Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients (...) and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures. -/- . (shrink)

Vakfilosofische opstellen over de hedendaagse vraagstukken binnen de ethiek.

In this article, the authors present several topics related to the nascent development of a merit-based hiring system in North Macedonia. This paper employs a normative approach. We advocate for a merit-based hiring system, similar to the American model. First, we explore the pressure exerted by the European Commission to adopt a merit-based system at all levels of government as a condition for entry into the European Union. Second, we delve into the patronage system in North Macedonia. Third, we provide (...) a short history of patronage in the United States and the difficulty that nation had in curbing its entrenched patronage system. Fourth, we discuss the advantages of a merit-based hiring system, namely the creation of good governance, the improvement of employee morale, the development of more public confidence in government, the reduction of the influence of ethnic politics and the furtherance of the rule of law. Finally, we present an example drawn from the American federal government about the basic procedures of a merit-based hiring process. (shrink)

Een van de kenmerken van de wijsgerige theologie zoals die in de Utrechtse school wordt beoefend, is de nadruk op een persoonlijk Godsbegrip. Daarom wordt voor de bijdragen gebundeld in Hoe is uw Naam? Opstellen over de eigenschappen van God geclaimd ‘dat over de eigenschappen van God niet op abstracte wijze wordt gespeculeerd, maar dat zij afgelezen worden uit het persoonlijk handelen van God jegens mens en wereld’. In het artikel ‘Conceptuele analyse en christelijk geloof. Over de wijsgerige theologie in (...) Utrecht’ heb ik geprobeerd aan te tonen dat deze claim slechts in beperkte mate wordt waar gemaakt. (shrink)

Cartwright and Munro argued that extrapolation of findings from randomized controlled trials to other settings can be difficult because information about the underlying causal structure and subgroups is often not available. They advocated the use of ‘capacities’ – that is fixed causal contributions – in predicting effects of interventions. In psychiatry, it is often not possible to determine what the fixed causal contributions are and one can only establish ‘approximate capacities’. However, using ‘approximate capacities’ does imply a different way of (...) evaluating health services, especially combined interventions. In health service research, if different studies, randomized controlled trials or other designs, have given different outcomes, the best way to investigate the effectiveness of a particular way of service organization is not to conduct more randomized controlled trials. It is preferable to study the effects of certain elements of the complex intervention, which have been tested before in other settings, that is investigating ‘approximate capacities’. One should check whether the separate elements do form a part of the complex intervention in practice and whether they have the same effect as in other studies and if not, why not. This enhances knowledge about the underlying causal structure and increases the possibility of extrapolation of the findings. (shrink)

This paper addresses the concept of moral luck. Moral luck is discussed in the context of medical error, especially an error of omission that occurs frequently, but only rarely has adverse consequences. As an example, a failure to compare the label on a syringe with the drug chart results in the wrong medication being administered and the patient dies. However, this error may have previously occurred many times with no tragic consequences. Discussions on moral luck can highlight conflicting intuitions. Should (...) perpetrators receive a harsher punishment because of an adverse outcome, or should they be dealt with in the same way as colleagues who have acted similarly, but with no adverse effects? An additional element to the discussion, specifically with medical errors, is that according to the evidence currently available, punishing individual practitioners does not seem to be effective in preventing future errors. The following discussion, using relevant philosophical and empirical evidence, posits a possible solution for the moral luck conundrum in the context of medical error: namely, making a distinction between the duty to make amends and assigning blame. Blame should be assigned on the basis of actual behavior, while the duty to make amends is dependent on the outcome. (shrink)

This paper addresses two issues: the controversy over pragmatism in environmental philosophy, and the habitual exclusion of William James's work from serious examination. Addressing critiques of pragmatic naturalism from Max Horkheimer, Eugene Hargrove and Holmes Rolston, I argue that their criticisms misfire, primarily due to skewed perception derived from mis-interpretative projections of views to which pragmatism is not committed. I conclude that the critics' major concerns are largely groundless, but that greater emphasis on pragmatism's experiential aspect would clarify this.

We have given a certain interpretation of Spinoza on the basis of an analysis of his methodology. In this study the present writer tried to restrict himself totally to this subject: viz. to give an exposition of Spinoza's methodology in its totality. He tried to give a modern approach in that he was primarily not concerned with the historical roots of Spinoza's ideas, but with the way in which these ideas function in his philosophy...... Zie: Introduction.

This is a response to the response by Robyn Bluhm to my paper, and I am again arguing for a limited role of capacities in psychiatry, given the current scientific uncertainties.

(1973). Suppose the Moment in Time had a Decisive Significance…A Critical Logical Analysis of Kierkegaard's Argumentation in the First Chapter of the ‘Philosophical Fragments’. Bijdragen: Vol. 34, No. 4, pp. 383-397.