The debate on the ethical permissibility of euthanasia in medicine has a corollary in the ethical application of drugs. The overall moral limits of medical treatment apply evenly to the moral acceptability of the pharmacological aspect of the act of euthanasia. The pharmacological aspect of the act is of ethical importance not only for the person requesting an active ending of his or her life, but also for the grieving family. Keywords: effectivity, ideal euthanaticum, patient's/family's interest, pharmacology of euthanasia, routes (...) of application CiteULike Connotea Del.icio.us What's this? (shrink)

Important bioethcs changes are underway in the Netherlands that carry, for better or worse, far-reaching social consequences. The two major areas of change involve economics and containing soaring health costs and end-of-life care as reflected in several high-profile cases: in a decision handed down by the Dutch Supreme Court on reviewing the procedures for the termination of life, in the discussion surrounding The Groningen Protocol and the active ending of lives in neonatology, and in a report of a Royal Dutch (...) Medical Society's Committee on the role of physicians in ending life in cases of requests to die outside the area of terminal diseases. (shrink)

The open practice of euthanasia in The Netherlands stood alone in the world until the government of the Northern Territories in Australia accepted the possibility of physician-assisted suicide. Even though the active ending of lives in The Netherlands is still a crime by law, the current practice allows it and acquits physicians if certain conditions have been met. Of the many facets of euthanasia, the teaching of this practice represents a further logical step. In this contribution, we intend to describe (...) the comprehensive teaching program of euthanasia of the Free University of Amsterdam's Postgraduate Family Medicine Program. Here students receive university-based training for 1 day a week in a cohort of 12 and on the job training for 4 days with individual family physicians for 2 consecutive years. We especially intend to portray the integration of euthanasia into the wider teaching of the process of counseling and aid of the dying. (shrink)

Hospital ethics committees in The Netherlands have had the unique responsibility of developing euthanasia policies for their institutions. Although each policy necessarily reflects a particular facility, family resemblances necessarily remain. In the interest of ethics committees outside The Netherlands that may soon face the same challenge, two such policies are presented here accompanied by commentary high-lighting their similarities and differences.

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and (...) of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

In pursuit of my ultimate objective of being in control of my self-deliverance at the time when my physical condition no longer warrants continuance, I have joined the Hemlock Society of Los Angeles. The Society urges its members to explore with their personal physicians this subject well in advance of the actual moment of necessity, and in particular the problem of acquiring a lethal dose of a drug that will provide a release consistent in quality with the degree of peace (...) and serenity sought in life. It is my hope that we can find a process commensurate with your moral and professional concerns which will allow us to collaborate. (shrink)

In spite of the seminal work A Philosophical Basis of Medical Practice, the debate on the task and goals of philosophy of medicine still continues. From an European perspective it is argued that the main topics dealt with by Pellegrino and Thomasma are still particularly relevant to medical practice as a healing practice, while expressing the need for a philosophy of medicine. Medical practice is a discursive practice which is highly influenced by other discursive practices like science, law and economics. (...) Philosophical analysis of those influences is needed to discern their effect on the goals of medicine and on the ways in which the self-image of man may be changed. The nature of medical practice and discourse itself makes it necessary to include different philosophical disciplines, like philosophy of science, of law, ethics, and epistemology. Possible scenario's of euthanasia and the human genome project in the USA and Europe are used to exemplify how philosopy of medicine can contribute to a realistic understanding of the problems which are related to the goals of medicine and health care. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this (...) book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

The high prevalence of cardiovascular diseases demands a reliable and sensitive risk assessment technique. In order to develop a fast and label-free immunosensor for C-reactive protein, a risk factor for this condition, anti-CRP antibodies were physically adsorbed to the hydrogen -terminated surface of nanocrystalline diamond. An Enzyme-Linked ImmunoSorbent Assay reference technique showed that this was a suitable substrate for antibody-antigen recognition reactions. Electrochemical Impedance Spectroscopy was used to electronically detect CRP recognition. The specificity of the immunosensor was demonstrated by incubation (...) with CRP and plasminogen as reference molecule. A different impedance behavior was observed in real-time after CRP addition as compared to plasminogen addition: the impedance increased only during CRP incubation. Fitting the data showed that this corresponded with a decrease in capacitance of the molecular layer due to its increased thickness by specific CRP recognition. Sensitivity experiments in real-time showed a clear discrimination between 1 μM, 100 nM, and 10 nM of CRP after 10 min at 100 Hz. Since, 10 nM of CRP was still clearly distinguishable from buffer solution, our CRP-directed immunosensor prototype reaches a sensitivity that is within the physiologically relevant concentration range of this biomarker in healthy controls and CVD patients. Moreover, this prototype displayed real-time discriminating power between spiked and unspiked serum, and thus also shows its applicability in this biological matrix. © 2011 Elsevier B.V. All rights reserved. (shrink)

Background Informed consent procedures for large population-based cohort studies should be comprehensive and easy-to-use. This is particularly challenging when participants from different socio-economic groups and multicultural ethnic backgrounds are involved. Recently, more and more studies have tried to use multimedia in informed consent procedures. We describe the development and testing of a digital informed consent app and elaborate on whether this may contribute to a comprehensive and practical procedure to obtain informed consent for public health research. Methods In a sample (...) of parents with young children, we used a mixed method approach to study the user experience of an informed consent app and evaluate whether it can be used to adequately inform people and register their consent. Through semi-structured interviews we investigated participants’ experiences with and opinions about the app, with a special focus on comprehensibility of the content and the usability of the app. Information retention questions were asked to evaluate to what extent participants could recall key aspects of the provided study information. Results The 30 participants in this study used the app between 4 and 15 min to give their consent. Overall, they found the app well-designed, informative and easy to use. To learn more about the study for which informed consent is asked, most of the participants chose to watch the animated film, which was generally found to convey information in a clear manner. The identification process was met with mixed reactions, with some feeling it as a secure way to give consent, while for others it contradicted their view of using data anonymously. Information retention questions showed that while all participants remembered various aspects of the study, fewer than half answered all four questions satisfactorily. Conclusion Our study shows that a well-designed informed consent app can be an effective tool to inform eligible participants and to record consents. Still, some issues remain, including trust barriers towards the identification procedure and lack of information retention in some participants. When implementing consent procedures that incorporate digital formats, it may be beneficial to also invest in a complementary face-to-face recruitment approach. (shrink)

We argue that Lewis would have rejected recent appeals to the notions of ‘metaphysical dependency’, ‘grounding’ and ‘ontological priority’, because he would have held that they’re not needed and they’re not intelligible. We argue our case by drawing upon Lewis’s views on supervenience, the metaphysics of singletons and the dubiousness of Kripke’s essentialism.

Al-Ghazzālī a toujours utilisé les travaux de ses prédécesseurs. Le Mi‘yār al-‘ilm fī fann, sorte de manuel de logique aristotélicienne adaptée au droit et à la théologie islamiques, contient ainsi une grande variété d’écrits avicenniens, du K. jusqu’à certaines parties du Šifā’. Mais quelques écrits farabiens, en particulier al-Qiyās et al-Maqūlāt, y sont mêlés. C’est la première et, à notre connaissance, la seule fois qu’al-Ghazzālī combine ainsi des éléments empruntés à ces deux grands maîtres.

Held, K. Das Problem der Intersubjektivität und die Idee einer phänomenologischen Transzendentalphilosophie.-Hoyos, G. Zum Teleologiebegriff in der Phänomenologie Husserls.-Claesges, U. Zweideutigkeiten in Husserls Lebenswelt-Begriff.-Aguirre, A. Transzendentalphänomenologischer Rationalismus.-Mall, R.A. Phenomenology of reason.-Janssen, P. Ontologie, Wissenschaftstheorie und Geschichte im Spätwerk Husserls.-Eley, L. Zeitlichkeit und Protologik.-Hoche, H.-U. Gegenwart und Handlung.-Düsing, K. Das Problem der Denkökonomie bei Husserl und Mach.-Wienbruch, U. Die Funktion der schematisierten Ansicht im literarischen Kunstwerk.-Karthaus, U. Phänomenologische und poetische Zeit.

Husserl on the Ego and its Eidos (Cartesian Meditations, IV) ALFREDO FERRARIN THE THEORY OF the intentionality of consciousness is essential for Husserl's philosophy, and in particular for his mature theory of the ego. But it runs into serious difficulties when it has to account for consciousness's transcendental constitution of its own reflective experience and its relation to immanent time. This intricate knot, the inseparability of time and constitution, is most visibly displayed in Husserl's writings from the 192os up to (...) the notion of the eidos ego in the fourth Cartesian Meditation. In this paper I want to dwell on the most problematic aspects of this theory. After a few preliminary remarks about the intentionality of consciousness (sec- tion 1), I try to place the theory of the substrate of habitualities in the context of Husserl's evolution on the issue of the reflection of the ego on itself (section ~). I briefly follow the threads of Husserl's shifting position from the Logical Investi- gat/ons and Ideas I to Ideas II, the Cartesian Meditations and the Cr/s/s. I indicate Husserl's works are quoted with the following abbreviations: CM = Cartesiani.~he Meditationen, Husserliana Bd. I, hrsg. v. S. Strasser (Den Haag, 195o); Carte- s/an M~, trans. D. Cairns (Dordrecht, 196o ) SW = Husserl, Shorter Works, ed. P. McCormick and F. Elliston (Notre Dame, 198a) IZ = Zur Phttnomenologie des inneren Zeilheun~tseim (z 893-z 917), Husserliana Bd. X, hrsg. v. R. Boehm (Den Haag, 1966 ) Ideen I = ldeen zu einer reinen Ph~nomenologie und ph~nomenologischen Philosophic, Husserliana Bd. III, hrsg. v. W. Biemel (Den Haag, t95o); Ideas I, trans. F. Kersten (The Hague, Boston, Lancaster, s983) ldeen// = ld., Hussefliana Bd. IV, hrsg. v. M. Biemel (Den Haag, 1952); Ideas I1, trans. R. Rojcewicz and A. Schuwer (Dordrecht, Boston, London, x 989) FTL = Forma/e und transzendenta~ Log/k, Husserliana Bd. XVII, hrsg. v. P. Janssen (Den Haag, t974) Kr/sh = Kr/s/s der europ~/schen W/ssen~haften, Husserliana Bd. VI, hrsg. v. W. Biemel (Den Haag, 1954) I wish to express my gratitude to Pierre Kerszberg and Alessandra Fussi for their helpful com- ments on an earlier draft of the paper, and to Graham Harman for checking the final version of my English text. [645] 646 JOURNAL OF THE HISTORY OF PHILOSOPHY 32:4 OCTOBER 1994 some historical antecedents, in particular Aristotle, of Husserl's theory of abid- ing properties which, as far as I can see, have not been pointed out before. Husserl's Entwicklungsgeschichte on the topic of the pure ego has already been the object of important scholarly works, of which Kern's 1964 Husserl und Kant seems to me the best example. But what the secondary literature does not do is develop thematically the ambiguities of Husserl's definitions of consciousness and temporality in a unitary and comprehensive way. While I follow the lead of Berger, Broekman, Kern, Marbach,' and others, I find that their work does not sufficiently stress the difficulties at the core ofintentionality and reflective time- consciousness. Therefore, although section 2 is a necessary presupposition for drawing some critical conclusions in the final two sections, it does not exhaust my theme. After clarifying the peculiarity of the notions of essence, intuition, tran- scendental and apriori, as well as their irl:educibility to a Kantian meaning, I turn to the "de facto transcendental ego" resulting from eidetic variation (section 3) in order to introduce an examination of temporality. The difficul- ties in the twofold requirement, namely, that consciousness be the identical subject of its Erlebnisse and be synthetically unified in time, concern the unity, primacy, and mutual relation of time and consciousness in the constitution of our experience. They have been heady pointed out by Ricoeur in his commen- tary on the Cartesian Meditations. But what I want to argue in section 4, going beyond Ricoeur's text, is that the tension between temporally constituted and constitutive consciousness in the ego's reflection on its own retentions and protensions does not simply make the question of time ambiguous, but has crucial and problematic bearings on the very definition of consciousness as intentionality. In this respect... -/- . (shrink)

The anti-realist argument from underconsideration focuses on the fact that, when scientists evaluate theories, they only ever consider a subset of the theories that can account for the available data. As a result, when scientists judge one theory to be superior to competitor theories, they are not warranted in drawing the conclusion that the superior theory is likely true with respect to what it says about unobservable entities and processes. I defend the argument from underconsideration from the objections of Peter (...) Lipton. I argue that the inconsistency that Lipton claims to find in the argument vanishes once we understand what the anti-realist means when she claims that scientists are reliable. I also argue that collapsing the distinction between relative and absolute evaluations, as Lipton recommends, has its costs. Finally, I briefly examine Richard Boyd's influential defence of realism. (shrink)

Why should we seek and tell the truth? Does anyone know what truth is? Many are skeptical about the relevance of truth. Truth Matters endeavours to show why truth is important in a world where the very idea of truth is contested. Putting philosophers in conversation with educators, literary scholars, physicists, political theorists, and theologians, Truth Matters ranges across both analytic and continental philosophy and draws on the ideas of thinkers such as Aquinas, Balthasar, Brandom, Davidson, Dooyeweerd, Gadamer, Habermas, Kierkegaard, (...) Plantinga, Ricoeur, and Wolterstorff. Some essays attempt to provide a systematic account of truth, while others wrestle with the question of how truth is told and what it means to live truthfully. Contributors address debates between realists and anti-realists, explore issues surrounding relativism and constructivism in education and the social sciences, examine the politics of truth telling and the ethics of authenticity, and consider various religious perspectives on truth. Most scholars agree that truth is propositional, being expressed in statements that are subject to proof or disproof. This book goes a step farther: yes, propositional truth is important, but truth is more than propositional. To recognize how it is more than propositional is crucial for understanding why truth truly matters. Contributors include Doug Blomberg (ICS), Allyson Carr (ICS), Jeffrey Dudiak (King’s University College), Olaf Ellefson (York University), Gerrit Glas (VU University Amsterdam), Gill K. Goulding (Regis College), Jay Gupta (Mills College), Clarence Joldersma (Calvin College), Matthew J. Klaassen (ICS), John Jung Park (Duke University), Pamela J. Reeve (St. Augustine’s Seminary), Amy Richards (World Affairs Council of Western Michigan), Calvin Seerveld (ICS), Ronnie Shuker (ICS), Adam Smith (Brandeis University), John Van Rys (Redeemer University College), Darren Walhof (Grand Valley State University), Matthew Walhout (Calvin College), and Lambert Zuidervaart (ICS). (shrink)

I evaluate the extent to which we could learn something about how we should be conducting collaborative research in science from the research on groupthink. I argue that Solomon has set us in the wrong direction, failing to recognize that the consensus in scientific specialties is not the result of deliberation. But the attention to the structure of problem-solving that has emerged in the groupthink research conducted by psychologists can help us see when deliberation could lead to problems for a (...) research team. I argue that whenever we need to generate alternative solutions or proposals, groupthink is a genuine threat, and research teams would be wise to allow individuals opportunities to work alone. But the benefits of team work emerge when scientists seek to evaluate the various proposals generated, and determine a course of action. Then the group is less prone is groupthink, and the interaction of group members can be an epistemic asset. (shrink)

Van Fraassen believes our current best theories enable us to make accurate predictions because they have been subjected to a selection process similar to natural selection. His explanation for the predictive success of our best theories has been subjected to extensive criticism from realists. I aim to clarify the nature of van Fraassen’s selectionist explanation for the success of science. Contrary to what the critics claim, the selectionist can explain why it is that we have successful theories, as well as (...) why it is reasonable to expect past successful theories to be successful in the future. I also argue that the plausibility of the realists’ explanation rests on an inaccurate understanding of the nature of predictive success . The predictive success of our best theories is a relative success. (shrink)

I present a history of Kuhn’s discovery of paradigms, one that takes account of the complexity of the discovery process. Rather than emerging fully formed in Structure , the concept paradigm emerged through a series of phases. Early criticism of Structure revealed that the role of paradigms was unclear. It was only as Kuhn responded to criticism that he finally articulated a precise understanding of the concept paradigm. In a series of publications in the 1970s, he settled on a conception (...) of a paradigm as a concrete exemplar that functions as a guide to future research. (shrink)

I examine the citation patterns to a revolutionary scientific paper, Hess’ “History of Ocean Basins”, which played a significant role in the plate tectonics revolution in the geosciences. I test two predictions made by the geoscientist Menard (in Science: growth and change. Harvard University Press, Cambridge, 1971): (1) that the peak year of citations for Hess’ article will be 1968; and (2) that the rate of citations to the article will then reach some lower level, continuing on accumulating citations at (...) some regular but unimpressive rate. Drawing on data covering the period from 1962 to 2019, I show that Menard was close with respect to the first prediction. But I also show that things are less clear with respect to the second prediction. I explain why the data are less clear with respect to the second prediction. (shrink)

Rejectionists argue that collective belief ascriptions are best understood as instances of collective acceptance rather than belief. Margaret Gilbert objects to rejectionist accounts of collective belief statements. She argues that rejectionists rely on a questionable methodology when they inquire into the nature of collective belief ascriptions, and make an erroneous inference when they are led to believe that collectives do not really have beliefs. Consequently, Gilbert claims that collective belief statements are best understood as instances of belief. I critically examine (...) Gilbert’s criticisms of rejectionism. I argue that rejectionism is still a viable account of collective belief ascriptions. I also argue that Gilbert’s most powerful criticism provides important insight into what really stands between her and the rejectionists. Gilbert and the rejectionists do not yet agree about what background assumptions can be made in developing an account of collective belief ascriptions. (shrink)

I examine the influence of James B. Conant on the writing of Kuhn’s Structure of Scientific Revolutions. By clarifying Conant’s influence on Kuhn, I also clarify the influence that others had on Kuhn’s thinking. And by identifying the various influences that Conant had on Kuhn’s view of science, I identify Kuhn’s most original contributions in Structure. On the one hand, I argue that much of the framework and many of the concepts that figure in Structure were part of Conant’s picture (...) of science, a picture that figured prominently in the general education natural science courses that Conant taught at Harvard. On the other hand, I show that Kuhn’s Structure contains important contributions that do not figure in Conant’s picture of science. I argue that the following three themes in Structure do not originate with Conant: (1) the concept of “normal science”; (2) “the problem of scientific revolutions,” that is, the apparent threat posed by radical changes of theory in science; and (3) Kuhn’s emphasis on the social dimensions of science, specifically the social structure of research communities. (shrink)

Increasingly, national governments across the globe are prioritizing investments in neuroscience. Currently, seven active or in-development national-level brain research initiatives exist, spanning four continents. Engaging with the underlying values and ethical concerns that drive brain research across cultural and continental divides is critical to future research. Culture influences what kinds of science are supported and where science can be conducted through ethical frameworks and evaluations of risk. Neuroscientists and philosophers alike have found themselves together encountering perennial questions; these questions are (...) engaged by the field of neuroethics, related to the nature of understanding the self and identity, the existence and meaning of free will, defining the role of reason in human behavior, and more. With this Perspective article, we aim to prioritize and advance to the foreground a list of neuroethics questions for neuroscientists operating in the context of these international brain initiatives. (shrink)

Social media applications such as Twitter, YouTube and Facebook have attained huge popularity, with more than three billion people and organizations predicted to have a social networking account by 2015. Social media offers a rapid avenue of communication with the public and has potential benefits for communicable disease control and surveillance. However, its application in everyday public health practice raises a number of important issues around confidentiality and autonomy. We report here a case from local level health protection where the (...) friend of an individual with meningococcal septicaemia used a social networking site to notify potential contacts. (shrink)