Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients (...) and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures. -/- . (shrink)

Cartwright and Munro argued that extrapolation of findings from randomized controlled trials to other settings can be difficult because information about the underlying causal structure and subgroups is often not available. They advocated the use of ‘capacities’ – that is fixed causal contributions – in predicting effects of interventions. In psychiatry, it is often not possible to determine what the fixed causal contributions are and one can only establish ‘approximate capacities’. However, using ‘approximate capacities’ does imply a different way of (...) evaluating health services, especially combined interventions. In health service research, if different studies, randomized controlled trials or other designs, have given different outcomes, the best way to investigate the effectiveness of a particular way of service organization is not to conduct more randomized controlled trials. It is preferable to study the effects of certain elements of the complex intervention, which have been tested before in other settings, that is investigating ‘approximate capacities’. One should check whether the separate elements do form a part of the complex intervention in practice and whether they have the same effect as in other studies and if not, why not. This enhances knowledge about the underlying causal structure and increases the possibility of extrapolation of the findings. (shrink)

This paper addresses the concept of moral luck. Moral luck is discussed in the context of medical error, especially an error of omission that occurs frequently, but only rarely has adverse consequences. As an example, a failure to compare the label on a syringe with the drug chart results in the wrong medication being administered and the patient dies. However, this error may have previously occurred many times with no tragic consequences. Discussions on moral luck can highlight conflicting intuitions. Should (...) perpetrators receive a harsher punishment because of an adverse outcome, or should they be dealt with in the same way as colleagues who have acted similarly, but with no adverse effects? An additional element to the discussion, specifically with medical errors, is that according to the evidence currently available, punishing individual practitioners does not seem to be effective in preventing future errors. The following discussion, using relevant philosophical and empirical evidence, posits a possible solution for the moral luck conundrum in the context of medical error: namely, making a distinction between the duty to make amends and assigning blame. Blame should be assigned on the basis of actual behavior, while the duty to make amends is dependent on the outcome. (shrink)

This is a response to the response by Robyn Bluhm to my paper, and I am again arguing for a limited role of capacities in psychiatry, given the current scientific uncertainties.

Crisis resolution and home treatment teams have been introduced into mental health care in the UK because, in general, patients do not want to be admitted to hospital, treatment at home is cheaper and in the only randomized controlled trial conducted so far there was no difference in symptomatic outcome. However, because of compulsory gate-keeping by CRHT teams, some patients no longer have the option of going to hospital if they want to. This aspect of the introduction of CRHT teams (...) has not been discussed so far, but it certainly warrants further examination. Intervention through CRHT teams may in fact increase compulsory admissions and serious and untoward incidents, although this is not certain. Sufferers from psychosis are the patient group most likely to be compulsorily admitted to hospital and they are generally considered less responsible for serious and untoward incidents. Therefore, a possible solution could be to offer a choice to some patients, namely those with a psychotic disorder, on whether they want to be admitted or not. At least one should investigate what the consequences of this policy would be, if it were to be adopted in a test region. This example shows that in developing policies for rationing health care, it can be important to look at subgroups and not just at average results when determining the best course of action. (shrink)

no abstract. Book review in Dutch about a book written in Dutch.

In this article, the authors present several topics related to the nascent development of a merit-based hiring system in North Macedonia. This paper employs a normative approach. We advocate for a merit-based hiring system, similar to the American model. First, we explore the pressure exerted by the European Commission to adopt a merit-based system at all levels of government as a condition for entry into the European Union. Second, we delve into the patronage system in North Macedonia. Third, we provide (...) a short history of patronage in the United States and the difficulty that nation had in curbing its entrenched patronage system. Fourth, we discuss the advantages of a merit-based hiring system, namely the creation of good governance, the improvement of employee morale, the development of more public confidence in government, the reduction of the influence of ethnic politics and the furtherance of the rule of law. Finally, we present an example drawn from the American federal government about the basic procedures of a merit-based hiring process. (shrink)

We have given a certain interpretation of Spinoza on the basis of an analysis of his methodology. In this study the present writer tried to restrict himself totally to this subject: viz. to give an exposition of Spinoza's methodology in its totality. He tried to give a modern approach in that he was primarily not concerned with the historical roots of Spinoza's ideas, but with the way in which these ideas function in his philosophy...... Zie: Introduction.

(1973). Suppose the Moment in Time had a Decisive Significance…A Critical Logical Analysis of Kierkegaard's Argumentation in the First Chapter of the ‘Philosophical Fragments’. Bijdragen: Vol. 34, No. 4, pp. 383-397.

In this article the author discusses some main problems and techniques of analytical philosophy as far as they are relevant for philosophical theology. By the latter he understands a discipline in which a doctrine of God and religion is given in a philosophical way, i.e. in which no argument referring to revelation or authority is decisive. He acknowledges that besides this discipline there is room for dogmatic theology to which analytical philosophy can contribute too. In this article he occasionally refers (...) to some of these contributions. By analytical philosophy the author understands a philosophy based upon a logical and linguistic analysis of our language, where analysis is to be understood as the translation of vague and ambiguous statements into clear and distinctive ones. Language is often a misleading factor in our thinking and distracts us from truth. Therefore analysis is necessary. The author points out that analytical philosophy is not to be identified with logical positivism. He proves that an absolute, closed metaphysical system is impossible, although this does not exclude the possibility of making metaphysical statements provided they are not definitive and not incorrigible. He gives an exposition of the theory of language-games. In a language-game we must distinguish between its vocabulary, its rules for making meaningful statements (well formed formulae) and its rules for deciding which statements are true and which not. The latter rules are not present in each language game. A scientific language-game, which also includes the languages of the social and historical sciences, is characterized by a set of principles of ordering, by which a maximum of primitive statements is ordered in the easiest way. Which statements are meaningful and which not and also which statements are primitive vary from language-game to language game. With respect to the revolutionary character of analytical philosophy the author admires the many technical improments it has given, without making the break with the past too great. In § 4 a survey is given of the various attitudes towards the status of theological statements. The author defends their cognitive character. At the end the author deals with some aspects of the proofs of God's existence and introduces some concepts of modal logic into the condition theory of causality, which is also important for other parts of philosophy. (shrink)

Vakfilosofische opstellen over de hedendaagse vraagstukken binnen de ethiek.

In an era of climate change, deforestation, melting ice caps, poisoned environments, and species loss, many people are turning to the power of the arts and humanities for sustainable solutions to global ecological problems. Introduction to the Environmental Humanities offers a practical and accessible guide to this dynamic and interdisciplinary field. This book provides an overview of the Environmental Humanities' evolution from the activist movements of the early and mid-twentieth century to more recent debates over climate change, sustainability, energy policy, (...) and habitat degradation in the Anthropocene era. The text introduces readers to seminal writings, artworks, campaigns, and movements while demystifying important terms such as the Anthropocene, environmental justice, nature, ecosystem, ecology, posthuman, and non-human. Emerging theoretical areas such as critical animal and plant studies, gender and queer studies, Indigenous studies, and energy studies are also presented. Organized by discipline, the book explores the role that the arts and humanities play in the future of the planet. Including case studies, discussion questions, annotated bibliographies, and links to online resources, this book offers a comprehensive and engaging overview of the Environmental Humanities for introductory readers. For more advanced readers, it serves as a foundation for future study, projects, or professional development. (shrink)

(2001). Looking toward the future of clinical trials: The application of communication variables to the recruitment of women into breast cancer clinical trials. World Futures: Vol. 57, Future Trends in Communications Strategies, pp. 599-613.