ABSTRACTIn 1991 the Dutch government released the results of the first national investigation into the nature and extent of decisions concerning end of life including euthanasia. A significant finding was that most cases of euthanasia were not reported. This prompted us to ask what effect, if any, not reporting caused. More specifically, we asked whether reporting has a positive or negative impact on the experiences of friends or relatives of patients who have received euthanasia. In cases of euthanasia, complications of (...) both process and experience can deter from a minimally complicated death. These difficulties arise when either the family or physician does not perceive the freedom to disclose euthanasia openly. On the basis of interviews with family members and patients, we illustrate that they generally benefit from reporting. Our premise is that reporting fosters open discussion of euthanasia. We further suggest physicians and society benefit from a milieu of openness initiated by reporting cases of euthanasia. (shrink)

ABSTRACT In 1991 the Dutch government released the results of the first national investigation into the nature and extent of decisions concerning end of life including euthanasia. A significant finding was that most cases of euthanasia were not reported. This prompted us to ask what effect, if any, not reporting caused. More specifically, we asked whether reporting has a positive or negative impact on the experiences of friends or relatives of patients who have received euthanasia. In cases of euthanasia, complications (...) of both process and experience can deter from a minimally complicated death. These difficulties arise when either the family or physician does not perceive the freedom to disclose euthanasia openly. On the basis of interviews with family members and patients, we illustrate that they generally benefit from reporting. Our premise is that reporting fosters open discussion of euthanasia. We further suggest physicians and society benefit from a milieu of openness initiated by reporting cases of euthanasia. (shrink)

Many recent events have contributed to the resurgence of the historically cyclical debate over euthanasia. Now, the focus rests on physician-assisted suicide. Many landmark events regarding physician-assisted suicide have occurred within the last year alone. For example, Derek Humphry's Final Exit recently became a best seller, giving people the detailed knowledge of how to “self-deliver” In The New England Journalbf Medicine, Dr. Timothy Quill shared his touching experience of assisting his patient “Diane” after she chose to decline treatment options for (...) leu- kemia. Dr. Jack Kevorkian made use of his highly publicized “death machine” to help Janet Adkins and subsequently, several other women, end their lives. (shrink)

Research is ongoing concerning the medical risks and benefits of routine neonatal male circumcision. Interpretation of the data, however, is controversial. Circumcision presents a number of challenges in obtaining informed consent because of a variety of interesting issues. It is a nonemergent, elective procedure that allows for evaluation and discussion over time. In this respect, observation of the informed consent process for circumcision is relevant to other medical decisions, such as advance directives, discussed between primary care providers and patients. Obtaining (...) informed consent for circumcision has its constraints. The process generally occurs over a brief hospital stay. There have been recent changes in the official position regarding the procedure by professional medical societies, and it raises considerable psychologic issues for the provider and may Impact the way in which Information is provided. (shrink)

The health of newborns has always been subject to the natural lottery. When in the past a severely disabled baby was born, nature provided the “solution,” and the child did not survive. Medical technology has brought about a change; fetuses who would have died during pregnancy or newborns who once would have had little chance to survive are now kept alive. Although these technological advances do benefit many children, the dark side is that more severely handicapped babies are surviving.When a (...) severely disabled baby is born, all persons concerned are faced with emotional difficulties as well as moral and legal dilemmas. Questions that arise include whether it is acceptable, morally and legally, to allow the severely handicapped newborn to die by forgoing treatment or by direct intervention. (shrink)

On April 10, 2001, after extensive committee deliberations, the Second Chamber of the Dutch Parliament passed a bill that was introduced in August 1999 legalizing physician-assisted death. The bill is officially called It was passed by a majority vote in the Second Chamber of Parliament and was supported by the majority parties constituting the present coalition government (i.e., liberals and socialists). Opposition to the law came mainly from a minority of Christian parties. In this report we explore the meaning of (...) this bill and describe some of its problematic and paradoxical items. (shrink)

The open practice of euthanasia in The Netherlands stood alone in the world until the government of the Northern Territories in Australia accepted the possibility of physician-assisted suicide. Even though the active ending of lives in The Netherlands is still a crime by law, the current practice allows it and acquits physicians if certain conditions have been met. Of the many facets of euthanasia, the teaching of this practice represents a further logical step. In this contribution, we intend to describe (...) the comprehensive teaching program of euthanasia of the Free University of Amsterdam's Postgraduate Family Medicine Program. Here students receive university-based training for 1 day a week in a cohort of 12 and on the job training for 4 days with individual family physicians for 2 consecutive years. We especially intend to portray the integration of euthanasia into the wider teaching of the process of counseling and aid of the dying. (shrink)

This case is both an excellent as well as a sad illustration of the complexities, intensities, and foibles of the issue of sick people to die. Although the reaction expressed here is that of a student, it is also, sadly, the reaction of many an experienced physician in being emotional, irrational, and hasty. The description is a perfect example of the student's dilemma: —altruism versus egocentric motivation.

Hospital ethics committees in The Netherlands have had the unique responsibility of developing euthanasia policies for their institutions. Although each policy necessarily reflects a particular facility, family resemblances necessarily remain. In the interest of ethics committees outside The Netherlands that may soon face the same challenge, two such policies are presented here accompanied by commentary high-lighting their similarities and differences.

Important bioethcs changes are underway in the Netherlands that carry, for better or worse, far-reaching social consequences. The two major areas of change involve economics and containing soaring health costs and end-of-life care as reflected in several high-profile cases: in a decision handed down by the Dutch Supreme Court on reviewing the procedures for the termination of life, in the discussion surrounding The Groningen Protocol and the active ending of lives in neonatology, and in a report of a Royal Dutch (...) Medical Society's Committee on the role of physicians in ending life in cases of requests to die outside the area of terminal diseases. (shrink)

The debate on the ethical permissibility of euthanasia in medicine has a corollary in the ethical application of drugs. The overall moral limits of medical treatment apply evenly to the moral acceptability of the pharmacological aspect of the act of euthanasia. The pharmacological aspect of the act is of ethical importance not only for the person requesting an active ending of his or her life, but also for the grieving family. Keywords: effectivity, ideal euthanaticum, patient's/family's interest, pharmacology of euthanasia, routes (...) of application CiteULike Connotea Del.icio.us What's this? (shrink)

I disagree with what Reidar Lie has presented here, not because his presentation is deficient, but because the philosophy of the relationship between physician and patient is too narrow. First of all he paints a one-sided and distorted picture of American formulations and descriptions of the concept of autonomy, especially one aspect of it: informed consent. He concludes that autonomy is not an adequate basis for understanding the medical relationship. And then he ends his paper in a vacuum: a proposal (...) to actively explore and experiment with new ways of seeing and modelling this relationship without a program or a script, based on Foucault’s description of the relationship between knowledge and power. That statement causes some suspicion, because it is this relationship that was part of the abuse of patients and research subjects in the first place. (shrink)

The approach to AIDS as a disease and a threat for social discrimination is used as an example to illustrate a conceptual thesis. This thesis is a claim that concerns what we call a medical issue or not, what is medicalised or needs to be demedicalised. In the friction between medicalisation and demedicalisation as discursive strategies the latter approach can only be effected through the employment of discourses or discursive strategies other than medicine, such as those of the law and (...) of economics. These discourses each realise different values, promote a different subject, and have a different concept of man. The concept of discourse is briefly outlined against concepts such as the linear growth concept of science and the growth model of science as changes in paradigm. The issue of testing for AIDS shows a conflict between the medical and the legal discourse and illustrates the title of our contribution: the human body as field of conflict between discourses. (shrink)

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

BackgroundInaccurate, false or incomplete research publications may mislead readers including researchers and decision-makers. It is therefore important that such problems are identified and rectified promptly. This usually involves collaboration between the research institutions and academic journals involved, but these interactions can be problematic.MethodsThese recommendations were developed following discussions at World Conferences on Research Integrity in 2013 and 2017, and at a specially convened 3-day workshop in 2016 involving participants from 7 countries with expertise in publication ethics and research integrity. The (...) recommendations aim to address issues surrounding cooperation and liaison between institutions and journals about possible and actual problems with the integrity of reported research arising before and after publication.ResultsThe main recommendations are that research institutions should: develop mechanisms for assessing the integrity of reported research that are distinct from processes to determine whether individual researchers have committed misconduct;release relevant sections of reports of research integrity or misconduct investigations to all journals that have published research that was investigated;take responsibility for research performed under their auspices regardless of whether the researcher still works at that institution or how long ago the work was done;work with funders to ensure essential research data is retained for at least 10 years.Journals should: respond to institutions about research integrity cases in a timely manner;have criteria for determining whether, and what type of, information and evidence relating to the integrity of research reports should be passed on to institutions;pass on research integrity concerns to institutions, regardless of whether they intend to accept the work for publication;retain peer review records for at least 10 years to enable the investigation of peer review manipulation or other inappropriate behaviour by authors or reviewers.ConclusionsVarious difficulties can prevent effective cooperation between academic journals and research institutions about research integrity concerns and hinder the correction of the research record if problems are discovered. While the issues and their solutions may vary across different settings, we encourage research institutions, journals and funders to consider how they might improve future collaboration and cooperation on research integrity cases. (shrink)

In spite of the seminal work A Philosophical Basis of Medical Practice, the debate on the task and goals of philosophy of medicine still continues. From an European perspective it is argued that the main topics dealt with by Pellegrino and Thomasma are still particularly relevant to medical practice as a healing practice, while expressing the need for a philosophy of medicine. Medical practice is a discursive practice which is highly influenced by other discursive practices like science, law and economics. (...) Philosophical analysis of those influences is needed to discern their effect on the goals of medicine and on the ways in which the self-image of man may be changed. The nature of medical practice and discourse itself makes it necessary to include different philosophical disciplines, like philosophy of science, of law, ethics, and epistemology. Possible scenario's of euthanasia and the human genome project in the USA and Europe are used to exemplify how philosopy of medicine can contribute to a realistic understanding of the problems which are related to the goals of medicine and health care. (shrink)

In pursuit of my ultimate objective of being in control of my self-deliverance at the time when my physical condition no longer warrants continuance, I have joined the Hemlock Society of Los Angeles. The Society urges its members to explore with their personal physicians this subject well in advance of the actual moment of necessity, and in particular the problem of acquiring a lethal dose of a drug that will provide a release consistent in quality with the degree of peace (...) and serenity sought in life. It is my hope that we can find a process commensurate with your moral and professional concerns which will allow us to collaborate. (shrink)

Voluntary active euthanasia and physician-assisted suicide remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In (...) this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

The prelims comprise: Death and Democracy Political Philosophy and Choosing Death Historical Roots Brain Death Abortion and Decisions for Neonates and Other Children Letting Die and Terminal Sedation Euthanasia and Physician‐Assisted Suicide Conclusion Notes.

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this (...) book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or (...) physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of the study (...) were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

We define a direct translation from finite rooted trees to finite natural functions which shows that the Worm Principle introduced by Lev Beklemishev is equivalent to a very slight variant of the well-known Kirby-Paris' Hydra Game. We further show that the elements in a reduction sequence of the Worm Principle determine a bad sequence in the well-quasi-ordering of finite sequences of natural numbers with respect to Friedman's gapembeddability. A characterization of gap-embeddability in terms of provability logic due to Lev Beklemishev (...) is also presented. (shrink)

In Gramsci and Languages Alessandro Carlucci explores the origins and significance of Antonio Gramsci's interest in language, showing in particular how his experience of linguistic and cultural diversity contributed to the shaping of his intellectual and political profile.

When the Canonical Ramsey’s Theorem by Erdős and Rado is applied to regressive functions, one obtains the Regressive Ramsey’s Theorem by Kanamori and McAloon. Taylor proved a “canonical” version of Hindman’s Theorem, analogous to the Canonical Ramsey’s Theorem. We introduce the restriction of Taylor’s Canonical Hindman’s Theorem to a subclass of the regressive functions, the $$\lambda$$ λ -regressive functions, relative to an adequate version of min-homogeneity and prove some results about the Reverse Mathematics of this Regressive Hindman’s Theorem and (...) of natural restrictions of it. In particular we prove that the first non-trivial restriction of the principle is equivalent to Arithmetical Comprehension. We furthermore prove that the well-ordering-preservation principle for base-$$\omega$$ ω exponentiation is reducible to this same principle by a uniform computable reduction. (shrink)

Contemporary development of research methods and tools is often conducive to ambitious art studies, in which the research methodology and study protocol are the result of negotiations between creative and research strategies. The article discusses the key sources, possibilities, and threats of interdisciplinary projects often referred to as practice-as-research. The following comparison of the orders of the scientific methodology and the artistic convention allows one to show the similarities and potential points of contact between science and art, which are independent (...) of the different values and methods of evaluation in both of these areas. The research-based practice model by Pil Hansen and Bruce Barton is also presented as a solution that takes these issues into account. It is also used to present the project of Interdisciplinary Center for New Technologies of the Nicolaus Copernicus University in Toruń and the Art & Science Research Foundation om—organisms and machines in culture (FUNom) the project "Neurophysiology of the Artist in Performance", which is a bold example of the transdisciplinary activities of scientists and researchers. Its content is analyzed through the reports of artists, researchers, and participants taking part in public presentations of the project. (shrink)

We investigate a new paradigm in the context of learning in the limit, namely, learning correction grammars for classes of computably enumerable (c.e.) languages. Knowing a language may feature a representation of it in terms of two grammars. The second grammar is used to make corrections to the first grammar. Such a pair of grammars can be seen as a single description of (or grammar for) the language. We call such grammars correction grammars. Correction grammars capture the observable fact that (...) people do correct their linguistic utterances during their usual linguistic activities. We show that learning correction grammars for classes of c.e. languages in the TxtEx-model (i.e., converging to a single correct correction grammar in the limit) is sometimes more powerful than learning ordinary grammars even in the TxtBe-model (where the learner is allowed to converge to infinitely many syntactically distinct but correct conjectures in the limit). For each n ≥ 0, there is a similar learning advantage, again in learning correction grammars for classes of c.e. languages, but where we compare learning correction grammars that make n + 1 corrections to those that make n corrections. The concept of a correction grammar can be extended into the constructive transfinite, using the idea of counting-down from notations for transfinite constructive ordinals. This transfinite extension can also be conceptualized as being about learning Ershov-descriptions for c.e. languages. For u a notation in Kleene's general system $(O,\, < _o )$ of ordinal notations for constructive ordinals, we introduce the concept of an u-correction grammar, where u is used to bound the number of corrections that the grammar is allowed to make. We prove a general hierarchy result: if u and v are notations for constructive ordinals such that $u\, < _o \,v$ , then there are classes of c.e. languages that can be TxtEx-learned by conjecturing v-correction grammars but not by conjecturing u-correction grammars. Surprisingly, we show that— above "ω-many" corrections—it is not possible to strengthen the hierarchy: TxtEx-learning u-correction grammars of classes of c.e. languages, where u is a notation in O for any ordinal, can be simulated by TxtBe-learning ω-correction grammars, where ω is any notation for the smallest infinite ordinal ω. (shrink)

We will prove that there exists a model of ZFC+"c = ω 2 " in which every $M \subseteq \mathbb{R}$ of cardinality less than continuum c is meager, and such that for every $X \subseteq \mathbb{R}$ of cardinality c there exists a continuous function f: R → R with f[X] = [0, 1]. In particular in this model there is no magic set, i.e., a set $M \subseteq \mathbb{R}$ such that the equation f[M] = g[M] implies f = g for (...) every continuous nowhere constant functions f, g: R → R. (shrink)

In his literary works, Witold Gombrowicz has developed an interesting concept of a person entangled in a social sphere. A human being, according to the author of Ferdydurke, is an intrinsic being autonomically shaping his or her attitude in relations with other people. It is rather other people's circle, a social form, that fundamentally conditions the way a particular person thinks and acts. The depiction of an individual, portrayed by Gombrowicz, is a scale of attitudes ranging from the attitude of (...) total submission to a social form to the attitude of peculiar freedom from the form. In my article I raise the questions of broadly understood “province-center” relations in the context of Gombrowicz's anthropological theses. Is the attitude of conformity and imitative adopting of thinking and behavior patterns characteristic of the “province” or of the “center” does? Is the “province” doomed to imitative nature of thinking and copying of what the “center” does? Where is it easier to free oneself from the social influence and reach intellectual and cultural autonomy? (shrink)

Enactive approaches to emotion are rare and to anxiety and anxiety disorder even more. This article aims to show how an enactive paradigm might be helpful in solving some problems in the clinical and scientific understanding of anxiety and anxiety disorder. I begin by pointing at a number of relevant clinical features of anxiety and anxiety disorder and by sketching how and why anxiety theories have difficulties with doing justice to these features. I specifically focus on two themes: a) how (...) to conceptualize anxiety as the expression of a dynamical interaction with the environment instead of as just a reaction to the environment (or to... (shrink)

This book focuses on two important, interlinked themes in psychiatry, i.e., the relation between self (or: person), context and psychopathology; and the intrinsic value-ladenness of psychiatry as a practice. -/- Written against the background of scientistic tendencies in today’s psychiatry, it is argued in Part I that psychiatry needs a clinical conception of psychopathology alongside more traditional scientific conceptions; that this clinical conception of psychopathology must be based on a fundamental rethinking of the interaction between illness manifestations, contextual influences and (...) the patient as person, such that psychopathology is conceived as the product of this interaction rather than as the outward manifestation of a broken mechanism within the patient. -/- In Part II, it is shown that self- and context-related factors have a large impact on who one is as a professional. I argue that an analysis is needed of the normative aspects of the relations that sustain and frame professional role-fulfilment. This analysis culminates into a so-called normative practice model (NPM) which distinguishes between qualifying, conditioning and foundational principles (or: rules, norms). The normative practice model helps to locate and resist scientistic defenses of the legitimacy of psychiatry and to replace them by a positive account that provides clinicians (and scientists) the conceptual tools they need to justify what they do in broader contexts. The main thrust of the argument is to show that psychiatry needs a value-sensitive account of its legitimacy, in which other normative dimensions are recognized than those that sustain the expert role. Psychiatrists should in other words not defend the legitimacy of their profession by referring to the expert role solely but provide a broader account in which justice is done to the broader social, legal, and economic contexts of professional activity. The analysis of this inherent normativity begins within clinical practice, it extends to the concept of disease as well as to wider domains of psychiatric care and the sociology of professions, and, finally, amounts into an analysis of the value-ladenness of interactions between healthcare institutions, the government, professional organizations and patient groups. (shrink)

Over the last years, self-management has become a central value in the practice of mental health care. Patients are positioned as expertclients who are actively involved in the management of their disease. Some of the ideas that are implied in the concept of self-management may raise important and intriguing questions. For instance, in the context of psychiatry impaired agency and altered self-experience are often part of the psychopathological process itself. The capacity to manage oneself may be impeded by the very (...) problem that needs to be managed. Therefore, how should self-management be conceived in... (shrink)