This is a volume of twelve essays concerning the fundamental tension in personalised medicine between individual choice and the common good.

This article offers a legal-ethical analysis of recent UK and Dutch proposals to regulate surrogacy proactively through a national system of pre-conception authorization of surrogacy agreements. Wi...

Over 30 million people worldwide have taken a commercial at-home DNA test, because they were interested in their genetic ancestry, disease predisposition or inherited traits. Yet, these consumer DNA data are also increasingly used for a very different purpose: to identify suspects in criminal investigations. By matching a suspect’s DNA with DNA from a suspect’s distant relatives who have taken a commercial at-home DNA test, law enforcement can zero in on a perpetrator. Such forensic use of consumer DNA data has (...) been performed in over 200 criminal investigations. However, this practice of so-called investigative genetic genealogy raises ethical concerns. In this paper, we aim to broaden the bioethical analysis on IGG by showing the limitations of an individual-based model. We discuss two concerns central in the debate: privacy and informed consent. However, we argue that IGG raises pressing ethical concerns that extend beyond these individual-focused issues. The very nature of the genetic information entails that relatives may also be affected by the individual customer’s choices. In this respect, we explore to what extent the ethical approach in the biomedical genetic context on consent and consequences for relatives can be helpful for the debate on IGG. We argue that an individual-based model has significant limitations in an IGG context. The ethical debate is further complicated by the international, transgenerational and commercial nature of IGG. We conclude that IGG should not only be approached as an individual but also—and perhaps primarily—as a collective issue. There are no data in this work. (shrink)

Millions of human biological samples are stored worldwide for medical research or treatment purposes. These biospecimens are of enormous potential value to law enforcement as DNA profiles can be obtained from these samples. However, forensic use of such biospecimens raises a number of ethical questions. This article aims to explore ethical issues of using human bodily material in medical biobanks for crime investigation and prosecution purposes. Concerns about confidentiality, trust, autonomy and justice will be discussed. We explore how to balance (...) these concerns against the importance of crime solving. Relevant case examples of forensic use of medical biobanks show that requests by law enforcement to access biobanks are handled in disparate ways. We identify some core ethical issues and conclude that further research on these issues is needed to provide ethical guidance. (shrink)

In the case of surrogacy, it is not new biotechnologies themselves that have challenged well-established principles in law and ethics, but rather political and social phenomena such as commodification of women’s reproductive tissue and labour, demands to allow new ways of forming families and (before Covid-19, at least) the comparative ease of international travel that enabled cross-border surrogacy to develop into a market valued at up to $2 billion annually in India alone as of 2016 (Dickenson 2016, citing an estimate (...) from The Indian National Commission for Women). This phenomenon stands the usual truth on its head: it is not new technologies but new pressures that have challenged the existing law and ethics of surrogate motherhood. (shrink)

This edited volume covers new ground by bringing together perspectives from symbolic legislation theory on the one hand, and from biolaw and bioethics on the other hand. Symbolic legislation has a bad name. It usually refers to instances of legislation which are ineffective and that serve other political and social goals than the goals officially stated. Recently, a more positive notion of symbolic legislation has emerged in legislative theory. From this perspective, symbolic legislation is regarded as a positive alternative to (...) the more traditional, top-down legislative approach. The legislature no longer merely issues commands backed up with severe sanctions, as in instrumental legislation. Instead, lawmakers provide open and aspirational norms that are meant to change behavior not by means of threat, but indirectly, through debate and social interaction. Since the 1990s, biomedical developments have revived discussions on symbolic legislation. One of the reasons is that biomedical legislation touches on deep-rooted, symbolic-cultural representations of the biological aspects of human life. Moreover, as it is often impossible to reach consensus on these controversial questions, legislators have sought alternative ways to develop legal frameworks. Consequently, communicative and interactive approaches to legislation are prominent within the governance of medical biotechnology. The symbolic dimensions of biolaw are often overlooked. Yet, it is clear that the symbolic is at the heart of many legal-political debates on bioethical questions. Since the rise of biomedical technologies, human body materials have acquired a scientific, medical and even commercial value. These new approaches, which radically question existing legal symbolizations of the human body, raise the question whether and how the law should continue to reflect symbolic values and meanings. Moreover, how can we decide what these symbolic values are, given the fact that we live in a pluralistic society? (shrink)

Not a single day goes by without some news about personalized medicine, especially in its genomic context (precision medicine). In tandem with the scientific excitement, however, come the cautionary notes. These include worries about Big Brother surveillance, concerns about the impact of genomic results on the psychosocial well‐being of patients and research subjects, and attention to issues of social and distributive justice. Personalised Medicine, Individual Choice and the Common Good, coedited by Britta van Beers, Sigrid Sterckx, and Donna (...) Dickenson, falls squarely into this discourse with an aim to “fuel and stimulate the debate about personalised medicine and enable its participants to come to a more balanced understanding of the interests and values at stake.” At its core, the book laments the shift from “We Medicine” to “Me Medicine,” with ostensibly all authors highlighting that, on balance, the costs associated with “Me Medicine” far outweigh the benefits. This is both a strength and a weakness of the book. (shrink)

With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely (...) and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition ‘to return good in proportion to the good we receive, and to make reparations for the harm we have done’, as a mid-level principle in infectious disease screening policies. More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers’ participation and the benefits for the control of public health. The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases. (shrink)

I en række afhandlinger beskrives den hollandske ISAF styrkes indsats i Afghanisatn fra 2001-2010. I en fireårig periode fra 2006-2010 var det hollandske kontingent indsat i den afghanske provins Uruzgan og opnåede bemærkelsesværdige resultater. Sikkerhedssituationen blev forbedret, den økonomiske udvikling blev stabiliseret ligesom den offentlige administration, uddannelsen af børn og sundhedsplejen m.v. blev forbedret. Efter 2010 er provinsen overtaget af amerikanske og australske tropper.

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

van Gelder argues that computational and dynamical systems are mathematically distinct kinds of systems. Although there are real experimental and theoretical differences between adopting a computational or dynamical perspective on cognition, and the dynamical approach has much to recommend it, the debate cannot be framed this rigorously. Instead, what is needed is careful study of concrete models to improve our intuitions.

In this survey of business ethics in Europe, we compare the present state of business ethics in Europe with the situation as described by Enderle (BEER 5(1):33–46, 1996 ). At that time, business ethics was still dominated by a mainly philosophical, normative analysis of business issues with a maximum of 25 chairs in business ethics all over Europe. It has since expanded dramatically in numbers as well as diversified into many different domains. We find this rich diversity in the conception (...) of business ethics back in the answers of our respondents to every single question. The concepts they propose, the courses they teach, the subjects under research as well as the training and consultancy offered to clients and even the challenges for the future all reflect this diversity. Decisive for the expansion of business ethics in Europe has been the advance of CSR and the official backing of CSR by the European Commission. We further argue that the prevalence and importance of business ethics and CSR differs throughout Europe. A rough approximation based on our survey results and literature review is that it is more important and more developed in core and Nordic European countries and somewhat less in Southern and Eastern European countries. The real East with countries like Belarus and Bulgaria remains a challenge. (shrink)

Belgium was already mired in a web of political crises for nearly a year when the full force of the bursting American credit bubble struck its seemingly robust financial system. Not surprisingly, the shockwaves from across the ocean did nothing to resolve the political stalemate. On the contrary, they set in motion a process of government intervention in the financial sector that last week resulted in another major political crisis and the resignation of the government. This came about because of (...) the near-collapse of one of the major banks, Fortis. (shrink)

In the corporate social responsibility (CSR) literature, the principle of voluntarism is predominant and implies that responsible business activities are discretionary and reach beyond the rule of law. This principle fails to explain that governments have a great interest in CSR and exercise influence on firms’ CSR activities. Therefore, we argue in favour of a contingency approach on voluntarism in CSR. To this end, we analyse the academic literature to demonstrate how governments are part of the CSR debate. We selected (...) 703 papers where the impact of governments is mentioned from five journals in our field (BEER, BEQ, BSE, BAS, JBE) in the period 1982–2011. We studied the titles and abstracts of these papers and provide an overview of: (i) the geographical orientation of the reviewed studies; (ii) the variety of government levels involved; and (iii) the various subjects where governments appear to be involved. In addition, an in‐depth reading of a subsample of 39 articles offers more details on the role of governments in the CSR literature. Hence, we offer a structured overview on the discussion of CSR and governments while stimulating a contingent understanding of the voluntarism concept in CSR. (shrink)

The first invariance principle, called “meaningfulness,” is germane to the common practice requiring that the form of a scientific law must not be altered by a change of the units of the measurement scales. By itself, meaningfulness does not put any constraint on the possible data. The second principle requires that the output variable is “order-invariant” with respect to any transformation (of one of the input variables) belonging to a particular family or class of such transformations which are characteristic of (...) the law. These principles are formulated as axioms of a theory. Taken together, meaningfulness and order-invariance axioms have strong consequences on the feasible theories. Three applications of our results are discussed in details, involving the Lorentz–FitzGerald contraction, Beer's law, and the Monomial laws, each of which is derived from three axioms implementing meaningfulness and order-invariance concepts. (An “initial condition” axiom is also used.) Not all scientific laws are order-invariant in the sense of this paper. An example is van der Waals' equation. (shrink)

There is a definite challenge in the air regarding the pivotal notion of internal representation. This challenge is explicit in, e.g., van Gelder, 1995; Beer, 1995; Thelen & Smith, 1994; Wheeler, 1994; and elsewhere. We think it is a challenge that can be met and that (importantly) can be met by arguing from within a general framework that accepts many of the basic premises of the work (in new robotics and in dynamical systems theory) that motivates such scepticism in the (...) first place. Our strategy will be as follows. We begin (Section 1) by offering an account (an example and something close to a definition) of what we shall term Minimal Robust Representationalism (MRR). Sections 2 & 3 address some likely worries and questions about this notion. We end (Section 4) by making explicit the conditions under which, on our account, a science (e.g., robot- ics) may claim to be addressing cognitive phenomena. (shrink)

A great deal of philosophy of mind in the modern era has been driven by an intense aversion to Cartesian dualism. In the 1950s, materialists claimed to have succeeded once and for all in exorcising the Cartesian ghost by identifying the mind with the brain. In subsequent decades, cognitive science put scientific meat on this metaphysical skeleton by explicating mental processes as digital computation implemented in the brain's hardware.

Recent studies such as Thelen and Smith, Kelso, Van Gelder, Beer, and others have presented a forceful case for a dynamical systems approach to understanding cognition and adaptive behavior. These studies call into question some foundational assumptions concerning the nature of cognitive scientific explanation and the role of notions such as internal representation and computation. These are exciting and important challenges. But they must be handled with care. It is all to easy in this debate to lose sight of the (...) explanatorily important issues and to talk at cross purposes, courtesy of the various ways in which different theorists often concieve key terms. (shrink)

What sort of epistemic positions are compatible with inquiries driven by interrogative attitudes like wonder and puzzlement? The ignorance norm provides a partial answer: interrogative attitudes directed at a particular question are never compatible with knowledge of the question’s answer. But some are tempted to think that interrogative attitudes are incompatible with weaker positions like belief as well. This paper defends that the ignorance norm is exhaustive. All epistemic positions weaker than knowledge directed at the answer to a question are (...) compatible with having an interrogative attitude towards that question. We offer two arguments for this conclusion. The first is based on considerations about the role of hedging in inquiry. The second is conditional on considerations related to the aim of inquiry as a goal-directed activity. (shrink)

Ancient philosophers had always been fascinated by religion. From the first century BC onwards the traditionally hostile attitude of Greek and Roman philosophy was abandoned in favour of the view that religion was a source of philosophical knowledge. This book studies that change, not from the usual perspective of the history of religion, but as part of the wider tendency of Post-Hellenistic philosophy to open up to external, non-philosophical sources of knowledge and authority. It situates two key themes, ancient wisdom (...) and cosmic hierarchy, in the context of Post-Hellenistic philosophy and traces their reconfigurations in contemporary literature and in the polemic between Jews, Christians and pagans. Overall, Post-Hellenistic philosophy displayed a relatively high degree of unity in its ideas on religion, which should not be reduced to a preparation for Neoplatonism. (shrink)

The ecofeminist argument for veganism is powerful. Meat consumption is a deeply gendered act that is closely tied to the systematic objectification of women and nonhuman animals. I worry, however, that presenting veganism as "the" moral ideal might reinforce rather than alleviate the disordered status quo in gendered eating, further disadvantaging women in patriarchal power structures. In this chapter, I advocate a feminist account of ethical eating that treats dietary choices as moral choices insofar as they constitute an integral part (...) of our relationships to ourselves and to others. I believe that we should think of dietary choices in Aristotelian moral terms as a mean relative to us, falling on a continuum between the vice of doing injustice to ourselves, on the one hand, and the vice of doing injustice to others, on the other. On this view, what it is moral to eat for individuals is not a fixed ideal, but rather depends on particulars of our physiological, psychological, economic, cultural, and relational situations. (shrink)

Emotional expressions constitute a rich source of information. Integrating theorizing on attribution, appraisal processes, and the use of emotions as social information, we examined how emotional expressions influence attributions of agency and responsibility under conditions of ambiguity. Three vignette studies involving different scenarios indicate that participants used information about others’ emotional expressions to make sense of ambiguous social situations. Expressions of regret fueled inferences that the expresser was responsible for an adverse situation, whereas expressions of anger fueled inferences that someone (...) else was responsible. Also, expressions of anger were interpreted as a sign of injustice, and expressions of disappointment increased prosocial intentions (i.e., to help the expresser). The results show that emotional expressions can help people understand ambiguous social situations by informing attributions that correspond with each emotion’s associated appraisal structures. The findings advance understanding of the ways in which emotional expressions help individuals understand and coordinate social life. (shrink)