Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

... 243-) INTRODUCTION §§243- constitute the eighth 'chapter' of the book. Its point of departure is a natural query with respect to the conclusion of the ...

Throughout its long history metaphysics has been variously conceived. At its most sublime, it has been taken to be the study of the super‐sensible, in particular of the existence of a god, the nature of the soul, and the possibility of an afterlife. When the young Ludwig Wittgenstein entered the lists, it was entirely reasonable to conceive of metaphysics in this manner. Its subject matter was held to be the language‐independent and thought‐independent de re necessities of the world. The Tractatus (...) is dominated by three problems: first, the nature of logic and logical necessity; secondly, the essence of the proposition and hence the characterization of the general propositional form; and thirdly, the intentionality of the proposition. Logical propositions are combinations of elementary propositions by means of truth‐functional logical connectives. The metaphysics adumbrated in the Tractatus, Wittgenstein thought, was required for the possibility of representation and for the possibility of logic. (shrink)

Throughout much of human history most people conceived of death as a transitional event. An alternative, secular, conception of death is as the permanent cessation of all life‐sustaining biological functions. The death of the physical organism is the death of the person or human being. However death be conceived, human beings are the only creatures that are aware of their mortality. The death penalty is often thought to be the most severe punishment of all, far worse than life imprisonment. Attitudes (...) towards death vary according to the acceptance or rejection of belief in an afterlife. Death in old age is generally held to be less deplorable than death in one's prime. Premature death, however, is commonly deemed to be tragic, but not because merely being alive is a good of one kind or another, let alone good in itself. Lucretius exaggerated the symmetry between prenatal and post‐ mortem events. (shrink)

Entertainments and celebrations are meant to give audiences and participants pleasure. Pleasure and enjoyment are an integral part of flourishing human life, and the desire for pleasure and enjoyment is a distinctive aspect of human nature. Psychological hedonism is a descriptive doctrine concerned with giving an account of actual human motivation. Ethical hedonism is a prescriptive doctrine that advances the view that human beings ought to pursue pleasure and avoid pain, that prospective pleasure and pain are severally the only good (...) reasons for action. ‘Pleasure’, ‘enjoyment’, and ‘being pleased’ are three graces that stand at the intersection of psychology, axiology, and practical reasoning. The relation between pleasure and awareness or consciousness of pleasure is subtle and unlike the corresponding relation to having a pain. To live the life of a practical hedonist is to live a life guided by the pursuit of pleasure. (shrink)

The powers of intellect and will, possession of which is constitutive of having a mind, are not powers of the mind, but of the being that has a mind. The Platonic metaphysical conception of the soul is of great interest irrespective of its informing both ancient and Renaissance neo‐Platonist ideas about the soul and its immortality, and, via Augustine, ultimately moulding the misconceived Cartesian conception of the soul. The dividing line between the soul and the flesh is quite different from (...) that between the mind and the body. The soul is associated with aesthetic sensibility and with the appreciation of beauty and pathos, with which conscience has no connection. The evil‐doer commonly aims, explicitly or implicitly, to destroy the moral order of humanity and the moral restraints on behaviour that are constitutive of moral beings. Evil‐doers have to suppress the voice of conscience. (shrink)

Some of human evil is a function of the historical stage of society. The evils and wickednesses of bureaucracy are as old as well‐developed bureaucratic hierarchies. Evil‐doers have character traits that may form recognizable patterns with explanatory weight. Evil‐doers produce reasons for their evil‐doing and offer justifications for their evil deeds. Psychological experiments may indeed establish important correlations and statistical probabilities that may be crucial for the formation of intelligent social policy. The greatest students of the place of evil in (...) human life and of the subjective psychology of evil in a complex social setting are great novelists, dramatists, and poets. From the late eighteenth century onwards ideological beliefs played a major role in stimulating evil, not for the greater glory of God but for the future glory of man. The first major social movement that bent an ideology to wholly evil policies were the Jacobins during the French Revolution. (shrink)

Global fatalism is an attitude towards life, an attitude of resignation and acceptance of what happens. Global fatalism in the form of predestinarianism is typically, but not exclusively, associated with monotheism rather than with polytheism, and in particular with Christianity and Islam. An individual form of fatalism consists in the belief that specific incidents in a person's life are preordained. Local fatalism appears to be common to many different cultures and societies. Individual fatalism is associated with other important events in (...) human life, such as meeting the person with whom one is destined to fall in love. The ubiquity of the various forms of individual fatalism suggests that they have a deep appeal to human sentiment. Descartes's successors, lumbered with dualism but rejecting causal interaction, struggled to preserve human freedom while acknowledging nomological determinism. Global nomological determinism is a picture, a preconception of the nature of change in all its forms. (shrink)

Happiness has been at the centre of philosophical reflection ever since Plato and Aristotle. Epicureans thought of happiness as the satisfaction of one's minimal needs and the absence of further desires. True happiness may be the love of another, or successful and virtuous public service recognized by society, or successful engagement in a favoured activity. Youthful happiness involves intensity of feeling, engagement with the passing moment, the discovery of first love and of sexuality, and the joys of dedication to a (...) beloved. The different forms of human engagement involve different kinds of happiness. Physical normality and good health are patently preconditions of happiness inasmuch as physical abnormalities and persistent diseases are barriers to leading a healthy and normal human life. A person's social conditions are highly relevant to the possibility of happiness. Happiness can be marred or shattered by a multitude of accidents of fate and by human malice, political upheavals, and economic disasters. (shrink)

The most common form of determinism in the first quarter of the twenty‐first century is neuroscientific determinism. Global neuroscientific determinism is a blank cheque on a non‐existent bank. Neuroscientists have discovered the character of the neural activity in the premotor cortex immediately antecedent to movement, and the nature of the neural impulses from the brain to the muscles in the relevant limb that will make them severally contract or relax. Being rational, being free, and being responsible for our actions and (...) omissions are essential species characteristics of mankind. Various forms of responsibility have been distinguished by philosophers and lawyers: causal responsibility, capacity responsibility, act responsibility, liability responsibility, role responsibility, and responsibility as a character trait. At the heart of the very idea of responsibility lies the notion of a normal rational human agent with normal human faculties. (shrink)

A life devoid of meaning is a life without happiness. But one may find meaning in one's life and in one's activities without being happy. Like pleasure and happiness, goodness and beauty, the meaningfulness one may find in one's life comes in degrees. Many achievements may mean something to a person without being of sufficient significance to lend meaning to their life, such as winning in some competitive activity or passing an important examination. Forms of illusory meaning, that is meaning (...) that rests on false or misconceived beliefs, can impart meaning to a person's life and make it genuinely meaningful, as long as it involves neither evil doing nor evil beliefs. The human condition as language‐using, self‐conscious social animals with limited capacities for good and evil, with highly competitive and killer instincts is anything but ludicrous, farcical, silly, or ridiculous. (shrink)

The key to a perspicuous overview of axiology is the realization that all values arise from life. This chapter provides a brief overview of von Wright's categories, or ‘varieties’, of goodness. Medical goodness is the most elemental variety of natural value and disvalue. Any language‐using creature that has the skills to make and to use tools, instruments, and other artefacts is going to need the concepts of artefactual goodness and its subcategory of instrumental goodness. Morality is essentially a social phenomenon (...) – it is an aspect of the form of life of a community. In evolved societies, it overlaps with and fades into law, into social mores or small morals, and into individual critical morality. Virtue, or moral goodness, as well as the moral virtues, which are moral character traits, are attributes of social beings who are, and who identify themselves as being, members of a community, people, or nation. (shrink)

Von Wright argued that moral goodness is a derivative form of goodness. He proceeded to give an account of the moral goodness of an act, in terms of the good of man. Philosophical anthropology must render the phenomenon of morality intelligible. This chapter suggests that the roots of moral value lie in human sympathy, in maternal love, in intuitive recognition of the humanity of others, and in the nature of loving friendship. The sentiment of sympathy is virtually ubiquitous, but sympathetic (...) propensities vary from person to person, being partly a function of their imagination. Sympathy is an emotional tap‐root of moral reasons and a presupposition of moral reasoning. Kant's argument in support of a requirement of equal formal respect for human beings as moral agents is problematic. The explicit emergence of the idea of formal respect is one of the great advances in our evolving understanding of human nature and our conception of ourselves. (shrink)

Humans are caught – in their lives, in their thoughts, in their hungers and ambitions, in their avarice and cruelty, and in their kindness and generosity too – in a net of good and evil. Natural evils are simply natural catastrophes that destroy human life, property, crops, and means of livelihood such as earthquakes, tsunamis, volcanic eruptions, avalanches, floods, and droughts. Some people may never recover from such evils and be incapable of leading a normal human life. The evil of (...) evil‐doers can therefore be explained away by showing that they themselves are victims. The existence of human evil is explained by reference to the wickedness of those who choose of their own will to do evil. The idea that evil is privative, that is, it consists in the absence of good, stripped of its theological trappings, is unconvincing. (shrink)

Modern utilitarianism has its roots in the eighteenth century, its philosophical blossom in the works of Bentham and the Mills, and its practical fruit in the works of nineteenth‐century radical legal and political utilitarian reformers. Utilitarians held that pleasure, and hence too happiness, are sensations. Human beings are in effect mere pleasure or happiness receptacles or desire‐satisfying mechanisms. The idea of a science of happiness appealed to some economists and social theorists who rightly felt increasingly ill at ease about measuring (...) national welfare and progress in terms of growth in gross national product. The goal of profit maximization dominated economic science. One stimulus for the development of a putative science of happiness was dissatisfaction with economists’ attempts to evaluate the success of an economic system and the progress of a society by measuring gross national product. In a happy society alienation is minimal, and freedom and dignity are respected and preserved. (shrink)

The concept of normal is so familiar that it can be hard to imagine contemporary life without it. Yet the term entered everyday speech only in the mid-twentieth century. Before that, it was solely a scientific term used primarily in medicine to refer to a general state of health and the orderly function of organs. But beginning in the middle of the twentieth century, normal broke out of scientific usage, becoming less precise and coming to mean a balanced condition to (...) be maintained and an ideal to be achieved. In Normality, Peter Cryle and Elizabeth Stephens offer an intellectual and cultural history of what it means to be normal. They explore the history of how communities settle on any one definition of the norm, along the way analyzing a fascinating series of case studies in fields as remote as anatomy, statistics, criminal anthropology, sociology, and eugenics. Cryle and Stephens argue that since the idea of normality is so central to contemporary disability, gender, race, and sexuality studies, scholars in these fields must first have a better understanding of the context for normality. This pioneering book moves beyond binaries to explore for the first time what it does—and doesn’t—mean to be normal. (shrink)

Writing from a scientifically and philosophically informed perspective, the authors provide a critical overview of the conceptual difficulties encountered in many current neuroscientific and psychological theories.