Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

Background: Funding organisations and research ethics committees should play a part in strengthening attention to gender equality in clinical research. In the research policy of European Union , funding measures have been taken to realise this, but such measures are lacking in the EU policy regarding RECs.Objective: To explore how RECs in Austria, Germany, Ireland, The Netherlands and Sweden deal with gender equality issues by asking two questions: Do existing procedures promote representation of women and gender expertise in the committee? (...) How are sex and gender issues dealt with in protocol evaluation?Methods: Two RECs were selected from each country. Data were obtained through interviews with key informants and content analysis of relevant documents .Results: All countries have rules to ensure the presence of women on RECs; gender expertise is not required. Drug study protocols are carefully evaluated, sometimes on a formal basis, as regards the inclusion of women of childbearing age. The reason for excluding either one of the sexes or including specific groups of women or making a gender-specific risk–benefit analysis are investigated by some RECs. Such measures are, however, neither defined in the regulations nor integrated in review tools.Conclusions: The RECs investigated in five European member states are found to pay limited attention to gender equality in their working methods and, in particular in protocol evaluation. Policy and regulations of EU are needed to strengthen attention to gender equality in the work of RECs. (shrink)

Body integrity identity disorder is a very rare condition in which people experience long-standing anguish because there is a mismatch between their bodies and their internal image of how their bodies should be. Most typically, these people are deeply distressed by the presence of what they openly acknowledge as a perfectly normal leg. Some with the condition request that their limb be amputated. 1 We and others have argued that such requests should be acceded to in carefully selected patients.1–4 Consistent (...) with this view, a group at the University of Sydney is developing a programme to better understand and treat BIID and to offer amputation if appropriate. In a recent paper, Patrone argues that such amputations should be prohibited.5 He suggests that authors supporting amputation in BIID depend on analogies with more familiar conditions and then claim that the ‘the desires, choices and requests of BIID patients should be held to exactly the same standards and treated with exactly the same respect as the desires, choices and requests of any more conventional patient’.5 He believes that these analogies are invalid and that therefore the arguments for amputation are invalid.Patrone concentrates a great deal upon whether a decision to have a particular medical intervention is to be regarded as ‘rational’. Unfortunately, he makes no attempt to define what he …. (shrink)

Is a whole something more than the sum of its parts? Are there things composed of the same parts? If you divide an object into parts, and divide those parts into smaller parts, will this process ever come to an end? Can something lose parts or gain new ones without ceasing to be the thing it is? Does any multitude of things (including disparate things such as you, this book, and the tail of a cat) compose a whole of some (...) sort? Questions such as these have occupied us for at least as long as philosophy has existed. They define the field that has come to be known as mereology-the study of all relations of part to whole and of part to part within a whole-and have deep and far-reaching ramifications in metaphysics as well as in logic, the foundations of mathematics, the philosophy of language, the philosophy of science, and beyond. In Mereology, A. J. Cotnoir and Achille C. Varzi have compiled decades of advanced research into a comprehensive, up-to-date, and formally rigorous picture. The early chapters cover the more classical aspects of mereology; the rest of the book deals with variants and extensions. Whether you are an established professional philosopher, an interested student, or a newcomer, inside you will find all the tools you need to join this ever-evolving field of inquiry and theorize about all things mereological. (shrink)

This essay considers the intricate relationship between the thought of William James and the political theory of Harold J. Laski mainly in the years 1915 to 1930. I suggest James's arguments and vocabulary have a greater presence in Laski's work than has been previously detailed. The links between James's and Laski's thought are apparent in Laski's accounts of the self and his descriptions of the nature and structure of social experience; each of these in some way derives from James's psychology, (...) empiricist metaphysics and pragmatic method. The links are demonstrated by Laski's explicit references to James's ideas in his books and letters as well as in his adoption of Jamesian terms, phrases and motifs. This essay also shows that in applying James's ideas to political life Laski brought to light the equivocal nature of James's philosophy. Equally however, reading Laski against the background of James's intellectual legacy helps us understand more clearly some of the ambiguities and tensions in Laski's work; for instance how he could move with apparent ease from advocating political pluralism to supporting centralized planning. Finally, this paper illustrates the complex relationship between political theory and metaphysics. (shrink)

This paper examines the identity of Asian swamp buffalo (Bubalus bubalis) from different value orientations. Buffalo were introduced into Northern (Top End) Australia in the early nineteenth century. A team of transdisciplinary researchers, including an ethicist, has been engaged in field research on feral buffalo in Arnhem Land over the past three years. Using historical documents, literature review, field observations, interviews with key informants, and interaction with the Indigenous land owners, an understanding of the diverse views on the scientific, cultural, (...) and economic significance of buffalo was obtained. While the diverse stakeholders in buffalo exploitation and management have historically delivered divergent value orientations on the nature of the human–buffalo relationship, we argue that over time there is the possibility of values and ethical convergence. Such convergence is possible via transdisciplinary and transcultural agreement on the value stances that constitute the construction of the being or identity of buffalo in the face of the overwhelming need to manage population density and gross numbers. (shrink)