This article analyzes the contribution Christian ethics might be able to make to the ethical debate on policy and caregiving in health and social care in the United Kingdom. The article deals particularly with the concepts of solidarity and subsidiarity which are essential in Christian social ethics and health care ethics, and which may be relevant for the ethical debate on health and social caregiving in the United Kingdom. An important argument in the article is that utilitarian and market-driven policies (...) in the National Health Service (NHS) and the social care system have marginalized the position of the elderly and have seriously impoverished the quality of care for the elderly. The neglect of the elderly and other vulnerable groups is also the result of widespread consumerist attitudes among patients and of libertarian models of noninterference which are affirmed by a public ethos of self-sufficiency and counter-dependency. Those who need care dare not make their need known to others and ask for help, while simultaneously those who could help are so intimidated by the public affirmation of privacy and negative rights that they do not dare to offer help except if this is explicitly demanded. This distant and standoffish attitude is in an important way responsible for the fact that the voice of those in need is altogether lost to the public forum. Christian ethics puts much emphasis on responsibility and solidarity with the needy other but is not able to have much impact on the delivery of care in a secularized society and health care system like the NHS. Nonetheless, Christianity still has a powerful and respected voice, by speaking up for those who cannot speak for themselves, such as the elderly and the handicapped. Christians can find allies in the ethics of care and other relational approaches in health care ethics in order to combat libertarianism, consumerism, and utilitarianism. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, (...) home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

The transhumanist literature encompasses diverse nonnovel positions on questions of disability and obligation reflecting long-running political philosophical debates on freedom and value choice, complicated by the difficulty of projecting values to enhanced beings. These older questions take on a more concrete form given transhumanist uses of biotechnologies. This paper will contrast the views of Hughes and Sandberg on the obligations persons with "disabilities" have to enhance and suggest a new model. The paper will finish by introducing a distinction between the (...) responsibility society has in respect of the presence of impairments and the responsibility society has not to abandon disadvantaged members, concluding that questions of freedom and responsibility have renewed political importance in the context of enhancement technologies. (shrink)

Health care policy in the Netherlands has long been guided by the values of solidarity and equality. As a result of several forces, particularly the scarcity of resources, the retreat of the Welfare State and the introduction of market forces in health care, both values are increasingly under strain. Next to solidarity and equality, freedom of choice and financial responsibility are playing an important role in Dutch health care. Consequently, there is a growing division in Dutch heaith care between two (...) tiers, one basic tier giving access to a basic package of services and a luxury tier giving access to a higher quality of care and to services not included in the basic package. The main thesis of the article is that a two-tier system is morally justified on the condition that the basic tier is universally accessible and is based on the value of humanitarian solidarity. Keywords: access to health care, health insurance, resource allocation, solidarity CiteULike Connotea Del.icio.us What's this? (shrink)

This article presents various developments in Dutch health care policy toward a greater role for individual financial responsibility, such as cost-control measures, priority setting, rationing, and market reform. Instead of the collective responsibility that is characteristic of previous times, one can observe in government policies an increased emphasis on the need for individuals to take care of one’s own health and health care needs. Moreover, surveys point to decreasing levels of public support for “unlimited” solidarity and “irresponsible” health behavior. This (...) article attempts to answer the question of how these policies and public attitudes are limiting the ethical principles of solidarity and equal access to care that have long guided Dutch health care policy making. The authors argue that from a moral point of view, the increased emphasis on individual responsibility is acceptable as long as it does not affect solidarity with those weak and vulnerable groups who are not able to take individual responsibility, such as the demented and mentally handicapped. (shrink)

In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients’ autonomy was found to be helpful for restoration of their autonomy. Two patterns in health professionals’ approach appeared to (...) be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients’ progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients’ preparation for autonomous living after discharge. (shrink)

REFERENCES Barwise, J. & R. Cooper (1981) — 'Generalized Quantifiers and Natural Language', Linguistics and Philosophy 4:2159-219. Van Benthem, J. (1983a) — ' Five Easy Pieces', in Ter Meulen (ed.), 1-17. Van Benthem, J. (1983b) ...

The question of whether old age should or should not play a role in medical decision-making for the elderly patient is regularly debated in ethics and medicine. In this paper we investigate exactly how age influences the decision-making process. To explore the normative argumentation in the decisions regarding an elderly patient we make use of the argumentation model advanced by Toulmin. By expanding the model in order to identify normative components in the argumentation process it is possible to analyse the (...) way that age-related value judgements influence the medical decision-making process. We apply the model to practice descriptions made by medical students after they had attended consultations and meetings in medical practice during their clinical training. Our results show the pervasive character of age-related value judgements. They influence the physician’s decision in several ways and at several points in the decision-making process. Such explicit value judgements were not exclusively used for arguments against further diagnosis or treatment of older patients. We found no systematic “ageist” pattern in the clinical decisions by physicians. Since age plays such an important, yet hidden role in the medical decision-making process, we make a plea for revealing such normative argumentation in order to gain transparency and accountability in this process. An explicit deliberative approach will make the medical decision-making process more transparent and improve the physician–patient relationship, creating confidence and trust, which are at the heart of medical practice. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% were suitable for analysis. The results show that in about half of (...) the cases nurses were involved in the decision making by the physician and that nurses were frequently involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

The idea that an adequate semantics of ordinary language calls for some theory of events has sparked considerable debate among linguists and philosophers. On the one hand, so many linguistic phenomena appear to be explained if (and, according to some authors, only if) we make room for logical forms in which reference to or quantification over events is explicitly featured. Examples include nominalization, adverbial modification, tense and aspect, plurals, and singular causal statements. On the other hand, a number of deep (...) philosophical questions arise as soon as we take events into consideration. Are events entities of a kind? What are their identity and individuation criteria? How does semantic theorizing depend on such metaphysical issues? The aim of this book is to address such issues in some depth, with emphasis precisely on the interplay between linguistic applications and philosophical implications. Contributors: N. Asher, P. M. Bertinetto, J. Brandl, D. Delfitto, R. Eckardt, J. Higginbotham, A. Lenci, T. Parsons, A. ter Meulen, H. Verkuyl. A comprehensive introductory essay (pp. 3-47) is included. (shrink)

Much problem solving and learning research in math and science has focused on formal representations. Recently researchers have documented the use of unschooled strategies for solving daily problems -- informal strategies which can be as effective, and sometimes as sophisticated, as school-taught formalisms. Our research focuses on how formal and informal strategies interact in the process of doing and learning mathematics. We found that combining informal and formal strategies is more effective than single strategies. We provide a theoretical account of (...) this multiple strategy effect and have begun to formulate this theory in an ACT-R computer model. We show why students may reach common impasses in the use of written algebra, and how subsequent or concurrent use of informal strategies leads to better problem-solving performance. Formal strategies facilitate computation because of their abstract and syntactic nature; however, abstraction can lead to nonsensical interpretations and conceptual errors. Reapplying the formal strategy will not repair such errors; switching to an informal one may. We explain the multiple strategy effect as a complementary relationship between the computational efficiency of formal strategies and the sense-making function of informal strategies. (shrink)

This revised version of Price's 1960 Gifford Lectures in two series at Aberdeen University presents an extensive analysis of the concept of belief and related problems. The author begins by exploring different senses of knowledge. He continues to examine some logical peculiarities of expressions about believing and knowing, of relationships between the two types of expressions, and remarks on the performatory aspects of the relevant expressions. Connections between believing, and the bearing on beliefs of perceptual evidence, self-consciousness, memory and testimony (...) are examined. The results of this examination are applied to introduce systematic distinctions and concepts, which are made constitutive of the concept of belief. The notion of degrees of belief is introduced. The problem of degrees of assent is examined in the context of Newman's criticisms of Locke's view. Specific theories of belief are surveyed, beginning with Hume's theory, and two traditional occurrence analyses of belief are touched upon. The first series is concluded with a brief examination of Descartes' and Hume's views on freedom of assent. The second series examines various dispositional analyses of belief; the notions of believing and "acting as if" are compared, and the connection between inference and assent examined. The notion of half-belief is reviewed, along with Newman's distinction between real and notional assent, and James' self-verifying beliefs. The second series concludes with a discussion of moral beliefs and feelings; belief "in" and belief "that" are compared, and the possibility of a rapprochement between religious belief and empiricist philosophy is examined. While the author offers no full-blown theory of belief--and does not purport to do so--he provides a most informative discussion of the matrix of epistemological and psychological problems called belief, offers new criticisms of both older and present-day views on persisting problems for belief-analysis, and refines these views with new distinctions and concepts.--J. R. H. (shrink)

This Handbook documents the main trends in current research between logic and language, including its broader influence in computer science, linguistic theory and cognitive science. The history of the combined study of Logic and Linguistics goes back a long way, at least to the work of the scholastic philosophers in the Middle Ages. At the beginning of this century, the subject was revitalized through the pioneering efforts of Gottlob Frege, Bertrand Russell, and Polish philosophical logicians such as Kazimierz Ajdukiewicz. Around (...) 1970, the landmark achievements of Richard Montague established a junction between state-of-the-art mathematical logic and generative linguistic theory. Over the subsequent decades, this enterprise of Montague Grammar has flourished and diversified into a number of research programs with empirical and theoretical substance. This appears to be the first Handbook to bring logic-language interface to the fore. Both aspects of the interaction between logic and language are demonstrated in the book i.e. firstly, how logical systems are designed and modified in response to linguistic needs and secondly, how mathematical theory arises in this process and how it affects subsequent linguistic theory. The Handbook presents concise, impartial accounts of the topics covered. Where possible, an author and a commentator have cooperated to ensure the proper breadth and technical content of the papers. The Handbook is self-contained, and individual articles are of the highest quality. (shrink)

In spite of the seeming heterogeneity of topics in its title - Revolutions, Systems, and Theories - this volume purports to be something more than a random collection of Essays in Political Philosophy. The Colloquium of the Philosophy Department of the University of Western Ontario at which initial versions of the first eight papers were delivered was entitled 'Political Theory'; and while the organizers anticipated and indeed welcomed topicality in the issues accorded priority arid in the empirical evidence invoked, they (...) were also hoping for a reasonably comprehensive explorat ion of some of the central issues of political philosophy. For this reason it was quickly decided that in such a field a philosophical focus on clarification of ordering concepts required the suppIement - and test - of researches into more particular subject maUers by social scientists. Thus, to speak in general terms, contributors include political scientists, economists and sociologists as well as philosophers, and juxtaposed as proponents and commentators ·to generate exchanges across disciplinary frontiers. While the five additional invited papers are alI by professional philosophers, they extend the original Colloquium either by continuing controversy on its funda­ mental issues or by their continued explorations in what are acknowledged to be boundary areas. The greatest topical emphasis is that on revolution. (shrink)