Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. (...) Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system. (shrink)

Volume 19, Issue 10, October 2019, Page 1-2.

At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...) interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach. (shrink)

Children and adults with dementia are vulnerable populations. Both groups are also relatively seldom included in biomedical research. However, including them in clinical trials is necessary, since both groups are in need of scientific innovation and new therapies. Their dependence and limited decision-making capacities increase their vulnerability, necessitating extra precautions when including them in clinical trials. Beside these similarities there are also many differences between the groups. The most obvious one is that children have an entire life ahead of them (...) and will become persons with certain ideals and preferences, while adults with dementia have lived a life in which they have expressed their ideals and preferences. Some of the available research guidelines recognize these differences, setting one list of specific requirements for groups of incapacitated adults and another list for children. Other documents, however, do not differentiate and only set requirements for subjects unable to consent as a single category of subjects. In this article we analyse to what extent the similarities and differences between the two groups are represented in legal documents and ethical guidelines. The article presents an overview and an analysis of the requirements for doing research with children and dementia patients. We conclude with suggestions about how to better incorporate the morally relevant aspects of these two groups in legislation and ethical guidelines. (shrink)

In order to discover an effective treatment for dementia it is necessary to include dementia patients in clinical research trials. Dementia patients face an increased risk to lose the capacity to consent to research participation, and research possibilities with incompetent participants are legally strictly limited. One solution is for patients to consent to research through an advance research directive whilst still competent. In order to explore whether such a directive would be useful and valuable in practice we conducted a qualitative (...) study. We explored the opinions and arguments of researchers in the field of dementia, aiming to map the possibilities and constraints of ARDs. It was argued that a positive ARD could be valuable to discuss research participation with proxies, and patients with a negative ARD will be excluded from research trials. However, it is argued that an ARD cannot replace the informed consent procedure, and in practice proxy dissent will overrule written consent. The practical use of these directives is thus limited, as most researchers will not comply with positive directives. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 43-44, June 2011.

On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees (...) for Termination of Life on Request and Euthanasia and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia. (shrink)

Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. (...) Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system. (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.

The next World Congress of Bioethics will be held in Doha, Qatar. Although this location provides opportunities to interact with a more culturally diverse audience, to advance dialogue between cultures and religions, offer opportunities for mutual learning, there are also huge moral concerns. Qatar is known for violations of human rights ‐ including the treatment of migrant workers and the rights of women ‐ corruption, criminalization of LGBTQI+ persons, and climate impact. Since these concerns are also key (bio)ethical concern we (...) call for a broad debate within the bioethics community whether organizing and attending the World Congress in Qatar is ethically problematic and how ethical concerns should be dealt with. (shrink)

Dementia is highly prevalent and incurable. The participation of dementia patients in clinical research is indispensable if we want to find an effective treatment for dementia. However, one of the primary challenges in dementia research is the patients’ gradual loss of the capacity to consent. Patients with dementia are characterized by the fact that, at an earlier stage of their life, they were able to give their consent to participation in research. Therefore, the phase when patients are still competent to (...) decide offers a valuable opportunity to authorize research, by using an advance research directive. Yet, the use of ARDs as an authorization for research participation remains controversial. In this paper we discuss the role of autonomous decision-making and the protection of incompetent research subjects. We will show why ARDs are a morally defensible basis for the inclusion of this population in biomedical research and that the use of ARDs is compatible with the protection of incompetent research subjects. (shrink)

Children and adults with dementia are vulnerable populations. Both groups are also relatively seldom included in biomedical research. However, including them in clinical trials is necessary, since both groups are in need of scientific innovation and new therapies. Their dependence and limited decision‐making capacities increase their vulnerability, necessitating extra precautions when including them in clinical trials. Beside these similarities there are also many differences between the groups. The most obvious one is that children have an entire life ahead of them (...) and will become persons with certain ideals and preferences, while adults with dementia have lived a life in which they have expressed their ideals and preferences. Some of the available research guidelines recognize these differences, setting one list of specific requirements for groups of incapacitated adults and another list for children. Other documents, however, do not differentiate and only set requirements for subjects unable to consent as a single category of subjects.In this article we analyse to what extent the similarities and differences between the two groups are represented in legal documents and ethical guidelines. The article presents an overview and an analysis of the requirements for doing research with children and dementia patients. We conclude with suggestions about how to better incorporate the morally relevant aspects of these two groups in legislation and ethical guidelines. (shrink)

In The Good Representative, Suzanne Dovi argues that democratic citizens should assess their representatives by their display of three virtues: they must be fair-minded, build critical trust, and be good gatekeepers. This important book provides standards for evaluating the democratic credentials of representatives. Identifies the problems with and obstacles to good democratic representation. Argues that democratic representation, even good democratic representation, is not always desirable. Timely and original, this book rejects the tendency to equate respect for the preferences of (...) citizens with neutrality on the standards used in choosing their representatives. (shrink)

The Just War principle of jus ad bellum explicitly requires a reasonable prospect of success; the prevailing view about personal self-defence is that it can be justified even if the prospect of success is low. This chapter defends the existence of this distinction and goes on to explore the normative basis of this difference between defensive war and self-defence and its implications. In particular, the chapter highlights the rationale of the ‘success condition’ within Just War thinking and argues that this (...) condition is grounded in assumptions about the nature of political authority and responsibility that do not apply to personal self-defence. This important difference is commonly ignored or side-lined by contemporary theorists who regard the principles of these two types of conflict as very closely aligned and the moral differences between them as matters of degree only. (shrink)

La tension entre le non-dualisme et le dualisme domine toute l’histoire du Vedanta. En face de l’advaita de Śaṅkara, le système de Madhva, auquel cette étude est consacrée, représente l’extrême dualisme, dvaita. Cependant Madhva, après avoir posé la réalité irréductible de la différence entre Dieu et le monde, a comme compensé cette scission de l’être par l’affirmation que tout être autre que l’Être absolu est dépendant de celui-ci, seul Dieu ne dépendant que de lui-même. L’originalité du système de Madhva est (...) d’inventer une relation nouvelle entre l’Être et les êtres. Seul l’Être est capable de faire exister des êtres différents de lui et totalement dépendants de lui ; Dieu permet à toute réalité d’être, et d’être ce qu’elle est. (shrink)

In this chapter, I offer an overview of current scholarly debates on Plato's Lysis. I also argue for my own interpretation of the dialogue. In the Lysis, Socrates argues that all love is motivated by the desire for one’s own good. This conclusion has struck many interpreters as unattractive, so much so that some attempt to reinterpret the dialogue, such that it either does not offer an account of interpersonal love, or that it offers an account on which love is, (...) in fact, an other-regarding state. Others, notably Vlastos, criticize Socrates’ theory as implausibly and repellently egoistic. I maintain, against the first group, that Socrates is indeed offering an egoistic theory of love. I argue, against the second, that, while Socrates’ theory may be repellent, it possesses considerable explanatory power and avoids certain weaknesses which infect contemporary approaches to love. (shrink)

Cover; Table of Contents; Introduction; References; List of Illustrations; Acknowledgments; 1. Essays; Intimacy Unveiled (Suzanne Anker); From Apocalypse to Analogy; Transforming Life; References; List of Illustrations; Through the Looking Glass: Encounters with Suzanne Anker's Wonderlands (Sabine Flach); I. Making is Thinking -- Art as Knowledge; II. "We can know more than we can tell"; III. Ars Quaerendi -- The Art of Asking Questions; IV. Synechein -- The Art of Interweaving; References; List of Illustrations; 2. Dialogues; Dialogue I: The (...) Glass Veil. (shrink)

In his Confessions, Saint Augustine narrates the intense struggle of a self divided and dissociated from itself in the throes of becoming other than what it is. His attempts at conversion and self-transformation involve a struggle with his habituated self; his habits, ever resistant to change, impede his becoming. Insofar as Augustine disavows the significance of his self ’s multiplicity to enabling his capacity to convert, he comes short of providing us with an account of the self ’s capacity for (...) change. It is on this point that reading Confessions with Deleuze and Guattari’s concept of “the body without organs” (a term that describes creative experimentation with forms of life and subjectivity) helps deepen our insights into the self ’s becoming. Such a minor reading of Confessions can be achieved by extracting the concept of “formless matter” (a term Augustine uses to designate the primacy of the capacity for mutability in creation) from his reading of Genesis in order to bring it to bear on thinking through the work of the self that enables his capacity for conversion. Beneath the theological account that privileges heaven, because of its changeless “cleaving to God,” over the ever-transient creatures of the earth, there lies an ontological account wherein formless matter, the capacity to change, plays a pivotal role in ethical becoming and capacitation. In his process of conversion, Augustine breaks his habituated patterns of sensing and makes himself into a “body without organs” in order to be capacitated by alterity, and in so doing enables a becoming different that takes place with and through difference. (shrink)

Nature, a topic central to art history, is concurrently a dominant concept in contemporary art, art theory and its related disciplines such as cultural theory, philosophy, aesthetic theory and environmental studies. The project Naturally Hypernatural questions lines of tradition and predetermined categories that coexist with the topic of nature. Currently, nature in art surpasses the simple depiction of art as a material or object. To clarify and analyze the interrelations between nature and art is the aim of the project Naturally (...) Hypernatural. Concepts of Nature - the first volume of this project - argues that contemporary art is predominantly concerned with concepts of nature regarding the depth of their implications in order to reveal and analyze their internal structure. (shrink)

Teaching Ethics through Literature provides in-depth understanding of a new and exciting shift in the fields of English education, Literature, Language Arts, and Literacy through exploring their connections with ethics. The book pioneers an approach to integrating ethics in the teaching of Literature. This has become increasingly relevant and necessary in our globally connected age. A key feature of the book is its integration of theory and practice. It begins with a historical survey of the emergence of the ethical turn (...) in Literature education and grounds this on the ideas of influential Ethical Philosophers and Literature scholars. Most importantly, it provides insights into how teachers can engage students in ethical concerns through rich on-the-ground case studies of high school Literature teachers in Australia, Singapore and the United States. (shrink)