When talking about decisionmaking for children with a life-threatening condition, the death of children with brain tumors deserves special attention. The last days of the lives of these children can be particularly harsh for bystanders, and raise questions about the suffering of these children themselves. In the Netherlands, these children are part of the group for whom a wide range of end-of-life decisions are discussed, and questions raised. What does the end-of-life for these children look like, and what motivates physicians (...) and parents to make decisions that may affect the life and death of these children? This article highlights the story of the parents of the sisters Roos and Noor. When both their daughters were diagnosed with a hereditary brain tumor, they had to make similar decisions twice. Their story sheds light on the suffering of children in the terminal phase, and how this suffering may motivate parents and physicians to make decisions that influence the end of life of these children’s lives.We argue that complete knowledge about suffering in the terminal phase of children with brain tumors is impossible. However, by collecting experiences like those of Roos and Noor, we can move toward an experienced-based understanding and better guide parents and physicians through these hardest of decisions. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

From 1991 to 1994 the Dutch Health Insurance Council financed research on Extracorporeal Membrane Oxygenation . This is a technique for providing cardiopulmonary bypass to patients with pulmonary and/or cardiac failure. Most often, these patients are premature neonates. During ECMO, blood is drained from the right atrium, pumped along a membrane where gas exchange takes place, and then redirected to the aorta. To prevent blood clotting, heparin is added. However, with the heparin added, the risk of hemorrhage is considerably increased. (...) Therefore, both the chance of surviving and the chance of severe disability are higher with ECMO than with conventional treatment. (shrink)

From 1991 to 1994 the Dutch Health Insurance Council financed research on Extracorporeal Membrane Oxygenation (ECMO). This is a technique for providing cardiopulmonary bypass to patients with pulmonary and/or cardiac failure. Most often, these patients are premature neonates. During ECMO, blood is drained from the right atrium, pumped along a membrane where gas exchange takes place, and then redirected to the aorta. To prevent blood clotting, heparin is added. However, with the heparin added, the risk of hemorrhage is considerably increased. (...) Therefore, both the chance of surviving and the chance of severe disability are higher with ECMO than with conventional treatment (i.e., ventilator support). (shrink)

ABSTRACTThis article discusses the turn to polytheism in postmodern theory. In postmodernism, there is a strong interest in polytheism as an alternative to the much-criticized dominance of onto-theology in the philosophical tradition. The article argues that the new polytheism cannot be unequivocally understood as an alternative for an onto-theological way of thinking, or as a ‘liberation’ from monotheism. Already in Romanticism, the engagement with polytheism and paganism was ambiguous. There was the familiar superiority of Christian monotheism over polytheism. But there (...) was also an appropriation of polytheism that served a new self-perception of the West. This article focuses on this second line of interpretation and argues that postmodern theory inherits the theo-political concerns central to eighteenth- and nineteenth- century Romanticism. The article sets out to sketch the role of polytheism in a post-secular paradigm. Subsequently, it sketches the engagement with polytheism in British and German Romanticism. It will be argued that in Romanticism, polytheism was always embedded in more substantial cultural and political narratives. The remainder of the article will scrutinize the function of polytheism in the writings of Richard Rorty and John Milbank and how their respective forms of polytheism give way to different political theologies. (shrink)

This second volume of the Amsterdam edition of the apologias contains the critical edition of the Latin text of one of the apologias against the Spanish theologian Jacobus Lopis Stunica.

This volume includes the critical edition of five apologias (1522-1529) in which Erasmus defended his New Testament translation and commentary (1516)against Diego López de Zúñiga and Sancho Carranza. The edition is partly based on manuscript sources never used before.

This volume includes the critical edition of five apologias in which Erasmus defended his New Testament translation and commentary against Diego López de Zúñiga and Sancho Carranza. The edition is partly based on manuscript sources never used before.

Around 1970, high numbers of traffic casualties among cyclists led to the creation of numerous local protest movements in the Netherlands. While activists employed protest strategies, their main interest lie in the way they exemplify a highly successful instance of “lay expertise”; the idea that users of a technology have a fundamentally different and valuable perspective on a technology than experts or system-builders. Specifically, cyclists claimed to be more knowledgeable about cycling conditions and safety than the state-employed engineers and traffic (...) experts who built the roads and cycling path network. A key actor in this story is the Dutch Cyclists’ Union, a national platform of local action groups formed in 1975. These activists used the cycling experience of everyday utilitarian cyclists to compile maps and blacklists of locations where cycling was dangerous, unpleasant, uncomfortable, or otherwise discouraging. In doing so, they successfully claimed legitimacy as a valuable knowledge partner for local engineers and policymakers. As a result, they gained some level of influence within local governments, a relation which in the intervening years has only grown stronger. This case study shows how users can shape socio-technical systems bottom-up, and can therefore to an extent be seen as a successful example of co-construction of technology.ZusammenfassungUm 1970 führte die hohe Zahl von Verkehrsunfällen unter Radfahrern zur Gründung zahlreicher lokaler Protestbewegungen in den Niederlanden. Obwohl die Aktivisten auch Proteststrategien einsetzten, besteht das Hauptinteresse dieses Artikels in der Art und Weise, wie sie ein äußerst erfolgreiches Beispiel für „Laienkompetenz“ darstellen. Die Idee dahinter ist, dass Nutzer eine wertvolle und grundlegend andere Perspektive auf eine Technologie haben als Experten oder Systembauer: Radfahrer gaben in Umfragen an, mehr über die Bedingungen und die Sicherheit von Fahrrädern zu wissen als die staatlich angestellten Ingenieure und Verkehrsexperten, die die Systeme des Straßen- und Radwegenetzes gebaut haben. Ein Hauptakteur dieser Geschichte ist der Fietsersbond [Radfahrerbund], eine nationale Plattform lokaler Aktionsgruppen, die 1975 gegründet wurde. Diese Aktivisten nutzten die Mobilitätserfahrung täglicher Radfahrer, um Karten und Liste von Orten zusammenzustellen, an denen das Radfahren gefährlich und unangenehm oder auf andere Weise beschwerlich war. Damit beanspruchten sie erfolgreich Legitimität als wertvoller Wissenspartner für lokale Ingenieure und politische Entscheidungsträger. Infolgedessen gewannen sie einen gewissen Einfluss auf die Kommunalverwaltung; eine Beziehung, die seitdem immer stärker geworden ist. Diese Fallstudie zeigt, wie Nutzer sozio-technische Systeme „von unten“ gestalten können; sie kann daher in gewissem Maße als erfolgreiches Beispiel für die kooperative Konstruktion von Technik angesehen werden. (shrink)

The Birth of String Theory by Cappelli et al. tells the story of the beginnings of string theory and of the evolutionary process it has undergone from its origins in S-matrix theory to its current status as a candidate unification theory. The book is intended for an audience of students and researchers in physics, as well as historians and philosophers of science with some background in quantum field theory.In the 50s and early 60s, theoretical particle physics focused on formulating a (...) theory to explain the strong interactions. Due to issues with the application of perturbative quantum field theory to the strong interactions, theoretical particle physicists shifted their attention to Heisenberg’s ‘S-matrix’ theory, which focused solely on observable quantities. This endeavour led in 1968 to the breakthrough of the famous ‘Veneziano amplitude’, which along with the Dolen–Horn–Schmid duality between the s- and the t-channels led to the dual resonance model . Following Ve .. (shrink)

The concept of ‘geneticization’ has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to (...) disease, health and the body. This article analyses the thesis of ‘geneticization’. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that ‘geneticization’ primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights. (shrink)

In 1970 Van Rensselaer Potter was the first to use the term "bioethics" in a publication to advocate the development of a new discipline to address the basic problems of human flourishing. This article analyzes Potter's notion of bioethics in order to understand its origins, sources, and substance. In early publications, Potter conceptualized bioethics as a bridge: between present and future, nature and culture, science and values, and finally between humankind and nature. In later publications, disappointed by a predominant focus (...) on individual and medical issues, and with a wish to underscore the need for a broader perspective, Potter introduced the new term "global bioethics," meant to transcend ethics specialties and integrate them into a new interdisciplinary endeavor to address global problems. A growing interest in global bioethics today means that Potter's original insights are more timely than ever. (shrink)

This paper explores the role of ‘community’ in the context of global bioethics. With the present globalization of bioethics, new and interesting references are made to this concept. Some are familiar, for example, community consent. This article argues that the principle of informed consent is too individual-oriented and that in other cultures, consent can be community-based. Other references to ‘community’ are related to the novel principle of benefit sharing in the context of bioprospecting. The application of this principle necessarily requires (...) the identification and construction of communities. On the global level there are also new uses of the concept of community as ‘global community.’ Three uses are distinguished: (1) a diachronic use, including past, present, and future generations, (2) a synchronic ecological use, including nonhuman species, and (3) a synchronic planetary use, including all human beings worldwide. Although there is a tension between the communitarian perspective and the idea of global community, this article argues that the third use can broaden communitarianism. The current development towards cosmopolitanism is creating a new global community that represents humanity as a whole, enabling identification of world citizens and evoking a sense of global solidarity and responsibility. The emergence of global bioethics today demonstrates this development. (shrink)

Current bioethical debate is bizarre because it concentrates on exceptional cases while it does not pay attention to underlying value perspectives that determine the agenda of the debate.

Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged distinguishing between different types of vulnerability, criticizing the categorization of populations as vulnerable, and questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon (...) of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously. (shrink)

Global bioethics and the environment -- Biodiversity -- Health -- Disease -- Drugs -- Food -- Water -- Global bioethics in practice.

This Dictionary presents a broad range of topics relevant in present-day global bioethics. With more than 500 entries, this dictionary covers organizations working in the field of global bioethics, international documents concerning bioethics, personalities that have played a role in the development of global bioethics, as well as specific topics in the field.The book is not only useful for students and professionals in global health activities, but can also serve as a basic tool that explains relevant ethical notions and terms. (...) The dictionary furthers the ideals of cosmopolitanism: solidarity, equality, respect for difference and concern with what human beings- and specifically patients - have in common, regardless of their backgrounds, hometowns, religions, gender, etc. Global problems such as pandemic diseases, disasters, lack of care and medication, homelessness and displacement call for global responses.This book demonstrates that a moral vision of global health is necessary and it helps to quickly understand the basic ideas of global bioethics. (shrink)

Building on an action theoretical perspective, it is assumed that most television viewing is a routine response to frequently occurring situations, which together make up everyday life. This interplay between television viewing and everyday life was studied using data from a national survey among Dutch adults and their families. From this survey, data of 225 couples were analyzed using event history analysis. Results indicate that one cannot see television viewing as merely an alternative for other activities. For instance, participatory activities (...) have two distinct effects: They tend to inhibit television viewing by the actor but stimulate television viewing by the actor’s partner. The effect of contacts with other variables appears to be important as well: Being at home, engagement in child care, household work, and eating and drinking often enhances television viewing. But presence of non-family may inhibit television viewing. Education was shown to have a consistently negative impact on television viewing, and there appeared to be some gender specific inducements for termination of television viewing. (shrink)

Geneticization is a broad term referring to several related processes such as a spreading tendency to use a genetic model of disease explanation, a growing influence of genetics in medical practice, and the slow changing of individual and societal attitudes towards reproduction, prevention and control of disease. These processes can be demonstrated in medical literature on preventive genetic screening and counselling programs for β-thalassaemia in Cyprus, the United Kingdom and Canada. The preventive possibilities of the new genetic and diagnostic technologies (...) have been quickly understood and advocated by health professionals, and their educational strategies have created a web of social control, in marked contrast to the alleged voluntary decision-making process and free choice. Genetic diagnostic technologies have led to considerable changes in control and management of β-thalassaemia, and have generated a number of unresolved incongruities. (shrink)

Although principles, as a framework to resolving moral dilemmas are still debated and seem to be in a philosophical quagmire, there are strong arguments that by specification one can resolve case-specific dilemmas in certain areas of bioethics. When it comes to genetic screening and testing however, the problem at the base is a moral disagreement on higher-order principles—such as the status of the embryo and parental issues. No amount of specification can resolve these issues without a dose of relativism. We (...) explore a possibility of agreement on debatable areas specifically in regard to genetics—such as conferring status to the embryo solely for purposes of preventing genetic selection; but it is difficult to see how this can be incorporated into law without extrapolation to other areas. We conclude therefore that the four-principles approach, albeit valuable for expounding opposing views and discussing issues, cannot either alone or by specification, help resolve issues of genetic screening and testing without agreeing on higher order principle. This does not seem to be a possibility in the near future. (shrink)

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics (...) focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us. (shrink)

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care (...) policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine. (shrink)

War has major health consequences and poses significant ethical dilemmas for health professionals. In caring for victims of armed conflicts, health providers are obliged to put medical ethics before military aims. While the normative framework of warfare is clear and accepted by almost all countries, in practice, restrictions on violence are continuously broken, and the safety and independence of health professionals are not ensured. In bioethics, the issue of war has not been treated as a major concern. The field can (...) do more to articulate the responsibilities of health practitioners and scientists, arguing that Red Cross founder Henri Dunant's principle of humanity and the principles of professional and global ethics reject the idea of military necessity. Bioethics should focus on strategies to prevent war, encouraging the collective action of health professionals. Bioethics should also stress—as, so far, one national medical association has—that war is a man‐made public health problem. (shrink)