sirI have been following with interest the series of articles in the Journal of Medical Ethics on the subject of Jehovah's Witnesses and the refusal of blood transfusions. There are a couple of aspects which have not been covered and which I would like to raise.Most of the discussion has centred around adult Jehovah's Witnesses. However, where children are involved the issues become more complex and emotive. I feel that there is a need to examine the rights and responsibilities of (...) parents in the making of life and death decisions on behalf of their …. (shrink)

In this paper, we will explain and analyse a phenomenological distinction between two kinds of actions. The distinction we have in mind is the difference between those actions that actors try, or are satisfied, to carry out, in like situations, ‘in the same way’, and all other actions. We call the first kind ‘mimeomorphic actions’ and the second kind ‘polimorphic actions’. We will define these two kinds of actions, and their species, on the basis of their characteristic intentions and experiences, (...) and thus our inquiry falls broadly into the phenomenology of action. The latter has been defined by D. W. Smith as the “description of the experience of acting, or doing something”. (shrink)

Required reading for anyone who believes in the equality of the sexes. A long awaited, highly acclaimed new translation of Simone De Beauvoir's landmark work.

This paper attempts to outline some of the important concepts and ideas used in system analysis which is taken to be a general mode of analysis used in all sciences. Systems are seen from three perspectives: that involving the relationship between system and environment, that involving interaction between several systems, and that involving one type of system composed of other types of systems. The writers also discuss the concepts "structure" and "equilibrium" as they apply to system analysis, the point being (...) made that the use of these concepts in the social sciences has often been vague or even incorrect. (shrink)

In terms of intervening in embodied experience, medical treatment is wonder-full in its ambition and its metaphysical presumption; yet, wonder’s role in clinical medicine has received little philosophical attention. In this paper, I propose, to doctors and others in routine clinical life, the value of an openness to wonder and to the sense of wonder. Key to this is the identity of the central ethical challenges facing most clinicians, which is not the high-tech drama of the popular conceptions of medical (...) ethics but, rather, the routine of patients’ undramatic but unremitting demands for the clinician’s time and respectful attention. Wonder (conceived as an intense and transfiguring attentiveness) is a ubiquitous ethical source, an alternative to the more familiar respect for rational autonomy, a source of renewal galvanizing diagnostic imagination, and a timely recalling of the embodied agency of both patient and clinician. (shrink)

Commentators are divided on the interpretation of Metaphysics Z4 1029b13–22. For one thing, it is unclear whether the passage rejects a claim about the essence of surface, or about the essence of pale. It is usually thought that the claim is disavowed because it involves a circular definition. However, this is conjectural, since Aristotle does not explicitly say anything about circularity in the lines in question. I argue here for an alternative account, which reads the disputed lines as an extension (...) of the immediately preceding remarks. If correct, this also solves the problem as to just what Aristotle is denying. As will emerge, my story is helped by St. Thomas’ reading of lines 21–22, an account that has been curiously ignored in the recent literature. (shrink)

Commentators are divided on the interpretation of Metaphysics Z4 1029b13–22. For one thing, it is unclear whether the passage rejects a claim about the essence of surface, or about the essence of pale. It is usually thought that the claim is disavowed because it involves a circular definition. However, this is conjectural, since Aristotle does not explicitly say anything about circularity in the lines in question. I argue here for an alternative account, which reads the disputed lines as an extension (...) of the immediately preceding remarks. If correct, this also solves the problem as to just what Aristotle is denying. As will emerge, my story is helped by St. Thomas’ reading of lines 21–22, an account that has been curiously ignored in the recent literature. (shrink)

It has been claimed that the earliest expression of a robust scepticism is in the Catalogue of Ships in the Iliad, and even commentators who would not go that far have thought the passage an important guide to epistemological attitudes in Homeric antiquity. It will be argued here that a close examination of the text does not support such conclusions. On the other hand, there are respectable reasons for an interpretation in which religious factors are operative, rather than epistemic ones. (...) The conclusion to be drawn is that the epistemic reading is groundless. (shrink)

It has been claimed that the earliest expression of a robust scepticism is in the Catalogue of Ships in theIliad, and even commentators who would not go that far have thought the passage an important guide to epistemological attitudes in Homeric antiquity. It will be argued here that a close examination of the text does not support such conclusions. On the other hand, there are respectable reasons for an interpretation in which religious factors are operative, rather than epistemic ones. The (...) conclusion to be drawn is that the epistemic reading is groundless. (shrink)

Medical screening is justified on the strength of the assumption that the earlier disease is detected, the better it is for the patient. On examination, however, the assumption turns out to be severely flawed, and inadequate anyway, since it is not only the patient with whom we should be concerned, but healthy people as well. Instead of making assumptions about the ill, we should prove a test's overall benefit to the individual taking it before we recommend it.

One of the dominant themes of the symposium from which this collection of articles arose was the ontological status of consent. Is consent a particular state of mind? Is it the signification of that state of mind via a conventionally recognized act? Or, is consent a normative concept that evaluates not only the presence of a state of mind or act, but also the appropriateness of that state of mind or act in the particular circumstances?

The International Classification of Functioning, Disability and Health (ICF), designed by the WHO, attempts to provide a holistic model of functioning and disability by integrating a medical model with a social one. The aim of this article is to analyze the ICF’s claim to holism. The following components of the ICF’s complexity are analyzed: (1) health condition, (2) body functions and structures, (3) activity, (4) participation, (5) environmental factors, (6) personal factors, and (7) health. Although the ICF claims to be (...) holistic, it presupposes a monistic materialistic ontology. We indicate some limitations of this ontology, proposing instead: (a) a pluralistic–holistic ontology (PHO) and (b) a multidimensional view of the human being, with individual and environmental aspects, in relation to three levels of reality implied by the PHO. For the ICF to attain its holistic claim, the interactions between its components should be based on (a) and (b). (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

The notion of patients’ duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients’ duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient (...) is always liable to be an opportunity cost in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one’s own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights-based approaches, and that a preferable alternative might be sought through the notion of a “virtuous patient” contributing to a problem-solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. (shrink)

In studying the thinkers discussed, we have generally used (translations of) their writings. The very breadth of this study makes one dependent upon ...

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or (...) moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to “veto” their social responsibility to take part in clinical research. (shrink)

I will divide my discussion into two. In the first part I will discuss Godin and Gingras's delicious claim that the experimenter's regress is anticipated by Sextus Empiricus's formulation of scepticism. In the second part, I will try to deal with Godin and Gingras's ‘critical argument’, that the experimenter's regress would be redundant if we were less concerned with ‘frightening philosophers’.