Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients.The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health (...) and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians , the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a “checklist of considerations” . Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline . The accordingly adapted “checklist of considerations” was tested in a pilot study , after which all experts endorsed the checklist .The resulting “checklist of considerations” structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest. (shrink)

Pluralism is a sound strategy in classifying disciplines of biology. The relevance of a particular classification depends on various methodological issues, on the way in which the scientist's problems are specified, and on factual matters.

Peter Wenz has recently distinguished various forms of moral pluralism in an effort to dissolve the controversy over monism and pluralism. I argue that the distinctions are not really helpful once the methodology and the substance of science are brought to bear on ethics. Theories in ethics and science alike are subject to context-dependent methodological trade-offs. Hence, the category of theories should be heterogeneous. Monism and pluralism are at cross-purposes since they endorse different unanalyzed notions of theory. Awareness of heterogeneity (...) among theories is helpful in dismissing the controversy. (shrink)

Peter Wenz has recently distinguished various forms of moral pluralism in an effort to dissolve the controversy over monism and pluralism. I argue that the distinctions are not really helpful once the methodology and the substance of science are brought to bear on ethics. Theories in ethics and science alike are subject to context-dependent methodological trade-offs. Hence, the category of theories should be heterogeneous. Monism and pluralism are at cross-purposes since they endorse different unanalyzed notions of theory. Awareness of heterogeneity (...) among theories is helpful in dismissing the controversy. (shrink)

Legal and moral reasoning share much methodology, and they address similar problems. This volume charts two shared problems: the relation between theory, principles and particular judgments; and the role of facts and factual assertions in normative settings. The relation between 'theory' and 'practice' and between 'principle' and 'particular judgment' has become the subject of much debate in moral philosophy. In the ongoing debate, some moral philosophers refer to legal philosophy for a support of their views on the primacy of 'practice' (...) over 'theory'. According to them, legal philosophy should have a more balanced view in that relation. In the contributions to Part One this claim is critically analysed. The role of the facts is underestimated in discussions on legal reasoning and legal theory, as well as moral reasoning and ethical theory. Factual statements enter into moral and legal discussions not only because they link the conclusion with a rule. They also play a role as background assumptions in supporting a theory. Its focus on the role of facts in normative reasoning makes this book of special interest to scholars of legal and moral argumentation. (shrink)

Philosophical theories about reduction and integration in science are at variance with what is happenign in science. A realistic approach to science show that possibilities for reduction and integration are limited. The classical ideal of a unified science has since long been rejected in philosophy. But the current emphasis on interdisciplinary integration in philosophy and in science shows that it survives in a different guise. It is necessary to redress the balance, specifically in biology. Methodological analysis shows that many of (...) the grand interdisciplinary theories involving biology actually represent pseudo-integration covered up by inappropriate, overgeneral concepts. Integrationism is not bad, but it must be kept within reasonable bounds. If the present analysis is appropriate, there will have to be fundamental changes in research strategy both in science and in the philosophy of science. (shrink)

Grime in a recently developed theory distinguished three basic plant strategies: stress tolerance,ruderality and competition. He relates them to environments characterized in terms of stress and disturbance. Classifications of strategies and environments both are ultimately defined in terms of production. This tends to make the theory tautological. If the theory is to make sense, environments had better be defined in independent terms.

Methodological analysis shows that the concepts of fitness and adaptation are more complex than the literature suggests. Various arguments against ‘adaptationism’ are inadequate since they are couched in terms of unduly simplistic notions.

Wim van der Steen charts conceptual foundations of evolutionary biology and, on the basis of this, he evaluates applications of evolutionary theory outside biology. Philosophical analysis shows that key notions of the theory such as fitness, adaptation, selection, and optimality are empty place-holder concepts that call for context-dependent specifications of meaning. For example, as he points out, the notion of optimality is empty without a specification of constraints. Hence, the controversial thesis that animals perform optimal behaviors as a result (...) of natural selection is meaningless rather than true or false. Analysis shows that many other controversies in evolutionary biology are spurious. Thus, the thesis of genic selectionism, which puts genes at center stage in evolutionary theory, is best reconstructed as an arbitrary conceptualization without substance. Disagreements over the thesis are futile. They reflect preferences for different conceptualizations which are ultimately equivalent. As concepts are properly specified, van der Steen asserts evolutionary theory turns out to be a body of interesting natural history at a low level of generality. General laws of evolution do not exist. Hence, evolutionary approaches do not allow sweeping claims about human nature. Unfortunately, in disciplines outside biology such claims are often defended with evolutionary approaches. Evolutionary theory also cannot serve as a foundation for normative views in ethics or epistemology. This is an important and controversial work for scholars and advanced researchers in biology and the philosophy of biology. (shrink)

Evolutionary psychology is put forward by its defenders as an extension of evolutionary biology, bringing psychology within the integrated causal chain of the hard sciences. It is extolled as a new paradigm for integrating psychology with the rest of science. We argue that such claims misrepresent the methods and explanations of evolutionary biology, and present a distorted view of the consequences that might be drawn from evolutionary biology for views of human nature. General theses about adaptation in biology are empty (...) schemata, not laws of nature allowing the subsumption of mind under biology. Functional thinking is an indispensable tool for psychology, mostly of value in abstractive unification and as a heuristic, but it gains little from association with evolutionary notions of selection. Thus, we argue, the cherished integrative causal model evaporates, and evolutionary phraseology serves no more than rhetorical purposes. Moreover, the universality of human nature and the evolutionary irrelevance of individual variation are presented as biological truths that psychologists should respect in their approach to mind. On closer inspection, this turns out to be rather dubious biology. Psychology might conceivably be better off as a continuation of biology by different means, but evolutionary psychology does not provide the conceptual integration leading to such a happy union. (shrink)

The impact of philosophy of science on biology is slight. Evolutionary biology, however, is nowadays an exception. The status of the neo-Darwinian theory of evolution is seriously challenged from a methodological perspective. However, the methodology used in the relevant discussions is plainly defective. A correct application of methodology to evolutionary theory leads to the following conclusions. The theory of natural selection is unfalsifiable in a strict sense of the term. This, however, does not militate against the theory, because no scientific (...) theory whatever is testable in this way. Under a more liberal testability criterion, the theory is surely testable. None the less, certain research programs may tend to make the theory untestable in practice. It has often been argued that the tautologous character of the principle of natural selection, allegedly the focus of evolutionary theory, makes the theory untestable through circular reasoning. Actually, the principle is only a tautology if ‘fitness’ is wrongly defined in terms of actual survival. But even then circular reasoning need not ensue. Evolutionary principles do not permit, without additional information, the derivation of statements about evolutionary events concerning particular species or populations. If this were a reason to criticize the theory , any other scientific theory would be inadequate by the same token. (shrink)

This paper argues, first, that biological evolution can be both random and divinely guided at the same time. Next it discusses the idea that the claim that evolution is unguided is not part of the science of evolution, and defends it against a number of objections.

Offers a practical philosophy of the life sciences, showing how scientific reasoning can, in limited contexts, be translated into the language of philosophy, and how science can correct the philosophy of science.

Both the concept of a Darwinian tree of life (TOL) and the possibility of its accurate reconstruction have been much criticized. Criticisms mostly revolve around the extensive occurrence of lateral gene transfer (LGT), instances of uptake of complete organisms to become organelles (with the associated subsequent gene transfer to the nucleus), as well as the implications of more subtle aspects of the biological species concept. Here we argue that none of these criticisms are sufficient to abandon the valuable TOL concept (...) and the biological realities it captures. Especially important is the need to conceptually distinguish between organismal trees and gene trees, which necessitates incorporating insights of widely occurring LGT into modern evolutionary theory. We demonstrate that all criticisms, while based on important new findings, do not invalidate the TOL. After considering the implications of these new insights, we find that the contours of evolution are best represented by a TOL. (shrink)

Various philosophers and evolutionary biologists have recently defended the thesis that species are individuals rather than sets. A decade of debates, however, did not suffice to settle the matter. Conceptual analysis shows that many of the key terms involved are ambiguous. Current disagreements should dissolve once this is recognized. Explication of the concepts involved leads to new programs for philosophical research. It could also help biology by showing how extant controversies concerning evolution may have conceptual rather than factual roots.

Science is not value-free and ethics is not fact-free. Science and ethics should be similar, but they are not. The author indicates how research in ethics is to change in the face of this. Ethicists should accommodate empirical work in their programs and they should take heed of methodologies developed in science and philosophy of science. They should abandon the search for a single overarching theory of morality. Controversies in ethics are often spurious for lack of articulate methodological key concepts. (...) For example, disagreements over the value of general theories are misguided since disputants implicitly use different notions of generality and different notions of theory. An appropriate methodology does not suffice for the resolution of controversies but it is indispensable for consensus. The book argues these theses in a general way and applies them to the subject of egoism and altruism in ethics. Further case studies concern the environment and psychiatric disorders. (shrink)

Overmedication is nowadays a serious problem in health care due to influences from the pharmaceutical industry and agencies responsible for regulation. The situation has indeed become appalling in psychiatry, where both theories and treatments have deteriorated under the impact of the industry. The overmedication problem is associated with biased biology in medicine. Adequate biological approaches would indicate that drug therapies must yield to diet therapies, particularly treatments involving omega-3 fatty acids, in many cases. To the extent that philosophy of science (...) adapts to mainstream medicine in analyses of the current situation, it may reinforce the existing bias. To redress imbalances in health care, we ultimately have to rely on common sense. (shrink)

Sober and Brandon et al. disagree about the role of screening-off in the appraisal of theories of natural selection. Some problems disregarded by them are unearthed in this discussion note.

Something is wrong with current discussions about theory reduction. The question of whether higher level theories are reducible to lower level theories cannot be posed in a sensible way if methodological principles that are needed to evaluate scientific theories are disregarded. If this is recognized, the problem looses much of its alleged importance.

Slavoj Zizek ist einer der prominentesten linken Intellektuellen. Der Sammelband lädt ein, Zizeks Ideen kritisch zu diskutieren, insbesondere sein Verständnis von Politik, politischen Organisationen und dem (vergangenen, gegenwärtigen und zukünftigen) Staat.

Chapter 1 Introduction The man was coughing again. Shocked he was as he discovered that his saliva had a reddish taint. Would he have a lung disease after all? Cancer perhaps? Long ago, relatives of his had died from LC, lung cancer.

Research in behaviour genetics uncovers causes of behaviour at the population level. For inferences about individuals we also need to know how genes and the environment affect phenotypes. Behaviour genetics fosters a biased view of individual behaviour since it identifies the environment with psychosocial factors and disregards ecology.

Autoimmune diseases such as rheumatoid arthritis and gastrointestinal disorders such as stomach ulcers are often treated with drugs. NSAIDs, a common treatment in rheumatoid arthritis, may cause stomach ulcers which call for additional medications, notably antacids in the sense of drugs that suppress acid secretion by the stomach. Infection with Helicobacter pylori also plays a role in the ulcers. The infection is typically treated with antibiotics added to antacids. Considering NSAIDs and antacids, we suspect that overmedication is common to the (...) extent that particular diets are a better option. Current research and current treatments with these drugs are also problematic since circadian rhythms are mostly disregarded. All the processes involved in the disorders treated show marked variations in the course of the day. Hence experiments conforming to the guidelines of evidence-based medicine, and treatments in line with them, have outcomes strongly depending on the time factor. This calls for reforms in medicine with fresh inputs from biology. (shrink)

Sober and Brandon et al. disagree about the role of screening-off in the appraisal of theories of natural selection. Some problems disregarded by them are unearthed in this discussion note.

Rachlin provides an impressive integrative view of altruism and selfishness that helps us correct older views. He presents a highly general theory, even though he is aware of context-dependence of key notions, including altruism. The context-dependence should extend much farther than Rachlin allows it to go. We had better replace theoretical notions of altruism and selfishness by common sense.

Biology incorporated into other disciplines is often distorted, alarmingly so in some areas of medicine. Together with other forms of bias, this may have detrimental effects for patients depending on medical research for their health. A case study concerning omeprazole (Losec), one of the acid-suppressive drugs against gastric ulcers, and NSAIDs, non-steroid anti-inflammatory drugs, confirms that distorted biology together with biased health care policies foster disasters in current biomedicine and medical practice. In our country, The Netherlands, omeprazole is presumably the (...) most commonly used medication. NSAIDs are also used in large quantities, increasingly since they have become available as analgesic over-the-counter drugs. Unofficial and official sources tend to inform the general public that the drugs promote human health. We argue that their being used on a massive scale is actually a medical disaster. The health of many patients would be served better if the drugs they take were replaced by proper forms of diet, but the pharmaceutical industry, the most potent force affecting medication policies, appears to prevent a shift in the balance from over-medicalization towards healthy life styles. The shift should come from government agencies responsible for regulation in the medication market. Policies of these agencies are now a dismal failure. (shrink)