This contribution consists of two parts. The first part identifies Augustine’s qualities as a mystagogue on the basis of the only poem he wrote that has been handed down: the Psalm against the Donatists. It shows that little is to be gained by studying Augustine as both poeta and mystagogue. Not his poetry itself, but his commentary on poetry as such reveals the transformative power that he ascribes to this genre. For this reason the second part examines Augustine’s Enarrationes in (...) psalmos. In this work, he makes explicit the transformative power that is contained in the 150 Psalms, which are both poetry and prayer. This part asks the question how Augustine articulates or heightens fear when the Psalmist in his dialogue with God ‘compels’ him to do this, as it were, by expressing fear of enemies or of the Last Judgement. He shows that he acknowledges that fear alone can lead to an unbalanced, and even a bad relationship with God. Fear should result in introspection and should be a guarantee against pride. That Augustine furthermore is not content to heighten the fear of God alone, but wants it to coincide with desire, joy, and hope, shows that he wishes to prevent any imbalance in the human who seeks a relationship with God. For Augustine, fear is necessary, but it is ‘only’ an ancilla of hope, joy, love, and desire. But as such, timor is indispensible. Fear causes attentiveness and carefulness: virtues that love presuppose and that also correlate with it. Nevertheless, love does not stand at the service of fear; for Augustine, it is the reverse. (shrink)

The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 per cent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept of (...) futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable. (shrink)

Background: Caring for terminally ill patients is a meaningful task, however the patient’s suffering can be a considerable burden and cause of frustration.Objectives: The aim of this study is to describe the experiences of general practitioners in The Netherlands in dealing with a request for euthanasia from a terminally ill patient.Methods: The data, collected through in-depth interviews, were analysed according to the constant comparative method.Results: Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described (...) as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without “intentionally hastening a patient’s death on his request”. The other GPs explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient’s request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient’s suffering through euthanasia and their personal values.Conclusion: Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient’s suffering and to promote a peaceful death. (shrink)

Hereditary structural completeness is established for a range of substructural logics, mainly without the weakening rule, including fragments of various relevant or many-valued logics. Also, structural completeness is disproved for a range of systems, settling some previously open questions.

The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits ‘justify access to this procedure for families who choose it,’ claiming that whenever and for whatever reason (...) it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given. (shrink)

Slow euthanasia or a good palliative intervention?There are many ways in which doctors influence the circumstances and/or the timing of a patient’s death. Some of these are accepted as normal medical practice—for instance, when a disproportional treatment is forgone, others are considered tolerable only under strict conditions or even intolerable, such as non-voluntary active euthanasia. A relatively new phenomenon in the ethical discussion on end-of-life decisions is terminal sedation. Terminal sedation is used in patients with terminal illnesses where normal medical (...) treatments cannot relieve severe symptoms such as pain and agitation, and no option is left but to take away the perception of these symptoms. Often, the decision to start terminal sedation is accompanied by the decision to forgo the provision of artificial nutrition and hydration in these patients. In The Netherlands, terminal sedation was estimated to be applied in 4–10% of all deaths in 2001.1 The combination of these two decisions have made the moral status of terminal sedation the subject of fierce ethical debates. Is it slow euthanasia2,3 or is it a good palliative intervention that should be sharply distinguished from euthanasia?4,5 One of the characteristics of this debate is that it is a very confused one: people disagree about the meaning of the term, the appropriateness of it and, of course, about the conditions under which it would be morally justified. As a matter of fact, these three discussions are deeply connected: as is often the case, a discussion about terms is a discussion about norms in disguise.The first observation to be made is that many seemingly descriptive definitions of terminal sedation contain normative claims. Examples of this are definitions of terminal sedation in which only …. (shrink)

We introduce the horizontal and vertical topologies on the product of topological spaces, and study their relationship with the standard product topology. We show that the modal logic of products of topological spaces with horizontal and vertical topologies is the fusion ${\bf S4}\oplus {\bf S4}$ . We axiomatize the modal logic of products of spaces with horizontal, vertical, and standard product topologies. We prove that both of these logics are complete for the product of rational numbers ${\Bbb Q}\times {\Bbb Q}$ (...) with the appropriate topologies. (shrink)

ABSTRACT:Although a research focus on the increasing involvement of corporations in shaping and maintaining the global rules of the game points out promising avenues for future research, it simultaneously makes clear how little currently established, mostly managerial conceptual frameworks have to offer in making sense of these developments. It is argued that we need to expand the rather restricted perspectives that these frameworks provide, in order to explore new conceptual foundations that will not only enable us to travel the confines (...) of the different disciplines involved with the study of the changing role of business in shaping the global rules of the game, but that can also systematically connect normative and positive research questions at the conceptual level. Three directions for this search for new foundations are briefly explored. (shrink)

In April 2002 a new law regarding euthanasia came into effect in the Netherlands. This law holds that euthanasia remains a criminal offence unless it is performed by a physician who acts according to six specified rules of due care and reports the case to a review committee. The six rules of due care are similar to those of the previous regulation and are largely based on jurisprudence. Completely new, however, is the article concerning a competent patient who has written (...) an advance directive requesting euthanasia under certain circumstances. The law stipulates that a physician may act according to that written request, as long as he or she fulfils all other rules of due care. The author defends the view that these requests are neither feasible nor ethically justifiable, and presents both moral and practical arguments for this, claiming that for consistency reasons one cannot act on the basis of a written statement and fulfil the other rules of due care at the same time. The author also examines a difficult case of a demented, severely depressed woman who had written a living will requesting euthanasia before she became demented. (shrink)

The term "stakeholder engagement" has gained increasing prominence over the last few years. This prominence is fueled by a range of issues such as an increased dissatisfaction with business's focus on stockholder/shareholder interests and the demands for greater transparency from business following major business scandals. A perceived response to this issue in South Africa has been the inclusion of guidelines on stakeholder engagement in the King II Report on Corporate Governance. Despite this growing interest, there has not been clarity on (...) how companies engage with their stakeholders and specifically with how they identify and prioritize their stakeholders. The study sought to establish the reporting practices of South African business in relation to stakeholder identification and prioritization through a content analysis of their annual reports. The findings are discussed and recommendations on the two aspects of stakeholder engagement presented. (shrink)

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses’ attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient and considered it generally better (...) not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units. (shrink)

Aim: To examine how physicians’ life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large (...) life-stance groups in each country.Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient’s death , physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics and Protestants reported ever having made such a decision.Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. (shrink)

Recent accounts on the global workspace theory suggest that consciousness involves transient formations of functional connections in thalamo-cortico-cortical networks. The level of connectivity in these networks is argued to determine the state of consciousness. Emotions are suggested to play a role in shaping consciousness, but their involvement in the global workspace theory remains elusive. In the present study, the role of emotion in the neural workspace theory of consciousness was scrutinized by investigating, whether unconscious and conscious display of emotional compared (...) to neutral facial expressions would differentially modulate EEG coherence. EEG coherence was measured by means of computing an average EEG coherence value between the frontal, parietal, and midline scalp sites. Objective awareness checks evidenced that conscious identification of the masked facial expressions was precluded. Analyses revealed reductions in EEG coherence in the lower frequency range for the masked as compared to unmasked neutral facial expressions. Crucially, a decline in EEG coherence was not observed for the emotional facial expressions. In other words, the level of EEG coherence did apparently vary as a function of awareness, but not when emotion was involved. The current finding suggests that EEG coherence is modulated by unconscious emotional processes, which extends common views on the global workspace architecture of consciousness. (shrink)

The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians and policy makers to participate in an interview about their practices and opinions concerning factors playing a role in decision making for patients in different age groups. (...) Both physicians and policy makers recognised allocation decisions as part of their reality. One of the strong general opinions of both physicians and policy makers was the rejection of age discrimination. Making allocation decisions as such seemed to be regarded as a foreign entity to the practice of medicine. In spite of the reluctance to make allocation decisions, physicians sometimes do. This would seem to be only acceptable if it is justified in terms of the best interests of the patient from whom treatment is withheld. (shrink)

Worries about safety of approved drugs have pushed post registration research to become the fastest growing drug research phase. Until recently, phase IV studies were mainly conducted for marketing purposes and run much like a phase III trial—at institutions with experienced investigators and a list of inclusion and exclusion criteria. Innovative phase IV studies involve ordinary physicians in research naïve communities. This brings ethical issues familiar to medical research into clinical practice. As a consequence, individual physicians are challenged to protect (...) scientific integrity and to secure the ethical conduct of research. Several ethical issues need to be addressed in the process of developing a scientifically sound and ethically high principled practice of phase IV research.PHASE IVEssential to phase IV research is the focus on how drugs work in the real world. The research goal may be to explore a specific pharmacological effect, to establish the incidence of adverse reactions, or to determine the effects of long-term administration of a drug. They may also be designed to establish a new clinical indication for a drug.1 Subjects may or may not be randomised, and the studies typically involve large numbers of patient-subjects and physicians.Doubts concerning the scientific rigor and clinical value have put postmarketing research in a poor light. However, high quality phase IV research is badly needed to further pharmaceutical science. First, because it can provide reliable data on the effectiveness, safety and optimal use of a drug in treated populations.2 3 In pre-registration clinical trials , a pharmaceutical product is studied under unrealistic circumstances. Under-representation of women and elderly are common and the concomitant use of medicines is usually extremely restrictive in these trials.4 Second, phase IV can provide much needed data for evidence-based …. (shrink)

Isolated habitats, the consequence of the fragmentation process, are the object of external disturbance. This divides the patch area into two zones: interior and edge. The interior-to-edge ratio quantifies the potential disturbance impact. A method is presented to calculate a reference value for the interior-to-edge ratio, based upon the minimum edge for a given interior. The method is based on pixel geometry features and mathematical morphology. A corrected interior-to-edge ratio is defined using the reference value. The method is illustrated for (...) woodlot fragments in the Belgian Kempen region. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 61.3 (2000) 381-395 [Access article in PDF] Minds, Forms, and Spirits: The Nature of Cartesian Disenchantment Han van Ruler What is Descartes's contribution to Enlightenment? Undoubtedly, Cartesian philosophy added to the conflict between philosophical and theological views which divided intellectual life in the Dutch Republic towards the end of its "Golden Age." 1 Although not everyone was as explicit as Lodewijk Meyer, who (...) said that his theological doubts were inspired by Descartes's philosophical method, Cartesianism along with Copernicanism, Socinianism, and Cocceianism played an important part in the growing skepticism towards the authority of Scripture. 2 Apart from Descartes's general method, however, specific Cartesian ideas encouraged a new view towards nature and towards God's role in governing it. In physics and physiology the new philosophy replaced the image of mind working on matter with the image of a self sufficient mechanism. This new causal metaphor led to a typically Cartesian form of "disenchantment." In this article I argue that on account of their approval of a Cartesian theory of causality, even authors with sincere religious motives came close to accepting radical and nearly Spinozistic ideas. I start with disenchantment in a very literal sense: Balthasar Bekker's denial of the activities of devils, angels, and other spirits. A comparison of Bekker's arguments with those of another Cartesian, Arnold Geulincx will, I hope, bring out the nature and importance of what I shall present as [End Page 381] Descartes's "mechanical reduction" in physics. Finally, I argue that the Cartesian separation of mind and body gave rise to a form of disenchantment that reached far beyond contemporary debates. Devils, Ghosts, and God's Omnipotence Balthasar Bekker's classic book The World Bewitched (1691-93) does not so much deal with the practice of sorcery as with its theory. Bekker offers a wide range of theological and philosophical arguments in order to combat the idea that ghosts, devils, and angels influence natural or historical events. In particular Bekker draws some important conclusions from the philosophy of Descartes. Yet it is immediately clear to the reader that the motives for his critique are religious rather than philosophical. 3 The World Bewitched is not written as a scientific assault on superstition. Bekker, at the time serving as a Calvinist minister in Amsterdam, presents his work as a new and perhaps final phase in the perfection of Christianity. For two centuries it had been a goal of the Protestant Reformation to accentuate God's majesty and to establish the idea of His absolute power over creation. Bekker's World again expresses this idea. His denial that ghosts and devils are active in the world is a logical consequence of the belief that there is no room for demigods in nature. Bekker thus adds a final touch to the project of the Reformation. The World Bewitched will testify to the fact "that I return as much of the honor of His Power and Wisdom to the Almighty, as they took from Him who gave it to the Devil. I ban [the Devil] from the World and I bind him in Hell." 4 Removing devils and spirits from nature, Bekker aims to distinguish superstition from true faith. The battle against superstitious beliefs had formed a characteristic element of Protestant tactics. Dutch Calvinists, for instance, took offense at the continuing practices of blessings and incantations. 5 Bekker wanted to go even further. The Protestantization of Christian dogma could only be completed by making everything in nature's course depend on God's unique power and providence. 6 "Science" in our sense of the word was a subsidiary matter. 7 Still, Bekker saw the new scientific theories of his day as useful allies. In particular it was the new philosophy of Descartes that attracted him. Following Descartes, Bekker reasons "that I think, that I will, [End Page 382] [and] that I understand something," without any part of my body being involved in this type of consciousness. Mind and body in fact have nothing in common: My... (shrink)

In this paper the authors give a survey of biological phenomena , for which the term ‘differentiation’, used in the widest sense, has a meaningful application. The last chapter deals with some general aspects of differentiation and connected phenomena, such as polarity, symmetry, loss of potencies, dedifferentiation, redifferentiation, adifferentiation, regulation and integration.To prevent this article becoming too voluminous, the authors had to refrain from extending the treatment of differentiation to non-living matter and to human society.