BackgroundExtremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and (...) drew much media attention. Aim of this study was to increase insight into the health effects for the survivors, and whether they received the needed care and support.MethodsSemi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size.ResultsAt both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later.ConclusionAlthough the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

In view of the arguments put forward by Clifton and Monton [this volume], we reconsider the alleged conflict of dynamical reduction models with the enumeration principle. We prove that our original analysis of such a problem is correct, that the GRW model does not meet any difficulty and that the reasoning of the above authors is inappropriate since it does not take into account the correct interpretation of the dynamical reduction theories.

“Tell me," Wittgenstein once asked a friend, "why do people always say, it was natural for man to assume that the sun went round the earth rather than that the earth was rotating?" His friend replied, "Well, obviously because it just looks as though the Sun is going round the Earth." Wittgenstein replied, "Well, what would it have looked like if it had looked as though the Earth was rotating?” What would it have looked like if we looked at all (...) sciences from the viewpoint of Wittgenstein’s philosophy? Wittgenstein is undoubtedly one of the most influential philosophers of the twentieth century. His complex body of work has been analysed by numerous scholars, from mathematicians and physicists, to philosophers, linguists, and beyond. This volume brings together some of his central perspectives as applied to the modern sciences and studies the influence they may have on the thought processes underlying science and on the world view it engenders. The contributions stem from leading scholars in philosophy, mathematics, physics, economics, psychology and human sciences; all of them have written in an accessible style that demands little specialist knowledge, whilst clearly portraying and discussing the deep issues at hand. (shrink)

It is shown, assuming the linear case of Schinzel's Hypothesis, that the first-order theory of the structure $\langle \omega; +, P\rangle$ , where P is the set of primes, is undecidable and, in fact, that multiplication of natural numbers is first-order definable in this structure. In the other direction, it is shown, from the same hypothesis, that the monadic second-order theory of $\langle\omega; S, P\rangle$ is decidable, where S is the successor function. The latter result is proved using a general (...) result of A. L. Semenov on decidability of monadic theories, and a proof of Semenov's result is presented. (shrink)

Skepticism is one of the most enduring and profound of philosophical problems. With its roots in Plato and the Sceptics to Descartes, Hume, Kant and Wittgenstein, skepticism presents a challenge that every philosopher must reckon with. In this outstanding collection philosophers engage with skepticism in five clear sections: the philosophical history of skepticism in Greek, Cartesian and Kantian thought; the nature and limits of certainty; the possibility of knowledge and related problems such as perception and the debates between objective knowledge (...) and constructivism; the transcendental method as a response to skepticism and the challenge of naturalism; overcoming the skeptical challenge. (shrink)

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

The concept of 'Archteypes' and the hypothesis of 'A Collective Unconscious' are two of Jung's better known and most exciting ideas. In this volume - taken from the Collected Works and appearing in paperback for the first time - Jung describes and elaborates the two concepts. Three essays establish the theoretical basis which are then followed by essays on specific archetypes. The relation of these to the process of individuation is examined in the last section. _The Archetypes and the Collective (...) Unconscious_ is one of Jung's central works. There are many illustrations in full colour. (shrink)

Michel Foucault had a great influence upon a wide range of disciplines, and his work has been widely interpreted and is frequently referred to, but it is often difficult for beginners to find their way into the complexities of his thought. This is especially true for readers whose background is Anglo-American or "analytic" philosophy. C. G. Prado argues in this updated introduction that the time is overdue for Anglo-American philosophers to avail themselves of what Foucault offers. In this clear and (...) greatly-revised second edition, Prado focuses on Foucault's "middle" or genealogical work, particularly Discipline and Punish and Volume One of The History of Sexuality, in which Foucault most clearly comes to grips with the historicization of truth and knowledge and the formation of subjectivity. Understanding Foucault's thought on these difficult subjects requires working through much complexity and ambiguity, and Prado's direct and accessible introduction is the ideal place to start. (shrink)

Six individuals with experience of psychosis were interviewed about their psychotic experiences. The material was analyzed using the empirical phenomenological psychological method. The results consist of a whole meaning structure, a gestalt, entailing the following characteristics: The feeling of estrangement in relationship to the world; the dissolution of time; the loss of intuitive social knowledge; the alienation of oneself, and finally; the loss of intentionality/loss of agency. In brief, the results show that an altered perception of the self and the (...) world was an essential part of the psychotic experience where subjects described themselves as changed; something was sensed as being wrong as psychosis is perceptible but hard to communicate. The normal life-world experience was altered and reality seemed strange. Time perception seemed to be changed as temporality appeared dissolved and the experience of time was focused on the current moment excluding the future. The subjects described loss of intentionality, they were no longer agents in their actions but partly steered by others and they could feel as if their experiences were not theirs. The patients also describe problems regarding their ability to socialize and communicate with others. They seem to lose their intuitive social capacity and were prone to suspiciousness. (shrink)

_Psychological Types_ is one of Jung's most important and most famous works. First published by Routledge in the early 1920s it appeared after Jung's so-called fallow period, during which he published little, and it is perhaps the first significant book to appear after his own confrontation with the unconscious. It is the book that introduced the world to the terms 'extravert' and 'introvert'. Though very much associated with the unconscious, in _Psychological Types_ Jung shows himself to be a supreme theorist (...) of the conscious. In putting forward his system of psychological types Jung provides a means for understanding ourselves and the world around us: our different patterns of behaviour, our relationships, marriage, national and international conflict, organizational functioning. Appearing in paperback for the first time this central volume from Jung's Collected Works will be essential to anyone requiring a proper understanding of Jung's psychology. (shrink)