The legalization of euthanasia, both in the Netherlands and in other countries is usually justified in reference to the right to autonomy of patients. Utilizing recent Dutch jurisprudence, this article intends to show that the judicial proceedings on euthanasia in the Netherlands have not so much enhanced the autonomy of patients, as the autonomy of the medical profession. Keywords: allowing to die, criminal law, euthanasia, law enforcement, legal aspects, legislation, medical ethics, medical profession, self determination, the Netherlands, voluntary euthanasia, withholding (...) treatment CiteULike Connotea Del.icio.us What's this? (shrink)

In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to (...) autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous. (shrink)

This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.

This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883–1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel''s warning against a dehumanization of medicine when the person of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...) best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)

This article examines whether cosmetic interventions by dentists and plastic surgeons are medically indicated and, hence, qualify as medical interventions proper. Cosmetic interventions (and the business strategies used to market them) are often frowned upon by dentists and physicians. However, if those interventions do not qualify as medical interventions proper, they should not be evaluated using medical-ethical norms. On the other hand, if they are to be considered medical practice proper, the medical-ethical principles of nonmaleficence, beneficence, justice and others hold (...) true for cosmetic interventions as much as they do for other medical and dental interventions. It is concluded that most cosmetic interventions do not qualify as medical interventions proper because they do not restore or maintain the patient's health (defined as the patient's integrity) by any objective standards. Rather, cosmetic interventions are intended to enhance a person's physical appearance; more specifically, they intend to fulfill the client's subjective perception of an enhanced appearance. (shrink)

There are at present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this urgent (...) question by reexamining Ignatius' own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's ,Jesuits to maintain their engagement in medical and health care education. (shrink)

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as (...) the moral parameters of swift and urgent medical action in the face of limited supportive information. (shrink)

In this article, I argue that the relationship between patients and their health care providers need not be construed as a contract between moral strangers. Contrary to the (American) legal presumption that health care providers are not obligated to assist others in need unless the latter are already contracted patients of record, I submit that the presence of a suffering human being constitutes an immediate moral commandment to try to relieve such suffering. This thesis is developed in reference to the (...) French philosopher Levinas and the Dutch theologian Schillebeeckx. An expanded version of the biblical parable of the Good Samaritan serves as test case. (shrink)

On one side of his sign board, a nineteenth century surgeon depicted a physician operating on a patient's leg; the other side showed the Good Samaritan taking care of the victim's wounds. Christ's parable has often been quoted and depicted as a primary example of human compassion, to be followed by all persons and, a fortiori, by so-called professionals such as physicians and nurses. If we grant that the parable has not lost its narrative power for 20th century “postmodern” readers (...) living in a “pluralistic” society, it merits a closer analysis. (shrink)

The Patient Self-Determination Act is a fact. Finally, respect for patient autonomy has been guaranteed. At first sight, there seems little reason to object to any measure that intends to increase the autonomy of the patient. Too long, one may argue, physicians have behaved paternalistically; too often, they have been advised to change this habit. If the profession of medicine is unwilling or simply unable to grant the patient the decision-making power that is her due, the law has to step (...) in. One may add, this law in no way hinders professional autonomy; by requiring a hospital official to provide the patient with information about advance directive, the law actually reduces the work load of the physician, who is already overburdened. (shrink)

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate, and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of best interest judgments entails a risk that health care providers withdraw (...) from the decision-making process, abandoning patients to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)

Background Over the past decade, the exponential growth of the literature devoted to personalized medicine has been paralleled by an ever louder chorus of epistemic and ethical criticisms. Their differences notwithstanding, both advocates and critics share an outdated philosophical understanding of the concept of personhood and hence tend to assume too simplistic an understanding of personalization in health care. Methods In this article, we question this philosophical understanding of personhood and personalization, as these concepts shape the field of personalized medicine. (...) We establish a dialogue with phenomenology and hermeneutics in order to achieve a more sophisticated understanding of the meaning of these concepts We particularly focus on the relationship between personal subjectivity and objective data. Results We first explore the gap between the ideal of personalized healthcare and the reality of today’s personalized medicine. We show that the nearly exclusive focus of personalized medicine on the objective part of personhood leads to a flawed ethical debate that needs to be reframed. Second, we seek to contribute to this reframing by drawing on the phenomenological-hermeneutical movement in philosophy. Third, we show that these admittedly theoretical analyses open up new conceptual possibilities to tackle the very practical ethical challenges that personalized medicine faces. Conclusion Finally, we propose a reversal: if personalization is a continuous process by which the person reappropriates all manner of objective data, giving them meaning and thereby shaping his or her own way of being human, then personalized medicine, rather than being personalized itself, can facilitate personalization of those it serves through the data it provides. (shrink)

In reference to historical developments, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the relationship(s) between theory and practice. The authors emphasize the need for scientific research in this neglected area for the sake of both clinical practice and medical education.

This book is for those searching for an ethics engine with enough philosophical power to drive healthcare reform toward a balance between medical technology and human compassion. Jos Welie's project is to This is an important goal that has eluded others. Jos Welie has more nearly succeeded in this book than any other author who has come to my attention.

Recently, Casasanto and Lupyan (2015) have asserted that there are no context-independent concepts: all concepts are constructed ad hoc when they are instantiated. My aim is to show that the ad hoc cognition framework can be characterized by a similarity-based theory of concepts, and that two different notions of concept should be distinguished —which may be identified with two distinct stages of their life cycle (storage and instantiation). This approach brings together virtues from opposing views: (a) invariantist: stored concepts are (...) stable enough to collect new information; (b) contextualist: instantiated concepts are context-dependent, what explains our adaptive ability to changing environments. (shrink)

The embedding and promotion of social change is faced with aparadoxical challenge. In order to mainstream an approach to socialchange such as responsible research and innovation and makeit into a practical reality rather than an abstract ideal, we need tohave conceptual clarity and empirical evidence. But, in order to beable to gather empirical evidence, we have to presuppose that theapproach already exists in practice. This paper proposes a social labmethodology that is suited to deal with this circularity. Themethodology combines the (...) defining features of social labs emergingfrom the literature such as agility and real-world focus withestablished theories and approaches such as action research andexperiential learning. Thereby it enables the parallel investigationand propagation of RRI. The framework thus constructed provides atheoretical embedding of sociallabs and overcomes some of theknown limitations of the constitutive approaches. (shrink)

Recently, Casasanto and Lupyan (2015) have proposed an appealing and daring thesis: there are no context-independent concepts—that is, all concepts are ad hoc concepts. They argue that the seeming stability of concepts is merely due to commonalities across their different instantiations but that, in fact, there is nothing invariant in them. In their view, concepts only exist when they are instantiated for categorizing, communicating, drawing inferences, etc., and those instantiations are produced on the fly from a set of contextual cues. (...) However, the main weakness of Casasanto and Lupyan’s framework is that it lacks a proposal for articulating it within a theory on the structure of concepts. My aim is to show that the ad hoc cognition framework can be characterized by means of a prototype theory of concepts developed in terms of a conceptual similarity space. (shrink)

This paper reports an experiment that investigates interpretive distinctions between two different expressions of generalization in Spanish. In particular, our aim was to find out when the distinction between generic statements (GS) such as Tigers have stripes and universally quantified statements (UQS) such as All tigers have stripes was acquired in Spanish-speaking children of two different age groups (4/5-year-olds and 8/9-year-olds), and then compare these results with those of adults. The starting point of this research was the semantic distinction between (...) GS and UQS in that the former admit exceptions, unlike the latter. On the other hand, several authors have observed a Generic overgeneralization effect (GOG) consisting in allowing for UQS to be felicitous in the face of exceptions, thus proposing that this “error” stems from GS being defaults (simpler, more easily learned and processed). In the current paper we aimed to test the “Generics as Default” (GaD) hypothesis by comparing GS and UQS in three different age ranges. Our data show that, overall, the accuracy of GS is greater than the accuracy of UQS. Moreover, we also confirm a hypothesized interaction between age and NP type (GS vs UQS). Further, we present several data points that are not predicted by the GaD, including an observed decline in the accuracy of GS in the older group of children as well as in adults, and that children fail at rejecting statements that are not considered to be true generalizations. (shrink)

Responding to recent concerns about the reliability of the published literature in psychology and other disciplines, we formed the X-Phi Replicability Project to estimate the reproducibility of experimental philosophy. Drawing on a representative sample of 40 x-phi studies published between 2003 and 2015, we enlisted 20 research teams across 8 countries to conduct a high-quality replication of each study in order to compare the results to the original published findings. We found that x-phi studies – as represented in our sample (...) – successfully replicated about 70% of the time. We discuss possible reasons for this relatively high replication rate in the field of experimental philosophy and offer suggestions for best research practices going forward. (shrink)

In this paper we reflect on the effectiveness of cognitive mapping as a method to study farm functioning in its complexity and its diverse forms in the framework of our own experiment with a diverse group of Flemish beef farmers. With a structured direct elicitation method we gathered 30 CMs. We analyzed the content of these maps both qualitatively and quantitatively. The central role of the concept “Income” in most maps indicated a shared concern for economic security. Further, the CMs (...) indicated that farmers dealt with this shared social reality differently, as the relationships included in their maps referred to different functional processes relating to revenue streams, marketing strategies, investment decisions, dependence on production inputs, on-farm resource management, and personal well-being. With a clustering algorithm we grouped farmers based on the relationships in their maps, which allowed us to trace some of the broader patterns within the data, such as the existence of more business- and investment-minded farmers, in contrast to farmers focused on their quality of life, and animal production-oriented in contrast to marketing-oriented farmers. Taking into account farmers’ comments, we find that the applied methods had limited capability to classify farmers based on their perspectives on farming. Still, the system presentations proved useful to study what aspects farmers were working on or towards, and how these aspects may actually fit together as a whole. CMing was therefore mostly effective in exploring farm functioning in its complexity, and less so in exploring farm functioning in its diversity. (shrink)

Appendix 1 was incomplete in the initial online publication. The original article has been corrected.