Euthanasia and physician-assisted suicide (PAS) by request and/or based on an advance directive are legal in The Netherlands under strict conditions, thus providing options for patients with Huntington's disease (HD) and other neurodegenerative diseases to stay in control and choose their end of life. HD is an inherited progressive disease characterised by chorea and hypokinesia, psychiatric symptoms and dementia. From a qualitative study based on interviews with 15 physicians experienced in treating HD, several ethical issues emerged. Consideration of these aspects (...) leads to a discussion about the professional role of a physician in relation to the personal autonomy of a patient. Such a discussion can raise awareness that talking about end-of-life wishes with an HD patient is part of the legal, professional and moral responsibility of the physician, and that a letter of intent on behalf of the physician can improve active participation in the process. Discussion of these issues can help to advance the debate on euthanasia and PAS in HD and other neurodegenerative diseases. (shrink)

A passing remark may at times be a clearer indication of basic conceptions or misconceptions than a well-pondered dissertation, and the present article had its inception in a passing remark of Professor Dewey's, to the effect that no man has as yet seen an atom, although it is quite possible that atoms might be observed in the future.

The medical record, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it routine in medical experience, what is written in the medical record nevertheless records decisions and actions of individuals. Viewed as an interpretive text, it can itself become the object of interpretation. This essay applies literary theory and methodology to the structure, content, and writing style(s) of an actual medical record for the purpose (...) of exploring the relationship between the forms and language of medical discourse and the daily decisions surrounding medical treatment. The medical record is shown to document not only the absence of a consistent treatment plan for the patient studied but also a breakdown in communication between different health professionals caring for that patient. The paper raises questions about the kind of education being given to house staff in this instance. The essay concludes with a consideration of how such situations might be more generally avoided. (shrink)

ABSTRACTThe recognition of emotional facial expressions is often subject to contextual influence, particularly when the face and the context convey similar emotions. We investigated whether spontaneous, incidental affective theory of mind inferences made while reading vignettes describing social situations would produce context effects on the identification of same-valenced emotions as well as differently-valenced emotions conveyed by subsequently presented faces. Crucially, we found an effect of context on reaction times in both experiments while, in line with previous work, we found evidence (...) for a context effect on accuracy only in Experiment 1. This demonstrates that affective theory of mind inferences made at the pragmatic level of a text can automatically, contextually influence the perceptual processing of emotional facial expressions in a separate task even when those emotions are of a distinctive valence. Thus, our novel findings suggest that language acts as a contex... (shrink)

This article discusses the nature of euthanasia, and the way in which redevelopment of the concept of euthanasia in some influential recent philosophical writing has led to morally less discriminating killing/letting die/not saving being misdescribed as euthanasia. Peter Singer's defence of non-voluntary ‘euthanasia’of defective infants in his influential book Practical Ethics is critically evaluated. We argue that Singer's pseudo-euthanasia arguments in Practical Ethics are unsatisfactory as approaches to determining the legitimacy of killing, and that these arguments present a total utilitarian (...) improvement policy—not a case for non-voluntary euthanasia. (shrink)

The standard medical case report often reduces patients and caregivers to complexes of medical facts and clinical decisions. Restructuring the genre itself to acknowledge the human dimensions of both patients and physicians allows questions of human values to regain their stature as integral components of the discourse.

What does a Utilitarian mean by happiness when he says that it is the good? Specifically, pleasure. But how many different kinds of experiences are included under this term? It appears that as the word was used by Bentham, and indeed by almost all other hedonists, it had so wide an extension that it included all experiences not properly termed "unhappiness." Partly, however, because of the identification of happiness with pleasure and the absence of pain, and partly because of a (...) failure to emphasize by frequent explanation the difference between the meanings of terms as used by hedonists and the same terms in common usage, there has existed at all times a disposition to assume that hedonists intended a narrower meaning than they actually did. Even in hedonistic writings there has been a tendency to make a distinction between the usages accorded "pleasure" and "happiness," the former as used more frequently to refer to pleasures of the moment, and the latter to a long continued state of felicific feeling; or a distinction is made between "pleasure" as used when referring to happiness which has an immediately obvious physiological origin and "happiness" to felicific feeling of all types. Nevertheless, the terms are not used consistently in this way, and on the whole it would be better to think of "pleasure" and "happiness" as interchangeable in the writings of Jeremy Bentham and many others. (shrink)

Every man experiences dreams and imaginations, the nature of which is admittedly subjective. It is perfectly possible for me to propose that this same lack of objectivity may characterize all experience. I may conceive that I am a god making the world for my own amusement, being real beyond the reality of this my dream. But this imagined god-head is merely the dream of an idle moment, for I cannot seriously suppose that were I to dream I would dream in (...) exactly this way. Had I the making of this world, it would be a braver, better world than it is. Braver? Better? On second thought, I am not so sure. I would want it to be a better world, but could I make it a better world? Could I spin from my imagination the grandeur and beauty of the universe of stars, the wealth and complexity of the invisibly minute, the beauties of nature, the truths of mathematics, the harmonies of music, the world of meaning everywhere? Could I? I doubt it. For I fail to understand even trivial things: I find myself failing even in unimportant projects. And if I fail in these, the least parts of my universe, could I so ably create the whole? There are, thus, two ways in which this doctrine fails to do more than amuse me for the moment. Did I create this dream, I would aim higher and achieve less. (shrink)

The objective of this study is to evaluate if use of a patient decision aid, when choosing between a repeat cesarean or a trial of labor after a cesarean, reduces medical liability exposure. The authors conclude that use of a PDA conferred liability protection when potential jurors were presented with a hypothetical malpractice claim against an obstetrician following a TOLAC.

Das allgemeine Prinzip der „Relativität der Begriffe” — vom Verfasser a. a. O. dargelegt — behauptet, dass ein und dieselbe Situation der Wirklichkeit auf verschiedene Weisen beschrieben werden kann, die sprachlich und begrifflich zwar verschieden sein mögen, doch grundsätzlich die gleichen bleiben. Die verbalen oder begrifflichen Unterschiede führen uns zu der falschen Annahme, dass den Elementen, welchen im Denken oder im sprachlichen Ausdruck weniger Bedeutung zugemessen wird, auch weniger Bedeuten in Wirklichkeit zukommen, oder dass sie weniger real sind.Die bedeutendste Anwendung (...) dieser Lehre auf die Biologie betrifft die Interpretation des „Individuellen”. Soll man das Individuum als eine Einheit verstehen, oder kommt der Begriff der Einheit einerseits den Teilen zu, wie z. B. Zellen, Molekülen und Atomen, oder andererseits höheren und synthetischen Einheiten wie z.B. Klassen, Arten, dem „élan vital”, u.s.w. ? Alle diese drei Ansichten haben etwas für sich, doch stehen auch jeder entscheidende Gegengründe gegenüber, so dass die einzig-mögliche Schlussfolgerung die Annahme der Begriffsrelativität ist. Jeder der drei Standpunkte ist nur in so weit wahr, als er etwas Positives beibringt, falsch jedoch solange er nur die beiden andern leugnet.Le principe de la relativité des concepts, ayant une application générale dans toutes: parties de la philosophie et de la science, est développé ailleurs par l'auteur. Ce principe propose qu'une situation quelconque peut être discutée dans plusieurs manières, se différant entre elles dans le choix des mots ou des concepts, tout en étant au fond indentiques. Les differences linguistiques ou conceptuelles nous mènent à l'assomption fausse que les éléments moins importants dans la pensée ou dans le langage sont moins importants dans la nature, ou même que ces éléments sont moins réels.En biologie, ce principe a une importance notable en ce qui concerne l'interprétation de l'individu. Doit-on entendre par l'individu les cellules, les molécules, les atomes, et les autres éléments qui le composent; ou bien l'individu même; ou encore doit-on oublier et l'individu et les éléments qui le composent, et baser sa philosophie sur les entités synthétiques telles que les espèces, les genres, et l'élan vital ? Chacune de ces trois opinions a des considérations en sa faveur; mais chacune d'elles se bute à des objections plus considérables encore qui l'empêchent d'être acceptée. La seule conclusion qui semble être possible est l'adoption du principe de la relativité des concepts, et l'assomption que chaque manière d'envisager l'individu est valide tant qu'elle a quelque chose de positif à dire; chaque manière est fausse quand elle nie Ja validité des autres points de vue. (shrink)

There are no new fallacies under the sun, any more than there are any new methods of reasoning. Therefore, the Fluxive Fallacy is nothing new. Yet, pointing out the Fluxive Fallacy and giving it a name has a distinct advantage in that it directs one's attention to errors which, without the advantage of a definite name and description, might pass unobserved.

The R-Being is, by definition, that entity which possesses all qualities which, expressed in English adjectives, begin with the letter R. It is of course unknown, at the commencement of our inquiry, whether any such entity exists, but it is nevertheless possible to determine the characteristics which such a being, whether existent or not, must possess.

Institutional review boards are almost universally considered to be overworked and understaffed. They also require substantial commitments of time and resources from their members. Although some surveys report average IRB memberships of 15 people or more, federal regulations require only five. We present data on IRB meetings at eight of the top 25 academic medical centers in the United States funded by the National Institutes of Health. These data indicate substantial contributions from primary reviewers and chairs during protocol discussions but (...) little from other members, which implies that it may be possible for smaller IRBs to accomplish the same tasks with no reduction in the quality of review. (shrink)

Research has shown that it requires less time to process information that is part of an objective causal relation describing states of affairs in the world (She was out of breath because she was running), than information that is part of a subjective relation (She must have been in a hurry because she was running) expressing a claim or conclusion and a supporting argument. Representing subjectivity seems to require extra cognitive operations. In Mental Spaces Theory (MST; Fauconnier, Gilles. 1994. Mental (...) spaces: Aspects of meaning construction in natural language. Cambridge: MIT Press) the difference between these two relation types can be described in terms of an extra mental space in the discourse representation of subjective relations: representing the Subject of Consciousness (SoC). In processing terms, this might imply that the processing difference is not present if this SoC has already been established in the discourse. We tested this prediction in two eye tracking experiments. The results of Experiment 1 showed that signaling the subjectivity of the relation by introducing a subject of consciousness beforehand did not diminish the processing asymmetry compared to a neutral context. However, the relative complexity of subjective relations was diminished in the context of Free Indirect Speech (No! He was absolutely sure. There was no doubt about it. She was running so she was in hurry; Experiment 2). In terms of MST and the representation of subjectivity in general, this implies that not only creating a representation of a thinking subject, but also assigning a claim to this thinking subject requires extra processing effort. (shrink)

Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have (...) genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots. (shrink)

Descartes' place in history, by L. J. Lafleur.--A central ambiguity in Descartes, by S. Rosen.--Doubt, common sense and affirmation in Descartes and Hume, by H. J. Allen.--Some remarks on logic and the cogito, by R. N. Beck.--The cogito, an ambiguous performance, by J. B. Wilbur.--The modalities of Descartes' proofs for the existence of God, by B. Magnus.--Descartes and the phenomenological problem of the embodiment of consciousness, by J. M. Edie.--The person and his body: critique of existentialist responses to Descartes, (...) by P. A. Bertocci. (shrink)

As sharing and secondary research use of biospecimens increases, IRBs and researchers face the challenge of protecting and respecting donors without comprehensive regulations addressing the human subject protection issues posed by biobanking. Variation in IRB biobanking policies about these issues has not been well documented.

New agrifood technologies are often difficult to grasp for the public, which may lead to resistance or even rejection. Insight into which technology features determine public acceptability of the technology could offer guidelines for responsible technology development. This paper systematically assesses the relative importance of specific technology features for consumer response in the agrifood domain in two consecutive studies. Prominent technology features were selected from expert judgment and literature. The effects of these features on consumer evaluation were tested in a (...) consumer study. Fictitious technologies were used to avoid any uncontrollable contextual influences that existing new technologies may evoke. Results show that technologies that were seen as more natural and newer were perceived less risky, more beneficial, and were evaluated more positively. Technologies applied to food were judged to be more beneficial, but also more risky than those applied to non-food. Technologies used in the production process were perceived to be less risky and evaluated more positively than those used in the product. Technologies owned by the market leader were perceived to be more beneficial, and evaluated more positively than those that were freely available. In a next study, effects of the technology features on consumer response were tested for existing new agrifood technologies. This study replicated the results for perceived naturalness, perceived newness, and place in the production process where the technology is applied. However, in contrast to the first study, we did not find an effect of application area and technology ownership. (shrink)

When experiencing personal distress, people usually expect their romantic partner to be supportive. However, when put in a situation to provide support, people may at times be struggling with issues of their own. This interdependent nature of dyadic coping interactions as well as potential spillover effects is mirrored in the state-of-the-art research method to behaviorally assess couple’s dyadic coping processes. This paradigm typically includes two videotaped 8-min dyadic coping conversations in which partners swap roles as sharer and support provider. Little (...) is known about how such dyadic coping interactions may feed back into one another, impacting the motivation and ability to be a responsive support provider. In three behavioral studies, we examined how sharers’ experiences may spill over to affect their own support provision in a subsequent dyadic coping interaction. We hypothesized that the extent to which sharers perceive their partner as responsive to their self-disclosure increases the quality of their own subsequent support provision, whereas sharers’ lingering negative affect reduces the quality of their own subsequent support provision. In line with our first hypothesis, perceived partner responsiveness predicted the provision of higher-quality support, though primarily as perceived by the partner. Sharers who perceived their partner to have been more responsive were somewhat more likely to subsequently engage in positive dyadic coping and were rated as more responsive by their partners. Negative dyadic coping behavior was unaffected. Evidence for our second hypothesis was mixed. While lingering negative affect did not affect positive dyadic coping behavior or perceived support, it did increase the chances of negative dyadic coping behavior. However, given the very low occurrences of negative affect and negative dyadic coping, these findings should be interpreted with caution. Taken together, these findings suggest that support interactions may feed back into one another, highlighting the complex and interdependent nature of dyadic coping. The strongest and most consistent findings concerned the spillover effect of perceived partner responsiveness on subsequent perceived support quality, speaking to the key role of believing that one’s partner is responsive to one’s needs in promoting healthy relationship functioning. (shrink)