Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of (...) the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. (shrink)

Après avoir rappelé les enjeux philosophiques de la problématique de l’idée d’un a priori affectif dans le parcours philosophique de Mikel Dufrenne, nous chercherons à mettre en valeur l’heuristique des a priori affectifs, conçue comme une herméneutique de la présence du sensible qui met en lumière l’affinité communicative entre les « a priori existentiels » et les « a priori cosmologiques ».

The aim of this research was to gain insight into the experiences and perspectives of individual members of a Medical Research Ethics Committee regarding their individual roles and possible tensions within and between these roles. We conducted a qualitative interview study among members of a large MREC, supplemented by a focus group meeting. Respondents distinguish five roles: protector, facilitator, educator, advisor and assessor. Central to the role of protector is securing valid informed consent and a proper risk-benefit analysis. The role (...) of facilitator implies that respondents want to think along with and assist researchers in order to help medical science progress. As educators, the respondents want to raise ethical and methodological awareness of researchers. The role of advisor implies that respondents bring in their own expertise. The role of assessor points to contributing to the overall evaluation of the research proposal. Various tensions were identified within and between roles. Within the role of protector, a tension is experienced between paternalism and autonomy. Between the role of protector and facilitator tensions occur when the value of a study is questioned while risks and burdens for the subjects are negligible. Within the role of assessor, a tension is felt between the implicit nature of judgments and the need for more explicit formulations. Awareness of various roles and responsibilities may prevent one-sided views on MREC work, not only by members themselves, but also by researchers. Tensions within and between the roles require reflection by MREC members. (shrink)

ABSTRACT: The following paper is not a literal exegesis of Hegel's æsthetics, but rather the attempt to encounter his æstheticsfrom a philosophical perspective which considers the æsthetic experience as intuition offinitude. From this perspective our purpose is to indicate the contemporary philosophical relevance of Hegel's æsthetics by underscoring some elements of it which can help us to rethink the relation between æsthetic experience and the subject in his interaction with his world. The question of this essay is: how can æsthetic (...) experience be a substantial experience for the modern subject? (shrink)

In this article I consider the Kantian preference for natural beauty from a socio-political point of view. Instead of only regarding the significance of beauty in nature as a symbol of morality, I show that the aesthetic appreciation of natural beauty must also be understood in its dialectical relation to society as By highlighting this dialectical understanding, I point out the socio-political contribution of aesthetic experience for the cultural progress of humanity. The fragility of beauty in the context of culture (...) can be further interpreted as a symbol of the temporality of the project of perpetual peace in politics. (shrink)

Résumé S’il y a un ethos artistique chez Valéry, il est lié à l’idéal et à la pratique de se faire soi-même l’instrument d’une disponibilité infinie à l’actualisation du savoir pouvoir faire. Le présent article éclaire comment, à partir de l’interaction entre ses dispositions (manières d’être, manies) et ses facultés (pouvoir faire, manier), Valéry a pu accroître la qualité de son savoir pouvoir faire en transformant son moi instrument en une structure d’accueil plus réceptive et plus consciente par rapport aux (...) sollicitations de sa propre sensibilité. (shrink)

En quel sens l’expérience esthétique peut-elle être subjective et profondément individuelle sans pour autant être arbitraire ? Le texte suivant essaie de répondre à cette question en tentant de considérer l’expérience esthétique comme le lieu d’une reconduction de la subjectivité individuelle aux éléments symboliques déterminants qui composent la substance de notre vie comme existence finie. C’est en suivant les réflexions de Valéry sur le pouvoir d’émission de la sensibilité formelle que nous visons cette problématique et tentons de dégager les aspects (...) de sa pensée poïétique contribuant à une herméneutique de l’expérience esthétique individuelle pour laquelle la subjectivité se sent irréductiblement concernée en elle-même comme finitude.In what sense can aesthetic experience be subjective and profoundly individual without being arbitrary ? The following paper tries to respond to this question by considering the aesthetic experience as the place where the individual subject is confronted with the symbolic elements composing the substance of his life as finitude. We want to develop this problematic by following the reflections of Valéry on what he calls the formal sensibility and their aesthetic solicitations. Our objective is to present how different aspects of his poetic conception can contribute to the elaboration of a hermeneutic of the aesthetic experience in which the individual subject feels itself to be concerned as a finite being. (shrink)

Volume 20, Issue 8, August 2020, Page 104-106.

It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, (...) and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage, or Fair-Trade guidelines. An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad. (shrink)

Depuis le début des années 1990, la traduction française des œuvres de Gadamer a connu une progression continue et fort réjouissante. Outre la traduction intégrale de Wahrheit und Methode en 1996, pas moins de treize titres sont parus en langue française qui permettent au lectorat franco-phone de mieux apprécier l’ampleur véritable de la pensée philosophique de Gadamer. Jean Grondin, à qui nous devons nombre d’études sur l’œuvre de Gadamer ainsi que plusieurs traductions de ses travaux, ajoute à cette liste un (...) nouveau titre, Les Chemins de Heidegger. Cet ouvrage que Gadamer a d’abord fait paraître en 1983, et qui a été repris ensuite au tome III des Gesammelte Werke en 1987, rassemble un nombre de textes consacrés, comme le titre l’indique, aux diverses routes empruntées par le célèbre penseur de Messkirch. (shrink)

Within a period of one year, two countries have enacted laws that articulate conditions under which euthanasia and physician assisted suicide are permitted. Belgium and the Netherlands thus distinguish themselves from all other countries of the world.In Belgium, palliative care organisations have been pro-actively involved in the debate on the contents of the law, highlighting that if euthanasia can ever be justified, it is necessary to provide good palliative care for all and to include in the euthanasia law what has (...) been called a palliative filter, i.e. a compulsory prior consultation with a specialised palliative care team. In the Netherlands, before the euthanasia law was enacted, there had been a policy of pragmatic tolerance for decades. The enactment itself did not give rise to intense debate. It can be questioned whether the new law would change anything at all since it only officially sanctioned an existing practice. This however does not mean that caregivers in palliative care, together with palliative care organisations, have not participated in the euthanasia debate.In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise. (shrink)

This article discusses the latest developments regarding euthanasia and palliative care in the Netherlands. On the one hand, a legally codified practice of euthanasia has been established. On the other hand, there has been a strong development of palliative care. The combination of these simultaneous processes seems to be rather unique. This contribution first focuses on these remarkable developments. Subsequently, the analysis concentrates on the question of how these new developments have influenced the ethical debate.

Dutch euthanasia and physician-assisted suicide stand on the eve of important legal changes. In the summer of 1999, a new government bill concerning euthanasia and physician-assisted suicide was sent to Parliament for discussion. This bill legally embodies a ground for exemption from punishment for physicians who conduct euthanasia or physician-assisted suicide and comply with certain requirements. On November 28, 2000, the Dutch parliament approved an adapted version of this bill. Since the approval by the Dutch Senate can be regarded as (...) a formality, it is expected that the bill will come into force in the course of this year (2001). In this paper we discuss these new developments. (shrink)

Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.

In the Infini-Rien fragment of his Pensées, Blaise Pascal develops an argument for the rationality of faith in God, which posthumously became known as Pascal’s Wager and at the same time represents a cornerstone of modern probability theory. While this betting argument has been the subject of much philosophical investigation, the contribution of this paper lies in the following: On the one hand, the bet is reconstructed in its basic features as well as its structure with the help of (...) modern decision and probability theory tools. Thus, it is shown that Pascal’s betting argument, in distinction to Hacking 1972 for instance, has the form of an a fortiori argument. On the other hand, as far as objections to Pascal’s argument are concerned, it is true that the premises have often been called into doubt, more or less convincingly. On the other hand, this article is dedicated to the question, often emphatically – especially in Hacking 1972 – and perhaps carelessly affirmed in Pascal research, whether Pascal’s premises imply his conclusion at all. (shrink)

The wager fragment in Blaise Pascal’s _Penseés _opens with the phrase "_infini rien_"—"infinite nothing"—which is meant to describe the human condition. Pascal was responding to what was, even in the seventeenth century, becoming a pressing human problem: we seem to be able to know much about the world but less about ourselves. The traditional European view of human beings as creatures made in the image of God and potentially capable of a mystical union with God was increasingly confounded by the (...) difficulty of finding God in nature. Despite his own scientific work, however, Pascal argued that if one does not know whether or not God exists, one should bet that he does: if one is right the rewards are infinitely good and, if one is wrong, what one has lost is, by comparison, utterly trivial. The argument behind this wager is one of the most celebrated—and disputed—in the history of philosophy. It has been seen in terms of the calculus of probabilities, as a piece of religious apologetic, as an event in the religious and psychological life of Pascal himself, and as an event in the life of the Jansenist movement and its various expressions at Port-Royal. In this book, Leslie Armour explores the underlying logic of ideas brought to the surface by the intersection of two philosophical lines of thought. He shows that Pascal had come to philosophy by way of two particular strands of Platonism, one strongly mystical, associated with the founder of the French Oratorian order, Pierre de Bérulle, and the other the Augustinian Platonism associated with Duvergier de Hauranne and Cornelius Jansen. At the same time Pascal was engaged in an internal struggle with skepticism. While he agreed that it is difficult to find God in physical nature, he disagreed with the claim that we know nothing of nature. The problem is that the human being is both infinite and nothing. Thus, Armour locates Pascal’s wager within the confluence of a vital neo-Platonism and an intellectually powerful skepticism. He concludes that even today, "If we must act and cannot know enough, we must bet.". (shrink)

Le séminaire “La vie la mort” de Derrida opère, comme d’avance motivé par ses suites et comme contresigné par ce nom qui n’apparaît pas—le nom d’Épicure—un virage vers un matérialisme non productif, non représentationnel, dépourvu en quelque sorte de statut ontologique, voire non ontologisable, triomphant, normatif, voué à une économie de la cause. Nietzsche, lecteur antagonique d’Épicure (Lettre à Ménécée: “Accoutume-toi à considérer que la mort n'est rien pour nous”)—constitue son écran-substitut. Nietzsche, dont la lecture sert à fermer-ouvrir les (...) grandes boucles du séminaire de Derrida. Il s’agit donc de fouiller “La vie la mort” à la recherche des traces de la rencontre Nietzsche-Épicure—une rencontre définitive, elle, bien qu’invisible et silencieuse, bien que presqu’illisible dans le texte de Derrida, au sujet du rapport “la vie la mort.”. (shrink)

Dans l'histoire de la philosophie occidentale ce n'est que Kant qui parvient, en la dissociant des phénomènes de la nature, à donner à la liberté un statut métaphysique autonome. Or Malebranche anticipe Kant. Il distingue la volonté qui vient de Dieu de la liberté qui surgit de l'homme. La volonté est une force de quantité déterminée, la liberté est un rien qui n'ajoute rien à cette forme mais en détermine le mouvement. La liberté n'est rien car elle (...) n'est pas elle-même une force, par conséquent, elle permet de fonder une réflexion morale autonome. Kant by separating freedom from the phenomena of nature endows it with an autonomous metaphysical status. Malebranche anticipates Kant. He distinguishes the will which comes from God and freedom which is from man. The will is a force of a given quantity, freedom is a nothing which does not increase or decrease this force but only determines its movement. Freedom is a nothing since it is not a force itself, thus it makes possible an autonomous moral philosophy. (shrink)

« À l’homme, rien de plus utile que l’homme ». Que signifie cette formule chez un auteur pour qui dans la nature droit et puissance ne font qu’un? Le conatus conduirait à l’égoïsme et à l’indifférence aux autres. Chacun recherchant son « utile propre », seules les lois permettraient la visée de « l’utile commun ». Cependant, selon l’ Éthique, l’individu conquiert sa liberté en prenant conscience de sa vulnérabilité résultant du caractère relationnel de son existence modale. Sa principale (...) vertu est la force d’âme qui mêle fermeté et générosité. La sollicitude n’est donc pas étrangère à l’éthique spinoziste. Reste à en définir les contours dans une philosophie de la puissance qui n’est pas totalement incompatible avec une vulnérabilité liée à la servitude. (shrink)

According to Gérard Genette, the chief function of an authorial preface is to ensure that the text is read properly. In other words, the purpose of the preface is to attract the reader’s attention and to steer him or her toward a particular understanding of the book. A preface, then, aims to get readers to read the book and often on certain terms, i.e., the author’s. As such, the authorial preface of Marx’s Capital (1867) is especially important — it allows (...) us to understand how Marx himself hoped to be understood by his readers. Commentators, whether hostile or sympathetic, usually focus on the postface to the second edition of Marx’s work. We will instead focus on the preface to the first edition, as to uncover Marx’s immediate political aims and ethical concerns. (shrink)