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In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches to desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has.
In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches to desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has.
Dit artikel stelt dat beleidsverandering binnen de Europese Unie (EU) ook voortkomt uit besluitvorming op dagelijks niveau. Om veranderingen aan te kunnen wijzen en te verklaren dient de traditionele rationele keuzetheorie en de oriëntatie op instrumenteel-strategisch handelen te worden aangevuld met een constructivistische zienswijze op discours als bron van verandering. Met de inzichten van constructivisten en communicatiewetenschappers wordt in dit artikel gekeken naar de voorwaarden en het zich voordoen van deliberatie als discursief proces dat beleidsverandering op dagelijks niveau bevordert. In dat verband is onderzoek verricht naar een tweetal besluitvormingsprocessen op het gebied van EU-justitiesamenwerking. De ene betreft een casestudie omtrent de onderhandelingen over de totstandkoming van het Europees Bewijsverkrijgingsbevel van 2008. De ander gaat over de onderhandelingen over een Raadsbesluit betreffende de toegang van politie tot het Visa Informatie Systeem. Uit beide casestudies blijkt dat onder bepaalde omstandigheden deliberatie uitmondend in beleidsverandering zich feitelijk heeft voorgedaan. ABSTRACT This paper argues that, in addition to the practice of strategic bargaining, one may very well find in the day-to-day running of the EU decision-making instances where changes in policy outcome result from occurrences of deliberation. Occurrences have indeed been signalled in both the 'EEW' and 'VIS' cases where negotiating parties engaged in reasoned exchanges of views that resulted in position shifts and even agreements on certain issues. Analysis of both cases demonstrates that in settings where the conditions of 'insulation','intensity' or 'access of non-state actors' were prominently present, deliberation and ensuing progress towards a more reasoned understanding of the issue concerned was more likely to occur. Furthermore, a certain detachment from technical detail, yet sufficient proximity to subject matter, absence of agenda constraints and small-group dynamics made it more likely that discussants were inclined to engage in more open-minded exchanges of views based on reason and argument. On balance, clearly identifiable occurrences of deliberation-promoting progress in decisionmaking have been found in the institutionally quite diversified and multifaceted environment of the EU. They can certainly be regarded as representative of other decision-making processes operating under similar conditions, processes of which the institutionally dense EU is particularly rich. In a way, the occurrences of deliberation identified constitute a path of progressive understanding that is bound to extend beyond the temporal boundaries of a specific decision-making procedure. Reasoned understandings on certain issues achieved in either the EEW or VIS process were likely to provide a fertile basis on which further reasoned discussion can evolve into other, future decision-making processes. As such the deliberative instances found in the EEW and the VIS cases are of all periods, including the post-Lisbon period, and should be examined as alternative sources of policy change in the EU, irrespective of the timeframe.
Dit artikel stelt dat beleidsverandering binnen de Europese Unie (EU) ook voortkomt uit besluitvorming op dagelijks niveau. Om veranderingen aan te kunnen wijzen en te verklaren dient de traditionele rationele keuzetheorie en de oriëntatie op instrumenteel-strategisch handelen te worden aangevuld met een constructivistische zienswijze op discours als bron van verandering. Met de inzichten van constructivisten en communicatiewetenschappers wordt in dit artikel gekeken naar de voorwaarden en het zich voordoen van deliberatie als discursief proces dat beleidsverandering op dagelijks niveau bevordert. In dat verband is onderzoek verricht naar een tweetal besluitvormingsprocessen op het gebied van EU-justitiesamenwerking. De ene betreft een casestudie omtrent de onderhandelingen over de totstandkoming van het Europees Bewijsverkrijgingsbevel van 2008. De ander gaat over de onderhandelingen over een Raadsbesluit betreffende de toegang van politie tot het Visa Informatie Systeem. Uit beide casestudies blijkt dat onder bepaalde omstandigheden deliberatie uitmondend in beleidsverandering zich feitelijk heeft voorgedaan. ABSTRACT This paper argues that, in addition to the practice of strategic bargaining, one may very well find in the day-to-day running of the EU decision-making instances where changes in policy outcome result from occurrences of deliberation. Occurrences have indeed been signalled in both the 'EEW' and 'VIS' cases where negotiating parties engaged in reasoned exchanges of views that resulted in position shifts and even agreements on certain issues. Analysis of both cases demonstrates that in settings where the conditions of 'insulation','intensity' or 'access of non-state actors' were prominently present, deliberation and ensuing progress towards a more reasoned understanding of the issue concerned was more likely to occur. Furthermore, a certain detachment from technical detail, yet sufficient proximity to subject matter, absence of agenda constraints and small-group dynamics made it more likely that discussants were inclined to engage in more open-minded exchanges of views based on reason and argument. On balance, clearly identifiable occurrences of deliberation-promoting progress in decisionmaking have been found in the institutionally quite diversified and multifaceted environment of the EU. They can certainly be regarded as representative of other decision-making processes operating under similar conditions, processes of which the institutionally dense EU is particularly rich. In a way, the occurrences of deliberation identified constitute a path of progressive understanding that is bound to extend beyond the temporal boundaries of a specific decision-making procedure. Reasoned understandings on certain issues achieved in either the EEW or VIS process were likely to provide a fertile basis on which further reasoned discussion can evolve into other, future decision-making processes. As such the deliberative instances found in the EEW and the VIS cases are of all periods, including the post-Lisbon period, and should be examined as alternative sources of policy change in the EU, irrespective of the timeframe.
In: Frank Gadinger, Martina Kopf, Ayşem Mert, and Christopher Smith (eds.). Political Storytelling: From Fact to Fiction (Global Dialogues 12) This essay presents a summary of important perspectives concerning the distinction between what counts as truth or fiction. As a source of inspiration, it starts with two examples found in literature – the first a classical Spanish novel and the second a collection of stories written by the leader of a social movement in Mexico. These two examples of the conflictive relations between truth and fiction, authenticity and imagination serve as a source of inspiration for the rest of this article, which shows that this issue has been a subject of intense debate in philosophy and in the philosophy of science and still presents a challenge in the 21st century. The essay states that absolute, objective truth is a myth. It describes that what counts as ‘truth’ in a particular era, is, among other things, the result of power relations. It suggests productive ways to deal with this problem in modern society, through deliberative, emancipatory processes of reflexivity (Weick 1999), participatory research and dialogue, facilitating innovation and generation of new solutions.
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