The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

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)

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

BackgroundThe biopharmaceutical industry operates at the intersection of life sciences, clinical research, clinical care, public health, and business, which presents distinct operational and ethical challenges. This setting merits focused bioethics consideration to complement legal compliance and business ethics efforts. However, bioethics as applied to a biopharmaceutical industry setting often is construed either too broadly or too narrowly with little examination of its proper scope.Main textAny institution with a scientific or healthcare mission should engage bioethics norms to navigate ethical issues that (...) arise from the conduct of biomedical research, delivery of clinical care, or implementation of public health programs. It is reasonable to assume that while bioethics norms must remain constant, their application will vary depending on the characteristics of a given setting. Context “specification” substantively refines ethics norms for a particular discipline or setting and is an expected, needed and progressive ethical activity. In order for this activity to be meaningful, the scope for bioethics application and the relevant contextual factors of the setting need to be delineated and appreciated. This paper defines biopharmaceutical bioethics as: the application of bioethics norms (concepts, principles, and rules) to the research, development, supply, commercialization, and clinical use of biopharmaceutical healthcare products. It provides commentary on this definition, and presents five contextual factors that need to be considered when applying bioethics norms to a biopharmaceutical industry setting: (1) dual missions; (2) timely and pragmatic guidance; (3) resource stewardship; (4) multiple stakeholders; and (5) operational complexity.ConclusionUnderstanding the scope of the biopharmaceutical enterprise and contextual factors of a biopharmaceutical industry setting is foundational for the application of bioethics norms. Establishing a common language and approach for biopharmaceutical bioethics will facilitate breadth and depth of discussion and subsequent implementation to benefit patients, the healthcare system and society. (shrink)

Background: Bioethics consultations are conducted in varied settings, including hospitals, universities, and other research institutions, but there is sparse information about bioethics consultations conducted in corporate settings such as pharmaceutical companies. The purpose of this article is to describe a bioethics consultation service at a pharmaceutical company, to report characteristics of consultations completed by the service over a 6-year period, and to share results of a consultation feedback survey. Methods: Data on the descriptive characteristics of bioethics consultations were collected from (...) 2008 to 2013 and analyzed in Excel 2007. Categorical data were analyzed via the pivot table function, and time-based variables were analyzed via formulas. The feedback survey was administered to consultation requesters from 2009 to 2012 and also analyzed in Excel 2007. Results: Over the 6-year period, 189 bioethics consultations were conducted. The number of consultations increased from five per year in 2008 to approximately one per week in 2013. During this time, the format of the consultation service was changed from a committee-only approach to a tiered approach (tailored to the needs of the case). The five most frequent topics were informed consent, early termination of a clinical trial, benefits and risks, human biological samples, and patient rights. The feedback survey results suggest the consultation service is well regarded overall and viewed as approachable, helpful, and responsive. Conclusions: Pharmaceutical bioethics consultation is a unique category of bioethics consultation that primarily focuses on pharmaceutical research and development but also touches on aspects of clinical ethics, business ethics, and organizational ethics. Results indicate there is a demand for a tiered bioethics consultation service within this pharmaceutical company and that advice was valued. This company's experience indicates that a bioethics consultation service raises awareness about bioethics, empowers employees to raise bioethical concerns, and helps them reason through challenging issues. (shrink)

The book is an “introductory” reconstruction of Davidson on interpretation —a claim to be taken with a grain of salt. Writing introductory books has become an idol of the tribe. This is a concise book and reflects much study. It has many virtues along with some flaws. Ramberg assembles themes and puzzles from Davidson into a more or less coherent viewpoint. A special virtue is the innovative treatment of incommensurability and of the relation of Davidson’s work to hermeneutic themes. The (...) weakness comes in a certain unevenness. While generally convincing and well written, the book has low points which may leave the reader confused or unconvinced. Davidson is the hero in this book, and our hero is sometimes over idealized. (shrink)

Both cognitive science and phenomenology accept the primacy of the organism-environment system and recognize that cognition should be understood in terms of an embodied agent situated in its environment. How embodiment is seen to shape our world, however, is fundamentally different in these two disciplines. Embodiment, as understood in cognitive science, reduces to a discussion of the consequences of having a body like ours interacting with our environment and the relationship is one of contingent causality. Embodiment, as understood phenomenologically, represents (...) the condition of intelligibility of certain terms in our experience and, as such, refers to one aspect of that background which presupposes our understanding of the world. The goals and approach to modeling an embodied agent in its environment are also fundamentally different dependent on which relationship is addressed. These differences are highlighted and are used to support our phenomenologically based approach to organism-environment interaction and its relationship to brain function. (shrink)

It is not uncommon to be frustrated by the outcome of an election or a decision in voting, law, economics, engineering, and other fields. Does this 'bad' result reflect poor data or poorly informed voters? Or does the disturbing conclusion reflect the choice of the decision/election procedure? Nobel Laureate Kenneth Arrow's famed theorem has been interpreted to mean 'no decision procedure is without flaws'. Similarly, Nobel Laureate Amartya Sen dashes hope for individual liberties by showing their incompatibility with societal needs. (...) This highly accessible book offers a new, different interpretation and resolution of Arrow's and Sen's theorems. Using simple mathematics, it shows that these negative conclusions arise because, in each case, some of their assumptions negate other crucial assumptions. Once this is understood, not only do the conclusions become expected, but a wide class of other phenomena can also be anticipated. (shrink)

Frank Tipler's The Physics of Immortality provides abundant cause for intellectual offense—including challenges to physics, to theology, and, seemingly, to common sense. Few philosophical conundrums remain unaddressed. Still, the book is stimulating and well presented.

Frank Tipler's The Physics of Immortality provides abundant cause for intellectual offense—including challenges to physics, to theology, and, seemingly, to common sense. Few philosophical conundrums remain unaddressed. Still, the book is stimulating and well presented.

At the beginning of the twentieth century the high mortality rates of both mothers and babies during childbirth became a predominant concern in Britain and its empire, provoking outcries from medical and nursing professionals as well as politicians and the wider public. Infant mortality became the new marker of the vitality of the nation and a widely used indicator of general standards of health. Efforts to improve maternal and infant welfare were part of a broader shift in Britain towards public (...) health as a government responsibility. Measures taken to reduce mortality rates emphasized state-run initiatives in maternal education and antenatal care, the medicalization of childbirth, and scientific infant feeding and childrearing practices. This shift in health care policies resulted in profound changes to the experience of childbirth and to the role of the state in the area of social welfare... (shrink)

Grafts of embryonic neural tissue into the brains of adult patients are currently being used to treat Parkinson's disease and are under serious consideration as therapy for a variety of other degenerative and traumatic disorders. This target article evaluates the use of transplants to promote recovery from brain injury and highlights the kinds of questions and problems that must be addressed before this form of therapy is routinely applied. It has been argued that neural transplantation can promote functional recovery through (...) the replacement of damaged nerve cells, the reestablishment of specific nerve pathways lost as a result of injury, the release of specific neurotransmitters, or the production of factors that promote neuronal growth. The latter two mechanisms, which need not rely on anatomical connections to the host brain, are open to examination for nonsurgical, less intrusive therapeutic use. Certain subjective judgments used to select patients who will receive grafts and in assessment of the outcome of graft therapy make it difficult to evaluate the procedure. In addition, little long-term assessment of transplant efficacy and effect has been done in nonhuman primates. Carefully controlled human studies, with multiple testing paradigms, are also needed to establish the efficacy of transplant therapy. (shrink)

This clear reference to unlimited freedom in values despite limited freedom in causality pictures quite accurately the theme of this article. Lord Russell made the statement in the closing eloquent paragraph of a 1927 volume he wrote to outline the problems of philosophy. He evidently feels that, prescinding from determinism or non-determinism in the causal sphere, freedom can still be meaningfully discussed in the ethical sphere, the realm of human values, though obviously in a special sense of the word ‘freedom’. (...) In other words, regardless of man’s psychological freedom or nonfreedom, Russell asserts that in the moral order man has perfect ‘freedom’ to decide for himself what shall be good or evil, right or wrong. (shrink)

The concept of “the good life” is not one that receives much attention from conventional economic theory.1 About the closest it comes to such attention is in the area of welfare economics and here it is mostly concerned with the distribution of costs and benefits of various economic choices and wherein benefits are measured in terms of utility and costs in terms of disutility or utility foregone. It is usually taken for granted that utility is a function of consumption of (...) goods and services, and disutility is a function of the “toil and trouble” associated with the effort to acquire goods and services. Labor, therefore, is typically taken to be a major source of disutility. Even many economists will admit that .. (shrink)

In this book Dr. Donald Bloesch sharply diverges from much traditional thinking on the relationship between theology and philosophy and suggests an alternative that is solidly anchored in biblical faith. Instead of seeing this relationship in terms of synthesis or correlation or even simple subordination, he calls for the conversion and transformation of philosophical meanings in the light of the biblical revelation. Philosophy can be of considerable aid to theologians, but they must take care not to let philosophical concepts (...) determine the meaning of faith. Reason can be enlisted in the service of revelation, but it cannot establish the truth of revelation. Against the irrationalism of contemporary existentialist theology and the rationalism that has pervaded both scholastic orthodoxy (Catholic and Protestant) and liberal philosophical theology, Bloesch proposes an evangelical theology of revelation that seeks to employ reason in the task of understanding the faith. The author upholds not an autonomous reason but an obedient reason, and he shows that this ideal has support in the history of theology as well as in the Bible. (shrink)

The mystery of the Jews as the chosen people of God is to be understood in light of the wider biblical view that God intends his covenant of grace for all humanity; all peoples are destined to serve the glory of God and to participate in his Kingdom.

The different ways in which contemporary theologians understand the saving work of Christ arise from the different premises with which the theological task is undertaken.

Despite some clinical promise, using fetal transplants for degenerative and traumatic brain injury remains controversial and a number of issues need further attention. This response reexamines a number of questions. Issues addressed include: temporal factors relating to neural grafting, the role of behavioral experience in graft outcome, and the relationship of rebuilding of neural circuitry to functional recovery. Also discussed are organization and type of transplanted tissue, the of transplant viability, and whether transplants are really needed to obtain functional recovery (...) after brain damage. (shrink)

This book explores some of Kit Fine's outstanding contributions to logic, philosophy of language, philosophy of mathematics, and metaphysics, among others. Contributing authors address in-depth issues about truthmaker semantics, counterfactual conditionals, grounding, vagueness, non-classical consequence relations, and arbitrary objects, offering critical reflections and novel research contributions. Each chapter is accompanied by an extensive commentary, in which Kit Fine offers detailed responses to the ideas and themes raised by the contributors. The book includes a brief autobiography and exhaustive list of his (...) publications to this date. This book is of interest to logicians of all stripes and to analytic philosophers more generally. (shrink)

Claims that representatives of both sides of the psi debate (e.g., J. E. Alcock; K. R. Rao and J. Palmer [see PA, Vol 76:10501 and 10507]) have implicitly adopted the empirical epistemology without spelling out or systematically applying the rational epistemology, an essential step for both psychology and parapsychology. ((c) 1997 APA/PsycINFO, all rights reserved).