The theoretical and methodological underpinnings of the cognitive paradigm have traditionally been discussed against the background of generative grammar, its immediate predecessor. A significantly less researched yet no less interesting relationship is the one between the cognitive and structuralist paradigm. This article focuses on the in part converging, in part diverging semiotic assumptions underlying European structural linguistics and Cognitive Grammar. A comparison of important concepts of both theories shows that, although Cognitive Grammar arrives at a more realistic understanding of how (...) language works in discourse, the theory fails to offer a coherent theory of the linguistic sign. (shrink)

When Georg von der Gabelentz’s book Die Sprachwissenschaft was published, the historical-comparative paradigm was the dominant perspective in empirical linguistic enquiry, and the then current theory of language was fijirmly rooted in language psychology. While itself based in this tradition, Gabelentz’s Sprachwissenschaft nevertheless strikes another chord, which sets it apart from contemporary sources. This chapter argues that the book is particularly noteworthy for its wide-ranging bottom-up approach to linguistic phenomena and its propensity to conceive of language both as object and (...) instrument of enquiry in a sense akin to the ‘reflexive’ stance that later would become a hallmark of Edmund Husserl’s phenomenology. The ‘phenomenological mindset’ can in particular be retraced in the way a diffferent philosophy of the language sciences and theory of meaning take shape in Die Sprachwissenschaft. (shrink)

philosophy of language, the study of the essence of language and its importance to mankind and culture, is concerned with the relationship between linguistic signs and thought, knowledge , consciousness, logic, communication, truth, reference, and reality.

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)

The volume is published on the occasion of the birth centennial of Eugenio Coseriu (1921–2002). It is the first collective volume to appear in English in which various scholars present a variety of perspectives on Coseriu’s scholarly work and discuss its continuing relevance for the language sciences. Coseriu’s international reputation has suffered from his commitment to publish in languages such as Spanish, German, French, Italian, Romanian and Portuguese, to the detriment of English. As a consequence, his work is less well-known (...) outside Romance and German linguistics. The volume aims to raise the general awareness of Coseriu’s work among linguists around the world, in accordance with Coseriu’s own adage that it takes a constructive mindset (acknowledging "accomplishments and limitations") to do justice to all scholarly work in the humanities. The articles are organized into three major thematic clusters: 1) philosophy of language, 2) history of the language sciences and 3) theory and practice of "Integral Linguistics". The volume is essential reading for anyone working in these fields and for those seeking to gain deeper understanding of Coseriu’s goal to develop a unitary approach to language which takes as its point of departure the "activity of speaking". (shrink)

To Aristotle, spoken words are symbols, not of objects in the world, but of our mental experiences related to these objects. Presently there are two major strands of interpretation of Aristotle’s concept of the linguistic sign. First, there is the structuralist account offered by Coseriu (Geschichte der Sprachphilosophie. Von den Anfängen bis Rousseau, 2003 [1969], pp. 65–108) whose interpretation is reminiscent of the Saussurean sign concept. A second interpretation, offered by Lieb (in: Geckeler (Ed.) Logos Semantikos: Studia Linguistica in Honorem (...) Eugenio Coseriu 1921–1981, 1981) and Weidemann (in: Schmitter (Ed.) Geschichte der Sprachtheorie 2. Sprachtheorien der abendländischen Antike, 1991), says that Aristotle’s concept of the linguistic sign is similar to the one presented in Ogden and Richard’s (The meaning of meaning: A study of the influence of language upon thought and of the science of symbolism, 1970 [1923]) semiotic triangle. This paper starts off with an introductory outline of the so-called phýsei-thései discussion which started during presocratic times and culminated in Plato’s Cratylus. Aristotle’s concept of the linguistic sign is to be regarded as a solution to the stalemate position reached in the Cratylus. Next, a discussion is offered of both Coseriu’s and Lieb’s analysis. We submit that Aristotle’s concept of the linguistic sign shows features of both Saussure’s and Ogden and Richards’s sign concept but that it does not exclusively predict one of the two. We argue that Aristotle’s concept of the linguistic sign is based on three different relations which together evince his teleological as well empiricist point of view: one internal (symbolic) relation and two external relations, i.e. a likeness relation and a relation katà synthéken. (shrink)

This article is the introduction to the 7th volume of the Iconicity in Language and Literature Series. First a brief historical outline of the concepts of naturalness and iconicity in linguistic theory is given. Both concepts are then separately dealt with in two sections, in which each concept is elaborated and an overview of seminal readings on naturalness and iconicity is presented. A thorough discussion is also provided of some unresolved issues in the iconicity and naturalness debates. The article rounds (...) off with a summary of the papers collected in the volume. (shrink)

To Aristotle, spoken words are symbols, not of objects in the world, but of our mental experiences related to these objects. Presently there are two major strands of interpretation of Aristotle’s concept of the linguistic sign. First, there is the structuralist account offered by Coseriu (Geschichte der Sprachphilosophie. Von den Anfängen bis Rousseau, 2003 [1969], pp. 65–108) whose interpretation is reminiscent of the Saussurean sign concept. A second interpretation, offered by Lieb (in: Geckeler (Ed.) Logos Semantikos: Studia Linguistica in Honorem (...) Eugenio Coseriu 1921–1981, 1981) and Weidemann (in: Schmitter (Ed.) Geschichte der Sprachtheorie 2. Sprachtheorien der abendländischen Antike, 1991), says that Aristotle’s concept of the linguistic sign is similar to the one presented in Ogden and Richard’s (The meaning of meaning: A study of the influence of language upon thought and of the science of symbolism, 1970 [1923]) semiotic triangle. This paper starts off with an introductory outline of the so-called phýsei-thései discussion which started during presocratic times and culminated in Plato’s Cratylus. Aristotle’s concept of the linguistic sign is to be regarded as a solution to the stalemate position reached in the Cratylus. Next, a discussion is offered of both Coseriu’s and Lieb’s analysis. We submit that Aristotle’s concept of the linguistic sign shows features of both Saussure’s and Ogden and Richards’s sign concept but that it does not exclusively predict one of the two. We argue that Aristotle’s concept of the linguistic sign is based on three different relations which together evince his teleological as well empiricist point of view: one internal (symbolic) relation and two external relations, i.e. a likeness relation and a relation katà synthéken. (shrink)

Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

If one formulates Helmholtz's ideas about perception in terms of modern-day theories one arrives at a model of perceptual inference and learning that can explain a remarkable range of neurobiological facts. Using constructs from statistical physics it can be shown that the problems of inferring what cause our sensory inputs and learning causal regularities in the sensorium can be resolved using exactly the same principles. Furthermore, inference and learning can proceed in a biologically plausible fashion. The ensuing scheme rests on (...) Empirical Bayes and hierarchical models of how sensory information is generated. The use of hierarchical models enables the brain to construct prior expectations in a dynamic and context-sensitive fashion. This scheme provides a principled way to understand many aspects of the brain's organisation and responses. In this paper, we suggest that these perceptual processes are just one emergent property of systems that conform to a free-energy principle. The free-energy considered here represents a bound on the surprise inherent in any exchange with the environment, under expectations encoded by its state or configuration. A system can minimise free-energy by changing its configuration to change the way it samples the environment, or to change its expectations. These changes correspond to action and perception, respectively, and lead to an adaptive exchange with the environment that is characteristic of biological systems. This treatment implies that the system's state and structure encode an implicit and probabilistic model of the environment. We will look at models entailed by the brain and how minimisation of free-energy can explain its dynamics and structure. (shrink)

This introductory chapter gives an overview of the debate on realism in political theory and sets out two themes that are particularly important for this debate: the role of practice in realist political theory and the nature and place of normativity in realist political theory. These two themes are not only among the most discussed topics in the debate on possibilities to do realist political theory. Answers to the question of what more applied forms of realist political theory might look (...) like will also depend significantly on how realists specify the role of practice in political theory and the meaning of realist normative argumentation. We outline some of the main positions in the field and highlight questions that have been insufficiently addressed. Finally, we give an overview of the arguments of the articles assembled in this collection and how they contribute to the ongoing debates on the two themes. (shrink)

Fragile X syndrome is the most common cause of inherited mental retardation in humans. The fragile X gene (FMR1) has been cloned and the mutation causing the disease is known. The molecular basis of the disease is an expansion of a trinucleotide repeat sequence (CGG) present in the first exon within the 5′ untranslated region of the FMR1 gene. Affected individuals have repeat CGG sequences of above 200. As a result the gene is not producing protein. It has been shown (...) that the FMR1 protein has RNA binding activity, but the function of this RNA binding activity is not known. The timing and mechanism of repeat amplification are not yet understood. An animal model for fragile X syndrome has been generated, which can be used to study the clinical and biochemical abnormalities caused by absence of FMR1 protein product. (shrink)

Humans can recollect past events in details and/or know that an object, person, or place has been encountered before. During the last two decades, there has been intense debate about how recollection and familiarity are organized in the brain. Here, we propose an integrative memory model which describes the distributed and interactive neurocognitive architecture of representations and operations underlying recollection and familiarity. In this architecture, the subjective experience of recollection and familiarity arises from the interaction between core systems and an (...) attribution system. By integrating principles from current theoretical views about memory functioning, we provide a testable framework to refine the prediction of deficient versus preserved mechanisms in memory-impaired populations. The case of Alzheimer's disease is considered as an example because it entails progressive lesions starting with limited damage to core systems before invading step-by-step most parts of the model-related network. We suggest a chronological scheme of cognitive impairments along the course of AD, where the inaugurating deficit would relate early neurodegeneration of the perirhinal/anterolateral entorhinal cortex to impaired familiarity for items that need to be discriminated as viewpoint-invariant conjunctive entities. The integrative memory model can guide future neuropsychological and neuroimaging studies aiming to understand how such a network allows humans to remember past events, to project into the future, and possibly also to share experiences. (shrink)

BackgroundThe emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD).AimExplore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD).MethodsSemi-structured, future scenario-based (...) interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission’s Ethics Guidelines for Trustworthy AI to structure the interviews.ResultsSix themes arose from the interviews: the ability of AI to rectify human doctors’ limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the ‘human touch’; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the ‘human touch’ in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients’ individual contexts and values, in consultation with the patient.ConclusionThe ‘human touch’ patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the ‘right to a human doctor’ is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward. (shrink)

Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

En el contexto político global contemporáneo, las diversas luchas sociales se están alienando entre sí hasta elpunto de que la ilusión del capitalismo como único sistema socioeconómico posible está difuminando todos los horizontesdel cambio social. En este artículo, trataremos de redefinir las causas comunes de las luchas sociales, demostrando su interseccionalidad e interdependencia. Para ello, nos ocuparemos de una serie de conceptos de la filosofía de Marx. En la introducción, examinaremos la noción de valor, afirmando que la teoría del valor (...) de Marx no es simplemente una teoría laboral del valor, sino que más bien refleja la estructura paralela de la producción y la circulación, cristalizada en la forma de valor última del dinero. Una vez obtenidas estas ideas preliminares, volveremos al fenómeno del trabajo en el capitalismo, para reinterpretar, en la primera sección del artículo, la distinción marxiana entre trabajo productivo e improductivo. A partir de ahí, se darán los primeros ejemplos concretos de la interseccionalidad de las luchas sociales contra la abstracción del capital: a saber, mostrar que las luchas de género y las raciales tienen ciertas causas comunes, enraizadas en la hegemonía gramsciana. En la segunda sección, examinaremos la distinción que Marx establece entre la subsunción formal y la real. Esta última, afirmaremos, es decisiva para entender cómo el capital estructura la cuasi-totalidad de nuestras relaciones sociales. Tras una interpretación de la película Toni Erdmann de Maren Ade, propondremos algunos medios posibles de lucha interseccional contra la subsunción real, que encontrarán su respaldo teórico en el concepto de universales subversivos. Las observaciones finales abordarán la lógica nuclear de la distribución y la acumulación del capital, un síntoma que pervive a lo largo de la historia preservado e impulsado por la omnipresencia de la ideología, y subrayarán de nuevo implícitamente la importancia de la lucha común en el descongelamiento de la emergencia de un nuevo sujeto revolucionario. (shrink)

The integrative memory model formalizes a new conceptualization of memory in which interactions between representations and cognitive operations within large-scale cerebral networks generate subjective memory feelings. Such interactions allow to explain the complexity of memory expressions, such as the existence of multiples sources for familiarity and recollection feelings and the fact that expectations determine how one recognizes previously encountered information.

In recent years, to protect the rights and welfare of human subjects, institutions in the USA have begun to set up programmes to monitor ongoing medical research. These programmes provide routine, onsite oversight, and thus go beyond existing oversight such as investigating suspected misconduct or reviewing paperwork provided by investigators. However, because of a lack of guidelines and evidence, institutions have had little guidance in setting up their programmes. To help institutions make the right choices, we used interviews and document (...) analysis to study how and why 11 US institutions have set up their monitoring programmes. Although these programmes varied considerably, we were able to distinguish two general types. ‘Compliance’ programmes on the one hand were part of the institutional review board office and set up to ensure compliance with regulations. Investigators’ participation was mandatory. Monitors focused on documentation. Investigators could be disciplined, and could be obliged to take corrective actions. ‘Quality-improvement’ programmes on the other hand were part of a separate office. Investigators requested to be monitored. Monitors focused more on actual research conduct. Investigators and other parties received feedback on how to improve the research process. Although both types of programmes have their drawbacks and advantages, we argue that if institutions want to set up monitoring programmes, quality improvement is the better choice: it can help foster an atmosphere of trust between investigators and the institutional review board, and can help raise the standards for the protection of human subjects. (shrink)

People in Java traditionally internalise the value of ‘nrima’. It is a verb, from the noun ‘ trima’ in Javanese language (box 1). The closest word to ‘nrima’ in English is acceptance, although the meaning in local wisdom is deeper. Historically, the concept is known as ‘ nrima ing pandhum’, which means a wholehearted, sincere and grateful acceptance of life events (usually unfortunate) that are given to us. This nrima attitude will result in resilience, perseverance and adaptability in facing adversity. (...) Nowadays, it is commonly shortened to ‘ nrimo’ or ‘nrima’. Nrima in daily life of Javanese is practised as accepting an event wholeheartedly, with a grateful feeling of an event or something that is (usually) unfortunate. Nrima involves accepting without protest and without being destructive, but not apathetic (continuing to try to overcome).1 2 Nrima can involve active reflection, reasoning and an attitude to turn something one initially thought was unacceptable into acceptance. However, nowadays nrima is often misinterpreted as deliberate, fatalistic and passive acceptance of a hardship, including health and disease.3 This misinterpretation of nrima has ethical relevance in the patient–doctor relationship. Box 1 ### Description about the context and Javanese language About the context and Javanese language. (shrink)

Kontingenz als der Bereich des Unbestimmten, Ambivalenten und Möglichen wirft Fragen auf, die für Geistes- und Sozialwissenschaften gleichermaßen relevant sind. Dennoch besteht ein gewisses Ungleichgewicht zwischen den Disziplinen. Kontingenz wird in der Politikwissenschaft weitaus weniger berücksichtigt als in Soziologie und Geschichtswissenschaft. Die interdisziplinär angelegte Aufsatzsammlung führt daher soziologische und geschichtswissenschaftliche mit dezidiert politikwissenschaftlichen Perspektiven zusammen. Ausgewiesene Wissenschaftler und Wissenschaftlerinnen befassen sich mit den Herausforderungen der kontingenzsensiblen Forschung für die Politikwissenschaft. Sie beziehen sich dabei auf ausgewählte empirische Beispiele, wie die normativen (...) Grundlagen politischen Handelns, die Probleme moderner Demokratie, und die politische Dynamik der europäischen Integration. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the Netherlands. We observed a total (...) of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

Persons with profound intellectual and multiple disabilities cannot speak about their Quality of Life, which makes it necessary to involve others. In current approaches, these ‘others’ are seen as assessors trying to describe QoL as objectively as possible, which involves a reduction of their experiences, through which they develop knowledge on the QoL of the person with PIMD. The objective of this paper is to give caregivers’ knowledge on the QoL of a person with PIMD a theoretical basis that values (...) these experiences. We will argue that caregivers should be seen as witnesses, not assessors, and their statements on QoL as testimonies, not assessments. Audiences judge the trustworthiness of these witnesses intersubjectively, which implies a relationship characterized by trust and suspicion. Trust supports the witness to tell in her own words about the QoL of the person with PIMD; it demands receptivity, indicating that both the witness and the audience are willing to reconsider their perspective on QoL. Suspicion is necessary too, which helps the witness to critically approach her own interpretations and supports her to create more trustworthy testimonies. We conclude that the concept of witnessing helps to acknowledge caregivers’ experiential knowledge of QoL of a person with PIMD, which may also apply to other persons who cannot speak about their own QoL. We hope that our study will empower caregivers to give testimonies on QoL of a person with PIMD, which is crucial when complex decisions about the life of this person have to be made. (shrink)

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

At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...) interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach. (shrink)

This article explores the philosophy of Alain Badiou from the vantage point of the concepts of the localization, delocalization, and relocalization of the void as thematized through literary arts, religion, emancipatory politics, and the subject of psychoanalysis. In short, these moments around the void characterize the processes through which truth is processed and seen through their full realization by a philosophical engagement across the various conditions in which these truths occur. The localization of a void is the naming of an (...) indiscernible element that is incommensurable to the rubric of constructible knowledge, sense and meaning which could saturate the space of truth. Thus, the naming that localizes the void acts as a subtraction of the invariant in the variance of situation such that across various points in space and time, we are still able to subtract the universal as the invariant not just as the fidelity to the localized truth but also as the resurrection of truth upon its relocalization at a different place and a different time. At its core, this article is concerned with truth, why truth is persistent, and why we have to struggle to articulate the truth that we are trying to be faithful to again and again with each instance that truth risks being covered-over and obscured. (shrink)

A la luz de algunas críticas recientes, en el marco de este texto se busca impulsar un debate que tiene lugar en dos frentes: por una parte, la lógica del origen de la lógica y, por otra parte, la relación entre psicoanálisis y marxismo. Para ello se recuperan algunos textos publicados por Alain Badiou hacia finales de la década de 1960, en los que polemiza con Jacques-Alain Miller alrededor de los concepto de "sutura" y "sujeto" (Zizek), para situar tanto las (...) diversas posiciones como las coherentes reconsideraciones a lo largo de su trayectoria intelectual. En efecto, desde "El concepto de modelo" hasta su más reciente trilogía (Teoría del sujeto, El ser y el acontecimiento y Lógica de los Mundos), se propone una perspectiva que lejos de establecer jerarquías y subordinaciones busca promover conexiones a partir de las especificidades y las diferencias a través de esa vía particular que es la filosofía. De este modo resulta posible apreciar que, pese a su crítica respecto de la primacía de la lógica del significante, los conceptos propuestos por Jacques Lacan funcionaron como una notoria fuente de inspiración para Badiou, especialmente en relación con el sujeto del inconsciente. (shrink)

Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within (...) a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research. (shrink)

From 22-25 May, 1999, the University of Groningen hosted an international conference on 'The Book of Nature. Continuity and change in European and American attitudes towards the natural world'. From Antiquity down to our own time, theologians, philosophers and scientists have often compared nature to a book, which might, under the right circumstances, be read and interpreted in order to come closer to the 'Author' of nature, God. The 'reading' of this book was not regarded as mere idle curiosity, but (...) it was seen as leading to a deeper understanding of God's wisdom and power, and it culturally legitimated and promoted a positive attitude towards nature and its study. A selection of the papers which were delivered at the conference has been edited in two volumes. The first deals with the perception of the Book of Nature in Antiquity and the Middle Ages; the second volume is devoted to the history of the concept in early modern and modern history. (shrink)

The hypothesis of no prime worlds (NPW) holds that for any possible world x that an omnipotent being has the power to actualize, there is a better world, y , that the omnipotent being could have actualized instead of x . NPW is generally deployed to defend theism against the charge that God failed to do his best in actualizing this world. Sometimes this view is deployed to defend theism against the charge that God failed to do better in actualizing (...) this world. These defences are compelling, and, accordingly, critics of theism have developed new anti-theistic arguments on NPW. Most anti-theistic arguments on this view are a posteriori : they typically hold that a God-actualized world would exhibit (or lack) certain features, and that, since the actual world fails (or seemingly fails) to conform to these expectations, it is reasonable to believe that God does not exist. Since most of these arguments appeal to certain claims about evil, they may be treated as versions of the problem of evil. Such arguments are controversial, and the literature surrounding them is vast. (shrink)