The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of (...) the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. (shrink)

The aim of this research was to gain insight into the experiences and perspectives of individual members of a Medical Research Ethics Committee regarding their individual roles and possible tensions within and between these roles. We conducted a qualitative interview study among members of a large MREC, supplemented by a focus group meeting. Respondents distinguish five roles: protector, facilitator, educator, advisor and assessor. Central to the role of protector is securing valid informed consent and a proper risk-benefit analysis. The role (...) of facilitator implies that respondents want to think along with and assist researchers in order to help medical science progress. As educators, the respondents want to raise ethical and methodological awareness of researchers. The role of advisor implies that respondents bring in their own expertise. The role of assessor points to contributing to the overall evaluation of the research proposal. Various tensions were identified within and between roles. Within the role of protector, a tension is experienced between paternalism and autonomy. Between the role of protector and facilitator tensions occur when the value of a study is questioned while risks and burdens for the subjects are negligible. Within the role of assessor, a tension is felt between the implicit nature of judgments and the need for more explicit formulations. Awareness of various roles and responsibilities may prevent one-sided views on MREC work, not only by members themselves, but also by researchers. Tensions within and between the roles require reflection by MREC members. (shrink)

The aim of this research was to gain insight into the experiences and perspectives of individual members of a Medical Research Ethics Committee regarding their individual roles and possible tensions within and between these roles. We conducted a qualitative interview study among members of a large MREC, supplemented by a focus group meeting. Respondents distinguish five roles: protector, facilitator, educator, advisor and assessor. Central to the role of protector is securing valid informed consent and a proper risk-benefit analysis. The role (...) of facilitator implies that respondents want to think along with and assist researchers in order to help medical science progress. As educators, the respondents want to raise ethical and methodological awareness of researchers. The role of advisor implies that respondents bring in their own expertise. The role of assessor points to contributing to the overall evaluation of the research proposal. Various tensions were identified within and between roles. Within the role of protector, a tension is experienced between paternalism and autonomy. Between the role of protector and facilitator tensions occur when the value of a study is questioned while risks and burdens for the subjects are negligible. Within the role of assessor, a tension is felt between the implicit nature of judgments and the need for more explicit formulations. Awareness of various roles and responsibilities may prevent one-sided views on MREC work, not only by members themselves, but also by researchers. Tensions within and between the roles require reflection by MREC members. (shrink)

Volume 20, Issue 8, August 2020, Page 104-106.

It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, (...) and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage, or Fair-Trade guidelines. An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad. (shrink)

This article discusses the latest developments regarding euthanasia and palliative care in the Netherlands. On the one hand, a legally codified practice of euthanasia has been established. On the other hand, there has been a strong development of palliative care. The combination of these simultaneous processes seems to be rather unique. This contribution first focuses on these remarkable developments. Subsequently, the analysis concentrates on the question of how these new developments have influenced the ethical debate.

Within a period of one year, two countries have enacted laws that articulate conditions under which euthanasia and physician assisted suicide are permitted. Belgium and the Netherlands thus distinguish themselves from all other countries of the world.In Belgium, palliative care organisations have been pro-actively involved in the debate on the contents of the law, highlighting that if euthanasia can ever be justified, it is necessary to provide good palliative care for all and to include in the euthanasia law what has (...) been called a palliative filter, i.e. a compulsory prior consultation with a specialised palliative care team. In the Netherlands, before the euthanasia law was enacted, there had been a policy of pragmatic tolerance for decades. The enactment itself did not give rise to intense debate. It can be questioned whether the new law would change anything at all since it only officially sanctioned an existing practice. This however does not mean that caregivers in palliative care, together with palliative care organisations, have not participated in the euthanasia debate.In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise. (shrink)

Dutch euthanasia and physician-assisted suicide stand on the eve of important legal changes. In the summer of 1999, a new government bill concerning euthanasia and physician-assisted suicide was sent to Parliament for discussion. This bill legally embodies a ground for exemption from punishment for physicians who conduct euthanasia or physician-assisted suicide and comply with certain requirements. On November 28, 2000, the Dutch parliament approved an adapted version of this bill. Since the approval by the Dutch Senate can be regarded as (...) a formality, it is expected that the bill will come into force in the course of this year (2001). In this paper we discuss these new developments. (shrink)

Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.

In the Infini-Rien fragment of his Pensées, Blaise Pascal develops an argument for the rationality of faith in God, which posthumously became known as Pascal’s Wager and at the same time represents a cornerstone of modern probability theory. While this betting argument has been the subject of much philosophical investigation, the contribution of this paper lies in the following: On the one hand, the bet is reconstructed in its basic features as well as its structure with the help of (...) modern decision and probability theory tools. Thus, it is shown that Pascal’s betting argument, in distinction to Hacking 1972 for instance, has the form of an a fortiori argument. On the other hand, as far as objections to Pascal’s argument are concerned, it is true that the premises have often been called into doubt, more or less convincingly. On the other hand, this article is dedicated to the question, often emphatically – especially in Hacking 1972 – and perhaps carelessly affirmed in Pascal research, whether Pascal’s premises imply his conclusion at all. (shrink)

Dans l'histoire de la philosophie occidentale ce n'est que Kant qui parvient, en la dissociant des phénomènes de la nature, à donner à la liberté un statut métaphysique autonome. Or Malebranche anticipe Kant. Il distingue la volonté qui vient de Dieu de la liberté qui surgit de l'homme. La volonté est une force de quantité déterminée, la liberté est un rien qui n'ajoute rien à cette forme mais en détermine le mouvement. La liberté n'est rien car elle (...) n'est pas elle-même une force, par conséquent, elle permet de fonder une réflexion morale autonome. Kant by separating freedom from the phenomena of nature endows it with an autonomous metaphysical status. Malebranche anticipates Kant. He distinguishes the will which comes from God and freedom which is from man. The will is a force of a given quantity, freedom is a nothing which does not increase or decrease this force but only determines its movement. Freedom is a nothing since it is not a force itself, thus it makes possible an autonomous moral philosophy. (shrink)

The wager fragment in Blaise Pascal’s _Penseés _opens with the phrase "_infini rien_"—"infinite nothing"—which is meant to describe the human condition. Pascal was responding to what was, even in the seventeenth century, becoming a pressing human problem: we seem to be able to know much about the world but less about ourselves. The traditional European view of human beings as creatures made in the image of God and potentially capable of a mystical union with God was increasingly confounded by the (...) difficulty of finding God in nature. Despite his own scientific work, however, Pascal argued that if one does not know whether or not God exists, one should bet that he does: if one is right the rewards are infinitely good and, if one is wrong, what one has lost is, by comparison, utterly trivial. The argument behind this wager is one of the most celebrated—and disputed—in the history of philosophy. It has been seen in terms of the calculus of probabilities, as a piece of religious apologetic, as an event in the religious and psychological life of Pascal himself, and as an event in the life of the Jansenist movement and its various expressions at Port-Royal. In this book, Leslie Armour explores the underlying logic of ideas brought to the surface by the intersection of two philosophical lines of thought. He shows that Pascal had come to philosophy by way of two particular strands of Platonism, one strongly mystical, associated with the founder of the French Oratorian order, Pierre de Bérulle, and the other the Augustinian Platonism associated with Duvergier de Hauranne and Cornelius Jansen. At the same time Pascal was engaged in an internal struggle with skepticism. While he agreed that it is difficult to find God in physical nature, he disagreed with the claim that we know nothing of nature. The problem is that the human being is both infinite and nothing. Thus, Armour locates Pascal’s wager within the confluence of a vital neo-Platonism and an intellectually powerful skepticism. He concludes that even today, "If we must act and cannot know enough, we must bet.". (shrink)

Le séminaire “La vie la mort” de Derrida opère, comme d’avance motivé par ses suites et comme contresigné par ce nom qui n’apparaît pas—le nom d’Épicure—un virage vers un matérialisme non productif, non représentationnel, dépourvu en quelque sorte de statut ontologique, voire non ontologisable, triomphant, normatif, voué à une économie de la cause. Nietzsche, lecteur antagonique d’Épicure (Lettre à Ménécée: “Accoutume-toi à considérer que la mort n'est rien pour nous”)—constitue son écran-substitut. Nietzsche, dont la lecture sert à fermer-ouvrir les (...) grandes boucles du séminaire de Derrida. Il s’agit donc de fouiller “La vie la mort” à la recherche des traces de la rencontre Nietzsche-Épicure—une rencontre définitive, elle, bien qu’invisible et silencieuse, bien que presqu’illisible dans le texte de Derrida, au sujet du rapport “la vie la mort.”. (shrink)

On trouve à la page A 292 (B 349) de la Critique de la raison pure une Table du Rien, ou, plus exactement, de « la division du concept de Rien ». Par convention, on désigne souvent par cette même appellation l’ensemble du morceau occupant les trois pages (A 290-292, B 346-349) qui entourent, en l’introduisant et en la commentant, cette Table. Il convient toutefois de remarquer d’entrée : Que l’exposé de Kant prend en compte le...

By defining consciousness as nothingness or simply as “nothing,” Sartre plays with several meanings of these terms: negativity and negation, distance, indetermination, irreducibility. The nothingness of consciousness takes on an ontological meaning: it is a “tearing away” from being-in-itself, a transcendence understood as the capacity to transcend what is, while retaining an epistemological meaning: it is what cannot be positively determined as “something” or as a property of being. Still, on the epistemological level as well as on the ontological level, (...) it is indeed from “something,” from physical and social being, that the nothingness of consciousness draws its existence and its capacities. In my article, I examine different meanings that can be given to the “nothing” of consciousness in the light of the thought of Sartre himself, emphasizing the difference between two major meanings of negation: as opposition and as indetermination. Then I confront Sartre’s concept of consciousness with more recent considerations of different inspiration, notably from researchers like Chalmers, Damasio, Gallagher, and Zahavi. My thesis is that the Sartrean concept, semi-transcendental and semi-naturalist, does admit the search for a naturalist explanation of consciousness, but assigns its limit precisely through the concept of nothingness. En définissant la conscience comme néant, néantisation, ou simplement comme un « rien », Sartre joue avec plusieurs acceptions de ces termes : négativité et négation, distance, indētefmination, irréductibilité... Le néant de la conscience prend un sens ontologique : c’est un « arrachement » à l’être-en-soi, une transcendance entendue comme capacité de transcender ce qui est, tout en gardant un sens épistémologique : c’est ce qui ne peut pas être déterminé de manière positive comme « quelque chose » ou comme une propriété d’être. D’autre part, sur le plan épistémologique comme sur le plan ontologique, c’est bien de « quelque chore », de l’être physique et social, que le néant de la conscience tire son existence et ses capacités. Dans mon article, j’examine différents sens qu’on peut donner au « rien » de la conscience à la lumière de la pensée de Sartre lui-même, en mettant l’accent sur la différence entre deux sens majeurs de la négation : comme opposition et comme indétermination. Ensuite je confronte le concept sartrien de la conscience avec les considérations plus récentes et d’inspiration différente, notamment chez les chercheurs comme Chalmers, Damasio, Gallagher et Zahavi. Ma thèse est que le concept sartrien, semi-transcendantal et semi-naturaliste, admet bien la recherche d’une explication naturaliste de la conscience, mais lui assigne la limite précisément par le concept du néant. (shrink)

Aperçu historiographique et méthodologique -- Notes sur le corpus deschampsien -- La double monade. Un matérialisme au-delà du système moniste de Spinoza et du système physique de d'Holbach ; Formes de totalité dans la tradition platonicienne et néoplatonicienne ; Dialectique de un et multiple -- Métaphysique et théologie négative. Réflexion sur les idées que nous avons foncièrement de Dieu ; Contre la raison du temps ; Dieu non-créateur ; Dieu créateur; Les concepts dionysiens de Théarchie et [suressentialité] ; La connaissance (...) antinomique -- Le "fond" de la religion et le "fond" de l'homme. Observations métaphysiques ; Le Dieu de la tradition ; Le Dieu des philosophes ; Dieu indistinct et distinct ; Les antithèses de Meister Eckhart ; Le "moi métaphysique" -- Quid nihil ? L'existence du Néant ; Le Livre du Néant ; Tout ou Rien ; La correspondance avec Robinet. (shrink)

« À l’homme, rien de plus utile que l’homme ». Que signifie cette formule chez un auteur pour qui dans la nature droit et puissance ne font qu’un? Le conatus conduirait à l’égoïsme et à l’indifférence aux autres. Chacun recherchant son « utile propre », seules les lois permettraient la visée de « l’utile commun ». Cependant, selon l’ Éthique, l’individu conquiert sa liberté en prenant conscience de sa vulnérabilité résultant du caractère relationnel de son existence modale. Sa principale (...) vertu est la force d’âme qui mêle fermeté et générosité. La sollicitude n’est donc pas étrangère à l’éthique spinoziste. Reste à en définir les contours dans une philosophie de la puissance qui n’est pas totalement incompatible avec une vulnérabilité liée à la servitude. (shrink)

Le savoir académique est une connaissance fragmentée qui évolue spontanément vers le dogme qui mène au pouvoir. Le savoir d’un praticien doit être transversal et intégrer des données hétérogènes fonctionnant dans un système indivisible. Une convergence de causes de natures différentes peut déclencher ou non, un même effet.Academic knowledge is fragmented knowledge evolves spontaneously to the dogma that leads to power. Knowledge of a practitioner must be transversal and integrate heterogeneous data in a running system indivisible. Convergence of different kinds (...) of causes can trigger or not, same effect. (shrink)

This paper analyzes the influence of J. Derrida’s philosophy on the early thought of French phenomenologist M. Richir. Main texts for the analysis are Derrida’s report « La Différance » and the article « Le Rien Enroulé » by Richir. The author stresses their deep figurative and substantive interconnectedness. Thus, Richir borrows from Derrida a number of key philosophical figures, including the figure of différance itself, and applies them to phenomenological landscape through the “first-person” narrative. Having examined the correlation (...) between Derrida’s figures of différance and Richir’s phenomenalization, the author concludes that Richir, influenced by the impersonal figure of différance, leads his “first-person” narrative in an attempt to take it beyond the limits of classical phenomenological discourse. Moreover, the author finds preconditions for Richir’s introduction of one of his early key concepts “nothing” (rien) in the text of Derrida’s « La Différance ». The main thesis of this research is: Richir borrows Derrida’s understanding of consciousness and performs phenomenological description from its perspective. The paper considers Derrida’s text as a key to understanding Richir’s article « Le Rien Enroulé » and, as a result, the key to his early philosophy in general. (shrink)

La formule célèbre d’Aristote « la nature ne fait rien en vain », telle qu’elle est utilisée dans le traité sur la Locomotion des animaux, invite à reformuler le problème général du finalisme en zoologie et de la conformité à la nature. Bien que cette formule, en première approche, semble aller dans le sens d’une téléologie cosmique ou globale, elle conduit en fait à privilégier une téléologie relative, c’est-à-dire locale, qui opère à l’échelle des êtres vivants. Elle s’applique en (...) effet, non pas de manière absolue, mais relativement aux possibilités définies par la nature de l’espèce (propriétés spécifiques et génériques). Toutefois, elle n’exprime pas seulement le rapport à la finalité organique stricto sensu, mais aussi les conditions nécessaires externes du mouvement animal, conditions qui définissent, pour les espèces et les genres, un régime commun d’organisation. (shrink)

According to Gérard Genette, the chief function of an authorial preface is to ensure that the text is read properly. In other words, the purpose of the preface is to attract the reader’s attention and to steer him or her toward a particular understanding of the book. A preface, then, aims to get readers to read the book and often on certain terms, i.e., the author’s. As such, the authorial preface of Marx’s Capital (1867) is especially important — it allows (...) us to understand how Marx himself hoped to be understood by his readers. Commentators, whether hostile or sympathetic, usually focus on the postface to the second edition of Marx’s work. We will instead focus on the preface to the first edition, as to uncover Marx’s immediate political aims and ethical concerns. (shrink)