Aim: To examine how physicians’ life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large (...) life-stance groups in each country.Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient’s death , physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics and Protestants reported ever having made such a decision.Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. (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)

Journal Name: Semiotica Issue: Ahead of print.

Why is ordinary language vague? We argue that in contexts in which a cooperative speaker is not perfectly informed about the world, the use of vague expressions can offer an optimal tradeoff between truthfulness (Gricean Quality) and informativeness (Gricean Quantity). Focusing on expressions of approximation such as “around”, which are semantically vague, we show that they allow the speaker to convey indirect probabilistic information, in a way that can give the listener a more accurate representation of the information available to (...) the speaker than any more precise expression would (intervals of the form “between”). That is, vague sentences can be _more informative_ than their precise counterparts. We give a probabilistic treatment of the interpretation of “around”, and offer a model for the interpretation and use of “around”-statements within the Rational Speech Act (RSA) framework. In our account the shape of the speaker’s distribution matters in ways not predicted by the Lexical Uncertainty model standardly used in the RSA framework for vague predicates. We use our approach to draw further lessons concerning the semantic flexibility of vague expressions and their irreducibility to more precise meanings. (shrink)

In this paper I want to do the following things. First I want to show that in the part of the Theaetetus where the relationship between knowledge and perception is examined, the concept of knowledge that is in question is very clearly characterized. We are left in no doubt as to what is to count as knowing. Secondly I want to unravel in some detail the case that Socrates puts on Protagoras’ behalf where he draws on what Protagoras actually wrote (...) (151 E-152C); as opposed to what he may have taught secretly to his pupils (152C-160D). Thirdly I wish to argue that if we let the dialogue speak for itself, it is manifest that this case put up on Protagoras’ behalf at 151 E-152C is not overthrown; it is not even shaken. (shrink)

The paper is meant to be a contribution to the study of Indian and comparative ethics. It treats the Vajj laggam, an anthology of Pr krit stanzas (subh sita literature) dealing with a variety of topics. Focusing on the 'ethical' sections of the VL, it tries to describe and analyse its underlying ethical system. In Part I the different ethical themes of the VL (Valour and Destiny, Virtues and Vices, Masters and Servants, Friendship and Affection, Poverty and Charity) are described (...) in detail. In Part II it is shown that the VL. offers a clear example of a virtue ethic with a strong emphasis on self-regarding virtues (gunas), based on a pluralistic and instrumental theory of the good. The paper also treats the crucial ethical problem of the relationship between personal well-being and virtuousness as described in the VL. (shrink)

In 2002, Belgium was the second country in the world to legalize euthanasia following the Netherlands. Since then, a few studies dealing with Belgium euthanasia practices have been published that are based on a survey given to a sample of physicians and nurses . All these studies from the past decade have implicitly proposed the practice of euthanasia as a medical act. Moreover, the last article published in this journal argued that the Belgian experiment concerning medical end-of-life decisions is unique (...) in the world and that the Belgian palliative care system, including euthanasia, should serve as a role-model for the rest of the world .The Belgium law provides a definition for euthanasia which lacks the analytical precision to apply it to medical studies . When analyzing the latest data provided by the Belgian Federal Euthanasia Comm .. (shrink)

Continuous sedation until death is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness, the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings (...) together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect. (shrink)

In this paper I want to do the following things. First I want to show that in the part of the Theaetetus where the relationship between knowledge and perception is examined, the concept of knowledge that is in question is very clearly characterized. We are left in no doubt as to what is to count as knowing. Secondly I want to unravel in some detail the case that Socrates puts on Protagoras’ behalf where he draws on what Protagoras actually wrote (...) ; as opposed to what he may have taught secretly to his pupils. Thirdly I wish to argue that if we let the dialogue speak for itself, it is manifest that this case put up on Protagoras’ behalf at 151 E-152C is not overthrown; it is not even shaken.In that part of the dialogue where the question is under examination whether or not knowledge and perception are the same, Socrates uses an idealized concept of knowledge. That is, he restricts the use of the word by setting down what he will consider to be the essential characteristics of knowledge, the sufficient and necessary conditions of its being instantiated. An excellent piece of philosophical procedure. (shrink)

The paper is meant to be a contribution to the study of Indian and comparative ethics. It treats the Vajjālaggam, an anthology of Prākrit stanzas (subhāsita literature) dealing with a variety of topics. Focusing on the ‘ethical’ sections of the VL, it tries to describe and analyse its underlying ethical system. In Part I the different ethical themes of the VL (Valour and Destiny, Virtues and Vices, Masters and Servants, Friendship and Affection, Poverty and Charity) are described in detail. In (...) Part II it is shown that the VL. offers a clear example of a virtue ethic with a strong emphasis on self‐regarding virtues (gunas), based on a pluralistic and instrumental theory of the good. The paper also treats the crucial ethical problem of the relationship between personal well‐being and virtuousness as described in the VL. (shrink)

Recent studies in neuroeducation highlight the benefits of teaching children about how the brain works. However, very little is known about children's naive conceptions about the brain. The current study examined these representations, by asking 6–10 year-old children and adults to draw a brain and the inside of a belly as a control drawing. The drawings were scored using a content analysis and a list of graphic indicators was derived. First, all the graphic indicators used in the brain drawings were (...) different from those used in the belly drawings, suggesting that children are able to distinguish these two organs. Second, with age, children depict an increasing number of indicators, more complex indicators, indicators that are more anatomically correct, to depict the brain. There is an important evolution between 6 and 8 years-old but also between 10 years-old and adults. These results are discussed in relation to children's metacognitive knowledge and to their implications for neuroeducation. (shrink)

Because anticipated and retrospective regret play important roles in practical deliberation and motivation, better understanding them can illuminate the contours of human agency. However, the possibility of self-ignorance and the fact that we change over time can make regret—especially anticipatory regret—not only a poor predictor of where the agent will be in the future but also an unreliable indicator of where the agent stands. Granting these, this paper examines the way in which prospective and, particularly, retrospective regret can nevertheless yield (...) important insight into the sorts of creatures we are, both generally and individually. The experience of retrospective regret can show a person she values something in a way she did not know or that she is (or was) a different person than she had thought, insights which can factor into forward-looking, or prospective, deliberation. Such instances of revelatory regret reveal something to the agent about herself as agent. I examine two cases of agential self-ignorance. In the first, the experience of regret reveals what the agent values, not only to others but even to the agent himself. In the second, the agent anticipates experiencing regret for an action but does not experience the regret, suggesting that the agent did not value the rejected alternative in the way she thought. Anticipatory regret is forward-looking and can play an important role in practical deliberation. But insofar as anticipatory regret flows from one’s imperfect judgment and prospection about oneself, retrospective regret can be an important corrective in helping the agent understand her own standpoint. (shrink)

Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical-ethical discussions in the opinion sections of medical and nursing journals. A content analysis of opinion pieces in medical and nursing literature was conducted to examine how clinicians define and describe CSD, and how they justify this practice morally. Most publications were written by physicians and published in palliative or general medicine journals. Terminal Sedation and Palliative Sedation are (...) the most frequently used terms to describe CSD. Seventeen definitions with varying content were identified. CSD was found to be morally justified in 73 % of the publications using justifications such as Last Resort, Doctrine of Double Effect, Sanctity of Life, Autonomy, and Proportionality. The debate over CSD in the opinion sections of medical and nursing journals lacks uniform terms and definitions, and is profoundly marked by ‘charged language’, aiming at realizing agreement in attitude towards CSD. Not all of the moral justifications found are equally straightforward. To enable a more effective debate, the terms, definitions and justifications for CSD need to be further clarified. (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)

Issu d'un travail collectif d'universitaires européens, cet ouvrage présente la réflexion d'une équipe sur l'aspect en grec ancien. A travers des sensibilités différentes et des angles d'attaque variés, les articles concourent à élaborer un point de vue homogène sur l'opposition aspectuelle présent, aoriste chez Platon, dans les infinitifs et les impératifs.

Continuous sedation at the end of life is a practice that has attracted a great deal of attention. An increasing number of guidelines on the proposed correct performance of the practice have been drafted. All of the guidelines stress the importance of using sedation in proportion to the severity of the patient’s symptoms, thus to reduce the patient’s consciousness no more than is absolutely necessary. As different patients can have different experiences of suffering, the amount of suffering should, ideally, be (...) assessed subjectively; that is, via communication with the patient. Continuously sedated patients are often unable to communicate, however, making subjective methods of pain assessment unusable. For these patients, the degree of consciousness is the sole available measure. It therefore seems important to adequately measure how deeply the patient is sedated, thereby allowing sedation to be increased when it is too light and decreased when it is too heavy. This is in accordance with the idea that reducing consciousness is not an ethically neutral act.Although consciousness measuring techniques are a hot topic in anesthesiology, almost no research exists on the use of such techniques in the context of continuous sedation at the end of life. This article aims to review existing techniques to measure consciousness and to evaluate their applicability, efficiency, and invasiveness for patients who are continuously sedated until death.Techniques commonly used to assess the depth of sedation in continuously sedated patients are basic clinical assessment and sedation scales, as they are often considered reliable and noninvasive. These techniques might not be very reliable, however, since it is known that some patients are nonresponsive and yet aware. Moreover, sedation scales require stimulation of the patient (for example prodding, shaking, or providing painful stimuli), and can thus be considered invasive of one’s bodily integrity or dignity. Other techniques, such as EEG (electroencephalography) derivatives, may score better on reliability and invasiveness. Yet these have so far never been compared to sedation scale scores for patients receiving continuous sedation at the end of life.Therefore, we conclude that, for both clinical and ethical reasons, research into the efficiency and applicability of other techniques, such as derivatives of EEG, are urgently needed. (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)

We investigate whether ordinary quantification over objects is an extensional phenomenon, or rather creates non-extensional contexts; each claim having been propounded by prominent philosophers. It turns out that the question only makes sense relative to a background theory of syntax and semantics (here called a grammar) that goes well beyond the inductive definition of formulas and the recursive definition of satisfaction. Two schemas for building quantificational grammars are developed, one that invariably constructs extensional grammars (in which quantification, in particular, thus (...) behaves extensionally) and another that only generates non-extensional grammars (and in which quantification is responsible for the failure of extensionality). We then ask whether there are reasons to favor one of these grammar schemas over the other, and examine an argument according to which the proper formalization of deictic utterances requires adoption of non-extensional grammars. (shrink)

My discussion addresses the differences between analytic and continental philosophy concerning the use of logic and exact reasoning in philosophical practice. These differences are mainly examined in the light of the controversial dominance of Hegel's concept of logic (and theory of concept) in twentieth-century continental philosophy. The inquiry is developed in two parts. In the first (Sections 1-2), I indicate some aspects of the analytic-continental divide, pointing to the role that the topic 'logic and philosophy' plays in it. In the (...) second part (Sections 3-6), I give a short account of the views of logic which are typical of the three main trends of continental philosophy (see Table 1). I also suggest how, with the aid of some typical analytical devices, some continental 'anti-logical' attitudes may be corrected, on their own terms. (shrink)

In his newly updated version of The Anatomy of a Constitutional Law Case, Alan F. Westin provides a documentary portrait of historically important constitutional law case, 'Youngstown Sheet & Tube Co. v. Sawyer, ' from its rise in a bargaining dispute in the steel industry during 1952 to the aftermath of its decision by the United States Supreme Court. Westin has added to his classic book additional materials and personal commentaries collected since the work was first published. The new information (...) covers what went on within the Truman administration, what went on within the Supreme Court when analyzing and resolving issues that come before it. Westin includes selections from transcripts, briefs and other official proceedings, adds notes describing each phase of the constitutional process, and a section of commentary and questions relating this case to others. (shrink)

F. N. Sibley; VIII—Colours, Proceedings of the Aristotelian Society, Volume 68, Issue 1, 1 June 1968, Pages 145–166, https://doi.org/10.1093/aristotelian/68.1.1.

It is not quite as easy to see that there is in fact no formula of this modal language having the same truth conditions (in terms of S5 Kripke semantics) as (1). This was rst conjectured by Allen Hazen2 and later proved by Harold Hodes3. We present a simple direct proof of this result and discuss some consequences for the logical analysis of ordinary modal discourse.

In discussing questions of free will, Soviet philosophers fail to distinguish conditions from causes. This makes them unable to understand the very opponents they like to criticize.

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In the current study, we investigated the question of whether automatic interference effects found in the dot-perspective task (Samson, Apperly, Braithwaite, Andrews, & Bodley Scott, 2010) are the product of domain-specific perspective-taking processes or of domain-general “submentalizing” processes (Heyes, 2014). Previous attempts to address this question have done so by implementing inanimate (...) controls, such as arrows, as stimuli. The rationale for this is that submentalizing processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g. arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from “novel entity” paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic “perspective-taking” effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalizing interpretations of the dot-perspective task are fully correct. (shrink)