Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (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?

I defend the permissibility of paid surrogacy arrangements against the arguments Sara Ketchum advances in " Selling Babies and Selling Bodies." I argue that the arrangements cannot be prohibited out of hand on the grounds that they treat persons as objects of sale, because it is possible to view the payments made in these arrangements as compensation for the woman ' s services. I also argue that the arguments based on exploitation and parental custodial rights fail to provide adequate grounds (...) for prohibiting the arrangements. (shrink)

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)

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 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)

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)

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.

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)

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)

Heide Schluepmann _Abendroethe der Subjektphilosophie: Eine Aesthetik des Kinos_ Frankfurt am Main/Basel: Stromfeld, 1998 ISBN 3-87877-740-X 187 pp.

Historical research is always in danger of being made use of for explaining and illustrating instead of testing one’s theoretical conceptions. Since Marxist historical research has certainly not been exempt from this temptation, one has to start any debate about Marxist historiography with the demand to accord empirical research the chance to shake even the cornerstones of one’s own theoretical conceptions. In a paper that has triggered off a new discussion on ‘Political Marxism’, Samuel Knafo and Benno Teschke insist on (...) such a practice. In what follows I try to position the ongoing discussion in the wider context of theoretical concepts of Marxist historiography. (shrink)

While the overview concerning debates on bourgeois revolutions is impressive, it cannot elucidate the theoretical concept of bourgeois revolutions. Neil Davidson’s own suggestion centres on the removal of hindrances to the breakthrough of capitalism, especially the pre-capitalist state. This formalistic definition is based on the assumption that revolutions occurred when the superstructure became a hindrance to the further development of productive forces. It deprives the theoretical concept of bourgeois revolutions of any concrete historical content. This paper suggests restricting the use (...) of the theoretical concept ‘bourgeois revolution’ to those revolutionary changes of domination and appropriation which occurred in European societies of the ancien régime. (shrink)

Helmets from Delphi Among the votive offerings which were found in Delphi, helmets play an essential part : There are about 90 specimen kept in the museum, approximately half of which are from one of the two sanctuaries for certain, it is likely that the other helmets are from there, as well. They were made between the 8th and the second half of the 5th century. The number of helmet-consecrations, however, already decreased in the middle of the 6th century. Only (...) few helmets give us a clue on the exhibition practices: By means of the fixing holes it is to be recognized that they were once exhibited in form of a "tropaeum". Some repaired examples clearly show that used helmets were consecrated. As it also happened in other sanctuaries, a lot of examples were damaged on purpose, others were cannibalized for their material. (shrink)

In recent decades, there has been a proliferation of alternative food networks which promote an agenda of reconnection, allegedly linking consumers and producers to the socio-ecological origins of food. Rarely, however, does the AFN literature address “origins” of food in terms of animals, as in the case of meat. This article takes a relational approach to the reconnection agenda between humans and animals by discussing how the phenomenon of animal welfare and “happy” meat are enacted by producers and consumers in (...) mundane, embodied, and nuanced ways. Utilizing hybrid conceptualizations of human–animal relations through “natureculture” and “being alongside”, we demonstrate that consumers and producers of AFNs perform natureculture entanglements daily, often considering humans and animals as part of one another and the ecological system. Nonetheless, we also point to how participants in AFNs set boundaries to distance themselves from moments of animal life and death, explaining away uncomfortable affective naturecultures through commodification logics. Drawing on qualitative data from consumers and producers of food networks in Austria, we introduce the concept of “human–animal magnetism” to illustrate that the draw for humans to care about other animal lives exists within a spectrum of attraction and disassociation, engendered through specific human–animal interactions. Ultimately, we offer a cautiously hopeful version of alterity in AFNs of meat in which more caring human–animal relations are possible. (shrink)

Michael T. Stuart (2021 and 2022) has proposed imagination as an intellectual dual‐process virtue, consisting of imagination1 (underwritten by cognitive Type 1 processing) and imagination2 (supported by Type 2 processing). This paper investigates the consequences of taking such an account seriously. It proposes that the dual‐process view of imagination allows us to incorporate recent insights from virtue epistemology, providing a fresh perspective on how imagination can be epistemically reliable. The argument centers on the distinction between General Reliability (GR) and Functional (...) System Reliability (FSR), for example in relation to Kengo Miyazono and Uko Tooming's (2023) argument for epistemic generativity. Furthermore, the paper claims that the dual‐process virtue account enables us to integrate a wide range of findings from the literature on epistemology and imagination. Moreover, it suggests a novel way to distinguish the virtues of creativity and imagination and presents a case for viewing imagination as a virtue rather than a skill. (shrink)

Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. (...) We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency. (shrink)

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)

The book series Linguistische Arbeiten (LA) publishes high-quality work in linguistics that addresses current issues in synchrony and diachrony, theoretically or empirically oriented.

In diesem Artikel wird skizziert, wie sich mithilfe der Kuhn-Sneedschen Wissenschaftstheorie literaturwissenschaftliche Theorien ihrer logischen Struktur nach analysieren und systematisch darstellen lassen. Die systematische Darstellung läßt sich von den zentralen theoretischen Prämissen bis zu den einzelnen Verwendungen einer Literaturtheorie durchführen, wobei an das mengentheoretische Verfahren Sneeds das satzanalytische Poppers angeschlossen wird. Dabei werden zwei Fragen andeutungsweise geklärt: Erstens wird das Verhältnis von Literaturtheorie und Hypothesenbildung der literaturwissenschaftlichen Einzeluntersuchungen näher bestimmt, zweitens das Abhängigkeitsverhältnis der Hypothesen, des Gegenstandsbereichs und der Methodiken von (...) der Literaturtheorie genauer untersucht. (shrink)

It is fashionable to argue that nature and society are obsolete categories. The two, we are told, can no longer be distinguished from one another; continuing loyalty to the ‘binary’ of the natural and the social blinds us to the logic of current ecological crises. This article outlines an argument for the opposite position: now more than ever – particularly in our rapidly warming world – we need to sift out the social components from the natural, if we wish to (...) understand the crises and retain the possibility of intervening in them. Tracing the current of hybridism to the writings of Bruno Latour, this article ends with a critique of the foremost proponent of a hybridism in Marxist garb: Jason W. Moore. Against his theories, it suggests that historical materialism is a form of property dualism that distinguishes between social and natural relations while considering them equally material in substance. That is also the analytical premise of ecological class hatred, the flames of which ecological Marxism seeks to fan. (shrink)

Im ersten Teil des Papiers wird der Begriff des wissenschaftlichen Fortschritts definiert. Ausgangspunkt ist die kritische Darstellung des Fortschrittshegriffs von Th. S. Kuhn. Die Ambivalenz seines Begriffs veranlaßte verschiedene Wissenschaftstheoretiker, nach genauen Kriterien für das Vorliegen von wissenschaftlichem Fortschritt zu suchen. Von diesen wird hier J.D. Sneeds Begriff der Theorienreduktion vorgestellt, der ein präzises Entscheidungskriterium liefert. Im zweiten Teil wird gezeigt, daß sich die Sneedsche Reduktionsrelation unter bestimmten Bedingungen auch auf geisteswissenschaften anwenden läßt.

In diesem Artikel wird skizziert, wie sich mithilfe der Kuhn-Sneedschen Wissenschaftstheorie literaturwissenschaftliche Theorien ihrer logischen Struktur nach analysieren und systematisch darstellen lassen. Die systematische Darstellung läßt sich von den zentralen theoretischen Prämissen bis zu den einzelnen Verwendungen einer Literaturtheorie durchführen, wobei an das mengentheoretische Verfahren Sneeds das satzanalytische Poppers angeschlossen wird. Dabei werden zwei Fragen andeutungsweise geklärt: Erstens wird das Verhältnis von Literaturtheorie und Hypothesenbildung der literaturwissenschaftlichen Einzeluntersuchungen näher bestimmt, zweitens das Abhängigkeitsverhältnis der Hypothesen, des Gegenstandsbereichs und der Methodiken von (...) der Literaturtheorie genauer untersucht. (shrink)