Ati Van

The aim of this article is to provide a preliminary ethical evaluation of the effect of telesurgery on patient care. In order to accomplish this task we give a broad description of the state of the art in telesurgery and analyse it using Joan Tronto’s articulation of care as a structured process. This structure illuminates the significance of the patient-physician relationship as the buttress for establishing and preserving practices of care in the healthcare context, with the ultimate goal of safeguarding patient dignity. The process of care combined with the moral aim of medicine—to fulfil the good of the patient—provides the ethical foundation for assessing telesurgery. By exploring various telesurgical scenarios we may assess its potential role in augmenting or diminishing patient care within the frame of the patient-physician relationship. The significance of conducting this evaluation lies in the fact that the practice of telesurgery may very shortly become routine and an evaluation has not yet been attempted.

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges

This paper provides a concise description and discussion of bottom–up and top–down approaches to misattribution of agency in schizophrenia. It explores if first-person accounts of passivity phenomena can provide support for one of these approaches. The focus is on excerpts in which the writers specifically examine their experiences of external influence. None of the accounts provides arguments that fit easily with only one of the possible approaches, which is in line with current attempts to theoretical integration.

An effective application of thePrecautionary Principle (PP) hinges on thestipulation that, ``a lack of scientificcertainty shall not be used as a reason forpostponing measures.'' The practicalconsequences of this expression are presentlynot clear enough in most contexts of use toenable constructive communication and thereforethe PP is not sufficiently operational now. Apragmatic and fundamental methodology forunderstanding scientific (un)certainty indifferent practical contexts needs to be put inplace to create a communicative basis foreffective precaution. Lack of clarity aboutproblem definition and problem ownershipcreates artificial controversies that willobstruct a precautionary approach. Given thefact that different practical contexts ofscientific (un)certainty exist, it may seemfrom one context as if no precaution iswarranted whereas concerns from anotherrelevant context may suggest otherwise.Therefore, an integrative methodologicalframework for communicating about scientific(un)certainty is sorely needed in internationalpolicy-making. By putting a focus on therelevance of specified research questions forthe objective of taking precaution, acommunicative methodology may be adopted thatis dedicated to the design properties of asustainable future. Precaution cannot beoperationalized without a methodological basisthat allows for effective transparency andevades the stalemates of artificialcontroversy. Existing debate methodologies haveso far not managed to accommodate thesepressing demands.

The King Report on Corporate Governance (1994) evoked unprecedented interest in corporate governance in South Africa. This does not mean that corporate governance was not an issue of concern before the release of this historical report. To the contrary, corporate governance in its broader sense has been at stake since the inception of the first publicly owned companies in South Africa. This article intends to give an overview of corporate governance in South Africa. It starts by making a distinction between broad and narrow conceptions of corporate governance. Before applying this distinction to the practice of corporate governance in South Africa, a brief overview of the corporate landscape in South Africa is provided. Then the South African situation with regard to broad and narrow corporate governance respectively is analysed. The article ends with a discussion of the review of corporate governance that currently is in the making in South Africa. Throughout the article both the financial and ethical dimensions of corporate governance is attended to.