If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

Health checks identify disease in individuals without a medical indication. More and more checks are offered by more providers on more risk factors and diseases, so we may speak of an omnipresence of health checks. Current ethical evaluation of health checks considers checks on an individual basis only. However, omnipresent checks have effects over and above the effects of individual health checks. They might give the impression that health is entirely manageable by individual actions and strengthen the norm of individual (...) responsibility for health to the point where people hold themselves and others responsible for health outcomes they cannot reasonably be held accountable for. This process of so-called ‘over-responsibilization’ may result in increased feelings of guilt over health, decreased health solidarity and unfairly distributed health outcomes. Moreover, effects on privacy and peace of mind may be observed. Taking into account all possible harms and benefits of health checks in their ethical evaluation requires evaluation of health checks on an individual basis as well as on the level of all checks. Therefore, we urge the amendment of existing ethical evaluation to include the effects of an omnipresence of health checks. We make a first attempt at the formulation of amended criteria. (shrink)

Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices. Providers unanimously formulate a (...) number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)

Health checks or health screenings identify disease in people without a specific medical indication. So far, the perspective of health check users has remained underexposed in discussions about the ethics and regulation of health checks. In 2017, we conducted a qualitative study with lay people from the Netherlands. We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Participants consider a good predictive value the most important characteristic of (...) a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark. (shrink)

In recent literature, panpsychism has been defended by appeal to two main arguments: first, an argument from philosophy of mind, according to which panpsychism is the only view which successfully integrates consciousness into the physical world (Strawson 2006; Chalmers 2013); second, an argument from categorical properties, according to which panpsychism offers the only positive account of the categorical or intrinsic nature of physical reality (Seager 2006; Adams 2007; Alter and Nagasawa 2012). Historically, however, panpsychism has also been defended by appeal (...) to a third argument based on considerations about the nature and observability of causation. This argument has not been much discussed in recent times. Here is a concise version from William James: "… the concrete perceptual flux, taken just as it comes, offers in our own activity-situations perfectly comprehensible instances of causal agency … If we took these experiences as the type of what actual causation is, we should have to ascribe to cases of causation outside of our life, to physical cases also, an inwardly experiential nature. In other words, we should have to espouse a so-called “pan-psychic” philosophy" (James 1911: 218). James here suggests that we have direct experience of causation in our own agency. He thereby directly contradicts David Hume, who famously denied that we have any experience of causation. James goes on to claim that if this experience is representative of causation in general, it follows that all causation is mental, and that panpsychism is true. This kind of argument for panpsychism can be called the argument from (experience of) causation. This chapter offers, first, a history of this argument and arguments closely related to it, and second, an analysis of the argument – is it valid, are its premises in any way defensible, and how does it relate to the other, more popular arguments for panpsychism from philosophy of mind and categorical properties? (shrink)

This paper is an update of the documents we have concerning the Acts of the Christian martyrs, focused on three main aspects: 1) the kind of acts we know of and their classification from the point of view of their historic value; 2) the versions or editions of the texts that are most accepted by scholars; 3) the relevance of the different parts that make up these documents in order to discern the original text from passages that were rewritten or (...) underwent later variations. In this way, the article offers an exhaustive list of the documents for use in researching Christian martyrs in the Roman period. (shrink)

The author presents and defends three theses: (1) "the first is that it is not profitable for us at present to do moral philosophy; that should be laid aside at any rate until we have an adequate philosophy of psychology." (2) "the second is that the concepts of obligation, And duty... And of what is morally right and wrong, And of the moral sense of 'ought', Ought to be jettisoned if this is psychologically possible...." (3) "the third thesis is that (...) the differences between the well-Known english writers on moral philosophy from sidgwick to the present day are of little importance." (staff). (shrink)

Hartry Field has shown us a way to be nominalists: we must purge our scientific theories of quantification over abstracta and we must prove the appropriate conservativeness results. This is not a path for the faint hearted. Indeed, the substantial technical difficulties facing Field's project have led some to explore other, easier options. Recently, Jody Azzouni, Joseph Melia, and Stephen Yablo have argued that it is a mistake to read our ontological commitments simply from what the quantifiers of our best (...) scientific theories range over. In this paper, I argue that all three arguments fail and they fail for much the same reason; would-be nominalists are thus left facing Field's hard road. (shrink)

Traditional Chinese commentators rightly see that understanding Zhuangzi's way with words is the presupposition for understanding Zhuangzi at all. They are not sure, however, if Zhuangzi's words are super-effective or pure nonsense. I consider Zhuangzi's experience with language, and then turn to Heidegger's word of being to see if it may throw light on Zhuangzi's way of saying. I argue that a conversation between Heidegger and Zhuangzi on language is possible, but only by expanding Heidegger's notion of Gestell and through (...) a destruction of the dominant Confucian discourse that obscures Zhuangzi's way of saying. (shrink)

This is the first comprehensive study of Nietzsche's earliest (and extraordinary) book, The Birth of Tragedy (1872). When he wrote it, Nietzsche was a Greek scholar, a friend and champion of Wagner, and a philosopher in the making. His book has been very influential and widely read, but has always posed great difficulties for readers because of the particular way Nietzsche brings his ancient and modern interests together. The proper appreciation of such a work requires access to ideas that cross (...) the boundaries of conventional specialisms. This is now provided by M. S. Silk and J. P. Stern in their joint study of Nietzsche's book. They examine in detail its content, style and form; its strange genesis and hybrid status; its biographical background and the controversy engendered by its publication; its value as an account of ancient Greek culture and as a theory of tragedy and music; its relation to other theories of tragedy; and its place in the history of German ideas and in Nietzsche's own philosophical career. (shrink)

Background. The COVID-19 pandemic necessitated drastic changes to undergraduate medical training at the University of Botswana (UB). To save the academic year when campus was locked down, the Department of Medical Education conducted a needs assessment to determine the readiness for emergency remote teaching (ERT) of the Faculty of Medicine, UB. Objectives. To report on the findings of needs assessment surveys to assess learner and teaching staff preparedness for fair and just ERT, as defined by philosopher John Rawls. Methods. Needs (...) assessment surveys were conducted using Office 365 Forms distributed via WhatsApp, targeting medical students and teaching staff during the 5 undergraduate years. Data were analysed quantitatively and qualitatively. Results. Ninety-two percent (266/289) of students and 73.5% (62/84) of teaching staff responded. Surveys revealed a high penetration of smartphones among students, but poor internet accessibility and affordability in homes. Some teaching staff also reported internet and device insufficiencies. Only WhatsApp was accessible to students and teaching staff. Conclusions. For equitable access to ERT in the future, the surveys revealed infrastructural improvement needs, including wider, stronger, affordable WiFi coverage within Botswana and enhanced digital infrastructures in educational institutions, with increased support for students. (shrink)

Greek text, english translation and commentary on the surviving fragments of Empedocles (fragments as known in 1981, does not include more recent finds).

Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on (...) the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)

Hubert Dreyfus has argued that cases of absorbed bodily coping show that there is no room for self-awareness in flow experiences of experts. In this paper, I argue against Dreyfus’ maxim of vanishing self-awareness by suggesting that awareness of agency is present in expert bodily action. First, I discuss the phenomenon of absorbed bodily coping by discussing flow experiences involved in expert bodily action: merging into the flow; immersion in the flow; emergence out of flow. I argue against the claim (...) that flow experience does not involve an awareness of agency for each of these features, while conceding that fluent agency does not involve self-awareness in the thetic sense. I challenge the assumption that the awareness of fluent agency must be understood in terms of a thetic awareness of agency. Instead, I develop an Anscombean account of the awareness of fluent agency in terms of the phenomenal character of knowing one’s aims. I respond to the challenge that if an Anscombean account of the awareness of agency is to succeed, then agents must be able to answer Anscombean questions. I consider the objection that awareness of agency is not a form of self-awareness by outlining an account of self-awareness as self-synthesis that is distinct from self-perception and self-ascription, but which makes room for self-awareness in expert bodily action. (shrink)

In this essay, after a brief decolonial analysis of the concept of “poetry” in Indigenous communities, I will investigate the poetic-philosophical implications of Cherokee culture, more specifically the poetic essence of the Cherokee language, the poetic aspects of Cherokee myth (pre-history) and post-myth (history), and the poetic-philosophical powers of Cherokee ritual. My first section analyzes the poetic essence, structure, special features, and historical context of the Cherokee language, drawing on Ruth Holmes and Betty Sharp Smith’s language textbook, Beginning Cherokee. My (...) second section considers poetic aspects of the pre-history and history of the Cherokee Nation considered as a text, using Robert J. Conley’s The Cherokee Nation: A History. And my third section investigates the poetic nature of the Cherokee rituals’ myth-ontological background and its existential psychological implications, via J. T. Garrett & Michael Tlanusta Garrett’s The Cherokee Full Circle: A Practical Guide to Ceremonies and Traditions. Collectively, these analyses will suggest that, just as the Cherokee and other tribes are the slandered, disenfranchised, suppressed and covered-over Indigenous peoples of the North American continent, so poetry writ large (including Indigenous philosophy) is the slandered, disenfranchised, suppressed and covered-over arche of western philosophy (as I have previously explored via a new interpretation of Nietzsche). In short, I will argue that both poetry and Cherokee culture can be understood as indigenous “absences” which are in truth vital and enduring presences. (shrink)

Bioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change. Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and greater (...) appreciation of the profound health implications of global warming. (shrink)