Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the pediatric (...) oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (shrink)

From 1827 to 1831 the German historian Leopold von Ranke travelled through Germany, Austria, and Italy, hunting for documents and archives. During this journey Ranke developed a new model for historical research that transformed the archive into the most important site for the production of historical knowledge. Within the archive, Ranke claimed, the trained historian could forget his personal predispositions and political loyalties, and write objective history. This essay critically examines Ranke's model for historical research through a study of the (...) obstacles, frustrations, and joys that he encountered on his journey. It shows how Ranke's archival experiences inspired him to re-evaluate his own identity as a historian and as a human being, and investigates some of the affiliations between his model for historical research and the political realities of Prince Metternich's European order. Finally, the essay compares Ranke's historical discipline to other nineteenth-century disciplines, such as anthropology and archaeology. (shrink)

The relatively new practice of continuous sedation at the end of life (CS) is increasingly being debated in the clinical and ethical literature. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assisted suicide (PAS) unnecessary, as CS could alleviate even the most severe suffering. This view has been widely adopted. In this article, we perform an in-depth analysis of four versions of this ?argument of preferable alternative.? Our goal (...) is to determine the extent to which CS can be considered to be an alternative to PAS and to identify the grounds, if any, on which CS may be ethically preferable to PAS. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying...

"The idea for this book arose in connection with the Workshop on Semantic functions of complementizers in European languages, which we organized in October 28-29, 2011, at the University of Copenhagen, Denmark. Around two thirds of the book chapters are elaborations on contributions to this workshop, the remaining one third arose independently of the workshop.".

BackgroundThe aim of this study is to compare depression and loneliness among adult siblings of people on the autism spectrum, adult siblings of normotypic individuals, and adults raised alone. In recent years, an increasing interest in the perspective of siblings of children diagnosed with autism has been observed, with studies among this population particularly concerned with the developmental trajectories of children and adolescents at “high risk” for ASD, rarely focusing on their mental well-being.MethodsThe respondents filled out: the survey on sociodemographic (...) data designed by the authors, Beck Depression Inventory II, and De Jong Gierveld Loneliness Scale.ResultsA rise in BDI and an increase in the DJGLS score were predicted by having a sibling diagnosed with ASD. Those effects were independent of subjects’ sex, educational status, place of residence, or a number of siblings.ConclusionThe results underline a fundamental need for the development of mental hygiene programs for families where children with autism spectrum are accompanied by healthy siblings. (shrink)

Recently there has been some discussion concerning a particular type of enhancement, namely ‘moral enhancement’. However, there is no consensus on what precisely constitutes moral enhancement, and as a result the concept is used and defined in a wide variety of ways. In this article, we develop a clarificatory taxonomy of these definitions and we identify the criteria that are used to delineate the concept. We think that the current definitions can be distinguished from each other by the criteria used (...) for determining whether an intervention is indeed moral enhancement. For example, some definitions are broad and include moral enhancement by any means, while other definitions focus only on moral enhancement by means of specific types of intervention. Moreover, for some definitions it suffices for an intervention to be aimed or intended to morally enhance a person, while other definitions only refer to ‘moral enhancement’ in relation to interventions that are actually effective. For all these differences in definitions we discuss some of their implications. This shows that definitions are significantly less descriptive and more normative than they are regularly portrayed to be. We therefore hope that the taxonomy developed in this paper and the comments on the implications for the normative debate of the variety of definitions will provide conceptual clarity in a complex and highly interesting debate. (shrink)

_The Grundtvigian Case for Museums_ This article investigates the notion that museums are caught between two opposites when it comes to defining the institutions Raison d'être: either you entertain, or you enlighten. Using Barbara Rosenwein’s thoughts on emotional communities, this museological dichotomy between emotion and intellect is challenged by a certain ‘Grundtvigian position’ that was inspired by the philosophy of pastor poet N.F.S. Grundtvig. At the turning point of the 19 th century this position resulted in numerus museums that made (...) the radical statement: the dichotomy is false. A museum should speak to emotions _ and _ the intellect. As opposed to the rationalistic, archeological approach that the National Museum represented, the grundtvigians saw themselves as mediators of a living history that needed to be told under the pressure of modern techniques and customs. (shrink)

When a new intervention or drug is developed, this has to pass through various phases of clinical testing before it achieves market approval, which can take many years. This raises an issue for drugs which could benefit terminally ill patients. These patients might set their hopes on the experimental drug but are unable to wait since they are likely to pass away before the drug is available. As a means of nevertheless getting access to experimental drug, many seriously ill and (...) terminally ill patients are therefore very willing to participate in randomised controlled trials. However, only very few terminally ill patients are able to actually participate, and those that do participate are at risk of participating solely as a way of getting experimental drugs. Currently, there are, however, ways of getting access to drugs that have not gained market approval. One such mean is via expanded access or compassionate use programs where terminally ill patients receive experimental new drugs that are not yet market approved. In this paper, I examine some of the common justifications for such programs. The most frequently voiced justifications for compassionate use or expanded access programs could be put in one of three categories. First, there are justifications of justice, where compassionate use programs could be seen as a just or fair way to distribute experimental new drugs to patients who are denied access to RCT’s through no fault of their own. Second, such programs could be justified by reference to the ethical principle of beneficence where it could be claimed that terminally ill patients stand to benefit greatly at very little risk. Third, there are considerations of autonomy where, it is claimed, patients should be able to exercise their autonomy and have access to such drugs if that is there free choice and they are fully aware of the risks associated with that choice. In this paper, I argue currently all justifications are potentially problematic. If they truly form the basis for justification, compassionate use programs should be designed to maximize justice, beneficence and autonomy. (shrink)

Pragmatism and the correspondence theory of truth are longtime foes. Nevertheless, there is an argument to be made that pragmatists must embrace truth as correspondence. I show that there is a distinctive pragmatic utility to taking truth to be correspondence, and I argue that it would be inconsistent for pragmatists to accept the utility of the belief that truth is correspondence while resisting the premise that this belief is correct. -/- In order to show how pragmatists can embrace truth as (...) correspondence, I develop a kind of alethic pluralism, which treats pragmatist truth as theoretically fundamental to truth as correspondence. This theoretical fundamentality of pragmatist truth allows the pragmatist to conditionally accept truth as correspondence for certain discourses without falling prey to the typical pragmatist objections to correspondence. This pluralist account of truth thus allows pragmatists to concede that, for certain domains of discourse, truth is correspondence, without thereby betraying their pragmatist principles. (shrink)

Animating Maurice Merleau-Ponty’s phenomenological idea of the body as a pre-reflective organizing principle in perception, consciousness and language has become a productive and popular endeavor within philosophy of mind during the last two decades. In this context Merleau-Ponty’s descriptions of an embodied mind has played a central role in the attempts to naturalize phenomenological insights in relation to cognitive science and neuropsychological research. In this dialogue the central role of art and aesthetics in phenomenology has been neglected or at best (...) treated as a peripheral phenomenon. In this article I argue that the failure to place art and aesthetics at the center of thought within phenomenology leads to a neglect of the expressive primacy of the body in movement. In the current naturalization of phenomenology the questions related to expressive movement are often consigned to the notions of motor intentionality or gesture. However, in his book How the Body Shapes the Mind the philosopher Shaun Gallagher interestingly concludes, based on experimental results, that bodily movements of gesture cannot be accounted for by the phenomenologically adapted notions of ‘body image’ and ‘body schema’. Symptomatically, Gallagher ends his chapter on bodily gesture with a section title asking the relevant question that remains unanswered within a phenomenology of mind: Expressive movement from the beginning? The search for an answer to this question points, in my view, to the possibility of a more radical understanding of the embodied mind based on the primacy of expressive experimentation rather than representational experience, which makes the question of art and aesthetics a core issue. Following the image of thought in the philosophy of Gilles Deleuze I argue that art, as the production of sensation through experimentation, presents us with a mode of thinking that accounts for expressive bodily movement as a constitutive force in subjective thought and experience. (shrink)

Background: The 21-item Nurses’ Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses. Objectives: The objective of this study was to make a Dutch translation of the Nurses’ Moral Courage Scale to describe the level of nurses’ self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium. Research design: A forward–backward translation method was applied to translate the English Nurses’ Moral Courage Scale to Dutch, and a pilot study was (...) conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used. Participants: The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders. Ethical considerations: Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent. Findings: The readability and understandability of the Dutch Nurses’ Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale and all subscales. Nurses’ mean score of the 21-item Nurses’ Moral Courage Scale was 3.77. The total Nurses’ Moral Courage Scale score was associated with age, experience, professional function, level of education and personal interest. Discussion and Conclusion: The Nurses’ Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice. (shrink)

In 2002 with the passing of the Euthanasia Law, Belgium became one of the few countries worldwide to legalize euthanasia. In the 18 years since the passing of the law, much has changed. We argue that in Belgium a widening of the use of euthanasia is occurring and that this can be ethically and legally problematic. This is in part related to the fact that several legal requirements intended to operate as safeguards and procedural guarantees in reality often fail to (...) operate as such. We focus on three kinds of safeguards or procedural guarantees: the legally defined due care criteria for eligibility for euthanasia; the consultation of a second physician; and the reporting of euthanasia cases to the Federal Control and Evaluation Commission for Euthanasia. We will show how each of these three safeguards can exhibit shortcomings in theory and practice. (shrink)

This article investigates the emergence of the archive as the primary venue for the production of historical knowledge in the 19thcentury. The turn to archival research, the article argues, may be considered as a response to the discussions about the problems of testimony that dominated 18th- and early 19th-century German writings on the methodology and epistemology of historical research. These discussions, especially regarding the epistemic virtues of witnesses, also helped create the particular culture of knowledge-making within German historical scholarship that (...) enabled the archival turn. The article illustrates these developments through the examples of Johann Peter von Ludewig, who was one of the most prominent historians of the early German Enlightenment, and Leopold von Ranke, who is normally considered the founder of the modern historical discipline and the most important advocate of the 19th-century archival turn. (shrink)

Deflationists believe that the question “What is truth?” should be answered not by means of a metaphysical inquiry into the nature of truth, but by figuring out what use we make of the concept of truth, and the word ‘true’, in practice. This article accepts this methodology, and it thereby rejects pluralism about truth that is driven by ontological considerations. However, it shows that there are practical considerations for a pluralism about truth, formulated at the level of use. The theory (...) expounded by this article states that truth is a dual-purpose tool; it can be used as a device for transferring justificatory burdens and, for select areas of discourse, it can also be used as a standard, a norm. This contrast in how truth is used introduces a bifurcation in our discourse that is reminiscent of metaphysical divides traced by more traditional versions of alethic pluralism. However, my pluralism “at the level of use” states that truth is plural solely at the level of use. It is unified at both the conceptual as well as the metaphysical level. At those levels, the theory takes its cue from deflationism. As such, this theory is offered as a midway point and as a potential way forward in the debate between deflationism and pluralism. (shrink)

The conceptual pair of own-world and common world constitutes an archaic pair, originally introduced by Heraclitus. More than two millennia after its introduction, Binswanger picked up this conceptual pair in the attempt to understand existence and mental disorder. Ever since, this conceptual pair has been part of the conceptualization of schizophrenia in phenomenological psychopathology. However, the concepts of ídios kósmos and koinós kósmos have seldomly been elaborated and expanded upon, and certain unclarities rest within the literature. This paper resolves some (...) of these unclarities and contributes to a theory of anthropological proportions, which furthers our understanding of ídios kósmos and koinós kósmos. The paper begins with an exploration of the theoretical underpinnings of this conceptual pair, i.e., it discusses the concept of world, what is understood by common world, and what it means to live in an own-world. This theoretical exploration segues into an in-depth analysis of the alterations of experiential life in schizophrenia, which can be illuminated via this conceptual pair. It is further argued that this conceptual pair contributes to an understanding of the puzzling phenomenon of double bookkeeping. Finally, the paper concludes in a discussion of clinical implications of this conceptual pair, stressing the importance of a mindfulness of the alterations to the ídios kósmos and koinós kósmos in schizophrenia. (shrink)

In The Myth of Morality Richard Joyce presents a simple and very influential argument for the truth of moral error theory. In this paper I point out that the argument does not have the form Joyce attributes to it, the argument is not valid in an extensional propositional logic and on the most natural way of explicating the meanings of the involved terms, it remains invalid. I conclude that more explanation is needed if we are to accept this particular argument (...) for moral error theory. (shrink)

The Aristotelian Πολιτεῖαι collected information on the history and organization of reportedly 158 city-states. Of these only the Ἀθηναίων πολιτεία survives almost in its entirety on two papyri. All that remains of the other constitutions is the epitome by Heraclides Lembus and about 130 fragments. This article will look at the transmission of Heraclides’ epitome and explore the possibility of identifying further fragments of the original text.

PART I : THE GOD-QUESTION TODAY -- God as a problem -- The denial of God in modern atheism -- The predicament of theology in the face of atheism -- Experience of God and knowledge of God -- Knowledge of God in faith. PART II : THE MESSAGE ABOUT THE GOD OF JESUS CHRIST -- God, the father almighty -- Jesus Christ, son of God -- The Holy Spirit, Lord, and giver of life. PART III : THE TRINITARIAN MYSTERY OF (...) GOD -- Establishment of the doctrine of the Trinity -- Exposition of the doctrine of the Trinity. (shrink)

In the perhaps most decisive reopening of philosophy in the twentieth century, Heidegger presented an existential analytic. This can be viewed as the highly complex analysis of one simple action: being-there. In the paper at hand, a Spinozist interpretation of this action is proposed. This implies a shift in the Aristotelian conceptuality, which, to a large extent, informs Heidegger’s analysis. The action of being-there is not a movement from potentiality to actuality. It is a force of existence. However, this force (...) is located right at the threshold between potentiality and actuality. Accordingly, it is not a matter of dismissing Aristotle’s concepts, but—with Heidegger—to observe carefully their deconstruction and pursue it to the point where these concepts become indistinct and where—beyond Heidegger—a Spinozian force of existence emerges. (shrink)

The Danish amateur scholar Christian Jürgensen Thomsen has often been described as a founder of modern “scientific” archaeology. Thomsen's innovation, this essay argues, reflects developments within neighboring fields, such as philology and history. He reacted against historians who limited themselves to histories of texts and therefore abandoned the earliest human history. Instead, he proposed a new history of objects, which included the entire history of humankind. Thomsen's work as director of the Royal Museum of Nordic Antiquities in Copenhagen was especially (...) important for this renewal. The arrangement of artifacts not only helped him formulate his theories, but also allowed him to present his arguments in a language of objects. At the same time, Thomsen's definition of archaeology as a museum science placed his branch of archaeology in a closer relationship with other museum sciences, such as geology and comparative anatomy. From the 1840s, Thomsen's museum became a model for how the study of human artifacts could deliver scientific insights into human nature and the laws of human development. (shrink)

Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives (...) and patients.We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying. The practice is generally considered to be legal as a form of symptom control, although this is mostly only assumed. France has passed an amendment to the Public Health Act that would grant certain terminally ill patients an explicit right to continuous deep sedation until they pass away. Such a (...) framework would be unique in the world. In this paper we will highlight and reflect on four relevant aspects and shortcomings of the proposed bill. First, that the bill suggests that continuous deeps sedation should be considered as a sui generis practice. Second, that it requires that sedation should always be accompanied by the withholding of all artificial nutrition and hydration. In the most recently amended version of the legal proposal it is stated that life sustaining treatments are withheld unless the patient objects. Third, that the French bill would not require that the suffering for which continuous deep sedation is initiated is unbearable. Fourth, the question as to whether the proposal should be considered as a way to avoid having to decriminalise euthanasia and/or PAS or, on the contrary, as a veiled way to decriminalise these practices. The French proposal to amend the Public Health Act to include a right to continuous deep sedation for some patients is a unique opportunity to clarify the legality of continuous deep sedation as an end-of-life practice. Moreover, it would recognize that the practice of continuous deep sedation raises ethical and legal issues that are different from those raised by symptom control on the one hand and assisted dying on the other hand. Nevertheless, there are still various issues of significant ethical concern in the French legislative proposal. (shrink)

Owen Griffiths has recently argued that Etchemendy’s account of logical consequence faces a dilemma. Etchemendy claims that we can be sure that his account does not overgenerate, but that we should expect it to undergenerate. Griffiths argues that if we define the relationship between formal and natural language as being dependent on logical consequence, then Etchemendy’s claims are not true; and if we define the relationship as being independent of logical consequence, then we cannot assess the truth of the claims (...) without further information. I argue that Griffiths misconstrues Etchemendy’s theory and overstates the first horn of the dilemma: Etchemendy does see the relationship as being dependent on logical consequence, but that does not mean that his claims are not true. (shrink)

Mortality seems to have no place in the theories on subjectivity in Kant and Husserl. It is suggested that this entente cordiale is an expression of the shared principle at the heart of their philosophy, i.e. the principle of self-preservation. Self-preservation is a principle that in a certain sense excludes mortality. It is argued that the primary sense of this exclusion is not theoretical but practical. Kant and Husserl are both endorsing the imperative that man should not let death attain (...) the dominion of his thoughts . The positive correlate to this is to be found in the demand that man should think of himself as if he was immortal. With special regard to Husserl the predicament that accompanies his relentless attempt to fulfill this demand is described as a sluice through which anthropology threatens to flow into the phenomenological enterprise. (shrink)

The line drawn in this paper is a long one, even far-fetched. It goes all the way from a phenomenology of touch beginning with Aristotle, and from there it will not be finished before it arrives at our present technological condition—a condition for which the French philosopher Jean-Luc Nancy has given us the word ecotechnie. The title of this drawing will be ‘responsiveness and technology’ as it connects exactly these two phenomena. Not in such a way, however, that the paper (...) begins with responsiveness and ends with technology. Rather, the line will begin with their intricate and intimate connection and then unfold until this connection is wholly exposed. And so the paper begins with a technical responsiveness to be found in touch; and it ‘ends’ with a worldwide responsive technology—which will in a sense prove to be without end. (shrink)

Name der Zeitschrift: Jahrgang: 13 Heft: 2 Seiten: 170-189.

I en dobbelt forstand kan døden siges at være uomgængelig, og i en dobbelt forstand fremstår det som et uomgængeligt problem for vor livsglade civilisation, idag tilsyneladende mere end nogensinde.

1. Aritmofobi Adomo definerede en gang i sine senere år en musiker som et menneske på flugt fra sin matematiklærer 1) denne definition kan uden tvivl udstrækkes til at gælde størstedelen af de få overlevende, som endnu forsøger at praktisere en humanistisk tænkning på trods af existensen af en "totalt forvaltet verden" udenfor.

Name der Zeitschrift: Cognitive Linguistics Jahrgang: 27 Heft: 1 Seiten: 67-100.

The organisation of health care is rapidly changing. There is a trend to move away from individual health care institutions towards transmural integrated care and interorganizational collaboration in networks. However, within such collaboration and network there is often likely to be a pluralism of values as different health care institutions often have very different values. For this paper, we examine three different models of how we believe institutions can come to collaborate in networks, and thus reap the potential benefits of (...) such collaboration, despite having different moral beliefs or values. A first way is the pragmatic way in which the different health care institutions avoid ethical reflection and focus on solutions. A second possible route is that of consensus where health care institutions base their collaboration on values that they all share. The third, and final, approach is that of compromise. Although moral compromise is often seen in a negative light, we argue that in many cases compromise might be necessary and ethically justified. In a final section, we will shift our focus from discussing various theoretical methods to allow collaboration to the potential content of consensus or compromise. (shrink)

Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because networks involve many risks. Due to their often (...) amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down. We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically. Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified. (shrink)