The aim of the article is threefold: to argue and motivate that unnecessary surgery is a worldwide phenomenon, that it exposes patients to unwarranted risks and that patients should actively participate in decision-making and take a shared responsibility to protect their interests. There is a firm belief that the enterprise of medicine is something of value – both intrinsically because being healthy is good and instrumentally since being healthy allows us to do what we wish to, to attain happiness and (...) to live valuable lives. However, this can only hold if treatment is justified in terms of accepted evidence-based criteria. Imperative for all forms of treatment, including costly and invasive investigations, this is particularly true for surgical interventions because no surgery is without risk. Surgery performed outside of the norms of accepted indications constitutes a grave form of assault. Medicine is a noble cause if we stick to the rules and help each other to do so. As professionals, our most fundamental regulation is by ourselves. (shrink)

Military metaphors are pervasive in biomedicine, including HIV research. Rooted in the mind set that regards pathogens as enemies to be defeated, terms such as “shock and kill” have become widely accepted idioms within HIV cure research. Such language and symbolism must be critically examined as they may be especially problematic when used to express scientific ideas within emerging health-related fields. In this article, philosophical analysis and an interdisciplinary literature review utilizing key texts from sociology, anthropology, history, and Chinese and (...) African studies were conducted to investigate the current proliferation of military metaphors. We found the use of these metaphors to be ironic, unfortunate, and unnecessary. To overcome military metaphors we propose to give them less aggressive meanings, and/or replace them with more peaceful metaphors. Building on previous authors' work, we argue for the increased use of “journey” metaphors as meaningful, cross-culturally app... (shrink)

Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment (...) and research to inform consent processes for cure research. In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions. Thematic analysis of transcribed IDIs and FGDs was conducted. The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research. (shrink)

Davidson's anomalous monism, his argument for the identity between mental and physical event tokens, has been frequently attacked, usually demanding a higher degree of physicalist commitment. My objection runs in the opposite direction: the identities inferred by Davidson from mental causation, the nomological character of causality and the anomaly of the mental are philosophically problematic and, more dramatically, incompatible with his famous argument against the third dogma of empiricism, the separation of content from conceptual scheme. Given the anomaly of the (...) mental and the absence of psychophysical laws, there are no conceptual resources to relate mental and physical predicates. We fall in the third dogma if we claim that the very same token event is mental and physical. One of the premises must be rejected: I will claim that we do not need a law to subsume cause and effect to be entitled to speak of causation. Davidson has never offered an argument to back this premise. Against such a dogma I will sketch some ideas pointing towards a different conception of causality, singularist and undetachable from explanatory practices. (shrink)

In recent years, functional connectivity in the developmental science received increasing attention. Although it has been reported that the anatomical connectivity in the preterm brain develops dramatically during the last months of pregnancy, little is known about how functional and effective connectivity change with maturation. The present study investigated how effective connectivity in premature infants evolves. To assess it, we use EEG measurements and graph-theory methodologies. We recorded data from 25 preterm babies, who underwent long-EEG monitoring at least twice during (...) their stay in the NICU. The recordings took place from 27 weeks postmenstrual age until 42 weeks PMA. Results showed that the EEG-connectivity, assessed using graph-theory indices, moved from a small-world network to a random one, since the clustering coefficient increases and the path length decreases. This shift can be due to the development of the thalamocortical connections and long-range cortical connections. Based on the network indices, we developed different age-prediction models. The best result showed that it is possible to predict the age of the infant with a root mean-squared error equal to 2.11 weeks. These results are similar to the ones reported in the literature for age prediction in preterm babies. (shrink)

This paper analyses the way in which discourse and argumentation may vary depending on participants’ educational level and gender. Men and women from three different educational levels (literacy, advanced level and university students) participated in discussion groups that debated about women and work, the sharing of housework and the way in which girls and boys are educated. The results showed important differences depending on participants’ educational level and gender. In general, the main differences were related to educational level, while gender (...) tended to interact with educational level, as a moderating factor. (shrink)

The axiomatic approaches of quantum mechanics and relativity theory are compared with approaches in which the theories are thought to describe readings of certain measurement operations. The usual axioms are shown to correspond with classes of ideal measurements. The necessity is discussed of generalizing the formalisms of both quantum mechanics and relativity theory so as to encompass more realistic nonideal measurements. It is argued that this generalization favours an empiricist interpretation of the mathematical formalisms over a realist one.

This study offers a re-interpretation of basic elements of Aristotle's semantics and metaphysics on the basis of a meticulous reconstruction of his semantics. By eliminating anachronistic conceptions commonly ascribed to him, many shortcomings or obscurities he is accused of will disappear.

We investigate the problem of “wave packet reduction” in quantum mechanics by solving the Schrödinger equation for a system composed of a model measuring apparatusM interacting with a microscopic objects. The “instrument” is intended to be somewhat more realistic than others previously proposed, but at the same time still simple enough to lead to an explicit solution for the time-dependent density matrix. It turns out that,practically, everything happens as if the wave packet reduction had occurred. This is a consequence of (...) the fact that the apparatus is made up of a very large number of microsystems interacting withs. More precisely, our model shows that the “macroscopic size” of a measuring apparatus can lead by itself to a density matrix for the systemM + s which is physically equivalent to the density matrix of a statistical mixture corresponding to the reduced wave packet. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 (...) years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

In this paper we consider an intuitionistic variant of the modal logic S4 (which we call IS4). The novelty of this paper is that we place particular importance on the natural deduction formulation of IS4— our formulation has several important metatheoretic properties. In addition, we study models of IS4— not in the framework of Kirpke semantics, but in the more general framework of category theory. This allows not only a more abstract definition of a whole class of models but also (...) a means of modelling proofs as well as provability. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole‐genome sequencing and micro‐array based analysis enable genome‐wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre‐test information and achieving autonomous decision‐making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by (...) the International Association of Bioethics, these challenges were presented for three different areas in which these so‐called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set‐up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set‐up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct‐to‐consumer applications of the new genetics. (shrink)

This paper aims to show issues raised by lacanian psychoanalyses concerning the reasons of the phenomenon of aggressiveness, mainly due to the frequency of this phenomenon in education. In this paper, it was intended to highlight the philosophical dimension of the problem, since we are using basically the dissertative method. Lacan takes Hegelian and Marxist legacy to develop the thesis of aggressiveness as realization of a dynamic introduced from the gaze and that has its modus operandi in the movements of (...) alienation and non-alienation. The aggressiveness illustrated, for example, by the injuries suffered by teachers shows itself as a tentative to cause the fall of the Other, this fall is considered as the object a of which its appearance is regulated by the Oedipus Complex. Namely, both the way how the parental authority figures are inscribed in the significant chains that compose the individual and how this inscription shapes the existential possibilities of interaction with the opposite sex would be the key to foresee the extent the individual makes use of aggressiveness. In this way, the Oedipus complex, reinvested by the event of puberty would be responsible for the displacement of the libido one time to the ´Other´ and other time to the own subject. The Other, in the theoretical development of Lacan that follows the decade of 1960, comprehends the identifier choices and also what escapes from any identification. The Other, as a teacher, has the role of positioning itself to generate intuitively one process of identification and has the delicate function of sustain the dialectic that emerges in the moment where the Other falls, moment which usually comes after the identification and that happens with a joy capable of unveiling the object a. Although the role of education is not to maintain an auscultation to this object, the education can influence its nonexclusion and make this object be contoured with the advent of singularities. In this moment, the explicitness of the rules which education constitutes itself as well as the empathy from the educator can be a fundamental instrument in education like the subject to be taught. From the text, we can conclude that: we need to put the aggressiveness in our speech as via of achievement of the non-alienation process conjugated with the possibility to support the desire. (shrink)