OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case (...) characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

It is a rare patient who always does everything healthcare providers advise. Sometimes no harm comes from this; sometimes good does. But occasionally, great harm comes from not listening, as when it results in patients returning time and again for costly and invasive treatments of, say, infections, valve replacements, pressure ulcers, and so forth. No class of patients arouses more anger and resentment in healthcare providers, who often put out a call to invoke some version of the three strikes rule (...) and refuse care. And if the patients are also unemployed substance abusers who live in a local park, impolite or dangerous to staff, disruptive to other patients, and have intimidating visitors, the call to say “No” is louder. Can care ever be refused? If so, when? These are the questions we take up in this article. The answers we provide were developed as part of a Paraplegics and Quadriplegics with Pressure Ulcers Project carried out at Vancouver Hospital and Health Sciences Centre. Following an established usage, we refer to patients who exhibit a cluster of the above characteristics, the dominant one of which is a reluctance to heed medical advice, as “noncompliant patients.” This term is offensive to some, but the politically correct lexicon does not provide any alternative which is as short and clear or substantially different. We use the term as a convenient way of referring to a familiar class of patients and without any imputation of blame. (shrink)

Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project “support and consultation in euthanasia in Amsterdam” which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the (...) general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. (shrink)

In the Netherlands, in 1995 approximately 9700 people explicitly requested euthanasia or assisted suicide, and EAS was performed approximately 3600 times. The most important reasons for not performing EAS when requested by a patient were that the patient died before EAS was performed, or that the physician refused the request.

The target article's evolutionary approach provides an excellent framework for understanding when and why people retaliate or forgive. We argue that recent findings on the basic processes in forgiveness can further refine the authors' proposed model. Specifically, the lack of executive control may restrict the explanatory power of relationship value and exploitation risk.

This study reports on the hierarchy of organizational values in public and private sector organizations in Slovenia and the Netherlands. We surveyed 400 managers in Slovenia and 382 in the Netherlands using an identical questionnaire on the importance of a selection of values in everyday decision making. In Slovenia, impartiality, incorruptibility, and transparency were rated significantly higher in the public sector, while profitability, obedience, and reliability were rated more important in business organizations. In contrast, in the Netherlands, 11 values differed (...) significantly between the sectors. Thus, a greater value congruence exists between the sectors in Slovenia than in the Netherlands, with a larger “common core” of values in Slovenia (14) compared with the Netherlands (9), just as we hypothesized. Historical and cultural developments, such as the communist rule in Slovenia and the different influences of the Protestant work ethic in both countries, led to more similarities between business and government organizations in the “new” EU member state, Slovenia. (shrink)

Looking back at the twentieth century the question is what we have 'learned' in the field of philosophy in that century. In the case of philosophy 'learning' is understood as getting a more adequate insight into the frameworks in terms of which we spell our experience, in particular as getting an eye for aspects of it that were overlooked or insufficiently noticed in the philosophy of earlier periods. In that connection four themes are discussed: 1. subjectivity and inwardness, i.e. the (...) issue of the special mode of being of the subject ; 2. intersubjectivity and connectedness, i.e. the 'discovery' that by the relation between subjects a very special dimension of reality is indicated that cannot be adequately characterized in terms of the subject-object relationship ; 3. mediation, the issue that meanings are always context and tradition bound, that subjectivity, mind, etc., manifest themselves only as 'incarnated', mediated by nature ; and 4. the evolution from a uniform to a manifold concept of rationality and experience. (shrink)

BackgroundIn many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholic beverages, and ever stricter smoke-free policies. Such interventions can enhance healthier behaviour, but when they become too intrusive, an unfree society can emerge. Which lifestyle interventions that use pressure or coercion are justifiable and which are not? We tried to develop an assessment model that can be used for answering this question, (...) on a generally acceptable way, for all sorts of lifestyle interventions.MethodsThe intended assessment model was developed in three phases. In the first phase the model was theoretically developed on the basis of literature study and reasoning. In the second phase the model was empirically tested by assessing two detailed cases from everyday practice using the model. The model was improved again and again. In the third phase the 10th version of the model was developed while writing this article.ResultsAn assessment model for the justification of intrusive lifestyle interventions. It comprises three components: 12 assessment criteria ; an assessment structure with three filters ; a way of assessing.ConclusionsWe have developed an assessment model for the justification of lifestyle interventions that use pressure or coercion to promote health. The correctness, completeness and practicality of the model are likely. Important principles for the justification are the logic and completeness of the underlying argumentation and the proper use of the available scientific information. Parties for and against a particular intervention could use the model to test and strengthen their argumentation and to improve the quality of the intervention. (shrink)

In many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholi..

Aanleiding voor dit nummer over 'democratie en representatie' is het overlijden, op 3 oktober van vorig jaar, van een van de belangrijkste naoorlogse politieke denkers in Frankrijk, Claude Lefort . Omdat we niet zozeer de man, maar des te meer zijn ideeën willen memoreren hebben we ervoor geopteerd om de kern van zijn politiek-filosofische nalatenschap onder de aandacht te brengen. Zonder twijfel is dat het inzicht in de onlosmakelijke verwevenheid van democratie en representatie.

How do work motivations and sector perceptions differ between graduate students at prestigious Business Schools and Public Policy in Asia? Where do Asia’s future business and government leaders want to work, and why? To answer these questions, we compare Asian Master of Business Administration students with Master of Public Policy and Master of Public Administration students from three leading Schools based in Singapore through a survey study and a series of seven focus groups. Our findings indicate that work motivations, sector (...) perceptions, and career preferences differ between both groups but slightly less so than between their Western counterparts. Moreover, future Asian leaders equally value being successful while many view government as bureaucratic and prone to cronyism regardless of degree program and employment preference. We discuss how our findings may advance a more robust management and leadership research agenda for Asia. (shrink)

Otto Duintjer is one of the philosophers who have anew put the theme of spirituality on the philosophical agenda. Indeed, philosophy understood as striving for wisdom has had a spiritual dimension from the outset. But in modern time that dimension has eclipsed ever more, especially in academic philosophy. An important reason is that philosophy has adapted itself to a model of science, for which a 'disinterested' and 'neutral' attitude of the knowing subject and a hypothetical form of thinking are charasteristic. (...) In the logic of this type of science, and hence of a corresponding philosophy, existential and metaphysical questions and the theme of transcendence, which are essential for spirituality, fundamentally have no place. An important line of modern thinking, of which Kant and Wittgenstein are leading representatives and that Duintjer also takes as his starting-point, acknowledges the significance of these questions. But it also thinks that they can only be handled in a negative and indirect way. At the basis of that is an epistemological conception that understands knowledge exclusively as fully explicit knowledge. But if knowledge can also comprise all sorts of partially explicated or 'tacit' knowledge, as twentieth century philosophy has come to think, perspectives are opened for forms of spiritual knowledge that are not solely dependent on negative or indirect ways of reaching them. (shrink)

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In his very interesting paper Harry Kunneman argues for an alternative view on voluntary work which not so much stresses the economic aspect but primarily its existentially meaningful aspect. To underpin this, Kunneman makes use of a broad range of hermeneutical, social-philosophical, complexity theoretical, biological and other ideas. This multipolar structure of the article might also prove to be its very weakness, because the rich train of thought remains highly abstract. This could be overcome by using examples and casuistry to (...) elucidate and specify the many distinctions in the article. (shrink)

Due to its extraordinary predictive power and the great generality of its mathematical structure, quantum theory is able, at least in principle, to describe all the microscopic and macroscopic properties of the physical world, from the subatomic to the cosmological level. Nevertheless, ever since the Copen hagen and Gottingen schools in 1927 gave it the definitive formu lation, now commonly known as the orthodox interpretation, the theory has suffered from very serious logical and epistemologi cal problems. These shortcomings were immediately (...) pointed out by some of the principal founders themselves of quantum theory, to wit, Planck, Einstein, Ehrenfest, Schrodinger, and de Broglie, and by the philosopher Karl Popper, who assumed a position of radical criticism with regard to the standard formulation of the theory. The aim of the participants in the workshop on Open Questions in Quantum Physics, which was held in Bari (Italy), in the Department of Physics of the University, during May 1983 and whose Proceedings are collected in the present volume, accord ingly was to discuss the formal, the physical and the epistemo logical difficulties of quantum theory in the light of recent crucial developments and to propose some possible resolutions of three basic conceptual dilemmas, which are posed respectively ~: (a) the physical developments of the Einstein-Podolsky-Rosen argument and Bell's theorem, i. e. (shrink)

Workplace aggression has been established as a prevalent and detrimental issue in organizations. While numerous studies have documented the important role of leaders in inhibiting or accelerating workplace aggression, a systematic overview of the associations between different leadership styles and workplace aggression as well as its boundary conditions is still lacking. This study reports a meta-analysis investigating the associations between leadership and workplace aggression. Drawing on data from 165 samples, our results revealed that change-oriented, relational-oriented, and values-based and moral leadership (...) were associated with reduced workplace aggression. In contrast, passive and destructive leadership were associated with increased workplace aggression. Importantly, relative weights analyses revealed that ethical leadership was most strongly negatively associated with workplace aggression. Additionally, moderation analyses revealed that the associations between leadership and workplace aggression were, in some cases, moderated by power distance and rating sources, but independent of measurement time lag. Overall, the findings of this meta-analysis highlight the important associations between leadership and workplace aggression. Implications for future research and policy recommendations aiming to reduce workplace aggression are discussed. (shrink)

Biodiversity informatics produces global biodiversity knowledge through the collection and analysis of biodiversity data using informatics techniques. To do so, biodiversity informatics relies upon data accrual, standardization, transferability, openness, and “invisible” infrastructure. What biodiversity informatics mean to society, however, cannot be adequately understood without recognizing what organizes biodiversity data. Using insights from science and technology studies, we story the organizing “visions” behind the growth of biodiversity informatics infrastructures in Sweden—an early adopter of digital technologies and significant contributor to global biodiversity (...) data—through interviews, scientific literature, governmental reports and popular publications. This case story discloses the organizational formation of Swedish biodiversity informatics infrastructures from the 1970s to the present day, illustrating how situated perspectives or “visions” shaped the philosophies, directions and infrastructures of its biodiversity informatics communities. Specifically, visions related to scientific progress and species loss, their institutionalization, and the need to negotiate external interests from governmental organizations led to unequal development across multiple infrastructures that contribute differently to biodiversity knowledge. We argue that such difference highlights that the social and organizational hurdles for combining biodiversity data are just as significant as the technological challenges and that the seemingly inconsequential organizational aspects of its infrastructure shape what biodiversity data can be brought together, modelled and visualised. (shrink)

Aanleiding voor dit nummer over 'democratie en representatie' is het overlijden, op 3 oktober van vorig jaar, van een van de belangrijkste naoorlogse politieke denkers in Frankrijk, Claude Lefort . Omdat we niet zozeer de man, maar des te meer zijn ideeën willen memoreren hebben we ervoor geopteerd om de kern van zijn politiek-filosofische nalatenschap onder de aandacht te brengen. Zonder twijfel is dat het inzicht in de onlosmakelijke verwevenheid van democratie en representatie.