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.     

Some clarifications of the CANDECOMP algorithm applied to INDSCAL

Carroll and Chang have claimed that CANDECOMP applied to symmetric matrices yields equivalent coordinate matrices, as needed for INDSCAL. Although this claim has appeared to be valid for all practical purposes, it has gone without a rigorous mathematical footing. The purpose of the present paper is to clarify CANDECOMP in this respect. It is shown that equivalent coordinate matrices are not granted at global minima when the symmetric matrices are not Gramian, or when these matrices are Gramian but the solution not globally optimal.Part of this research has been supported by The Netherlands Organization for Scientific Research (NWO), PSYCHON-grant (560-267-011).     

The hyperreality of clinical ethics: A unitary theory and hermeneutics

Medical ethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts of medical ethical issues, including the creative development of a broader philosophical framework for a practicable medical ethics. Several alternative approaches and conceptions have been proposed. The unified clinical ethics theory, developed by Graber and Thomasma, is an interesting attempt to synthesize these alternative approaches. It correctly identifies as the crucial problem the present disconnectedness of medical ethics from theoretical philosophy as well as the practice of medicine. In this paper, however, it is argued that the unitary theory should take more serious attention to the hermeneutic character of medicine as well as ethics. This implies that the unitary theory must in fact transform itself into aninterpretive clinical ethics theory. The theoretical characteristics and practical consequences of an interpretive theory of medical ethics are discussed in the present paper.     

An alternating least squares method for the weighted approximation of a symmetric matrix

Bailey and Gower examined the least squares approximationC to a symmetric matrixB, when the squared discrepancies for diagonal elements receive specific nonunit weights. They focussed on mathematical properties of the optimalC, in constrained and unconstrained cases, rather than on how to obtainC for any givenB. In the present paper a computational solution is given for the case whereC is constrained to be positive semidefinite and of a fixed rankr or less. The solution is based on weakly constrained linear regression analysis.The authors are obliged to John C. Gower for stimulating this research.     

When sanctions fail to increase cooperation in social dilemmas: considering the presence of an alternative option to defect

Previous social dilemma research has shown that sanctioning defection may enhance cooperation. The authors argue that this finding may have resulted from restricting participants to two behaviors (cooperation and defection). In this article, the authors introduce the concept of a "social trilemma" (a social dilemma in which an alternative option to defect is present) and tested the effect of a sanction. The authors show that a sanction only increased cooperation and collective interests in the traditional social dilemma. In a social trilemma, the sanction failed because it caused some people to choose the alternative option to defect. Moreover, the results indicate that this was especially the case when people did not expect fellow group members to cooperate. In this case, the sanction even worked counterproductive because it decreased collective interests. It is concluded that allowing individuals to consider alternative options to defect can reveal the potential detrimental effects of sanctioning systems for the collective.     

全球生命伦理学

探讨生命伦理学的起源,并阐述了不同理论支持者的观点,发现无论准确的生命伦理学历史起源是什么,目前生命伦理学已经变成了一种真正的全球现象。它在全世界具有重要的意义,因为人类不仅仅是欧洲人或亚洲人,也是世界公民和一个全球道德共同体的成员。生命伦理学对任何地方、任何人都是重要的,并不是因为它是"拿来"的,而是因为它提供了一个普遍的框架去解释和管理正在经历的变化,这个变化包括了目前所有的国家和文化。然而,这个框架的解释和应用必须依据本土环境。因此,现代生命伦理学具有全球性和本土特征的特点。     

Long-term retention of a theatrical script by repertory actors: the role of context.

Four actors were requested to perform Sartre's No Exit after a retention interval of more than 5 months. Their recall of the play was studied either with the spatial and visual contextual cues normally available during a performance or without such cues. Total recall was still considerable, equalling 85%. The number of paraphrases of, and inferences on, the original text was however quite large (32%), suggesting that the actors had learned their lines according to their meaning rather than as a result of rote memorisation. The context manipulation showed that actors' recall is facilitated by the availability of spatial-visual information, but only to a limited extent. The relative importance of textual and contextual cues in the long-term retention of a play is discussed.     

Pupil dilation as an index of effort in cognitive control tasks: A review

Pupillometry research has experienced an enormous revival in the last two decades. Here we briefly review the surge of recent studies on task-evoked pupil dilation in the context of cognitive control tasks with the primary aim being to evaluate the feasibility of using pupil dilation as an index of effort exertion, rather than task demand or difficulty. Our review shows that across the three cognitive control domains of updating, switching, and inhibition, increases in task demands typically leads to increases in pupil dilation. Studies show a diverging pattern with respect to the relationship between pupil dilation and performance and we show how an effort account of pupil dilation can provide an explanation of these findings. We also discuss future directions to further corroborate this account in the context of recent theories on cognitive control and effort and their potential neurobiological substrates.     

Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.