For many years the prevailing paradigm for medical decision making for children has been the best interest standard. Recently, some authors have proposed that Mill’s “harm principle” should be used to mediate or to replace the best interest standard. This article critically examines the harm principle movement and identifies serious defects within the project of using Mill’s harm principle for medical decision making for children. While the harm principle proponents successfully highlight some difficulties in present-day use of the best interest (...) standard, the use of the harm principle suffers substantial normative and conceptual problems. A medical decision-making framework for children is suggested, grounded in the four principles. It draws on the best interest standard, incorporates concepts of harm, and provides two questions that can act as guide and limit in medical decision making for children. (shrink)

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, (...) the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician’s opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician’s advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient’s confidence in physician referral and advice. (shrink)

Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient’s wellbeing, to promote the patient’s interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient’s goals and wishes, or is it a (...) matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: objective functioning/health and the patient’s view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. (shrink)

This work clarifies the role of the best interest standard as ethical principle in the medical care of children. It relates the BIS to the ethical framework of medical practice. The BIS is shown to be a general principle in medical ethics, providing grounding to prima facie obligations. The foundational BIS of Kopelman and Buchanan and Brock are reviewed and shown to be in agreement with the BIS here defended. Critics describe the BIS as being too demanding, narrow, opaque, not (...) taking the family into account and not suitable as limiting principle. This work responds to these criticisms, showing that they do not stand up to scrutiny. They either do not apply to the BIS, only apply to misuses of the BIS or criticise a BIS that is not seriously defended in the literature. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when (...) addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

Ever since they began to take an interest in lens grinding, the brothers Christiaan and Constantijn Huygens searched for high-quality glass to turn in to lenses. Historical research in combination with optical measurements on preserved lenses has allowed the verificationof the lenses ground by the brothers, and also provided information on who helped them with the necessary knowledge and material.

A letter written by Christiaan Huygens to David Gregory is published here for the first time. After an introduction about the contacts between the two correspondents, an annotated English translation of the letter is given. The letter forms part of the wider correspondence about the ‘new calculus’, in which L'Hospital and Leibniz also participated, and gives some new evidence about Huygens's ambivalent attitude towards the new developments. Therefore, two mathematical passages in the letter are discussed separately. An appendix contains (...) the original Latin text. (shrink)

Entre les premiers développements de la mécanique galiléenne et la publication des Principia de Newton, s’est jouée une transformation radicale de la philosophie naturelle des modernes. Mathématiques, sciences de la nature et techniques de précision ont façonné d’une part une nouvelle manière, active et opératoire, d’interroger la nature, et d’autre part une image du monde fondée sur l’idée d’une rationalité intégrale des phénomènes.Interlocuteur infatigable de Mersenne, Galilée, Descartes, Leibniz ou Newton, Christiaan Huygens a assuré un lien nécessaire pour son (...) époque entre l’assimilation critique des Principes de la philosophie de Descartes, dont il retient l’exigence d’intelligibilité dans la conduite de la science, et la réception – critique elle aussi – des Principes mathématiques newtoniens. La méthode de Huygens se structure dans les apports cartésien et galiléen : choc des corps, oscillations du pendule, étude de la force et du mouvement en tant qu’expression de rapports géométriques, caractérisation de la nature de la lumière sont autant de champs dans lesquels il est impossible de ne pas voir l’imprégnation d’un questionnement philosophique permanent. C’est donc en philosophe tout autant qu’en physicien qu’il s’oppose aux définitions newtoniennes de la lumière et de la pesanteur. (shrink)

In the histories of science, technology and aviation Christiaan Huygens has been unjustly neglected. Documents in the corpus of his works show a life-long interest in the problem of human flight together with some considerable anticipations of, and contributions to, its solution. He was among the first, if not the first, in perceiving the potential of the heavier-than-air approach. He clearly recognized the need for a powerful, mechanical motive source. He stated the first laws of aerodynamics and conceived the (...) modern propeller for propulsion. He was the first to conceive of the aeroplane. His approach to the problem of flying was both global and scientific. (shrink)

The objective of this doctoral dissertation is to interpret the explanation of akrasia that the Dutch philosopher Benedictus Spinoza (1632-1677) gives in his work The Ethics. One is said to act acratically when one intentionally performs an action that one judges to be worse than another action which one believes one might perform instead. In order to interpret Spinoza’s explanation of akrasia, a large part of this dissertation investigates Spinoza’s theory of emotion. The first chapter is introductory and outlines Spinoza’s (...) categorisation of mental states and his conception of the relation between the mind and the body. The second chapter deals with Spinoza’s epistemology and the relation between cognitive mental states and states of the brain. The third chapter argues that Spinoza holds that emotions are non-cognitive mental states that are caused by cognitive mental states. The fourth chapter interprets Spinoza’s discussion of the emotions of Joy and Sadness insofar as they are mental states. The fifth chapter suggests that when Spinoza says that the power of our body is increased or decreased when we are joyful or sad, he means that when we are joyful or sad then, at the same time, our heart and perhaps the organs of our digestive system are affected in such a way that our bodily health is increased or decreased. The sixth chapter points to three problems that concern Spinoza’s definitions of the psychophysical states of pleasure, pain, cheerfulness and melancholy, and offers slightly altered definitions of these states. The seventh chapter interprets the various aspects of Spinoza’s conception of the emotion of Desire, both insofar as it is a state of the mind and insofar it is a state of the body, as well as the relation between the emotion of Desire and man’s striving for self-preservation. The eighth chapter discusses what Spinoza writes on the strength of emotions and the way in which we make value judgments in order to finally interpret why it is, according to Spinoza, that ‘we so often see the better for ourselves but follow the worse’. (shrink)

The article engages Bakhtin’s corpus with Nietzschean ideas in order to draw out critical resources for the social theory of ‘community’. It begins by considering both thinkers’ debt to neo-Kantianism, and proceeds to relate the ‘will to power’ to Bakhtin’s early intersubjective phenomenology of intentional acts. This interpretation is then extended to Bakhtin’s conception of art, where aesthetics stands in tensile relation to ethics in the exercise of authorial will. Bakhtin’s later work might be seen as elaborating more complex terms (...) for describing will and event, now as composite embodiments of multiple intentions within art, discourse and language, thus suggesting a novel approach to ‘communality’ in modern social life. (shrink)

In response to critiques of rights as moralistic and depoliticising, a literature on the political nature and contestability of rights has emerged. In this view, rights are not merely formal, liberal and moralistic imperatives, but can also be invoked by the excluded in a struggle against domination. This article examines the limits to this practice of rights-claiming and its implication in forms of domination. It does this by returning to Marx’s blueprint for the critique of subjective rights. This engagement with (...) Marx will, however, take a particular form. I will read Marx first through the eyes of Claude Lefort and thereafter against Lefort. The latter’s critique of Marx still constitutes the strongest case against the dismissal of subjective rights. Introducing a reading of Lefort into the argument allows us to discover what is dead and what is well alive in the Marxist theory of rights. What is dead, I will argue, is Marx’s early conception of subjective rights as ideology and illusion. However, the more mature Marx developed a theory and critique of the legal form that is able to explain why the politics of rights—despite its undeniable advances—has not been able to overcome certain forms of domination. (shrink)

The study is designed to provide an informal summary of what is known about consumer switching of health insurance plans and to contribute to knowledge about what motivates consumers who choose to switch health plans. Do consumers switch plans largely on the basis of critical reflection and assessment of information about the quality, and price? The literature suggests that switching is complicated, not always possible, and often overwhelming to consumers. Price does not always determine choice. Quality is very hard for (...) consumers to understand. Results from a random sample survey ( n = 2791) of the Alkmaar region of the Netherlands are reported here. They suggest that rather than embracing the opportunity to be active critical consumers, individuals are more likely to avoid this role by handing this activity off to a group purchasing organization. There is little evidence that consumers switch plans on the basis of critical reflection and assessment of information about quality and price. The new data reported here confirm the importance of a group purchasing organizations. In a free-market-health insurance system confidence in purchasing groups may be more important for health insurance choice than health informatics. This is not what policy makers expected and might result a less efficient health insurance market system. (shrink)

In 1665, in a response to a question posed by Robert Boyle, Spinoza gave a definition of the coherence between bodies in the universe that seems to be inconsistent both with what he had written in a previous letter to Boyle (1661) and with what he would later write in his main work, the Ethics (1677). Specifically, Spinoza’s 1665 letter to Boyle asserts that bodies can adapt themselves to another body in a non-mechanistic way and absent the agency of an (...) external cause. This letter – Letter 32 – seems, therefore, to be in clear contradiction with the metaphysical determinism that is an important and characteristic element of his philosophy. This article suggests that the viewpoint expressed by Spinoza in Letter 32 may have been inspired by a spectacular discovery made by Christiaan Huygens a few months prior, namely, the self-synchronization of pendulum clocks. As I argue in this article, this new, hypothesized link to Huygens’ pendulum experiments may account for Spinoza’s otherwise paradoxical answer to Boyle in Letter 32. (shrink)

In 1672, inspired by the wave theory of Ignace Gaston Pardies, Christiaan Huygens made his first attempt to explain the sine law of refraction, but in 1673 he abandoned his plans owing to difficulties concerning double refraction. Huygens was able to explain double refraction on 6 August 1677 after his discoveries of the axis of symmetry of the crystal and of ‘Huygens's principle’. On 6 August 1679, he wrote: ‘I have found the confirmation of my theory of light and (...) of refraction’, and then described an ‘experimentum crucis’ to decide between his theory and a rival hypothesis. A study of caustics may have led Huygens to the discovery of ‘Huygens's principle’. (shrink)

Males are often found to outperform females in tests of mathematics achievement and it has been proposed that this may in part be explained by differences in cognitive style. This study investigated the relation between Wholistic-Analytic and Verbal-Imagery cognitive style, gender and mathematics achievement in a sample of 190 Australian primary school students aged between 8?11?years (M?=?9.77, SD?=?1.05). It was hypothesised that males would outperform females in mathematics achievement tests, and that gender would interact with cognitive style on mathematics performance. (...) A significant gender/cognitive style interaction was found. Boys with an Analytic/Imagery style achieved significantly higher results than the girls with an Analytic/Imagery style, supporting the contention that certain cognitive styles affect boys and girls mathematics performance differently. Implications of results and strategies for improving mathematics achievement among girls are discussed. (shrink)

Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of (...) defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

In the first half of this article, the author argues that the notion of criticizability plays a central role in the communicative rationality that Jiirgen Habermas proposes. He also identifies the incurable errors that Habermas recognizes in the philosophy of consciousness, and explains how Habermas thinks the concept of communicative rationality overcomes these errors. At the end of this discussion, he shows how the theory of communicative action suffers from vague and unsatisfying treatments of the key philosophical issues of cognition (...) and objectivity, and suggests that these deficiencies in the theory result from Habermas's desire to avoid all things subject-centered and metaphysical. In the latter half of the article, the author discusses the cognitional theory of Bernard Lonergan and shows how it (1) avoids the legitimate criticisms Habermas raises against the philosophy of consciousness and (2) supplements and complements the theory of communicative action. /// Na primeira parte do presente artigo, o autor defende que a noção de critica-bilidade desempenha um papel central na racionalidade comunicativa proposta por Jürgen Habermas. Aí são também identificados os erros insanáveis que Habermas reconhece na filosofia da consciência, e se explica de que modo Habermas pensa que o conceito de racionalidade comunicativa supera esses erros. No final da discussão, porém, o autor do artigo mostra até que ponto a teoria da acção comunicativa padece de tratamentos vagos e insatisfatórios de questões filosóficas chave relativas à cognição e à objectividade, sugerindo que estas deficiências na teoria resultam do desejo de Habermas de evitar tudo o que seja centrado no sujeito e de natureza metafísica. Na segunda grande porção do artigo, o autor discute a teoria cognitiva de Bernard Lonergan procurando demonstrar de que modo ela (1) evita as críticas legítimas de Habermas relativamente à filosofia da consciência e (2) suplementa e complementa a teoria da acção comunicativa. (shrink)