The purpose of this article is to critically address a widespread assumption that reads like this: Works of art that make use of digital media automatically, through interactivity, are generally better suited for generating democratic processes in society than other art forms or phenomena that do not make use of digital media, and, therefore, digital art is more avant-garde than other art forms. By analysing the chains of equivalence underlying this assumption the article presents and discusses a number of issues (...) that, taken together, render this assumption fallacious. (shrink)

JEAN-PIERRE CLERO, LYNDA LOTTE. — Lacan est mort il y a un peu plus de vingt ans, en 1981 ; il semble que sa présence, pour ne pas dire son règne, n’ait jamais été aussi éclatante. Il faut toutefois se méfier de ce qui paraît évident et peut-être y a-t-il eu de profonds changements au cours de ces deux dernières décennies où son œuvre est apparue..

On ne peut pas attendre que les psychanalystes, qui n’ont guère le défaut de chercher à concourir ès qualité, à tout prix, au pouvoir politique, soient très complaisants envers celui-ci, dans lequel ils repèrent, fussent-ils recouverts des oripeaux républicains et démocratiques, les traits du discours du maître, dont Lacan avait pensé la nécessité structurelle dans les années 1960,..

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Objectives: To investigate why physicians label end-of-life acts as either ‘euthanasia/ending of life’ or ‘alleviation of symptoms/palliative or terminal sedation’, and to study the association of such labelling with intended reporting of these acts. Methods: Questionnaires were sent to a random, stratified sample of 2100 Dutch physicians. They were asked to label six hypothetical end-of-life cases: three ‘standard’ cases and three cases randomly selected, that varied according to type of medication, physician’s intention, type of patient request, patient’s life expectancy and (...) time until death. We identified the extent to which characteristics of cases are associated with physician’s labelling, with multilevel multivariable logistic regression. Results: The characteristics that contributed most to labelling cases as ‘euthanasia/ending of life’ were the administration of muscle relaxants or disproportional morphine. Other important factors were an intention to hasten death and a life expectancy of several months. Physicians were much more willing to report cases labelled as ‘euthanasia’ or ‘ending of life’ than other cases. Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not. (shrink)

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A (...) hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence. (shrink)

Engaging civil society actors as knowledgeable dialogue partners in the development and governance of emerging technologies is a new challenge. The starting point of this paper is the observation that the design and orchestration of current organized interaction events shows limitations, particularly in the articulation of issues and in learning how to address the indeterminacies that go with emerging technologies. This paper uses Dewey’s notion of ‘publics’ and ‘reflective inquiry’ to outline ways of doing better and to develop requirements for (...) a more productive involvement of civil society actors. By studying four novel spaces for interaction in the domain of nanotechnology, this paper examines whether and how elements of Dewey’s thought are visible and under what conditions. One of the main findings is that, in our society, special efforts are needed in order for technology developers and civil society actors to engage in a joint inquiry on emerging nanotechnology. Third persons, like social scientists and philosophers, play a role in this respect in addition to external input such as empirically informed scenarios and somewhat protected spaces. (shrink)

There is interest in more and better interaction between civil society and actors developing nanotechnologies, nano-materials and nano-enabled products: government agencies but also branch organizations in the chemical sector position civil society organizations (CSOs) as ‘voices of civil society’, and invite CSOs to participate in multistakeholder events. In such events, CSOs are expected to articulate societal needs, issues and values so that these can be taken up by actors with institutional roles and mandates to develop and embed newly emerging nanosciences (...) and nanotechnologies (NEST). This article argues that such a division of moral labor between CSOs and nanotechnology actors is not productive to address NEST and its emerging societal issues. There is an assumption that societal issues are ‘out there’ and can be recognized by CSOs, while in fact, societal issues might co-evolve with new development trajectories and thus have to be discovered and articulated. More productive deliberation requires, ideally, overcoming the traditional division of moral labor between these two groups of actors: technology developers should also inquire into and articulate emerging societal issues, and CSOs should inquire into and reflect on actual development trajectories. In order to explore issues and repercussions that arise in such a repositioning, this article will discuss a bottom up experiment of such an interaction between a nanotechnology developer (DuPont) and a CSO (Environmental Defense Fund). Based on the empirical analysis of this bottom up experiment, tentative requirements will be developed for how joint inquiries between technology developers and CSOs can be realized on a larger scale in our society. (shrink)

(2009). How automatic is “automatic vigilance”? The role of working memory in attentional interference of negative information. Cognition & Emotion: Vol. 23, No. 6, pp. 1106-1117.

Background: Caring for terminally ill patients is a meaningful task, however the patient’s suffering can be a considerable burden and cause of frustration.Objectives: The aim of this study is to describe the experiences of general practitioners in The Netherlands in dealing with a request for euthanasia from a terminally ill patient.Methods: The data, collected through in-depth interviews, were analysed according to the constant comparative method.Results: Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described (...) as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without “intentionally hastening a patient’s death on his request”. The other GPs explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient’s request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient’s suffering through euthanasia and their personal values.Conclusion: Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient’s suffering and to promote a peaceful death. (shrink)

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)

ABSTRACTRecent research suggests that impaired emotion regulation may play an important role in the development of youth psychopathology. However, little research has explored the effects of ER strategies on affect in early adolescents. In Study 1, we examined if early adolescents are able to use distraction and whether the effects of this strategy are similar to talking to one’s mother. In Study 2, we compared the effects of distraction, cognitive reappraisal, acceptance, and rumination. In both studies, participants received instructions on (...) how to regulate their emotions after a standardised negative mood induction. In general, the results indicated that distraction, but also cognitive reappraisal and acceptance, had promising short-term effects on positive and negative affect in early adolescents. These findings suggest that targeting adaptive ER skills, such as distraction, acceptance, and cognitive reappraisal, may be an important strategy to prevent or treat psychological pro... (shrink)

Aim: To examine how physicians’ life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large (...) life-stance groups in each country.Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient’s death , physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics and Protestants reported ever having made such a decision.Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. (shrink)

The recent process of deinstitutionalization of the psychiatric treatment system, in both Denmark and other European countries, has relied heavily on the involvement in treatment and recovery of cohabitant relatives of diagnosed people. However, political objectives regarding depression and involvement rely on a limited body of knowledge about people’s ways of managing illness-related problems in everyday life. Drawing on a discursive notion of gender laid out by Raewyn Connell, the aim of the article is to elucidate how the involvement of (...) relatives is guided by an extra- individual rationale about gender and caregiving, and how this gendered discourse might frame different challenges and burdens, depending on the gender of the diagnosed person and the cohabitant relative. Drawn from a larger, multisited field study on involvement processes in Danish psychiatry, t he article is based on field notes and 21 interviews with seven heterosexual couples. The analysis shows that gender works as a decisive premise for the division of caregiving labour among the couples, and clarifies how the couples’ gendered institution is disrupted after the onset of depression. The article argues that gender-blind involvement strategies could produce divergent treatment outcomes and varying social effects in relation to couples’ everyday family lives. (shrink)

In 1968, Jürgen Habermas claimed that, in an advanced technological society, the emancipatory force of knowledge can only be regained by actively recovering the ‘forgotten experience of reflection’. In this article, we argue that, in the contemporary situation, critical reflection requires a deliberative ambiance, a process of mutual learning, a consciously organised process of deliberative and distributed reflection. And this especially applies, we argue, to critical reflection concerning a specific subset of technologies which are actually oriented towards optimising human cognition. (...) In order to create a deliberative ambiance, fostering critical upstream reflection on emerging technologies, we developed the concept of a mutual learning exercise. Building on a number of case studies, we analyse what an MLE involves, both practically and conceptually, focussing on key aspects such as ambiance and expertise, the role of ‘genres of the imagination’ and the profiles of various ‘subcultures of debate’. Ideally, an MLE becomes a contemporary version of the Socratic agora, providing a stage where multiple and sometimes unexpected voices and perspectives mutually challenge each other, in order to strength-en the societal robustness and responsiveness of emerg-ing technologies. (shrink)

ABSTRACTPrevious work has shown that a stooped posture may activate negative mood. Extending this work, the present experiments examine how stooped body posture influences recovery from pre-existing negative mood. In Experiment 1, participants were randomly assigned to receive either a negative or neutral mood induction, after which participants were instructed to take either a stooped, straight, or control posture while writing down their thoughts. Stooped posture led to less mood recovery in the negative mood condition, and more negative mood in (...) the neutral mood condition. Furthermore, stooped posture led to more negative thoughts overall compared to straight or control postures. In Experiment 2, all participants underwent a negative mood induction, after which half received cognitive reappraisal instructions and half received no instructions. Mood-congruent cognitions were assessed through autobiographical memory recall. Again, stooped position led to less mood recovery. Notably, this was independent of regulation instruction. These findings demonstrate for the first time that posture plays an important role in recovering from negative mood. (shrink)

In this paper, I examine the strategic function of four variants of pragmatic argumentation in the context of advisory health brochures. I argue that each variant functions as a strategic manoeuvre that deals with potential countermoves: with variant I and II writers can address anticipated doubt with respect to the standpoint and with variants III and IV they can strategically erase potential criticism of or possible alternatives to the proposed action. Keywords: health brochures, health communication, pragma-dialectical theory, pragmatic argumentation, strategic (...) maneuvering. (shrink)

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)

Reality TV is immensely popular, and various shows in this media genre involve a storyline of infertility and infertility treatment. Feminists argue that normative and constructed realities about infertility and infertility treatment, like those in reality TV, are central to the emancipation of women. Such realities are able to steer viewers' perceptions of the world. This article examines the emancipatory significance of representations of women on 'infertility reality TV shows'. While the women in these shows all have 'abnormal' qualities, we (...) consider their portrayal as figurations of monstrosity. In the literature, monstrosity is understood as a way to challenge nonemancipatory norms by offering an alternative identity. Through a content analysis of seven reality TV shows, we identified four types of in/fertile monsters: the cyborg, the freak, the abject, and the childless. We show that these monsters are predominantly non-emancipatory as they all involve mechanisms of altering, excluding, or condemning infertility in relation to what is considered normal and acceptable womanhood. Therefore, at the end of this article, we make a plea for more diverse and emancipatory representations of infertile women in popular culture. (shrink)

The policies of the European Union concerning the development of biofuels can be termed a lock-in. Biofuels were initially hailed as a green, sustainability technology. However evidence to the contrary quickly emerged. The European Commission proposed to alter its policies to accommodate for these effects but met with fierce resistance from a considerable number of member states who have an economic interest in these first generation biofuels. In this paper I argue that such a lock-in might have been avoided if (...) an experimental approach to governance had been adopted. Existing approaches such as anticipation and niche management either do not reduce uncertainty sufficiently or fail to explicitly address conflicts between values motivating political and economic support for new technologies. In this paper, I suggest to apply an experimental framework to the development of sustainable biobased technologies. Such an approach builds on insights from adaptive management and transition management in that it has the stimulation of learning effects at its core. I argue that these learning effects should occur on the actual impacts of new technologies, on the institutionalisation of new technologies and most specifically on the norms and values that underly policies supporting new technologies. This approach can be relevant for other emerging technologies. (shrink)

Technological developments often bring about new risks. Informed consent has been proposed as a means to legitimize the imposition of technological risks. This principle was first introduced in medical practice to assure the autonomy of the patient.The introduction of IC in the field of technological practice raises questions about the comparability of the type of informed consent. To what extent are thepossibilities to include laypeople in making decisions regarding risks similar in the technological field to giving informed consent in the (...) medical field and whatdoes this imply for the design and implementation of IC in the technological field? Medical and the technological practice are clearly alike in that both fieldsare characterized by highly specialized, technical knowledge which can be quite inaccessible to the average layperson. However, a fundamental difference ariseswith regard to the aim, knowledge of risks and exclusiveness of the practices in each field. The differences in aim imply that the necessity for each practice isperceived differently by laypeople, thus leading them to assess the respective risks differently. The differences in knowledge of risks arise from the variabilityin the ways that can be used to describe a given risk. Definition of risk in medical practice is more homogenous in this respect than the risk definition intechnological fields. Futhermore, medical practice tends to be more exclusive, leading laypeople immersed in that practice to necessarily embrace most of thefundamental underlying that practice. These differences result in divergent recommendations for the implementation of informed consent in the technological field, basically: there is a need for more extensive procedure and for less decisive authority for the individual. (shrink)

The approach of responsible research and innovation has been proposed to support the introduction of technologies that touch upon socially sensitive issues. RRI is intended to help designers and manufacturers of new technologies identify and accommodate public concerns when developing a new technology by engaging with a wide range of relevant actors in an interactive, transparent process. However what this approach amounts to exactly remains elusive as of yet, i.e. it is unclear what its contribution to the societal embedding of (...) new technologies should consists of exactly. The transition to a sustainable bio-economy that uses biomass as its main resource is a complicated trajectory involving many actors and touching upon societally sensitive issues such as the use of genetic modification. In this paper we pose the question in what way RRI can stimulate the development and diffusion of a sustainable bio-economy in The Netherlands and Europe. We claim that for the further development and diffusion of the bio-economy, trust among actors in the relevant value-chain is a prerequisite. RRI can play a pivotal part in the bio-economy by providing conditions for trustworthiness of actors and by enhancing trusting relationships. This can be achieved through instruments such as personal relationships, third person guarantors, institutions and the communication of values. From the application of RRI to the context of the bio-economy, lessons can be drawn for other socially intricate technological trajectories. (shrink)

In the unfolding debate on the prospects, challenges and viability of the imminent transition towards a ‘Bio-Based Society’ or ‘Bio-based Economy’—i.e. the replacement of fossil fuels by biomass as a basic resource for the production of energy, materials and food, ‘big’ concepts tend to play an important role, such as, for instance, ‘sustainability’, ‘global justice’ and ‘naturalness’. The latter concept is, perhaps, the most challenging and intriguing one. In public debates concerning biotechnological interactions with the natural environment, the use of (...) terms such as ‘nature’ and ‘naturalness’ is both inevitable and hazardous . Indeed, various conflicting interpretations of naturalness play a role on both sides of the current debate. This paper aims to analyse and critically assess the role of ‘nature-speak’ in the BBS transition. We will begin with a concise overview of the vicissitudes of the nature-concept so far, focussing on how modern science and technology have challenged and affected our understanding of what nature is. Subsequently, we describe how ‘naturalness’ functions in the unfolding BBS debate. Finally, we will focus on a particular case study, namely the production of rubber with the help of natural latex coming from dandelion plants rather than from rubber trees. On the one hand, this is presented as a more natural and nature-friendly way of producing rubber. On the other hand, it is a sophisticated process, involving high technology and primarily focussed on competitiveness on the global market. To what extent or in what sense can dandelion latex be regarded as more natural? And what can we learn from this case study when it comes to addressing naturalness in the broader conceptual and bio-political arena? (shrink)