Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.

At the beginning of the twentieth century the high mortality rates of both mothers and babies during childbirth became a predominant concern in Britain and its empire, provoking outcries from medical and nursing professionals as well as politicians and the wider public. Infant mortality became the new marker of the vitality of the nation and a widely used indicator of general standards of health. Efforts to improve maternal and infant welfare were part of a broader shift in Britain towards public (...) health as a government responsibility. Measures taken to reduce mortality rates emphasized state-run initiatives in maternal education and antenatal care, the medicalization of childbirth, and scientific infant feeding and childrearing practices. This shift in health care policies resulted in profound changes to the experience of childbirth and to the role of the state in the area of social welfare... (shrink)

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Bridge From Analysis to Action:Psychodynamic Analyses of Religion and Michael S. Hogue's American ImmanenceAJ Turner (bio)I. IntroductionThe purpose of this essay is to work constructively with Michael S. Hogue's groundbreaking American Immanence: Democracy for an Uncertain World to demonstrate how psychodynamic analyses of religion are essential theoretical allies in the fight for resilient democracy. The "revolution in mind"1 that psychodynamic approaches contribute, especially in their analyses of religion, (...) both complements and complicates socio-political theory as a whole. In the improvisational spirit of "yes-and," the goal here is not to identify and decry the failures and shortcomings of Hogue's theopolitical vision but rather to inspire the recovery of a sibling discourse—a kind of "rebirth of a forgotten alternative"2—that also draws deeply from the American immanental tradition in order to add psychodynamic depth to Hogue's timely and important analysis. Psychodynamic theories of religion shed light on how symbolic identifications, including and especially ultimate concerns, structure personal and collective experience. By engaging religion and theology sympathetically, constructively, and creatively, theorists such as Rollo May, Gordon Allport, Karen Horney, Erich Fromm, and Ernest Becker departed from the skepticism, reductionism, and dismissal that characterized psychoanalytic analyses of religion in the wake of Freud.3 Each of these figures, and especially Becker whose work will be a focus in this essay, are noteworthy interlocutors for extending Hogue's theopolitical theorizing of resilient democracy, particularly in how they drew unique inspiration from the American immanental tradition [End Page 44] in their social analyses. In this respect, they provide a more robust theorization of the psychosocial conditions of the associational ethos needed to connect Hogue's conception of resilient democracy with forms of agonistic organization and democratic activism. Briefly stated, psychodynamic approaches are a helpful bridge for connecting these proposals to strategies of organization, their impediments, and collective action.In this way, both psychodynamic analyses of religion and Hogue's theopolitical innovation insist that no revolutionary political change is possible, and certainly not of the kind or scale needed to counter our wickedly entangled global crises, without a deep engagement with theological imaginaries. They differ, however, in their theoretical aims. Whereas Hogue compellingly argues for the political upshot of a theology deriving from the American immanental tradition, psychodynamic analysts of religion focus on the function of ultimate concerns in individual and collective life. In other words, American Immanence rests on a methodology of analyzing the philosophical and theological assumptions that have contributed to our climate crises and then presenting clear and compelling articulation of an alternative paradigm meant to open up new ways of being. In contrast psychodynamic analyses leverage conceptual clarity of psychic reality for the fundamentally therapeutic aim of transformation. At their best, both approaches share what could be called an etiological orientation to ontological questions in order to provide liberative alternatives through rational understanding and clarification, but the terrain, and thus the problems they hope to mitigate in their analyses are focused differently. Extending the visual metaphor, they are different lenses highlighting different areas of the same landscape. Furthermore, it must be said that neither are sufficient in themselves, but the psychodynamic theorists of religion to be highlighted in this essay share deeply with Hogue's heading in American Immanence.II. A Problematic AssumptionIn emphasizing and attempting to explain4 the role of non-rational processes in the both individual and social processes of perception and organization of experience, psychodynamic theories confound a widely held and problematic assumption that the triumph of rational analysis is the hallmark for building the society to which we should aspire. Political theory in general, [End Page 45] especially as it has taken its cues from a rationalist legacy about the inherently liberating force of Reason, has been weighted toward an assumption that its task of exposing the mystifications of power would suffice in inspiring more "rational" and therefore necessarily equitable social organization. This speaks to the longstanding socio-political interest in "consciousness raising" tactics, which are often meant to dispel "false consciousness." It even comes across in the emphases of Deweyan pragmatists on education. Psychologists of all stripes point out that this approach... (shrink)

_Germany and the French Wars of Religion, 1560-1572_ explores how the first decade of the religious wars in France was interpreted by German Protestants and why they felt compelled to intervene.

A. W. Price explores the varying ways in which context is relevant to our reasoning about what to do.

In this paper, we propose a new technique for the enhancing images. It will work on removing the noise contained in the image as well as improving its contrast based on three different enhancing transforms, we commence by embedding the image into a neutrosophic domain; where the image will be mapped in three different levels, a level of trueness, a level of falseness and a level of indeterminacy. Hence, we act separately on each level using the enhancement transforms. Finally, we (...) introduce a new analysis in the field of analysis and processing of images using the neutrosophic crisp set theory via Mat lab program where has been obtained three images, which helps in a new analysis to improve and retrieve images. (shrink)

In this book, I will discuss three main topics: the roots and aims of scientific knowledge, scientific knowledge in society, and science and values I understand scientific knowledge as being a planned and continuous production of the general and common knowledge of scientific communities. I begin my discussion with a brief analysis of the main differences between sciences, on the one hand, and everyday experience, philosophies, religions, and ideologies, on the other. I define the concept of science as a set (...) of family resemblances (in Wittgenstein's sense). The sciences can be distinguished along three lines, in terms of the difference between empirical and non-empirical sciences, differences in degrees of theoretical and methodological structure among individual sciences and scientific disciplines. Scientific knowledge is based upon some grounds, paradigmatic knowledge bases. Scientific knowledge is founded on a unified paradigmatic knowledge base. The latter includes fundamental theories, basic facts, generally accepted empirical regularities (laws), scientific research methods, scientific explanations, and established relations to other sciences. Scientific knowledge in general is defined well in classical terms by the definition that knowledge is a true and rationally-justified belief. In this connection, scientific truth is relative, depending on the given paradigmatic knowledge base and on the precision and accessibility of the measurements and observations involved. In the book's first part, I consider the production and testing of scientific hypotheses, scientific explanations, the structure of scientific theories, and the problem of scientific realism. I consider explanation an integral part of a wider nexus of heuristic and theoretical activities in science like giving reasons, understanding, clarification, and founding. Continuous production of scientific explanations is a necessary condition for the systematic reproduction of scientific knowledge. Accordingly, it does not suffice to describe them in terms of the logical structure of the arguments on which they are based, but rather, scientific explanations ought to be given complete with an epistemic and pragmatic context of the explanation. I consider especially deductive-nomological, inductive-statistical, dispositional, teleological-functional, and genetic explanations. I emphasize the ever-increasing importance of explanations by analogy and by model. Orthogonal to these distinctions lies the distinction between causal and epistemic explanation. Epistemic explanations relate scientific discoveries to epistemic progress, and causal explanations are these epistemic explanations that relate scientific discoveries to reality too. Causal explanations inform us that certain changes occur in the world as agents of other changes, or rather, that certain changes are real consequences of other changes. Thus, by having explanations of causes, we can intervene in the world to induce by design certain changes in some course of phenomena. I consider scientific theories as logically and epistemically ordered wholeness of scientific knowledge in a realm of research that enables us to construct useful models of reality. After the discussion of different 'statement' views on theories and different interpretations of the theory-experience relation, I introduce the 'model' theoretical (non-statement) views on theories, especially the structural theory of science. The model views on theories transcend the realism-antirealism dualism by introducing models between theory and reality. Therefore, the question of scientific realism is not merely whether and, if so, which element(s), of scientific theories represent reality, but rather which conditions suffice to infer from a theory that one of its models truly expresses reality. In other words, under which conditions do models of a theory represent models of reality? Generally, models are just as much images of reality in a theory as they are images of a theory in reality. The actual problem of scientific realism doesn't originate in the observable-unobservable distinction (even if this distinction is otherwise theoretically loaded), but rather in ontological quandaries, of the sort especially encountered in modern physical theories such as quantum mechanics, relativity theory, and cosmological theories, although they are known to arise in other sciences as well. Scientific theories may be real, even if they describe nothing about the world. However, such theories can be given this status only if their formal, mathematical postulates exhibit some formal homology between reality and mathematical forms. The very fact that it is possible to describe reality with the help of mathematics even in cases, where every (representational, conceptual) language and thought fall short, would indicate that even mathematics itself is, in some sense, a part of reality, although 'outside' of the empirical world. It follows we have to distinguish the non-empirical reality and the empirical world. Formal objectivity and non-arbitrariness of theories do not emerge from either our language or thoughts, or from the world of facts, causes, and effects, but rather from non-empirical reality, which frames the world as some kind of objective transcendental condition for the possibility of the existence of the world, thoughts, and language. In the second part of the book, I consider the incorporation of scientific work and scientific knowledge into modern society and its relations to values and ethics. Production of scientific knowledge goes on as a parallel distributed process of a special kind of social (shared) cognition. The central part of this cognition is the presentation of parts of the world by scientific (theoretical) models which are warranted by the shared and public practice of justification, and in reflective acting in the world as it would. I consider various formal concepts of collective propositional knowledge (distributed, mutual, common knowledge). Scientific knowledge is an achievement to be ascribed to a scientific community or, indirectly, to all those who apply or expand it, rather than to individuals per se. It presents the continuous and partially planned production of non-trivial common knowledge of the research communities in modern societies. However, besides common knowledge, shared dispositional knowledge (knowledge how of scientific teams) and shared knowledge by acquiring (knowledge of fundamental similarities and differences in scientific teams) are parts of the real body of scientific knowledge. Scientific common knowledge implies the projection into idealized universal knowledge of all real or potentially rational and well-informed individuals. The respect of scientific knowledge thus presents the norm of rationality. Science as the intensively shared and socially distributed kind of cognition enters into modern society as a special kind of work (general work), as a productive force (social invention drive), and as a form of capital (human, social, cultural, informational, etc.). However any of these categories can adequately represent the socio-economical role of science in modern societies, and we are still waiting for a more adequate general concept that would theoretically cover the 'scientification' of modern societies. My thesis is that the most important general effect of scientification is (and will be) the growth of social processes that structurally resemble parallel distributed shared social cognition of science, and not so much the rise of the use of scientific knowledge and scientifically based information in all kinds of production. Scientification of modern societies inevitably includes a much stronger need for moral and social responsibility of scientists for their work and its effects in their local society and the global world. This need comes in contradiction with the quite large accepted idea (and even the 'norm') on value-free research. I discuss to some degree different arguments for the absence of non-epistemic values and ethical reasoning from science and find them non-convincing. The sound idea of value-free research lies in the need for the absence of categorical value statements from scientific explanations and theoretical deductions. Values and ethical judgment have, and sometimes they even have to play an important role in another part of research and its application in science or outside it. Not the value-loudness of research is a danger for science but its blind, non-reflective use. It leads to the ideologization and politicization of science. A similar danger lies in the purely value-neutrality of research. It leads to the instrumentalization of science to the technical or bureaucratic means for 'any' aims. (shrink)

Catalog of the collection of the Madamkhand Museum of Art, named after the wife of Batzhargalyn Batbai︠a︡r, businessman and member of the Mongolian Khural.

This introduction to the basic ideas of structural proof theory contains a thorough discussion and comparison of various types of formalization of first-order logic. Examples are given of several areas of application, namely: the metamathematics of pure first-order logic (intuitionistic as well as classical); the theory of logic programming; category theory; modal logic; linear logic; first-order arithmetic and second-order logic. In each case the aim is to illustrate the methods in relatively simple situations and then apply them elsewhere in much (...) more complex settings. There are numerous exercises throughout the text. In general, the only prerequisite is a standard course in first-order logic, making the book ideal for graduate students and beginning researchers in mathematical logic, theoretical computer science and artificial intelligence. For the new edition, many sections have been rewritten to improve clarity, new sections have been added on cut elimination, and solutions to selected exercises have been included. (shrink)