This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the (...) guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% were suitable for analysis. The results show that in about half of (...) the cases nurses were involved in the decision making by the physician and that nurses were frequently involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Irreplicability is framed as crisis, blamed on sloppy science motivated by perverse stimuli in research. Structural changes to the organization of science, targeting sloppy science (e.g., open data, pre‐registration), are proposed to prevent irreplicability. While there is an unquestionable link between sloppy science and failures to replicate/reproduce scientific studies, they are currently conflated. This position can be understood as a result of the erosion of the role of theory in science. The history, sociology, and philosophy of science reveal alternative explanations (...) for irreplicability to show it is part of proper, informative and valuable science. Irreplicability need not equate research waste. Sloppy science is the problem, also when results do replicate. Hence, the solution should focus on opposing sloppy research. (shrink)

In this book, a dozen distinguished scholars in the field of the history of philosophy and science investigate aspects of the commentary tradition on Aristotle's De generatione et corruptione, one of the least studied among Aristotle's treatises in natural philosophy. Many famous thinkers such as Johannes Philoponus, Albert the Great, Thomas Aquinas, John Buridan, Nicole Oresme, Francesco Piccolomini, Jacopo Zabarella, and Galileo Galilei wrote commentaries on it. The distinctive feature of the present book is that it approaches this commentary tradition (...) as a coherent whole, thereby ignoring the usual historiographical distinctions between the Middle Ages, the Renaissance, and the seventeenth century. Frans de Haas and Henk Kubbinga address the Greek commentary tradition on De generatione et corruptione. Simone van Riet's essay is devoted to the Latin version of Avicenna's third treatise of his Kitab al Shifa, which discusses Aristotle's De generatione et corruptione. James Otte traces the intricate history of the identification of the Latin translator of Aristotle's treatise as Burgundio of Pisa. The essay by John Murdoch explores the fortuna of atomistic arguments in the Latin commentary tradition. Jurgen Sarnowsky, Henk Braakhuis, and Stefano Caroti examine various themes in the commentaries that were produced by the so-called Buridan School, that is, John Buridan, Albert of Saxony, Nicholas Oresme, and Marsilius of Inghen. The article by Silvia Donati focuses on the influential commentary by the Expositor, Giles of Rome. The final essay, written by Anita Guerrini, tackles Robert Boyle's attitude in the Origin of Forms and Qualities toward such Aristotelian key concepts as forms, matter, qualities, and mixture. These essays are prefaced by a preliminary survey by Hans Thijssen of Aristotle's text, its Latin translations and its Greek, Arabic and Latin commentaries. (shrink)

ABSTRACT This essay considers the highly ambivalent attitude of the Austrian-Dutch physicist Paul Ehrenfest toward contemporary developments in both science and society. On the one hand, he was in the vanguard of the quantum and relativity revolutions, supported industrialization and economic planning based on mathematical models, and, in general, cherished technocratic ideals. The essay highlights several influences that shaped his attitude in these respects, from his ties with the Philips Physics Laboratory and his sojourns in the United States to the (...) utopian visions of H. G. Wells. On the other hand, he was extremely worried about the harmful consequences of contemporary changes in science and society, such as specialization, the growing pace of city life, and the increasing dependence on modern technologies, be they material or mathematical. In this regard, he agreed with cultural critics such as Max Nordau, Henri Bergson, Ostwald Spengler, and Ludwig Klages. Rather than attempting to solve this paradox, the essay suggests that this kind of ambiguity characterized a great deal of innovative science in the period. (shrink)

In this article the relevance to the development of John Stuart Mill's political thought of his reading of Fran?ois Guizot's early historical works is examined jointly with some aspects of Tocqueville's imputed influence on the British thinker. Some ideas that are claimed here to have been Mill's intellectual debts to Guizot, have been habitually associated with Tocqueville's influence on Mill. In the first place it is argued that one of Mill’s most cherished ideas, what he called ‘the principle of systematic (...) antagonism’, owes much more to Guizot than to Tocqueville, and that Tocqueville's Democracy in America simply came to corroborate and give concrete focus to this idea. In the second place some of Mill's views concerning modern civilization and its consequences are shown to have been part of his thought before he came to know of Tocqueville's works, and one of the sources of these views is shown to be Guizot's historical work. In the third place Tocqueville's supposed impact on Mill's methodological approach to the study of politics is placed in a broader context, and Guizot's previously ignored relevance in this respect is considered. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

v. 1. Nicomachean ethics. Politics. The Athenian Constitution. Rhetoric. On Poetics.--v. 2. Logic.--v. 3. Physics. Metaphysics. On the soul. Short physical treaties.--v. 4. On the heavens. On generation and corruption. Meteorology. Biological treatises.

Avec son livre r cent, Locke and French materialism (Oxford 1991), John Yolton - connu de longue date pour avoir le premier focalis le contexte th ologique et moral du nouveau 'way of ideas' chez Locke - a donn le signal de d part d'une exploration de la place de Locke dans la lutte philosophique en France au dix-septi me si cle. Prenant acte que le th me, pourtant majeur, des id es inn es dans la r ception fran aise (...) de Locke n'a pas encore re u l'attention qu'il m rite, le pr sent livre poursuit une analyse approfondie de la fortune de la pol mique contre les id es inn es chez les philosophes fran ais, de Jean Le Clerc (1688) Saint-Lambert (1801). Apr s une pr sentation du sc nario mis en place au dix-septi me si cle (Descartes, Malebranche, Locke), on suit dans un ordre chronologique l' volution de la critique des id es inn es chez les philosophes fran ais jusqu' la defense d'une tabula rasaabsolue la fin du si cle (Helv tius, d'Holbach), passant par plusieurs tapes qui marquent chacune la fois un aboutissement et un nouveau point de d part dans la radicalisation progressive du leitmotiv lanc par Locke: consid r es comme le pilier m me de la m taphysique chr tienne, les id es inn es sont d nonc es de fa on de plus en plus radicale, d'abord dans le Refuge, ensuite en France sur une route jalonn e d'affaires' (Voltaire 1734, Prades 1751, Helv tius 1758, d'Holbach 1770). Or, si la pol mique contre les id es inn es semble voluer selon une logique interne n cessaire, ce livre d voile en m me temps l'existence d'une critique des id es inn es plus proche de la cause apolog tique par son souci de pr server l'immat rialit de l' me, l'existence de Dieu et celle d'une loi naturelle (morale) objective et absolue. Enfin, on voit par les r sultats de cette enqu te comment, aujourd'hui, le d bat entre l'inn et l'acquis, toujours d'actualit, trouve ses origines dans l'histoire retrac e ici - comme d'ailleurs plus g n ralement la s cularisation et ses diff rents avatars, mat rialisme, nihilisme, ath isme. Remerciements. (shrink)

An appropriate framework is put forward for the construction of $$\lambda $$ -models with $$\infty $$ -groupoid structure, which we call homotopic $$\lambda $$ -models, through the use of an $$\infty $$ -category with cartesian closure and enough points. With this, we establish the start of a project of generalization of Domain Theory and $$\lambda $$ -calculus, in the sense that the concept of proof (path) of equality of $$\lambda $$ -terms is raised to higher proof (homotopy).

Borsboom and colleagues have recently proposed a “network theory” of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an “extended” network theory provide? The aim of this article is to critically examine what explanatory strategies the network theory that includes (...) both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward’s interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations. (shrink)

On page 1 of his classic text, Millsap states, “Measurement invariance is built on the notion that a measuring device should function the same way across varied conditions, so long as those varied conditions are irrelevant [emphasis added] to the attribute being measured.” By construction, measurement invariance techniques require not only detecting varied conditions but also ruling out that these conditions inform our understanding of measured domains. In fact, measurement invariance techniques possess great utility when theory and research inform their (...) application to specific, varied conditions that, if not detected, introduce measurement biases, and, thus, depress measurement validity. Yet, we see emerging bodies of work where scholars have “put the cart before the horse” when it comes to measurement invariance, and they apply these techniques to varied conditions that, in fact, may reflect domain-relevant information. These bodies of work highlight a larger problem in measurement that likely cuts across many areas of scholarship. In one such area, youth mental health, researchers commonly encounter a set of conditions that nullify the use of measurement invariance, namely discrepancies between survey reports completed by multiple informants, such as parents, teachers, and youth themselves. In this paper, we provide an overview of conceptual, methodological, and measurement factors that should prevent researchers from applying measurement invariance techniques to detect informant discrepancies. Along the way, we cite evidence from the last 15 years indicating that informant discrepancies reflect domain-relevant information. We also apply this evidence to recent uses of measurement invariance techniques in youth mental health. Based on prior evidence, we highlight the implications of applying these techniques to multi-informant data, when the informant discrepancies observed within these data might reflect domain-relevant information. We close by calling for a moratorium on applying measurement invariance techniques to detect informant discrepancies in youth mental health assessments. In doing so, we describe how the state of the science would need to fundamentally “flip” to justify applying these techniques to detect informant discrepancies in this area of work. (shrink)