In 2002, Belgium was the second country in the world to legalize euthanasia following the Netherlands. Since then, a few studies dealing with Belgium euthanasia practices have been published that are based on a survey given to a sample of physicians and nurses . All these studies from the past decade have implicitly proposed the practice of euthanasia as a medical act. Moreover, the last article published in this journal argued that the Belgian experiment concerning medical end-of-life decisions is unique (...) in the world and that the Belgian palliative care system, including euthanasia, should serve as a role-model for the rest of the world .The Belgium law provides a definition for euthanasia which lacks the analytical precision to apply it to medical studies . When analyzing the latest data provided by the Belgian Federal Euthanasia Comm .. (shrink)

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

The present study explored the multidimensionality of moral identity. In four studies (N = 1,159), we compiled a comprehensive list of moral traits, analyzed their factorial structure, and established relationships between the factorial dimensions and outcome variables. The resulting dimensions are Connectedness, Truthfulness, Care, and Righteousness. To examine relations to personality traits and pro- and antisocial inclinations we developed a new instrument, the Moral Identity Profile (MIP). Our results show distinctive relationships for the four dimensions, which challenge previous unidimensional conceptualizations (...) of moral identity. We discuss implications, limitations, and how our conceptualization reaffirms the social aspect of morality. (shrink)

This article comments on the article of Thorn and Schurz in this volume and focuses on, what we call, the problem of parasitic experts. We discuss that both meta- induction and crowd wisdom can be understood as pertaining to absolute reliability rather than comparative optimality, and we suggest that the involvement of reliability will provide a handle on this problem.

In the middle of the 18th century, a new fad found its way into the gardens of England's well-to-do: building fake Gothic ruins. Newly constructed castle towers and walls looked like they were already falling apart, even on the first day of their creation. Made of stone, plaster, or even canvas, these "sham ruins" are often considered an embarrassing blip in English architectural history. However, Sham Ruins: A User's Guide expands the specific example of the sham ruin into a general (...) principle to examine the way purposely broken objects can be used both to uncover old truths and invent new ones. Along with architecture, work by Ivan Vladislavić, Tom Stoppard, Alain Mabanckou, Aleksei Fedorchenko, Michael Haneke, and Sturtevant is used to develop this thesis, as well as artifacts such as pre-torn jeans, fake histories, and broken screen apps. Using these examples, one of the key questions the book raises is: What is it that sham ruins ruin? In other words, if real ruins are ruins of what they actually are, then sham ruins should be considered ruins of what they are not. Thus sham ruins are about imposing new meaning where such meaning does not and should not exist. They also can show how things we think are functioning well are actually already broken. Sham ruins do this, and much more, by being lies, ruses, and embarrassments. This is what gives them the power with which we can think about objects in new, unintended ways. (shrink)

Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If (...) medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role?Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities. (shrink)

'By identifying the extent to which Aristotle's thinking about ethics was shaped by notions drawn from the crafts Angier has thrown new light on a surprising number of topics and has deepened our understanding of tensions within Aristotle's thought. It is by now a rare achievement to have said something new, true and important about Aristotle.' -- Alasdair MacIntyre, Emeritus Professor of Philosophy, University of Notre Dame, USA.

In three experiments, picture quality between test items was manipulated to examine whether subjects’ expectations about the fluency normally associated with these different stimuli might influence the effects of fluency on preference or familiarity-based recognition responses. The results showed that fluency due to pre-exposure influenced responses less when objects were presented with high picture quality, suggesting that attributions of fluency to preference and familiarity are adjusted according to expectations about the different test pictures. However, this expectations influence depended on subjects’ (...) awareness of these different quality levels. Indeed, imperceptible differences seemed not to induce expectations about the test item fluency. In this context, fluency due to both picture quality and pre-exposure influenced direct responses. Conversely, obvious, and noticed, differences in test picture quality did no affect responses, suggesting that expectations moderated attributions of fluency only when fluency normally associated with these different stimuli was perceptible but difficult to assess. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our (...) analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

This paper explores ethical issues raised by whole slide image-based computational pathology. After briefly giving examples drawn from some recent literature of advances in this field, we consider some ethical problems it might be thought to pose. These arise from the tension between artificial intelligence research—with its hunger for more and more data—and the default preference in data ethics and data protection law for the minimisation of personal data collection and processing; the fact that computational pathology lends itself to kinds (...) of data fusion that go against data ethics norms and some norms of biobanking; the fact that AI methods are esoteric and produce results that are sometimes unexplainable and the fact that computational pathology is particularly dependent on scanning technology manufacturers with interests of their own in profit-making from data collection. We shall suggest that most of these issues are resolvable. (shrink)

As incoming Editor and Deputy Editor we describe our impression of the current situation that those committed to understanding and upholding environmental values find themselves in. We consider some of the factors that make enviornmental concern difficult to maintain, including conditions that affect us as academics, publishers, global citizens and activists. We describe some of the emerging trends that have appeared in Environmental Values in recent years, in philosophy, ecological economics, critical social science and widening interdisciplinarity in the environmental humanities. (...) We highlight the journal's commitment to engaged, plural and open investigation of environmental values and consider what we might expect and hope for in the coming years. (shrink)

Recent work in the metaphysics of gender mostly focuses on trying to solve the exclusion problem - roughly, the problem of giving a metaphysical account of gender that doesn’t exclude anyone from their appropriate gender category. It is acknowledged that no completely satisfactory answer to the exclusion problem has yet been given in the literature; typically such theories fail to account for the diverse experiences and characteristics of trans people. One response is to adopt an anti-realism about gender properties, such (...) as Heather Logue’s gender fictionalism. I rebut the move to an anti-realism, showing that it relies on assuming a representationalism about gender vocabulary that we need not hold. I put forward a non-representationalist theory of gender properties that analyses gender vocabulary in terms of its inferential profile, rather than its representational features. This theory constitutes a deflationary realism about gender properties; it solves the inclusion problem, and guarantees the first-person epistemic authority of an individual regarding their own gender identity. (shrink)

Canadian ethicists Jocelyn Downie and Udo Schuklenk seek to assess the effect of Canada’s decriminalisation of ‘medical assistance in dying’ ‘to inform Canada’s ongoing discussions and because other countries will confront the same questions if they contemplate changing their assisted dying law.’1 Their assessment focuses on two arguments earlier levied against expansion of these procedures. The first is that of a ‘slippery slope’ and the second is what they disingenuously call, ‘social determinants of health’. They conclude that, in both cases, (...) the effect of legislation permitting first limited and then expanded options for medical termination has been benign. The argument in this brief commentary is that the ‘slippery slope’ is clearly evident and support for those with chronic, progressive diagnoses a clear contributor to the ever increasing number of persons seeking MAID. Downie and Schuklenk first review the legal and legislative history of MAID. In Carter v Canada, the courts found …. (shrink)

This essay discusses ways in which contemporary mathematical logic may be reconciled with John Dewey’s logical theory. Standard formal techniques drawn from dynamic modal logic, situation theory, generative grammar, generalized quantifier theory, category theory, lambda calculi, game theoretic semantics, network exchange theory, etc., are accommodated within a framework consistent with Dewey’s Logic: The Theory of Inquiry (1938). This essay outlines some basic features of Dewey’s logical theory, working in a top-down fashion through various technical notions pertaining to existential and ideational (...) aspects of inquiry, from contextual notions of situations and ideologies, to primitive operational and empirical notions of modes of action and particular qualities. The aim here is to display the scope of Dewey’s logical theory and thus establish a framework relative to which details may be explored without losing sight of their larger significance. (shrink)

Some of the early‐modern changes in the social framing of science, while often believed to be essential, are shown to be contingent. They contribute to the flawed public narrative around science today, and especially to the misconceptions around science and religion. Four are examined in detail, each of which contributes to the demise of the contemplative stance that science both requires and offers. They are: (1) a turn from an immersed subject to the pretense of a pure objectivity, (2) a (...) turn from imagination as a legitimate pathway to knowledge, (3) a turn from shared and participative science to a restricted professionalism, and (4) an overprosaic reading of the metaphor of the “Book of Nature.” All four, but especially the imperative to consider reading nature as poetry, and a deeper examination of the entanglements between poetry and theoretical science, draw unavoidably on theological ideas, and contribute to a developing “theology of science.”. (shrink)

Democracies and authoritarian regimes have different approaches to international law, grounded in their different forms of government. As the balance of power between democracies and non-democracies shifts, it will have consequences for international legal order. Human rights may face severe challenges in years ahead, but citizens of democratic countries may still benefit from international legal cooperation in other areas. Ranging across several continents, this volume surveys the state of democracy-enhancing international law, and provides ideas for a way forward in the (...) face of rising authoritarianism. (shrink)

This article explores the basic assumptions of Generative Lexicon Theory (GL) and the implications for the general theory of the linguistic sign that arise from the generative mechanisms “selective binding,” “co-composition,” and “type coercion.” The article focuses on the assumption underlying GL that interpretation and polysemy are part of lexical structure. It is shown that encoded lexical meaning and inferred non-lexical knowledge cannot be clearly distinguished in GL. In order to be consistent, GL must also be supplemented by a theory (...) of “normal language use” and be able to account for semantic underspecification in a semiotically coherent way. (shrink)

ABSTRACTIt is known that people covertly attend to threatening stimuli even when it is not beneficial for the task. In the current study we examined whether overt selection is affected by the presence of an object that signals threat. We demonstrate that stimuli that signal the possibility of receiving an electric shock capture the eyes more often than stimuli signalling no shock. Capture occurred even though the threat-signalling stimulus was neither physically salient nor task relevant at any point during the (...) experiment. Crucially, even though fixating the threat-related stimulus made it more likely to receive a shock, results indicate that participants could not help but doing it. Our findings indicate that the presence of a stimulus merely signalling the possibility of receiving a shock is prioritised in selection, and exogenously captures the eyes even when this ultimately results in the execution of the threat. Oculomotor capture was particularly pronounced for the fastest saccades which is consistent with the idea that threat influences visual selection at an early stage of processing, when selection is mainly involuntarily. (shrink)

In this essay we critically evaluate the progress that has been made in solving the problem of meaning in artificial intelligence (AI) and robotics. We remain skeptical about solutions based on deep neural networks and cognitive robotics, which in our opinion do not fundamentally address the problem. We agree with the enactive approach to cognitive science that things appear as intrinsically meaningful for living beings because of their precarious existence as adaptive autopoietic individuals. But this approach inherits the problem of (...) failing to account for how meaning as such could make a difference for an agent’s behavior. In a nutshell, if life and mind are identified with physically deterministic phenomena, then there is no conceptual room for meaning to play a role in its own right. We argue that this impotence of meaning can be addressed by revising the concept of nature such that the macroscopic scale of the living can be characterized by physical indeterminacy. We consider the implications of this revision of the mind-body relationship for synthetic approaches. (shrink)

Offers possible solutions to such medical dilemmas as who should receive organ transplants.

It is generally held that doctors and researchers have an obligation to obtain informed consent. Over time there has been a move in relation to this obligation from a requirement to disclose information to a requirement to ensure that that information is understood. Whilst this change has been resisted, in this article I argue that both sides on this matter are mistaken. When investigating what information is needed for consent to be informed we might be trying to determine what information (...) a person would need in order to consent at all, or we might be trying to determine what information a person needs in order to make an informed choice about whether or not to consent. I argue that the obligation to ensure understanding only applies to information generated by the first type of enquiry; but that much of the information generally thought necessary in order for consent to be informed is only required if our concern is with the second type of enquiry. For this reason it is neither the case that doctors and researchers should ensure all the information they provide is understood, nor is it the case that their only obligation is to disclose it. (shrink)

Previous studies show that medical students in clinical training face ethical problems that are not often discussed in the literature. In order to make teaching timely and relevant for them, it is important to understand what medical students perceive as ethical problems, as various factors may influence their perception, including cultural differences and working environment. The purpose of this qualitative study was to explore students’ perceptions of what an ethical problem is, during their clinical training in the hospital, and compare (...) the results from two different countries. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools, in Indonesia and the Netherlands. Data were interpreted and analyzed using content analysis. We found that students in both settings encounter problems which are closer to their daily work and responsibilities as medical students and perceive these problems as ethical problems. Indonesian students perceived substandard care and inequity in healthcare as ethical problems, while Dutch students perceived that cases which are not matters of life and death are less worthy to discuss. Our study suggests that there might be a gap between ethical problems that are discussed in class with teachers, and problems that students actually encounter in practice. Teachers should be aware of the everyday situations in clinical training which may be perceived by students as ethically problematic and should acknowledge and discuss these ethical problems with students as part of the learning processes in ethics education. (shrink)

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their (...) healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. (shrink)

This book focuses on the idea of a modus vivendi as a way of governing political life and addressing problems characterized by pluralism or deep-rooted diversity. The individual essays illustrate both the merits and the limitations of a political theory of modus vivendi; how it might be interpreted and developed; specific challenges entailed by articulating it in a convincing form; what its institutional implications might be; and how it relates to other seminal issues and concepts in political theory; such as (...) legitimacy, toleration, the social contract, etc. The book makes a significant contribution to the discussion on the scope and limits of liberal political theory, and on how to deal politically with deep-rooted diversity. (shrink)

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical grounds in dealing with two (...) problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics. (shrink)

We are living through a demographic transition from a world in which there were lots of young people and very few older adults to one in which the numbers in these age groups are becoming more evenly balanced. One reason for this is that more of us are living into our seventies, eighties, nineties, and beyond. That is the good news. Unfortunately, the chance of developing chronic illnesses (including diabetes, arthritis, and dementia) is typically higher for people in these older (...) age groups than for those who are younger. Because we do not know how to cure these illnesses, many of us will spend at least some of this extra time with one or more chronic illness. While we are more likely than in the past to live into older age, we are likely to be living with illness when we get there. That raises a challenge: how should we respond to this change? (shrink)