Belgium and the Netherlands are the first countries in the world that have legalized euthanasia and assisted suicide. Since September 23, 2002, Belgian physicians can perform an act of euthanasia without at the same time performing a criminal act. In the Netherlands, the act on euthanasia went into force already on April 1, 2002. This special issue of Ethical Perspectives on ‘Euthanasia in the Low Countries’ offers a forum for critical dialogue on the different aspects of this new legal situation (...) in Belgium and the Netherlands.First, the legal situation will be introduced. In his contribution, Herman Nys makes a careful comparison of both laws. In spite of the fact that Belgium and the Netherlands are the first countries in the world that legalized euthanasia, the differences between the Belgian and Dutch law are fundamental. As Nys indicates, the scope of the Dutch law is more specified since it explicitly includes physician-assisted suicide while it remains unclear whether the Belgian act is also applicable in cases of assisted suicide. There are also fundamental differences regarding the persons regulated by the law, the health condition of the patient, the obligations of the physician with respect to the request and the health status of the patient, and the notification procedure.However, not only are there fundamental differences between Belgium and the Netherlands on the level of the law. Also the public debate and the values underlying the the debate show dissimilarities. In the Netherlands this debate took more than twenty years and the subsequent law on euthanasia reflected an existing medical practice. In Belgium, on the contrary, the parliament came to vote on the euthanasia law after only half a decade of debate. In our contribution , we identify the right to autonomy understood as ‘self-possession’ as the central value in the Belgian debate. Guy Widdershoven asserts that the moral basis of euthanasia in the Netherlands is different. He argues that the Dutch debate — and by now Dutch practice — cannot be reduced to the "principlist canon of autonomy and beneficence". Instead, the values of responsibility, deliberation and care are claimed to be central to Dutch euthanasia practice.In his contribution, Daniel Sulmasy offers an exhaustive analysis of the notion of dignity that constantly arises in the debate on euthanasia. For Christian churches and Catholic healthcare institutions, the recent legalization of euthanasia and assisted suicide is at least challenging. Jan Jans describes the way in which the main Christian churches in Belgium and the Netherlands engaged in the debate and reacted to the eventual legalization. Chris Gastmans presents the view of the Flemish Association of Catholic Healthcare Institutions.Law-making with respect to euthanasia is one thing. Bringing the law into practice is somewhat different. The question arises to what extent the new legal situation will bear upon the medical practice. Particularly, the responses of physicians are difficult to assess in advance. Physicians face the dilemma to report or not to report. They can take up their responsibility and report their practices of euthanasia, thereby exposing themselves to critical examination and possibly criminal prosecution. On the other hand, the physician can opt for safety and decide not to report his involvement in one of his patients’ euthanasia. In the latter case, the introduction of new legislation would have missed the mark. To this day, the only available data with regard to physicians’ reactions to an established legal framework wherein euthanasia is legalized come from the Netherlands. In his contribution, Albert Klijn presents the reactions of Dutch physicians to the new legal situation in their country and, particularly, the performance of their duty to report cases of euthanasia. Since the vote on the law in 2000 and the establishment of ‘regional review committees for termination of life on request and assisted suicide’ in 2001, the reports of euthanasia have declined. Klijn considers two possible explanations. On the one hand, there is insecurity about how the newly established regional review committees will evaluate physician' reports. On the other hand, the increased investment in research on palliative care and the availability of palliative sedation are held responsible for the drop in reported cases.This very interesting suggestion by Klijn needs further clarification. Therefore, the meaning of palliative care and the possibility of palliative sedation are elaborated in the contribution of Bert Broeckaert and Rien Janssens.With this special issue on ‘Euthanasia in the Low Countries’ we hope to have answered the numerous requests for further information on the Belgian and Dutch situation. Data, clarification and critical review may shed more light on the development of a practice, which some still consider as non-medical behaviour. This issue may therefore also function as a catalyst for further medical, ethical and legal debate. (shrink)

The current debate on euthanasia in the Lowlands is a perfect examplification of the predominance of the principle of respect for autonomy in present-day medical-ethical decisionmaking. The aim of this article is the exploration of the more fundamental philosophical issues concerning the current status of autonomy in medical ethics. The starting point for this exploration is an analysis of the principle of respect for autonomy. The authors argue that the view on autonomy in contemporary bioethical discussions is more related to (...) the Millian understanding of autonomy rather than to Kant’s conception of respect for autonomy. The uncompromising veneration of personal autonomy and the subsequent view on the human self as unencumbered is placed under critique because this portrayal of the human person is rather unreal especially in medical-ethical decisionmaking where the fragility of human life is at stake. Furthermore, extending the claims of autonomy risks to undermine the public sphere. The defence of the principle of autonomy is taken on by the quality-of-life ethic that values human life because of its qualities. Being capable of making autonomous decisions is one of this main qualities. By this, the quality-of-life approach runs counter to an idea that is deeply ingrained in medicine, viz. the sanctity of human life that holds both the inviolability and the equal value of human life. These two approaches can, however, be integrated in Christian ethics by adopting a view on quality-of-life judgements in which the proportionality of benefits and burdens has a pivotal function. To conclude this article, the authors argue for a non-absolutist account of autonomy based on two modes of decentrement of the human self: the fundamental passivity at the core of the human person and the intersubjectivity of the human existence. (shrink)

Belgium is the second country in the world that decriminalized euthanasia. On May 28, 2002 the Belgian Parliament approved the bill on euthanasia. With this approval, the political majority in the Belgian Parliament took a momentous decision concerning how we as a society deal with life and death.For many, euthanasia holds a promise. They take euthanasia literally as the ‘good death’. Others identify the recourse to euthanasia as a symptom of a ‘culture of death’. Given the importance of legislation on (...) euthanasia, an ethical reflection on the rationale and course of the Belgian debate on euthanasia urges itself.It is the aim of this contribution to shed light on the Belgian debate on euthanasia from an ethical perspective. The focus is thus rather on the arguments underlying the debate and their ethical assessment which implies the clarification of the values involved and the options made in the eventual legislation.To understand how and why the Belgian debate evolved as it did resulting in the final vote on the law on euthanasia, two reports of the Belgian Federal Advisory Committee on Bioethics are cardinal: the Advice n° 1 concerning the Desirability of Legislation on Euthanasia and the Advice n° 9 concerning the Termination of Life of Incompetent Patients .These two reports expressed the opinions and moral viewpoints present in Belgian society. After the presentation of the two reports and their underlying axiology we will examine what their relationship is with the eventual law on euthanasia which was the tailpiece of five years of public and political debate.In this examination, the pivotal question will be whether the legislature has succeeded in doing justice to the different moral viewpoints and the tendencies to a moral consensus that were formulated in the two reports. (shrink)

(2004). From an Exercise in Professional Etiquette to Society's Wish List? Review of American Medical Association, Code of Medical Ethics: Current Opinions with Annotations. The American Journal of Bioethics: Vol. 4, No. 2, pp. 69-70. doi: 10.1162/152651604323097907.

Because of their responsibilities for providing high-quality care, at times when they are continuously confronted with inherent professional and ethical challenges, nurses should meet high ethical standards of practice and conduct. Contrary to other countries, where codes of ethics for nurses are formulated to support those standards and to guide nurses’ professional practice, Belgian nurses do not have a formal code of ethics. Nevertheless, professional ethics is recognized as an important aspect in legal and other professional documents. The aim of (...) this article is to illustrate that codes of ethics are not the only professional documents reflecting nurses’ values, norms and responsibilities. Other documents can also set out professional nursing ethics, and as such replace codes of ethics. (shrink)

The purpose of this article is to clarify both the role of nurses in ethics meetings and the way in which ethics meetings can function as a catalyst for good nursing care. The thoughts presented are practice based; they arose from our practical experiences as nurses and ethicists with ethics meetings in health care organizations in Belgium. Our reflections are written from the perspective of the nurse in the field who is participating in (inter)professional ethical dialogue. First, the difficulties that (...) nurses experience while participating in ethics meetings are described. Then the possibilities for support of nurses in their ethical responsibility are explored. (shrink)

Health care systems have four objectives: (1) the provision of the best possible care for all; while (2) guaranteeing equal access to health care; (3) maintaining freedom of choice for health care providers and patients; and (4) controlling the costs. In an ideal world with abundant resources the realization of these objectives would pose no significant problems. However, any actual health care system will need a trade-off between the different objectives because resources are limited. In Setting Limits Fairly, Norman Daniels (...) and James Sabin investigate how limits can be set in the allocation of health care resources. (shrink)

In this article, the question is discussed if and how Healthcare Ethics Committees (HECs) should be regulated. The paper consists of two parts. First, authors from eight EC member countries describe the status quo in their respective countries, and give reasons as to the form of regulation they consider most adequate. In the second part, the country reports are analysed. It is suggested that regulation of HECs should be central and weak. Central regulation is argued to be apt to improve (...) HECs’ accountability, relevance and comparability. To facilitate biomedical citizenship and ethical reflection, regulation should at the same time be weak rather than strict. Independence of HECs to deliberate about ethical questions, and to give solicited and unsolicited advice, should be supported and only interfered with by way of exception. One exception is when circumstances become temporary adversarial to ethical deliberation in healthcare institutions. In view of European unification, steps should be taken to develop consistent policies for both Eastern and Western European countries. (shrink)

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement (...) with our commentators and respond to their critical evaluations. (shrink)

We argue that abduction does not work in isolation from other inference mechanisms and illustrate this through an inference scheme designed to evaluate multiple hypotheses. We use game theory to relate the abductive system to actions that produce new information. To enable evaluation of the implications of this approach we have implemented the procedures used to calculate the impact of new information in a computer model. Experiments with this model display a number of features of collective belief-revision leading to consensus-formation, (...) such as the influence of bias and prejudice. The scheme of inferential calculations invokes a Peircian concept of ‘belief’ as the propensity to choose a particular course of action. (shrink)

This paper surveys the many misunderstandings of Descartes Meditations in Hobbes' objections --the third set--issued in 1641. Some of the understanding can be traced to different understandings of philosophy or science, as well as differences over the importance epistemological scepticism.

The Noble Ape Simulation offers an account of the mind as something that can be observed, measured, and ultimately simulated through external effects. This version of the applied mind is not created through a single method but through layering three simulations relating to information chemistry, social constraints, and evolving narrative. As examples, additional simulation elements in Noble Ape are presented to offer the simulation methodology of Noble Ape. This chapter, rather than being a theoretical critique, is intended as a project (...) report relating to three distinct yet interoperating simulated models of the mind. These are presented both as individual simulations and also the simulations’ interactions. This produces a novel account of the applied mind. The methods used in creating such an applied mind provide an interesting insight into the possible origin of mind through pragmatic application rather than conjecture. (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 8-9, September 2012.

_Parages_ brings together four essays by Derrida on the fictions of Maurice Blanchot. Three of the essays—"Living On," "Title To Be Specified," and "The Law of Genre," are by now canonical. The fourth, "_Pa_ce Not" as well as Derrida's 1986 introduction to the French edition of the book, appear here in English for the first time. This was a breakthrough publication in the analysis of Blanchot, a notoriously difficult writer. It is safe to say Derrida contributed much to that writer's (...) reputation in both French and English, always insisting on the philosophical pertinence of Blanchot's work to any discussion of the relationship between literature and critical thought. Through patient citation, and an ample collocation and readings of Blanchot's various motifs, Derrida explores a variety of questions, including the limits of genre, the procedure of crossing out, and the evocation of a non-dialectical and non-privative negativity. The book marks a crucial stage in Derrida's itinerary and provides a context for his later writings on apophatics in such works as _On the Name_ and his response to Heidegger on death in _Aporias_. (shrink)

We understand regulatory policy problems against the backdrop of existing implementations of a regulatory framework. There are argument schemes for proposing a policy and for criticising a proposal, rooted in a shared understanding that there is an existing regulatory framework which is implemented in social structures in society, yet has problems. The problems with the existing implementations may be attributed either to those implementations or to the constraints imposed by the regulatory framework. In this paper we propose that calls for (...) change of regulatory policy, and case-based and statistical evidence produced in support of policy proposals, are based in model-based problem solving activities. This perspective suggests schemes for a good argument pro or con a policy proposal, while avoiding the problem of backing up claims and evidence on the policy level with a conjectural deep model of the policy domain. (shrink)

This book considers traditional public economy theory of public goods provision as oversimplified, because it is state centered and fiscally focused.