BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately (...) operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative (...) care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

Seattle, Prague, Quebec, Nice, Gothenburg, Genoa, Brussels, Barcelona, ≡ All these cities formed the setting of mass globalization protests. In most mass media reports, the presence of thousands of peaceful demonstrators has been outshone by the pictures of radical activists smashing McDonald's and Niketown. In the search for an adequate theological response to today's context of globalization, this article takes precisely this radical activism as a starting–point. In line with those postmodern iconoclasts’ own legitimation, a theological approach to this case (...) leads to the Marxist theory of fetishism and idolatry as it has already been investigated by liberation theologians two decades ago. Surprisingly, a renewed version of this critique of the theologization of economics can be found in No Logo , the trend–setting globalization critique written by the Canadian journalist Naomi Klein. A theological close reading of this best–selling book brings to the light a recurrent use of religious metaphor to characterize the corporate logo as a major aesthetic figure in the context of globalization. In order to understand the aesthetic and theological processes involved, a confrontation with the theological aesthetics of Hans Urs von Balthasar delivers a striking formal parallel between the Church's cross and today's corporate logo. Beyond an at first sight similar theo–aesthetic programme, Balthasar's theological aesthetics however opens up a position which enables us to expose the contemporary global socio–economic system as a subtly inverted Christianity. (shrink)

Through an exploration of the interpretation history of Matt. 25:33-46, this article develops an apocalyptic ethics based on Christ’s encountering us in the least of his brothers and sisters. Proposing the newly coined expression ‘ visitatio Christi’, the article offers a counterpoint to the common theological-ethical theme of imitatio Christi. First, it recalls how Jesus’ eschatological parable has time and again inspired love of the neighbour in need and challenged the scope of the required option for the poor. Next, the (...) article shows how an apocalyptic ethics based in Matthew 25, which imagines our moral life as a response to the visitatio Christi, implies a transformation of attitude/perception, a reversal of roles, and finds its source in the sacramental presence of Christ in the poor. Finally, the different aspects of the argument are recapitulated drawing upon Pope Francis’s use of Matthew 25. (shrink)

Love lies at the very heart of the Christian faith and its conception of both God and the human being. Nevertheless, the growing field of theological anthropology has yet to fully avail itself of philosophy’s and theology’s renewed attention to the theme of love. The Introduction to this special issue proposes the phrase ‘in the image of Love’ as an invitation to examine the relation between theological anthropology and love throughout the history of Christian thought. Guided by this motif, the (...) issue’s contributors consider ten historical thinkers on love and the human in relation to their philosophical conversation partners at the time. The volume thus has a genealogical dimension, delving into often forgotten layers beneath our current, late modern view of the human/love. It thereby assists future theological anthropological discussions in the much-needed task of both integrating the crucial theme of love and formulating more historically grounded perspectives. This special issue also reveals the ways in which theologians have attempted to respond to the challenge posed by the modern subject while retaining the idea that the human creature is called by Love and called to Love, and provides an alternative to Nygren’s opposition of agape and eros. (shrink)

This short article provides an introduction to a special section, consisting of six papers on human evolution and the imago Dei. These papers are the result of dialogue between theologians and philosophers of religion at the University of Oxford and the Catholic University of Leuven. All contributors focus on the imago Dei, and consider how this theological notion can be understood from an evolutionary perspective, looking at a variety of disciplines, including the psychology of reasoning, cognitive science of religion, paleoanthropology, (...) evolutionary psychology, and evolutionary ethics. (shrink)

In this volume we present the proceedings from the fourth international Leuven Encounters in Systematic Theology (LEST IV, November 5-8, 2003), which focussed ...

This short article provides an introduction to a special section, consisting of six papers on human evolution and the imago Dei. These papers are the result of dialogue between theologians and philosophers of religion at the University of Oxford and the Catholic University of Leuven. All contributors focus on the imago Dei, and consider how this theological notion can be understood from an evolutionary perspective, looking at a variety of disciplines, including the psychology of reasoning, cognitive science of religion, paleoanthropology, (...) evolutionary psychology, and evolutionary ethics. (shrink)

This article discusses plant-closing decisions by multinational enterprises applying a stakeholder theory approach. In particular, we focus on the emergence of “intra-stakeholder alliances,” that is, alliances among the various stakeholder groups of a specific corporation. We analyze the emergence of stakeholder alliances in reaction to MNEs' decisions to terminate production locally and discuss their influence on the outcomes of such decisions. Our research is inspired by two exceptional case studies of two multinational breweries that announced their decisions to close niche (...) breweries in small towns in Italy and Belgium. In both cases, the initial decision was ultimately reversed through the actions of intra-stakeholder alliances. We combine insights from stakeholder theory and the social movement literature to analyze the action and influence of intra-stakeholder alliances in seven cases of plant-closing decisions. We conclude by formulating four general propositions that can provide guidance to MNE management in plant-closing decisions. Our findings extend managerial stakeholder theory, show how this approach can improve strategic management analysis, emphasize the importance of the relationships among stakeholders in the value-creation process, and shed light on the collective action and influence of intra-stakeholder alliances. (shrink)

The study of complexity in chronic care is an emergent discipline that has not yet developed a consistent theoretical framework. Thinking in the field of complexity encompasses complexity science and complexity theories, which represent a convergence of different types of ideas and theories that focus on the interactions of individual parts that make up a complex system. In this context, an important distinction is to be made between "complex" and "complicated." If a system—despite the fact that it may consist of (...) a huge number of components— can be given a complete description in terms of its individual constituents, such a system is merely complicated. An example could be computers. In a complex system, on the .. (shrink)

Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H-2-antihistamines by general practitioners, internists and "astroenterologists were obtained from the Belgian (...) national health insurance database (1997-2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the Iona term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care. (shrink)

Les errements d'Yves de Vallone (1666/67-1705) et les péripéties de sa carrière sont remarquables. Engagé malgré lui dans la Congrégation de Sainte-Geneviève à l'âge de 16 ans, il s'enflamme lorsqu'il est informé qu'il existe une "petite Église" de sociniens au sein de son ordre. Il accuse les directeurs génovéfains d'hérésie et subit une persécution très éprouvante, mais finit par faire démettre le supérieur général et ses acolytes, non pas à cause de leur hérésie, mais à cause de la persécution (...) qu'ils lui ont infligée. La nouvelle direction génovéfaine cherchant à venger l'ancienne, Vallone s'échappe en Suisse et en Allemagne et se convertit au protestantisme en 1697. Appelé à Zwolle aux Provinces-Unies, il s'érige en apologiste rationaliste de la doctrine calviniste de la prédestination dans deux écrits dirigés contre les luthériens. Cependant, ne voulant abandonner la métaphysique aux libertins ; il se laisse emporter par la logique de sa propre conception malebranchiste de l'Être infiniment parfait et se heurte à la critique de Jacques Bernard et à la censure par un synode de l'Église réformée en 1703. Il abandonne alors, non pas son rationalisme malebranchiste, mais la doctrine du péché originel qui avait entraîné toutes ses difficultés : sous l'influence de Leenhof, et à l'aide des œuvres de Richard Simon, de Pierre Bayle et de Spinoza, il dresse une histoire accablante de la doctrine chrétienne et élabore un système philosophique où Dieu, principe intelligent de tout ce qui existe, agit par la nécessité de sa propre nature et finit par se confondre avec la Nature."--Page 4 of cover. (shrink)

L'État pluriculturel est devenu un concept majeur du début du XXIe siècle, tant au Nord qu'au Sud de la planète. La plupart des États sont confrontés à l'éveil ou à l'affirmation des différentes cultures des différentes communautés en leur sein. Pour nos sociétés plurielles, voici venu le temps des droits aux différences. En réalité, devant ce phénomène universel, les positions de l'État varient : il aménage la coexistence des communautés culturelles ; ou il ne veut pas les connaître. Entre ces (...) deux pôles, bien des nuances existent, du refus des différences à leur tolérance, et enfin à leur reconnaissance. La France est un exemple typique de déchirement : elle est arc-boutée sur le principe fondateur de la République une et indivisible, mais elle prévoit à ce principe de telles exceptions qu'elle est en plein bouleversement. Comment l'État démocratique va-t-il régir sa pluriculturalité? Comment les différentes options praticables peuvent-elles, chacune, impliquer une part de cohésion et une part de fragmentation sociale? Comment concilier droits à la différence et droit à l'indifférence? De telles questions ne peuvent être traitées qu'en analysant les diverses expériences. C'est ce que fait le présent ouvrage, publiant les travaux d'un colloque tenu à Nouméa en juillet 2002, avec la participation de juristes et de politistes, d'anthropologues et de tous chercheurs en sciences sociales en général. Les États les plus divers, de tous les continents, sont analysés. Les expériences de contextes extrêmement contrastés sont évoquées : les différences ont un long chemin à faire, pour s'affirmer en droit. Le cas très particulier de la Nouvelle-Calédonie est approfondi : à la fois symbole de la France pluriculturelle et consécration d'institutions fortement dérogatoires. Cet ouvrage est une contribution au code universel du Vivre ensemble. (shrink)

We investigate agents that have incomplete information and make decisions based on their beliefs expressed as situation calculus bounded action theories. Such theories have an infinite object domain, but the number of objects that belong to fluents at each time point is bounded by a given constant. Recently, it has been shown that verifying temporal properties over such theories is decidable. We take a first-person view and use the theory to capture what the agent believes about the domain of interest (...) and the actions affecting it. In this paper, we study verification of temporal properties over online executions. These are executions resulting from agents performing only actions that are feasible according to their beliefs. To do so, we first examine progression, which captures belief state update resulting from actions in the situation calculus. We show that, for bounded action theories, progression, and hence belief states, can always be represented as a bounded first-order logic theory. Then, based on this result, we prove decidability of temporal verification over online executions for bounded action theories. (shrink)

Although classical evolutionary theory, i.e., population genetics and the Modern Synthesis, was already implicitly ‘gene-centred’, the organism was, in practice, still generally regarded as the individual unit of which a population is composed. The gene-centred approach to evolution only reached a logical conclusion with the advent of the gene-selectionist or gene’s eye view in the 1960s and 1970s. Whereas classical evolutionary theory can only work with (genotypically represented) fitness differences between individual organisms, gene-selectionism is capable of working with fitness differences (...) among genes within the same organism and genome. Here, we explore the explanatory potential of ‘intra-organismic’ and ‘intra-genomic’ gene-selectionism, i.e., of a behavioural-ecological ‘gene’s eye view’ on genetic, genomic and organismal evolution. First, we give a general outline of the framework and how it complements the—to some extent—still ‘organism-centred’ approach of classical evolutionary theory. Secondly, we give a more in-depth assessment of its explanatory potential for biological evolution, i.e., for Darwin’s ‘common descent with modification’ or, more specifically, for ‘historical continuity or homology with modular evolutionary change’ as it has been studied by evolutionary developmental biology (evo-devo) during the last few decades. In contrast with classical evolutionary theory, evo-devo focuses on ‘within-organism’ developmental processes. Given the capacity of gene-selectionism to adopt an intra-organismal gene’s eye view, we outline the relevance of the latter model for evo-devo. Overall, we aim for the conceptual integration between the gene’s eye view on the one hand, and more organism-centred evolutionary models (both classical evolutionary theory and evo-devo) on the other. (shrink)

Although classical evolutionary theory, i.e., population genetics and the Modern Synthesis, was already implicitly ‘gene-centred’, the organism was, in practice, still generally regarded as the individual unit of which a population is composed. The gene-centred approach to evolution only reached a logical conclusion with the advent of the gene-selectionist or gene’s eye view in the 1960s and 1970s. Whereas classical evolutionary theory can only work with fitness differences between individual organisms, gene-selectionism is capable of working with fitness differences among genes (...) within the same organism and genome. Here, we explore the explanatory potential of ‘intra-organismic’ and ‘intra-genomic’ gene-selectionism, i.e., of a behavioural-ecological ‘gene’s eye view’ on genetic, genomic and organismal evolution. First, we give a general outline of the framework and how it complements the—to some extent—still ‘organism-centred’ approach of classical evolutionary theory. Secondly, we give a more in-depth assessment of its explanatory potential for biological evolution, i.e., for Darwin’s ‘common descent with modification’ or, more specifically, for ‘historical continuity or homology with modular evolutionary change’ as it has been studied by evolutionary developmental biology during the last few decades. In contrast with classical evolutionary theory, evo-devo focuses on ‘within-organism’ developmental processes. Given the capacity of gene-selectionism to adopt an intra-organismal gene’s eye view, we outline the relevance of the latter model for evo-devo. Overall, we aim for the conceptual integration between the gene’s eye view on the one hand, and more organism-centred evolutionary models on the other. (shrink)

First the ‘Weismann barrier’ and later on Francis Crick’s ‘central dogma’ of molecular biology nourished the gene-centric paradigm of life, i.e., the conception of the gene/genome as a ‘central source’ from which hereditary specificity unidirectionally flows or radiates into cellular biochemistry and development. Today, due to advances in molecular genetics and epigenetics, such as the discovery of complex post-genomic and epigenetic processes in which genes are causally integrated, many theorists argue that a gene-centric conception of the organism has become problematic. (...) Here, we first explore the causal implications of the following two central dogma-related issues: (1) widespread reverse transcription—arguing for an extension from ‘DNA-genome’ to RNA-encompassing ‘NA-genome’ and, thus, from traditional DNA-centrism to a broader ‘NA-centrism’; and (2) the absence of a mechanism of reverse translation—arguing for the ‘structural primacy’ of NA-sequence over protein in cellular biochemistry. Secondly, we explore whether this latter conclusion can be extended to a ‘functional primacy’ of NA-sequence over protein in cellular biochemistry, which would imply a limited kind of ‘gene/NA-centrism’ confined to the subcellular level of NA/protein-based biochemistry. Finally, we explore the conditions—and their (non)fulfilment—for a more generalised form of gene-centrism extendable to higher levels of biological organisation. We conclude that the higher we go in the biological hierarchy, the more dubious gene-centric claims become. (shrink)

The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery–Asberg Depression Rating Scale. A subsample of 41 patients from an RCT was included. For each case, two sessions of brief inpatient psychodynamic psychotherapy were transcribed and then coded using the (...) Defense Mechanism Rating Scales and the Psychotic Defense Mechanism Rating Scales, an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient’s defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy. (shrink)

Présenter un aperçu de la « mystique chrétienne médiévale » n’est possible qu’en la situant brièvement dans l’histoire de la « mystique » en Occident. Le terme n’est pas dénué d’ambiguïté. Apparaissant dans le contexte des religions à mystères, la mystique évolue vers une expérience silencieuse que les mots ne peuvent capter, avant de désigner des phénomènes anormaux décrits dans une rhétorique de l’étrange. Par rapport à la littérature moderne, les textes médiévaux sont très sobres. Faisant à écho à la (...) théologie mystique de Denys l’Aréopagite (ve-vie s.), ils présentent une voie d’union à l’Un en deçà des mots et des concepts. Il ne suffit pas de connaître (mathein) Dieu par un savoir notionnel, il faut en faire l’expérience, « en pâtir » (pathein). Ce « pâtir Dieu » sera repris par Maître Eckhart (1260-1328), le chef de file de la mystique rhénane. (shrink)

An important mechanism for the evolution of phenotypic complexity, diversity and innovation, and the origin of novel gene functions is the duplication of genes and entire genomes. Recent phylogenomic studies suggest that, during the evolution of vertebrates, the entire genome was duplicated in two rounds (2R) of duplication. Later, ∼350 mya, in the stem lineage of ray‐finned (actinopterygian) fishes, but not in that of the land vertebrates, a third genome duplication occurred—the fish‐specific genome duplication (FSGD or 3R), leading, at least (...) initially, to up to eight copies of the ancestral deuterostome genome. Therefore, the sarcopterygian (lobe‐finned fishes and tetrapods) genome possessed originally only half as many genes compared to the derived fishes, just like the most‐basal and species‐poor lineages of extant fishes that diverged from the fish stem lineage before the 3R duplication. Most duplicated genes were secondarily lost, yet some evolved new functions. The genomic complexity of the teleosts might be the reason for their evolutionary success and astounding biological diversity. BioEssays 27:937–945, 2005. © 2005 Wiley Periodicals, Inc. (shrink)