This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. (...) Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. (shrink)
If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)
BackgroundIn the Canadian Alliance for Healthy Hearts and Minds cohort, participants underwent magnetic resonance imaging of the brain, heart, and abdomen, that generated incidental findings. The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants were recruited with (...) a follow-up questionnaire administered to 909 participants at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% of participants, with the highest proportions found in the brain and abdomen. The majority of participants informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)
To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the (...) guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (shrink)
It is commonly supposed that the philosophy of education is not a reputable area of concern for a philosopher. I have never heard a coherent, sustained and successful case made for this view. Only vague remarks about ‘autonomy’ and narrowly protectionist views of philosophy are ventured. So I shall not discuss the matter further. I shall simply be content to side with Plato, Aristotle, Comenius, Locke, Rousseau, Kant, Mill and Dewey, who thought that educational issues fell within the province of (...) philosophy. Kant was so concerned with education that he interrupted his work on the Critique of Pure Reason in order to support Basedow's experimental school, the Philanthropin, and the educational reforms which it intended to institute. Kant says ‘… the greatest and most difficult problem to which man can devote himself is the problem of education.’ But if those who hold that the philosophy of education is unimportant, or even disreputable, have come to that view after examining a good deal of what is currently being said in this field, then their adverse reaction is not hard to understand, because a good deal of contemporary work here is clearly inadequate. I hope to show that the contemporary perspective is too narrow, and to advocate a return to a more traditional view of the philosophy of education in the hope that the subject may once again be given the importance which was formerly attributed to it. (shrink)
It is a pleasure to read Hume, and to watch him explore recalcitrant problems with agility of mind and grace of style. Ironically these twin abilities have worked against each other from the beginning, in the first place because in the matter of writing Hume was an innovator — nobody before him had so successfully albeit unwittingly adapted French syntax to the writing of English-and-Scottish - and in the second place because on the grace of his style subtleties of thought (...) flow past his readers, who then accuse him of obscurity. So abstruse were his writings to his contemporaries that he failed to achieve the literary recognition for which he craved; and even today, long after the elegance of his style has been received, it is said by Passmore that Hume in contrast to Berkeley ‘was a philosophical puppy-dog, picking up and worrying one problem after another, always leaving his teeth-marks in it, but casting it aside when it threatened to become wearisome.’ Similarly Selby-Bigge says in his introduction to the Enquiries : His pages, especially those of the Treatise, are so full of matter, he says so many things in so many different ways and different connexions, and with so much indifference to what he has said before, that it is very hard to say positively that he taught, or did not teach, this or that particular doctrine. He applies the same principles to such a great variety of subjects that it is not surprising that many verbal, and some real inconsistencies can be found in his statements. He is ambitious rather than shy of saying the same thing in different ways, and at the same time he is often slovenly and indifferent about his words and formulae. This makes it easy to find all philosophies in Hume, or, by setting up one statement against another, none at all. (shrink)
A considerable part of mystical literature deals with, or reports on, experiences that are of a cognitive and not merely of an emotive nature. Information is alleged to have been received not only from higher spheres but also about these higher spheres. Detailed, and at times highly complex, theories are put forward regarding the nature and evolution of the cosmos, the essence of man and his place and function in the scheme of things. The writings of many mystics reveal mysteries (...) that have been infused from above, or apprehended ‘from below’ by the development and use of special spiritual or mental organs. What all these higher insights have in common in spite of their great diversity, is their discursive, objective and detailed, elaborate character. Mysticism of this type is a kind of supernal science. It is distinct from ordinary science as regards its origin and its emotional charge, but it is similar to science in terms of its formal structure. The Jewish mysticism known as Kabbalah is, I think, an instructive example of this discursive tendency, for the literary output of the kabbalists very largely substitutes a theosophical dialectic for the traditional legal dialectic of the Talmudic rabbis. In the case of the kabbalists this tendency was indebted to the medieval identification of mysticism and prophecy: like prophecy, every illumination by the Holy Spirit was supposed to be a matter of ‘clear and distinct’ contents. But, of course, not every form of cognitive mysticism is related to doctrines of prophecy. Cognitive mysticism can be found everywhere, in the revelation of gnostic mysteries as well as in the quest of modern ‘spiritual’ sciences, such as theosophy and anthroposophy, for hidden and occult truths. (shrink)
Routledge is now re-issuing this prestigious series of 204 volumes originally published between 1910 and 1965. The titles include works by key figures such asC.G. Jung, Sigmund Freud, Jean Piaget, Otto Rank, James Hillman, Erich Fromm, Karen Horney and Susan Isaacs. Each volume is available on its own, as part of a themed mini-set, or as part of a specially-priced 204-volume set. A brochure listing each title in the "International Library of Psychology" series is available upon request.
R. J. Hankinson traces the history of ancient Greek thinking about causation and explanation, from its earliest beginnings through more than a thousand years to the middle of the first millennium of the Christian era. He examines ways in which the Ancient Greeks dealt with questions about how and why things happen as and when they do, about the basic constitution and structure of things, about function and purpose, laws of nature, chance, coincidence, and responsibility.
We provide a justification for political liberalism’s Reciprocity Principle, which states that political decisions must be justified exclusively on the basis of considerations that all reasonable citizens can reasonably be expected to accept. The standard argument for the Reciprocity Principle grounds it in a requirement of respect for persons. We argue for a different, but compatible, justification: the Reciprocity Principle is justified because it makes possible a desirable kind of political community. The general endorsement of the Reciprocity Principle, we will (...) argue, helps realize joint political rule and relationships of civic friendship. The main obstacle to the realization of these values is the presence of reasonable disagreement about religious, moral, and philosophical issues characteristic of liberal societies. We show the Reciprocity Principle helps to overcome this obstacle. (shrink)
Political liberals ask citizens not to appeal to certain considerations, including religious and philosophical convictions, in political deliberation. We argue that political liberals must include a demanding requirement of intellectual modesty in their ideal of citizenship in order to motivate this deliberative restraint. The requirement calls on each citizen to believe that the best reasoners disagree about the considerations that she is barred from appealing to. Along the way, we clarify how requirements of intellectual modesty relate to moral reasons for (...) deliberative restraint. And we argue against attempts to weaken our requirement of intellectual modesty by emphasizing those moral reasons. (shrink)
This is an extremely well-edited collection of articles dealing with Austin. A number of articles help to present general biographical information and to provide an overview of the man and his philosophic style. Three sections of this anthology are divided so as to include papers that deal with issues raised in Austin's Philosophical Papers, Sense and Sensibilia, and How to Do Thing with Words. Papers are included by those who are sympathetic and admire Austin's work as well as those who (...) have been very critical of his work. Altogether this symposium includes a judicious selection of some of the best articles dealing with Austin. There are papers by Warnock, Urmson, Hampshire, Pears, Cavell, Quine, Chisholm, Ayer, Searle, etc. There is a bibliography of Austin's writings as well as writings about Austin.--R. J. B. (shrink)
Abstract In this article, which is the first of two to examine the ideas of R. S. Peters on moral education, consideration is given to his justificatory arguments found in Ethics and Education. Here he employs presupposition arguments to show to what anyone engaging in moral discourse is committed. The result is a group of procedural principles which are recommended to be employed in moral education. This article is an attempt to examine the presupposition arguments Peters employs, to comment on (...) the procedural principles he believes are presupposed, and to consider the strength of the presupposition argument. My conclusion is that Peters's arguments fail to establish the conclusion he arrives at, and that any gains from the form of argument he uses are hollow. (shrink)