In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued that autonomy (...) and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of Socratic autonomy is introduced. (shrink)

In his concept of an anthropological physiology, F.J.J. Buytendijk has tried to lay down the theoretical and scientific foundations for an anthropologically-oriented medicine. The aim of anthropological physiology is to demonstrate, empirically, what being specifically human is in the most elementary physiological functions. This article contains a sketch of Buytendijk''s life and work, an overview of his philosophical-anthropological presuppositions, an outline of his idea of an anthropological physiology and medicine, and a discussion of some episternological and methodological problems. It is (...) demonstrated that Buytendijk''s design of an anthropological physiology is fragmentary and programmatic and that his methodology offers few points of contact for specific anthropological experimental research.Notwithstanding, it is argued that Buytendijk''s description of the subjective, animated body forms a pre-eminent point of reference for all research in physiology and psychology in which the specific human aspect is not ignored beforehand. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or “NEST-ethics”). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics (...) arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some “good life” arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second “level” arguments—those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called “hard impacts”—quantifiable risks and benefits of the technology. Its “soft impacts”—effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention. (shrink)

In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or “NEST-ethics”). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics (...) arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some “good life” arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second “level” arguments—those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called “hard impacts”—quantifiable risks and benefits of the technology. Its “soft impacts”—effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention. (shrink)

Pure Type Systems, PTSs, were introduced as a generalization of the type systems of Barendregt's lambda cube and were designed to provide a foundation for actual proof assistants which will verify proofs. Systems of illative combinatory logic or lambda calculus, ICLs, were introduced by Curry and Church as a foundation for logic and mathematics. In an earlier paper we considered two changes to the rules of the PTSs which made these rules more like ICL rules. This led to four kinds (...) of PTSs. Most importantly PTSs are about statements of the form M:A, where M is a term and A a type. In ICLs there are no explicit types and the statements are terms. In this paper we show that for each of the four forms of PTS there is an equivalent form of ICL, sometimes if certain conditions hold. (shrink)

Based on our empirical research on global meaning in people with spinal cord injury and people with stroke, we formulated ‘inner posture’ as a concept in rehabilitation. Inner posture, as we concluded from our empirical data, refers to the way in which people bear what cannot be changed. It helps them to live with their injury. Considering that much has already been written about meaning from a variety of disciplines, the question arises whether the concept of inner posture adds something (...) new to the existing literature, or is just another name for a phenomenon that has already been described before in different terms. In this paper, we aim to investigate this and to clarify our conceptualization, by comparing the concept of inner posture with influential concepts in healthcare literature which seem to be more or less related. In the work of Puchalski regarding spirituality, Pargament regarding religion, Eliott regarding hope and Frankl regarding attitude, we found definitions and descriptions that seemed to come close to the phenomenon we refer to as inner posture. Because these concepts have various theoretical backgrounds, the comparison can help to better understand our concept of inner posture, through a process of dialogue between traditions, following Gadamer’s notion of dialogue as fusion of horizons of understanding. We conclude that inner posture differs from the other concepts in several ways. Some of these differences are more fundamental, other are partial. This suggests that we identified a new perspective on a phenomenon partially described earlier. The comparison also inspired us to slightly adjust our definition and to formulate new research questions. (shrink)

Background: Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. Objectives: (1) To identify and compare the five ethical issues considered most important by surveyed expert panellists in non-genetic and genetic AD research and (2) to compare our empirical findings with ethical issues in genetic research in general as described in the literature. (...) Method: A modified Delphi study in two rounds Results: Genetic and non-genetic research into AD generated an approximately equal number of topics with a considerable overlap. Different priorities in the ethics of both types of research were found. Genetic research raised new topics such as “confidentiality of genetic information” and “implications of research for relatives” which changes the impact and application of existing ethical topics such as “informed consent” and is judged to have more impact on both individuals and society. A difference with the results of more theoretical approaches on ethical aspects related to AD research was also found. Conclusions: Different priorities are given to ethical issues in genetic and non-genetic research. These arise partly because genetic research causes unique and new questions, mostly related to the position of family members and the status of and access to genetic information. Differences found between the results of our empirical study and the more theoretical literature, suggest an additional value for empirical research in medical ethics. (shrink)

In this article a case is made for the importance of a previously overlooked phenomenon, physical empathy orcompathy,defined as the physical manifestation of caregiver distress that occurs in the presence of a patient in physical pain or distress. According to the similarity of a caregiver's response to the original symptoms, there can be four types of compathetic response: identical, initiated, transferred, and converted. Controlling for the compathetic response may involve narrowing one's focus and/or changing caregiver attitudes. Finally, we argue that (...) while the compathetic response may be beneficial to the caregiving relationship, enabling the provision of appropriate and adequate humane treatment and care, the caregiver must at times shield against the compathetic response in order to provide care. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Interdisciplinary integration has fundamental limitations. This is not sufficiently realized in science and in philosophy. Concerning scientific theories there are many examples of pseudo-integration which should be unmasked by elementary philosophical analysis. For example, allegedly over-arching theories of stress which are meant to unite biology and psychology, upon analysis, turn out to represent terminological rather than substantive unity. They should be replaced by more specific, local theories. Theories of animal orientation, likewise, have been formulated in unduly general terms. A natural (...) history approach is more suitable for the study of animal orientation. The tendency to formulate overgeneral theories is also present in evolutionary biology. Philosophy of biology can only deal with these matters if it takes a normative turn. Undue emphasis on interdisciplinary integration is a modern variant of the old unity of science ideal. The replacement of the ideal by a better one is an important challenge for the philosophy of science. (shrink)

Grime (1979) in a recently developed theory distinguished three basic plant strategies: stress tolerance,ruderality and competition. He relates them to environments characterized in terms of stress and disturbance. Classifications of strategies and environments both are ultimately defined in terms of production. This tends to make the theory tautological. If the theory is to make sense, environments had better be defined in independent terms.

The Constitution of the Athenians ascribed to Xenophon the orator.--The Politeia of the Spartans by Xenophon.--The Boeotian Constitution from the Oxyrhynchus historian.--The Constitution of Athens by Aristotle.

Philosophical theories about reduction and integration in science are at variance with what is happenign in science. A realistic approach to science show that possibilities for reduction and integration are limited. The classical ideal of a unified science has since long been rejected in philosophy. But the current emphasis on interdisciplinary integration in philosophy and in science shows that it survives in a different guise. It is necessary to redress the balance, specifically in biology. Methodological analysis shows that many of (...) the grand interdisciplinary theories involving biology actually represent pseudo-integration covered up by inappropriate, overgeneral concepts. Integrationism is not bad, but it must be kept within reasonable bounds. If the present analysis is appropriate, there will have to be fundamental changes in research strategy both in science and in the philosophy of science. (shrink)

Many authors have argued that the core of evolutionary biology as represented by the catchphrase 'The fittest survive' is tautological. Concerning the fitness concept of population genetics it is easy to rebut this charge by a proper explication of the term 'survival'. In biology and in the philosophy of biology, various fitness concepts over and above that of population genetics have been elaborated. These concepts, which are called 'supervenient' by some philosophers, have a limited usefulness. On some interpretations they do (...) lead to unacceptable tautologies and circular reasoning. The so-called propensity concept of fitness is problematic in this respect. If interpreted in a proper way, supervenient concepts appear not to allow the formulation of highly general explanations and theories; at best they reveal common patterns among diverse non-general explanations and theories. Philosophers cherishing supervenient fitness concepts are apparently motivated by a mistaken search for general theory. The fitness concept of population genetics may play a role in relatively general theories and explanations. Supervenient concepts cannot play such a role. They should rather help us recognize the value of natural history in biology. (shrink)

Methodological analysis shows that the concepts of fitness and adaptation are more complex than the literature suggests. Various arguments against adaptationism are inadequate since they are couched in terms of unduly simplistic notions.

Science is not value-free and ethics is not fact-free. Science and ethics should be similar, but they are not. The author indicates how research in ethics is to change in the face of this. Ethicists should accommodate empirical work in their programs and they should take heed of methodologies developed in science and philosophy of science. They should abandon the search for a single overarching theory of morality. Controversies in ethics are often spurious for lack of articulate methodological key concepts. (...) For example, disagreements over the value of general theories are misguided since disputants implicitly use different notions of generality and different notions of theory. An appropriate methodology does not suffice for the resolution of controversies but it is indispensable for consensus. The book argues these theses in a general way and applies them to the subject of egoism and altruism in ethics. Further case studies concern the environment and psychiatric disorders. (shrink)

The impact of philosophy of science on biology is slight. Evolutionary biology, however, is nowadays an exception. The status of the neo-Darwinian (synthetic) theory of evolution is seriously challenged from a methodological perspective. However, the methodology used in the relevant discussions is plainly defective. A correct application of methodology to evolutionary theory leads to the following conclusions. (a) The theory of natural selection (the core of neo-Darwinism) is unfalsifiable in a strict sense of the term. This, however, does not militate (...) against the theory, because no scientific theory whatever is testable in this way. Under a more liberal testability criterion, the theory is surely testable. None the less, certain (not all) research programs may tend to make the theory untestable in practice. (b) It has often been argued that the tautologous character of the principle of natural selection, allegedly the focus of evolutionary theory, makes the theory untestable through circular reasoning. Actually, the principle is only a tautology if fitness is wrongly defined in terms of actual survival. But even then circular reasoning need not ensue. (c) Evolutionary principles do not permit, without additional information, the derivation of statements about evolutionary events concerning particular species or populations. If this were a reason to criticize the theory (as has been argued in the literature), any other scientific theory would be inadequate by the same token. (shrink)

Apparently factual disagreement on the level(s) at which selection operates often results from different interpretations of the term selection. Attempts to resolve terminological problems must come to grips with a dilemma: a narrow interpretation of selection may lead to a restricted view on evolution; a broader, less precise, definition may wrongly suggest that selection is the centre of a unified, integrated theory of evolution. Different concepts of selection, therefore, should carefully be kept apart.

Rosenberg has rightly argued that fitness is supervenient. But he has wrongly assumed that this makes The fittest survive nontautologous. Supervenience makes strict reduction impossible. It sheds light on disputes concerning the testability of evolutionary theory.

Messianic peacemakers: Intertextual relationships between Zechariah 9-14 and the Gospel of Matthew. This article deals with images of war, violence and peace and with the role of messianic leaders in Deutero-Zechariah and the way in which texts from Zechariah 9–14 have been interpreted in the Gospel of Matthew. The first section describes the lines of meaning in Zechariah 9–14 on the basis of word fields related to violence and universal peace. The second section discusses Deutero-Zechariah’s own position in the development (...) of messianic expectations in Old Testament texts. In the third section, the question is asked how the meaning of texts from Zechariah 9–14 about messianic leaders has been influenced by earlier prophetic texts, and how these texts in their turn have been transformed and updated in the Gospel of Matthew, which contains explicit quotations from Deutero-Zechariah in 21:5; 26:15; 26:31 and 27:9–10. The fourth section summarises some interesting semantic shifts appearing in Matthew’s gospel compared to Deutero-Zechariah. Moreover, some critical comments are presented against the idea defended in some recent studies that there is a sharp tension between Jesus’s role in Matthew as the bringer of a peaceful ethical message, and his violent and vindictive role at the final judgement. At the end of this article, the burning question is raised whether Zechariah’s and Matthew’s messages, both of which are characterised by a certain degree of exclusivity, can play a constructive role in modern multi-religious discussions about common roads leading to global peace. (shrink)