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)

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in (...) practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

Developments in biotechnology present difficult social and ethical challenges that need to be resolved by regulators among others. One crucial problem for regulators of new technologies is to ensure that regulation is both clear and sufficiently flexible to respond to new developments. This is particularly difficult to achieve in contentious fields such as medical biotechnology. In the European Union there is a divergence in the solutions to this problem which has lead to different regulatory frameworks for medical biotechnology. This paper (...) compares and contrasts the British and Dutch regulatory frameworks for the selection of embryos by preimplantation genetic diagnosis as an example of the regulation of medical biotechnology. Some of the outcomes of the regulatory choices and possible reasons behind the divergent frameworks are discussed, such as the ethical outlooks and political systems in these countries. (shrink)

Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices. Providers unanimously formulate a (...) number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)

Health checks or health screenings identify disease in people without a specific medical indication. So far, the perspective of health check users has remained underexposed in discussions about the ethics and regulation of health checks. In 2017, we conducted a qualitative study with lay people from the Netherlands. We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Participants consider a good predictive value the most important characteristic of (...) a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark. (shrink)

Health checks identify disease in individuals without a medical indication. More and more checks are offered by more providers on more risk factors and diseases, so we may speak of an omnipresence of health checks. Current ethical evaluation of health checks considers checks on an individual basis only. However, omnipresent checks have effects over and above the effects of individual health checks. They might give the impression that health is entirely manageable by individual actions and strengthen the norm of individual (...) responsibility for health to the point where people hold themselves and others responsible for health outcomes they cannot reasonably be held accountable for. This process of so-called ‘over-responsibilization’ may result in increased feelings of guilt over health, decreased health solidarity and unfairly distributed health outcomes. Moreover, effects on privacy and peace of mind may be observed. Taking into account all possible harms and benefits of health checks in their ethical evaluation requires evaluation of health checks on an individual basis as well as on the level of all checks. Therefore, we urge the amendment of existing ethical evaluation to include the effects of an omnipresence of health checks. We make a first attempt at the formulation of amended criteria. (shrink)

Cardiovascular health checks test risk factors for cardiovascular disease. They are offered to improve health: in case of an increased risk, participants receive lifestyle advice and medication. With this review, we investigate what is known about the reasons why people do or do not test for CVD risk factors. To what extent do these reasons relate to health monitoring and/or improvement? And do reasons differ in different contexts in which health checks are offered? We conducted a literature search and included (...) 22 papers in which we identified a broad range of motives. We conclude that people have reasons to test related to health improvement and reasons other than health improvement, practical reasons related to the way health checks are offered play an important role and motives should be understood in the context of the situation in which health checks are offered. Our results are relevant for public health officials and providers of health checks: first, if people undergo testing for reasons unrelated to health, this could explain why participation in health checks does not necessarily lead to health improvement. Second, efforts to improve uptake not necessarily serve justice and may hamper informed consent. (shrink)

Formulating sound and acceptable embryo research policy remains challenging especially in a pluralistic world. This challenge has acquired a new dimension of complexity with the advent of so-called embryo models, which are derived from stem cells. In this article, we present a normative strategy to facilitate the process of sound policy-making in the field of human embryology. This strategy involves seeking neutral agreements on higher level theories and doctrines as well as seeking agreements on the level of concrete policy proposals. (...) We call this strategy: going high and low. By going high and low, the plurality of reasonable moral and epistemic convictions of stakeholders involved in the domain of human embryology is respected while the process of policy-making in this area is improved. (shrink)

IntroductionIDIS is a multidisciplinary journal with a focus on identity in the information society. The information society is usually associated with information and communication technologies, such as computers, mobile phones and the Internet, and with information in the form of computer- or human-readable data. In this special issue on genetics, information and identity, however, we focus on a different type of information, namely genetic information. The DNA of the human genome is often called a ‘blueprint’ of human life, containing information (...) that regulates—in various and very complex ways—most of the processes in human life. In this sense, genetics may well be considered an information technology in its own right.Genetic information is becoming ever more important in society, although current knowledge of the human genome and how the genome relates to human life is still limited. Nevertheless, what knowledge we have about the genetic make-up of people—whether in terms of congen .. (shrink)

Eva Picardi has been one of the most influential Italian analytic philosophers of her generation. She taught for forty years at the University of Bologna, raising three generations of students. This collection of selected writings honors her work, confirming Picardi's status as one of the most important Frege scholars of her generation and a leading authority on the philosophy of Donald Davidson. Bringing together Picardi's contributions to the history of analytic philosophy, it includes her papers on major 20th-century figures such (...) as Wittgenstein, Quine, Davidson, Rorty, and Brandom. She examines their work in comparison with the philosopher Michael Dummett's, illuminating contrasts between American Neo-pragmatism and Continental philosophy. By considering key contributions made by Gadamer and Adorno and contrasting them with Davidson and Rorty's proposals, Picardi is able to bridge the Analytic and Continental divide. Featuring an introduction by Annalisa Coliva and new translations of previously unpublished papers, this collection emphasizes the significance of Picardi's work for a new generation of readers. (shrink)

This book provides a philosophical theory explicating the cognitive contribution of metaphor. Metaphor effects a transference of meaning, not between two terms, but between two structured domains of content, or ‘semantic fields’. Semantic fields, construed as necessary to a theory of word-meaning, provide the contrastive and affinitive relations that govern a term’s literal use. In a metaphoric use, these relations are projected into a second domain which is thereby reordered with significant cognitive effects. The book provides a revision and refinement (...) of ‘the semantic theory of metaphor’. Taking into account pragmatic considerations and recent linguistic and psychological studies, the book aims to forge a new understanding of the relation between metaphoric and literal meaning. It illustrates the thesis with sensitive and systematic analyses of metaphors found in literature, philosophy, science, and everyday language. Keywords:,, . (shrink)

Philosophische Familien- und Geschlechterkonzeptionen waren zu allen Zeiten ein wesentlicher Bestandteil der philosophischen Arbeit, insbesondere in der politischen Philosophie, da jede gesellschaftliche Ordnung auf einer bestimmten Familienform und darin institutionalisierten Geschlechterverhältnissen beruht. Auch Hegel hat sich intensiv mit den Begriffen Familie und Geschlecht auseinandergesetzt. Eva Bockenheimers Arbeit liefert einen Kommentar zu den dafür zentralen Abschnitten der "Phänomenologie des Geistes" und der "Grundlinien der Philosophie des Rechts" unter Einbeziehung zahlreicher Schriften und Vorlesungen, insbesondere der "Naturphilosophie" und der "Vorlesungen über die Philosophie (...) der Weltgeschichte". Ergebnis ist, dass Hegel einen ausgefeilten, systematisch eingebetteten Gedankengang zum Familien- und Geschlechterverhältnis und dessen Geschichte präsentiert, der grundlegende Einsichten bietet - auch für die Analyse der aktuellen Verhältnisse und für die Erarbeitung eines auf Emanzipation zielenden, zeitgemässen Begriffs von Familie und Geschlechtlichkeit."--Publisher's website. (shrink)

The right not to know is underappreciated in policy-making. Despite its articulation in medical law and ethics, policy-makers too easily let other concerns override the right not to know. This observation is triggered by a recent decision of the Dutch government on embryo selection for Huntington’s disease. This is a monogenetic debilitating disease without cure, leading to death in early middle age, and thus is a likely candidate for preimplantation genetic diagnosis. People possibly affected with the Huntington gene do not (...) always want to know their genetic status themselves, which is very burdensome knowledge. For prospective parents, this creates a difficulty in having unaffected children through embryo selection without knowing their own genetic status. A solution is provided by the exclusion test: it allows embryo selection while honouring the parents’ right not to know. The Dutch government however disallowed the exclusion test and chose to allow PGD on Huntington only for parents who test themselves first. To avoid “unnecessary” in-vitro fertilisation procedures for unaffected parents, prospective parents are “forced to know” before they can conceive through embryo selection. This article analyses the scope of the right not to know in the context of embryo selection against Huntington’s disease. It concludes that the right not to know implies that PGD against Huntington should be allowed by means of the exclusion test. (shrink)

Ideas about heredity and evolution are undergoing a revolutionary change. New findings in molecular biology challenge the gene-centered version of Darwinian theory according to which adaptation occurs only through natural selection of chance DNA variations. In Evolution in Four Dimensions, Eva Jablonka and Marion Lamb argue that there is more to heredity than genes. They trace four "dimensions" in evolution -- four inheritance systems that play a role in evolution: genetic, epigenetic, behavioral, and symbolic. These systems, they argue, can all (...) provide variations on which natural selection can act. Evolution in Four Dimensions offers a richer, more complex view of evolution than the gene-based, one-dimensional view held by many today. The new synthesis advanced by Jablonka and Lamb makes clear that induced and acquired changes also play a role in evolution.After discussing each of the four inheritance systems in detail, Jablonka and Lamb "put Humpty Dumpty together again" by showing how all of these systems interact. They consider how each may have originated and guided evolutionary history and they discuss the social and philosophical implications of the four-dimensional view of evolution. Each chapter ends with a dialogue in which the authors engage the contrarieties of the fictional "I.M.," or Ifcha Mistabra -- Aramaic for "the opposite conjecture" -- refining their arguments against I.M.'s vigorous counterarguments. The lucid and accessible text is accompanied by artist-physician Anna Zeligowski's lively drawings, which humorously and effectively illustrate the authors' points. (shrink)

abstract Applied ethics engages with concrete moral issues. This engagement involves the application of philosophical tools. When the philosophical tools used in applied ethics are problematic, conclusions about applied problems can become skewed. In this paper, I focus on problems with the idea that comparison cases must be exactly alike, except for the moral issue at hand. I argue that this idea has skewed the debate regarding the moral distinction between killing and letting die. I begin with problems that can (...) arise from attempts to produce comparison cases that are exactly alike, except for the moral issue at hand. I then argue that attempts to produce such examples are doomed to failure. Finally, I argue that abandoning concerns about similarity advances the debate regarding the moral distinction between killing and letting die. (shrink)

Recent studies indicate that the processing of an unexpected word is costly when the initial, disconfirmed prediction was strong. This penalty was suggested to stem from commitment to the strongly predicted word, requiring its inhibition when disconfirmed. Additional studies show that comprehenders rationally adapt their predictions in different situations. In the current study, we hypothesized that since the disconfirmation of strong predictions incurs costs, it would also trigger adaptation mechanisms influencing the processing of subsequent strong predictions. In two experiments, participants (...) made speeded congruency judgments on two-word phrases in which the first word was either highly constraining or not. We manipulated the proportion of disconfirmed predictions in highly constraining contexts between participants. The results provide additional evidence of the costs associated with the disconfirmation of strong predictions. Moreover, they show a reduction in these costs when participants experience a high proportion of disconfirmed strong predictions throughout the experiment, indicating that participants adjust the strength of their predictions when strong prediction is discouraged. We formulate a Bayesian adaptation model whereby prediction failure cost is weighted by the participant’s belief about the likelihood of encountering the expected word, and show that it accounts for the trial-by-trial data. (shrink)

In some medical cases there is a moral distinction between killing and letting die, but in others there is not. In this paper I present an original and principled account of the moral distinction between killing and letting die. The account provides both an explanation of the moral distinction and an explanation for why the distinction does not always hold. If these explanations are correct, the moral distinction between killing and letting die must be taken seriously in medical contexts. Defeasibly, (...) when an agent kills she takes responsibility, but when an agent lets die she does not take responsibility. Therein lies the moral distinction between killing and letting die. The distinction, however, is defeated when an agent is already responsible for the surrounding situation. In such cases, killing does not involve taking any further responsibility and letting die does not avoid taking any responsibility. Medical examples are frequently complicated because patients' autonomous choices impact upon medical practitioners' surrounding responsibility. (shrink)

The question of whether global democracy requires a world state has with few exceptions been answered with an unequivocal ‘No’. A world state, it is typically argued, is neither feasible nor desirable. Instead, different forms of global governance arrangements have been suggested, involving non-hierarchical and multilayered models with dispersed authority. The overall aim of this paper is to addresses the question of whether global democracy requires a world state, adopting a so-called ‘function-sensitive’ approach. It is shown that such an approach (...) is equipped to resist the predominant binary view of a world state and offer a more differentiated and nuanced answer to this question. In brief, a basic presumption of a function-sensitive approach is that the content, justification and status of principles of democracy are dependent on the aim they are set out to achieve, what functions they are intended to regulate (e.g., decision-making, implementation, enforce... (shrink)

In der Öffentlichkeit häufig als Auswanderungsland wahrgenommen, unternahm China in den letzten Jahren verstärkt Bemühungen, qualifizierte Fachkräfte aus dem Ausland für den chinesischen Arbeitsmarkt zu gewinnen. Die Einführung eines Fachkräfteeinwanderungssystem mit abgestuften Rechten für Arbeitsmigrant:innen sollte diese Entwicklung fördern. Die vorliegende Analyse zeigt, dass diese Reform des Einwanderungssystems die Gerichtspraxis nicht verändert hat. Abseits der politischen Diskurse um die Anwerbung von internationalen Talenten und der Propagierung Chinas als Wissenssupermacht, bleibt China aufgrund der existierenden Probleme im bestehenden Rechtssystems für Arbeitsmigrant:innen unattraktiv.

Georg Wilhelm Friedrich Hegel und die Weiter- und Höherenentwicklung seiner Ideen, von A. Abusch.-G.W.F. Hegel und seine Zeit (1770-1831). Eine Chronik.-G.W.F. Hegels Werke in Erstausgaben.-Aus Werken Hegels.-Marx, Engels, Lenin über Hegel.-Hegel Literatur in der DDR 1949-1969.-Hegel Literatur zum Hegel Jahr 1970.-Veranstaltungen aus Anlass des 200. Geburtstages von G.W.F. Hegel am 27. August 1970.

With regard to current debates on the ethical implementation of AI, especially two demands are linked: the call for explainability and for ultimate human responsibility. In the medical field, both are condensed into the role of one person: It is the physician to whom AI output should be explainable and who should thus bear ultimate responsibility for diagnostic or treatment decisions that are based on such AI output. In this article, we argue that a black box AI indeed creates a (...) rationally irresolvable epistemic situation for the physician involved. Specifically, strange errors that are occasionally made by AI sometimes detach its output from human reasoning. Within this article it is further argued that such an epistemic situation is problematic in the context of ultimate human responsibility. Since said strange errors limit the promises of explainability and the concept of explainability frequently appears irrelevant or insignificant when applied to a diverse set of medical applications, we deem it worthwhile to reconsider the call for ultimate human responsibility. (shrink)

Is musical practice 'real' - and how is it connected with everyday life? Eva-Maria Houben shows that making music changes as soon as its meaning is not sought in a purpose-oriented production of results, but in performing music as an activity - indeed, as play. Musical practice, Eva-Maria Houben contends, should be understood as open and never finished. Such an emphasis on repetition can free us from perfection, productivity, and purpose, allowing meaning to unfold in specific situations, places, and relationships. (...) Thus understood, musical practice can become a form of life and a reality in its own right. (shrink)

'...a challenging and useful book, both because it provokes a careful scrutiny of one's own basic ideas regarding evolutionary theory, and because it cuts across so many biological disciplines.' -The Quarterly Review of Biology 'In my view, this work exemplifies Theoretical Biology at its best...here is rampant speculation that is consistently based on cautious reasoning from the available data. Even more refreshing is the absence of sloganeering, grandstanding, and 'isms'.' -Biology and Philosophy 'Epigenetics is fundamental to understanding both development and (...) gene expression, and not surprisingly, evolutionary biologists have long been fascinated with its proper place in evolutionary theory...Enter Jablonka and Lamb, who provide a thoughtful review of the recent molecular literature and suggest a number of potential consequences.' -EvolutionSince first publication of this controversial book, much of the initial opposition to the ideas it contained has been replaced by a general, although often grudging, acceptance of them. Advances in knowledge, especially at the molecular level, have enhanced general awareness and interest in epigenetics and the evolution of systems that store and transmit information and put any of the authors' speculations on a more solid basis. This paperback edition contains a new Preface that sets out the major changes in the scientific world and in the authors' own thinking that have occurred since the book was published. A new Appendix provides a selected bibliography of the many books and articles about epigenetic inheritance and its role in evolution that have appeared since first publication. (shrink)

Cursory review of the reception of Adorno's unfinished Aesthetic Theory up to the present suggests that an introduction to the book's major concerns, its structure (or lack thereof), and its concepts is missing to this date. Going back to Fredric Jameson's watershed contribution Late Marxism: Adorno, Or, the Persistence of the Dialectic (1990), the article attempts to provide the introduction missing to date. It is organized around key concepts of Adorno's Aesthetic Theory, beginning with the guiding juxtaposition of Kant's formalist (...) aesthetics vs. Hegel's content aesthetics and the various notions of the End of Art, followed by two sections on art and its respective others (from the culture industry and art appreciation to nature and natural beauty), and concluding with the axiom of suffering and its impact on the key notions of semblance, expression, and mimesis. (shrink)

Time and the body -- Time and the mind -- Time and culture -- Time in our time.

В сборнике представлены работы, посвященные опыту истории государственно-конфессиональных отношений в России, а также проблемам свободомыслия в истории религиозной и общественно-политической жизни, теории и практике марксистско-ленинского атеизма.

The scientific study of consciousness or subjective experiencing is a rapidly expanding research program engaging philosophers of mind, psychologists, cognitive scientists, neurobiologists, evolutionary biologists and biosemioticians. Here we outline an evolutionary approach that we have developed over the last two decades, focusing on the evolutionary transition from non-conscious to minimally conscious, subjectively experiencing organisms. We propose that the evolution of subjective experiencing was driven by the evolution of learning and we identify an open-ended, representational, generative and recursive form of associative (...) learning, which we call Unlimited Associative Learning (UAL), as an evolutionary transition marker of minimal consciousness. This evolutionary marker provides evidence that the evolutionary transition to consciousness has gone to completion and allows reverse-engineering from this learning capacity to the system that enables it – making possible the construction of a toy model of UAL. The model allows us to identify some of the key processes and structures that constitute minimal consciousness, points its taxonomic distribution and the ecological context in which it first emerged, highlights its function and suggests a framework for exploring developmental and evolutionary modifications of consciousness. We point to ways of experimentally testing the relationship between UAL and consciousness in human and in non-human animals and discuss the theoretical and ethical implications of our approach. The framework we offer allows the exploration of the evolutionary changes in agency, value systems, selective processes and goals that were involved in the transition to subjective experiencing from a perspective that resonates with the approaches of bio-semioticians. (shrink)

Eva Brann delves into Heraclitus's famously cryptic saying, "all things come to be in accordance with this Logos.".