Amy Van

In 1892, near Trinil on the island of Java, laborers under the direction of the expatriate Dutch physician‐anatomist Eugène Dubois uncovered fossil bones that, Dubois believed, belonged to a single member of a hitherto‐undiscovered species. Dubois named the species Pithecanthropus erectus , a reflection of his steadfast belief in its transitional role in human evolution. The fossil, popularly known as “Java Man,” is now classified as Homo erectus—a species not fully human but far closer to us than Dubois envisioned.Dubois and Pithecanthropus have been covered before: briefly in Carl Swisher, Garniss Curtis, and Roger Lewin's Java Man and at length in Bert Theunissen's Eugene Dubois and the Ape‐Man from Java . Pat Shipman's interests are more strictly biographical: Dubois as a family man, as a European in Southeast Asia, and as a scientist struggling to establish a career and a reputation. The Man Who Found the Missing Link weaves together the multiple threads of a complex life: extensive travels, eclectic scientific interests, tempestuous relations with colleagues, and a slowly disintegrating marriage. It vividly conveys Dubois's near‐obsession with the Pithecanthropus erectus fossils and his tenacity in defending their significance. Shipman tells the story almost exclusively from Dubois's point of view and almost exclusively in the present tense, sacrificing authorial distance for immediacy. The book often reads, therefore, as if it were Dubois's own memoir, “as told to” Shipman.Lavishly produced by a major trade publisher, Shipman's book is clearly aimed at readers who have enjoyed the work of Dava Sobel, Bella Bathurst, and Simon Winchester. Taken on those terms, it succeeds admirably. Like Sobel's Longitude and Winchester's The Map That Changed the World , it is a vigorous tale of an embattled scientific maverick who triumphs despite repeated setbacks. Like them, it succeeds both as literature and as a character study.Historians interested in the book for professional reasons will find it less satisfying. It is full of recounted conversations and descriptions of unvoiced thoughts and feelings—these elements are the heart of the book's literary style and essential to its characterization of Dubois. The sparse and sketchy endnotes make it impossible, however, to determine the sources of this material or to draw clear lines between contemporary accounts, after‐the‐fact recollections, the author's inferences, and outright speculations. Shipman writes, in one alarming example, that “Dubois is something else, something extraordinary, the coolies conclude. He is a chosen man. Clearly he has been given a special role or dharma through a divine revelation: that is the only possible explanation” . With no endnote to explain the source of this insight into the coolies' thoughts, readers are left to wonder if it is Dubois's own imperialist fantasy, reported as if it were fact.Shipman also does little to relate Dubois to the scientific world of his day. Coverage of the culture of colonial science, Dutch scientific institutions, and turn‐of‐the‐century debates over human evolution is scant. Scientists like Henry Fairfield Osborn, Ales Hrdlicka, and Ralph Von Koenigswald are introduced with only vague indications of their interests, status, or intellectual commitments. Hominid fossils other than Pithecanthropus erectus receive little more attention; even the Neanderthals, on whom Shipman has coauthored an authoritative book, are accorded only a handful of pages. All of this makes it difficult to assess whether Dubois's experiences were typical of the times, places, and fields in which he worked. It also undercuts Shipman's claim that Dubois, by his dogged insistence on the “missing link” status of Pithecanthropus erectus, forced his fellow scientists to confront the reality of human evolution

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.

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions.

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia

In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed

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

Objectives: To investigate why physicians label end-of-life acts as either ‘euthanasia/ending of life’ or ‘alleviation of symptoms/palliative or terminal sedation’, and to study the association of such labelling with intended reporting of these acts. Methods: Questionnaires were sent to a random, stratified sample of 2100 Dutch physicians. They were asked to label six hypothetical end-of-life cases: three ‘standard’ cases and three cases randomly selected, that varied according to type of medication, physician’s intention, type of patient request, patient’s life expectancy and time until death. We identified the extent to which characteristics of cases are associated with physician’s labelling, with multilevel multivariable logistic regression. Results: The characteristics that contributed most to labelling cases as ‘euthanasia/ending of life’ were the administration of muscle relaxants or disproportional morphine. Other important factors were an intention to hasten death and a life expectancy of several months. Physicians were much more willing to report cases labelled as ‘euthanasia’ or ‘ending of life’ than other cases. Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not.

Experiences of substitute decision-makers with requests for consent to non-therapeutic research participation during the dying process, including to what degree such requests are perceived as burdensome, have not been well described. In this study, we explored the lived experiences of family members who consented to non-therapeutic research participation on behalf of an imminently dying patient. We interviewed 33 family members involved in surrogate research consent decisions for dying patients in intensive care. Non-therapeutic research involved continuous physiological monitoring of dying patients prior to and for 30 min following cessation of circulation. At some study centres participation involved installation of bedside computers. At one centre electroencephalogram monitoring was used with a subset of participants. Aside from additional monitoring, the research protocol did not involve deviations from usual end-of-life care. Thematic analysis of interviews suggests most family members did not perceive this minimal-risk, non-therapeutic study to affect their time with patients during the dying process, nor did they perceive research consent as an additional burden. In our analysis, consenting for participation in perimortem research offered families of the dying an opportunity to affirm the intrinsic value of patients’ lives and contributions. This opportunity may be particularly important for families of patients who consented to organ donation but did not proceed to organ retrieval. Our work supports concerns that traditional models of informed consent fail to account for possible benefits and harms of perimortem research to surviving families. Further research into consent models which integrate patient and family perspectives is needed. All data relevant to the study are included in the article.

This research examined the influence of social-, genetic-, and brain-based explanations on attributions of others’ behaviors. Participants were university students in Studies 1, 2, and 3. Participants read a vignette about an individual who possessed several undesirable behaviors and answered related questions. The first two studies had within-subjects designs. Participants in Study 1 were provided with social-, genetic-, and brain-based explanations for the individual’s behavior. The order of the genetic- and brain-based explanations was reversed in Study 2. Study 3 used the same materials, but had a between-subjects design where participants were assigned to one of three groups that differed in their explanation: social, genetic, or brain. Participants also completed measures of social desirability and free will beliefs in all three studies. Consistently, biological explanations had more influence than social explanations on ratings of others’ responsibility, capacity for change, and sentencing considerations. There was inconsistent evidence across the three studies, however, that brain-based explanations had more influence than genetic-based explanations. Interestingly, Free will scores were associated with aspects of the individual’s behavior in the social condition but not in the biological conditions. Additional social cognition research is needed to determine whether brain-based explanations are just one specific instantiation of biological explanations or whether they are unique in this regard when it comes to the attributions we make about others’ behaviors.

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