The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

Resumo Não há dúvida que tanto Kant como Hegel viram os seus respectivos trabalhos, como contribuições para aquilo que consideravam ser a “metafísica”. No entanto, a autora argumenta, que isto só deve ser compreendido, tendo presente, as concepções de metafísica de cada um dos autores. A autora, começando pela distinção implícita entre metafísica geral e metafísica especial na Crítica da Razão Pura, argumenta que Kant, Fichte, Schelling e Hegel comprometeram-se com uma investigação que, até essa altura, era do domínio da (...) metafísica geral. A autora, concentrando-se na noção de sistema de razão pura, tal como aludido na Crítica da Razão Pura, mostra, que os sucessores de Kant, interpretaram erroneamente a distinção kantiana entre crítica e sistema, o que permitiu elaborarem um sistema completo de razão pura, contrário àquilo que era intenção de Kant. Palavras-chave : Fichte, Hegel, idealismo alemão, Kant, metafísica, sistemaThere is no doubt that both Kant and Hegel saw their work as contributions to what they considered metaphysics proper. Yet what they meant by this, I argue, can only be understood by taking into account their own conception of metaphysics. Starting from Kant’s implicit distinction between general metaphysics and special metaphysics in the Critique of Pure Reason, I argue that Kant, Fichte, Schelling and Hegel engaged in the investigation that used to be carried out in general metaphysics. Focusing on the notion of a system of pure reason intimated in the Critique of Pure Reason, I show, moreover, that Kant’s successors, while misinterpreting the Kantian distinction between critique and system, elaborated a method that made it possible to produce a complete system of pure reason, albeit one that differed from the system Kant had in mind. Keywords : Fichte, german idealism, Hegel, Kant, metaphysics, system. (shrink)

Syltern et al. (2022) propose a new approach to decision-making at the limit of viability: by default, intensive care will be initiated for every infant born in “the gray zone” of viability. This w...

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit (...) what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

This paper articulates a formal theory of belief incorporating three key theses: (1) belief is a dyadic relation between an agent and a property; (2) this property is not the belief's truth condition (i.e., the intuitively self-ascribed property which the agent must exemplify for the belief to be true) but is instead a certain abstract property (a "thought-content") which contains a way of thinking of that truth condition; (3) for an agent a to have a belief "about" such-and-such items it (...) is necessary that a possesses a language of thought, $M_{a}$ , and that a (is disposed as one who) inwardly affirms a sentence of $M_{a}$ in which there are terms that denote those objects. Employing an extended version of E. Zalta's system ILAO, the proffered theory locates thought-contents within a typed hierarchy of "senses" and their "modes of presentation", the provisional definitions of which (suppressing complications added later to accommodate the contents of beliefs about beliefs) are as follows. A mode of presentation of e is a ternary relation of the sort [λxyz z is a name in $M_{y}$ that denotes x, and $D_{e}yz$ ] in which $D_{e}$ is an e-determiner - a relation between agents and their mental expressions imposing a syntactico-semantic condition sufficient for such an expression to denote e therein. A sense of an entity e is an abstract property that "contains" a mode of presentation $R_{e}$ of e by dint of encoding its property-reduct [λx(∃y)(∃z) $R_{e}xyz$ ]. In particular, a thought-content is a sense T of an ordinary first-order property P containing a mode of presentation whose P-determiner $D_{P}$ is such that, for any y and z, $D_{P}yz$ entails that z is a λ-abstract [λv S] of $M_{y}$ in which S is a sentence whose non-logical parts stand in appropriate semantic relations to the constituents of T's (some of which may themselves be senses). Where $I_{a}$ is agent a's dedicated self-demonstrative and |T| is the mode of presentation contained in a thought-content T, the belief relation itself is then characterized as obtaining between a and T iff a( is disposed as one who) inwardly affirms the substitution instance $S(I_{a}/v)$ of a sentence S in $M_{a}$ such that |T|(P, a, [λv S]). The aforementioned "constituents" and "appropriate semantic relations" are formally characterized so as to permit a system of canonical descriptions for thought-contents of arbitrary complexity. These canonical descriptions are then employed to chart the nature and interrelations of belief de re, de dicto and de se and to identify the source of opacity in belief ascription. (shrink)

ZusammenfassungWährend eines Abendessens in einem amerikanischen Restaurant wurde eine Gruppe von christlichen Ethikern, von denen einige Lutheraner waren, von einer jungen Frau angesprochen. Als sie hörte, welchen Beruf die Gruppe ausübte, antwortete sie: »Ich bin eine Lutheranerin – daher habe ich zu christlicher Ethik nichts zu sagen.« Dieser Artikel versucht herauszufinden, in welcher Hinsicht die Frau Recht gehabt haben könnte. Ich argumentiere dafür, dass zu dem Bereich des »Ethischen« zumindest drei Charakteristika gehören: Universalität, Normativität, und ein Verweis auf einen Begriff (...) des höchsten Gutes . Anschließend wird dafür argumentiert, dass eine der Konsequenzen aus Luthers Verweis auf Gott als höchstes Gut darin besteht, dass der sogenannte politische Gebrauch des Gesetzes zugleich ausgeprägt ethisch und christlich ist. Sein christliches Element besteht jedoch weniger in der Bestimmung derjenigen Werte, deren Realisierung angestrebt werden sollen, also im Feld der normativen Ethik, da das Gesetz in seiner politischen Interpretation allen Menschen, Gläubigen und Nicht-Gläubigen gleichermaßen, bekannt ist und auf alle angewandet werden kann. Der Beitrag des Christentums für die Ethik liegt vielmehr auf zwei anderen Ebenen: zum einen auf einer metaethischen Ebene ; und zum zweiten, aufgrund von Luthers Betonung der menschlichen Freiheit als Konsequenz der Versöhnung, auf der Ebene der Realisation des Guten. Abschließend wird argumentiert, dass Luthers theologischer Gebrauch des Gesetzes ebenso wie seine Lehre von der menschlichen Freiheit kaum als Ethik begriffen werden können, da die Charakteristika der Universalität und der Normativität fehlen. Einige mögen dies als eine Schwäche ansehen, aber die Kritik könnte auch in die entgegengesetzte Richtung gewendet werden: denn für Luther gehört mehr zum guten Leben als Normativität und Universalität allein.SummaryWhile having dinner in an American restaurant, a group of Christian ethicists, some of whom were Lutherans, were addressed by a woman. Upon hearing the profession of the group, she replied, “Well, I'm a Lutheran, so I don't know anything about Christian Ethics.” This article intends to explore in what sense the woman might have been correct. In order to do this, I argue that the realm of “the ethical” comprises at least three characteristics: universalisability, prescriptivity, and a reference to a conception of the highest good . After this, it is argued that, as a consequence of Luther's reference to God as the highest good, the so-called political use of the law can be seen as strongly ethical and Christian at the same time. The Christian element lies, however, not so much in the designation of what values ought to be pursued, i. e., in the field of normative ethics, since the law in its political interpretation may be known by, and is applicable, to all people, believers and nonbelievers alike. Rather, the contribution of Christianity to ethics lies on two other levels of ethics: first, on the level of metaethics ; and, second, because of Luther's stress on human freedom as a consequence of salvation, on the level of the realisation of the good. Finally, it is argued that Luther's theological use of the law as well as his doctrine of human freedom can hardly be conceived as ethics, due to the absence of the characteristics of universalisability and prescriptivity. By some, this may be considered as a flaw, but the criticism might also go in the other direction: to Luther, there is more to the good life than prescriptivity and universalisability alone. (shrink)

Hegel is most famous for his view that conflicts between contrary positions are necessarily resolved. Whereas this optimism, inherent in modernity as such, has been challenged from Kierkegaard onward, many critics have misconstrued Hegel's own intentions. Focusing on the Science of Logic, this transformative reading of Hegel on the one hand exposes the immense force of Hegel's conception of tragedy, logic, nature, history, time, language, spirit, politics, and philosophy itself. Drawing out the implications of Hegel's insight into tragic conflicts, on (...) the other hand, De Boer brings into play a form of negativity that allows us to understand why the entanglement of complementary positions always tends to turn into their conflict, but not necessarily into its resolution. (shrink)

Este artigo tem por objetiva geral descrever a linguagem musical sob a perspectiva da teoria histórico-cultural, conforme Vygotsky, seu principal representante. Neste sentido, procura-se também entender o conceito de mediação, como elemento articulador entre linguagem musical e o fenômeno pedagógico, produzido nos enredos intersubjetivos de professores e alunos. Nessa perspectiva, e com as contribuições da Base Nacional Comum Curricular (BNCC), que integra a música no ensino de Arte, identifica-se a relevância da linguagem musical na formação cidadã de estudantes da Educação (...) Básica. O presente estudo se caracteriza como uma pesquisa bibliográfica, amparada em obras originais de Vygotsky e de outros autores que escrevem a respeito da temática em questão, para embasamento aprofundado. Constatou-se que a música, enquanto linguagem, é dinâmica cujas habilidades e ações, construídas socialmente, são mediadas na interação professor-aluno. Portanto, a leitura que se faz da música, enquanto linguagem, não pode prescindir do caráter histórico-cultural, subjacente a toda e qualquer manifestação cultural. (shrink)

Given the history of the twentieth century, it is understandable that many contemporary philosophers—in the wake of Kierkegaard, Marx, and Nietzsche—have turned against Hegel’s seemingly unbridled optimism. As I will argue in this chapter, however, Hegel’s account of modern civilizations is much less optimistic than his account of the past. Hegel’s hesitation as to the capacity of modernity to resolve its immanent conflicts preeminently emerges in his account of the oppositions between poverty and wealth and between the state and its (...) citizens. In this chapter I will focus on passages from the Essay on Natural Law, the Lectures on the Philosophy of History, and the Philosophy of Right that express this hesitation and, hence, complicate the prevailing view of Hegel’s philosophy of world history. (shrink)

Does philosophical critique have a future? What are its possibilities, limits, and presuppositions? Bringing together outstanding scholars from various traditions, this collection of essays is the first to examine the forms of critique that have shaped modern and contemporary continental thought. Through critical analyses of key texts by, among others, Spinoza, Kant, Hegel, Marx, Adorno, Habermas, Foucault, and Rancière, it traces the way critique has time and again geared itself towards new cultural, social, and political problems, shedding those of its (...) assumptions no longer deemed tenable. It is our hope that the many voices of critique that arise from the present volume will produce effects – new doubts, new insights, new challenges, or new resources – that none could have achieved on their own. (shrink)

although mostly known to specialists nowadays, Kenelm Digby was a remarkable figure on the intellectual scene of the early seventeenth century. He has been described as “one of the most influential natural philosophers” of his time,1 and corresponded with many of the great scholars of his days, including Descartes, and the French pioneer of atomism, Pierre Gassendi. In the later years of his life, Digby, alongside men like Robert Boyle, became one of the founding members of the Royal Society.2Digby authored (...) one major work of philosophy: the Two Treatises of 1644. This work consisted of a long First Treatise on bodies, and a shorter, Second Treatise on the human soul. In the First Treatise, Digby argued... (shrink)

While we endorse Heidegger’s effort to reclaim Kant’s Critique of Pure Reason as a work concerned with the possibility of metaphysics, we hold, first, that his reading is less original than is often assumed and, second, that it unduly marginalizes the critical impetus of Kant’s philosophy. This article seeks to shed new light on Kant and the Problem of Metaphysics and related texts by relating Heidegger’s interpretation of Kant to, on the one hand, the epistemological approach represented by Cohen’s Kant’s (...) Theory of Experience and, on the other, the metaphysical readings put forward by Heimsoeth, Wundt and others in the 1920s. On this basis, we argue that Heidegger’s interpretation of Kant remains indebted to the methodological distinction between ground and grounded that informed Cohen’s reading and was transferred to the problem of metaphysics by Wundt. Even if Heidegger resists a ‘foundationalist’ mode of this distinction, we argue that his focus on the notions of ground and grounding does not... (shrink)

In this paper, we examine the qualitative moral impact of machine learning-based clinical decision support systems in the process of medical diagnosis. To date, discussions about machine learning in this context have focused on problems that can be measured and assessed quantitatively, such as by estimating the extent of potential harm or calculating incurred risks. We maintain that such discussions neglect the qualitative moral impact of these technologies. Drawing on the philosophical approaches of technomoral change and technological mediation theory, which (...) explore the interplay between technologies and morality, we present an analysis of concerns related to the adoption of machine learning-aided medical diagnosis. We analyze anticipated moral issues that machine learning systems pose for different stakeholders, such as bias and opacity in the way that models are trained to produce diagnoses, changes to how health care providers, patients, and developers understand their roles and professions, and challenges to existing forms of medical legislation. Albeit preliminary in nature, the insights offered by the technomoral change and the technological mediation approaches expand and enrich the current discussion about machine learning in diagnostic practices, bringing distinct and currently underexplored areas of concern to the forefront. These insights can contribute to a more encompassing and better informed decision-making process when adapting machine learning techniques to medical diagnosis, while acknowledging the interests of multiple stakeholders and the active role that technologies play in generating, perpetuating, and modifying ethical concerns in health care. (shrink)

This article challenges the prevailing interpretations of Hegel's account of the concept "contradiction" in the Science of Logic by arguing that it is concerned with the principle of Hegel's method rather than with the classical law of non-contradiction. I first consider Hegel's Doctrine of Essence in view of Kant's discussion of the concepts of reflection in the first Critique. On this basis, I examine Hegel's account of the logical principles based on the concepts "identity," "opposition," and "contradiction." Finally, I point (...) out how the principle Hegel derives from the concept of contradiction actually informs his own method. (shrink)

During the Corona pandemic, it became clear that people are vulnerable to potentially harmful nonhuman agents, as well as that our own biological existence potentially poses a threat to others, and vice versa. This suggests a certain reciprocity in our relations with both humans and nonhumans. In his The Visible and the Invisible, Merleau-Ponty introduces the notion of the flesh to capture this reciprocity. Building on this idea, he proposes to understand our relationships with other humans, as well as those (...) with nonhuman beings as having a chiasmic structure: to sense, or perceive another entity in a particular way simultaneously implies to be sensed or perceived in a particular way by this other entity. In this paper, we show how a postphenomenological perspective expands on Merleau-Ponty: first, it more radically interprets Merleau-Ponty’s notion of flesh by not only considering it to be a medium that is the condition of possibility for vision but as pointing to the constitution of an intercorporeal field in which entities—both human and nonhuman—mutually sense one another. Second, it augments Merleau-Ponty’s thought by drawing attention to how technologies mediate chiasmic relations. This is clarified through the example of the facemask, which reveals the chiasmic structure of our relation with nonhuman entities, and shows that technologies co-constitute interpersonal relationships by making humans present to one another in a particular way. We suggest that these aspects are not unique to the facemask, but point to a general technologically mediated chiasmic structure of human-world relations. (shrink)

Numerous studies in the fields of Science and Technology Studies and philosophy of technology have repeatedly stressed that scientific practices are collective practices that crucially depend on the presence of scientific technologies. Postphenomenology is one of the movements that aims to draw philosophical conclusions from these observations through an analysis of human–technology interactions in scientific practice. Two other attempts that try to integrate these insights into philosophy of science are Ronald Giere’s Scientific Perspectivism and Davis Baird’s Thing Knowledge. In this (...) paper, these two approaches will be critically discussed from the perspective of postphenomenology. We will argue that Giere and Baird problematically assume that scientific instruments have a determined function, and that all human members of a scientific collective have immediate access to this function. However, these assumptions also allow them to offer a clear answer to the question how scientists can collectively relate to scientific phenomena. Such an answer is not yet formulated within the postphenomenological perspective. By adding a postphenomenological touch to the semiotic approach in Actor-Network Theory, we offer an account of how different individual human–technology relations are integrated into larger scientific collectives. We do so by showing that scientific instruments not only help constitute scientific phenomena, but also the intersubjectivity within such collectives. (shrink)

By drawing on Jean-Luc Nancy’s philosophy of ontological relationality, this article explores what it means to be a ‘we’ in breast cancer. What are the characteristics—the extent and diversity—of couples’ relationally lived experiences of bodily changes in breast cancer? Through analyzing duo interviews with diagnosed women and their partners, four ways of sharing an embodied life are identified. While ‘being different together’, partners have different, albeit connected kinds of experiences of breast cancer. While ‘being there for you’, partners take care (...) of each other in mutually dependent ways. While ‘being reconnected to you’, partners relate to each other through intimacy and sexuality. While ‘being like you’, partners synchronize their embodied daily lives to one another, sometimes up to the point that the self cannot be distinguished from the other anymore. These ways reveal that being a ‘we’ involves complex affective, bodily encounters in which the many fault lines that both separate partners into individual selves and join them together as a unity are continuously reshaped and negotiated. Being a ‘we’ may be understood as something we have to do. Therefore, in being true to the legacy of Nancy, we argue at the end of this article for a sensible praxis of sharing a life and body, particularly in breast cancer. (shrink)

This paper focuses on a particular method which is used in contemporary empirical happiness studies, namely measuring people’s happiness by scoring their emotions (Kahneman is a prominent scholar). I examine the presupposition in this field that emotion scores can be added or subtracted, that throughout affective space runs a straight axis that plots hedonic tone or pleasure.

A central issue in postphenomenology is how to explain the multistability of technologies: how can it be that specific technologies can be used for a wide variety of purposes (the “multi”), while not for all purposes (the “stability”)? For example, a table can be used for the purpose of sleeping, having dinner at, or even for staging a fencing match, but not for baking a cake. One explanation offered in the literature is that the (material) design of a technology puts (...) constraints on the purposes for which technologies can be used. In this paper, I argue that such an explanation—while partly correct—fails to address the role of the environment in which human beings operate in putting constraints on technology use. I suggest that James Gibson’s affordance theory helps highlighting how stabilities in technology use arise in the interaction between human being and environment. Building on more recent approaches in affordance theory, I suggest that the environment can be conceptualized as a “rich landscape of affordances” that solicits certain actions, which are not just cued by the environment’s material structure, but also by the normativity present in the form of life in which a human being participates. I briefly contrast the approach to affordances developed in this paper with how Klenk (2020) and Tollon (2021) have conceptualized the “affordance character” of technological artifacts, and highlight how a focus on the situated nature of affordances augments these earlier conceptualizations. (shrink)

in a late note, dated 1797, Kant refers to the schematism of the pure understanding as one of the most difficult as well as one of the most important issues treated in the Critique of Pure Reason.1 His treatment of this theme is indeed notorious for its obscurity.2 As I see it, part of the problem is caused by the fact that Kant frames his discussion in terms that he could expect his readers to be familiar with, while he gradually (...) develops ideas that breach any traditional account of cognition. This holds for his references to the power of judgment and the related view that cognition is a matter of subsuming intuitions under concepts3 as well as for the suggestion that there is an initial gap between categories... (shrink)