This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. (...) Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. (shrink)

If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (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)

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the (...) guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (shrink)

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four (...) principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy—one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline. (shrink)

Is it remarkable that the Royal Dutch Medical Association as a medical professional organization has the point of view that in particular circumstances euthanasia is an acceptable act for a physician. Seen from the viewpoints in the international community, we might say that it is highly remarkable. Frankly put: the RDMA has met strong international disapproval of its standpoint on euthanasia during the last 10 years or so. For instance, the World Medical Association still condemns physicians performing euthanasia as “unethical.” (...) So far the RDMA is the only professional medical organization that holds the view that in particular cases euthanasia is morally acceptable. However, viewed within the context of Dutch society, the Dutch system of healthcare, and the sociocultural approach to moral questions in The Netherlands, the RDMA point of view ceases to be reprehensible. (shrink)

In the United Kingdom women have access to termination of pregnancy for maternal reasons until 24 weeks’ completed gestation, but it is accepted practice for children born at or beyond 25 weeks’ gestation to be treated according to the child’s perceived best interests even if this is not in accordance with parental wishes. The authors present a case drawn from clinical practice which highlights the discomfort that parents may feel about such an abrupt change in their rights over their child, (...) and argue that parents should have greater autonomy over treatment decisions regarding their prematurely born children. (shrink)

Focusing on a discussion by Ruddich and Stassen of the ?Remarks on Frazer's Golden Bough?, this paper shows that some of the usual criticisms made by sociologists of Wittgenstein are misplaced. He does not reject causal explanations of beliefs and actions and replace them with some other form of explanation, but dismisses the idea that any explanation is called for here. His argument that the origin of the desire to explain beliefs is to be found in a misconceived parallel between (...) science and magic is explained and discussed. (shrink)

It is usual to interpret Mill's understanding of liberty in terms deriving from his distinction in On Liberty between self-regarding and other-regarding conduct. Granted this distinction and Mill's genuine concern to define and defend it, it remains a relevant question why he attached so much importance to it. This raises a less familiar theme in Mill, namely the inter-connection of self-regarding and other-regarding conduct. An uncommitted reading of the main texts suggests an equivalent value is attached to this. Mill clearly (...) and constantly asserts a close connection between each person's own attempt to improve himself, to cultivate his ‘affections and will’, and the social and political structure in which he acts. Self-regarding virtue and responsible social conduct are interdependent; the quality of each depends upon the quality of the other. A fuller recognition of this and its central place in Mill's revision of Bentham may be of help in examining some of the particular problems raised by recent scholarship on Mill. (shrink)

“A society is more than a set of entities to which the same class-name applies” . Taking this obiter dictum of Whitehead's seriously, the present paper seeks to elucidate some of the more abstract properties of a society. By “society” I understand primarily human society in the sense in which it is an object of study for social theory, though part of what is said may admit of application to societies in some wider sense. An apology should perhaps be offered (...) for the terminology introduced. The writer's only excuse is that there seemed no other way of expressing the ideas in question. (shrink)

Systemic autoimmune diseases are characterized by the production of antibodies against a broad range of self-antigens. Recent evidence indicates that the majority of these autoantigens are modified in various ways during cell death. This has led to the hypothesis that the primary immune response in the development of autoimmunity is directed to components of the dying cell. In this article, we summarize data on the modification of autoantigens during cell death and the possible consequences of this for autoimmunity. BioEssays 22:627–636, (...) 2000. © 2000 John Wiley & Sons, Inc. (shrink)

One cannot but notice Plato's interest in prophecy and divination. He speaks disparagingly of the art and of those who practised it, yet it seems to have held some fascination for him. Moreover, he frequently uses the language of prophecy in a metaphorical sense, and it is this which I am to examine. Often, of course, this use is facetious, especially with the nouns ‘prophet’ and ‘prophecy’: he is ridiculing obscurity or playfully lending dignity to an obvious inference. But I (...) suggest that this facetious usage is common enough to be in itself evidence for the familiarity of Plato with this way of thinking. (shrink)

As critical incidents and terrorist threats are on the increase, the military/SWAT (Special Weapons and Tactics) aspects of U.S. civilian policing are being expanded. The person called upon as a last resort to kill the criminal agent has a unique position on the SWAT team. The police sniper is asked to kill with premeditation and usually not in a situation of self-defense. Very little appears in the ethics literature analyzing the morality of the sniper role. This paper will tentatively outline (...) a process of analysis that draws upon the framework of principles associated with the just-war tradition. Elements examined are the ends of sniper killing, intention and motives, relevant emotions, and implementation means used. The conclusion is that a plausible case can be made for the moral justification of such killing as long as certain conditions or tests are met. (shrink)

The European Union ambassadors revenue are lost to fraud and crime,” the of the Council of Minister, Mr. in BiH follow very closely develrelease read. Papandreou, and Mr. Solana, urged the opments as regards the issue of “We also have in mind the positive effect authorities of BiH recently to reach a the adoption, at a state level of single..