Van Paul

Despite increasing attention to the involvement of family members or informal caregivers in patient care, their role remains underdeveloped in medical decision-making (MDM) models implemented in clinical practice. Moreover, family involvement in MDM may conflict with patient rights, particularly the patient’s right to self-determination. This study aimed to assess whether Belgian general practitioners (GPs) endorse legally impermissible strategies for family involvement in MDM, and how this relates to their knowledge of the legal framework, attitudes toward MDM, sociodemographic and professional characteristics. An online vignette survey was distributed among Dutch-speaking GPs in Belgium. The vignettes were designed using a nominal group technique, in which complex real-life cases of family involvement in MDM were discussed with GPs and medical lawyers. The survey assessed GPs’ endorsement of legally impermissible strategies for family involvement in MDM, described in four vignettes, along with their knowledge of the legal permissibility of these strategies. Regression analyses were run to examine the associations between GPs’ endorsement and their legal knowledge, attitudes toward MDM, sociodemographic and professional background variables. The final sample consisted of 290 GPs. Depending on the vignette, 26.9% to 43.8% of respondents endorsed legally impermissible strategies, and 26.2% to 35.9% demonstrated insufficient knowledge of the relevant legal framework. Greater legal knowledge emerged as the strongest protective factor against endorsing legally impermissible strategies. However, 10.3% to 20% of respondents still endorsed such strategies despite having sufficient knowledge. A considerable proportion of GPs endorsed the use of legally impermissible strategies for family involvement in MDM. Considering that some of these respondents had adequate legal knowledge, findings suggest a need to reassess the responsiveness and practical applicability of the legal framework to clinical realities.

By the eleventh century, communities of religious practitioners in China had developed a theory and practice of meditative self-cultivation that combined the so-called Three Teachings. By the seventeenth century, Wu Shouyang created a synthesis of the various lineages of this "inner alchemy," combining it with elements from Buddhism and Confucianism. By the late nineteenth century, his writings had become bestsellers in the genre and his became the standard account of this tradition. This first book-length English-language study of Wu Shouyang's life and works introduces his remarkable life and formulates answers to fundamental questions about this important tradition.

In this contribution it will be demonstrated, on the basis of two treatises in St Augustine’s In lohannis euangelium tractatus centum viginti quatuor, that Augustine, precursor of the later negative theology, sees the awareness of human consciousness as the prelude to the realisation that God is incomprehensible. His reflections on human consciousness as the seat of God, in their turn, form the prelude to reflections on two types of inadequacy of human intelligence. In Tractatus 1 he first reduces this inadequacy to the need people feel to see God as all too human, and exactly therefore refuse to appreciate Him as the Incomprehensible One. He regards this as reprehensible and he attributes this attempt to certain heresies. In addition the cognitive capacity of inspired men like St John is inadequate, because they too are caught in the limitations of the concrete dimensions of time and space inherent in their existence on earth. They are not reprehensible, however. Augustine also expands the awareness of God’s incomprehensibility by emphasizing that God cannot possibly be grasped conceptually by means of words. He takes great pains to evoke some kind of consciousness of God as the Word, by making use of comparisons, but these attempts are structurally embedded in reflections on the incomprehensibility of God, precisely as the Word, not to be compared with a human, spoken, transient word. Nevertheless, in accordance with a principle, already recognized in De ordine, Augustine emphasizes that, on the authority of St John however incomprehensible the Word that is God may be for him, the Word made flesh, Who dwelt among us, is very near indeed. Also in Tractatus I and II of In lohannis euangelium tractatus Augustine tries to find a language evoking God’s incomprehensibility by reminding us that the experience of God is an experience that is in perfect contrast with a sensual experience; it is a counter-experience that cannot possibly be grasped in concepts. At the same time he tries to see the Incarnation as an appeal to become as humble as God Himself.

The article deals with the violence applied to the Donatists, trying to answer three questions. The first is the about the development that Augustine experienced which finally led him to approve violence against the Donatists and to adopt the coge intrare (i. 112) as his device. The second question deals with the function Augustine envisaged for the use of violence and coercion in the process of returning heretics to the Catholic Church. Finally it traces the general and fundamental principles in Augustine’s way of thinking on violence. For this third question the article considers Augustine’s passages on coercion and violence in texts in which he speaks about administration of justice and medicine, and about the role of God at the Last Judgment.

In the last decade, a number of studies in the behavioural sciences, particularly in psychology and economics, have explored the complexity of individual risk behaviour and its underlying factors. Most previous studies have examined the influences of various socio-economic, cognitive, biological and psychological factors on human decision-making however, the relationship between the decision-makers’ risk preferences and occupational background has not received much empirical attention. Accordingly, in the current study, we investigated how occupational background, together with decision-making framing (e.g., variations in decision domain, context, presentation of risk and utility ratios), influence participants’ risk preferences for decision options with equivalent expected utility. Our novel findings indicate that risk preferences may vary among individuals from different occupational backgrounds. As such, when the task was framed in gain terms, participants who mostly deal with health/safety-related risks on a day-to-day basis (high-risk occupations) were predominantly risk-averse (avoiding risky options), while participants who mostly deal with financial/social risks (white-collar occupations) were prone to risk-seeking behaviour (avoiding certain options). Specifically, in “high-risk” occupations, participants’ pattern of choices changed from risk-averse in gain scenarios to risk-seeking in loss scenarios. However, the opposite pattern of risk preferences was found in participants with “white-collar” occupations. Our findings indicate that decision-makers’ occupational backgrounds influence risk preferences under some circumstances.

Towards the end of a ramble: transfer of knowledge, embracing values and the teaching profession according to Augustine In this article the first traces of Augustine’s desire to be not only a teacher but also, in conjunction with this, a writer of protreptics are pointed out in his Soliloquia and his De catechizandis rudibus. Protrepsis and first catechesis need to coincide. In De catechizandis rudibus, he advised deacon Deogratias to clarify the Last Judgement and the resurrection of the body. These two doctrines were both a pièce de resistance for pagans, and therefore also for rudes. The choice of these doctrines demonstrates Augustine’s attempt to have the deacon adopt a protreptic approach in his first catechesis – possibly without Deogratias even knowing it himself. There was no chance that the beginners would already be truly acquainted with these essential aspects of the Christian view of the world and of the future. As it turns out, the line between protrepsis and catechesis is a very fine one in this case.