Philosophy of medicine in the Netherlands

This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.     

Negative and affirmative precepts

Summary That negative precepts play the critical role in the generalization principle is a consequence of the relationship of negative to affirmative precepts, i.e. that the negative give the essential negative condition for observing the affirmative precept. This relationship in turn is based on the nature of: 1) the negative precept which obliges to inaction and consequently demands action in order to violate it; 2) the affirmative precept which obliges to action and can be violated by inaction. Since action requires agency, and agency involves more responsibility than does the non-agency present in violating affirmative percepts, we conclude that violating negative precepts demands more responsibility and consequently that they oblige more than do affirmative precepts. To emphasize this critical role of agency I shall conclude with an example proposed by Michael Tooley: Imagine a machine which contains two children, John and Mary. If one pushes a button, John will be killed, but Mary will emerge unharmed. If one does not push the button, John will emerge unharmed, but Mary will be killed. In the first case one kills John, while in the second case one merely lets Mary die. Does one seriously wish to say that the action of intentionally refraining from pushing the button is morally preferable to the action of pushing it, even though exactly one person will perish in either case?²⁰ Tooley's judgment on this example indicates that the outcome - in either case one person will perish - is the sole moral determinant (intentions do not enter this case) and that agency of pushing the button is of no moral significance. Yet, if you, the reader, stood before this machine and tried to decide what you should do, the fact of your agency in pushing the button would control your decision. Consider pushing the button. What reason could you have for that action? That otherwise Mary would die. But who can say that Mary's life is more valuable than John's? That Mary will die is no valid reason for pushing the button. But what of saving Mary's life? You can't do that without yourself actively killing John. But if you don't, Mary will die. This is true, but she will not die from your agency, and this is critical to your choice. What a machine may or may not do may or may not be under your control. What you do is under your control, and you may not do evil, not even that good may come of it. Consequently, you would be forced to say: the decision of intentionally refraining from pushing the button is morally preferable to the action of pushing it even though exactly one person perishes in either case.     

Barriers to Adult Career Change

Adults have unique problems in making career changes. They face crucial economic, educational, and psychological barriers that require special guidance services. In this article, barriers to adult career change are identified and a five-county regional learning service using paraprofessionals is described. Results in working with more than 200 adults making career changes is reported. Suggestions for overcoming some of the problems adults face in making career changes are explained.     

TEACHING THE HANDICAPPED TO EAT IN PUBLIC PLACES: ACQUISITION,GENERALIZATION AND MAINTENANCE OF RESTAURANT SKILLS

This study examined classroom-based instruction in restauranting skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.     

An information processing system for the psychiatric emergency room

An information processing system for a psychiatric emergency room is described. Several studies are presented that show the utility of the system. In the first study, variables involved in diagnosis are explicated. The second study attempts to determine the characteristics that distinguish recidivists from nonrecidivists at an emergency room. The third study attempts to find patient variables related to success in short-term treatment programs. The final study is aimed at discovering whether there are psychopathological effects related to the use of inhalants. Together, these studies show the potential of a mental health information system for learning more about the nature of mental disorders and their treatment.     

Foveal diplopia thresholds and fixation disparities

Comparison of the magnitude and intrinsic spread of foveal diplopia thresholds with the accuracy of ocular alignment as determined with a subjective alignment method shows that: the accuracy of alignment in the vertical direction (within 1–2 min) is remarkably good and much better than in the horizontal direction; the largest disparities occurring due to restricted alignment accuracy are usually substantially smaller than the foveal diplopia thresholds; interindividual variability in the magnitude of foveal diplopia thresholds is not due only to interindividual variability in the alignment accuracy; and the spread of foveal diplopia thresholds exceeds the spread of ocular alignment, which implies that the noise in the foveal disparity domain is not only due to the restricted alignment accuracy but also to sensory processes. Finally, the data confirm that, unlike the case with diplopia thresholds, the spread of stereoscopic thresholds is not affected by the restricted alignment accuracy.