Animal welfare scientific literature has accumulated rapidly in recent years, but bias may exist which influences understanding of progress in the field. We conducted a survey of articles related to animal welfare or well being from an electronic database. From 8,541 articles on this topic, we randomly selected 115 articles for detailed review in four funding categories: government; charity and/or scientific association; industry; and educational organization. Ninety articles were evaluated after unsuitable articles were rejected. The welfare states of animals in (...) new treatments, conventional treatments or control groups with no treatment were classified as high, medium or low according to one or more. More articles were published in which the welfare of animals in new treatments was better than that of animals in the conventional or no treatment groups, demonstrating a positive result bias. Failure to publish studies with negative or inconclusive results may lead to other scientists unnecessarily repeating the research. The authors’ assessments of the welfare state of the groups were similarly rated high, medium or low, and it was found that new treatments were rated lower if the research was funded by industry, and higher when funded by charities, with government funding agencies intermediate. These differences were not evident in the Five Freedoms assessment, demonstrating an authors’ assessment bias that appeared to support the funding agencies’ interests. North American funded publications rated the welfare of animals in New treatments higher and those in a Conventional or No Treatment lower, compared with European-funded publications. It is concluded that preliminary evidence was provided of several forms of publication bias in animal welfare science. (shrink)

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The (...) questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (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.

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Although euthanasia and assisted suicide in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. A survey was distributed amongst a random sample of Dutch 2641 citizens and 3000 physicians. Acceptance and conceivability of (...) performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria. (shrink)

Background Studies describing physicians’ experiences with sedation at the end of life are indispensible for informed palliative care practice, but they are scarce. We describe the accounts of physicians from the USA and the Netherlands, two countries with different regulations on end-of-life decisions regarding their use of sedation.Methods Qualitative face-to-face interviews were held in 2007–2008 with 36 physicians , including primary care physicians and specialists. We applied purposive sampling and conducted constant comparative analyses.Results In both countries, the use of sedation (...) was described in diverse terms, especially in the USA, and was often experienced as emotionally challenging. Respondents stated different and sometimes multiple intentions for their use of sedation. Besides alleviating severe suffering, most Dutch respondents justified its use by stating that it does not hasten death, while most American respondents indicated that it might hasten death but that this was justifiable as long as that was not their primary intention. While many Dutch respondents indicated that they initiated open discussions about sedation proactively to inform patients about their options and to allow planning, the accounts of American respondents showed fewer and less-open discussions, mostly late in the dying process and with the patient's relatives.Conclusions The justification for sedation and the openness with which it is discussed were found to differ in the accounts of respondents from the USA and the Netherlands. Further clarification of practices and research into the effect and effectiveness of the use of sedation is recommended to enhance informed reflection and policy making. (shrink)

The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain. We did an electronic search of seven Dutch national newspapers between January 2009 and May 2010 and conducted a content analysis. Of the 284 articles containing the term ‘euthanasia’, 24% referred to practices outside the scope of the law, mostly (...) relating to the forgoing of life-prolonging treatments and assistance in suicide by others than physicians. Of the articles with euthanasia as the main topic, 36% described euthanasia in the context of a terminally ill patient, 24% for older persons, 16% for persons with dementia, and 9% for persons with a psychiatric disorder. The most frequent arguments for euthanasia included the importance of self-determination and the fact that euthanasia contributes to a good death. The most frequent arguments opposing euthanasia were that suffering should instead be alleviated by better care, that providing euthanasia can be disturbing, and that society should protect the vulnerable. Of the newspaper articles, 24% uses the term ‘euthanasia’ for practices that are outside the scope of the euthanasia law. Typically, the more unusual cases are discussed. This might lead to misunderstandings between citizens and physicians. Despite the Dutch legalisation of euthanasia, the debate about its acceptability and boundaries is ongoing and both sides of the debate are clearly represented. (shrink)

Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient’s life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics.

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

Objective To assess whether the frequency of end-of-life decisions for children under 1 year of age in the Netherlands has changed since ultrasound examination around 20 weeks of gestation became routine in 2007 and after a legal provision for deliberately ending the life of a newborn was set up that same year. Methodology This was a recurrent nationwide cross-sectional study in the Netherlands. In 2010, a sample of death certificates from children under 1 year of age was derived from the (...) central death registry. All 223 deaths that occurred in a 4-month study period were included. Physicians who had reported a non-sudden death (n=206) were sent a questionnaire on the end-of-life decisions made. 160 questionnaires were returned (response 78%). Findings In 2010, 63% of all deaths of children under 1 year of age were preceded by an end-of-life decision—a percentage comparable to other times when this study was conducted (1995, 2001, 2005). These end-of-life decisions were mainly decisions to withdraw or withhold potentially life-sustaining treatment. In 2010, the percentage of cases in which drugs were administered with the explicit intention to hasten death was 1%, while in 1995 and 2001, this was 9% and in 2005, this was 8%. Discussion and conclusion There has been a reduction of infant deaths that followed administration of drugs with the explicit intention to hasten death. One explanation for this reduction relates to the introduction of routine ultrasound examination around 20 weeks of gestation. In addition, the introduction of legal criteria and a review process for deliberately ending the life of a newborn may have left Dutch physicians with less room to hasten death. (shrink)

As humans, we frequently engage in mental time travel, reliving past experiences and imagining possible future events. This study examined whether similar factors affect the subjective experience associated with remembering the past and imagining the future. Participants mentally “re-experienced” or “pre-experienced” positive and negative events that differed in their temporal distance from the present , and then rated the phenomenal characteristics associated with their representations. For both past and future, representations of positive events were associated with a greater feeling of (...) re-experiencing than representations of negative events. In addition, representations of temporally close events contained more sensorial and contextual details, and generated a stronger feeling of re-experiencing than representations of temporally distant events. It is suggested that the way we both remember our past and imagine our future is constrained by our current goals. (shrink)

Animal welfare scientific literature has accumulated rapidly in recent years, but bias may exist which influences understanding of progress in the field. We conducted a survey of articles related to animal welfare or well being from an electronic database. From 8,541 articles on this topic, we randomly selected 115 articles for detailed review in four funding categories: government; charity and/or scientific association; industry; and educational organization. Ninety articles were evaluated after unsuitable articles were rejected. The welfare states of animals in (...) new treatments, conventional treatments or control groups with no treatment were classified as high, medium or low according to one or more. More articles were published in which the welfare of animals in new treatments was better than that of animals in the conventional or no treatment groups, demonstrating a positive result bias. Failure to publish studies with negative or inconclusive results may lead to other scientists unnecessarily repeating the research. The authors’ assessments of the welfare state of the groups were similarly rated high, medium or low, and it was found that new treatments were rated lower if the research was funded by industry, and higher when funded by charities, with government funding agencies intermediate. These differences were not evident in the Five Freedoms assessment, demonstrating an authors’ assessment bias that appeared to support the funding agencies’ interests. North American funded publications rated the welfare of animals in New treatments higher and those in a Conventional or No Treatment lower, compared with European-funded publications. It is concluded that preliminary evidence was provided of several forms of publication bias in animal welfare science. (shrink)

Many political theorists, philosophers, social scientists, and other academics engage in political activism. And many think this is how things ought to be. In this essay, I challenge the ideal of the politically engaged academic. I argue that, quite to the contrary, political theorists, philosophers, and other political thinkers have a prima facie duty to refrain from political activism. This argument is based on a commonsense moral principle, a claim about the point of political thought, and findings in cognitive psychology.

ABSTRACT Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in (...) medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

The label ‘Translational Research’ (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the lab bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific research. The rhetorical as well as moral force of the label TR obscure, however, that it is actually used in very different ways. In (...) this paper, we analyse the scientific discourse on TR, with the aim to disentangle and critically evaluate the different meanings of the label. We start with a brief reconstruction of the history of the concept. Subsequently, we unravel how the label is actually used in a sample of scientific publications on TR and examine the presuppositions implied by different views of TR. We argue that it is useful to distinguish different views of TR on the basis of three dimensions, related to (1) the construction of the ‘translational gap’; (2) the model of the translational process; and (3) the cause of the perceived translational gap. We conclude that the motive to make society benefit from its investments in biomedical science may be laudable, but that it is doubtful whether the dominant views of TR will contribute to this end. (shrink)

Due to the terrorist attacks of 9/11 and the anthrax letters of a few weeks later, the concept of dual use has spread widely in the life sciences during the past decade. This article is aimed at a clarification of the dual use concept and its scope of application for the life sciences. Such a clarification would greatly facilitate the work of policymakers seeking to ensure security while avoiding undesirable interventions of government in the conduct of science. The article starts (...) with an overview of the main developments in life sciences in relation to dual use. This is illustrated by discussions on synthetic biology and dual use. The findings lead to a reconsideration of the dual use concept. An area in need of further attention is to what extent threats and intentions should have impact on the definition of dual use. Possible threats are analyzed against the background of the phenomenon of securitization of health care and life sciences: considering these sectors of society in security terms. Some caveats that should be taken into account in a dual use policy are described. An acceptable, adequate and applicable definition of the dual use concept could help researchers, universities, companies and policy makers. Such a definition should build upon, but go beyond, the view developed in the influential Fink-report, which concentrates on the so-called ‘experiments of concern’, e.g. experiments that enhance the virulence of pathogens (National Research Council of the National Academies 2004) It will be argued that—in addition to these more technical aspects—a definition of dual use should include the aspect of threats and intentions. (shrink)

On the basis of both published and unpublished manuscripts written from 1914 to 1917, this article gives an overview of Lev Vygotsky’s early ideas. It turns out that Vygotsky was very much involved in issues of Jewish culture and politics. Rather surprisingly, the young Vygotsky rejected all contemporary ideas to save the Jewish people from discrimination and persecution by creating an autonomous state in Palestine or elsewhere. Instead, until well into 1917, Vygotsky proposed the rather traditional option of strengthening the (...) spiritual roots of the Jews by returning to the religious writings. Socialism was rejected, because it merely envisioned the compulsory redistribution of material goods and ‘man lives not by bread alone’. It was only after the October Revolution that Vygotsky switched from arguments in favour of the religious faith in the Kingship of God to the communist belief in a Radiant Future. (shrink)

Recent research suggests that one can have the feeling of being the cause of an action’s outcome, even in the absence of a prior intention to act. That is, experienced self-agency over behavior increases when outcome representations are primed outside of awareness, prior to executing the action and observing the resulting outcome. Based on the notion that behavior can be represented at different levels, we propose that priming outcome representations is more likely to augment self-agency experiences when the primed representation (...) corresponds with a person’s behavior representation level. Three experiments, using different priming and self-agency tasks, both measuring and manipulating the level of behavior representation, confirmed this idea. Priming high level outcome representations enhanced experienced self-agency over behavior more strongly when behavior was represented at a higher level, rather than a lower level. Thus, priming effects on self-agency experiences critically depend on behavior representation level. (shrink)

Rational agents are important objects of study in several research communities, including economics, philosophy, cognitive science, and most recently computer science and artificial intelligence. Crudely, a rational agent is an entity that is capable of acting on its environment, and which chooses to act in such a way as to further its own best interests. There has recently been much interest in the use of mathematical logic for developing formal theories of such agents. Such theories view agents as practical reasoning (...) systems, deciding moment by moment which action to perform next, given the beliefs they have about the world and their desires with respect to how they would like the world to be. In this article, we survey the state of the art in developing logical theories of rational agency. Following a discussion on the dimensions along which such theories can vary, we briefly survey the logical tools available in order to construct such theories. We then review and critically assess three of the best known theories of rational agency: Cohen and Levesque's intention logic, Rao and Georgeff's BDI logics, and the KARO framework of Meyer et al. We then discuss the various roles that such logics can play in helping us to engineer rational agents, and conclude with a discussion of open problems. (shrink)

Although normative systems, or social laws, have proved to be a highly influential approach to coordination in multi-agent systems, the issue of compliance to such normative systems remains problematic. In all real systems, it is possible that some members of an agent population will not comply with the rules of a normative system, even if it is in their interests to do so. It is therefore important to consider the extent to which a normative system is robust, i.e., the extent (...) to which it remains effective even if some agents do not comply with it. We formalise and investigate three different notions of robustness and related decision problems. We begin by considering sets of agents whose compliance is necessary and/or sufficient to guarantee the effectiveness of a normative system; we then consider quantitative approaches to robustness, where we try to identify the proportion of an agent population that must comply in order to ensure success; and finally, we consider a more general approach, where we characterise the compliance conditions required for success as a logical formula. We furthermore introduce a logic for specifying properties of norm compliance in general and norm robustness in particular. (shrink)

The philosophical aspects of Greek medicine are now more widely appreciated, not only by historians of science and medicine but also by students of philosophy in a more narrow sense. There has also been a greater appreciation of the fact that Greek medical writers not only reflect a derivative awareness of developments in philosophy but that they also actively contributed to the formation of philosophical thought more strictly defined, for instance by developing concepts and methodologies for the acquisition of knowledge (...) and understanding. Yet the consequences of this for a renewed study of the formation of Greek philosophy have yet to be drawn; and disciplinary boundaries between historians of medicine on the one hand and philosophers and historians of philosophy on the other still pose obstacles to an integrated account of Greek thought that takes on board the contributions by the medical writers. Some preliminary remarks may therefore be in order. (shrink)

Making better choices about future technologies that are being researched or developed is an important motivator behind lay ethics interventions. However, in practice, they do not always succeed to serve that goal. Especially authors who have noted that lay ethicists sometimes take recourse to well-known themes which stem from old, even ‘archetypical’ stories, have been criticized for making too little room for agency and decision-making in their approach. This paper aims to contribute to a reflection on how lay ethics can (...) acquire more practical relevance. It will use resources in narrative ethics to suggest that in order to be relevant for action, facilitators of lay ethics interventions need to invite participants to engage in a narrative quest. As part of a quest, lay ethicists should be asked to reflect on a specific question or choice, use diverse input which is informative about the heterogeneity of viewpoints that are defended in society and argue for their standpoints. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council (...) in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also ‘the condition of equal voice’. (shrink)

The impact of philosophy of science on biology is slight. Evolutionary biology, however, is nowadays an exception. The status of the neo-Darwinian theory of evolution is seriously challenged from a methodological perspective. However, the methodology used in the relevant discussions is plainly defective. A correct application of methodology to evolutionary theory leads to the following conclusions. The theory of natural selection is unfalsifiable in a strict sense of the term. This, however, does not militate against the theory, because no scientific (...) theory whatever is testable in this way. Under a more liberal testability criterion, the theory is surely testable. None the less, certain research programs may tend to make the theory untestable in practice. It has often been argued that the tautologous character of the principle of natural selection, allegedly the focus of evolutionary theory, makes the theory untestable through circular reasoning. Actually, the principle is only a tautology if ‘fitness’ is wrongly defined in terms of actual survival. But even then circular reasoning need not ensue. Evolutionary principles do not permit, without additional information, the derivation of statements about evolutionary events concerning particular species or populations. If this were a reason to criticize the theory , any other scientific theory would be inadequate by the same token. (shrink)

Enculturation is known to shape the perception of meter in music but this is not explicitly accounted for by current cognitive models of meter perception. We hypothesize that meter perception is a strategy for increasing the predictability of rhythmic patterns and that the way in which it is shaped by the cultural environment can be understood in terms of probabilistic predictive coding. Based on this hypothesis, we present a probabilistic model of meter perception that uses statistical properties of the relation (...) between rhythm and meter to infer meter from quantized rhythms. We show that our model can successfully predict annotated time signatures from quantized rhythmic patterns derived from folk melodies. Furthermore, we show that by inferring meter, our model can better predict the onsets of future events than a similar probabilistic model that does not infer meter. Finally, we demonstrate how our model can be used in a proof-of-concept simulation of enculturation. From this simulation, we derive a class of rhythms that are likely to be interpreted differently by enculturated listeners with different histories of exposure to rhythms. (shrink)

Sound and complete axiomatizations are provided for a number of different logics involving modalities for the knowledge of multiple agents and operators for branching time, extending previous work of Halpern, van der Meyden and Vardi [to appear, SIAM Journal on Computing] for logics of knowledge and linear time. The paper considers the system constraints of synchrony, perfect recall and unique initial states, which give rise to interaction axioms. The language is based on the temporal logic CTL*, interpreted with respect to (...) a version of the bundle semantics. (shrink)

Newborn screening consists of taking a few drops of blood from a baby's heel in the first week of life and testing it for a list of disorders. In the United States and most countries in Europe, newborn screening programs began in the 1960s and 1970s with screening for phenylketonuria (PKU), a rare metabolic disease that causes severe and irreversible mental retardation unless treated before problems arise. As knowledge about rare diseases expanded and new screening technologies were introduced—such as the (...) tandem mass spectrometer and high‐performance liquid chromatography—the same blood sample could be used to test for a whole list of disorders. In general, screening programs in most countries have tended to expand, but in different countries they have expanded in different ways. Regulation also varies. In some states, screening is mandatory, whereas in others—Wyoming and Maryland—parents are asked for their informed consent. Germany and France have adopted an explicit informed consent procedure, whereas other European countries have a more informal “opt‐out” procedure that does not require signing an informed consent form. Whether newborn screening requires informed consent is an ongoing issue in bioethics. In this article, we will focus on the tension between informed consent and the problem of compliance in newborn screening. Asking for informed consent—allowing parents to opt out—is often thought to pose a threat to compliance. Building on the work of Onora O'Neill on informed consent and trust, however, as well as on work she coauthored with Neil Manson, we will argue that informed consent procedures may actually help maintain trust in newborn screening and may therefore support compliance. (shrink)

Various philosophers and evolutionary biologists have recently defended the thesis that species are individuals rather than sets. A decade of debates, however, did not suffice to settle the matter. Conceptual analysis shows that many of the key terms involved are ambiguous. Current disagreements should dissolve once this is recognized. Explication of the concepts involved leads to new programs for philosophical research. It could also help biology by showing how extant controversies concerning evolution may have conceptual rather than factual roots.

Since Gallie introduced the notion of essentially contested concepts, it has given rise to considerable debate and confusion. The aim of this paper is to bring clarity to these debates by offering a critical reconstruction of the notion of essential contestedness. I argue that we should understand essentially contestable concepts as concepts that refer to ideals or to concepts and phenomena that can only be fully understood in light of ideals and that are, as a consequence, open to pervasive contestation. (...) Moreover, some concepts are second-order essentially contested: it may be a matter of ongoing dispute as to whether they should be regarded as essentially contested. The concept of law is an example. Some authors argue that it is ideal-oriented, whereas others claim it is not. This insight that ‘law’ is a second-order essentially contested concept may explain some of the disagreements between legal positivism and its various opponents. (shrink)

In his own day, the name of Pierre Bayle was as famous as that of any philosopher in Europe. Yet despite his vast influence on the eighteenth century and the Enlightenment, Bayle's name was eclipsed by those of other, more methodical thinkers of his age, eliciting the following remark from one modern scholar, J.C. Laursen: 'Why do professional philosophers spend so much time on Descartes and so little time on Pierre Bayle, when Bayle was clearly the better philosopher?'In the past (...) decades a surge of new interest in Bayle has led to the rediscovery of the depth of his philosophical thought as well as the extent of his influence-yet the scholarly debate is shadowed by deep uncertainty as to how to tackle his eclectic writings, especially the expansive historical-philosophical publication that became one of the Enlightenment's best-sellers: the Dictionnaire Historique et Critique, first published in 1696 and counting more than six million words.This volume provides an important new study of both Bayle and the Dictionnaire. (shrink)

In this article, I examine the relation between Bateson and Guattari’s ecological thoughts: two thinkers whose ecological ideas at first sight have a lot in common. In order to show the difference between the thoughts of both thinkers, I will take my clue from Guattari’s remark that he parts ways with Bateson on the role of context. Explaining the role of context in both authors will allow me to show how Guattari’s thought implies both an endorsement and a critique of (...) cybernetics, and, specifically, promoting a machinic rather than cybernetic ecology. I will conclude by indicating what is at stake in this distinction. (shrink)

The skopos of this new type of church Bible is: ‘How would the source texts of the Bible have sounded in Afrikaans in the context envisaged for its hypothesised first audience?’ Fully acknowledging the complexities of language as a dynamic and complex system embedded in the culture and conceptual world of its speakers, as well as the wide range of frames that are involved in the process of Bible translation as a difficult form of secondary communication, this article addresses two (...) of the challenges of this ambitious project. In the first section the incongruence between the world of the Old Testament and speakers of Afrikaans is treated. Examples are provided of instances where both the nature of difficult secondary intercultural communication as well as the subjective theories of the host audience constrains the ‘directness’ of the translation. In the second section, some of the challenges of distinguishing between the formal and functional features of Biblical Hebrew are dealt with. The article concludes that, although the notion ‘communicative clue’ provides a useful heuristic device to act as point of departure for negotiations on the construal of the meaning of the text in the source language and host language respectively, the notion has to be supplemented by insights from the fields of cultural anthropology, cognitive linguistics and linguistic typology. A better understanding of how meaning ‘works’ provides members of a translation team with some criteria to make informed decisions when they negotiate how the meaning of specific Biblical Hebrew constructions are to be construed ‘directly’ in Afrikaans.Keywords: Afrikaans Bibles; Bible translation; Biblical Hebrew; church Bible; code model; cognitive linguistics; cognitive semantics; communication model; communicative clue; direct translation; discourse marker; dynamic equivalent translation; functionalist tran. (shrink)

Lon Fuller, one of the great American jurists of this century, is often remembered only for his stand on the morality of law in the Fuller-Hart debate. Rediscovering Fuller considers the full range of Fuller's writings, from his early engagement with legal fictions and his critique of legal positivism to his later work on implicit law and the art of institutional design. Contributors from the fields of both civil law and common law argue that Fuller's insights are highly relevant to (...) contemporary concerns. The book contains essays by K. Winston, D. Dyzenhaus, P. Cliteur, F. Schauer ("Beyond the Fuller-Hart Debate"), P. Westerman, W. van der Burg, D. Luban ("Moralities of Law"), G. Postema, P. Teachout ("Implicit Law"), R. Macdonald, W. Witteveen, J. Allison, M. Hertogh, K. Soltan ("The Art of Institutional Design"), J. Allan, F. Mootz, J. Vining ("Law's Dialogue"), and a preface by Ph. Selznick. "At some point in the future, when we become more open to the moral relevance of social inquiry, more empirical in our study of philosophical issues, more capable of uniting moral and social theory, Lon Fuller's work will stand as a landmark. This volume will help show the way." —Ph. Selznick. (shrink)

The growth of global value chains (GVCs) and the emergence of novel forms of value chain governance pose two questions for normative business ethics. First, how should we conceptualize the relationships between members of a GVC? Second, what ethical implications follow from these relationships, both with respect to interactions between GVC members and with respect to achieving broader transnational governance goals? We address these questions by examining the emergence of transnational eco-labeling as an increasingly prominent form of GVC governance that (...) is redefining the relationship between nominally independent firms. On the first question, we argue that GVCs occupy a middle ground between intrafirm and interfirm transactions, thereby posing a challenge to theoretical frameworks that attempt to apply ethical standards based on transaction types. On the second question, we argue that this unique institutional status leads to a range of novel ethical considerations and dilemmas for GVC members. Lead firms, their suppliers, and third-party standard-setters all confront new ethical quandaries when third-party eco-labeling is introduced to a GVC. The nature of these quandaries means that, while GVCs may be well-positioned to serve as instruments of transnational governance, they are frequently not well-oriented to do so. Our analysis marks an initial attempt to map the ethical considerations that apply to members of a GVC, and in doing so, places the literature on normative business ethics and transnational governance in a closer conversation. (shrink)