Nanotechnology is an important platform technology which will add new features like improved biocompatibility, smaller size, and more sophisticated electronics to neuro-implants improving their therapeutic potential. Especially in view of possible advantages for patients, research and development of nanotechnologically improved neuro implants is a moral obligation. However, the development of brain implants by itself touches many ethical, social and legal issues, which also apply in a specific way to devices enabled or improved by nanotechnology. For researchers developing nanotechnology such issues (...) are rather distant from their daily work in the lab, but as soon as they use their materials or devices in medical applications such as therapy of brain diseases they have to be aware of and deal with them. This paper is intended to raise sensitivity for the ethical, legal and social aspects (ELSA) involved in applying nanotechnology in brain implants or other devices by highlighting the short term problems of testing and clinical trials within the existing regulatory frameworks (A), the short and medium-term questions of risks in the application of the devices (B) and the long-term perspectives related to problems of enhancement (C). To identify and address such issues properly nanotechnologists should involve ethical, legal and social experts and regulatory bodies in their research as early as possible. This will help to remove pressure from regulatory bodies, to settle public concern and to prevent non-acceptable developments for the benefit of the patients. (shrink)

Until recently, physician assisted suicide was dealt with on the same basis as active voluntary euthanasia in the Netherlands. Over the last years, several cases relating to assistance in suicide of mental patients did raise specific issues, not addressed so far in the debate on euthanasia. One of these cases resulted in a Supreme Court decision. The paper summarizes this decision and comments on it from a legal point of view.

Until recently, physician assisted suicide was dealt with on the same basis as active voluntary euthanasia in the Netherlands. Over the last years, several cases relating to assistance in suicide of mental patients did raise specific issues, not addressed so far in the debate on euthanasia. One of these cases resulted in a Supreme Court decision. The paper summarizes this decision and comments on it from a legal point of view.

Developments in medical technology have increased the possibility of diagnosing severe structural abnormalities in the fetus If these occur, a woman may request termination of her pregnancy. This raises serious ethical and legal questions, in particular if the anomalies are discovered in the third trimester when the fetus is considered viable. Should doctors be allowed to act upon a request for abortion in such a situation, and, if so, which safeguards should be in place? These questions are discussed with special (...) reference to the Netherlands where a commission established by the government recently published a report on this matter. (shrink)

Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

The advent of personal genomics companies offering direct translation of scientific data into personal health information, calls into question traditional policies to refuse disclosure of such scientific data to research participants. This seems especially true for population biobanks, as they collect not only genotype information but also associated phenotype information, and thus may be in a unique position to translate their scientific findings into personal health information for their participants. Disclosure of such information seems mandated by the expectations raised by (...) biobanks ('to help bring about the era of personalized medicine') and their participants' rights to know health information, to know clinical research results, to life and health and particularly their right to benefit. Refusals to disclose such information can be grounded in the lack of analytical validity and/or clinical utility of most findings, the need to avoid the therapeutic misconception, the complexity and costs involved in translation and disclosure and the disproportionate burden resulting from the obligation to respect participants' right not to know before any disclosure can be made. Currently, any demands by participants in population biobanks for full disclosure of all pertinent personal health information potentially resulting from the biobank's scientific findings are unlikely to be granted by a Dutch court under Dutch and international law. As the law stands now, a population biobank is neither a doctor nor a personal genomics company. However, in view of the rapid scientific, medical, technological, commercial and social developments, population biobanks must prepare to take more care of their participants' legitimate interest in receiving as much validated personal health information as reasonably possible, in a timely fashion, by developing appropriate translation and disclosure mechanisms. This paper examines whether population biobank participants have the right, under Dutch civil law and international law, to full disclosure, i.e. to all information generated by the biobank that is pertinent to their present and future health. It pioneers the format of a hypothetical court case to elucidate the legal and policy arguments" for and against full disclosure. (shrink)

Most contemporary conflicts can be characterized as ‘wars or conflicts amongst the people’. International military forces deployed in such conflicts are confronted with complex operational environments where the distinction between combatants and non-combatants is often impossible to make. At the same time, there is a moral requirement imposed on Western coalition forces to perform in a humane manner and to keep casualties to a minimum. Non-lethal weapons are expected to enable military forces to accomplish their mission without having to kill (...) or destroy. The extent to which these weapons meet that promise in real world conditions is the subject of debate. A defence technology assessment of non-lethal weapons is proposed that validates their utility and moral implications by considering the user, the weapon and the target in the context of the deployment situation. It will be illustrated that the technical parameters of the non-lethal weapons are no guarantee that the weapons will perform as intended as the user and target introduce many factors of uncertainty in real world situations. Although such uncertainties undermine the moral acceptability of non-lethal weapons, it is argued that the principle of non-lethality is compliant with the Just War Tradition principle of proportionality. The principles of non-combatant immunity and discrimination need to be re-calibrated given the human-centricity of many military intervention operations. (shrink)

Over the last two decades, Dutch courts have left room for euthanasia. Although a crime under the Penal Code, euthanasia will usually not result in prosecution and conviction if it is committed by a physician according to rules of careful medical practice ; if the patient's request is voluntary, well-considered, and enduring; and if there is unacceptable and hopeless suffering and there are no other solutions to the patient's situation.

Addressing both the humanities and the social sciences, this volume aims to explore the enduring significance of the work of Jacques Derrida (1930-2004) in the field of cultural theory. It assembles a variety of articles by internationally renowned scholars from different academic disciplines and traditions. Contrary to recent commemorative publications on Derrida¿s oeuvre, this volume proposes to critically evaluate and rethink key concepts in Derrida¿s work within the present state of affairs in cultural theory. Centred around four main topics (manoeuvres, (...) societies, images and fictions), the sections propose a creative and contemporary reading of `Derrida¿ and its openings to new work in cultural theory. Ce livre qui se destine à la fois aux humanités et aux études sociales tente d¿explorer la signification durable de l¿¿uvre de Jacques Derrida (1930-2004) dans le champ de la théorie culturelle. Il rassemble un ensemble d¿articles variés écrits par des chercheurs de renommée internationale provenant de différentes disciplines et traditions académiques. S¿opposant par là à la majorité du flot de publications récentes sur l¿¿uvre de Derrida ce volume se propose d¿évaluer et de repenser d¿un point de vue critique les concepts clé de Derrida tenant compte de l¿état actuel de la recherche en études culturelles. Centrées autour de quatre domaines majeurs (man¿uvres ¿ sociétés ¿ images ¿ fictions), les sections offrent une lecture créatrice et actuelle de `Derrida¿ et des ouvertures que sa pensée permet vers une nouvelle idée de la théorie culturelle. (shrink)

In this study, we directly contrast two approaches that have been proposed to explain the SNARC effect. The traditional direct mapping account suggests that a direct association exists between the position of a number on the mental number line and the location of the response. On the other hand, accounts are considered that propose an intermediate step in which numbers are categorized as either small or large between the number magnitude and the response representations. In a magnitude comparison task, we (...) departed from the usual bimanual left/right response dimension and instead introduced the unimanual close/far dimension. A spatial-numerical association was observed: small numbers were associated with a close response, while large numbers were associated with a far response, regardless of the movement direction (left/right). We discuss why these results cannot be explained by assuming a direct mapping from the representation of numbers on a mental number line to response locations and discuss how the results can be explained by the alternative accounts. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

Recently, new developments took place in the Dutch debate on the legislation of euthanasia. After a brief account of that debate, the article discusses a new government proposal for legislation in this field, which was submitted to the Dutch parliament in November 1991. This proposal relates not only to euthanasia but also to some other medical decisions concerning the end of life. The author concludes that, for several reasons, it is unsatisfactory.

The nature of unconscious information processing is a heavily debated issue in cognitive science, and neuroscience. Traditionally, it has been thought that unconscious cognitive processing is restricted to knowledge that is strongly prepared by conscious processes. In three experiments, we show that the task that is performed consciously can also be applied unconsciously to items outside the current task set. We found that a same–different judgment of two target stimuli was also performed on two subliminally presented prime stimuli. This was (...) true for target and prime stimuli from entirely different categories, as well as for prime and target stimuli at different levels of abstraction. These results reveal that unconscious processing can generalize more widely than previously accepted. (shrink)

The nature of unconscious information processing is a heavily debated issue in cognitive science , and neuroscience . Traditionally, it has been thought that unconscious cognitive processing is restricted to knowledge that is strongly prepared by conscious processes . In three experiments, we show that the task that is performed consciously can also be applied unconsciously to items outside the current task set. We found that a same–different judgment of two target stimuli was also performed on two subliminally presented prime (...) stimuli. This was true for target and prime stimuli from entirely different categories, as well as for prime and target stimuli at different levels of abstraction. These results reveal that unconscious processing can generalize more widely than previously accepted. (shrink)

The advent of personal genomics companies offering direct translation of scientific data into personal health information, calls into question traditional policies to refuse disclosure of such scientific data to research participants. This seems especially true for population biobanks, as they collect not only genotype information but also associated phenotype information, and thus may be in a unique position to translate their scientific findings into personal health information for their participants. Disclosure of such information seems mandated by the expectations raised by (...) biobanks and their participants' rights to know health information, to know clinical research results, to life and health and particularly their right to benefit. Refusals to disclose such information can be grounded in the lack of analytical validity and/or clinical utility of most findings, the need to avoid the therapeutic misconception, the complexity and costs involved in translation and disclosure and the disproportionate burden resulting from the obligation to respect participants' right not to know before any disclosure can be made. Currently, any demands by participants in population biobanks for full disclosure of all pertinent personal health information potentially resulting from the biobank's scientific findings are unlikely to be granted by a Dutch court under Dutch and international law. As the law stands now, a population biobank is neither a doctor nor a personal genomics company. However, in view of the rapid scientific, medical, technological, commercial and social developments, population biobanks must prepare to take more care of their participants' legitimate interest in receiving as much validated personal health information as reasonably possible, in a timely fashion, by developing appropriate translation and disclosure mechanisms. This paper examines whether population biobank participants have the right, under Dutch civil law and international law, to full disclosure, i.e. to all information generated by the biobank that is pertinent to their present and future health. It pioneers the format of a hypothetical court case to elucidate the legal and policy arguments" for and against full disclosure. (shrink)

For more than two decades euthanasia and assisted suicide have been openly debated in the Netherlands. This development started in 1973 when the Regional Court in Leeuwarden decided a case in which a physician had administered a deadly dose of morphine to her terminally ill mother on the mother's serious and persistent request. In this case the court concluded that the average Dutch physician no longer considered it his or her duty to prolong a patient's life under all circumstances. The (...) court accepted that in specific cases a physician is allowed to prevent serious and irreversible suffering, even if the patient's life is short ened. This case was the first in which a legal opening for euthanasia or assisted suicide was created. In this specific case the physician was formally declared guilty, but the court gave her a suspended sentence of one week imprisonment. This decision started a debate on euthanasia and assisted suicide throughout all levels of Dutch society. (shrink)