Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H-2-antihistamines by general practitioners, internists and "astroenterologists were obtained from the Belgian (...) national health insurance database (1997-2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the Iona term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care. (shrink)

Objectives: The objective of this study is to estimate the proportion of different types of end‐of‐life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice. Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self‐administered mail questionnaire per death case (max. 5/doctor) Results: the response rate was 55% (...) (N=269). In 37.3% of all cases at least one ELD was made (16.5% non‐treatment decisions; 16% potential life‐shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases were an ELD was made that decision was legally questionable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life‐stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD‐cases were in response to a direct request from the patient Conclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected. (shrink)

Objectives: The objective of this study is to estimate the proportion of different types of end‐of‐life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice.Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self‐administered mail questionnaire per death case (max. 5/doctor)Results: the response rate was 55% (N=269). In (...) 37.3% of all cases at least one ELD was made (16.5% non‐treatment decisions; 16% potential life‐shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases were an ELD was made that decision was legally questionable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life‐stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD‐cases were in response to a direct request from the patientConclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected. (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)

International Rules brings together exemplary works from the most prominent approaches to international rules of International Law and International Relations disciplines. Included are chapters on Natural Law, Legal Positivism, Classical Realism, the New Haven School, Institutionalism, Structural Realism, the New Stream, and Feminist Voices. Each of the eight chapters begins with a brief overview, offers a representative work or works, and concludes with a selected bibliography. From Hugo Grotius to David Kennedy, from George Kennan to Robert Keohane, the featured (...) authors provide valuable insights into their common subject: international rules. Despite divergent methods and objectives, they address fundamentally the same questions: What is the nature of such rules? What is their purpose? How do they originate? What role, if any, do they play in politics? Framing the selections assembled are two original chapter-length essays. The first chapter of this volume assesses the prospects for interdisciplinary collaboration; the final one suggests a direction for future research. (shrink)

Several themes of David Lewis's theory of counterfactuals, especially their sensitivity to context, pave the way for a viable theory of non-trivial counterpossibles. If Lewis was successful in defending his account against the early objections, a semantics of counterpossibles can be defended from similar objections in the same way. The resulting theory will be extended to address 'might' counterfactuals and questions about the relative "nearness" of impossible worlds.

Plausibly, no agent ever performs an action without some desire to perform that action. If so, a regress argument shows that, given incompatibilism, we are only rarely free. The argument sidesteps recent objections to this thesis.

Winner of the Los Angeles Times Book Prize With a new preface by the author In his most powerful and important book, renowned psychiatrist Robert Jay Lifton presents a brilliant analysis of the crucial role that German doctors played in the Nazi genocide. Now updated with a new preface, The Nazi Doctors remains the definitive work on the Nazi medical atrocities, a chilling exposé of the banality of evil at its epitome, and a sobering reminder of the darkest side (...) of human nature. (shrink)

The relationship between love/care and justice was one of the key tensions from which care ethics originated; to this very day it is subject of debate between various streams of thought within care ethics. With some exceptions most approaches have in common the belief that care and justice are mutually exclusive concepts, or at least as so different that their application is situated on different levels. Hence, both are complementary, but distinct, so that there is no real interaction. This paper (...) aims to investigate whether, and if so, how, a deeper understanding of Ricoeur’s thoughts on this matter enriches the relationship between care and justice with respect to care ethics. This connection suggests itself from Ricoeur’s interpretation of the relationship as a dialectical one in which the logic of superabundance and the logic of equivalence meet. Care enables people to see the face and individuality of the one, ‘le chacun,’ within the anonymous structures of justice that tend to reduce all human beings to the anonymous each, ‘le on’; justice in its turn is the precondition for love to become incarnated and made real. What may this view—of care and justice standing in close connection, in which they correct and strengthen each other—add to the understanding of concrete practices of care? (shrink)

Name der Zeitschrift: Byzantinische Zeitschrift Jahrgang: 108 Heft: 2 Seiten: 827-844.

This paper offers an overview of "the species problem", arguing for a view of species as homeostatic property cluster kinds, positioning the resulting form of realism about species as an alternative to the claim that species are individuals and pluralistic views of species. It draws on taxonomic practice in the neurosciences, especially of neural crest cells and retinal ganglion cells, to motivate both the rejection of the species-as-individuals thesis and species pluralism.

Drawing on a passage from Ramsey's Truth and Probability, we formulate a simple, plausible constraint on evaluating the accuracy of credences: the Calibration Test. We show that any additive, continuous accuracy measure that passes the Calibration Test will be strictly proper. Strictly proper accuracy measures are known to support the touchstone results of accuracy-first epistemology, for example vindications of probabilism and conditionalization. We show that our use of Calibration is an improvement on previous such appeals by showing how it answers (...) or sidesteps problems that have been raised for previous work in this area. (shrink)

The thirty chapters work through various fundamental metaphysical issues, sometimes focusing more on scholastic thought, sometimes on the seventeenth century.

This chapter focuses on one of the common fallacies in Western philosophy called “adverse consequences”. The argument from adverse consequences can be seen as an argument that is intended to be pragmatic ‐ about what we should do, not about what is true ‐ but then comes to the wrong kind of conclusion. In many genuinely pragmatic arguments, however, adverse consequences are relevant to the conclusion and no fallacy is committed. So it is important to notice exactly what the conclusion (...) of the argument is. (shrink)

This entry provides a brief exposition and formal reconstruction of the argument for possible worlds in David Lewis's _Counterfactuals_.

The theory of possible worlds has permeated analytic philosophy in recent decades, and its best versions have a consequence which has gone largely unnoticed: in addition to the panoply of possible worlds, there are a great many impossible worlds. A uniform ontological method alone should bring the friends of possible worlds to adopt impossible worlds, I argue, but the theory's applications also provide strong incentives. In particular, the theory facilitates an account of counterfactuals which avoids several of the implausible results (...) of David Lewis's account, and it paves the way for the analogues of Kripkean semantics for epistemic and relevant logics. On the theories of possible worlds as abstract objects, worlds bear a strong resemblance to propositions. I contend that if there are distinct necessarily false propositions, then there are likewise distinct impossible worlds. However, one who regards possible worlds as concrete objects must not recognize impossible worlds, in part because concrete worlds cannot misrepresent certain features of reality, as some impossible worlds must. Accordingly, I defend and develop a theory of impossible worlds as maximal impossible states of affairs. Impossible worlds perform admirably in the analysis of counterfactuals with impossible antecedents. I argue that, contrary to standard accounts, not all counterpossibles are trivially true, and I develop a Lewis-style semantics which allows this result. The point is crucial, since many views presuppose that some counterpossibles are substantive philosophical truths. Finally, I show that impossible worlds hold great promise for doxastic and relevant logics. Epistemic logic needs a domain of propositions which is not closed under strict implication to avoid the problem of logical omniscience, and relevant logic needs such a domain to avoid the famous paradoxes of implication. In sum, impossible world theory promises natural, elegant solutions to philosophical problems in numerous areas where possible worlds alone flounder. These solutions come to most possible world theorists at no cost, since the existence of impossible worlds is entailed by theses they already hold. (shrink)

Are interpersonal comparisons of desire possible? Can we give an account of how facts about desires are grounded, that underpins such comparisons? This paper supposes the answer to the first question is yes, and provides an account of the nature of desire that explains how this is so. The account is a modification of the interpretationist metaphysics of representation that the author has recently been developing. The modification is to allow phenomenological affective valence into the “base facts” on which correct (...) interpretation is grounded. To use this extra resource within that theory to vindicate interpersonal comparisons, we will need to appeal rational connections between level of valence and level of desire, which this paper sets out and examines. (shrink)

A recently advanced argument for purgatory hinges on the need for complete sanctification before one can enter heaven. The argument has a modal gap.The gap can be exploited to fashion a competing account of how sanctification occurs in the afterlife according to which it is in part a heavenly process.The competing account usefully complicates the overall case for purgatory and raises questions about how the notion ought to be understood.

The paper offers an analysis of Protagoras’ fr. DK 80 B 1 and rejects the traditional reading of Protagoras as relativist. By considering the ipsissima verba that Protagoras makes use of in his passage, it is argued that alternative interpretations are possible, of which epistemological reism and psychological individualism are proposed. On a more general level, it is discussed to what extent Protagoras’ fragment contains descriptive rather than normative claim.

The early nineteenth century was a time between empires in German-speaking lands, following the collapse of the holy Roman empire in 1806. This was also the time at which modern concepts of nations, nationalism, and the state entered theological discourse, bound together with emerging notions of world historical progress. From this time until the First World War, the task of conceptualizing national identity and the nature of the ‘Christian state’ became a pressing theological problem. This essay seeks to locate Schleiermacher’s (...) reflections on the Christian state within this developing problematic. Schleiermacher’s philosophical and theological works closely engaged emerging ideas of the nation, state, and historical progress. However, he departed from the more totalizing affirmations of national spirit and the Christian state of many of his contemporaries, arguing for a more limited conception of the state as a point of transition in the ongoing historical development of the reign of God. (shrink)

In the good old days, when general philosophy of science ruled the Earth, a simple division was often invoked to talk about philosophical issues specific to particular kinds of science: that between the natural sciences and the social sciences. Over the last 20 years, philosophical studies shaped around this dichotomy have given way to those organized by more fine-grained categories, corresponding to specific disciplines, as the literatures on the philosophy of physics, biology, economics and psychology--to take the most prominent four (...) examples--have blossomed. In general terms, work in each of these areas has become increasingly enmeshed with that in the corresponding science itself, increasingly naturalistic (in at least one sense of that term), and in my view, increasingly interesting. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

The rise of nationalist and populist tendencies and their exclusivist discourse and consequent polarizing effects challenge the Christian narrative, especially if politicians openly look for support within the Catholic Church and Christian churches, thereby referring to Europe’s Christian heritage and Judeo-Christian roots. This article shows how Fratelli tutti can be read as a response to this attempted exclusivist interpretation of Christian identity. Pope Francis is not unaware of the underlying dynamics that lead people to become exclusivist rather than embrace inclusion, (...) as is shown by his remarkable recognition of the sentiments of fear and resentment. As a response, however, he refuses to interpret Christianity so narrowly that it can be used to legitimize the construction of walls to keep “the other” outside enclosed communities. By taking the Good Samaritan as his focal point, Francis reorients Christianity toward its inherent cosmopolitan roots with a call to move from fear to fraternity. (shrink)

Faced with at least two major challenges, namely, worldwide poverty and inequalities, and ecological changes, our world is confronted with the issue of balancing the concern for the social needs of the present generation, as an expression of intragenerational responsibilities, with the care for the environment for future generations, as fulfilling intergenerational responsibilities. After demonstrating how the philosophical debate indeed validates the notion of intergenerational responsibilities, this article seeks to investigate the relationship between inter- and intragenerational responsibilities. Whereas this relationship (...) is often considered as a troubled and conflicting one, I aim to show that there are reasons to link the problems of global justice and ecological degradation. It will be argued that both global inequality and the ecological crisis are moral problems caused by a particular kind of development philosophy and lifestyle. Consequently, people have a responsibility to take these social and ecological issues into account in their daily lives. In the last section, some theological reflections are provided with regard to the idea of intergenerational responsibilities, their relationship to intragenerational responsibilities, and the contribution of theology as an inspirational source for change. (shrink)

My aim is to propose affectivity as a criterion for personal identity. My proposal is to be taken in its weak version: affectivity as _only one_ of the criteria for personal identity. I start by arguing for affectivity being a better candidate as a criterion for personal identity than thinking. Next, I focus on synchronic vs. diachronic and on ontic vs. epistemic distinctions (my proposal will concern diachronic ontic personal identity) and consider the realm of affectivity in its temporal dimension. (...) In my argument, I rely on the genuineness of affectivity and I exploit chiefly long- or everlasting feelings (or emotions) and those which involve the feeling subject more rather than less. I conclude by stating that genuine long-lasting feelings (or emotions) are constitutive of diachronic ontic personal identity. (shrink)

The general concept of a trope – that of a non-shareable character-grounder – admits of a distinction between modifier tropes and module tropes. Roughly, a module trope is self-exemplifying whereas a modifier trope is not. This distinction has wide-ranging implications. Modifier tropes are uniquely eligible to be powers and fundamental determinables, whereas module tropes are uniquely eligible to play a direct role in perception and causation. Moreover, each type of trope theory faces unique challenges concerning character- grounding. Modifier trope theory (...) faces challenges concerning the inscrutability of predication and the incompatibility with bundle theory, whereas module trope theory faces challenges concerning character overdetermination and a collapse into austere nominalism. These differences indicate that the modifier/module distinction divides the advantages of general trope theory and thus presents the trope theorist with a pivotal choice. (shrink)

In this paper I explore Michael Loux’s important distinction between “tropes” and “tropers”. First, I argue that the distinction throws into relief an ambiguity and discrepancy in the literature, revealing two fundamentally different versions of trope theory. Second, I argue that the distinction brings into focus unique challenges facing each of the resulting trope theories, thus calling into question an alleged advantage of trope theory—that by uniquely occupying the middle ground between its rivals, trope theory is able to recover and (...) preserve the insights of these views. Ultimately, the distinction suggests that trope theory is a divided house. (shrink)