Versterven bij een psychiatrische patiënt: hindernissen voor patiënt, familie en behandelteam

In deze klinische les beschrijven we een patiënt met een uitgebreide psychiatrische voorgeschiedenis van een chronische depressie die na een jarenlange ambivalente houding besluit te stoppen met eten en drinken, omdat hij – zoals de KNMG het noemt – ‘lijdt aan het leven’. Patiënt had geen verzoek tot euthanasie of hulp bij zelfdoding. Zijn eerste poging, die zes weken duurde, resulteerde niet in het door hem gewenste overlijden. Een tweede poging, vier maanden later, was wel succesvol. In de les komen de hindernissen aan de orde die de patiënt, de familie en het behandelteam tegenkwamen. Met name de psychiatrische voorgeschiedenis, de als gevolg daarvan bestaande polyfarmacie met diverse psychofarmaca, de overmatige dorst, de rol van de echtgenote en de dilemma’s van het behandelend team, maakten deze casus extra gecompliceerd. Daarmee worden dergelijke casus een grote uitdaging voor behandelaars die immers de plicht hebben in zo’n geval goede palliatieve zorg te verlenen

The global diffusion of inequality since 1970

Since 1970 income inequality has been stable or rising in almost every country in the world. It has not, however, risen at the same time or at the same rate throughout the world. This suggests the globalization, skills premium, and technological change explanations that prevail in the economics literature are likely incorrect, since all of these processes should in principle have relatively uniform global impacts. Instead, the timing and geo-cultural patterns of rising inequality bear the hallmarks of a diffusion model. Inequality has not arisen simultaneously around the world; it has "spread" from country to country in recognizable and sensible patterns. The diffusion model offers a simple, intuitively-appealing alternative to extraordinarily complex regression models of rising inequality. Diffusion can occur either through emulation (a macrophenomenological mechanism) or through coercion (a macrorealist mechanism). These two mechanisms are not mutually exclusive. Either or both can be used by national elites to effect major changes of policy regime. Diffusion by emulation and diffusion by coercion are two macro-level mechanisms that can be used as a template for understanding the implementation of inequality-increasing social and economic policies in diverse countries around the world. They can be differentiated through examination of the micro-level mechanisms through which diffusion occurred in specific historical cases. This injection of agency into the inequality debates requires extensive microlevel work on individual countries, but the clear existence of macro-level trends suggests that this micro-level work should be done within the context of some form of macro-level diffusion model.Collective Behavior & Social Movements section of the American Sociological Association, the Development Sociology section of the American Sociological Association, the Human Rights section of the American Sociological Association, the RC02 (Economy and Society) of the International Sociological Association and the School of Social & Political Sciences of the University of Sydney

Memory enhancing drugs and Alzheimer’s Disease: Enhancing the self or preventing the loss of it?

In this paper we analyse some ethical and philosophical questions related to the development of memory enhancing drugs (MEDs) and anti-dementia drugs. The world of memory enhancement is coloured by utopian thinking and by the desire for quicker, sharper, and more reliable memories. Dementia is characterized by decline, fragility, vulnerability, a loss of the most important cognitive functions and even a loss of self. While MEDs are being developed for self-improvement, in Alzheimer’s Disease (AD) the self is being lost. Despite this it is precisely those patients with AD and other forms of dementia that provide the subjects for scientific research on memory improvement. Biomedical research in the field of MEDs and anti-dementia drugs appears to provide a strong impetus for rethinking what we mean by ‘memory’, ‘enhancement’, ‘therapy’, and ‘self’. We conclude (1) that the enhancement of memory is still in its infancy, (2) that current MEDs and anti-dementia drugs are at best partially and minimally effective under specific conditions, (3) that ‘memory᾿and ‘enhancement᾿are ambiguous terms, (4) that there is no clear-cut distinction between enhancement and therapy, and (5) that the research into MEDs and anti-dementia drugs encourages a reductionistic view of the human mind and of the self

De dans om het intensive care-bed. Een ethisch commentaar

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Huisarts en thuiszorg

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Het lichaam als tekst : het probleem van lage-rugklachten

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Chronische aandoeningen (redactioneel)

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Huisartsgeneeskunde en ethiek : de stand van zaken

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Chronisch ziek-zijn

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