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Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

The International Classification of Functioning, Disability and Health (ICF), designed by the WHO, attempts to provide a holistic model of functioning and disability by integrating a medical model with a social one. The aim of this article is to analyze the ICF’s claim to holism. The following components of the ICF’s complexity are analyzed: (1) health condition, (2) body functions and structures, (3) activity, (4) participation, (5) environmental factors, (6) personal factors, and (7) health. Although the ICF claims to be (...) holistic, it presupposes a monistic materialistic ontology. We indicate some limitations of this ontology, proposing instead: (a) a pluralistic–holistic ontology (PHO) and (b) a multidimensional view of the human being, with individual and environmental aspects, in relation to three levels of reality implied by the PHO. For the ICF to attain its holistic claim, the interactions between its components should be based on (a) and (b). (shrink)

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)

The framework of Findlay & Walker's target article provides a first attempt to model the saccadic system at all levels. Their scheme is based on two main principles. These are “parallel processing of saccade timing and metrics” and “competitive inhibition through winner-take-all strategies.” In our opinion, however, both concepts are in their strictest sense at odds with the current knowledge of the saccadic system, and need to be refined to make the scheme more relevant.

We give an example in which it is possible to understand quantum statistics using classical concepts. This is done by studying the interaction of chargedmatter oscillators with the thermal and zeropoint electromagnetic fields characteristic of quantum electrodynamics and classical stochastic electrodynamics. Planck's formula for the spectral distribution and the elements of energy hw are interpreted without resorting to discontinuities. We also show the aspects in which our model calculation complement other derivations of blackbody radiation spectrum without quantum assumptions.

Rapid advancements in machine learning techniques allow mass surveillance to be applied on larger scales and utilize more and more personal data. These developments demand reconsideration of the privacy-security dilemma, which describes the tradeoffs between national security interests and individual privacy concerns. By investigating mass surveillance techniques that use bulk data collection and machine learning algorithms, we show why these methods are unlikely to pinpoint terrorists in order to prevent attacks. The diverse characteristics of terrorist attacks—especially when considering lone-wolf terrorism—lead (...) to irregular and isolated footprints. The irregularity of data affects the accuracy of machine learning algorithms and the mass surveillance that depends on them which can be explained by three kinds of known problems encountered in machine learning theory: class imbalance, the curse of dimensionality, and spurious correlations. Proponents of mass surveillance often invoke the distinction between collecting data and metadata, in which the latter is understood as a lesser breach of privacy. Their arguments commonly overlook the ambiguity in the definitions of data and metadata and ignore the ability of machine learning techniques to infer the former from the latter. Given the sparsity of datasets used for machine learning in counterterrorism and the privacy risks attendant with bulk data collection, policymakers and other relevant stakeholders should critically re-evaluate the likelihood of success of the algorithms and the collection of data on which they depend. (shrink)

This paper introduces the logic _Q__L__E__T_ _F_, a quantified extension of the logic of evidence and truth _L__E__T_ _F_, together with a corresponding sound and complete first-order non-deterministic valuation semantics. _L__E__T_ _F_ is a paraconsistent and paracomplete sentential logic that extends the logic of first-degree entailment (_FDE_) with a classicality operator ∘ and a non-classicality operator ∙, dual to each other: while ∘_A_ entails that _A_ behaves classically, ∙_A_ follows from _A_’s violating some classically valid inferences. The semantics of _Q__L__E__T_ (...) _F_ combines structures that interpret negated predicates in terms of anti-extensions with first-order non-deterministic valuations, and completeness is obtained through a generalization of Henkin’s method. By providing sound and complete semantics for first-order extensions of _FDE_, _K3_, and _LP_, we show how these tools, which we call here the method of _anti-extensions + valuations_, can be naturally applied to a number of non-classical logics. (shrink)

In the present essay we attempt to reconstruct Newtonian mechanics under the guidance of logical principles and of a constructive approach related to the genetic epistemology of Piaget and García. Instead of addressing Newton’s equations as a set of axioms, ultimately given by the revelation of a prodigious mind, we search for the fundamental knowledge, beliefs and provisional assumptions that can produce classical mechanics. We start by developing our main tool: the no arbitrariness principle, that we present in a form (...) that is apt for a mathematical theory as classical mechanics. Subsequently, we introduce the presence of the observer, analysing then the relation objective–subjective and seeking objectivity going across subjectivity. We take special care of establishing the precedence among all contributions to mechanics, something that can be better appreciated by considering the consequences of removing them: the consequence of renouncing logic and the laws of understanding is not being able to understand the world, renouncing the early elaborations of primary concepts such as time and space leads to a dissociation between everyday life and physics, the latter becoming entirely pragmatic and justified a-posteriori, changing our temporary beliefs has no real cost other than effort. Finally, we exemplify the present approach by reconsidering the constancy of the velocity of light. It is shown that it is a result of Newtonian mechanics, rather than being in contradiction with it. We also indicate the hidden assumption that leads to the contradiction. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Resumen. Se presentan los conceptos básicos de muestreo secuencial en sus cinco modalidades,incluyendo muestreo secuencial de tipo estándar, usando solo una densidad crítica, por una precisiónfija, por medio de presencia-ausencia y finalmente de tipo temporal. Se notan un ejemplo real para cadacaso. Se nota y se explica la importancia de la distribución de los datos y los pertinentes ecuaciones. Sepresentan a través de ejemplos reales las ecuaciones para estimar el tamaño óptimo de la muestra paracada uno de las cinco modalidades (...) del muestreo secuencial. Se enfatiza la ventaja económica de estetipo de muestreo.Palabras clave: Distribución de los datos, muestreo secuencial, tamaño óptimo de la muestra. Fundamental concepts of sequential sampling in all its types including standard sequentialsampling, sequential sampling using only one critical density, fixed precision sequential sampling,presence-absence sequential sampling, and time sequential sampling are highlighted. A real caseexample for each of the five sequential samplings is given. The relevance of data distribution forsequential sampling along with corresponding equations is provided and explained. Equations to assessthe optimal sample size for each case are noted and exemplified. The economic advantages of sequentialsampling in stressedKeywords: Data distribution, sample size, sequential sampling. (shrink)

Resumen. Se analizan de forma detallada las bases del muestreo multietápico, la estimación de submuestreo y el muestreo de respuesta aleatoria. Se presentan las ecuaciones pertinentes ejemplificando por medio de casos reales. También se argumentan las situaciones en donde se debe utilizar estos casos específicos. Palabras claves. Caso multietápico, muestreo de respuesta aleatoria, submuestreo.. The basics of multi-stage sampling, sub-sampling and random response sampling are analyzed. Detailed equations regarding these types of sampling are provided. The applications of these types of (...) samplings are denoted by means of real case studies. Keywords. Multi-stage sampling, sub-sampling, random response sampling. (shrink)