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)

Cardiovascular health checks test risk factors for cardiovascular disease. They are offered to improve health: in case of an increased risk, participants receive lifestyle advice and medication. With this review, we investigate what is known about the reasons why people do or do not test for CVD risk factors. To what extent do these reasons relate to health monitoring and/or improvement? And do reasons differ in different contexts in which health checks are offered? We conducted a literature search and included (...) 22 papers in which we identified a broad range of motives. We conclude that people have reasons to test related to health improvement and reasons other than health improvement, practical reasons related to the way health checks are offered play an important role and motives should be understood in the context of the situation in which health checks are offered. Our results are relevant for public health officials and providers of health checks: first, if people undergo testing for reasons unrelated to health, this could explain why participation in health checks does not necessarily lead to health improvement. Second, efforts to improve uptake not necessarily serve justice and may hamper informed consent. (shrink)

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)

Provability, Computability and Reflection.

In this paper we continue our study, begun in [5], of the connection between ultraproducts and saturated structures. IfDis an ultrafilter over a setI, andis a structure, the ultrapower ofmoduloDis denoted byD-prod. The ultrapower is important because it is a method of constructing structures which are elementarily equivalent to a given structure. Our ultimate aim is to find out what kinds of structure are ultrapowers of. We made a beginning in [5] by proving that, assuming the generalized continuum hypothesis, for (...) each cardinalαthere is an ultrafilterDover a set of powerαsuch that for all structures,D-prodisα+-saturated. (shrink)

We show that each of the five basic theories of second order arithmetic that play a central role in reverse mathematics has a natural counterpart in the language of nonstandard arithmetic. In the earlier paper [3] we introduced saturation principles in nonstandard arithmetic which are equivalent in strength to strong choice axioms in second order arithmetic. This paper studies principles which are equivalent in strength to weaker theories in second order arithmetic.

Shelah's theory of forking is generalized in a way which deals with measures instead of complete types. This allows us to extend the method of forking from the class of stable theories to the larger class of theories which do not have the independence property. When restricted to the special case of stable theories, this paper reduces to a reformulation of the classical approach. However, it goes beyond the classical approach in the case of unstable theories. Methods from ordinary forking (...) theory and the Loeb measure construction from nonstandard analysis are used. (shrink)

Introduction. This paper is a sequel to our paper [3]. In that paper we introduced the notion of a finite approximation to an infinitely long formula, in a language L with infinitely long expressions of the type considered by Henkin in [2]. The results of the paper [3] show relationships between the models of an infinitely long sentence and the models of its finite approximations. In the present paper we shall apply the main result of [3] to prove a number (...) of theorems about ordinary finitely long sentences; these theorems are of a type which one might call “preservation theorems”. The following two known results are typical preservation theorems: A sentence φ is preserved under substructures if and only if φ is equivalent to some universal sentence ; φ is preserved under homomorphic images if and only if φ is equivalent to some positive sentence. An expository account of preservation theorems may be found in Lyndon [9].We shall use freely all of the notation introduced in [3], and shall not attempt to make this paper selfcontained. However, the reader should have no difficulty following this paper after he has read [3]. In § 1 we cover some preliminary topics. In § 2 and § 3 we shall illustrate our method in familiar situations by proving anew the two preservation theorems mentioned above. We shall then obtain four new preservation theorems in §§ 4, 5, and 6, involving respectively direct powers and roots, strong homomorphisms and retracts, and direct factors. The result in § 6 was stated in the abstract [4], while the results in § 5 were stated in the abstract [5]. (shrink)

In a nonstandard universe, the κ-saturation property states that any family of fewer than κ internal sets with the finite intersection property has a nonempty intersection. An ordered field F is said to have the λ-Bolzano-Weierstrass property iff F has cofinality λ and every bounded λ-sequence in F has a convergent λ-subsequence. We show that if $\kappa < \lambda$ are uncountable regular cardinals and $\beta^\alpha < \lambda$ whenever $\alpha < \kappa$ and $\beta < \lambda$, then there is a κ-saturated nonstandard (...) universe in which the hyperreal numbers have the λ-Bolzano-Weierstrass property. The result also applies to certain fragments of set theory and second order arithmetic. (shrink)

In a nonstandard universe, the $\kappa$-saturation property states that any family of fewer than $\kappa$ internal sets with the finite intersection property has a nonempty intersection. An ordered field $F$ is said to have the $\lambda$-Bolzano-Weierstrass property iff $F$ has cofinality $\lambda$ and every bounded $\lambda$-sequence in $F$ has a convergent $\lambda$-subsequence. We show that if $\kappa < \lambda$ are uncountable regular cardinals and $\beta^\alpha < \lambda$ whenever $\alpha < \kappa$ and $\beta < \lambda$, then there is a $\kappa$-saturated nonstandard (...) universe in which the hyperreal numbers have the $\lambda$-Bolzano-Weierstrass property. The result also applies to certain fragments of set theory and second order arithmetic. (shrink)

§0. Introduction. In [16], Barwise described his graduate study at Stanford. He told of his interactions with Kreisel and Scott, and said how he chose Feferman as his advisor. He began working on admissible fragments of infinitary logic after reading and giving seminar talks on two Ph.D. theses which had recently been completed: that of Lopez-Escobar, at Berkeley, on infinitary logic [46], and that of Platek [58], at Stanford, on admissible sets.Barwise's work on infinitary logic and admissible sets is described (...) in his thesis [4], the book [13], and papers [5]—[16]. We do not try to give a systematic review of these papers. Instead, our goal is to give a coherent introduction to infinitary logic and admissible sets. We describe results of Barwise, of course, because he did so much. In addition, we mention some more recent work, to indicate the current importance of Barwise's ideas. Many of the central results are stated without proof, but occasionally we sketch a proof, to indicate how the ideas fit together.Chapters 1 and 2 describe infinitary logic and admissible sets at the time Barwise began his work, circa 1965. From Chapter 3 on, we survey the developments that took place after Barwise appeared on the scene.§1. Background on infinitary logic. In this chapter, we describe the situation in infinitary logic at the time that Barwise began his work. We need some terminology. By a vocabulary, we mean a set L of constant symbols, and relation and operation symbols with finitely many argument places. As usual, by an L-structureM, we mean a universe set M with an interpretation for each symbol of L. (shrink)

The separation, uniformization, and other properties of the Borel and projective hierarchies over hyperfinite sets are investigated and compared to the corresponding properties in classical descriptive set theory. The techniques used in this investigation also provide some results about countably determined sets and functions, as well as an improvement of an earlier theorem of Kunen and Miller.

We shall prove quantifier elimination theorems for neocompact formulas, which define neocompact sets and are built from atomic formulas using finite disjunctions, infinite conjunctions, existential quantifiers, and bounded universal quantifiers. The neocompact sets were first introduced to provide an easy alternative to nonstandard methods of proving existence theorems in probability theory, where they behave like compact sets. The quantifier elimination theorems in this paper can be applied in a general setting to show that the family of neocompact sets is countably (...) compact. To provide the necessary setting we introduce the notion of a law structure. This notion was motivated by the probability law of a random variable. However, in this paper we discuss a variety of model theoretic examples of the notion in the light of our quantifier elimination results. (shrink)

When Newton articulated the concept of absolute time in his treatise, Philosophae Naturalis Principia Mathematica (Mathematical Principles of Natural Philosophy), along with its correlate, absolute space, he did not present it as anything controversial. Whereas his references to attraction are accompanied by the self- protective caveats that typically signal an expectation of censure, the Scholium following Principia’s definitions is free of such remarks, instead elaborating his ideas as clarifications of concepts that, in some manner, we already possess. This is not (...) surprising. The germ of the concept emerged naturally from astronomers’ findings, and variants of it had already been formulated by other seventeenth century thinkers. Thus the novelty of Newton’s absolute time lay mainly in the use to which he put it. (shrink)

A general metatheorem is proved which reduces a wide class of statements about continuous time stochastic processes to statements about discrete time processes. We introduce a strong language for stochastic processes, and a concept of forcing for sequences of discrete time processes. The main theorem states that a sentence in the language is true if and only if it is forced. Although the stochastic process case is emphasized in order to motivate the results, they apply to a wider class of (...) random variables. At the end of the paper we illustrate how the theorem can be used with three applications involving submartingales. (shrink)

First order reasoning about hyperintegers can prove things about sets of integers. In the author’s paper Nonstandard Arithmetic and Reverse Mathematics, Bulletin of Symbolic Logic 12 100–125, it was shown that each of the “big five” theories in reverse mathematics, including the base theory, has a natural nonstandard counterpart. But the counterpart of has a defect: it does not imply the Standard Part Principle that a set exists if and only if it is coded by a hyperinteger. In this paper (...) we find another nonstandard counterpart, *RCA0′, that does imply the Standard Part Principle. (shrink)

Book Information Epistemology: Classic Problems and Contemporary Responses. By Laurence BonJour. Rowman and Littlefield. Lanham MD. 2002. Pp. viii + 289. Hardback, US$75. Paperback, US$23.95.