Though power is commonly seen as a special feature of exceptional personalities, van Ginkel argues that power is actually a given feature of all humans, animals ...

Political liberals ask citizens not to appeal to certain considerations, including religious and philosophical convictions, in political deliberation. We argue that political liberals must include a demanding requirement of intellectual modesty in their ideal of citizenship in order to motivate this deliberative restraint. The requirement calls on each citizen to believe that the best reasoners disagree about the considerations that she is barred from appealing to. Along the way, we clarify how requirements of intellectual modesty relate to moral reasons for (...) deliberative restraint. And we argue against attempts to weaken our requirement of intellectual modesty by emphasizing those moral reasons. (shrink)

This contribution consists of two parts. The first part identifies Augustine’s qualities as a mystagogue on the basis of the only poem he wrote that has been handed down: the Psalm against the Donatists. It shows that little is to be gained by studying Augustine as both poeta and mystagogue. Not his poetry itself, but his commentary on poetry as such reveals the transformative power that he ascribes to this genre. For this reason the second part examines Augustine’s Enarrationes in (...) psalmos. In this work, he makes explicit the transformative power that is contained in the 150 Psalms, which are both poetry and prayer. This part asks the question how Augustine articulates or heightens fear when the Psalmist in his dialogue with God ‘compels’ him to do this, as it were, by expressing fear of enemies or of the Last Judgement. He shows that he acknowledges that fear alone can lead to an unbalanced, and even a bad relationship with God. Fear should result in introspection and should be a guarantee against pride. That Augustine furthermore is not content to heighten the fear of God alone, but wants it to coincide with desire, joy, and hope, shows that he wishes to prevent any imbalance in the human who seeks a relationship with God. For Augustine, fear is necessary, but it is ‘only’ an ancilla of hope, joy, love, and desire. But as such, timor is indispensible. Fear causes attentiveness and carefulness: virtues that love presuppose and that also correlate with it. Nevertheless, love does not stand at the service of fear; for Augustine, it is the reverse. (shrink)

Several important ethical dilemmas emerge when nurses join a public-sector strike. Such industrial action is commonplace in South Africa and was most notably illustrated by a national wage negotiation in 2010. Media coverage of the proceedings suggested unethical behaviour on the part of nurses, and further exploration is merited. Laws, policies and provisional codes are meant to guide nurses’ behaviour during industrial action, while ethical theories can be used to further illuminate the role of nurses in industrial action. There are, (...) however, important aspects to consider before judging whether nurses act unethically when striking. Following Loewy’s suggestion that the nature of the work, the proceeding commitment of the nurse to the patient, the prevailing situation when the strike is planned and the person(s) who stand(s) to benefit from the strike be considered, coupled with a consideration of the South African historical socio-political context, important aspects of the ethics of nurses’ behaviour in industrial action transpire. (shrink)

We introduce the horizontal and vertical topologies on the product of topological spaces, and study their relationship with the standard product topology. We show that the modal logic of products of topological spaces with horizontal and vertical topologies is the fusion ${\bf S4}\oplus {\bf S4}$ . We axiomatize the modal logic of products of spaces with horizontal, vertical, and standard product topologies. We prove that both of these logics are complete for the product of rational numbers ${\Bbb Q}\times {\Bbb Q}$ (...) with the appropriate topologies. (shrink)

The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 per cent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept of (...) futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable. (shrink)

Hereditary structural completeness is established for a range of substructural logics, mainly without the weakening rule, including fragments of various relevant or many-valued logics. Also, structural completeness is disproved for a range of systems, settling some previously open questions.

Isolated habitats, the consequence of the fragmentation process, are the object of external disturbance. This divides the patch area into two zones: interior and edge. The interior-to-edge ratio quantifies the potential disturbance impact. A method is presented to calculate a reference value for the interior-to-edge ratio, based upon the minimum edge for a given interior. The method is based on pixel geometry features and mathematical morphology. A corrected interior-to-edge ratio is defined using the reference value. The method is illustrated for (...) woodlot fragments in the Belgian Kempen region. (shrink)

In this paper the authors give a survey of biological phenomena , for which the term ‘differentiation’, used in the widest sense, has a meaningful application. The last chapter deals with some general aspects of differentiation and connected phenomena, such as polarity, symmetry, loss of potencies, dedifferentiation, redifferentiation, adifferentiation, regulation and integration.To prevent this article becoming too voluminous, the authors had to refrain from extending the treatment of differentiation to non-living matter and to human society.

The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits ‘justify access to this procedure for families who choose it,’ claiming that whenever and for whatever reason (...) it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given. (shrink)

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

ABSTRACT:Although a research focus on the increasing involvement of corporations in shaping and maintaining the global rules of the game points out promising avenues for future research, it simultaneously makes clear how little currently established, mostly managerial conceptual frameworks have to offer in making sense of these developments. It is argued that we need to expand the rather restricted perspectives that these frameworks provide, in order to explore new conceptual foundations that will not only enable us to travel the confines (...) of the different disciplines involved with the study of the changing role of business in shaping the global rules of the game, but that can also systematically connect normative and positive research questions at the conceptual level. Three directions for this search for new foundations are briefly explored. (shrink)

Abstract:Work on stakeholder theory has proceeded on a variety of fronts; as Donaldson and Preston (1995) have noted, such work can be parsed into descriptive, instrumental, and normative research streams. In a normative vein, Phillips (1997) has made an argument for a principle of fairness as a means of identifying and adjudicating among stakeholders. In this essay, I propose that a reconstructed principle of fairness can be combined with the idea of consent as outlined in integrative social contract theory (ISCT) (...) to bring about a more normative stakeholder theory that also has ramifications for corporate governance. (shrink)

In April 2002 a new law regarding euthanasia came into effect in the Netherlands. This law holds that euthanasia remains a criminal offence unless it is performed by a physician who acts according to six specified rules of due care and reports the case to a review committee. The six rules of due care are similar to those of the previous regulation and are largely based on jurisprudence. Completely new, however, is the article concerning a competent patient who has written (...) an advance directive requesting euthanasia under certain circumstances. The law stipulates that a physician may act according to that written request, as long as he or she fulfils all other rules of due care. The author defends the view that these requests are neither feasible nor ethically justifiable, and presents both moral and practical arguments for this, claiming that for consistency reasons one cannot act on the basis of a written statement and fulfil the other rules of due care at the same time. The author also examines a difficult case of a demented, severely depressed woman who had written a living will requesting euthanasia before she became demented. (shrink)

Aim: To examine how physicians’ life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large (...) life-stance groups in each country.Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient’s death , physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics and Protestants reported ever having made such a decision.Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. (shrink)

The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians and policy makers to participate in an interview about their practices and opinions concerning factors playing a role in decision making for patients in different age groups. (...) Both physicians and policy makers recognised allocation decisions as part of their reality. One of the strong general opinions of both physicians and policy makers was the rejection of age discrimination. Making allocation decisions as such seemed to be regarded as a foreign entity to the practice of medicine. In spite of the reluctance to make allocation decisions, physicians sometimes do. This would seem to be only acceptable if it is justified in terms of the best interests of the patient from whom treatment is withheld. (shrink)

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses’ attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient and considered it generally better (...) not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units. (shrink)