There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in (...) practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical (...) medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology. (shrink)

Epigenetic markers could potentially be used for risk assessment in risk-stratified population-based cancer screening programmes. Whereas current screening programmes generally aim to detect existing cancer, epigenetic markers could be used to provide risk estimates for not-yet-existing cancers. Epigenetic risk-predictive tests may thus allow for new opportunities for risk assessment for developing cancer in the future. Since epigenetic changes are presumed to be modifiable, preventive measures, such as lifestyle modification, could be used to reduce the risk of cancer. Moreover, epigenetic markers (...) might be used to monitor the response to risk-reducing interventions. In this article, we address ethical concerns related to personal responsibility raised by epigenetic risk-predictive tests in cancer population screening. Will individuals increasingly be held responsible for their health, that is, will they be held accountable for bad health outcomes? Will they be blamed or subject to moral sanctions? We will illustrate these ethical concerns by means of a Europe-wide research programme that develops an epigenetic risk-predictive test for female cancers. Subsequently, we investigate when we can hold someone responsible for her actions. We argue that the standard conception of personal responsibility does not provide an appropriate framework to address these concerns. A different, prospective account of responsibility meets part of our concerns, that is, concerns about inequality of opportunities, but does not meet all our concerns about personal responsibility. We argue that even if someone is responsible on grounds of a negative and/or prospective account of responsibility, there may be moral and practical reasons to abstain from moral sanctions. (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy—as a right and as an ideal—we (...) describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so. (shrink)

In a discussion about human enhancement it is common to make a distinction between medical treatment and enhancement. The treatment‐enhancement (TE) distinction may work as long as we are faced with extreme and evident examples of treatments and enhancements, but it leaves us with unanswered questions if we are confronted with the borderlines cases in the muddy gray area between obvious treatment and obvious enhancement. This chapter focuses on this gray area, shows its complexities, and asks how we can answer (...) questions regarding the medical domain, or regarding the moral obligation for reimbursement if we cannot depend on the TE distinction. The example of adult attention deficit hyperactivity disorder (ADHD) is used to show how difficult it is to distinguish between treatment of disease and enhancement of normal function, especially given the phenomena of medicalization, disease mongering, and expanding disease definitions. (shrink)

The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical (...) medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology. (shrink)

Background Massively parallel sequencing techniques, such as whole exome sequencing (WES) and whole genome sequencing (WGS), may reveal unsolicited findings (UFs) unrelated to the diagnostic aim. Such techniques are frequently used for diagnostic purposes in pediatric cases of developmental delay (DD). Yet policy guidelines for informed consent and return of UFs are not well equipped to address specific moral challenges that may arise in these children’s situations. Discussion In previous empirical studies conducted by our research group, we found that it (...) is sometimes uncertain how children with a DD will develop and whether they could come to possess capacities for autonomous decision-making in the future. Parents sometimes felt this brought them into a Catch-22 like situation when confronted with choices about UFs before undergoing WES in trio-analysis (both the parents’ and child’s DNA are sequenced). An important reason for choosing to consent to WES was to gain more insight into how their child might develop. However, to make responsible choices about receiving or declining knowledge of UFs, some idea of their child’s future development of autonomous capacities is needed. This undesirable Catch-22 situation was created by the specific policy configuration in which parents were required to make choices about UFs before being sequencing (trio-analysis). We argue that this finding is relevant for reconfiguring current policies for return of UFs for WES/WGS and propose guidelines that encompass two features. First, the informed consent process ought to be staged. Second, differing guidelines are required for withholding/disclosing a UF in cases of DD appropriate to the level of confidence there is about the child’s future developmental of autonomous capacities. Conclusion When combined with a dynamic consent procedure, these two features of our guidelines could help overcome significant moral challenges that present themselves in the situations of children undergoing genomic sequencing for clarifying a DD. (shrink)

Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or (...) more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity. (shrink)

In this article ethical issues are discussed which play a role in pharmacogenetics. Developments in pharmacogenetics have a large impact on many different practices such as clinical trials, the practice of medicine and society at large. In clinical trials, questions rise regarding the exclusion of genetic subgroups that may be non- or poor-responders to the experimental drug. Also, the question is asked how pharmaceutical companies should deal with their growing knowledge about the relations between genetic variation and adverse effects. Moreover, (...) pharmacogenetics may provide disease-specific predictive information which may have a significant impact on the relations between physicians, patients and their relatives in the practice of medicine. Here, issues also arise regarding responsibility of patients and physicians for health and disease. In the society at large, the high costs of new pharmacogenetic possibilities lead to questions concerning solidarity and fair distribution on a national as well as an international level. It is concluded that in the near future, ethical research should be focused on the themes responsibility, inclusion and exclusion and global justice. (shrink)

Research from behavioural sciences shows that people reach decisions in a much less rational and well-considered way than was often assumed. The doctrine of informed consent, which is an important ethical principle and legal requirement in medical practice, is being challenged by these insights into decision-making and real-world choice behaviour. This article discusses the implications of recent insights of research on decision-making behaviour for the informed consent doctrine. It concludes that there is a significant tension between the often non-rational choice (...) behaviour and the traditional theory of informed consent. Responsible ways of dealing with or solving these problems are considered. To this end, patient decisions aids are discussed as suitable interventions to support autonomous decision-making. However, current PDAs demand certain improvements in order to protect and promote autonomous decision-making. Based on a conception of autonomy, we will argue which type of improvements are needed. (shrink)

The next World Congress of Bioethics will be held in Doha, Qatar. Although this location provides opportunities to interact with a more culturally diverse audience, to advance dialogue between cultures and religions, offer opportunities for mutual learning, there are also huge moral concerns. Qatar is known for violations of human rights ‐ including the treatment of migrant workers and the rights of women ‐ corruption, criminalization of LGBTQI+ persons, and climate impact. Since these concerns are also key (bio)ethical concern we (...) call for a broad debate within the bioethics community whether organizing and attending the World Congress in Qatar is ethically problematic and how ethical concerns should be dealt with. (shrink)

Barbara Bolt takes the most relevant of Heidegger's texts, including his most famous work, 'Being and Time', and sets out ways of thinking about art in a post-medium, digital, technocratic and post-human age.

This article contributes to the debate on governance of emerging technologies, focusing in particular on the international level and taking into account the fact that these technologies are developed through a common effort of different stakeholders including governments, research communities, industry and civil society actors. These issues are explored from the perspective of communitarian ethical criticism of liberal social contract thinking, in order to enhance visibility of the influence collective non-state actors exercise on the development of these technologies. In particular, (...) the effect of different values in the discussion on emerging technologies on the perceived governance options is explored. A paradigm shift from defensive values such as security, risk and human rights to more optimistic values like peace, justice and integrity of creation is proposed and discussed. (shrink)

This article analyses current trends in and future expectations of nanotechnology and other key enabling technologies for security as well as dual use nanotechnology from the perspective of the ethical Just War Theory (JWT), interpreted as an instrument to increase the threshold for using armed force for solving conflicts. The aim is to investigate the relevance of the JWT to the ethical governance of research. The analysis gives rise to the following results. From the perspective of the JWT, military research (...) should be evaluated with different criteria than research for civil or civil security applications. From a technological perspective, the boundaries between technologies for civil and military applications are fuzzy. Therefore the JWT offers theoretical grounds for making clear distinctions between research for military, civil security and other applications that are not obvious from a purely technological perspective. Different actors bear responsibility for development of the technology than for resorting to armed force for solving conflicts or for use of weapons and military technologies in combat. Different criteria should be used for moral judgment of decisions made by each type of actor in each context. In addition to evaluation of potential consequences of future use of the weapons or military technologies under development, the JWT also prescribes ethical evaluation of the inherent intent and other foreseeable consequences of the development itself of new military technologies. (shrink)

All stakeholders agree publicly that innovation and governance of emerging technologies should be done responsibly. However, the international debate on who should do what to contribute to this lofty goal is nowhere near a solution. The starting point of this paper is the issue of how and for which reason to engage stakeholders in addition to governments in the international governance of nanotechnology. This article examines the mainly North-American communitarian criticism of political liberalism and the related concept of subsidiarity in (...) order to shed new light on this discussion. The central research question is: Can a communitarian-subsidiarity perspective on the roles of governments, companies and civil society actors that hold a stake in emerging technologies clarify the grounds on which each actor should be expected to contribute to responsible research and innovation at the international level? After selecting some relevant aspects of a communitarian-subsidiarity model for a dialogue society, an analytical framework is proposed. This framework is then applied to the recent international dialogue on responsible governance of nanotechnology. The outcomes of the analysis are compared to the OECD planning guide on public engagement and outreach in nanotechnology, and indicators for monitoring progress in responsible global innovation are suggested. The main contribution of the selected communitarian-subsidiarity perspective is that it offers philosophical grounds for a return of citizens to the driving seat in cooperative international responsible innovation. (shrink)

ISI Books' Crosscurrents series makes available in English-usually for the first time-new translations of both classic and contemporary works by authors working within, or with crucial importance for, the conservative, religious, and humanist intellectual traditions. Book jacket.

This article re-introduces the notion of liturgical mysticism from both the perspectives of systematic theology and Church history. The authors adopt an interdisciplinary approach grounded in theology aiming to revisit the concept of liturgical mysticism in order to contribute to developing an adequate interpretive model for mystical texts. The article introduces the notion of liturgical mysticism firstly by a systematic-theological fundamental analysis of Christian mystical experience, showing the uniqueness of that experience and the possible interconnections with liturgy; secondly, by studying (...) liturgical mysticism historically, in the context of the Middle Dutch tradition in the sixteenth century, especially the Arnhem Mystical Sermons, in order to provide a solid historical basis for our argumentation; lastly, the article explores first the impact of our findings on the theological understanding and method in the study of mysticism, and second it notes some ramifications for contemporary Christian spirituality. The authors attempt to show that liturgical mysticism, understood and practised as a tradition bound and context sensitive religious experience, is historically plausible and theologically promising. (shrink)

Hugh of Saint-Victor's De Sacramentis is usually regarded as an early summa of theology. As such it has been regarded as not totally satisfying, lacking a clearness of its conceptual system when compared with the work of e.g. Peter the Lombard. What may make up for this lack of system and even confer coherence, be it on a different level, is Hugh's pedagogical view of creation and salvation history, as it shows most clearly in his tropological digressions. In his exposition (...) of the history of salvation as it unfolds since the very beginning, Hugh incorporates the process by which the monk can not only follow the story of the macrocosm, but at the same time can read his self into being, allowing recognition of ambivalence from the start, and thus presenting a multi-demensional view of being human. In the same way as, on the cosmic level, any pre-lapsarian state of innocence exhibits a flaw from the very beginning, so the life of man is in a permanent state of ambiguity. This ambiguity is the framework for man as a moral being. Only within the possibility of choice can man be just or happy, without choice justus and beatus have no real significance. Matters are shown to be even more complicated when, in the story of Eve Hugh draws attention to her doubtful interpretation of God's command, as a factor which precedes her choice. In this way, De Sacramentis is not only a doctrina in our sense of the content of Christian dogma, but it offers the monk a point to which he can attach and conform his intentio: by bringing his intentio in form with the story about creation and fall and reparation, the reader can in fact effect the necessary reparatio, consisting of knowledge of truth and love of virtue. (shrink)

Nanomaterials are handled in global value chains for many different products, albeit not always recognisable as nanoproducts. The global market for nanomaterials faces an uncertain future, as the international dialogue on regulating nanomaterials is still ongoing and risk assessment data are being collected. At the same time, regulators and civil society organisations complain about a lack of transparency about the presence of nanomaterials on the market. In the project on Sustainable Nanotechnologies, a Decision Support System has been developed, primarily for (...) confidential use by risk and sustainability managers inside a company or consortium. In this article, we formulate a scenario concerning a potential role for an open access decision support system in negotiations on international agreements regulating trade in nanomaterials. The scenario includes design rules for decision support systems as well as procedures for use of such a system in stakeholder dialogue and policy-making on governance of these and other emerging technologies. This article incorporates analysis of results of stakeholder engagement on nanomaterials as well as literature and internet sources suggested by these stakeholders. (shrink)

In debates about genetic testing of children, as well as about disclosing unsolicited findings (UFs) of pediatric exome sequencing, respect for future autonomy should be regarded as a prima facie consideration for not taking steps that would entail denying the future adult the opportunity to decide for herself about what to know about her own genome. While the argument can be overridden when other, morally more weighty considerations are at stake, whether this is the case can only be determined in (...) concrete cases. Importantly, when children grow into adolescents, respect for future autonomy will have to give way to respecting their emerging autonomy. When pediatric exome sequencing is done for complex conditions not involving developmental delay, respect for the child’s future or emerging autonomy should be a primary consideration for those charged with deciding on behalf of the child. Building on what Emanuel and Emanuel have termed the ‘deliberative model’ of shared decision making, we argue that if parents fail to give these considerations their due, professionals should actively invite them to do so. Taking a directive stance may be needed in order to make sure that the future or emerging autonomy of the child are duly considered in the decision-making process, but also to help the parents and themselves to shape their respective roles as responsible care-givers. (shrink)

Carnal Knowledge is an outcome of the renewed energy and interest in moving beyond the discursive construction of reality to understand the relationship between what is conceived of as reality and materiality, described as the "material turn." It draws together established and emerging writers, whose research spans dance, music, film, fashion, design, photography, literature, painting and stereo-immersive VR, to demonstrate how art allows us to map the complex relations between nature and culture, between the body, language and knowledge. These writings (...) are unique in the field because they represent the authors' commitment to a new materialism through the creative arts. The questions they address include: Does the material turn in the creative arts take a different turn from continental epistemology, philosophy and the humanities? How does the agency of matter, the material nature of artistic practice and the notion of "truth to materials" affect what we understand as the "new materialism?" In engaging with these questions the book offers perspectives on the emergence of this exciting fresh field of new materialism. (shrink)

This chapter contains section titled: Care Ethics Applied Ethics Autonomy Communicative Ethics Feminist Ethical Strategies Notes Further Reading.

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Beta‐oxidation of fatty acids and detoxification of reactive oxygen species are generally accepted as being fundamental functions of peroxisomes. Additionally, these pathways might have been the driving force favoring the selection of this compartment during eukaryotic evolution. Here we performed phylogenetic analyses of enzymes involved in beta‐oxidation of fatty acids in Bacteria, Eukaryota, and Archaea. These imply an alpha‐proteobacterial origin for three out of four enzymes. By integrating the enzymes' history into the contrasting models on the origin of eukaryotic cells, (...) we conclude that peroxisomes most likely evolved non‐symbiotically and subsequent to the acquisition of mitochondria in an archaeal host cell. (shrink)

It has long been noted that there are links between the Homeric portrayals of Odysseus' companions and the suitors. These two largely anonymous groups of Ithacans are connected not only by their ἀτασθαλίαι but also by the fact that by the end of theOdysseyboth groups will be dead. Clearly, these fatalities are – in their different ways – crucial to the story. Nagler regards the death of the suitors as a ‘grim inversion’ of the death of Odysseus' crew. Odysseus himself (...) is depicted both by the primary narrator and in his own narrative inOd.9–12 as making every effort to save his crew, all in vain. By contrast, he is the prime and highly effective instigator of the death of the suitors. (shrink)

"The fourth in a series that explores cultural and ethical values in Classical Antiquity, this volume examines the negative foils, the anti-values, against ...

Thirty years ago, H. Flashar discussed the introduction to an anonymous commentary on the Aphorisms of Hippocrates. The text contains an interesting picture of Hippocrates as a culture hero, who saved suffering humanity by the introduction of systematic medicine. The first section of this introduction offers some complicated problems. It ends with an extremely long and difficult sentence, which, has not yet been explained quite satisfactorily, and it contains a curious use of the verb σαρκόω, combined with τν ύσιν, which (...) has led Flashar to suspect Christian influence. These two points are the subject of the first part of this paper. (shrink)