This article’s aim is to understand if and how the efforts to accumulate and organize clinical data transformed the regulation of pharmaceutical care. The authors analyze how the employment of databases by collectives of physicians and researchers shape both clinical and policy practice—and thereby reshape the relation between clinical work and policy. Since the late 1990s, Dutch government has supported the development of clinical databases for specific expensive medicines to gain oversight about actual medicine use. To be able to produce (...) evidence for appropriate medicine use, the collectives set regulations in clinical practice. These internal regulations provide a framework for establishing “appropriate medicine use”, steering reimbursement decisions. However, internal regulation and policy rules differ in how quickly they can change. While the employment of databases in clinical practices results in a constant adjustment of the protocols, policy makers require the databases to provide for static moments of “proven appropriate medicine use” in order to account for and define a fixed and closed formulary. Subsequently, the employment of the databases did not deliver on the promise of oversight and control due to different clinical and policy requirements. Nevertheless, the databases did stimulate appropriate medicine use and reimbursement in clinical practice. (shrink)

Jonathan Schaffer has argued that a contrastive causal ontology is beneficial in juridical contexts: lawyers and judges should treat the causal relation as a quaternary relation, not as binary one. In this paper we investigate to what extent a contrastive causal ontology is beneficial in genetics and in physics. We conclude that it is beneficial in these scientific domains. We also point out that the nature of the benefit differs in the three context that we discuss. Key words: Contrastive causation, (...) causation in genetics, causation in physics, Jonathan Schaffer. (shrink)

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In this paper we first develop a logic independent account of relevant implication. We propose a stipulative denition of what it means for a multiset of premises to relevantly L-imply a multiset of conclusions, where L is a Tarskian consequence relation: the premises relevantly imply the conclusions iff there is an abstraction of the pair such that the abstracted premises L-imply the abstracted conclusions and none of the abstracted premises or the abstracted conclusions can be omitted while still maintaining valid (...) L-consequence. Subsequently we apply this denition to the classical logic consequence relation to obtain NTR-consequence, i.e. the relevant CL-consequence relation in our sense, and develop a sequent calculus that is sound and complete with regard to relevant CL-consequence. We present a sound and complete sequent calculus for NTR. In a next step we add rules for an object language relevant implication to the sequent calculus. The object language implication reflects exactly the NTR-consequence relation. One can see the resulting logic NTR-> as a relevant logic in the traditional sense of the word. By means of a translation to the relevant logic R, we show that the presented logic NTR is very close to relevance logics in the Anderson-Belnap-Dunn-Routley-Meyer tradition. However, unlike usual relevant logics, NTR is decidable for the full language, Disjunctive Syllogism and Adjunction are valid, and neither Modus Ponens nor the Cut rule are admissible. (shrink)

RESUMO Com base na noção de currículo como uma arena de embates discursivos, este artigo tem por objetivo principal analisar de que modo a Base Nacional Comum Curricular de Língua Portuguesa e Literaturas compreende os conceitos de fruição e de leitor-fruidor. Com efeito, é nossa intenção compreender como a ideia de leitura literária é proposta por esse documento oficial curricular. Para tanto, as habilidades e conteúdos indicados pela Base Nacional Comum Curricular foram analisados a partir de uma perspectiva metodológica interpretativista (...) e sob a perspectiva dialógica de análise do discurso desenvolvida pelo Círculo de Bakhtin. ABSTRACT Based on the notion of curriculum as an arena of discursive clashes, this paper aims at verifying how the Base Nacional Comum Curricular [Common Core] for Portuguese Language and Literature understands the concepts of fruition and reader-in-fruition. Indeed, it is our intention to understand the very idea of literary reading proposed by this official curriculum document. For this purpose, the skills and contents indicated by BNCC were analyzed from an interpretive research methodology view and under the dialogic perspective for discourse analysis developed by the Bakhtin Circle. (shrink)

This article provides an overview of the scarce international literature concerning nurses’ attitudes to euthanasia. Studies show large differences with respect to the percentage of nurses who are (not) in favour of euthanasia. Characteristics such as age, religion and nursing specialty have a significant influence on a nurse’s opinion. The arguments for euthanasia have to do with quality of life, respect for autonomy and dissatisfaction with the current situation. Arguments against euthanasia are the right to a good death, belief in (...) the possibilities offered by palliative care, religious objections and the fear of abuse. Nurses mention the need for more palliative care training, their difficulties in taking a specific position, and their desire to express their ideas about euthanasia. There is a need to include nurses’ voices in the end-of-life discourse because they offer a contextual understanding of euthanasia and requests to die, which is borne out of real experience with people facing death. (shrink)

At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...) interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach. (shrink)

The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country—after the Netherlands—to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care (...) process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. “Intense” is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one’s power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed. (shrink)

Blood service organizations employ various ways to ensure transfusion blood safety, including the testing of all donations for transfusion-transmissible infections (TTI) and the exclusion of donors who are at increased risk of a recent infection. As some TTIs are more common among men who have sex with men (MSM), many jurisdictions (temporarily) defer the donation of blood by sexually active MSM. This boils down to a categorical exclusion of a large group solely on the basis of their sexual orientation, which (...) is seen as unduly discriminatory and stigmatizing. Blood service organizations in the U.K. and the Netherlands have recently changed their deferral policies for MSM. The problem of the MSM deferral involves a conflict between fundamental rights: the right of MSM to equal treatment and the right to health of the recipients of blood and blood products. We distinguish and discuss three broad alternative options to the current categorical deferral of MSM donations: (1) completely abandoning donor selection on the basis of sexual behavior, (2) individual risk assessment of the sexual activities of each potential donor, and (3) individual risk assessment of the sexual activities of MSM only. The new U.K. policy falls within the second category, and the new Dutch policy is in the third category. We argue that each approach comes with moral costs but that the most reasonable option is different from the policies of both the U.K. and the Netherlands. (shrink)

Background: Although nurses worldwide are confronted with euthanasia requests from patients, the views of palliative care nurses on their involvement in euthanasia remain unclear.Objectives: In depth exploration of the views of palliative care nurses on their involvement in the entire care process surrounding euthanasia.Design: A qualitative Grounded Theory strategy was used.Setting and participants: In anticipation of new Belgian legislation on euthanasia, we conducted semistructured interviews with 12 nurses working in a palliative care setting in the province of Vlaams-Brabant.Results: Palliative care (...) nurses believed unanimously that they have an important role in the process of caring for a patient who requests euthanasia, a role that is not limited to assisting the physician when he is administering life terminating drugs. Nurses’ involvement starts when the patient requests euthanasia and ends with supporting the patient’s relatives and healthcare colleagues after the potential life terminating act. Nurses stressed the importance of having an open mind and of using palliative techniques, also offering a contextual understanding of the patient’s request in the decision making process. Concerning the actual act of performing euthanasia, palliative care nurses saw their role primarily as assisting the patient, the patient’s family, and the physician by being present, even if they could not reconcile themselves with actually performing euthanasia.Conclusions: Based on their professional nursing expertise and unique relationship with the patient, nurses participating as full members of the interdisciplinary expert team are in a key position to provide valuable care to patients requesting euthanasia. (shrink)

The issue of the introduction of viennese "scientific philosophy" in France appears to be resolved. However, the rediscovery of the positivist physicist Marcel Boil (1886-1971), who was the first - well before Louis Rougier - to draw the French public 's attention to the works of Schlick, Frank. and Carnap, obliges us to rethink the passage from traditional positivism to neo-positivism during the l920s and l930s. The French reception of the Vienna circ le can be dated earlier than accepted (...) and is more profound than usualy assumed. (shrink)