In the perhaps most decisive reopening of philosophy in the twentieth century, Heidegger presented an existential analytic. This can be viewed as the highly complex analysis of one simple action: being-there. In the paper at hand, a Spinozist interpretation of this action is proposed. This implies a shift in the Aristotelian conceptuality, which, to a large extent, informs Heidegger’s analysis. The action of being-there is not a movement from potentiality to actuality. It is a force of existence. However, this force (...) is located right at the threshold between potentiality and actuality. Accordingly, it is not a matter of dismissing Aristotle’s concepts, but—with Heidegger—to observe carefully their deconstruction and pursue it to the point where these concepts become indistinct and where—beyond Heidegger—a Spinozian force of existence emerges. (shrink)

The aim of the paper is to demonstrate that the concept of Eiendommelighed in Kierkegaard has a considerable philosophical weight, although it figures only marginally. It is emphasized that Kierkegaard—well ahead of the deconstruction of community in contemporary philosophy—creates a concept by which the complicity of singularity and community becomes evident. The gist of the concept is an indistinction between the proper and the improper. Eiendommelighed is that by which singularities, or neighbors, are called into the inappropriability of their ownmost (...) being. This call is then recalled between neighbors who in this way form an (im)proper community. (shrink)

There has been a significant increase in studies devoted to Søren Kierkegaard’s Works of Love in contemporary Kierkegaard research. There are several good reasons why this is so. The single theme that dominates, though, is the relation between preferential love and neighborly love. Are they reconcilable or not? The present paper recasts this discussion by situating Works of Love in the trajectory of deconstructive readings of community from Jean-Luc Nancy and onwards. It is divided into three sections. It is first (...) shown that a deconstructive take on preferential and neighborly love indicates how any community has a place for love as its condition of (im)possibility. The opening of this place is then located in the Christian love-commandment. Finally, the expanse of this place is found in the spreading-out of the promise of love. The paper is conceived as a step towards letting love find its place in the analytics of being-there—as the phenomenon which opens the “there” without losing its “with.” The paper concludes with a postscript that points towards this broader context. (shrink)

The paper presents a phenomenology of the hand in four declinations: the touching, the grasping, the working and the throwing hands. This selective sequence expresses not only the disposition but also a hypothesis. To be disclosed is a distance already in the intimate doings and a proximity still in the far-reaching operations of the hands. The claim is that this intimate alienness and distant proximity makes the human hands technical and associates the human being originally with technology. It is assumed (...) that pedagogical philosophy will have an interest in this anthropo-technical condition fundamental to the Bildung of man. (shrink)

Name der Zeitschrift: Nietzsche-Studien Jahrgang: 46 Heft: 1 Seiten: 219-233.

The line drawn in this paper is a long one, even far-fetched. It goes all the way from a phenomenology of touch beginning with Aristotle, and from there it will not be finished before it arrives at our present technological condition—a condition for which the French philosopher Jean-Luc Nancy has given us the word ecotechnie. The title of this drawing will be ‘responsiveness and technology’ as it connects exactly these two phenomena. Not in such a way, however, that the paper (...) begins with responsiveness and ends with technology. Rather, the line will begin with their intricate and intimate connection and then unfold until this connection is wholly exposed. And so the paper begins with a technical responsiveness to be found in touch; and it ‘ends’ with a worldwide responsive technology—which will in a sense prove to be without end. (shrink)

What confronts us today is precisely the formal knowledge—the knowledge of non-knowledge, even—of the fact that every supreme signification always signifies, beyond itself, the responsibility for an ultimate irresponsibility of sense. In the last instance, we are accountants of the measureless... When Heidegger wrote “The Question Concerning Technology,” he was well aware that we are not in a situation to know what we are questioning when we question technology. For that reason, the very first sentence of his essay is: “In (...) what follows we shall be questioning concerning technology”. And Heidegger even puts ‘questioning’ in italics to get his point across: the title of the.. (shrink)

In two of the most significant and influential contemporary exponents of German philosophical anthropology, anthropogenetic accounts play a large role. Hans Blumenberg and Peter Sloterdijk have presented their mode of philosophical anthropology as a philosophical anthropogenealogy. To this end both of them have ventured into an alliance with paleoanthropology, incidentally drawing on the same paleoanthropolgist, the forgotten pioneer of philosophical anthropology: Paul Alsberg. Taking this observation as its cue, the article addresses two questions. What are the motives for philosophical anthropology (...) to turn into philosophical anthropogenealogy? What is the methodological status of anthropogenetic accounts in philosophical anthropology? By reflecting on these questions the article aspires to convey a synthesis of themes in contemporary German philosophical anthropology and introduce them especially to an English-speaking audience. (shrink)

The relatively new practice of continuous sedation at the end of life (CS) is increasingly being debated in the clinical and ethical literature. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assisted suicide (PAS) unnecessary, as CS could alleviate even the most severe suffering. This view has been widely adopted. In this article, we perform an in-depth analysis of four versions of this ?argument of preferable alternative.? Our goal (...) is to determine the extent to which CS can be considered to be an alternative to PAS and to identify the grounds, if any, on which CS may be ethically preferable to PAS. (shrink)

From 1827 to 1831 the German historian Leopold von Ranke travelled through Germany, Austria, and Italy, hunting for documents and archives. During this journey Ranke developed a new model for historical research that transformed the archive into the most important site for the production of historical knowledge. Within the archive, Ranke claimed, the trained historian could forget his personal predispositions and political loyalties, and write objective history. This essay critically examines Ranke's model for historical research through a study of the (...) obstacles, frustrations, and joys that he encountered on his journey. It shows how Ranke's archival experiences inspired him to re-evaluate his own identity as a historian and as a human being, and investigates some of the affiliations between his model for historical research and the political realities of Prince Metternich's European order. Finally, the essay compares Ranke's historical discipline to other nineteenth-century disciplines, such as anthropology and archaeology. (shrink)

Background: The 21-item Nurses’ Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses. Objectives: The objective of this study was to make a Dutch translation of the Nurses’ Moral Courage Scale to describe the level of nurses’ self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium. Research design: A forward–backward translation method was applied to translate the English Nurses’ Moral Courage Scale to Dutch, and a pilot study was (...) conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used. Participants: The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders. Ethical considerations: Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent. Findings: The readability and understandability of the Dutch Nurses’ Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale and all subscales. Nurses’ mean score of the 21-item Nurses’ Moral Courage Scale was 3.77. The total Nurses’ Moral Courage Scale score was associated with age, experience, professional function, level of education and personal interest. Discussion and Conclusion: The Nurses’ Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice. (shrink)

Recently there has been some discussion concerning a particular type of enhancement, namely ‘moral enhancement’. However, there is no consensus on what precisely constitutes moral enhancement, and as a result the concept is used and defined in a wide variety of ways. In this article, we develop a clarificatory taxonomy of these definitions and we identify the criteria that are used to delineate the concept. We think that the current definitions can be distinguished from each other by the criteria used (...) for determining whether an intervention is indeed moral enhancement. For example, some definitions are broad and include moral enhancement by any means, while other definitions focus only on moral enhancement by means of specific types of intervention. Moreover, for some definitions it suffices for an intervention to be aimed or intended to morally enhance a person, while other definitions only refer to ‘moral enhancement’ in relation to interventions that are actually effective. For all these differences in definitions we discuss some of their implications. This shows that definitions are significantly less descriptive and more normative than they are regularly portrayed to be. We therefore hope that the taxonomy developed in this paper and the comments on the implications for the normative debate of the variety of definitions will provide conceptual clarity in a complex and highly interesting debate. (shrink)

In a recent JME article, Joona Räsänen makes the case for allowing legal age change. We identify three problems with his argument and, on that basis, propose an improved version thereof. Unfortunately, even the improved argument is vulnerable to the objection that chronological age is a better proxy for justice in health than both legal and what we shall call official age.

The conceptual pair of own-world and common world constitutes an archaic pair, originally introduced by Heraclitus. More than two millennia after its introduction, Binswanger picked up this conceptual pair in the attempt to understand existence and mental disorder. Ever since, this conceptual pair has been part of the conceptualization of schizophrenia in phenomenological psychopathology. However, the concepts of ídios kósmos and koinós kósmos have seldomly been elaborated and expanded upon, and certain unclarities rest within the literature. This paper resolves some (...) of these unclarities and contributes to a theory of anthropological proportions, which furthers our understanding of ídios kósmos and koinós kósmos. The paper begins with an exploration of the theoretical underpinnings of this conceptual pair, i.e., it discusses the concept of world, what is understood by common world, and what it means to live in an own-world. This theoretical exploration segues into an in-depth analysis of the alterations of experiential life in schizophrenia, which can be illuminated via this conceptual pair. It is further argued that this conceptual pair contributes to an understanding of the puzzling phenomenon of double bookkeeping. Finally, the paper concludes in a discussion of clinical implications of this conceptual pair, stressing the importance of a mindfulness of the alterations to the ídios kósmos and koinós kósmos in schizophrenia. (shrink)

"The idea for this book arose in connection with the Workshop on Semantic functions of complementizers in European languages, which we organized in October 28-29, 2011, at the University of Copenhagen, Denmark. Around two thirds of the book chapters are elaborations on contributions to this workshop, the remaining one third arose independently of the workshop.".

In The Myth of Morality Richard Joyce presents a simple and very influential argument for the truth of moral error theory. In this paper I point out that the argument does not have the form Joyce attributes to it, the argument is not valid in an extensional propositional logic and on the most natural way of explicating the meanings of the involved terms, it remains invalid. I conclude that more explanation is needed if we are to accept this particular argument (...) for moral error theory. (shrink)

Name der Zeitschrift: Cognitive Linguistics Jahrgang: 27 Heft: 1 Seiten: 67-100.

Owen Griffiths has recently argued that Etchemendy’s account of logical consequence faces a dilemma. Etchemendy claims that we can be sure that his account does not overgenerate, but that we should expect it to undergenerate. Griffiths argues that if we define the relationship between formal and natural language as being dependent on logical consequence, then Etchemendy’s claims are not true; and if we define the relationship as being independent of logical consequence, then we cannot assess the truth of the claims (...) without further information. I argue that Griffiths misconstrues Etchemendy’s theory and overstates the first horn of the dilemma: Etchemendy does see the relationship as being dependent on logical consequence, but that does not mean that his claims are not true. (shrink)

Name der Zeitschrift: Jahrgang: 13 Heft: 2 Seiten: 170-189.

In 2002 with the passing of the Euthanasia Law, Belgium became one of the few countries worldwide to legalize euthanasia. In the 18 years since the passing of the law, much has changed. We argue that in Belgium a widening of the use of euthanasia is occurring and that this can be ethically and legally problematic. This is in part related to the fact that several legal requirements intended to operate as safeguards and procedural guarantees in reality often fail to (...) operate as such. We focus on three kinds of safeguards or procedural guarantees: the legally defined due care criteria for eligibility for euthanasia; the consultation of a second physician; and the reporting of euthanasia cases to the Federal Control and Evaluation Commission for Euthanasia. We will show how each of these three safeguards can exhibit shortcomings in theory and practice. (shrink)

Recombination maps of ancestral species can be constructed from comparative analyses of genomes from closely related species, exemplified by a recently published map of the human‐chimpanzee ancestor. Such maps resolve differences in recombination rate between species into changes along individual branches in the speciation tree, and allow identification of associated changes in the genomic sequences. We describe how coalescent hidden Markov models are able to call individual recombination events in ancestral species through inference of incomplete lineage sorting along a genomic (...) alignment. In the great apes, speciation events are sufficiently close in time that a map can be inferred for the ancestral species at each internal branch ‐ allowing evolution of recombination rate to be tracked over evolutionary time scales from speciation event to speciation event. We see this approach as a way of characterizing the evolution of recombination rate and the genomic properties that influence it. (shrink)

Relational egalitarianism says that moral equals should relate as equals. We explore how moral unequals should relate.

The all-affected principle is a widely accepted solution to the problem of constituting the demos. Despite its popularity, a basic question in relation to the principle has not received much attention: why does the fact that an individual is affected by a certain decision ground a right to inclusion in democratic decision-making about that matter? An answer to this question must include a reason that explains why an affected individual should be included because she is affected. We identify three such (...) reasons in the literature – to wit, interest protection, self-government and welfare – and show why they all fail. We then propose two alternative reasons, equal relations and fairness, and show why they are also deficient. Surprisingly, the all-affected principle then appears groundless, which supports withholding belief in the all-affected principle or(/and) investing future research in identifying the thus-far unidentified reason why being affected grounds a claim to inclusion. (shrink)

Construed as a theory of justice, relational egalitarianism says that justice requires that people relate as equals. Construed as a theory of what makes democracy valuable, it says that democracy is a necessary, or constituent, part of the value of relating as equals. Typically, relational egalitarians want their theory to provide both an account of what justice requires and an account of what makes democracy valuable. We argue that relational egalitarians with this dual ambition face the justice-democracy dilemma: Understanding social (...) relations in such a way that renders relational egalitarianism plausible as an answer to what makes democracy valuable comes at the price of understanding social relations in a way that makes it less plausible as a theory of justice, and vice versa. We also argue that there is no easy way out of the dilemma and that relational egalitarians, who want relational equality to provide both accounts mentioned, may simply have to set their ambitions lower on behalf of relational equality. (shrink)

When a new intervention or drug is developed, this has to pass through various phases of clinical testing before it achieves market approval, which can take many years. This raises an issue for drugs which could benefit terminally ill patients. These patients might set their hopes on the experimental drug but are unable to wait since they are likely to pass away before the drug is available. As a means of nevertheless getting access to experimental drug, many seriously ill and (...) terminally ill patients are therefore very willing to participate in randomised controlled trials. However, only very few terminally ill patients are able to actually participate, and those that do participate are at risk of participating solely as a way of getting experimental drugs. Currently, there are, however, ways of getting access to drugs that have not gained market approval. One such mean is via expanded access or compassionate use programs where terminally ill patients receive experimental new drugs that are not yet market approved. In this paper, I examine some of the common justifications for such programs. The most frequently voiced justifications for compassionate use or expanded access programs could be put in one of three categories. First, there are justifications of justice, where compassionate use programs could be seen as a just or fair way to distribute experimental new drugs to patients who are denied access to RCT’s through no fault of their own. Second, such programs could be justified by reference to the ethical principle of beneficence where it could be claimed that terminally ill patients stand to benefit greatly at very little risk. Third, there are considerations of autonomy where, it is claimed, patients should be able to exercise their autonomy and have access to such drugs if that is there free choice and they are fully aware of the risks associated with that choice. In this paper, I argue currently all justifications are potentially problematic. If they truly form the basis for justification, compassionate use programs should be designed to maximize justice, beneficence and autonomy. (shrink)

Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives (...) and patients.We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases. (shrink)

This article investigates the emergence of the archive as the primary venue for the production of historical knowledge in the 19thcentury. The turn to archival research, the article argues, may be considered as a response to the discussions about the problems of testimony that dominated 18th- and early 19th-century German writings on the methodology and epistemology of historical research. These discussions, especially regarding the epistemic virtues of witnesses, also helped create the particular culture of knowledge-making within German historical scholarship that (...) enabled the archival turn. The article illustrates these developments through the examples of Johann Peter von Ludewig, who was one of the most prominent historians of the early German Enlightenment, and Leopold von Ranke, who is normally considered the founder of the modern historical discipline and the most important advocate of the 19th-century archival turn. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying. The practice is generally considered to be legal as a form of symptom control, although this is mostly only assumed. France has passed an amendment to the Public Health Act that would grant certain terminally ill patients an explicit right to continuous deep sedation until they pass away. Such a (...) framework would be unique in the world. In this paper we will highlight and reflect on four relevant aspects and shortcomings of the proposed bill. First, that the bill suggests that continuous deeps sedation should be considered as a sui generis practice. Second, that it requires that sedation should always be accompanied by the withholding of all artificial nutrition and hydration. In the most recently amended version of the legal proposal it is stated that life sustaining treatments are withheld unless the patient objects. Third, that the French bill would not require that the suffering for which continuous deep sedation is initiated is unbearable. Fourth, the question as to whether the proposal should be considered as a way to avoid having to decriminalise euthanasia and/or PAS or, on the contrary, as a veiled way to decriminalise these practices. The French proposal to amend the Public Health Act to include a right to continuous deep sedation for some patients is a unique opportunity to clarify the legality of continuous deep sedation as an end-of-life practice. Moreover, it would recognize that the practice of continuous deep sedation raises ethical and legal issues that are different from those raised by symptom control on the one hand and assisted dying on the other hand. Nevertheless, there are still various issues of significant ethical concern in the French legislative proposal. (shrink)

Heloise Robinson argues that pregnant women have a higher moral status than non-pregnant persons and that, for this reason, pregnant women ought to be treated ‘noticeably’ better than non-pregnant persons.1 In this commentary, we present two challenges to Robinson’s argument. First, the compounding disadvantage objection: treating involuntarily, non-pregnant women worse than voluntarily pregnant women unjustly compounds their disadvantage. Second, the identity objection: treating non-pregnant people worse than pregnant people amounts to pro tanto wrongful discrimination based on a fundamental aspect of (...) people’s identity. We conclude that either pregnant persons do not have a higher moral status than non-pregnant persons, or they do, but higher moral status so grounded does not justify better treatment. According to the standard view of moral status: (1) most human beings are persons; (2) persons have a higher moral status than non-persons; and (3) persons have an equal moral status. Many believe: (1) is true because most human beings have a sufficiently high level of personhood-generating psychological capacities; (2) is true because moral status is tied to personhood; and (3) is true because variations in the level of personhood-generating psychological capacities do not matter to an individual’s moral status once that individual’s level surpasses the threshold required for personhood.2 (3) is significant …. (shrink)

Following considerable debate, the practice of euthanasia was legalized in Belgium in 2002, thereby making Belgium one of the few places in the world where this practice is legal. In 2014 the law was amended for the first time. The 2014 amendment makes euthanasia legally possible for all minors who repeatedly and voluntarily request euthanasia and who are judged to possess “capacity of discernment”, as well as fulfil a number of other criteria of due care. This extension of the 2002 (...) euthanasia law generated a lot of national and international debate and has been applauded by many and heavily criticized by others. This evolution is clearly of interest to end-of-life debates in the entire world. This paper will therefore describe how this amendment came to get passed using official documents from Belgium's Senate and Chamber of Representatives where this amendment was discussed and subsequently passed. Next, some of the most commonly given arguments in favour of the law are identified, as well as the arguments most often voiced against the amendment. All these arguments will be expanded upon and it will be examined whether they hold up to ethical scrutiny. Analysing the official documents and identifying the most commonly voiced arguments gives valuable insight into how Belgium came to amend its euthanasia law and why it did so in 2014. It also becomes clear that although the current amendment is often seen as far-reaching, more radical ideas were proposed during the drafting of the law. Also, in analysing those arguments in favour of the amendment and those against, it is clear that the validity of some of these is questionable. (shrink)

1. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety and phobias are common in schizophrenia, and anxiety is often part of the dysphoric mood (A...

Immanuel Kant's ‘Critique of Judgment’ is often read either in terms of art appreciation or teleology. In this paper however, the object is to examine the ‘Critique of Judgment’, especially the concepts of the Beautiful and the Sublime, in relation to the Kantian version of the Enlightenment. The main theses in the paper are as following: That Beauty can provide us with the sensuous experience of the possibility of the moral law and that the Sublime can provide us with the (...) sensuous experience of the possibility that we as rational beings can effectuate the actual existence of the moral law. (shrink)

I en dobbelt forstand kan døden siges at være uomgængelig, og i en dobbelt forstand fremstår det som et uomgængeligt problem for vor livsglade civilisation, idag tilsyneladende mere end nogensinde.

1. Aritmofobi Adomo definerede en gang i sine senere år en musiker som et menneske på flugt fra sin matematiklærer 1) denne definition kan uden tvivl udstrækkes til at gælde størstedelen af de få overlevende, som endnu forsøger at praktisere en humanistisk tænkning på trods af existensen af en "totalt forvaltet verden" udenfor.

From surrealism’s beginnings around a Parisian séance table, it oscillated between the occult and the political. One of its key methods, automatism, provided access to both the esoteric and the exoteric: it took form in the mid-19th century as a spiritualist technique for communicating with the other side while, simultanously, this other side could address political issues as equal rights, de-colonisation and a utopian future with an authority coming from beyond the individual. By tracing the development of automatism, the article (...) shows how automatism in surrealism became a call for both a re-orientation of life and an institutional re-organisation by becoming a divination tool for a future community looking back to hermeticism to find a way forward. The article argues that not only can surrealism fruitfully be understood in the light of an occult revival in reaction to crises but, additionally, that it marks the return of and a reaction to a kind of magical thinking in the modern – due to waning religious and socio-economic orthodoxies – that echoes eerily into our own big data contemporary of social medias where we tend to substitute equations with associations. (shrink)

BackgroundThe aim of this study is to compare depression and loneliness among adult siblings of people on the autism spectrum, adult siblings of normotypic individuals, and adults raised alone. In recent years, an increasing interest in the perspective of siblings of children diagnosed with autism has been observed, with studies among this population particularly concerned with the developmental trajectories of children and adolescents at “high risk” for ASD, rarely focusing on their mental well-being.MethodsThe respondents filled out: the survey on sociodemographic (...) data designed by the authors, Beck Depression Inventory II, and De Jong Gierveld Loneliness Scale.ResultsA rise in BDI and an increase in the DJGLS score were predicted by having a sibling diagnosed with ASD. Those effects were independent of subjects’ sex, educational status, place of residence, or a number of siblings.ConclusionThe results underline a fundamental need for the development of mental hygiene programs for families where children with autism spectrum are accompanied by healthy siblings. (shrink)

If biotechnology can be used to "upgrade" humans physically and mentally, should it be done? And if so, to what extent? How will biotechnology affect societal cohesion, and can the development be controlled? Or is this a Pandora's box that should remain closed? These are just a few of the many questions that arise as a result of the increasing ability of technology to change biology and, eventually, transform human living conditions. This development has created a new horizon of a (...) posthuman future that will influence contemporary life and politics in a number of ways. The book gathers researchers within the fields of biotechnology, medicine, ethics, politics, and aesthetics. Among the contributors are Francis Fukuyama, Julian Savulescu, Maxwell Mehlman, Lone Frank and Chris Hables Gray. (shrink)

The organisation of health care is rapidly changing. There is a trend to move away from individual health care institutions towards transmural integrated care and interorganizational collaboration in networks. However, within such collaboration and network there is often likely to be a pluralism of values as different health care institutions often have very different values. For this paper, we examine three different models of how we believe institutions can come to collaborate in networks, and thus reap the potential benefits of (...) such collaboration, despite having different moral beliefs or values. A first way is the pragmatic way in which the different health care institutions avoid ethical reflection and focus on solutions. A second possible route is that of consensus where health care institutions base their collaboration on values that they all share. The third, and final, approach is that of compromise. Although moral compromise is often seen in a negative light, we argue that in many cases compromise might be necessary and ethically justified. In a final section, we will shift our focus from discussing various theoretical methods to allow collaboration to the potential content of consensus or compromise. (shrink)

Health care organization is entering a new age. Focus is increasingly shifting from individual health care institutions to interorganizational collaboration and health care networks. Much hope is set on such networks which have been argued to improve economic efficiency and quality of care. However, this does not automatically mean they are always ethically justified. A relevant question that remains is what ethical obligations or duties one can ascribe to these networks especially because networks involve many risks. Due to their often (...) amorphous and complex structure, collective responsibility and accountability may increase while individual responsibility goes down. We argue that a business ethics approach to ethical obligations for health care networks, is problematic and we propose to opt for a patient perspective. Using the classic four principles of biomedical ethics it is possible to identify specific ethical duties. Based on the principle of justice, health care networks have an ethical duty to provide just and fair access for all patients and to be transparent to patients about how access is regulated. The principle of nonmaleficence implies an obligation to guarantee patient safety, whereas the principle of beneficence implies an obligation for health care networks to guarantee continuity of care in all its dimensions. Finally, the principle of autonomy is translated into a specific obligation to promote and respect patient choice. Networks that fail to meet any of these conditions are suspect and cannot be justified ethically. Faced with daunting challenges, the health care system is changing rapidly. Currently many hopes ride on integrated care and broad health care networks. Such networks are the topic of empirical debate, but more attention should be given to the ethical aspects. Health care networks raise new and pressing ethical issues and we are in need of a framework for assessing how and when such networks are justified. (shrink)

Continuous sedation at the end of life is the practice whereby a physician uses sedatives to reduce or take away a patient's consciousness until death. Although the incidence of CS is rising, as of yet little research has been conducted on how the administration of CS is experienced by medical practitioners. Existing research shows that many differences exist between medical practitioners regarding how and how often they perform CS. We conducted a focus group study to find out which factors may (...) facilitate or constrain the use of continuous sedation by physicians and nurses. The participants often had clear ideas on what could affect the likelihood that sedation would be used. The physicians and nurses in the focus groups testified that the use of continuous sedation was facilitated in cases where a patient has a very limited life expectancy, suffers intensely, makes an explicit request and has family members who can cope with the stress that accompanies sedation. However, this ‘paradigm case’ was considered to occur only rarely. Furthermore, deviations from the paradigm case were said to be sometimes due to physicians initiating the discussion on CS too late or not initiating it at all for fear of inducing the patient. Deviations from the paradigm case may also occur when sedation proves to be too difficult for family members who are said to sometimes pressure the medical practitioners to increase dosages and speed up the sedation. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying...