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

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit (...) what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

Syltern et al. (2022) propose a new approach to decision-making at the limit of viability: by default, intensive care will be initiated for every infant born in “the gray zone” of viability. This w...

This paper articulates a formal theory of belief incorporating three key theses: (1) belief is a dyadic relation between an agent and a property; (2) this property is not the belief's truth condition (i.e., the intuitively self-ascribed property which the agent must exemplify for the belief to be true) but is instead a certain abstract property (a "thought-content") which contains a way of thinking of that truth condition; (3) for an agent a to have a belief "about" such-and-such items it (...) is necessary that a possesses a language of thought, $M_{a}$ , and that a (is disposed as one who) inwardly affirms a sentence of $M_{a}$ in which there are terms that denote those objects. Employing an extended version of E. Zalta's system ILAO, the proffered theory locates thought-contents within a typed hierarchy of "senses" and their "modes of presentation", the provisional definitions of which (suppressing complications added later to accommodate the contents of beliefs about beliefs) are as follows. A mode of presentation of e is a ternary relation of the sort [λxyz z is a name in $M_{y}$ that denotes x, and $D_{e}yz$ ] in which $D_{e}$ is an e-determiner - a relation between agents and their mental expressions imposing a syntactico-semantic condition sufficient for such an expression to denote e therein. A sense of an entity e is an abstract property that "contains" a mode of presentation $R_{e}$ of e by dint of encoding its property-reduct [λx(∃y)(∃z) $R_{e}xyz$ ]. In particular, a thought-content is a sense T of an ordinary first-order property P containing a mode of presentation whose P-determiner $D_{P}$ is such that, for any y and z, $D_{P}yz$ entails that z is a λ-abstract [λv S] of $M_{y}$ in which S is a sentence whose non-logical parts stand in appropriate semantic relations to the constituents of T's (some of which may themselves be senses). Where $I_{a}$ is agent a's dedicated self-demonstrative and |T| is the mode of presentation contained in a thought-content T, the belief relation itself is then characterized as obtaining between a and T iff a( is disposed as one who) inwardly affirms the substitution instance $S(I_{a}/v)$ of a sentence S in $M_{a}$ such that |T|(P, a, [λv S]). The aforementioned "constituents" and "appropriate semantic relations" are formally characterized so as to permit a system of canonical descriptions for thought-contents of arbitrary complexity. These canonical descriptions are then employed to chart the nature and interrelations of belief de re, de dicto and de se and to identify the source of opacity in belief ascription. (shrink)

ZusammenfassungWährend eines Abendessens in einem amerikanischen Restaurant wurde eine Gruppe von christlichen Ethikern, von denen einige Lutheraner waren, von einer jungen Frau angesprochen. Als sie hörte, welchen Beruf die Gruppe ausübte, antwortete sie: »Ich bin eine Lutheranerin – daher habe ich zu christlicher Ethik nichts zu sagen.« Dieser Artikel versucht herauszufinden, in welcher Hinsicht die Frau Recht gehabt haben könnte. Ich argumentiere dafür, dass zu dem Bereich des »Ethischen« zumindest drei Charakteristika gehören: Universalität, Normativität, und ein Verweis auf einen Begriff (...) des höchsten Gutes . Anschließend wird dafür argumentiert, dass eine der Konsequenzen aus Luthers Verweis auf Gott als höchstes Gut darin besteht, dass der sogenannte politische Gebrauch des Gesetzes zugleich ausgeprägt ethisch und christlich ist. Sein christliches Element besteht jedoch weniger in der Bestimmung derjenigen Werte, deren Realisierung angestrebt werden sollen, also im Feld der normativen Ethik, da das Gesetz in seiner politischen Interpretation allen Menschen, Gläubigen und Nicht-Gläubigen gleichermaßen, bekannt ist und auf alle angewandet werden kann. Der Beitrag des Christentums für die Ethik liegt vielmehr auf zwei anderen Ebenen: zum einen auf einer metaethischen Ebene ; und zum zweiten, aufgrund von Luthers Betonung der menschlichen Freiheit als Konsequenz der Versöhnung, auf der Ebene der Realisation des Guten. Abschließend wird argumentiert, dass Luthers theologischer Gebrauch des Gesetzes ebenso wie seine Lehre von der menschlichen Freiheit kaum als Ethik begriffen werden können, da die Charakteristika der Universalität und der Normativität fehlen. Einige mögen dies als eine Schwäche ansehen, aber die Kritik könnte auch in die entgegengesetzte Richtung gewendet werden: denn für Luther gehört mehr zum guten Leben als Normativität und Universalität allein.SummaryWhile having dinner in an American restaurant, a group of Christian ethicists, some of whom were Lutherans, were addressed by a woman. Upon hearing the profession of the group, she replied, “Well, I'm a Lutheran, so I don't know anything about Christian Ethics.” This article intends to explore in what sense the woman might have been correct. In order to do this, I argue that the realm of “the ethical” comprises at least three characteristics: universalisability, prescriptivity, and a reference to a conception of the highest good . After this, it is argued that, as a consequence of Luther's reference to God as the highest good, the so-called political use of the law can be seen as strongly ethical and Christian at the same time. The Christian element lies, however, not so much in the designation of what values ought to be pursued, i. e., in the field of normative ethics, since the law in its political interpretation may be known by, and is applicable, to all people, believers and nonbelievers alike. Rather, the contribution of Christianity to ethics lies on two other levels of ethics: first, on the level of metaethics ; and, second, because of Luther's stress on human freedom as a consequence of salvation, on the level of the realisation of the good. Finally, it is argued that Luther's theological use of the law as well as his doctrine of human freedom can hardly be conceived as ethics, due to the absence of the characteristics of universalisability and prescriptivity. By some, this may be considered as a flaw, but the criticism might also go in the other direction: to Luther, there is more to the good life than prescriptivity and universalisability alone. (shrink)

Este artigo tem por objetiva geral descrever a linguagem musical sob a perspectiva da teoria histórico-cultural, conforme Vygotsky, seu principal representante. Neste sentido, procura-se também entender o conceito de mediação, como elemento articulador entre linguagem musical e o fenômeno pedagógico, produzido nos enredos intersubjetivos de professores e alunos. Nessa perspectiva, e com as contribuições da Base Nacional Comum Curricular (BNCC), que integra a música no ensino de Arte, identifica-se a relevância da linguagem musical na formação cidadã de estudantes da Educação (...) Básica. O presente estudo se caracteriza como uma pesquisa bibliográfica, amparada em obras originais de Vygotsky e de outros autores que escrevem a respeito da temática em questão, para embasamento aprofundado. Constatou-se que a música, enquanto linguagem, é dinâmica cujas habilidades e ações, construídas socialmente, são mediadas na interação professor-aluno. Portanto, a leitura que se faz da música, enquanto linguagem, não pode prescindir do caráter histórico-cultural, subjacente a toda e qualquer manifestação cultural. (shrink)

Does philosophical critique have a future? What are its possibilities, limits, and presuppositions? Bringing together outstanding scholars from various traditions, this collection of essays is the first to examine the forms of critique that have shaped modern and contemporary continental thought. Through critical analyses of key texts by, among others, Spinoza, Kant, Hegel, Marx, Adorno, Habermas, Foucault, and Rancière, it traces the way critique has time and again geared itself towards new cultural, social, and political problems, shedding those of its (...) assumptions no longer deemed tenable. It is our hope that the many voices of critique that arise from the present volume will produce effects – new doubts, new insights, new challenges, or new resources – that none could have achieved on their own. (shrink)

although mostly known to specialists nowadays, Kenelm Digby was a remarkable figure on the intellectual scene of the early seventeenth century. He has been described as “one of the most influential natural philosophers” of his time,1 and corresponded with many of the great scholars of his days, including Descartes, and the French pioneer of atomism, Pierre Gassendi. In the later years of his life, Digby, alongside men like Robert Boyle, became one of the founding members of the Royal Society.2Digby authored (...) one major work of philosophy: the Two Treatises of 1644. This work consisted of a long First Treatise on bodies, and a shorter, Second Treatise on the human soul. In the First Treatise, Digby argued... (shrink)

BackgroundIn the Netherlands, patients have the legal right to make a request for euthanasia to their physician. However, it is not clear what it means in a moral sense for a physician to receive a request for euthanasia. The aim of this study is to explore the moral values of physicians regarding requests for euthanasia. MethodsSemi-structured interviews were conducted with nine primary healthcare physicians involved in decision-making about euthanasia. The data were inductively analyzed which lead to the emergence of themes, (...) one of which was about values regarding end-of-life decisions.ResultsFour clusters of values related to euthanasia requests are described: values related to 1) the patient; 2) the family; 3) the physician; and 4) life and death. The data show that the participants value patient autonomy as a necessary but not sufficient condition for meeting a euthanasia request. A good relationship with the patient and the family are important. For the physician, the values physician autonomy, responsibility, understanding the patient and relief of suffering play a role. Life as an intrinsic good and a peaceful death are also important values.ConclusionThis study shows that next to patient autonomy and the relationship with the patient and the family, it is important for the participants to act in accordance with their professional values and to do justice to values related to life and death. The awareness of going against the intrinsic value of life is crucial, even if performing euthanasia may result in a feeling of relief or gratitude afterwards. (shrink)

Some bioethicists engage with empirical work on stakeholders’ values, attitudes, and experiences as a basis for theorizing ethics in the context of healthcare. Related to this empirical turn, a deb...

After having defined the KARO logic for specifying intelligent agents in earlier work we now turn to the question how to realise agents specified in the KARO framework. To this end we look at agent programming languages that we have defined, and investigate how programs in these languages can be linked to the KARO logic.

Jackendoff's scenario of the evolution of language is a major contribution towards a more rigorous theory of the origins of language, because it is theoretically constrained by a testable theory of modern language. However, the theoretical constraints from evolutionary theory are not really recognized in his work. We hope that Jackendoff's lead will be followed by intensive cooperation between linguistic theorists and evolutionary modellers.

The review by De Bie et al. (2023) provides an overview of the current ethical literature on artificial womb technology (AWT). Two characteristics stand out, and provide the basis for our commentar...

Brain imaging technologies are increasingly used to find networks and brain regions that are specific to the functional realization of particular aspects of the self. In this paper, we aim to show how neuroscientific research and techniques could be used in the context of self-formation without treating them as representations of an inner realm. To do so, we show first how a Cartesian framework underlies the interpretation and usage of brain imaging technologies as functional evidence. To illustrate how material-technological inventions (...) and developments can have a significant and lasting impact on views of the self, we show how this framework was influenced by another technology: the camera obscura. Subsequently, we show that brain imaging technologies challenge the idea that privileged access to the self can be obtained merely through introspection, indicating a strong discontinuity between the Cartesian and the current neuroscientific framework. Building on these insights, we reframe the self in terms of self-formation. This view neither regards the brain as an independent realizer of aspects of the self, nor assumes that self-knowledge can be obtained through introspection. From this perspective, self-formation is realized throughcritical self-identification: instead of offering representational knowledge of an ‘inner self,’ the potential use of brain imaging technologies within this framework lies in their capacity to offer what we call ‘extrospective knowledge’ that pragmatically can contribute to self-formation. Brain imaging technologies contribute to this process because they foreground our neurophysiology, which helps to critically integrate biological aspects into self-formation. (shrink)

Scholarly debates on the Critique of Pure Reason have largely been shaped by epistemological questions. Challenging this prevailing trend, Kant's Reform of Metaphysics is the first book-length study to interpret Kant's Critique in view of his efforts to turn Christian Wolff's highly influential metaphysics into a science. Karin de Boer situates Kant's pivotal work in the context of eighteenth-century German philosophy, traces the development of Kant's conception of critique, and offers fresh and in-depth analyses of key parts of the (...) Critique of Pure Reason, including the Transcendental Deduction, the Schematism Chapter, the Appendix to the Transcendental Analytic, and the Architectonic. The book not only brings out the coherence of Kant's project, but also reconstructs the outline of the 'system of pure reason' for which the Critique was to pave the way, but that never saw the light. (shrink)

BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

Science is highly dependent on the technologies needed to observe scientific objects. In How Scientific Instruments Speak, Bas de Boer develops a philosophical account of instruments in scientific practice, focusing on the cognitive neurosciences. He argues for an understanding of scientific instruments as mediating technology.