This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

BackgroundHuntington’s disease has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive. Little is known about the perspectives of HD patients on their AED.AimTo gain insight into patients’ views on and attitudes towards their AED, and changes over time.MethodsA longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients who either had an AED or (...) were thinking about drawing it up participated in this study.ResultsWe identified two themes that characterize patients’ perspectives on their AEDs: general character of the AED; uncertainty around their AED. Ad The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.ConclusionHD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care. (shrink)

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals and ethicists (...) working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (shrink)

Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.Methods:Ethnographic field study.Ethical considerations:The boards (...) representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. The (...) author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don’t, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, “reciprocity” is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making. (shrink)

This article introduces a new hybrid intake procedure developed for posttraumatic stress disorder (PTSD) screening, which combines an automated textual assessment of respondents’ self-narratives and item-based measures that are administered consequently. Text mining technique and item response modeling were used to analyze long constructed response (i.e., self-narratives) and responses to standardized questionnaires (i.e., multiple choices), respectively. The whole procedure is combined in a Bayesian framework where the textual assessment functions as prior information for the estimation of the PTSD latent trait. (...) The purpose of this study is twofold: first, to investigate whether the combination model of textual analysis and item-based scaling could enhance the classification accuracy of PTSD, and second, to examine whether the standard error of estimates could be reduced through the use of the narrative as a sort of routing test. With the sample at hand, the combination model resulted in a reduction in the misclassification rate, as well as a decrease of standard error of latent trait estimation. These findings highlight the benefits of combining textual assessment and item-based measures in a psychiatric screening process. We conclude that the hybrid test design is a promising approach to increase test efficiency and is expected to be applicable in a broader scope of educational and psychological measurement in the future. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.

The book "Philosophical Foundations of Neuroscience" is an engaging criticism of cognitive neuroscience from the perspective of a Wittgensteinian philosophy of ordinary language. The authors' main claim is that assertions like "the brain sees" and "the left hemisphere thinks" are integral to cognitive neuroscience but that they are meaningless because they commit the mereological fallacy—ascribing to parts of humans, properties that make sense to predicate only of whole humans. The authors claim that this fallacy is at the heart of Cartesian (...) dualism, implying that current cognitive neuroscientists are Cartesian dualists. Against this claim, we argue that the fallacy cannot be committed within Cartesian dualism either, for this doctrine does not allow for an intelligible way of asserting that a soul is part of a human being. Also, the authors' Aristotelian essentialistic outlook is at odds with their Wittgensteinian stance, and we were unconvinced by their case against explanatory reductionism. Finally, although their Wittgensteinian stance is congenial with radical behaviorism, their separation between philosophy and science seems less so because it is based on a view of philosophy as a priori. The authors' emphasis on the a priori, however, does not necessarily commit them to rationalism if it is restricted to conceptual or analytical truths. (shrink)

Current report assessed measurement reproducibility and reliability of magnetic resonance spectroscopy (1H-MRS) at 3 Tesla in left and right posterior insular, pregenual and anterior midcingulate subdivisions. 10 healthy male volunteers aged 20 to 30 years were tested on four different days, of which 9 were included in the data analysis. Intra- and inter-subject variability of myo-Inositol (mI), Creatine (Cre), Glutamate (glu), total-Choline (tCho), total-N-acetylaspartate (tNAA) and combined Glutamine-Glutamate (Glx) were calculated considering the influence of movement parameters, age, daytime of measurements (...) and tissue composition. Overall mean intra-subject variability revealed small mean coefficients of variation (CV) across the four regions: 5.3% in aMCC, 6.6% in pgACC, 7.3% in pIL and 8.2% in pIR. For all neurochemicals combined, mean inter-subject variability demonstrated mean CVs of 9.05% (aMCC), 8.84% (pgACC), 10.00% (pIL) and 10.55% (pIR). Head movement, tissue composition and day time revealed no significant explanatory variance contribution suggesting a negligible influence on data. A strong correlation between Cramer-Rao Lower Bounds (CRLB; a measure of fitting errors) and the mean intra-subject CV (r=0.799, p<0.001) outlined the importance of low CRLB in order to obtain robust and finally meaningful 1H-MRS measures. The present findings confirm 1H-MRS as a reliable tool to measure brain neurochemistry in small subregions of the human brain. (shrink)

The first studies that sought to establish two-way communication between humans and great apes led to important findings but were nevertheless heavily criticized for their training methods, testing procedures, and claims. More recently, hundreds of pet owners around the world have begun training domesticated animals to use Augmentative Interspecies Communication (AIC) soundboard devices, contributing to the first ever large-scale study on interspecies communication. Here, we introduce our scientific approach to our global citizen science project, where we will investigate how dogs (...) and cats use AIC devices, building an incremental research program starting from their associative learning of buttons to determining how AIC device use might impact their welfare and their capacity for symbolic representation. We discuss how our multi-faceted approach can alleviate many of the concerns regarding the original studies performed with apes, achieving larger sample sizes, ample documentation of training techniques, and testing animals’ performance in controlled experimental settings. (shrink)

The inconsistent definition of empathy has had a negative impact on both research and practice. The aim of this article is to review and critically appraise a range of definitions of empathy and, through considered analysis, to develop a new conceptualisation. From the examination of 43 discrete definitions, 8 themes relating to the nature of empathy emerged: “distinguishing empathy from other concepts”; “cognitive or affective?”; “congruent or incongruent?”; “subject to other stimuli?”; “self/other distinction or merging?”; “trait or state influences?”; “has (...) a behavioural outcome?”; and “automatic or controlled?” The relevance and validity of each theme is assessed and a new conceptualisation of empathy is offered. The benefits of employing a more consistent and complete definition of empathy are discussed. (shrink)

In a recent issue of this journal, P.E. Vermaas ([2005]) claims to have demonstrated that standard quantum mechanics is technologically inadequate in that it violates the 'technical functions condition'. We argue that this claim is false because based on a 'narrow' interpretation of this technical functions condition that Vermaas can only accept on pain of contradiction. We also argue that if, in order to avoid this contradiction, the technical functions condition is interpreted 'widely' rather than 'narrowly', then Vermaas, argument for (...) his claim collapses. The conclusion is that Vermaas' claim that standard quantum mechanics is technologically inadequate evaporates. (shrink)

The papers in this volume reflect much of the current unease of a world that perceives itself once more at the edge of chaos. The authors present different vistas of that experience and their inherent dialectic, expressed in numerous and ceaseless conflicts between ordering and disordering processes. They can be read as comments on the ongoing processes that lead toward greater complexity.

Combining her expertise in legal theory and her judicial practice in criminal law in a Court of Appeal, Jeanne Gaakeer explores the intertwinement of legal theory and practice to develop a humanities-inspired methodology for both the academic interdisciplinary study of law and literature and for legal practice. This volume addresses judgment and interpretation as a central concern within the field of law, literature and humanities. It is not only a study of law as praxis that combines academic legal theory with (...) judicial practice, but proposes both as central to humanistic jurisprudence and as a training in the conduct of public life. Drawing extensively on philosophical and legal scholarship and through analysis of literary works, Gaakeer proposes a perspective on law as part of the humanities that will inspire legal professionals, scholars and advanced students of law alike.-Back cover. (shrink)

Science education is most efficacious and enduring when undertaken within a philosophical framework akin to that of science, itself. This entails recognition that, above all, science is a mode of rational inquiry pursued by those who are curious about the natural world and motivated to seek rational answers to personally meaningful questions. The key to successful science instruction lies in fostering a student' 's self-motivation and productively channeling his innate curiosity. To do this a science educator must convey to students (...) an accurate and sympathetic impression of the importance of science to their cultural development; help students develop an ability to evaluate information critically and arrive at logical conclusions; provide students opportunities to engage in creative, personally meaningful scientific research. (shrink)