This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

BackgroundHuntington’s disease has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive. Little is known about the perspectives of HD patients on their AED.AimTo gain insight into patients’ views on and attitudes towards their AED, and changes over time.MethodsA longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients who either had an AED or (...) were thinking about drawing it up participated in this study.ResultsWe identified two themes that characterize patients’ perspectives on their AEDs: general character of the AED; uncertainty around their AED. Ad The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.ConclusionHD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care. (shrink)

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals and ethicists (...) working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (shrink)

Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. The (...) author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don’t, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, “reciprocity” is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making. (shrink)

This article introduces a new hybrid intake procedure developed for posttraumatic stress disorder (PTSD) screening, which combines an automated textual assessment of respondents’ self-narratives and item-based measures that are administered consequently. Text mining technique and item response modeling were used to analyze long constructed response (i.e., self-narratives) and responses to standardized questionnaires (i.e., multiple choices), respectively. The whole procedure is combined in a Bayesian framework where the textual assessment functions as prior information for the estimation of the PTSD latent trait. (...) The purpose of this study is twofold: first, to investigate whether the combination model of textual analysis and item-based scaling could enhance the classification accuracy of PTSD, and second, to examine whether the standard error of estimates could be reduced through the use of the narrative as a sort of routing test. With the sample at hand, the combination model resulted in a reduction in the misclassification rate, as well as a decrease of standard error of latent trait estimation. These findings highlight the benefits of combining textual assessment and item-based measures in a psychiatric screening process. We conclude that the hybrid test design is a promising approach to increase test efficiency and is expected to be applicable in a broader scope of educational and psychological measurement in the future. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.

The place of the emotions among the passions -- The analytic of the emotions I -- The analytic of the emotions II -- The dialectic of the emotions -- Pride, arrogance, and humility -- Shame, embarrassment, and guilt -- Envy -- Jealousy -- Anger -- Love -- Friendship -- Sympathy and empathy.

Women who had had breast cancer and had been enrolled in a large genetic breast cancer epidemiological study were interviewed about their experience of participation in the study, their attitudes to the confidentiality of data, and the feedback of personal and general research results. Collection of family history information seemed more salient in indicating the genetic nature of the study than the enrolment information sheet. There were no concerns about confidentiality.While participants would have welcomed general feedback about the results of (...) the study and were critical that this had not been provided, the feedback of personal information proved complicated and, sometimes, difficult. It is suggested that individual feedback of genetic test information in epidemiological studies should be undertaken only when there are specific reasons. (shrink)

The concept of normal is so familiar that it can be hard to imagine contemporary life without it. Yet the term entered everyday speech only in the mid-twentieth century. Before that, it was solely a scientific term used primarily in medicine to refer to a general state of health and the orderly function of organs. But beginning in the middle of the twentieth century, normal broke out of scientific usage, becoming less precise and coming to mean a balanced condition to (...) be maintained and an ideal to be achieved. In Normality, Peter Cryle and Elizabeth Stephens offer an intellectual and cultural history of what it means to be normal. They explore the history of how communities settle on any one definition of the norm, along the way analyzing a fascinating series of case studies in fields as remote as anatomy, statistics, criminal anthropology, sociology, and eugenics. Cryle and Stephens argue that since the idea of normality is so central to contemporary disability, gender, race, and sexuality studies, scholars in these fields must first have a better understanding of the context for normality. This pioneering book moves beyond binaries to explore for the first time what it does—and doesn’t—mean to be normal. (shrink)

In worlds that lack life, there is no value. For all that, there is no mystery about 'the existence of values in a world of facts'. The world does not consist of facts, rather true descriptions of the world consist of statements of fact. It is as much a fact concerning the world that there are things that are of value to living things, that human beings value things and possess valuable characteristics, perform valuable deeds, stand in valuable relationships to (...) others, as it is a fact that there is life on earth. (shrink)

The experimental study of the emotions as pursued by LeDoux and Damasio is argued to be flawed as a consequence of the inadequate conceptual framework inherited from the work of William James. This paper clarifes the conceptual structures necessary for any discussion of the emotions. Emotions are distinguished from appetites and other non-emotional feelings, as well as from agitations and moods. Emotional perturbations are distinguished from emotional attitudes and motives. The causes of an emotion are differentiated from the objects of (...) an emotion, and the objects of an emotion are distinguished into formal and material ones. The links between emotions and reasons for the emotion, for associated beliefs and for action are explored, as well as the connection between emotion and care or concern, and between emotion and fantasy. The behavioural criteria for the ascription of an emotion are clarified. In the light of this conceptual network, Damasio’s theory of the emotions is subjected to critical scrutiny and found wanting. (shrink)

This chapter contains section titled: Baker's New Conception Waismann and Wittgenstein Wittgenstein on the Psychoanalytic Analogy Wittgenstein's Methodology Reconsidered Wittgenstein and Ryle 1: Categorial Confusions Wittgenstein and Ryle 2: Logical Geography Baker's Wittgenstein.

The book "Philosophical Foundations of Neuroscience" is an engaging criticism of cognitive neuroscience from the perspective of a Wittgensteinian philosophy of ordinary language. The authors' main claim is that assertions like "the brain sees" and "the left hemisphere thinks" are integral to cognitive neuroscience but that they are meaningless because they commit the mereological fallacy—ascribing to parts of humans, properties that make sense to predicate only of whole humans. The authors claim that this fallacy is at the heart of Cartesian (...) dualism, implying that current cognitive neuroscientists are Cartesian dualists. Against this claim, we argue that the fallacy cannot be committed within Cartesian dualism either, for this doctrine does not allow for an intelligible way of asserting that a soul is part of a human being. Also, the authors' Aristotelian essentialistic outlook is at odds with their Wittgensteinian stance, and we were unconvinced by their case against explanatory reductionism. Finally, although their Wittgensteinian stance is congenial with radical behaviorism, their separation between philosophy and science seems less so because it is based on a view of philosophy as a priori. The authors' emphasis on the a priori, however, does not necessarily commit them to rationalism if it is restricted to conceptual or analytical truths. (shrink)

Bioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change. Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and greater (...) appreciation of the profound health implications of global warming. (shrink)

In offering his analysis of the concepts of the good and the just, the author combines certain techniques of social science with a philosophical reflection upon certain fundamental issues. It is the objective of this book to establish a balanced approach differing from relativism and historicism on the one hand, and normative absolutism on the other. The task is not an easy one; many may view the attempt here to be less than conclusive, though it is certainly challenging. Essentially the (...) book argues for a concept of human nature that is "dispositional," and defined contextually, but in some sense not bound to circumstances in the way in which the historicist would have it. Kaplan utilizes the principles of "systems analysis," explained in detail in the first chapter of the book, to reach this contextual understanding of human nature. It is by identification of social systems as homeostatic that the argument is advanced that units of social and political analysis cannot be treated in the abstract, nor can they be understood without acknowledging contextual rules that are in some sense objective. (shrink)

Unger has written a thoughtful but problematic study of the shortcomings of liberal political theory. The specific method of the critique is his own, but it is well-structured and readable. The problem is that the precise nature of the "liberal psychology" and "liberal political theory" under attack is never very clear. This lack of clarity stands in marked contrast to the general tone of the work. One can assume with some justification that the author sees the classic core of the (...) liberal doctrine "in the work of Thomas Hobbes, of his contemporaries, and of his successors...." Nevertheless, the doctrine addressed by the author appears to be of much wider scope; Hobbes, Locke, Hume, Spinoza, Rousseau, and Kant are all called in "to illustrate rather than to prove their adherence to the doctrines that are the subject of the critique." It is with reservations concerning the subject under attack that one must approach this study. (shrink)

The strength of this book is not a novelty of analysis, but rather its clarity and readability. The author intends it to be a useful teaching tool, "a genuine introduction, presupposing neither background in philosophy nor familiarity with the issues...." It is well arranged and quite successful as an introductory commentary. The book would appear to work best as a secondary source, supplementing more extensive philosophical texts. It need not be limited to courses specifically dealing with social and political philosophy. (...) The first chapter offers an elementary explanation of the nature of philosophical discourse in general; chapters three, "Freedom," and five "Utilitarianism and Justice," would be useful in a course on ethics. (shrink)