Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project “support and consultation in euthanasia in Amsterdam” which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the (...) general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. (shrink)

The authors of this commentary concur with the viewpoint presented by Mareschal et al. (2007a; 2007b) concerning the relevance of neurological data when theorizing about cognitive development. However, we argue here that Mareschal et al. fail to consider adequately the relevance of reorganizational brain events occurring through adolescence and early adulthood, especially regarding the prefrontal cortex and the ontogeny of executive functioning. In addition, evidence from the lifespan neurodevelopmental literature indicates that increased activity of neural networks may signify less efficient (...) processing. This observation is of potential relevance when considering the neurological changes associated with cognitive development during childhood and adolescence. (shrink)

In the Netherlands, in 1995 approximately 9700 people explicitly requested euthanasia or assisted suicide, and EAS was performed approximately 3600 times. The most important reasons for not performing EAS when requested by a patient were that the patient died before EAS was performed, or that the physician refused the request.

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)

What if the Big Bang was an exodus of non-existing reality into existence? In this book a theory of the reality is started from the principle that 'existing takes time' but in states of the universe there are pre-things in moments, thus non-existing, which realize in strings over specific time intervals as existing phenomena. Causality must be reviewed now and new paradigms for reality follow. The existing and observed universe are discontinuous and "limits" in mathematical models do not correspond to (...) reality. New interpretations in evolution theory and the human condition are being investigated. (shrink)

In this paper we consider the algebra of differential operators with polynomial coefficients acting on Clifford algebra-valued functions from both sides. We characterize the subalgebra of SO(m)-invariant differential operators, which itself contains the subalgebra of GL(m)-invariant differential operators.

An innovative, multifaceted approach to scientific experiments as designed by and shaped through interaction with the modeling process The role of scientific modeling in mediation between theories and phenomena is a critical topic within the philosophy of science, touching on issues from climate modeling to synthetic models in biology, high energy particle physics, and cognitive sciences. Offering a radically new conception of the role of data in the scientific modeling process as well as a new awareness of the problematic aspects (...) of data, this cutting-edge volume offers a multifaceted view on experiments as designed and shaped in interaction with the modeling process. Contributors address such issues as the construction of models in conjunction with scientific experimentation; the status of measurement and the function of experiment in the identification of relevant parameters; how the phenomena under study are reconceived when accounted for by a model; and the interplay between experimenting, modeling, and simulation when results do not mesh. Highlighting the mediating role of models and the model-dependence of data measurement, this volume proposes a normative and conceptual innovation in scientific modeling--that the phenomena to be investigated and modeled must not be precisely identified at the start but specified during the course of the interactions arising between experimental and modeling activities. Contributors: Nancy D. Cartwright, U of California, San Diego; Anthony Chemero, U of Cincinnati; Ronald N. Giere, U of Minnesota; Jenann Ismael, U of Arizona; Tarja Knuuttila, U of South Carolina; Andrea Loettgers, U of Bern, Switzerland; Deborah Mayo, Virginia Tech; Joseph Rouse, Wesleyan U; Paul Teller, U of California, Davis; Michael Weisberg, U of Pennsylvania; Eric Winsberg, U of South Florida. (shrink)

In 1988 Fodor and Pylyshyn issued a challenge to the newly-popular connectionism: explain the systematicity of cognition without merely implementing a so-called classical architecture. Since that time quite a number of connectionist models have been put forward, either by their designers or by others, as in some measure demonstrating that the challenge can be met (e.g., Pollack, 1988, 1990; Smolensky, 1990; Chalmers, 1990; Niklasson and Sharkey, 1992; Brousse, 1993). Unfortu- nately, it has generally been unclear whether these models actually do (...) have this implication (see, for instance, the extensive philosophical debate in Smolensky, 1988; Fodor and McLaughlin, 1990; van Gelder, 1990, 1991; McLaughlin, 1993a, 1993b; Clark, 1993). Indeed, we know of no major supporter of classical orthodoxy who has felt compelled, by connectionist models and argu- ments, to concede in print that connectionists have in fact delivered a non-classical explanation of systematicity. (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)

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In the current study, we investigated the question of whether automatic interference effects found in the dot-perspective task (Samson, Apperly, Braithwaite, Andrews, & Bodley Scott, 2010) are the product of domain-specific perspective-taking processes or of domain-general “submentalizing” processes (Heyes, 2014). Previous attempts to address this question have done so by implementing inanimate (...) controls, such as arrows, as stimuli. The rationale for this is that submentalizing processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g. arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from “novel entity” paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic “perspective-taking” effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalizing interpretations of the dot-perspective task are fully correct. (shrink)

Experimental modeling is the construction of theoretical models hand in hand with experimental activity. As explained in Section 1, experimental modeling starts with claims about phenomena that use abstract concepts, concepts whose conditions of realization are not yet specified; and it ends with a concrete model of the phenomenon, a model that can be tested against data. This paper argues that this process from abstract concepts to concrete models involves judgments of relevance, which are irreducibly normative. In Section 2, we (...) show, on the basis of several case studies, how these judgments contribute to the determination of the conditions of realization of the abstract concepts and, at the same time, of the quantities that characterize the phenomenon under study. Then, in Section 3, we compare this view on modeling with other approaches that also have acknowledged the role of relevance judgments in science. To conclude, in Section 4, we discuss the possibility of a plurality of relevance judgments and introduce a distinction between locally and generally relevant factors. (shrink)

Although most consumers are positive about socially responsible companies, in order to benefit from CSR efforts, effective and clear CSR communication is important. However, due to the constantly rising profusion of eco-labels, based on either own claims from the organization or claims made by an external third party, consumers may encounter difficulties in identifying truly responsible firms, which could result in less effective CSR initiatives, even for those responsible firms. Therefore, building on attribution theory, this study seeks to identify how (...) uncertified internal CSR claims and external third-party CSR labels should be used in order to deter greenwashing and increase positive consumer evaluations. Within a 3 × 2 design, respondents are exposed to different coffee product packages measuring their attitude toward the brand, corporate credibility, purchase intention, and scent perception, as well as perceived attributional CSR motives. Overall, findings indicate that especially an external CSR label affects consumer responses toward the firm. Moreover, perceived CSR motives serve as a mediator between an external CSR label and corporate credibility and brand attitude, respectively. These findings warrant further consideration of introducing an external multilevel rating systems by governmental law. (shrink)

After having defined the KARO logic for specifying intelligent agents in earlier work we now turn to the question how to realise agents specified in the KARO framework. To this end we look at agent programming languages that we have defined, and investigate how programs in these languages can be linked to the KARO logic.

Libertarians often bill their theory as an alternative to both the traditional Left and Right. _The Routledge Handbook of Libertarianism_ helps readers fully examine this alternative, without preaching it to them, exploring the contours of libertarian thinking on justice, institutions, interpersonal ethics, government, and political economy. The 31 chapters--all written specifically for this volume--are organized into five parts. Part I asks, what should libertarianism learn from other theories of justice, and what should defenders of other theories of justice learn from (...) libertarianism? Part II asks, what are some of the deepest problems facing libertarian theories? Part III asks, what is the right way to think about property rights and the market? Part IV asks, how should we think about the state? Finally, part V asks, how well can libertarianism deal with some of the major policy challenges of our day, such as immigration, trade, religion in politics, and paternalism in a free market. Among the _Handbook_’s chapters are those from critics who write about what they believe libertarians get right as well as others from leading libertarian theorists who identify what they think libertarians get wrong. As a whole, the _Handbook_ provides a comprehensive, clear-eyed look at what libertarianism has been and could be, and why it matters. (shrink)

Over 30 million people worldwide have taken a commercial at-home DNA test, because they were interested in their genetic ancestry, disease predisposition or inherited traits. Yet, these consumer DNA data are also increasingly used for a very different purpose: to identify suspects in criminal investigations. By matching a suspect’s DNA with DNA from a suspect’s distant relatives who have taken a commercial at-home DNA test, law enforcement can zero in on a perpetrator. Such forensic use of consumer DNA data has (...) been performed in over 200 criminal investigations. However, this practice of so-called investigative genetic genealogy raises ethical concerns. In this paper, we aim to broaden the bioethical analysis on IGG by showing the limitations of an individual-based model. We discuss two concerns central in the debate: privacy and informed consent. However, we argue that IGG raises pressing ethical concerns that extend beyond these individual-focused issues. The very nature of the genetic information entails that relatives may also be affected by the individual customer’s choices. In this respect, we explore to what extent the ethical approach in the biomedical genetic context on consent and consequences for relatives can be helpful for the debate on IGG. We argue that an individual-based model has significant limitations in an IGG context. The ethical debate is further complicated by the international, transgenerational and commercial nature of IGG. We conclude that IGG should not only be approached as an individual but also—and perhaps primarily—as a collective issue. There are no data in this work. (shrink)

Millions of human biological samples are stored worldwide for medical research or treatment purposes. These biospecimens are of enormous potential value to law enforcement as DNA profiles can be obtained from these samples. However, forensic use of such biospecimens raises a number of ethical questions. This article aims to explore ethical issues of using human bodily material in medical biobanks for crime investigation and prosecution purposes. Concerns about confidentiality, trust, autonomy and justice will be discussed. We explore how to balance (...) these concerns against the importance of crime solving. Relevant case examples of forensic use of medical biobanks show that requests by law enforcement to access biobanks are handled in disparate ways. We identify some core ethical issues and conclude that further research on these issues is needed to provide ethical guidance. (shrink)

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

This article addresses the research question: “How do Dutch highly educated Muslim women of Moroccan descent use prayer in dealing with problems?” The theoretical framework was mainly based on the work of Pargament et al. regarding religious coping. The empirical part of the study consisted of a quantitative and a qualitative part. This article presents results of the quantitative part. For the quantitative part of our research, 177 questionnaires were collected using snowball sampling. We asked respondents about their praying practices (...) and their ways of religious coping, using the Brief RCOPE. The connection and communication in their prayer with a loving, caring, benevolent God is the main religious way in which these Muslim women of Moroccan descent cope with all kinds of problems. This use of prayer as a way of coping can be clarified through the psychological functions of religiosity and prayer that are suggested by Pargament, Koenig, and Perez. Prayer could help them in: finding meaning, being master over their circumstances and controlling their emotions, finding comfort and closeness to God, experiencing intimacy with others and closeness to God, and transforming their way of life. We did find few negative religious coping strategies, such as negative feelings towards God or alienation. This is in line with research results of Abu Raiya and Pargament. As Islam implies surrender to God, it may be difficult for Muslims to admit their religious distress, doubts, and struggles. (shrink)

Although Next Generation Sequencing (NGS) has increased our ability to test and diagnose, its results are often not clear-cut and require a complex interpretation and negotiation process by both healthcare professionals and patients involved. In this paper, we explore how diagnoses identified through NGS are socially shaped under influence of the broader social context. Using an analytical framework stemming from the sociology of health and illness and science and technology studies, with a focus on the construction of diagnosis and the (...) role of uncertainty in medicine, we analyze the existing corpus of literature on NGS diagnostic practices. We show how in this early implementation phase of NGS, in which standardization efforts are not yet solidified, the boundary struggles around diagnoses obtained through NGS are particularly visible. We discuss the different steps in the diagnosis shaping process and what it subsequently entails to give and a receive a diagnosis using NGS. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

Research Objective: This study focuses on ADs in the Netherlands and introduces a cross-cultural perspective by comparing it with other countries. Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%. Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive (AED, 64%). Both low (...) education and the presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD. Discussion: This study shows that the subjects of palliative care and end-of-life-decision-making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings. (shrink)