On 23 September 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world to have an Act on euthanasia. Even though there is currently legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia.

This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some essential values and norms that must be observed in an ethical evaluation of physical restraint. These values and norms provide the ethical foundation for a number of concrete recommendations that could give clinical and ethical support to caregivers when they make decisions about physical restraint. Respect for the autonomy and overall wellbeing of (...) older persons, a proportional assessment of the advantages and disadvantages, a priority focus on the alternatives to physical restraint, individualised care, interdisciplinary decision making, and an institutional policy are the central points that make it possible to deal responsibly with the use of physical restraint for older persons in nursing homes. (shrink)

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of ‘more’ than the competent performance of a number of caring activities. For many nurses it is less clear what this ‘more’ means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care can be considered as (...) a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process. (shrink)

The aim of this article is to provide a preliminary ethical evaluation of the effect of telesurgery on patient care. In order to accomplish this task we give a broad description of the state of the art in telesurgery and analyse it using Joan Tronto’s articulation of care as a structured process. This structure illuminates the significance of the patient-physician relationship as the buttress for establishing and preserving practices of care in the healthcare context, with the ultimate goal of safeguarding (...) patient dignity. The process of care combined with the moral aim of medicine—to fulfil the good of the patient—provides the ethical foundation for assessing telesurgery. By exploring various telesurgical scenarios we may assess its potential role in augmenting or diminishing patient care within the frame of the patient-physician relationship. The significance of conducting this evaluation lies in the fact that the practice of telesurgery may very shortly become routine and an evaluation has not yet been attempted. (shrink)

This article opens by reviewing the state of the knowledge on the most current worldwide facts about suicide in older people. Next, a number of values that have a role in this problem are considered. Having a clear and current understanding of suicide and of the related self-held and social values forms the framework for a number of clinical–ethical recommendations for care practice. An important aspect of caring for older people with suicidal tendencies is to determine whether their primary care (...) fosters self-esteem and affirms their dignity. In addition to providing a timely and appropriate diagnosis and treatment of suicidality, the caregiver is responsible for helping the patient to cope with stressful conditions, and for treating the patient with respect and consideration, thereby supporting the patient’s dignity and giving the patient a reason to live. Paying attention to these central points will foster caring contact with suicidal older people. (shrink)

Background: Although nurses worldwide are confronted with euthanasia requests from patients, the views of palliative care nurses on their involvement in euthanasia remain unclear.Objectives: In depth exploration of the views of palliative care nurses on their involvement in the entire care process surrounding euthanasia.Design: A qualitative Grounded Theory strategy was used.Setting and participants: In anticipation of new Belgian legislation on euthanasia, we conducted semistructured interviews with 12 nurses working in a palliative care setting in the province of Vlaams-Brabant.Results: Palliative care (...) nurses believed unanimously that they have an important role in the process of caring for a patient who requests euthanasia, a role that is not limited to assisting the physician when he is administering life terminating drugs. Nurses’ involvement starts when the patient requests euthanasia and ends with supporting the patient’s relatives and healthcare colleagues after the potential life terminating act. Nurses stressed the importance of having an open mind and of using palliative techniques, also offering a contextual understanding of the patient’s request in the decision making process. Concerning the actual act of performing euthanasia, palliative care nurses saw their role primarily as assisting the patient, the patient’s family, and the physician by being present, even if they could not reconcile themselves with actually performing euthanasia.Conclusions: Based on their professional nursing expertise and unique relationship with the patient, nurses participating as full members of the interdisciplinary expert team are in a key position to provide valuable care to patients requesting euthanasia. (shrink)

Since Carol Gilligan's In a Different Voice (1982) the ethics of care has developed as a movement of allied thinkers, in different continents, who have a shared concern and who reflect on similar topics. This shared concern is that care can only be revalued and take its societal place if existing asymmetrical power relations are unveiled, and if the dignity of care givers and care receivers is better guaranteed, socially, politically and personally. In this first volume of a new series (...) leading care ethicists from Europe and the United States focus on the moral significance of two concepts in the debate that ask for further reflection. In discussion with the work of Axel Honneth on recognition and the work of Emmanuel Housset on compassion a contribution is made to a reconsideration of recognition and compassion from an ethics of care perspective. This volume contains contributions by Andries Baart, Estelle Ferrarese, Chris Gastmans, Mieke Grypdonck, Emmanuel Housset, Carlo Leget, Hilde Lindemann, Axel Liegeois, Christa Schnabl, Joan C. Tronto, Annelies van Heijst, Linus Vanlaere, Frans Vosman and Margaret Urban Walker. (shrink)

DINÇ L and GASTMANS C. Nursing Inquiry 2012; 19: 223–237 Trust and trustworthiness in nursing: an argument‐based literature reviewCaring requires nurses to establish trusting relationships with patients and to be trustworthy professionals. This article provides insight into the conceptual understanding of trust and trustworthiness in nursing through an argument‐based literature review of 17 articles published between 1980 and 2010. Trust is characterized as an attitude relying with confidence on someone. The importance of trust relationships is considered by addressing the (...) imbalances of power in nurse–patient relationships as they increase the vulnerability and dependency of the truster. Trust is considered as a process, and time, reliance on others, risk and fragility are identified as basic attributes of trust. However, trustworthiness is inadequately explored in the nursing ethics literature. Nurse educators have a responsibility to ensure that nurses are equipped with the attitudes and knowledge that are needed to establish trusting nurse–patient relationships. (shrink)

Objective: Although nurses have an important role in the care process surrounding artificial food or fluid administration in patients with dementia or in terminally ill patients, little is known about their attitudes towards this issue. The purpose of this study was to thoroughly examine nurses’ attitudes by means of a literature review.Method: An extensive systematic search of the electronic databases PubMed, Cinahl, PsycINFO, The Cochrane Library, FRANCIS, Philosopher’s Index and Social Sciences Citation Index was conducted to identify pertinent articles published (...) from January 1990 to January 2007.Findings: Nurses’ arguments for or against could be categorised as ethical-legal, clinical or social-professional. The most important arguments explicitly for artificial food and fluid administration in patients with dementia or in terminally ill patients were sanctity of life, considering artificial food and fluid administration as basic nursing care, and giving reliable nutrition, hydration or medication. An explicit counter-argument was the high cost of treatment. Arguments used by opponents and proponents were quality of life and dignified death. The arguments were not strikingly different for the two patient populations. It turned out that the nurses’ ethical arguments remarkably reflected the current ethical debate. But some of their clinical presuppositions contradicted current clinical evidence.Conclusion: The interaction between clinical facts and ethical reflections makes the findings of this review extremely relevant for clinical ethics. A large need exists to clearly communicate to nurses the latest clinical evidence and the main results of ongoing ethical debates. (shrink)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately (...) operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

The philosophical theory of scientific explanation proposed here involves a radically new treatment of causality that accords with the pervasively statistical character of contemporary science. Wesley C. Salmon describes three fundamental conceptions of scientific explanation--the epistemic, modal, and ontic. He argues that the prevailing view is untenable and that the modal conception is scientifically out-dated. Significantly revising aspects of his earlier work, he defends a causal/mechanical theory that is a version of the ontic conception. Professor Salmon's theory furnishes a robust (...) argument for scientific realism akin to the argument that convinced twentieth-century physical scientists of the existence of atoms and molecules. To do justice to such notions as irreducibly statistical laws and statistical explanation, he offers a novel account of physical randomness. The transition from the "reviewed view" of scientific explanation to the causal/mechanical model requires fundamental rethinking of basic explanatory concepts. (shrink)

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

_Rhetoric_ is the sixth volume in The New Hackett Aristotle series, a series featuring translations, with Introductions and Notes, by C. D. C. Reeve, Delta Kappa Epsilon Distinguished Professor of Philosophy at The University of North Carolina at Chapel Hill. The series will eventually include all of Aristotle's works.

C. S. Lewis sets out to persuade his audience of the importance and relevance of universal values such as courage and honor in contemporary society.

Investigates the resolution of contradictions and ambiguous derogations in a code, by means of the imposition of partial orderings. Although formulated as a study in the logic of norms, it provided the initial ideas for work on the logic of theory (or belief) change, developed by the authors in a series of papers by the authors and Peter Gardenfors beginning in 1985.

Aristotle's treatise De Interpretatione is one of his central works; it continues to be the focus of much attention and debate. C. W. A. Whitaker presents the first systematic study of this work, and offers a radical new view of its aims, its structure, and its place in Aristotle's system, basing this view upon a detailed chapter-by-chapter analysis.By treating the work systematically, rather than concentrating on certain selected passages, Whitaker is able to show that, contrary to traditional opinion, it forms (...) an organized and coherent whole. He argues that the De Interpretatione is intended to provide the underpinning for dialectic, the system of argument by question and answer set out in Aristotle's Topics; and he rejects the traditional view that the De Interpretatione concerns the assertion and is oriented towards the formal logic of the Prior Analytics. In doing so, he sheds valuable new light on some of Aristotle's most famous texts. (shrink)

This book critically assesses arguments for the existence of the God of classical theism, develops an innovative account of objects’ persistence, and defends new arguments against classical theism. The authors engage the following classical theistic proofs: Aquinas’s First Way, Aquinas’s De Ente argument, and Feser’s Aristotelian, Neo-Platonic, Augustinian, Thomistic, and Rationalist proofs. The authors also provide the first systematic treatment of the ‘existential inertia thesis’. By connecting the thesis to relativity theory and recent developments in the philosophy of physics, and (...) by developing a variety of novel existential-inertia-friendly explanations of persistence, they mount a formidable new case against classical theistic proofs. Finally, they defend new arguments against classical theism based on abstract objects and changing divine knowledge. The text appeals to students, researchers, and others interested in classical theistic proofs, the existence and nature of God, and the ultimate explanations of persistence, change, and contingency. (shrink)

'Original and provocative . . . engagingly written. (C Fred Alford) counters Levinas's notorious obscurity with a goodly dose of transparency' - John Lechte, Macquarrie University Abstract and evocative, writing in what can only be ...

C. Stephen Evans explains and defends Kierkegaard's account of moral obligations as rooted in God's commands, the fundamental command being `You shall love your neighbour as yourself'. The work will be of interest not only to those interested in Kierkegaard, but also to those interested in the relation between ethics and religion, especially questions about whether morality can or must have a religious foundation. As well as providing a comprehensive reading of Kierkegaard as an ethical thinker, Evans puts him into (...) conversation with contemporary moral theorists. Kierkegaard's divine command theory is shown to be an account that safeguards human flourishing, as well as protecting the proper relations between religion and state in a pluralistic society. (shrink)

Is there such a thing as natural knowledge of God? C. Stephen Evans presents the case for understanding theistic arguments as expressions of natural signs in order to gain a new perspective both on their strengths and weaknesses. Three classical, much-discussed theistic arguments - cosmological, teleological, and moral - are examined for the natural signs they embody. At the heart of this book lie several relatively simple ideas. One is that if there is a God of the kind accepted by (...) Christians, Jews, and Muslims, then it is likely that a 'natural' knowledge of God is possible. Another is that this knowledge will have two characteristics: it will be both widely available to humans and yet easy to resist. If these principles are right, a new perspective on many of the classical arguments for God's existence becomes possible. We understand why these arguments have for many people a continued appeal but also why they do not constitute conclusive 'proofs' that settle the debate once and for all. Touching on the interplay between these ideas and contemporary scientific theories about the origins of religious belief, particularly the role of natural selection in predisposing humans to form beliefs in God or gods, Evans concludes that these scientific accounts of religious belief are fully consistent, even supportive, of the truth of religious convictions. (shrink)

Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, (...) Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)

_Verificationism_ is the first comprehensive history of a concept that dominated philosophy and scientific methodology between the 1930s and the 1960s. The verificationist principle - the concept that a belief with no connection to experience is spurious - is the most sophisticated version of empiricism. More flexible ideas of verification are now being rehabilitated by a number of philosophers. C.J. Misak surveys the precursors, the main proponents and the rehabilitators. Unlike traditional studies, she follows verificationist theory beyond the demise of (...) positivism to examine its reappearance in the work of modern philosophers. Most interestingly, she argues that despite feminism's strenuous opposition to positivism, verificationist thought is at the heart of much of contemporary feminist philosophy. _Verificationism_ is an excellent assessment of a major and influential system of thought. (shrink)

"A rich collection. Since it holds a number of introductory pieces along with advanced essays and review articles, the volume will be accessible to a broad audience and will work well in philosophy of science courses....Essential."--Lawrence Sklar, University of Michigan.

Different embodiments of technology permeate all layers of public and private domains in society. In the public domain of aged care, attention is increasingly focused on the use of socially assistive robots supporting caregivers and older adults to guarantee that older adults receive care. The introduction of SARs in aged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening the connection between these two fields (...) is crucial to have a full understanding of the ethical impact of these technological artefacts. To bridge this gap, we propose a philosophical-ethical framework for SAR use, one that is grounded in the dialogue between empirical-ethical knowledge about and philosophical-ethical reflection on SAR use. We highlight the importance of considering the intuitions of older adults and their caregivers in this framework. Grounding philosophical-ethical reflection in these intuitions opens the ethics of SAR use in aged care to its own socio-historical contextualisation. Referring to the work of Margaret Urban Walker, Joan Tronto and Andrew Feenberg, it is argued that this socio-historical contextualisation of the ethics of SAR use already has strong philosophical underpinnings. Moreover, this contextualisation enables us to formulate a rudimentary decision-making process about SAR use in aged care which rests on three pillars: stakeholders’ intuitions about SAR use as sources of knowledge; interpretative dialogues as democratic spaces to discuss the ethics of SAR use; the concretisation of ethics in SAR use. (shrink)

A critical and detailed introduction to Kant's philosophy, with particular reference to the Critique of Pure Reason. Since Broad's death there have been many publications on Kant but Broad's 1978 book still finds a definite place between the very general surveys and the more specialised commentaries. He offers a characteristically clear, judicious and direct account of Kant's work; his criticisms are acute and sympathetic, reminding us forcefully that 'Kant's mistakes are usually more important than other people's correctitudes'. C.D. Broad was (...) Knightsbridge Professor of Moral Philosophy at Cambridge from 1933 to 1953, and this book is based on his undergraduate lectures on Kant. Broad died in 1971 and Dr Lewy has since edited the book for publication. (shrink)

In this investigation of the contemporary notion of evil, C. Fred Alford asks what we can learn about this concept, and about ourselves, by examining a society where it is unknown--where language contains no word that equates to the English term "evil." Does such a society look upon human nature more benignly? Do its members view the world through rose-colored glasses? Korea offers a fascinating starting point, and Alford begins his search for answers there.In conversations with hundreds of Koreans from (...) diverse religions and walks of life--students, politicians, teachers, Buddhist monks, Confucian scholars, Catholic priests, housewives, psychiatrists, and farmers--Alford found remarkable agreement about the nonexistence of evil. Koreans regard evil not as a moral category but as an intellectual one, the result of erroneous Western thinking. For them, evil results from the creation of dualisms, oppositions between people and ideas.Alford's interviews often led to discussions about imported ways of thinking and the impact of globalization upon society at large. In particular, he was struck by how Koreans' responses to globalization matched Westerners' views about evil. In much of the world, he argues, globalization is the ultimate dualism--attractive for the enlightenment and freedom it brings, terrifying for the great social and personal upheaval it can cause. (shrink)