Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study Amsterdam (N=1284 (2001), N=1303 (2005) and N=1245 (2008)) were studied. Respondents were asked whether they could imagine requesting their physician to end their life (euthanasia), or imagine asking for a pill to end their life if they became tired (...) of living in the absence of a severe disease (end-of-life pill). Using logistic multivariable techniques, changes of attitudes over time and their association with demographic and health characteristics were assessed. Results The proportion of respondents with a positive attitude somewhat increased over time, but significantly only among the 64–74 age group. For euthanasia, these percentages were 58% (2001), 64% (2005) and 70% (2008) (OR of most recent versus earliest period (95% CI): 1.30 (1.17 to 1.44)). For an end-of-life pill, these percentages were 31% (2001), 33% (2005) and 45% (2008) (OR (95% CI): 1.37 (1.23 to 1.52)). For the end-of-life pill, interaction between the most recent time period and age group was significant. Conclusions An increasing proportion of older people reported that they could imagine desiring euthanasia or an end-of-life pill. This may imply an increased interest in deciding about your own life and stresses the importance to take older peoples' wishes seriously. (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)

Hilde Lindemann Nelson focuses on the stories of groups of people--including Gypsies, mothers, nurses, and transsexuals--whose identities have been defined by those with the power to speak for them and to constrain the scope of their actions. By placing their stories side by side with narratives about the groups in question, Nelson arrives at some important insights regarding the nature of identity. She regards personal identity as consisting not only of how people view themselves but also of how others (...) view them. These perceptions combine to shape the person's field of action. If a dominant group constructs the identities of certain people through socially shared narratives that mark them as morally subnormal, those who bear the damaged identity cannot exercise their moral agency freely.Nelson identifies two kinds of damage inflicted on identities by abusive group relations: one kind deprives individuals of important social goods, and the other deprives them of self-respect. To intervene in the production of either kind of damage, Nelson develops the counterstory, a strategy of resistance that allows the identity to be narratively repaired and so restores the person to full membership in the social and moral community. By attending to the power dynamics that constrict agency, Damaged Identities, Narrative Repair augments the narrative approaches of ethicists such as Alasdair MacIntyre, Martha Nussbaum, Richard Rorty, and Charles Taylor. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

-Fabrice Luchini, vous lisez l'Evangile de saint Marc? - Pas encore. Avant de plonger dans les Evangiles, je lis Pierre Boutang. C'est du lourd?! Hier soir, je dînais avec François Hollande qui me dit? : "?Vous lisez Boutang?? C'est la passion de mon père?!?" Je lui réponds? : "?Transmettez mon salut admiratif à votre père car un lecteur de Boutang, c'est un costaud.?" Je suis paumé... - Qu'est-ce qui vous attire chez Boutang?? - Le poison de la curiosité. Pourquoi suis-je (...) ainsi happé?? C'est d'un tel niveau philosophique que je n'ai pas les moyens de suivre. Pourtant j'y vais. Autant Nietzsche, je peux facilement m'y mettre, car c'est un styliste poète, autant ces philosophes qui mettent Kant en allemand face à Thomas d'Aquin en latin... je ne fais pas le poids?! (Fabrice Luchini interrogé par Luc Adrian pour Famille chrétienne, le 10 mai 2016.) Ce livre est un manuel pour commencer à lire Boutang, le philosophe français le plus nécessaire et le plus libre du siècle. " Méthode d'investigation sans concession ", " classique modernité ", " courage " sont les mots par lesquels Pierre Boutang rendait compte des tout premiers travaux de son élève en Sorbonne : " Nous sommes ici en présence du véritable commencement d'une oeuvre ". (shrink)

The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

These days many gyms and fitness centers are closed to reduce transmission of the SARS-CoV-2 virus in society. The gym is an environment rich in microorganisms, and careful hygiene is a necessity to keep infections at bay. Exercise centers strive for better hygiene compliance among their members. This effort has become essential in light of the current pandemic. Several experimental studies show that others’ physical presence, or the “illusion” of being watched, may alter behavior. This article reports on a natural (...) field experiment testing one specific social nudge intended to increase gym members’ hygienic behavior. The study was conducted before the SARS-COV-2 pandemic. A picture of “observing eyes” was attached to paper dispensers and cleanser spray bottles at two different gyms in Norway. A reversal design, also called an ABA design, with and without the nudge’s presence, was used to investigate the impact on gym members’ hygienic behavior. A follow-up study was conducted in one of the centers to investigate whether the nudge stimuli would function over time. The study included 254 individual choice situations during nine observation sessions conducted over 9 weeks. The results from both centers provide evidence of a strong effect of the nudge. However, the effect decreased during the follow-up study. These findings support previous research indicating that human behavior is influenced by the presence of implicit observation cues – in this case – observing eyes. However, insights into the long-term effect of implicit observation cues are still needed since the salience of the stimuli faded over time. (shrink)

Background: Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns. Aims: We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents. Research design: This is a qualitative study utilizing data from focus group discussions. Participants and research context: (...) We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation. Ethical considerations: The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent. Findings: In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals. Discussion: We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies. Conclusion: Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance. (shrink)

In human lives, technology holds sway in mundane and extraordinary ways, such as in the ways we work, entertain, transport, and feed ourselves, and importantly in the ways we encounter and manage health, disease, illness, and death. A significant area of Heidegger's later work is questioning technology. Unlike many current inquiries that centre on contemporary technology's function, utility, and positive transformations, Heidegger offers a radical way of thinking about technology through developing an inquiry that uncovers technology's essence of revealing. In (...) this article, Heidegger's thinking about technological modes of revealing in regard to bodies, health, and illness is explored. In Heidegger's view, the ordered revealing of modern technology has overshadowed other modes of revealing. This article highlights how remembering concealment and unconcealment in its many modes can be relevant to nurses and others involved in health care. Through tracing Heidegger's thinking about technology, a more critical approach to the effects and outcomes of modern technologies within health care systems can be generated. (shrink)

Machine generated contents note: -- Acknowledgements -- Disrupting the Impression of Stability in the Gender-Technology Relation -- Changing Images of Computers and its Users since 1980 -- Discursive Developments Within Computer Education -- Variations in Gender-ICT Relations Among Male and Female Computer Students -- Stories About Individual Change and Transformation -- Layered Meanings and Differences Within -- Is there an Elsewhere? -- References -- Endnotes -- Index.

This paper works within a model of ungraded belief that characterizes epistemic states as logically closed and consistent sets of sentences. The aim of this paper is to discuss three diachronic coherence conditions for such beliefs. These coherence conditions are formulated in terms of the reasoner's present beliefs about how his present beliefs will evolve in the future, for instance, in response to different pieces of future evidence.

Narratives have always played a prominent role in both bioethics and medicine; the fields have attracted much storytelling, ranging from great literature to humbler stories of sickness and personal histories. And all bioethicists work with cases--from court cases that shape policy matters to case studies that chronicle sickness. But how useful are these various narratives for sorting out moral matters? What kind of ethical work can stories do--and what are the limits to this work? The new essays in Stories and (...) Their Limits offer insightful reflections on the relationship between narratives and ethics. (shrink)

This book explores the social practice of holding each other in our identities, beginning with pregnancy and on through the life span. Lindemann argues that our identities give us our sense of how to act and how to treat others, and that the ways in which we we hold each other in them is of crucial moral importance.

The essays in this volume critically analyze and revitalize agrarian philosophy by tracing its evolution in the classical American philosophy of key figures such as Franklin, Jefferson, Emerson, Thoreau, Dewey, and Royce.

In the Eudemian Ethics II 1, 1219a34–b8, Aristotle defines happiness as ‘the activity of a complete life in accordance with complete virtue’. Most scholars interpret a complete life as a whole lifetime, which means that happiness involves virtuous activity over an entire life. This article argues against this common reading by using Aristotle’s notion of ‘activity’ (energeia) as a touchstone. It argues that happiness, according to the Eudemian Ethics, must be a complete activity that reaches its end at any and (...) every moment. The upshot of this reading is that life reaches completeness within a lifetime and that death cannot be the requirement for making life complete. (shrink)

The end-state comfort effect refers to the consistent tendency of healthy adults to end their movements in a comfortable end posture. In children with and without developmental coordination disorder, the results of studies focusing on ESC planning have been inconclusive, which is likely to be due to differences in task constraints. The present pilot study focused on the question whether children with and without DCD were able to change their planning strategy and were more likely to plan for ESC when (...) demanded by complex object manipulations at the end of a task. To this end, we examined ESC planning in 18 children with and without DCD using the previously used sword-task and the newly developed hammer-task. In the sword-task, children had to insert a sword in a wooden block, which could be relatively easily completed with an uncomfortable end-posture. In the hammer-task, children had to strike down a nail in a wooden pounding bench, which required additional force and speed demands, making it relatively difficult to complete the movement with an uncomfortable end-posture. In line with our hypothesis, the results demonstrated that children with and without DCD were more likely to plan for ESC on the hammer-task compared with the sword-task. Thus, while children with and without DCD show inconsistent ESC planning on many previously used tasks, the present pilot study shows that many of them are able to take into account the end-state of their movements if demanded by task constraints. (shrink)

Violence is often considered gendered on the basis that it is violence against women. This assumption is evident both in “gender-based violence” interventions in Africa and in the argument that gender is irrelevant if violence is also perpetrated against men. This article examines the relation of partner violence not to biological sex, but to gender as conceptualized in feminist theory. It theorizes the role of gender as an analytical category in dominant social meanings of “wifebeating” in Tanzania by analyzing arguments (...) for and against wife-beating expressed in 27 focus group discussions in the Arumeru and Kigoma-Vijijini districts. The normative ideal of a “good beating” emerges from these data as one that is supported by dominant social norms and cyclically intertwined with “doing gender.” The author shows how the good beating supports, and is in turn supported by, norms that hold people accountable to their sex category. These hegemonic gender norms prescribe the performance of masculinity and femininity, power relations of inequality, and concrete material exploitation of women’s agricultural and domestic labor. The study has implications for policy and practice in interventions against violence, and suggests untapped potential in theoretically informed feminist research for understanding local power relations in the Global South. (shrink)

The scope of Aumann’s (1976) Agreement Theorem is needlessly limited by its restriction to Conditioning as the update rule. Here we prove the theorem in a more comprehensive framework, in which the evolution of probabilities is represented directly, without deriving new probabilities from new certainties. The framework allows arbitrary update rules subject only to Goldstein’s (1983) requirement that current expectations agree with current expectations of future expectations.

When I accidentally fell into the job of Associate Editor at the Hastings Center Report, I soon learned that one of my duties was to copyedit the case studies that the Report publishes on a regular basis. The Hastings Center being the kind of institution it is, as I edited the essays, I also imbibed a good deal of bioethics. I began to publish scholarly articles and coauthor a book, all under the mentorship of Dan Callahan and the Center's other (...) associates. Joe Fins, then the Associate for Medicine, patiently answered all my many questions about ethical issues surrounding the doctor-patient relationship; Susan Wolf, the Associate for Law, taught me some classic court cases, starting with Schloendorff; and Jamie... (shrink)

If personhood involves the construction of a narrative identity, then what are we to say of someone who is seriously ill or disabled? How can her life have any narrative when she is unable to write one?

The early coronavirus disease 2019 (COVID‐19) outbreak inflicted vulnerability on individuals and societies on a completely different scale than we have seen previously. The pandemic developed rapidly from 1 day to the next, and both society and individuals were put to the test. Older people's experiences of the early outbreak were no exception. Using an abductive analytical approach, the study explores the individual experiences of vulnerability as described by older people hospitalised with COVID–19 in the early outbreak. In these older (...) people, we found that the societal context and the individual experiences of vulnerability were inextricable linked. The study demonstrates that despite significant individual stress, informants displayed an interesting ability to also view their situation to reorient their perspective. The experience of vulnerability is both conditional and individual, which imposes a degree of unpredictability that neither they nor others were able to negotiate. The article discusses the phenomenon of unpredictability in light of a modern society with regard to how individuals and society may encounter unexpected events in the future where the potential to reorient will be vital. (shrink)

As hubs of global exchange, port cities are host to inconvenient and contested pasts. Many of these pasts have yet to be fully recognized. In the wake of demonstrations against racial injustices this summer, the PortCityFutures team discussed how our own research practices relate to systemic inequalities within port cities. It was concluded that we need to better understand how these contested and complex pasts, legacies of diversity and segregation, and colonial pasts impact port cities today.

A long lasting debate in the field of implicit learning is whether participants can learn without acquiring conscious knowledge. One crucial problem is that no clear criterion exists allowing to identify participants who possess explicit knowledge. Here, we propose a method to diagnose during a serial reaction time task those participants who acquire conscious knowledge. We first validated this method by using Stroop-like material during training. Then we assessed participants’ knowledge with the Inclusion/Exclusion task and the wagering task . Both (...) experiments confirmed that for participants diagnosed as having acquired conscious knowledge about the underlying sequence the Stroop congruency effect disappeared, whereas for participants not diagnosed as possessing conscious knowledge it only slightly decreased. In addition, both experiments revealed that only participants diagnosed as conscious were able to strategically use their acquired knowledge. Thus, our method allows to reliably distinguish between participants with and without conscious knowledge. (shrink)

This paper is a revised version of the essay that won the Zapffe Prize in 2017. -/- In «The Last Messiah» and On the tragic, Peter Wessel Zapffe suggests that humankind should cease to reproduce, as the meaning of life cannot be found and human life at its best is tragic. The theory has been criticized for assuming that the meaning of life must be explained by an external cause and implicitly asks for an infinite causal chain. In this paper, (...) I argue that it is possible to escape this critique by adding a new element to the definition of the tragic: namely, the insight that the tragic cannot come into existence if the subject does not demonstrate its greatness. Precisely because a human, on Zapffe’s understanding, must prove its brilliance if tragedy is to arise, I argue that the tragic cannot be devoid of meaning. In contrast, the individual seems to be provided with a tragic meaning of life, rather than being deprived of it. Furthermore, the new definition of the tragic affects Zapffe’s antinatalism, because a tragic meaning of life does not necessitate that humankind should cease to reproduce. Yet, the definition does not suggest that humans should reproduce either. Instead, it confronts us with the following question: Should one bring new life into the world, when the meaning of life only can be found in the tragic? (shrink)

This chapter contains section titled: Where We've Been Where We're Going Feminist Epistemology Counterstories Acknowledgments Notes References.

The first decisive steps of medicine towards becoming a science in its present shape happen to coincide with “the rise of the novel” in the eighteenth century. Before this well known and in our days still growing scientific specialization of medicine, the connections between literature and medicine were both many and close. By reading and analyzing a contemporary novel, The Death of a Beekeeper by the Swedish author Lars Gustafsson (1978), this article is an attempt to explore to which extent (...) a fictional narrative about a unique case of cancer may illuminate challenges associated with the experience of serious illness. Our claim is that medicine might draw wisdom from literature, its ability to create connections through narrative, to illuminate the complexity of ethical dilemmas, and to intertwine symptoms, life stories, and contexts. We argue that by being in the company of literary narratives and philosophical questions, physicians as well as other health care professionals may acquire clinically relevant skills which help them reach the ethically defined goals of their profession. (shrink)

All conceptions of equal opportunity draw on some distinction between morally justified and unjustified inequalities. We discuss how this distinction varies across a range of philosophical positions. We find that these positions often advance equality of opportunity in tandem with distributive principles based on merit, desert, consequentialist criteria or individuals' responsibility for outcomes. The result of this amalgam of principles is a festering controversy that unnecessarily diminishes the widespread acceptability of opportunity concerns. We therefore propose to restore the conceptual separation (...) of opportunity principles concerning unjustified inequalities from distributive principles concerning justifiable inequalities. On this view, equal opportunity implies that that morally irrelevant factors should engender no differences in individuals' attainment, while remaining silent on inequalities due to morally relevant factors. We examine this idea by introducing the principle of ‘opportunity dominance' and explore in a simple application to what extent this principle may help us arbitrate between opposing distributive principles. We also compare this principle to the selection rules developed by John Roemer and Dirk Van de Gaer. (shrink)