Objectives: To investigate why physicians label end-of-life acts as either ‘euthanasia/ending of life’ or ‘alleviation of symptoms/palliative or terminal sedation’, and to study the association of such labelling with intended reporting of these acts. Methods: Questionnaires were sent to a random, stratified sample of 2100 Dutch physicians. They were asked to label six hypothetical end-of-life cases: three ‘standard’ cases and three cases randomly selected, that varied according to type of medication, physician’s intention, type of patient request, patient’s life expectancy and (...) time until death. We identified the extent to which characteristics of cases are associated with physician’s labelling, with multilevel multivariable logistic regression. Results: The characteristics that contributed most to labelling cases as ‘euthanasia/ending of life’ were the administration of muscle relaxants or disproportional morphine. Other important factors were an intention to hasten death and a life expectancy of several months. Physicians were much more willing to report cases labelled as ‘euthanasia’ or ‘ending of life’ than other cases. Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not. (shrink)

This contribution is a gentle introduction to so-called dynamic epistemic logics, that can describe how agents change their knowledge and beliefs. We start with a concise introduction to epistemic logic, through the example of one, two and finally three players holding cards; and, mainly for the purpose of motivating the dynamics, we also very summarily introduce the concepts of general and common knowledge. We then pay ample attention to the logic of public announcements, wherein agents change their knowledge as the (...) result of public announcements. One crucial topic in that setting is that of unsuccessful updates: formulas that become false when announced. The Moore-sentences that were already extensively discussed at the conception of epistemic logic in Hintikka’s ‘Knowledge and Belief’ give rise to such unsuccessful updates. After that, we present a few examples of more complex epistemic updates. Our closing observations are on recent developments that link the ‘standard’ topic of belief revision, as in ‘On the Logic of Theory Change: partial meet contraction and revision functions’, by Alchourron et al. , to the dynamic epistemic logics introduced here. (shrink)

Results of two survey studies are presented. It is shown that attitudes of the public about "technology in general" are not stable and can easily be affected by how the subject is introduced. Eight areas of technology are compared on the basis of empirical relations in attitudinal judgments, in attribute ratings, in self- assigned importance weights of attributes, and in importance of reference groups and persons. On the basis of similarities in these four kinds of judgments, three clusters of technology (...) areas were identified: a cluster of modern reproductive technologies, an information cluster containing automation, computer, and communication technologies, and a cluster containing nuclear energy and military technology. The attitude toward "technology in general" can not be considered as an aggregation of attitudes toward these areas of technology: The relations between general attitude and specific attitudes are only moderate to negligible. (shrink)

This systematic review aimed to provide an overview of earlier research on the relationships between age conceptualizations and indicators of employability. We have conducted a systematic literature search using PsycINFO, Academic Search Premier, Business Source Complete, CINAHL, ERIC, MEDLINE, and Science Direct. Two raters evaluated the articles and subsequently distinguished k = 41 studies that met the inclusion criteria for this systematic review. Our review revealed that many researchers adopted different operationalizations to measure employability. Moreover, most studies included calendar age (...) as indicator of aging at work, and were based on a cross-sectional design. Based on the Standardized Index of Convergence method, different types of evidence were found for the relationships between age and the employability measures. For relationships between psychosocial age and lifespan age, on the one hand, and employability measures, on the other hand, too few studies were found to draw conclusions. Yet, for relationships between calendar age and labor market-based measures strong consistent negative relationships were found across the studies, and moderately strong positive relationships were found for functional age and labor market- based measures. For organizational age and both competence-based as well as labor market-based measures moderately strong negative relationships were found. We discuss the implications of these results and propose a research agenda for future studies. (shrink)

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC and the (...) reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

Bijdragen over de actuele betekenis van de filosofie, met name de Reformatorische Wijsbegeerte.

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC and the (...) reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

The explanatory gap refers to the lack of concepts for understanding “how it is that . . . a state of consciousness comes about as a result of irritating nervous tissue.” By assuming that there are colours in the outside world, Block needlessly widens this gap and Lycan and Kitcher simply fail to see the gap. When such assumptions are abandoned, an unnecessary and incomprehensible constraint disappears. It then becomes clear that the brain can use its own neural language for (...) representing aspects of the outside world. While this may not close the gap, it becomes clearer where we need new concepts. (shrink)

Group-based emotions have been conceptualised as being rooted in perceivers' social identity. Consistent with this idea, previous research has shown that social identity salience affects group-based emotions, but no research to date has directly examined the role of group-based appraisals in comparison with individual appraisals. In the present studies, we measured group-based appraisals through a thought-listing procedure. In Experiment 1, we explicitly reminded people of their group identity, which led to the predicted change in group-based anger. This effect was mediated (...) by group-based appraisals. In Experiment 2, participants either discussed a group-relevant scenario in small groups or a related topic irrelevant to the group. The group-relevant condition not only led to stronger indignation but the perceived presence of group-based appraisals was also related to participants' reports of indignation. These results provide further evidence for the importance of group-based appraisals as components of group-based emotions. (shrink)

Everybody knows the phenomena summarized with the term attention: concentration, focalization, limitation, selection, and intensification . The explanation of these phenomena is, however, a different matter. Problems easily arise with regard towhathas to be explained and with regard to thestyleof explanation. A problem of the first kind is the “methodology of ‘bad focus’”: the explanation starts with and is fixated on an intuitively striking but nonessential behavioral feature or cognitive achievement. A problem of the second kind is a “virtus dormitiva” (...) explanation: the explanation starts with emphasizing one aspect of the observed phenomena, the emphasized aspect receives an interesting and suggestive name, and that name with its connotations is used as a concept in the explanation. At the start of contemporary, behavior-based, information processing psychology, avirtus dormitivaexplanation infiltrated the functional accounts of the phenomena of attention; the empirical observation that people show performance limitations was translated into the theoretical concept of a communication channel with a limited capacity. That limited capacity notion became the core concept in what can be called the standard theory of attention. This standard theory of attention faced severe difficulties in explaining the guidance of attention by the information processor's goals and intentions. Subsequent modifications, concerned with removing these difficulties, revealed that selection, guided by goals and intentions, is the essential behavioral feature and that the observed performance limitations are a result of this selection. So, the limited capacity theorizing was not only plagued by avirtus dormitivaexplanation, it also suffered from the methodology of bad focus. (shrink)

In line with recent proposals for experimental philosophy and philosophy of science in practice, we propose that the philosophy of medicine could benefit from incorporating empirical research, just as bioethics has. In this paper, we therefore take first steps towards the development of an empirical philosophy of medicine, that includes investigating practical and moral dimensions. This qualitative study gives insight into the views and experiences of a group of various medical professionals and patient representatives regarding the conceptualization of health and (...) disease concepts in practice and the possible problems that surround them. This includes clinical, epistemological, and ethical issues. We have conducted qualitative interviews with a broad range of participants (n = 17), working in various health-related disciplines, fields and organizations. From the interviews, we highlight several different practical functions of definitions of health and disease. Furthermore, we discuss 5 types of problematic situations that emerged from the interviews and analyze the underlying conceptual issues. By providing theoretical frameworks and conceptual tools, and by suggesting conceptual changes or adaptations, philosophers might be able to help solve some of these problems. This empirical-philosophical study contributes to a more pragmatic way of understanding the relevance of conceptualizing health and disease by connecting the participants’ views and experiences to the theoretical debate. Going back and forth between theory and practice will likely result in a more complex but hopefully also better and more fruitful understanding of health and disease concepts. (shrink)

A study is made of the dominant terms of an earlier model-based formula describing the dispersion energy of axially symmetric interacting molecules. The existence of mixed-pole eighth-order terms is noted.

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

Health technology assessment consists of thesystematic study of the consequences of theintroduction or continued use of the technology in aparticular context, with the explicit objective toarrive at a judgment of the value or merit of thetechnology. Ideally, it is aimed at assessing allaspects of a given technology or group oftechnologies, including non-technical, e.g.socio-ethical, aspects. However, methods for assessingsocio-ethical implications of health technology arerelatively undeveloped and few mechanisms exist totake action based on the results of such evaluations.Still, the examples of cochlear (...) inplants and other cases illustratethat HTA is not a matter of merely collecting thefacts about a technology. The facts must beplausible and relevant from a particular framework,which is not always shared by different groups. It ishere that socio-ethical aspects are encountered. Ifhealth technology assessment aims to enhance theaccountability of the decision making processregarding funding and use of health technology, it isa major challenge to assessors of health technologiesto deal adequately with existing value pluralism. Inthis respect interactive evaluation may have somethingto offer. (shrink)

We identify two aspects of the problem of maintaining perceptual stability despite an observer's eye movements. The first, visual direction constancy, is the (egocentric) stability of apparent positions of objects in the visual world relative to the perceiver. The second, visual position constancy, is the (exocentric) stability of positions of objects relative to each other. We analyze the constancy of visual direction despite saccadic eye movements.Three information sources have been proposed to enable the visual system to achieve stability: the structure (...) of the visual field, proprioceptive inflow, and a copy of neural efference or outflow to the extraocular muscles. None of these sources by itself provides adequate information to achieve visual direction constancy; present evidence indicates that all three are used.Our final question concerns how information processing operations result in a stable world. The three traditionally suggested means have been elimination, translation, or evaluation. All are rejected. From a review of the physiological and psychological evidence we conclude that no subtraction, compensation, or evaluation need take place. The problem for which these solutions were developed turns out to be a false one. We propose a “calibration” solution: correct spatiotopic positions are calculated anew for each fixation. Inflow, outflow, and retinal sources are used in this calculation: saccadic suppression of displacement bridges the errors between these sources and the actual extent of movement. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

The ground-state dispersion energy of a pair of axially symmetric molecules is calculated, to arbitrary order in the inverse intermolecular separation, on the basis of London's anisotropic oscillator model.