Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study Amsterdam (N=1284 (2001), N=1303 (2005) and N=1245 (2008)) were studied. Respondents were asked whether they could imagine requesting their physician to end their life (euthanasia), or imagine asking for a pill to end their life if they became tired (...) of living in the absence of a severe disease (end-of-life pill). Using logistic multivariable techniques, changes of attitudes over time and their association with demographic and health characteristics were assessed. Results The proportion of respondents with a positive attitude somewhat increased over time, but significantly only among the 64–74 age group. For euthanasia, these percentages were 58% (2001), 64% (2005) and 70% (2008) (OR of most recent versus earliest period (95% CI): 1.30 (1.17 to 1.44)). For an end-of-life pill, these percentages were 31% (2001), 33% (2005) and 45% (2008) (OR (95% CI): 1.37 (1.23 to 1.52)). For the end-of-life pill, interaction between the most recent time period and age group was significant. Conclusions An increasing proportion of older people reported that they could imagine desiring euthanasia or an end-of-life pill. This may imply an increased interest in deciding about your own life and stresses the importance to take older peoples' wishes seriously. (shrink)
BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)
The essays in this volume critically analyze and revitalize agrarian philosophy by tracing its evolution in the classical American philosophy of key figures such as Franklin, Jefferson, Emerson, Thoreau, Dewey, and Royce.
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)
I re-examine Coherence Arguments (Dutch Book Arguments, No Arbitrage Arguments) for diachronic constraints on Bayesian reasoning. I suggest to replace the usual game–theoretic coherence condition with a new decision–theoretic condition ('Diachronic Sure Thing Principle'). The new condition meets a large part of the standard objections against the Coherence Argument and frees it, in particular, from a commitment to additive utilities. It also facilitates the proof of the Converse Dutch Book Theorem. I first apply the improved Coherence Argument to van Fraassen's (...) (1984) Reflection principle. I then point out the failure of a Coherence Argument that is intended to support Conditionalization as a naive, universal, update rule. I also point out that Reflection is incompatible with the universal use of Conditionalization thus interpreted. The Coherence Argument therefore defeats the naive view on Bayesian learning that it was originally designed to justify. (shrink)
"A first-rate introduction to the field, accessible to scholars working from a variety of disciplinary and theoretical perspectives. Highly recommended... " —Choice "... offers both broad theoretical considerations and applications to specific art forms, diverse methodological perspectives, and healthy debate among the contributors.... [an] outstanding volume."—Philosophy and Literature "... this volume represents an eloquent and enlightened attempt to reconceptualize the field of aesthetic theory by encouraging its tendencies toward openness, self-reflexivity and plurality." —Discourse & Society "All of the authors challenge (...) the traditional notion of a pure and disinterested observer that does not allow for questions of race/ethnicity, class, sexual preference, or gender." —Signs These essays examine the intellectual traditions of the philosophy of art and aesthetics. Containing essays by scholars and by the writer Marilyn French, the collection ranges from the history of aesthetic theory to a philosophical reflection on fashion. The contributions are unified by a sustained scrutiny of the nature of "feminist," "feminine," or "female" art, creativity, and interpretation. (shrink)
This book explores the social practice of holding each other in our identities, beginning with pregnancy and on through the life span. Lindemann argues that our identities give us our sense of how to act and how to treat others, and that the ways in which we we hold each other in them is of crucial moral importance.
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)
Hilde Lindemann Nelson focuses on the stories of groups of people--including Gypsies, mothers, nurses, and transsexuals--whose identities have been defined by those with the power to speak for them and to constrain the scope of their actions. By placing their stories side by side with narratives about the groups in question, Nelson arrives at some important insights regarding the nature of identity. She regards personal identity as consisting not only of how people view themselves but also of how others (...) view them. These perceptions combine to shape the person's field of action. If a dominant group constructs the identities of certain people through socially shared narratives that mark them as morally subnormal, those who bear the damaged identity cannot exercise their moral agency freely.Nelson identifies two kinds of damage inflicted on identities by abusive group relations: one kind deprives individuals of important social goods, and the other deprives them of self-respect. To intervene in the production of either kind of damage, Nelson develops the counterstory, a strategy of resistance that allows the identity to be narratively repaired and so restores the person to full membership in the social and moral community. By attending to the power dynamics that constrict agency, Damaged Identities, Narrative Repair augments the narrative approaches of ethicists such as Alasdair MacIntyre, Martha Nussbaum, Richard Rorty, and Charles Taylor. (shrink)
Violence is often considered gendered on the basis that it is violence against women. This assumption is evident both in “gender-based violence” interventions in Africa and in the argument that gender is irrelevant if violence is also perpetrated against men. This article examines the relation of partner violence not to biological sex, but to gender as conceptualized in feminist theory. It theorizes the role of gender as an analytical category in dominant social meanings of “wifebeating” in Tanzania by analyzing arguments (...) for and against wife-beating expressed in 27 focus group discussions in the Arumeru and Kigoma-Vijijini districts. The normative ideal of a “good beating” emerges from these data as one that is supported by dominant social norms and cyclically intertwined with “doing gender.” The author shows how the good beating supports, and is in turn supported by, norms that hold people accountable to their sex category. These hegemonic gender norms prescribe the performance of masculinity and femininity, power relations of inequality, and concrete material exploitation of women’s agricultural and domestic labor. The study has implications for policy and practice in interventions against violence, and suggests untapped potential in theoretically informed feminist research for understanding local power relations in the Global South. (shrink)
The first decisive steps of medicine towards becoming a science in its present shape happen to coincide with “the rise of the novel” in the eighteenth century. Before this well known and in our days still growing scientific specialization of medicine, the connections between literature and medicine were both many and close. By reading and analyzing a contemporary novel, The Death of a Beekeeper by the Swedish author Lars Gustafsson, this article is an attempt to explore to which extent a (...) fictional narrative about a unique case of cancer may illuminate challenges associated with the experience of serious illness. Our claim is that medicine might draw wisdom from literature, its ability to create connections through narrative, to illuminate the complexity of ethical dilemmas, and to intertwine symptoms, life stories, and contexts. We argue that by being in the company of literary narratives and philosophical questions, physicians as well as other health care professionals may acquire clinically relevant skills which help them reach the ethically defined goals of their profession. (shrink)
Naturalized bioethics represents a revolutionary change in how health care ethics is practised. It calls for bioethicists to give up their dependence on utilitarianism and other ideal moral theories and instead to move toward a self-reflexive, socially inquisitive, politically critical, and inclusive ethics. Wary of idealisations that bypass social realities, the naturalism in ethics that is developed in this volume is empirically nourished and acutely aware that ethical theory is the practice of particular people in particular times, places, cultures, and (...) professional environments. These essays situate the bioethicist within the clinical or research context, take seriously the web of relationships in which all human beings are nested, and explore a number of the different kinds of power relations that inform health care encounters. Naturalized Bioethics aims to help bioethicists, doctors, nurses, allied health professionals, disability studies scholars, medical researchers, and other health professionals address the ethical issues surrounding health care. (shrink)
The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.
Ranking theory delivers an account of iterated contraction; each ranking function induces a specific iterated contraction behavior. The paper shows how to reconstruct a ranking function from its iterated contraction behavior uniquely up to multiplicative constant and thus how to measure ranks on a ratio scale. Thereby, it also shows how to completely axiomatize that behavior. The complete set of laws of iterated contraction it specifies amend the laws hitherto discussed in the literature.
Critically analyzes and revitalizes agrarian philosophy by tracing its evolution. Today, most historians, philosophers, political theorists, and scholars of rural America take a dim view of the agrarian ideal that farmers and farming occupy a special moral and political status in society. Agrarian rhetoric is generally seen as special pleading on the part of farmers seeking protection from labor reform and environmental regulation while continuing to receive direct payments and subsidies from the public till. Agrarianism should not be viewed as (...) a set of immutable claims about farming and political order, but as a tradition of moral and political philosophy that has evolved and deepened over the centuries. Agrarian naturalism--the belief that culture and conduct are conditioned by nature because they are of a piece with nature--becomes pragmatic naturalism, giving way to a new set of puzzles about how we are to understand the rural landscape and our responsibilities for its use. The agrarian idea that personality and sociability are integrated with the material transformation of the landscape can serve as the basis for a new, pragmatically grounded ethic of natural resources and rural development. The essays in this volume critically analyze and revitalize agrarian philosophy by tracing its evolution in the classical American philosophy of key figures such as Franklin, Jefferson, Emerson, Thoreau, Dewey, and Royce. Three chapters address the belief that farming peoples develop moral virtue and a taste for democracy as it evolved in the American context, and four examine how a reconstitution of agrarian themes might invigorate our nation's thinking on environment, food, and rural development policy. The Agrarian Roots of Pragmatism will be of broad interest to scholars of American philosophy, rural history, history of ideas, geography, and agricultural or natural resource policy. (shrink)
By considering the museum itself as art, rather than as a receptacle, Hein's Public Art: Thinking Museums Differently argues for an improved understanding of the role museums play in shaping public discourse.
An Invitation to Feminist Ethics is a hospitable approach to the study of feminist moral theory and practice. Designed to be small enough to be used as a supplement to other books, it also provides the theoretical depth necessary for stand-alone use in courses in feminist ethics, feminist philosophy, and women's studies. The "overviews" section introduces important concepts in feminist ethical theory and contrasts that theory with the standard moral theories. The "close-ups" section looks at three topics--bioethics, violence, and the (...) globalized economy--to help students put the theories presented in the Overviews section to practical use. (shrink)
The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the structure of families, how families can participate more fully in medical decision-making, and how to understand the impact on families when medical advances extend life but not vitality.
In Poetics 13, Aristotle claims that the protagonist in the most beautiful tragedies comes to ruin through some kind of ‘failure’—in Greek, hamartia. There has been notorious disagreement among scholars about the moral responsibility involved in hamartia. This article defends the old reading of hamartia as a character flaw, but with an important modification: rather than explaining the hero's weakness as general weakness of will (akrasia), it argues that the tragic hero is blinded by temper (thumos) or by a pursuit (...) for fine, good and desirable things—that is, by what may be labelled ‘qualified’ weakness of will. The upshot is that hamartia ends up as being less blameworthy than ‘proper’ akrasia, but still explains why morally outstanding people are unsuitable for the most beautiful tragedies. (shrink)
The end-state comfort effect refers to the consistent tendency of healthy adults to end their movements in a comfortable end posture. In children with and without developmental coordination disorder, the results of studies focusing on ESC planning have been inconclusive, which is likely to be due to differences in task constraints. The present pilot study focused on the question whether children with and without DCD were able to change their planning strategy and were more likely to plan for ESC when (...) demanded by complex object manipulations at the end of a task. To this end, we examined ESC planning in 18 children with and without DCD using the previously used sword-task and the newly developed hammer-task. In the sword-task, children had to insert a sword in a wooden block, which could be relatively easily completed with an uncomfortable end-posture. In the hammer-task, children had to strike down a nail in a wooden pounding bench, which required additional force and speed demands, making it relatively difficult to complete the movement with an uncomfortable end-posture. In line with our hypothesis, the results demonstrated that children with and without DCD were more likely to plan for ESC on the hammer-task compared with the sword-task. Thus, while children with and without DCD show inconsistent ESC planning on many previously used tasks, the present pilot study shows that many of them are able to take into account the end-state of their movements if demanded by task constraints. (shrink)
: The feminist ethic of care has often been criticized for its inability to address four problems--the problem of exploitation as it threatens care givers, the problem of sustaining care-giver integrity, the dangers of conceiving the mother-child dyad normatively as a paradigm for human relationships, and the problem of securing social justice on a broad scale among relative strangers. We argue that there are resources within the ethic of care for addressing each of these problems, and we sketch strategies for (...) developing the ethic more fully. (shrink)
All conceptions of equal opportunity draw on some distinction between morally justified and unjustified inequalities. We discuss how this distinction varies across a range of philosophical positions. We find that these positions often advance equality of opportunity in tandem with distributive principles based on merit, desert, consequentialist criteria or individuals' responsibility for outcomes. The result of this amalgam of principles is a festering controversy that unnecessarily diminishes the widespread acceptability of opportunity concerns. We therefore propose to restore the conceptual separation (...) of opportunity principles concerning unjustified inequalities from distributive principles concerning justifiable inequalities. On this view, equal opportunity implies that that morally irrelevant factors should engender no differences in individuals' attainment, while remaining silent on inequalities due to morally relevant factors. We examine this idea by introducing the principle of ‘opportunity dominance' and explore in a simple application to what extent this principle may help us arbitrate between opposing distributive principles. We also compare this principle to the selection rules developed by John Roemer and Dirk Van de Gaer. (shrink)
Since the eighteenth century, museums have played a prominent part in constituting the artworld, populating it with inhabitants and assigning value to them. Museums have the institutional function of collecting and preserving objects identified as having a certain cultural value. Unlike private collectors, who can indulge their personal tastes independently of the public, museums are obliged to make depersonalized judgments that are normative. Museums are expected to be both archival and celebratory. They are managed by expert staffs whose function it (...) is to use public and/or private funds to select, study and exhibit those items whose aesthetic and historic interest merits special custodial and scholarly attention. Museums are thus implicated in the dissemination of cultural canons and, I contend, of their formation as well. (shrink)
This collection fills an important gap for students of American philosophy. Striking to this reader is the use of the phrase African- American philosophy, for the authors represented, all of whom are black, are neither more nor less American than are most of us who trace our roots to Anglo-European stock. Perhaps we should call ourselves Euro-American philosophers. This observation is not trivial, for it is plain from the contents of the book that the philosophers included, like most of us, (...) have been influenced by their teachers and contemporary movements, and the essays reflect most of the important currents of American thought in the twentieth century. These range from the more or less homegrown pragmatism and critical realism of the early part of the century to the imported varieties of positivism, Marxism, phenomenology, Frankfurt School critical theory, and Oxford ordinary language and conceptual analysis. (shrink)
Nelson Goodman cast the ‘problem of induction’ as the task of articulating the principles and standards by which to distinguish valid from invalid inductive inferences. This paper explores some logical bounds on the ability of a rational reasoner to accomplish this task. By a simple argument, either an inductive inference method cannot admit its own fallibility, or there exists some non-inferable hypothesis whose non-inferability the method cannot infer (violating the principle of ‘negative introspection’). The paper discusses some implications of this (...) limited self-knowledge for the justifiability of inductive inferences, auto-epistemic logic, and the epistemic foundations of game theory. (shrink)
In recent decades, the governance of food safety, food quality, on-farm environmental management and animal welfare has been shifting from the realm of ‘the government’ to that of the private sector. Corporate entities, especially the large supermarkets, have responded to neoliberal forms of governance and the resultant ‘hollowed-out’ state by instituting private standards for food, backed by processes of certification and policed through systems of third party auditing. Today’s food regime is one in which supermarkets impose ‘private standards’ along the (...) food supply chain to ensure compliance with a range of food safety goals—often above and beyond those prescribed by government. By examining regulatory governance in Australia, Norway and the United Kingdom we highlight emerging trajectories of food governance. We argue that the imposition of the new private forms of monitoring and compliance continue the project of agricultural restructuring that began with government support for structural adjustment schemes in agriculture and that these are most evident in the UK and Australia where neoliberalism is an entrenched philosophy. However, despite Norway’s identity as a social democracy, we also identify neoliberal ‘creep’ into the system of food governance. Small-scale producers in all three nations are finding themselves increasingly subject to governance through private, market-based mechanisms that, to varying degrees, are dominated by major supermarket chains. The result is agricultural restructuring not through the traditional avenues of elected governments, but via non-elected market operatives. (shrink)