The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable (...) medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. (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)

This study bases itself in the epistemological and methodological development of a broad and interdisciplinary dialogue where various voices in the form of different domains converse in order to establish an integrated whole. The research contributes to the actual corporative question regarding spirituality in the workplace, specifically aimed at the individual in the middle-career phase. This phase is characterised as a re-evaluation period aimed at personal and professional growth. A shift in emphasis to the meaning and sense of work is (...) linked to spiritual intelligence as spirituality can be described and understood as a type of intelligence. The study shows that the middle-career experience provides opportunity for an altered future view. Lifestyle coaching serves as facilitating process and offers guidance in answering existential questions which are included in the spiritual. The probable outcome promises to add meaning as a manifesting component in a dynamic and transforming life strategy. (shrink)

Infants acquire their first words through interactions with social partners. In the first year of life, infants receive a high frequency of visual and auditory input from faces, making faces a potential strong social cue in facilitating word-to-world mappings. In this position paper, we review how and when infant gaze to faces is likely to support their subsequent vocabulary outcomes. We assess the relevance of infant gaze to faces selectively, in three domains: infant gaze to different features within a face (...) ; then to faces ; and finally to more socially relevant types of faces. We argue that infant gaze to faces could scaffold vocabulary construction, but its relevance may be impacted by the developmental level of the infant and the type of task with which they are presented. Gaze to faces proves relevant to vocabulary, as gazes to eyes could inform about the communicative nature of the situation or about the labeled object, while gazes to the mouth could improve word processing, all of which are key cues to highlighting word-to-world pairings. We also discover gaps in the literature regarding how infants’ gazes to faces or to different types of faces relate to vocabulary outcomes. An important direction for future research will be to fill these gaps to better understand the social factors that influence infant vocabulary outcomes. (shrink)

This article discusses whether ecology represents an alternative type of natural science, that is normatively committed. Central questions are: -- how man and human action are integrated into the subject matter of ecology; -- whether evaluative concepts like 'health' are incorporated into the conceptual structure of ecology; and -- whether ecology transcends the image of natural knowledge as control of nature. It is concluded that all hypotheses of ecology being inherently judgmental in character must be rejected.

We introduce a family of proportional surplus division values for TU-games. Each value first assigns to each player a compromise between her stand-alone worth and the average stand-alone worths over all players, and then allocates the remaining worth among the players in proportion to their stand-alone worths. This family contains the proportional division value and the new egalitarian proportional surplus division value as two special cases. We provide characterizations for this family of values, as well as for each single value (...) in this family. (shrink)

Selection on grandparental investment is more complex than Coall & Hertwig (C&H) propose. Patterns of investment are subject to an intergenerational conflict over how resources should be distributed to maximize fitness. Grandparents may be selected to distribute resources unevenly, while their descendants will be selected to manipulate investment in their own favor. Here we outline the evolutionary basis of this conflict.

This paper critically engages with new self-tracking technologies. In particular, it focuses on a conceptual tension between the idea that disclosing personal information increases one’s autonomy and the idea that informational privacy is a condition for autonomous personhood. I argue that while self-tracking may sometimes prove to be an adequate method to shed light on particular aspects of oneself and can be used to strengthen one’s autonomy, self-tracking technologies often cancel out these benefits by exposing too much about oneself to (...) an unspecified audience, thus undermining the informational privacy boundaries necessary for living an autonomous life. (shrink)

_Thinking Education Through Alain Badiou_ represents the first collection to explore the educational implications of French philosopher Alain Badiou's challenge to contemporary philosophical orthodoxy put forth in his 1993 work, _Ethics: An Essay on the Understanding of Evil._ Represents the first collection of work in education to grapple with what Alain Badiou might mean for the enterprise of schooling Takes up Badiou's challenge to contemporary and conventional Anglo-American doxa Includes original essays by experts in several different educational fields.

The Censor’s Hand invites us to explore the murky side of formal research-ethics review in the United States, as embodied in “Institutional Review Boards”. Amidst some 340 publications and several blogs that have taken formal research-ethics review to task, this book is the seventh detailed monograph on this topic—the others are Robert Klitzman’s The Ethics Police?, Zachary Schrag’s Ethical Imperialism, Laura Stark’s Behind Closed Doors, and my own works, Walking the Tightrope, The Seduction of Ethics, and The Ethics Rupture. This (...) is a particularly welcome volume. It is the second that comes from the hands of someone in medicine (Schneider is a professor of.. (shrink)

There are indications that the interpersonal affective factor and the social deviation factor, both of which are underlying dimensions of psychopathy, have a positive and a negative relationship, respectively, with executive functioning. However, this is seldom taken into consideration in the research on the relationship between executive functioning and psychopathy, which may be an explanation for the many inconsistent results in this area as reported in the literature (e.g., Rogers, 2006). In the present study, executive functioning was studied using the (...) Wisconsin Card Sorting Test (WCST) in 53 inpatients of a Dutch forensic psychiatric clinic who were classified by means of the Psychopathy Checklist-Revised (PCL-R). Special attention was given to the relationship between the two separate factors and executive functioning. Age, educational level, and substance abuse were controlled for in the analysis. No difference was found between psychopathic (N = 17) and nonpsychopathic (N = 36) patients in the WCST scoring categories, nor was there a significant difference in the four diagnostic subgroups defined by the two factors. However, the trends observed do justify further study in this direction. (shrink)

In 1998, Greenpeace, Natuur en Milieu(Nature and Environment), Milieudefensie(Environmental Defense), and the National ConsumersUnion presented a report about the possible risks andhazards associated with pesticide residues on fruitsand vegetables. Although these organizationsexplicitly denied having unassailable evidence on theharmful effects of pesticides, they claimed that bynow there are sufficient indications that pesticidesmay indeed lead to such health hazards. They used anappeal to the so-called precautionary principle tounderpin their claims. The committee officially incharge of deciding on the admission of pesticidesaccused the organizations (...) of scaremongering. Afterdistinguishing three possible versions of theprecautionary principle, we then show that the fourorganizations used in their campaign an improperversion of the precautionary principle to convince thegeneral public. (shrink)

This book puts the hymns by the Neoplatonist Proclus in the context of his philosophy and offers a detailed commentary together with a new translation of them.

In order to contain public care expenditure, policymakers in the Netherlands have over the last decades formulated in ever more stringent ways what ought to be expected from spouses, partners, and family members with regard to care for dependent relatives. The current Dutch coalition cabinet plans to shift the principal responsibility for nonmedical care, including demanding forms of care such as long-term personal care, to individuals and families. I argue that these policy developments imply cost redistribution rather than cost containment (...) and that this redistribution is disadvantageous for women. (shrink)

Nurses find themselves in a unique position - between patient and physicians, and in close proximity to the patient. Moral sensitivity can help nurses to cope with the daily turmoil of demands and opinions while delivering care in concordance with the value system of the patient. This article aims to reconsider the concept of moral sensitivity by discussing the function of emotions in morality. We turn to the ideas of historic and contemporary authors on the function of emotions in morality (...) to expand our understanding of moral sensitivity. Ancient philosophers and contemporary psychologists uphold different strategies on the orientation of morality being (a) personal growth or (b) community living, and the primordial function of (c) reason and (d) emotions in the creation of judgements about good and bad. The theoretical discussion on the function of emotions in morality shows that by focusing on reason alone, one leaves out an essential part of morality. The concept of moral sensitivity should (1) include an initial judgment of good and bad based on emotions, (2) hold the ability to reflect on the initial judgement and the associated emotions, (3) include the ability to understand other stakeholders' perspectives based on the ideal-types and (4) include a personal decision on the right course of action. (shrink)

This paper explores and rehabilitates the value of decisional privacy as a conceptual tool, complementary to informational privacy, for critiquing personalized choice architectures employed by self-tracking technologies. Self-tracking technologies are promoted and used as a means to self-improvement. Based on large aggregates of personal data and the data of other users, self-tracking technologies offer personalized feedback that nudges the user into behavioral change. The real-time personalization of choice architectures requires continuous surveillance and is a very powerful technology, recently coined as (...) “hypernudging.” While users celebrate the increased personalization of their coaching devices, “hypernudging” technologies raise concerns about manipulation. This paper addresses that intuition by claiming that decisional privacy is at stake. It thus counters the trend to solely focus on informational privacy when evaluating information and communication technologies. It proposes that decisional privacy and informational privacy are often part of a mutually reinforcing dynamic. Hypernudging is used as a key example to illustrate that the two dimensions should not be treated separately. Hypernudging self-tracking technologies compromise autonomy because they violate informational and decisional privacy. In order to effectively judge whether technologies that use hypernudges empower users, we need both privacy dimensions as conceptual tools. (shrink)

E-Co-Affectivity is a philosophical investigation of affectivity in various forms of life: photosynthesis and growth in plants, touch and trauma in bird feathers, the ontogenesis of human life through the placenta, the bare interface of human skin, and the porous materiality of soil. Combining biology, phenomenology, Ancient Greek thought, new materialisms, environmental philosophy, and affect studies, Marjolein Oele thinks through concrete, living places that show the receptive, responsive power of living beings to be affected and to affect. She focuses (...) on these localized interfaces to explain how affectivity emerges in places that are always evolving, creative, porous, and fluid. Every interface is material, but is also "more" than its current materiality in co-creating place, time, and being. After extensively describing the effects of the milieu and community within which each example of affectivity takes place, in the final chapter Oele adds a prescriptive, ethical lens that formulates a new epoch beyond the Anthropocene, one that is sensitive to the larger ecological, communal concerns at stake. (shrink)

This paper takes as its point of departure the recent publication of Heidegger’s lecture course Basic Concepts of Aristotelian Philosophy and focuses upon Heidegger’s reading of Aristotle’s concept of pathos. Through a comparative analysis of Aristotle’s concept of pathos and Heidegger’s inventive reading of this concept, I aim to show the strengths and weaknesses of Heidegger’s reading. It is my thesis that Heidegger’s account is extremely rich and innovative as he frees up pathos from the narrow confines of psychology and (...) incidental change and places it squarely into the center of the fundamental changes affecting a living being’s existence; simultaneously, however, Heidegger sometimes overstates the ties that pathos has with other concepts such as ousia and logos and highlights exceptional rather than common meanings of pathos, thereby risking the charge of being unfaithful to Aristotle’s text. (shrink)

BackgroundContradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview.MethodsA descriptive qualitative study. The data were collected in the context (...) of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study.ResultsThe interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible.ConclusionThe open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview. (shrink)