World Health Organization [WHO] -- Australia -- Belgium -- Bulgaria -- Canada -- [People's Republic of] China -- Czech Republic -- France -- Hellas [Greece] -- Hungary -- Ireland -- Israel -- Malaysia -- The Netherlands -- Nigeria -- Peru -- Poland -- Singapore -- South Africa -- Spain -- Sweden -- United Kingdom -- United States of America -- Uruguay.

The Belgian health care system has a few features that may havecontributed to the rising costs of health care: patients' freechoice of physicians, large clinical freedom of physicians, essentiallya fee-for-service remuneration for medical specialists in which the feesare agreed between insurance funds and physicians. The increased medicalconsumption and costs have prompted the state and insurance companies totake measures that limit the professional autonomy of the physicians.Access to medical education, free until 1997, is now restricted. Themedical profession is organized in the (...) Order of Physicians that hasestablished a code of professional ethics that has moral but not legalforce. So far, there is no special legislation for thepatient–physician relationship, though laws on specific issueslike organ transplantation contain duties for physicians. In recentyears a debate is taking place on patients' rights, of which informedconsent is central and gaining importance in medico-legal publications.An analysis of (ethical and legal) regulations concerning thewithholding or withdrawal of treatment by physicians demonstrate thatthe profession still enjoys a large clinical autonomy, though duediscussion with the patient has become more explicitly required. Therespect for professional autonomy is not primarily due to any formalpower that the Order of Physicians would have, but is rather grounded inthe generally high quality of the patient–physician relationshipthat in ethical terms is considered essentially as a confidencerelationship rather than a contractual relationship. (shrink)

Bioethics has been in existence now for more than twenty years. Much has changed, however, since Van Rensselaer Potter2 first used the term bioethics in 1971. For Potter, bioethics was an applied science with its roots in the biological sciences and its orientation towards the betterment of human life. Today the concept is used in a different context. It has become the name given to the ethical research that has become necessary in light of the new possibilities created by revolutionary (...) developments in medical science. Generally speaking, bioethics is concerned with the beginning and the end of life. In a certain sense, however, this is merely a de facto definition which does not possess a great deal of internal logical consistency.If we attempt to reconstruct the incredibly rapid evolution of bioethics we quickly realize how the times were truly ripe for this new discipline to begin to mature. In a very short space of time bioethics was taken seriously in just about every University and medical centre the world over. There is no part of the world which has not organised a colloquium or developed a study programme or created a Centre for Biomedical Ethics. Yet this advance is hardly surprising if we consider the fact that there have been revolutionary developments in themedical world in the 1960’s which have made it necessary to engage in serious ethical reflection on the borderline questions of human life.From the start, bioethicists have concerned themselves primarily with ethical problems related to reproductive technology such as in vitro fertilization, medically assisted fertilization with donor gametes, pregnancy termination, and the status of the embryo. More recently, however, questions concerning the end of life have entered the bioethicist’s field of interest, e.g. ethical questions related to euthanasia and the problems surrounding the artificial nutrition and hydration of persistently vegetative patients. In the meantime, of course, bioethics has broadened its field of interest beyond questions related to the beginning and end of life. Serious ethical and juridical reflection has resulted from the problems surrounding organ transplantation, transplantation of brain tissue, and the problem of AIDS.With the many recent developments in genetics, the first applications of gene therapy, and the world-wide human genome research project bioethics is assured an exciting future. It is clear that the issues which grab the bioethicist’s attention are rather disparate. Moreover, we are now beginning to realize that a whole gamut of specific questions cannot be addressed unless the broader context of the ethics of health care in general is taken into account. Such a realization has led to something of a new movement within the bioethical sphere which is interested in widening the notion of ‘medical ethics’ or ‘ethics of health’.The purpose of this article is to help familiarize the reader with the world of bioethics. Such a task is both simple and complex; bioethics has become a house with many rooms, a house, furthermore, which is being constantly renovated and rebuilt. By way of introduction, we shall take an investigative and evaluative stroll through the broad landscape bioethics has traced in the first twenty years of its existence. (shrink)

Bioethics has been in existence now for more than twenty years. Much has changed, however, since Van Rensselaer Potter2 first used the term bioethics in 1971. For Potter, bioethics was an applied science with its roots in the biological sciences and its orientation towards the betterment of human life. Today the concept is used in a different context. It has become the name given to the ethical research that has become necessary in light of the new possibilities created by revolutionary (...) developments in medical science. Generally speaking, bioethics is concerned with the beginning and the end of life. In a certain sense, however, this is merely a de facto definition which does not possess a great deal of internal logical consistency.If we attempt to reconstruct the incredibly rapid evolution of bioethics we quickly realize how the times were truly ripe for this new discipline to begin to mature. In a very short space of time bioethics was taken seriously in just about every University and medical centre the world over. There is no part of the world which has not organised a colloquium or developed a study programme or created a Centre for Biomedical Ethics. Yet this advance is hardly surprising if we consider the fact that there have been revolutionary developments in themedical world in the 1960’s which have made it necessary to engage in serious ethical reflection on the borderline questions of human life.From the start, bioethicists have concerned themselves primarily with ethical problems related to reproductive technology such as in vitro fertilization, medically assisted fertilization with donor gametes, pregnancy termination, and the status of the embryo. More recently, however, questions concerning the end of life have entered the bioethicist’s field of interest, e.g. ethical questions related to euthanasia and the problems surrounding the artificial nutrition and hydration of persistently vegetative patients. In the meantime, of course, bioethics has broadened its field of interest beyond questions related to the beginning and end of life. Serious ethical and juridical reflection has resulted from the problems surrounding organ transplantation, transplantation of brain tissue, and the problem of AIDS.With the many recent developments in genetics, the first applications of gene therapy, and the world-wide human genome research project bioethics is assured an exciting future. It is clear that the issues which grab the bioethicist’s attention are rather disparate. Moreover, we are now beginning to realize that a whole gamut of specific questions cannot be addressed unless the broader context of the ethics of health care in general is taken into account. Such a realization has led to something of a new movement within the bioethical sphere which is interested in widening the notion of ‘medical ethics’ or ‘ethics of health’.The purpose of this article is to help familiarize the reader with the world of bioethics. Such a task is both simple and complex; bioethics has become a house with many rooms, a house, furthermore, which is being constantly renovated and rebuilt. By way of introduction, we shall take an investigative and evaluative stroll through the broad landscape bioethics has traced in the first twenty years of its existence. (shrink)

In Belgium the legal conditions to practise euthanasia are governed by the act on euthanasia of 28 May, 2002 that entered into force on 23 September, 2002. There is no relevant jurisprudence and no guidance is offered by self-regulation made up by the medical profession itself before or after the enactment of the act. Thoughtful comments on the act are, understandably, lacking up to now while the discussions in parliament have been often unclear, contradictory and sometimes even misleading. In other (...) words, the law on euthanasia in Belgium almost coincides with the act on euthanasia.In this respect the situation in the Netherlands is totally different. The law on euthanasia is first of all governed by the "Termination of life on request and assisted suicide act" of 10 April, 2001 that entered into force on 1 April, 2002. This act is generally considered as the codification of the norms and procedures that have governed the practice of euthanasia in the Netherlands for almost three decades. These norms and procedures have largely emerged from within the medical profession itself and were later adopted by the courts in the context of criminal prosecutions. There also exists a very important legal doctrine that offers guidance in understanding this act. In other words, studying the law on euthanasia in the Netherlands is more than merely studying the act on euthanasia. The act is only the ‘tip of the iceberg’.While the Dutch act aims to codify existing practices, the Belgian act mainly aims to modify the behaviour of physicians when ending the life of their patients. It is hoped that a law that pretends to offer legal security to physicians and patients will stimulate patients to express a voluntary and explicit request and that physicians will abandon their practice of ending the lives of patients without their request. Research indeed had pointed out that Belgian physicians frequently 'forget' to obtain the patient’s request before ending his life.Is should be made clear from the outset that a comparison of the Belgian and the Dutch law regulating the practice of euthanasia is a hazardous undertaking. Just comparing both acts — at first sight the Belgian act, although much more detailed, could be considered a 'clone' of the Dutch act — will lead to misleading and even incorrect results. Not only the acts, but also medical practice and legal practice have to be considered when we try to compare the law on euthanasia in both countries. In this article I will make an attempt to do this. Lack of space requires omitting many details from the comparison. (shrink)

The participation of minors in clinical trials is essential to provide safe and effective medical care to children. Because few drugs have been tested in children, pediatricians are forced to prescribe medications off-label with uncertain efficacy and safety. In this article, we analyze how the enrollment of minors in clinical trials is negotiated within relationships of mutual trust between clinicians, minors, and their parents. After a brief description of the problems associated with involving minors in clinical research, we consider how (...) existing “relationships of trust” can be used as a place where the concerns of research subjects can be more fully discussed and addressed. Building on the tacit recognition of trust found in The European Clinical Trials Directive we make policy recommendations that allow for clearer, more ethically informed guidelines for enrolling minors in clinical research. (shrink)

The combination of the issue of return of individual genetic results/incidental findings and paediatric biobanks is not much discussed in ethical literature. The traditional arguments pro and con return of such findings focus on principles such as respect for persons, autonomy and solidarity. Two dimensions have been distilled from the discussion on return of individual results in a genetic research context: the respect for a participant’s autonomy and the duty of the researcher. Concepts such as autonomy and solidarity do not (...) fit easily in the discussion when paediatric biobanks are concerned. Although parents may be allowed to enrol children in minimal risk genetic research on stored tissue samples, they should not be given the option to opt out of receiving important health information. Also, children have a right to an open future: parents do not have the right to access any genetic data that a biobank holds on their children. In this respect, the guidelines on genetic testing of minors are applicable. With regard to the duty of the researcher the question of whether researchers have a more stringent duty to return important health information when their research subjects are children is more difficult to answer. A researcher’s primary duty is to perform useful research, a policy to return individual results must not hamper this task. The fact that vulnerable children are concerned, is an additional factor that should be considered when a policy of returning results is laid down for a specific collection or research project. (shrink)

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law (...) may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today. (shrink)

Balancing the rights and obligations of custodians and applicants in relation to access to biobanks is of utmost importance to guarantee trust and confidence. This study aimed to reveal which issues divide dif..

BackgroundBalancing the rights and obligations of custodians and applicants in relation to access to biobanks is of utmost importance to guarantee trust and confidence. This study aimed to reveal which issues divide different stakeholders in an attempt to determine the rights and/or obligations held on human biological materials and data.MethodsTwenty-eight informants in the Benelux and Scandinavia were interviewed in order to capture the perspectives of experts and stakeholders in relation to the rights and obligations held by custodians and applicants with (...) respect to access to HBM and data.ResultsThere was no consensus among the informants on whether the custodian of a biobank should decide upon the scientific merits and the utility of an access request. Nearly all informants agreed that a new request or an amendment to the initial request has to be submitted when an applicant wants to use leftover HBM in a new or follow-up project. Several informants felt that it might be justified to charge higher access fees to external or industrial applicants that did not contribute to the collection of HBM and data. Most informants agreed that a custodian of a biobank could request the sharing and return of research results. It was furthermore argued that some of the benefits of research projects should be fed back into biobanks.ConclusionsThe interviews revealed a rather complex web of rights and obligations allocated to the custodian and the applicant in relation to access to HBM and data stored in biobanks. Some rights and obligations are negotiated on a case-by-case basis, while others are stipulated in access arrangements. We did find a consensus on the attribution of certain general rights to the custodians and the applicant. (shrink)

The Database on Ethics Related Legislation and Guidelines was launched in March 2007 as the fourth database of the UNESCO Global Ethics Observatory system of databases in ethics of science and technology. The database offers a collection of legal instruments searchable by region, country, bioethical themes, legal categories and applicability to specific articles of the UNESCO Universal Declaration on Bioethics and Human Rights and International Declaration on Human Genetic Data. This paper discusses the background and rationale for the database and (...) its role as a consultative and comparative resource hub for the study of ethics related legal instruments across the world, with the purpose of informing and inspiring relevant stakeholders on the implementation of the principles contained within the UNESCO declarations on bioethics. (shrink)

This paper discusses the legal implications of setting up two new biobanks in Belgium. The first is hospital-based and will archive tissue from patients with haematologic cancer, whereas the second is linked to a general practice based morbidity registry and will involve storage of blood samples. To date, Belgium has no specific legislation that regulates storage of human tissue and related databases. Several issues concerning the protection of individuals with regard to the processing of personal medical data are discussed from (...) the existing privacy legislation. We will address the principle of consent (broad versus specific) and the type of data recorded (anonymous, encoded and identifiable) for both biobanks. (shrink)

Herman Cappelen investigates how language and other representational devices can go wrong, and how to fix them. We use language to understand and talk about the world, but what if our language has deficiencies that prevent it from playing that role? How can we revise our concepts, and what are the limits on revision?

The standard view of philosophical methodology is that philosophers rely on intuitions as evidence. Herman Cappelen argues that this claim is false: it is not true that philosophers rely extensively on intuitions as evidence. At worst, analytic philosophers are guilty of engaging in somewhat irresponsible use of 'intuition'-vocabulary. While this irresponsibility has had little effect on first order philosophy, it has fundamentally misled meta-philosophers: it has encouraged meta-philosophical pseudo-problems and misleading pictures of what philosophy is.

Cappelen and Dever present a forceful challenge to the standard view that perspective, and in particular the perspective of the first person, is a philosophically deep aspect of the world. Their goal is not to show that we need to explain indexical and other perspectival phenomena in different ways, but to show that the entire topic is an illusion.

We give a precis of our book Insensitive Semantics.

_Insensitive Semantics_ is an overview of and contribution to the debates about how to accommodate context sensitivity within a theory of human communication, investigating the effects of context on communicative interaction and, as a corollary, what a context of utterance is and what it is to be in one. Provides detailed and wide-ranging overviews of the central positions and arguments surrounding contextualism Addresses broad and varied aspects of the distinction between the semantic and non-semantic content of language Defends a distinctive (...) and explanatorily powerful combination of semantic minimalism and speech act pluralism Confronts core problems which not only run to the heart of philosophy of language and linguistics, but which arise in epistemology, metaphysics, and moral philosophy as well. (shrink)

Cappelen and Hawthorne present a powerful critique of fashionable relativist accounts of truth, and the foundational ideas in semantics on which the new relativism draws. They argue compellingly that the contents of thought and talk are propositions that instantiate the fundamental monadic properties of truth and falsity.

Cappelen and Hawthorne present a powerful critique of fashionable relativist accounts of truth, and the foundational ideas in semantics on which the new relativism draws. They argue compellingly that the contents of thought and talk are propositions that instantiate the fundamental monadic properties of truth and falsity.

I call the activity of assessing and developing improvements of our representational devices ‘conceptual engineering’.¹ The aim of this chapter is to present an argument for why conceptual engineering is important for all parts of philosophy (and, more generally, all inquiry). Section I of the chapter provides some background and defines key terms. Section II presents the argument. Section III responds to seven objections. The replies also serve to develop the argument and clarify what conceptual engineering is.

The beginning of the twenty-first century saw something of a comeback for relativism within analytical philosophy. Relativism and Monadic Truth has three main goals. First, we wished to clarify what we take to be the key moving parts in the intellectual machinations of self-described relativists. Secondly, we aimed to expose fundamental flaws in those argumentative strategies that drive the pro-relativist movement and precursors from which they draw inspiration. Thirdly, we hoped that our polemic would serve as an indirect defence of (...) a traditional and natural picture concerning truth. According to this picture, what we call ‘Simplicity’, the fundamental structure of semantic reality is best revealed by construing truth as a simple monadic property of propositions that serve as the objects of belief, assertion, meaning and agreement. Our project was not a straightforward one. So-called relativists are not uniform in their key ideology, are often sloppy, casual, obscure or confused in their self-characterization, and differ in their argumentative emphasis among themselves and over time, thereby presenting a target that is both amorphous and shifty. This is an area where parties will frequently claim not to understand each other and where certain parties will sometimes accuse others of failing to make any sense at all. In such a situation, any effort to impose order will inevitably strike some parties as tendentious and unfair. That said, we felt that we had enough of …. (shrink)

This paper evaluates arguments presented by John Perry (and Ken Taylor) in favor of the presence of an unarticulated constituent in the proposition expressed by utterance of, for example, (1):1 1. It's raining (at t). We contend that these arguments are, at best, inconclusive. That's the critical part of our paper. On the positive side, we argue that (1) has as its semantic content the proposition that it is raining (at t) and that this is a location-neutral proposition. According to (...) the view we propose, an audience typically looks for a location when they hear utterances of (1) because their interests in rain are location- focused: it is the location of rain that determines whether we get wet, carrots grow, and roads become slippery. These are, however, contingent facts about rain, wetness, people, carrots, and roads – they are not built into the semantics for the verb 'rain'. (shrink)

Bundel met aanvullingen op colleges, gegeven aan de landbouwhogeschool te Wageningen, waarin de opvattingen worden besproken van ondermeer de Wiener Kreis (Carnap), Popper, Kuhn, Lakatos en Habermas.

Overzicht van de discussies in Nederland in de twintigste eeuw over historisch besef, gevoerd vanuit verschillende wetenschappelijke disciplines en invalshoeken.

Bad Language is the first textbook on an emerging area in the study of language: non-idealized language use, the linguistic behaviour of people who exploit language for malign purposes. This lively, accessible introduction offers theoretical frameworks for thinking about such topics as lies and bullshit, slurs and insults, coercion and silencing.

In this Introduction, we aim to introduce the reader to the basic topic of this book. As part of this, we explain why we are using two different expressions (‘conceptual engineering’ and ‘conceptual ethics’) to describe the topics in the book. We then turn to some of the central foundational issues that arise for conceptual engineering and conceptual ethics, and finally we outline various views one might have about their role in philosophy and inquiry more generally.

This book explores how physicists, astronomers, chemists, and historians in the late nineteenth and early twentieth centuries employed ‘epistemic virtues’ such as accuracy, objectivity, and intellectual courage. In doing so, it takes the first step in providing an integrated history of the sciences and humanities. It assists in addressing such questions as: What kind of perspective would enable us to compare organic chemists in their labs with paleographers in the Vatican Archives, or anthropologists on a field trip with mathematicians poring (...) over their formulas? While the concept of epistemic virtues has previously been discussed, primarily in the contexts of the history and philosophy of science, this volume is the first to enlist the concept in bridging the gap between the histories of the sciences and the humanities. Chapters research whether epistemic virtues can serve as a tool to transcend the institutional disciplinary boundaries and thus help to attain a ‘post-disciplinary’ historiography of modern knowledge. Readers will gain a contextualization of epistemic virtues in time and space as the book shows that scholars themselves often spoke in terms of virtue and vice about their tasks and accomplishments. This collection of essays opens up new perspectives on questions, discourses, and practices shared across the disciplines, even at a time when the neo-Kantian distinction between sciences and humanities enjoyed its greatest authority. Scholars including historians of science and of the humanities, intellectual historians, virtue epistemologists, and philosophers of science will all find this book of particular interest and value. (shrink)

An introduction to relativism about truth.

Herman Philipse puts forward a powerful new critique of belief in God. He examines the strategies that have been used for the philosophical defence of religious belief, and by careful reasoning casts doubt on the legitimacy of relying on faith instead of evidence, and on probabilistic arguments for the existence of God.

The view defended in this paper - I call it the No-Assertion view - rejects the assumption that it is theoretically useful to single out a subset of sayings as assertions: (v) Sayings are governed by variable norms, come with variable commitments and have variable causes and effects. What philosophers have tried to capture by the term 'assertion' is largely a philosophers' invention. It fails to pick out an act-type that we engage in and it is not a category we (...) need in order to explain any significant component of our linguistic practice. Timothy Williamson (2000) defends a theory of type (i). He says that a theory of assertion has as its goal "[…] that of articulating for the first time the rules of a traditional game that we play" (p. 240). Among those who think we play the game of assertion, there's disagreement about what the rules are. Some think it's a single rule and disagree about what that rule is. Others think the rules change across contexts. According to the No-Assertion view we don’t play the assertion game. The game might exist as an abstract object, but it is not a game you need to learn and play to become a speaker of a natural language. (shrink)