At the beginning of the twentieth century the high mortality rates of both mothers and babies during childbirth became a predominant concern in Britain and its empire, provoking outcries from medical and nursing professionals as well as politicians and the wider public. Infant mortality became the new marker of the vitality of the nation and a widely used indicator of general standards of health. Efforts to improve maternal and infant welfare were part of a broader shift in Britain towards public (...) health as a government responsibility. Measures taken to reduce mortality rates emphasized state-run initiatives in maternal education and antenatal care, the medicalization of childbirth, and scientific infant feeding and childrearing practices. This shift in health care policies resulted in profound changes to the experience of childbirth and to the role of the state in the area of social welfare... (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians (...) to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues. (shrink)

The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.

Although narcissists often emerge as leaders, the relationship between leader narcissism and follower performance is ambiguous and often even found to be negative. For women, narcissism seems especially likely to lead to negative evaluations. Since narcissists have the tendency to be impulsive and change their minds on a whim, they may come across as inconsistent. We propose “inconsistent leader behavior” as a new mechanism in the relationship between leader narcissism and follower performance and argue that leader gender plays an important (...) role in whether narcissistic leaders are perceived as inconsistent. Specifically, we expect leader narcissism to have a negative relationship with follower performance through perceived inconsistent leader behavior, especially for female leaders. Thus, we examine leader gender as a personal factor moderating the relationship between narcissism and perceived inconsistent behavior. Also, as perceived inconsistency is likely less problematic when a good relationship exists, we examine leader–member exchange as a contextual condition moderating the relationship between leader behavior and follower performance. We test our moderated mediation model in a multi-source study with 165 unique leader–follower dyads. As expected, leader narcissism was positively related to perceived inconsistent leader behavior, and this relationship was stronger for female leaders. Inconsistent leader behavior was negatively related to follower performance, but only when LMX was low. Our research highlights that perceived behavioral inconsistency can be problematic and—for female leaders—provides an explanation of the negative relation of leader narcissism with follower performance and of the inconsistencies in evaluations of narcissistic leaders’ effectiveness. (shrink)

_Germany and the French Wars of Religion, 1560-1572_ explores how the first decade of the religious wars in France was interpreted by German Protestants and why they felt compelled to intervene.

Both the concept of a Darwinian tree of life (TOL) and the possibility of its accurate reconstruction have been much criticized. Criticisms mostly revolve around the extensive occurrence of lateral gene transfer (LGT), instances of uptake of complete organisms to become organelles (with the associated subsequent gene transfer to the nucleus), as well as the implications of more subtle aspects of the biological species concept. Here we argue that none of these criticisms are sufficient to abandon the valuable TOL concept (...) and the biological realities it captures. Especially important is the need to conceptually distinguish between organismal trees and gene trees, which necessitates incorporating insights of widely occurring LGT into modern evolutionary theory. We demonstrate that all criticisms, while based on important new findings, do not invalidate the TOL. After considering the implications of these new insights, we find that the contours of evolution are best represented by a TOL. (shrink)

The empirical-transcendental debate in philosophy of technology, as debates go, took a turn toward the counterposing of the two perspectives, ‘empirical’-pragmatic-pragmatist versus ‘transcendental’-critical. Postphenomenology aligns itself with the former standpoint, and it is in this spirit that commentators have criticized it for its too-instrumentalist stance and lack of overarching, i.e., transcendental orientation. But the positions may have become too starkly delineated in order for the debate to reach any breakthrough: a seemingly unbridgeable gap yawns between the stances of ‘technology with (...) a small “t”’ and ‘Technology with a capital “T.”' Is there any way to reorient the debate? In this paper I propose to do so by considering whether there would be some way of arriving from one end of the spectrum to the other—crossing the gap. Exploring the purported wasteland in between “technology” and “Technology” by way of object-oriented ontology (OOO)—Harman, Morton—we can find it actually filled with countless gaps, adhering to every thing. Following the radical insights of OOO, we’d have to attest to a ‘thing-transcendentality.’ The ‘gap,’ then, that seemed so threatening and all-encompassing, becomes smeared out, levelled down to a multiplicity of perspectives. And this casts the debate, with its purported strict tension between ‘empirical’ and ‘transcendental’ positions, in fresh terms, opening up new ways for studying how the two interrelate. (shrink)

We discuss games of both perfect and imperfect information at two levels of structural detail: players’ local actions, and their global powers for determining outcomes of the game. We propose matching logical languages for both. In particular, at the ‘action level’, imperfect information games naturally model a combined ‘dynamic-epistemic language’ – and we find correspondences between special axioms and particular modes of playing games with their information dynamics. At the ‘outcome level’, we present suitable notions of game equivalence, plus some (...) simple representation results. (shrink)

Logic is not just about single-agent notions like reasoning, or zero-agent notions like truth, but also about communication between two or more people. What we tell and ask each other can be just as 'logical' as what we infer in Olympic solitude. We show how such interactive phenomena can be studied systematically by merging epistemic and dynamic logic.

Cimpian et al. observed that we accept generic statements of the form ‘Gs are f’ on relatively weak evidence, but that if we are unfamiliar with group G and we learn a generic statement about it, we still treat it inferentially in a much stronger way: all Gs are f. This paper makes use of notions like ‘representativeness’, ‘contingency’ and ‘relative difference’ from psychology to provide a uniform semantics of generics that explains why people accept generics based on weak evidence. (...) The spirit of the approach has much in common with Leslie’s cognition-based ideas about generics, but the semantics will be grounded on a strengthening of Cohen’s relative readings of generic sentences. In contrast to Leslie and Cohen, we propose a uniform semantic analysis of generics. The basic intuition is that a generic of the form ‘Gs are f’ is true because f is typical for G, which means that f is valuably associated with G. We will make use of Kahneman and Tversky’s Heuristics and Biases approach, according to which people tend to confuse questions about probability with questions about representativeness, to explain pragmatically why people treat many generic statements inferentially in a much stronger way. (shrink)

Keuze van artikelen uit het werk van de Vlaamse filosoof over wetenschap, milieu, en medische en biologische ethiek.

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The (...) aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and (...) several strategies for achieving these goals using existing “legal hooks” that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR. (shrink)

This book discusses the relationship between the philosophy of science and philosophy of engineering, and demonstrates how philosophers of engineering design as well as design researchers can benefit from the conceptual toolkit that the philosophy of science has to offer. In this regard, it employs conceptual tools from the philosophical literature on scientific explanation to address key issues in engineering design and philosophy of engineering design. Specifically, the book focuses on assessing the explanatory value of function ascriptions used in engineering (...) design and philosophy of technical functions; on elaborating the structure of explanation in engineering design; on assessing the role and value of design representations in engineering design and philosophy thereof; and on elaborating means for the testing of design methods. Presenting a novel and effective approach to tackling key issues in the field, philosophers of engineering and design alike will greatly benefit from this book. (shrink)

Emotions have traditionally been viewed as intrapersonal phenomena. Over the past decades, theory and research have shifted toward a more social perspective that emphasizes the role of emotional ex...

Liang Shuming’s 梁漱溟 China: the Country of Reason is a little-known, posthumously published manuscript composed between 1967 and 1970 during the Cultural Revolution. It offers a unique perspective on Liang’s philosophical attempt to reconcile the Communist revolutionary legacy with the Confucian tradition that he continued to uphold in mainland China after the founding of the People’s Republic. By presenting and analyzing the main themes and concepts of this book, I try to cast some light on Liang’s idiosyncratic repurposing of historical (...) materialist concepts in reinterpreting what he takes to be “early enlightenment” accomplished through the Confucian celebration of “reason” and its “replacement of religion by morality.” In doing so, I explore the complex relations between revolutionary, religious, and ethnic identity in his late philosophy. (shrink)

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In European science and technology policy, various styles have been developed and institutionalised to govern the ethical challenges of science and technology innovations. In this paper, we give an account of the most dominant styles of the past 30 years, particularly in Europe, seeking to show their specific merits and problems. We focus on three styles of governance: a technocratic style, an applied ethics style, and a public participation style. We discuss their merits and deficits, and use this analysis to (...) assess the potential of the recently established governance approach of ‘Responsible Research and Innovation’ (RRI). Based on this analysis, we reflect on the current shaping of RRI in terms of ‘doing governance’. (shrink)

In this paper several arguments are discussed and evaluated concerning the possibility of discrete space and time.

Predictive processing is an increasingly popular approach to cognition, perception and action. It says that the brain is essentially a hierarchical prediction machine. It is typically construed in a representationalist and inferentialist fashion so that the brain makes contentful inferences on the basis of representational models. In this paper, I argue that the predictive processing framework is inconsistent with this epistemic position. In particular, I argue that the combination of hierarchical modeling, contentful inferentialism and representationalism entail an internal inconsistency. Specifically, (...) for a particular set of states, there will be both a representation requirement and not. Yet a system cannot both be required to represent a certain set of states and not be required to represent those states. Due to this contradiction, I propose to reject the standard view. I suggest that predictive processing is best interpreted in terms of reliable covariation instead, entailing an instrumentalist approach to the statistical machinery. (shrink)

Despite an attempt to break with the hierarchical picture in traditional emergentist thought, non-standard accounts of emergence are often still committed to a premise that ontology is prior to epistemology. This paper aims to topple this last remnant of the traditional hierarchy by explicating a pragmatic view of emergence based on John Dewey’s work. Dewey argued that the traditional notion of ontology is premised on a view of existence as complete. Through a discussion of Dewey’s work it is argued that (...) this premise results in a process of reification that unduly excludes from ontology many precarious and indeterminate aspects involved both in everyday life and in philosophic and scientific inquiry. Building on a recent explication of transformational emergence the paper proposes a diachronic and non-hierarchical account of emergence, called pragmatic emergence. According to that account the relation between ontology and epistemology is a temporally reciprocal one. This means that ontological and epistemological features co-determine each other over time. Determinacy and continuity become historical features of a multitude of unfinished processes that we view from within. (shrink)