Dissociative symptoms have been related to higher rapid eye movement sleep density, a sleep phase during which hyperassociativity may occur. This may enhance artistic creativity during the day. To test this hypothesis, we conducted a creative photo contest to explore the relation between dissociation, sleep, and creativity. During the contest, participants (N = 72) took one photo per day for five consecutive days, based on specific daily themes (consisting of single words) and the instruction to take as creative a photo (...) as possible each day. Furthermore, they completed daily measures of state dissociation and a short sleep diary. The photos and their captions were ranked by two professional photographers and two clinical psychologists based on creativity, originality, bizarreness, and quality. We expected that dissociative people would rank higher in the contest compared with low-dissociative participants, and that the most original photos would be taken on days when the participants scored highest on acute dissociation. We found that acute dissociation predicted a higher ranking on creativity. Poorer sleep quality and fewer hours of sleep predicted more bizarreness in the photos and captions. None of the trait measures could predict creativity. In sum, acute dissociation related to enhanced creativity. These findings contribute to our understanding of dissociative symptomatology. (shrink)

Llewellyn has written a fascinating article about rapid eye movement dreams and how they promote the elaborative encoding of recent memories. The main message of her article is that hyperassociative and fluid cognitive processes during REM dreaming facilitate consolidation. We consider one potential implication of this analysis: the possibility that excessive or out-of-phase REM sleep fuels dissociative symptomatology. Further research is warranted to explore the psychopathological ramifications of Llewellyn's theory.

Insight problem solving is thought to underpin creative thought as it incorporates both divergent (generating multiple ideas and solutions) and convergent (arriving at the optimal solution) thinking approaches. The current literature on schizotypy and creativity is mixed and requires clarification. An alternate approach was employed by designing an exploratory web-based study using only correlates of schizotypal traits (paranoia, dissociation, cognitive failures, fantasy proneness, and unusual sleep experiences) and examining which (if any) predicted optimal performance on an insight problem-solving task. One (...) hundred and twenty-one participants were recruited online from the general population and completed the number reduction task. The discovery of the hidden rule (HR) was used as a measure of insight. Multivariate logistic regression analyses highlighted persecutory ideation to best predict the discovery of the HR (OR = 1.05; 95% CI 1.01–1.10, p = 0.017), with a one-point increase in persecutory ideas corresponding to the participant being 5% more likely to discover the HR. This result suggests that persecutory ideation, above other schizotypy correlates, may be involved in insight problem solving. (shrink)

In this article, I examine the relation between Bateson and Guattari’s ecological thoughts: two thinkers whose ecological ideas at first sight have a lot in common. In order to show the difference between the thoughts of both thinkers, I will take my clue from Guattari’s remark that he parts ways with Bateson on the role of context. Explaining the role of context in both authors will allow me to show how Guattari’s thought implies both an endorsement and a critique of (...) cybernetics, and, specifically, promoting a machinic rather than cybernetic ecology. I will conclude by indicating what is at stake in this distinction. (shrink)

Dynamic Epistemic Logic This article tells the story of the rise of dynamic epistemic logic, which began with epistemic logic, the logic of knowledge, in the 1960s. Then, in the late 1980s, came dynamic epistemic logic, the logic of change of knowledge. Much of it was motivated by puzzles and paradoxes. The number … Continue reading Dynamic Epistemic Logic →.

Some alethic pluralists maintain that there are two kinds of truths operant in our alethic discourse: a realist kind and an anti-realist kind. In this paper, we argue that such a binary conception cannot accommodate certain social truths, specifically truths about race. Most alethic pluralists surprisingly overlook the status of racial truths. Douglas Edwards is, however, an exception. In his version of alethic pluralism—Determination Pluralism—racial truths are superassertible (anti-realist) true rather than correspondence (realist) true. We argue that racial truths exhibit (...) features of both superassertibility (anti-realism) and correspondence (realism). This suggests a fuzzy boundary between realist and anti-realist kinds of truth. There may be a continuum rather than a dichotomy of truths. We conclude by sketching one way for alethic pluralists to accommodate such a notion. (shrink)

Dynamic Epistemic Logic This article tells the story of the rise of dynamic epistemic logic, which began with epistemic logic, the logic of knowledge, in the 1960s. Then, in the late 1980s, came dynamic epistemic logic, the logic of change of knowledge. Much of it was motivated by puzzles and paradoxes. The number … Continue reading Dynamic Epistemic Logic →.

Abstract‘Social inclusion’ is the leading ideal in services and care for people with intellectual disabilities in most countries in the Global North. ‘Social inclusion’ can refer simply to full equal rights, but more often it is taken to mean something like ‘community participation’. This narrow version of social inclusion has become so ingrained that it virtually goes unchallenged. The presumption appears to be that there is a clear moral consensus that this narrow understanding of social inclusion is good. However, that (...) moral consensus is not clear in the case of people with profound intellectual and/or multiple disabilities (PIMD), who are not able to express their needs and preferences verbally. Moreover, social inclusion has proven to be difficult to conceptualize and implement for people with PIMD. Therefore, it becomes imperative to ask about the ethical rationale of the narrow understanding of social inclusion. For what reasons do we think social inclusion is good? And do those reasons also apply for people with PIMD? This article addresses these questions by providing an ethical analysis of the ideal of social inclusion for people with PIMD. It discusses four ethical arguments for social inclusion and probes their relevance for people with PIMD. The article argues that none of these arguments fully convince of the value of the narrow understanding of social inclusion for people with PIMD. It ends with advocating for an ethical space for imagining a good life for people with PIMD otherwise. (shrink)

Background Notwithstanding the need to produce evidence-based knowledge on medications for pregnant women, they remain underrepresented in clinical research. Sometimes they are excluded because of their supposed vulnerability, but there are no universally accepted criteria for considering pregnant women as vulnerable. Our aim was to explore whether and if so to what extent pregnant women are vulnerable as research subjects. Method We performed a conceptual and empirical analysis of vulnerability applied to pregnant women. Analysis A conceptual analysis supports Hurst's definition (...) of vulnerability. Consequently, we argue that pregnant women are vulnerable if they encounter an identifiably increased likelihood of incurring additional or greater wrong. According to the literature, this increased likelihood could exist of four alleged features for pregnant women's vulnerability: informed consent, susceptibility to coercion, higher exposure to risk due to lack of knowledge, vulnerability of the fetus. Discussion Testing the features against Hurst's definition demonstrates that they all concern the same issue: pregnant women are only vulnerable because a higher exposure to risk due to lack of scientific knowledge comprises an increased wrong. Research Ethics Committees have a responsibility to protect the vulnerable, but a higher exposure to risk due to lack of scientific knowledge is a much broader issue and also needs to be addressed by other stakeholders. Conclusions The only reason why pregnant women are potentially vulnerable is to the extent that they are increasingly exposed to higher risks due to a lack of scientific knowledge. Accordingly, the discussion can advance to the development of practical strategies to promote fair inclusion of pregnant women in clinical research. (shrink)

To understand pre-Fregean theories of judgment and proposition, such as those found in Locke and the Port-Royal logic, it is important to distinguish between propositions in the modern sense and propositions in the pre-Fregean sense. By making this distinction it becomes clear that these pre-Fregean theories cannot be meant to solve the propositional attitude problem. Notwithstanding this fact, Locke and Arnauld are able to make a distinction between asserted and unasserted propositions (in their sense). The way Locke makes this distinction (...) turns out to be very different from the way it is made by Arnauld. (shrink)

The Russian invasion of Ukraine on February 24, 2022, has already caused large amounts of greenhouse gas (GHG) emissions and will continue to do so for manyyears after hostilities have ceased mainly because of the emissions linked to the rebuilding of destroyed or damaged housing, public buildings, infrastructure, factories, and the like. My aim in this paper is to discuss how in a time of climate emergency such emissions of war should impact the political morality of states initiating, continuing, and (...) ending war (through a just and enduring peace) as understood by just war theory (JWT). My point of departure is a study by Lennard de Klerk and six co-authors detailing the emissions of the first year of the Russo-Ukrainian war. (shrink)

In this paper, we examine the relationship between Christian religiosity, attitudes towards corporate social responsibility, and CSR behavior of executives. We distinguish four types of CSR attitudes and five types of CSR behavior. Based on empirical research conducted among 473 Dutch executives, we find that CSR attitudes mediate the influence of religiosity on CSR behavior. Intrinsic religiosity positively affects the ethical CSR attitude and negatively affects the financial CSR attitude, whereas extrinsic religiosity stimulates the philanthropic CSR attitude. Financial, ethical, and (...) philanthropic CSR attitudes significantly affect some types of CSR behaviors. However, because religiosity has opposing effects on the three attitudes, the joint mediation effect of the three attitudes is negligible. Furthermore, we find a direct negative influence of intrinsic religiosity on diversity and a direct positive influence on charity. (shrink)

Ernest Mandel theorised the capitalist world economy as an articulated system of capitalist, semi-capitalist and precapitalist relations of production, linked to each other by capitalist relations of exchange and domination by the capitalist world market. This seems to be an interesting starting point for an historically well-founded theory, building on and going beyond Marx's work, of the worldwide expansion of the capitalist mode of production from its origins to the present. In his attempt to formulate his theory, Mandel did not (...) succeed in resolving all difficulties, however. His main works – Marxist Economic Theory and Late Capitalism – show a number of dangling loose ends. The central question is whether these loose ends are merely technical difficulties or whether they reveal fatal flaws in the theory as a whole. In order to come a step closer to answering this question, a conference was organised in Amsterdam, November 2003. This introduction formulates the five, closely interrelated issues that were highlighted at this conference. (shrink)

Over the past decades, both wild and domesticated insect pollinators are in dramatic decline, which puts at stake the existence of species, ecosystem resilience and global food security. Globally, 87 of major food crops depend on animal pollination. Together these account for 35 % of the world food production volume. Pollinator mediated crops are indispensable for essential micronutrients in the human diet. Many ornamental plants as well as crops for fibre, fodder, biofuels, timber and phytopharmaceuticals also depend on insect pollinators. (...) This article aims to map the current situation of pollinators worldwide, with a focus on the critical role of pollinators in the human food chain and ecosystem sustainability, their intrinsic and extrinsic value, as well as the causes of their declines and the interventions needed to conserve them, in order to develop an argument for the importance of conserving and restoring pollinator populations and diversity. The present pollinator crisis threatens global and local food security, can worsen the problems of hidden hunger, erodes ecosystem resilience, and can destabilise ecosystems that form our life support system. An integrated approach that simultaneously addresses the key drivers is needed. This includes creation and restoration of floral and nesting resources, a global phase out of prophylactic use of neonicotinoids and fipronil, improvement of test protocols in authorisation of agrochemicals, and restoration and maintenance of independence in regulatory science. The authors argue that an international treaty for global pollinator stewardship and pollinator ecosystem restoration should be initiated in order to systemically counteract the current crisis. (shrink)

Most research in environmental psychology is conducted in individualistic countries and focuses on factors pertaining to individuals. It is yet unclear whether these findings also apply to more collectivistic countries, in which group factors might play a prominent role. In the current paper, we test the individual-focused value–identity–behaviour pathway, in which personal biospheric values relate to pro-environmental actions via environmental self-identity, in an individualistic and a collectivistic country. Furthermore, we test in both countries whether a new group-focused pathway also exists, (...) in which group values relate to pro-environmental behaviour via environmental group identity, particularly in collectivistic countries. Questionnaire studies were conducted among Dutch and Chinese students. Our results indicated that personal biospheric values, mostly via environmental self-identity, predict pro-environmental behaviour in both countries. We also found initial support for our newly proposed value–identity–behaviour pathway at the group level, particularly in China. Yet, in both countries, the association between group-level variables and pro-environmental behaviour was weaker than for personal-level variables, and partly overlapped with personal-level variables. Our findings show the relevance of personal- and group-level factors in understanding pro-environmental behaviour in both individualistic and collectivistic countries, which has strong theoretical and practical implications, particularly for developing international strategies to promote pro-environmental actions across the world. (shrink)

ABSTRACTIn The Netherlands, the public funding of a number of health care services is controversial. What can we learn from this about the moral concerns that underlie these judgements? And, if there is anything to learn, can we use this improved understanding to scrutinise the adequacy of particular decisions concerning the public funding of health care services? In the present paper, I will analyse three cases: corrective surgey, In Vitro Fertilisation and liver transplantation. I will summarise the arguments that have (...) been used to support or to challenge the public funding of these services. I will then assess the merits of Daniels’fair equality of opportunity account of justice in health care. Can this account improve our understanding of the moral concerns underlying our judgements about the public funding of these services? Can it serve to scrutinise the adequacy of particular decisions that are made concerning the public funding of health care services? My answer to both questions will be a qualified yes. Daniels’account can provide guidance, but not because we can deductively infer from it what is right and what is wrong. Instead, I will argue for a more casuistic use of the concept of fair equality of opportunity. (shrink)

The notion of cognitive act is of importance for an epistemology that is apt for constructive type theory, and for epistemology in general. Instead of taking knowledge attributions as the primary use of the verb 'to know' that needs to be given an account of, and understanding a first-person knowledge claim as a special case of knowledge attribution, the account of knowledge that is given here understands first-person knowledge claims as the primary use of the verb 'to know'. This means (...) that a cognitive act is an act that counts as cognitive from a first-person point of view. The method of linguistic phenomenology is used to explain or elucidate our epistemic notions. One of the advantages of the theory is that an answer can be given to some of the problems in modern epistemology, such as the Gettier problem. (shrink)

Human cognition is unique in the way in which it relies on combinatorial (or compositional) structures. Language provides ample evidence for the existence of combinatorial structures, but they can also be found in visual cognition. To understand the neural basis of human cognition, it is therefore essential to understand how combinatorial structures can be instantiated in neural terms. In his recent book on the foundations of language, Jackendoff described four fundamental problems for a neural instantiation of combinatorial structures: the massiveness (...) of the binding problem, the problem of 2, the problem of variables, and the transformation of combinatorial structures from working memory to long-term memory. This paper aims to show that these problems can be solved by means of neural “blackboard” architectures. For this purpose, a neural blackboard architecture for sentence structure is presented. In this architecture, neural structures that encode for words are temporarily bound in a manner that preserves the structure of the sentence. It is shown that the architecture solves the four problems presented by Jackendoff. The ability of the architecture to instantiate sentence structures is illustrated with examples of sentence complexity observed in human language performance. Similarities exist between the architecture for sentence structure and blackboard architectures for combinatorial structures in visual cognition, derived from the structure of the visual cortex. These architectures are briefly discussed, together with an example of a combinatorial structure in which the blackboard architectures for language and vision are combined. In this way, the architecture for language is grounded in perception. Perspectives and potential developments of the architectures are discussed. Key Words: binding; blackboard architectures; combinatorial structure; compositionality; language; dynamic system; neurocognition; sentence complexity; sentence structure; working memory; variables; vision. (shrink)

We analyze the cognitive strategies underlying performance in the Number task, a Math game that requires both arithmetic fluency and mathematical creativity. In this game all elements in a set of numbers have to be used precisely once to create a target number with basic arithmetic operations. We argue that some instances of this game are NP complete, by showing its relation to the well-known Partition problem. We propose heuristics based on the distinction in forward and backward reasoning. The Number (...) Game is part of Math Garden, a popular online educational platform for practicing and monitoring math skills using innovations in computerized adaptive testing. These educational games generate enormous amounts of rich data on children's cognitive development. We found converging evidence for the use of forward proximity heuristics in the data of Math Garden, consisting of more than 20 million answers to 1,700 items. Item difficulties and the structure of correct answers were analyzed. (shrink)

This article provides an affirmative feminist reading of the philosophy of Henri Bergson by reading it through the work of Karen Barad. Adopting such a diffractive reading strategy enables feminist philosophy to move beyond discarding Bergson for his apparent phallocentrism. Feminist philosophy finds itself double bound when it critiques a philosophy for being phallocentric, because the setup of a master narrative comes into being with the critique. By negating a gender-blind or sexist philosophy, feminist philosophy only reaffirms its parameters, and (...) setting up a master narrative costs feminist philosophy its feminism. I thus propose and practice a different methodological starting point, one that capitalizes on "diffraction." This article experiments with the affirmative phase in feminist philosophy prophesied by Elizabeth Grosz, among others. Working along the lines of the diffractive method, the article at the same time proposes a new reading of Bergson (as well as of Barad), a new, different metaphysics indeed, which can be specified as onto-epistemological or "new materialist.". (shrink)

In pleas for the recognition of cultural minority rights, claims to educational authority often figure as concrete examples. The right to educational authority is said to be an exemplary minority right. This is striking, for of all minority rights this is one which is impossible to justify. Difficulties invovled in recent attempts to reconcile cultural minority rights with liberal democracy demonstrate that educational minority rights in particular cannot be justified without underestimating civic and liberal risks and ignoring the complicated nature (...) of the relationships between communities and ‘their’ children and between parents and ‘their’ children. (shrink)

In this article, we sketch a new approach to law and ethics. The traditional paradigm, exemplified in the debate on liberal moralism, becomes increasingly inadequate. Its basic assumptions are that there are clear moral norms of positive or critical morality, and that making statutory norms is an effective method to have citizens conform to those norms. However, for many ethical issues that are on the legislative agenda, e.g. with respect to bioethics and anti-discrimination law, the moral norms are controversial, vague (...) or still evolving. Moreover, law proves not to be a very effective instrument. Therefore, we need a new paradigm, both for descriptive and for normative analysis. This interactive paradigm, as a normative position, can be summarised in two theses. The process of legislation on ethical issues should be structured as a process of interaction between the legislature and society or relevant sectors of society, so that the development of new moral norms and the development of new legal norms may reinforce each other. And legislation on ethical issues should be designed in such a way that it is an effective form of communication which, moreover, facilitates an ongoing moral debate and an ongoing reflection on such issues, because this is the best method to ensure that the practice remains oriented to the ideals and values the law tries to realise. (shrink)

Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no longer controversial (...) that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship. (shrink)

This article provides an affirmative feminist reading of the philosophy of Henri Bergson by reading it through the work of Karen Barad. Adopting such a diffractive reading strategy enables feminist philosophy to move beyond discarding Bergson for his apparent phallocentrism. Feminist philosophy finds itself double bound when it critiques a philosophy for being phallocentric, because the setup of a master narrative comes into being with the critique. By negating a gender-blind or sexist philosophy, feminist philosophy only reaffirms its parameters, and (...) setting up a master narrative costs feminist philosophy its feminism. I thus propose and practice a different methodological starting point, one that capitalizes on “diffraction.” This article experiments with the affirmative phase in feminist philosophy prophesied by Elizabeth Grosz, among others. Working along the lines of the diffractive method, the article at the same time proposes a new reading of Bergson (as well as of Barad), a new, different metaphysics indeed, which can be specified as onto-epistemological or “new materialist.”. (shrink)

Hoewel in de laatste jaren sterk de nadruk is gelegd op de “autonomie” van het geschrevene ten opzichte van de schrijver en diens belevingswereld, wil deze auteur graag beginnen met een persoonlijke betuiging van erkentelijkheid. Een mens is toch wel zodanig verbonden met een geesteskind dat hij lang bij zich gedragen heeft, dat hij de aandacht en de grondigheid die uit de hiervoor geplaatste reacties spreekt, alleen maar in hoge mate kan waarderen. Hij heeft ze ervaren als toonbeelden van “ontmoeting”. (...) De verschillen tussen de drie reacties laten nog eens zien dat ontmoeting verre van monotoon is. Juist ook die verschillen vond ik leerzaam. Bij de opzet van mijn repliek wil ik aan de diversiteit zo goed mogelijk recht doen door de reacties stuk voor stuk te bespreken. Af en toe zal een “intertekstuele” opmerking wenselijk of onvermijdelijk zijn. Overigens vrees ik dat binnen het bestek van deze repliek niet voldoende ingegaan kan worden op alle vragen en tegenwerpingen. (shrink)

The central thesis of this paper is that, for most issues of multiculturalism, regarding them as a problem of tolerance puts us on the wrong track because there are certain biases inherent in the principle of tolerance. These biases -- individualism, combined with a focus on religion and a focus on beliefs rather than on persons or practices -- can be regarded as distinctly Protestant. Extending the scope of tolerance may seem a solution but if we really want to counter (...) these biases, the principle of tolerance becomes so general that it loses any distinctive meaning. Therefore, we should accept the limited scope of tolerance and its biases. The principle of tolerance can still be useful for some problems where there is a clear and direct link to political or religious beliefs. Moreover, it should be cherished as a more general attitude or practice in Dutch society. For most problems of multiculturalism, however, we should appeal to broader theoretical frameworks that do justice to persons and practices. (shrink)

The concept of meaningful work is used to evaluate the quality of work. Typical cases of meaningless work that have been used to clarify this concept are assembly line work, and work involving other types of mindless tasks, but also David Graeber's ‘bullshit jobs’. I argue that there are at least two fundamental reasons to care about meaningful work: reasons from the wellbeing of the worker and reasons pertaining to meaningfulness of the worker's life. I first argue that a concept (...) of meaningful work needs to reflect these two values, but that these two values may come apart. Because of this, accounts that provide a single answer to the question to what extent a particular work context is meaningful work for a particular worker are unable to reflect these two values. I then survey three promising accounts of meaningful work: perfectionism, which captures the self-interested aspect of meaningful work well but fails to capture the meaningfulness aspect appropriately; consequentialism, which captures the meaningfulness aspect well but fails to capture the self-interested aspect; and Wolf's Fitting Fulfilment View of meaningful projects, which can be read as addressing both concerns but leads to implausible judgments about meaningful work. I then argue that we should conceive of the concerns that fall under the notion of meaningful work as two separate concepts and values. The best work incorporates both these dimensions but falling short on either dimension is problematic for different reasons. (shrink)

There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study. We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment. Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

As humans, we frequently engage in mental time travel, reliving past experiences and imagining possible future events. This study examined whether similar factors affect the subjective experience associated with remembering the past and imagining the future. Participants mentally “re-experienced” or “pre-experienced” positive and negative events that differed in their temporal distance from the present , and then rated the phenomenal characteristics associated with their representations. For both past and future, representations of positive events were associated with a greater feeling of (...) re-experiencing than representations of negative events. In addition, representations of temporally close events contained more sensorial and contextual details, and generated a stronger feeling of re-experiencing than representations of temporally distant events. It is suggested that the way we both remember our past and imagine our future is constrained by our current goals. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)