As the issue of assisted dying continues toward more expanded legal standing, we shift our primary focus from questions of patients' rights to the largely overlooked challenges that face physicians who elect to assist patients in ending their lives. Dr. Howard Grossman, a Manhattan internist and plaintiff in the unsuccessful New York lawsuit to the Supreme Court, came forward to say, “Anybody who has done it knows that it is a tremendous decision that you carry with you forever.”1 We focus (...) our attention on the psychological experience and philosophical conflicts faced by physicians engaged in physician-assisted dying. Based on those potential conflicts, we argue for a new model of the physician and patient relationship in assisted dying: a medical friendship. a. (shrink)

The debate on the ethical permissibility of euthanasia in medicine has a corollary in the ethical application of drugs. The overall moral limits of medical treatment apply evenly to the moral acceptability of the pharmacological aspect of the act of euthanasia. The pharmacological aspect of the act is of ethical importance not only for the person requesting an active ending of his or her life, but also for the grieving family. Keywords: effectivity, ideal euthanaticum, patient's/family's interest, pharmacology of euthanasia, routes (...) of application CiteULike Connotea Del.icio.us What's this? (shrink)

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and (...) of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and (...) of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

The open practice of euthanasia in The Netherlands stood alone in the world until the government of the Northern Territories in Australia accepted the possibility of physician-assisted suicide. Even though the active ending of lives in The Netherlands is still a crime by law, the current practice allows it and acquits physicians if certain conditions have been met. Of the many facets of euthanasia, the teaching of this practice represents a further logical step. In this contribution, we intend to describe (...) the comprehensive teaching program of euthanasia of the Free University of Amsterdam's Postgraduate Family Medicine Program. Here students receive university-based training for 1 day a week in a cohort of 12 and on the job training for 4 days with individual family physicians for 2 consecutive years. We especially intend to portray the integration of euthanasia into the wider teaching of the process of counseling and aid of the dying. (shrink)

Hospital ethics committees in The Netherlands have had the unique responsibility of developing euthanasia policies for their institutions. Although each policy necessarily reflects a particular facility, family resemblances necessarily remain. In the interest of ethics committees outside The Netherlands that may soon face the same challenge, two such policies are presented here accompanied by commentary high-lighting their similarities and differences.

Important bioethcs changes are underway in the Netherlands that carry, for better or worse, far-reaching social consequences. The two major areas of change involve economics and containing soaring health costs and end-of-life care as reflected in several high-profile cases: in a decision handed down by the Dutch Supreme Court on reviewing the procedures for the termination of life, in the discussion surrounding The Groningen Protocol and the active ending of lives in neonatology, and in a report of a Royal Dutch (...) Medical Society's Committee on the role of physicians in ending life in cases of requests to die outside the area of terminal diseases. (shrink)

In pursuit of my ultimate objective of being in control of my self-deliverance at the time when my physical condition no longer warrants continuance, I have joined the Hemlock Society of Los Angeles. The Society urges its members to explore with their personal physicians this subject well in advance of the actual moment of necessity, and in particular the problem of acquiring a lethal dose of a drug that will provide a release consistent in quality with the degree of peace (...) and serenity sought in life. It is my hope that we can find a process commensurate with your moral and professional concerns which will allow us to collaborate. (shrink)

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

In spite of the seminal work A Philosophical Basis of Medical Practice, the debate on the task and goals of philosophy of medicine still continues. From an European perspective it is argued that the main topics dealt with by Pellegrino and Thomasma are still particularly relevant to medical practice as a healing practice, while expressing the need for a philosophy of medicine. Medical practice is a discursive practice which is highly influenced by other discursive practices like science, law and economics. (...) Philosophical analysis of those influences is needed to discern their effect on the goals of medicine and on the ways in which the self-image of man may be changed. The nature of medical practice and discourse itself makes it necessary to include different philosophical disciplines, like philosophy of science, of law, ethics, and epistemology. Possible scenario's of euthanasia and the human genome project in the USA and Europe are used to exemplify how philosopy of medicine can contribute to a realistic understanding of the problems which are related to the goals of medicine and health care. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this (...) book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (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)

Background Informed consent procedures for large population-based cohort studies should be comprehensive and easy-to-use. This is particularly challenging when participants from different socio-economic groups and multicultural ethnic backgrounds are involved. Recently, more and more studies have tried to use multimedia in informed consent procedures. We describe the development and testing of a digital informed consent app and elaborate on whether this may contribute to a comprehensive and practical procedure to obtain informed consent for public health research. Methods In a sample (...) of parents with young children, we used a mixed method approach to study the user experience of an informed consent app and evaluate whether it can be used to adequately inform people and register their consent. Through semi-structured interviews we investigated participants’ experiences with and opinions about the app, with a special focus on comprehensibility of the content and the usability of the app. Information retention questions were asked to evaluate to what extent participants could recall key aspects of the provided study information. Results The 30 participants in this study used the app between 4 and 15 min to give their consent. Overall, they found the app well-designed, informative and easy to use. To learn more about the study for which informed consent is asked, most of the participants chose to watch the animated film, which was generally found to convey information in a clear manner. The identification process was met with mixed reactions, with some feeling it as a secure way to give consent, while for others it contradicted their view of using data anonymously. Information retention questions showed that while all participants remembered various aspects of the study, fewer than half answered all four questions satisfactorily. Conclusion Our study shows that a well-designed informed consent app can be an effective tool to inform eligible participants and to record consents. Still, some issues remain, including trust barriers towards the identification procedure and lack of information retention in some participants. When implementing consent procedures that incorporate digital formats, it may be beneficial to also invest in a complementary face-to-face recruitment approach. (shrink)

The high prevalence of cardiovascular diseases demands a reliable and sensitive risk assessment technique. In order to develop a fast and label-free immunosensor for C-reactive protein, a risk factor for this condition, anti-CRP antibodies were physically adsorbed to the hydrogen -terminated surface of nanocrystalline diamond. An Enzyme-Linked ImmunoSorbent Assay reference technique showed that this was a suitable substrate for antibody-antigen recognition reactions. Electrochemical Impedance Spectroscopy was used to electronically detect CRP recognition. The specificity of the immunosensor was demonstrated by incubation (...) with CRP and plasminogen as reference molecule. A different impedance behavior was observed in real-time after CRP addition as compared to plasminogen addition: the impedance increased only during CRP incubation. Fitting the data showed that this corresponded with a decrease in capacitance of the molecular layer due to its increased thickness by specific CRP recognition. Sensitivity experiments in real-time showed a clear discrimination between 1 μM, 100 nM, and 10 nM of CRP after 10 min at 100 Hz. Since, 10 nM of CRP was still clearly distinguishable from buffer solution, our CRP-directed immunosensor prototype reaches a sensitivity that is within the physiologically relevant concentration range of this biomarker in healthy controls and CVD patients. Moreover, this prototype displayed real-time discriminating power between spiked and unspiked serum, and thus also shows its applicability in this biological matrix. © 2011 Elsevier B.V. All rights reserved. (shrink)

We argue that Lewis would have rejected recent appeals to the notions of ‘metaphysical dependency’, ‘grounding’ and ‘ontological priority’, because he would have held that they’re not needed and they’re not intelligible. We argue our case by drawing upon Lewis’s views on supervenience, the metaphysics of singletons and the dubiousness of Kripke’s essentialism.

Al-Ghazzālī a toujours utilisé les travaux de ses prédécesseurs. Le Mi‘yār al-‘ilm fī fann, sorte de manuel de logique aristotélicienne adaptée au droit et à la théologie islamiques, contient ainsi une grande variété d’écrits avicenniens, du K. jusqu’à certaines parties du Šifā’. Mais quelques écrits farabiens, en particulier al-Qiyās et al-Maqūlāt, y sont mêlés. C’est la première et, à notre connaissance, la seule fois qu’al-Ghazzālī combine ainsi des éléments empruntés à ces deux grands maîtres.

In this paper I build a case for considering the pioneering behaviourist philosopher Grace de Laguna as one of the grandmothers of analytic philosophy. I argue against the ‘Great Men’ narrative of analytic philosophy as composed of Moore, Russell, Wittgenstein and their followers, and in favour of a more inclusive ‘movement’ narrative of analytic philosophy as a broad and varied movement with an anti-idealist and naturalistic orientation aimed at fitting around novel development in the sciences, including Einsteinian physics and psychology. (...) I compare de Laguna’s prescient early views to Whitehead’s; both share an anti-idealist but also anti-atomist solution to the problem of perception, and both oppose the bifurcation of nature, with de Laguna expressing these views before Whitehead did. I conclude that while both opposed the narrower project of logical atomism, both count as ancestors of the wider analytic movement. (shrink)

The development and management of the Covid-19 outbreak in the Netherlands is described. The “intelligent lockdown” was aimed at minimizing new infections and limiting the number of deaths, while keeping the economy running as much as possible. Changes in consumer behavior, exit strategy, and lessons learned are considered.

How do people interleave attention when multitasking? One dominant account is that the completion of a subtask serves as a cue to switch tasks. But what happens if switching solely at subtask boundaries led to poor performance? We report a study in which participants manually dialed a UK-style telephone number while driving a simulated vehicle. If the driver were to exclusively return his or her attention to driving after completing a subtask (i.e., using the single break in the xxxxx-xxxxxx representational (...) structure of the number), then we would expect to see a relatively poor driving performance. In contrast, our results show that drivers choose to return attention to steering control before the natural subtask boundary. A computational modeling analysis shows that drivers had to adopt this strategy to meet the required performance objective of maintaining an acceptable lateral position in the road while dialing. Taken together these results support the idea that people can strategically control the allocation of attention in multitask settings to meet specific performance criteria. (shrink)

An odd dissensus between confident metaphysicians and neopragmatist antimetaphysicians pervades early twenty-first century analytic philosophy. Each faction is convinced their side has won the day, but both are mistaken about the philosophical legacy of the twentieth century. More historical awareness is needed to overcome the current dissensus. Lewis and his possible-world system are lionised by metaphysicians; Quine’s pragmatist scruples about heavy-duty metaphysics inspire antimetaphysicians. But Lewis developed his system under the influence of his teacher Quine, inheriting from him his empiricism, (...) his physicalism, his metaontology, and, I will show in this paper, also his Humeanism. Using published as well as never-before-seen unpublished sources, I will make apparent that both heavy-duty metaphysicians and neopragmatist antimetaphysicians are wrong about the roles Quine and Lewis played in the development of twentieth-century philosophy. The two are much more alike than is commonly supposed, and Quine much more instrumental to the pedigree of current metaphysics. (shrink)

This article reviews ECJ case law on the conceptualization and legal circumscription of the doctrine of consistent interpretation, reflecting its fundamental importance as a mode of giving effect to Community law before national authorities. Legal uncertainty, an inherent characteristic of the technique, should be reduced, it is argued, by improving the reasoning of the ECJ's judgments. In particular, a highly critical discussion of the Arcaro judgment concludes that its precedent value is very limited. A parallelism in approach to both consistent (...) interpretation and direct effect is suggested. Partly, this has already been achieved insofar as the issue of expiry of the transposition period of directives is concerned. In addition, the article suggests a reform of the case law on consistent interpretation in actions by the State versus individuals and offers explanations for the seemingly inconsistent nature of the cases producing a horizontal impact of directives despite the lack of horizontal direct effect properly so‐called (incidental effects). In considering whether the doctrine gives rise to unacceptable legal uncertainty, a comparison with the interpretive obligation under the UK Human Rights Act 1998 is made, which produces similar results. (shrink)

The use of coercive measures in the care for the addicted has changed over the past 20 years. Laws that have adopted the “dangerousness” criterion in order to secure patients’ rights to non-intervention are increasingly subjected to critique as many authors plead for wider dangerousness criteria. One of the most salient moral issues at stake is whether addicts who are at risk of causing danger to themselves should be involuntarily admitted and/or treated. In this article, it is argued that the (...) dilemma between coercion on the one hand and abandonment on the other cannot be analysed without differentiated perspectives on the key notions that are used in these debates. The ambiguity these notions carry within care practice indicates that the conflict between the prevention of danger and respect for autonomy is not as sharp as the legal systems seem to imply. Some coercive measures need not be interpreted as an infringement of autonomy—rather, they should be interpreted as a way to provide good care. (shrink)

1. Cornelius Valerius en Sebastianus Foxius Morzillus als bronnen van Coornhert.

The Einstein-Podolsky-Rosen (EPR) paradox and the correlated states it introduced comprise one of the central interpretive problems of quantum mechanics. Because of the apparent nonlocal character of this paradox, it should be given a relativistic treatment. The purpose of this paper is to provide such a treatment.

W.V. Quine, a champion of philosophical naturalism and pioneer of mathematical logic, was one of the most important philosophers of the 20th century. This volume provides a full picture of the development of Quine's views on structure and how it permeates and shapes his attitude to a range of philosophical questions.

Understanding a sentence and integrating it into the discourse depends upon the identification of its focus, which, in spoken German, is marked by accentuation. In the case of written language, which lacks explicit cues to accent, readers have to draw on other kinds of information to determine the focus. We study the joint or interactive effects of two kinds of information that have no direct representation in print but have each been shown to be influential in the reader’s text comprehension: (...) i. the (low-level) rhythmic-prosodic structure that is based on the distribution of lexically stressed syllables, and ii. the (high-level) discourse context that is grounded in the memory of previous linguistic content. Systematically manipulating these factors, we examine the way readers resolve a syntactic ambiguity involving the scopally ambiguous focus operator auch (engl. `too') in both oral (Experiment 1) and silent reading (Experiment 2). The results of both experiments attest that discourse context and local linguistic rhythm conspire to guide the syntactic and, concomitantly, the focus-structural analysis of ambiguous sentences. We argue that reading comprehension requires the (implicit) assignment of accents according to the focus structure and that, by establishing a prominence profile, the implicit prosodic rhythm directly affects accent assignment. (shrink)

Enactive approaches to emotion are rare and to anxiety and anxiety disorder even more. This article aims to show how an enactive paradigm might be helpful in solving some problems in the clinical and scientific understanding of anxiety and anxiety disorder. I begin by pointing at a number of relevant clinical features of anxiety and anxiety disorder and by sketching how and why anxiety theories have difficulties with doing justice to these features. I specifically focus on two themes: a) how (...) to conceptualize anxiety as the expression of a dynamical interaction with the environment instead of as just a reaction to the environment (or to... (shrink)

Retinoids play a critical role in patterning, segmentation, and neurogenesis of the posterior hindbrain and it has been proposed that they act as a posteriorising signal during hindbrain development. Until now, direct evidence that endogenous retinoid signalling acts through a gradient to specify cell fates along the anteroposterior axis has been missing. Two recent studies tested the requirement for retinoid signalling in the developing hindbrain through systematic application of a pan-retinoic acid receptor antagonist.(1,2) They demonstrate a stage-dependent requirement for increasing (...) retinoid signalling activity along the hindbrain that proceeds from anterior to posterior. Together these findings challenge the concept of a stable gradient of retinoic acid across the hindbrain and warrant a re-interpretation of the phenotypes obtained by genetic and nutritional disruption of retinoid signalling in the amniote embryo. BioEssays 23:981–986, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

In his book A secular age, Charles Taylor rejects the view that modernity must lead to a steady decline of religion and argues that although the conditions of belief changed, causing a destabilization and recomposition of religious forms, our modern world still can and should be open to the transcendent. I attempt to give a general overview of A secular age by describing shifts in worldview with respect to nature, self, society and God. Finally, I discuss how Taylor’s message relates (...) to that of Reformational thinking. Taylor’s description of motivations to regard the world as closed to the transcendent corresponds well with the Reformational analysis of the humanistic ground motives of freedom and nature. Taylor, however, seems to consider our current worldview as a neutral basis and religion as an optional add-on. (shrink)