular, the aftermath of death in the continuing lives of the living. We conclude with some implications for ‘bereavement’ practice, from a UK perspective.

How to think about pain with the whole person in mind

Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly directed toward these individuals, whose symptoms aren’t well explained by known pain mechanisms. A root problem is not seeing the person in pain or the suffering they experience. This presentation aims to help participants develop a more comprehensive perspective on pain that better integrates its complexities within clinical practice. Participants will be introduced to the Multi-modal Assessment model of Pain (MAP; Wideman et al, Clinical Journal of Pain 2019; 35(3): 212). MAP offers a novel framework to understand the fundamentally subjective natures of pain and suffering and how they can be best addressed within clinical practice. MAP aims to help clinicians view pain, first and foremost, as an experience (like sadness), which may or may not correspond to specific pathology or diagnostic criteria (like clinical depression). MAP aims to facilitate a more compassionate approach to pain management by providing a rationale for why all reported pain should be validated, even when poorly understood. Viewing pain in this manner helps highlight the central importance of listening to patients’ narrative reports, trying to understand the meaning and context for their experiences of pain and using this understanding to help alleviate suffering.

Parrots, Cockroaches, Octopuses: Are They Conscious?

Which living organisms are conscious, feeling creatures, and which are more like sophisticated robots that can only respond to stimuli and solve simple problems? There are many different and hotly debated answers to this question. We used biology to come up with a new approach for determining which organisms are conscious. We propose that organisms that can learn in a specific, flexible manner are conscious. Using this criterion, it is likely that consciousness first appeared about 540 million years ago and can now be found in many animal species. If our ideas are accepted, this means that we must change our attitude toward non-human animals and do a better job of protecting them from pain and suffering.

Linden Hills

Linden Hills by Gloria Naylor marks psychological fragmentation which results into immense pain and suffering. Naylor, in this novel, addresses the physical and mental hierarchies which act as blockades in the higher purpose of human integration. This paper aims to investigate the saga of undiluted suffering in the lives of women in Linden Hills. The novelist shows in true colors how the black women become sacrificial lambs and receive the brunt of the frustration of the black males of their society. This paper is also a close study of black males mentality when they get unbridled power and exert it on all those who are subversive to them. Women become the easy victim of their ruthless power play. The tragedy is more intense because the women have been suffering for many generations. In every generation, Nedeed male marries a light-complexioned woman just to reduce her to a child-bearing tool. Failing that, the woman has to lead a life full of hardships and depravity. This paper analyses how her loud desires to stand against the institutionalized trauma herald a new era of freedom from pain and suffering.

“Good death” – the circumstances in which it would be best for a person to die. The representative survey of Latvian population

The paper analyses the opinions of Latvian residents about the desired/best conditions for person’s death. Our intention was to use the concept of “good death” as it has been described in academic literature on the end of life to describe what circumstances of dying are preferred in Latvian population. A nationally representative survey of Latvian permanent residents (n = 1012) was conducted in October 2020. The obtained answers are analysed in different demographic groups, as well as in connection with other respondents’ perceptions and values. The results of the study show that the possibility of dying in pain and suffering is a major concern for the majority of Latvian society, and a large percentage of people would like to leave their lives in sleep or sudden death. The results of the study also show people’s desire to be in their homes at the time of death, to die in the presence of relatives. The survey shows a statistically significant relationship between people’s perceptions of the desired/best conditions in which to die - “good death” and a range of demographic and social factors. The data of the study carried out provide new information on people’s perceptions of death, highlighting differences in different socio-demographic groups.

LAUGHTER AND EMPATHY

At a biological level, laughter was found to help in dealing with pain and suffering. From a psychological perspective, its effects have been studied both at intrapersonal and interpersonal levels. At an intrapersonal level, laughter contributes to self-regulating emotions (especially lowering the trait anxiety), diminishing the expression of anger, internally or externally, the same time with increasing self-acceptance. At interpersonal level, laughing together builds trust, while being laughed at may be traumatic. In the present study, the objective was to investigate the effects of laughter on empathy, awareness, and acceptance of personal experience. The participants in the study, all women, watched a situational comedy for 1.5 hours, with different life situations which may seem negative, but presented in an amusing manner, and, very important, with a happy end. At the end, they completed the empathy and awareness questionnaires. Statistical analysis, comparing their scores with those in a non-treatment condition, showed that laughing at the situational comedy significantly influenced almost all aspects of empathy, significantly decreasing the personal distress from empathizing with others, but also sensitivity and emotional interest towards them, without significant influence on awareness and acceptance of personal experience.

The Bullet-Biting Response to the Non-Identity Problem

According to the bullet-biting response to the non-identity problem: Given a choice between creating a well-off child, A, and a different child, B, that is significantly worse off than A, it is not impermissible to create B. David Boonin has presented an argument for the bullet-biting response. He claims that although the conclusion of his argument is implausible, the rejection of the argument is even more implausible. But Boonin’s argument is more implausible than he realizes. Three specific premises, together with the claim that creating a child cannot make that child better or worse off than she would otherwise have been, jointly entail that it is not impermissible to create children whose lives contain only pain and suffering. This is a damning objection to Boonin’s argument. I argue that this objection cannot be avoided without undermining the other premises of Boonin’s argument. Finally, I suggest a fairly weak moral principle that avoids the bullet-biting response. According The Weak Principle (WP): If you are choosing between only Act 1 and Act 2, then Act 1 is impermissible if (a) the outcome of Act 2 is significantly better than the outcome of Act 1, (b*) Act 2 wouldn’t cause anyone to incur a significant cost, and (c) Act 2 wouldn’t violate anyone’s rights.

Anti-inflammatory iron chelator, DIBI, reduces leukocyte-endothelial adhesion and clinical symptoms of LPS-induced interstitial cystitis in mice

BACKGROUND: Interstitial cystitis (IC) is a prevalent and debilitating chronic inflammatory disease of the urinary bladder. Currently there are no fully effective therapeutic agents available, in part due to the still obscure pathogenesis of IC. Lipopolysaccharide (LPS) also known as endotoxin from Gram negative bacteria elicits IC in mice and has formed the basis of model systems for investigation. Excess free iron plays an important role in inflammation through generation of reactive oxygen species (ROS). The novel iron chelator DIBI has been shown to sequester excess free iron and dampen excess inflammatory responses to systemic LPS administration and also to Gram negative bacterial infections. OBJECTIVE: The overall objective of this study was to evaluate the effects of DIBI on LPS induced IC in mice. Leukocyte activation, endothelial adhesion and functional capillary density were assessed by intravital microscopy of the bladder microcirculation following a single intravesical LPS administration with or without intravesical DIBI treatment. Clinical IC symptoms were also assessed through behavioral and pain threshold force measurements. METHODS: Four groups of female BALB/c mice (n = 5–6/group) were randomized in this study: control group, IC group without therapy, IC group with DIBI therapy and control group with DIBI therapy. The groups were examined using intravital microscopy (IVM) of the bladder for leukocyte-endothelial interactions (adherent leukocytes, temporarily interacting leukocytes) and functional capillary density (FCD). A modified behavioral score by Boucher et al. and Von-Frey-Aesthesiometry were used to evaluate key behavioral indices related to pain and visceral pain perception. RESULTS: LPS introduced intravesically induced an early (≤2h) inflammation of the bladder evidenced by leukocyte activation and adhesion to bladder capillary walls. Intravesical DIBI therapy of mice 30min following LPS administration and assessed after 1.5h treatment showed a significant decrease in the number of adherent leukocytes compared to IC animals without DIBI treatment. DIBI treated mice showed a significantly lowered increase in behavioral distress scores compared to IC mice without therapy. Untreated IC mice exhibited a significantly decreased threshold force value for evoked pain response and DIBI treatment improved the threshold pain response. A significant inverse correlation was found for the two pain and suffering evaluation methods results. CONCLUSION: DIBI reduced inflammatory endothelial leukocyte adhesion and key indices related to pain and suffering over those observed in untreated IC mice. Our findings suggest a potential therapeutic role for DIBI for IC treatment.

BARKING UP THE WRONG TREE ‒ THE ACTIO DE PAUPERIE REVISITED Van Meyeren v Cloete (636/2019) [2020] ZASCA 100 (11 September 2020)

It is trite that the South African law of delict follows a generalising approach. This entails that liability will only ensue when all the elements of delict are present. South African law does not recognise individual “delicts”. The generalising approach followed in South African law is qualified in that there are three main delictual actions, namely the actio legis Aquiliae for patrimonial loss; the actio inuriarum for loss arising from intentional infringements of personality rights; and the Germanic action for pain and suffering, in terms of which a plaintiff can claim compensation for negligent infringements of the physical-mental integrity. This approach is further qualified in that numerous actions dating back to Roman law still exist in our law today. Included in this mix are the actions for harm caused by animals, such as the actio de pauperie, the actio de pastu, and the actio de feris, each with its own requirements. There have been questions as to whether these actions, in particular the actio de pauperie, still form part of South African law. In Loriza Brahman v Dippenaar (2002 (2) SA 477 (SCA) 487) the defendant claimed that the actio was no longer part of the South African law. The Supreme Court of Appeal (SCA) per Olivier JA held that the actio de pauperie had been part of South African law for more than 24 centuries and not fallen into disuse. Olivier JA held that the fact that the action is based on strict liability (one of the arguments raised against it) is no reason to ban it from South African law as strict liability was increasing and in suitable instances fulfils a useful function.The SCA, again, recently confirmed the continued existence of the action in South African law in the case of Van Meyeren v Cloete ((636/2019) [2020] ZASCA 100 (11 September 2020) 40). In this case, the SCA had to decide whether to extend the defences against liability in terms of the actio de pauperie to the negligence of a third party that was not in control of the animal. The defendant held that the court should develop the common law in this regard. Considering both case law and the requirements for the development of the common law, the SCA held that such an extension could not be justified.

The Right to Die and the Communal Body - An examination of the media influence, ethical principles and stakeholder attitudes towards assisted dying in New Zealand from a sociology in bioethics perspective

<p>This thesis is based on a sociology in bioethics approach which seeks to demonstrate that the current rhetoric being used by parties on both sides of the debate is no longer useful for the realities that people are expressing or living. In sociology, the assisted dying literature has tended to focus on the social, political, economic and cultural contexts within which it is sought, and to understand the range of definitions that are used to conceptualise a good death. Bioethics literature, on the other hand, has removed the socially situated individual from ethical discussions of assisted dying. By engaging with an idea of the communal body, interpreted as a moral community who experience intersubjective realties, this thesis provides a platform to combine these two perspectives. It seeks to examine the range of possibilities for understanding the socially situated and relationally autonomous individual requesting medically-assisted death. The debate in New Zealand surrounding the right-to-die was brought to the fore in 2015 when terminally ill Lecretia Seales took a case to the High Court. Her argument sought a clarification of the current law, which would have allowed her doctor to provide life-ending medication should her pain and suffering become unbearable. Seales’ case was unsuccessful but it, along with the following events, has succeeded in bringing attention about end-of-life choices to the New Zealand public and media. The current End of Life Choice Bill, which stands before Parliament and was proposed by Member of Parliament (MP) David Seymour of the ACT Party, will once again provide a chance for these issues to be voted on by New Zealand’s elected officials. A critical analysis of provincial New Zealand media articles, across the time periods between 2002-2005 and 2012-2015, has sought to highlight the ways the media influences public perceptions of the debate and emphasises the limited discourse available. These years represent significant periods during which events in time led the media to variably describe these deaths from murders to mercy killings. Further thematic analysis (TA) of 12 interviews undertaken with stakeholders in the field of medically-assisted dying show discrepancies between lay public knowledge and informed stakeholder views. Overall, this thesis situates the communal body within the right-to-die argument in New Zealand. The results lend themselves to support a view that the current lack of available discourse has for the most part irrevocably rendered a divide between those who campaign for change and those who do not. In this thesis, I argue that by positioning itself within a sociology in bioethics approach, the right-to-die debate in New Zealand will be afforded a clearer understanding.</p>