ABSTRACT Background: Biomedical science is producing an avalanche of data about risk factors, often with a small predictive value, associated with a broad diversity of diseases. Prevention and screening are increasingly moving from public health into the clinic. Therefore, the question of which risk factors to investigate and disclose in the individual patient, becomes ethically increasingly urgent. In line with Wilson and Jungner's public health‐related 10 principles for screening, it seems crucial to distinguish important from unimportant health risks. Aim: to (...) explore the ways in which clinicians distinguish important from unimportant health risks. Methods: We interviewed 36 respondents (gastroenterologists and gynaecologists/obstetrics) in 5 focus group interviews and 15 open in‐depth interviews on their interpretation of what makes a health risk important. Results: Physicians primarily interpreted importance as the severity of the possible harm, less often its probability. Possibilities of prevention or reassurance strongly influenced their judgment on importance. Discussion: It is not likely that interpreting ‘important’ as ‘severe’ will help in differentiating meaningful from meaningless risk knowledge. A more fundamental change in our ways of dealing with risk may be called for. We discuss existing literature on resilience as an alternative way to deal with risk. Balancing prevention and risk reduction with resilience could be a fruitful direction. (shrink)

BackgroundConsent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and (...) health-related data for observational research.MethodsWe conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues.ResultsSudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients’ data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives.ConclusionsSudden cardiac arrest patients’ donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants’ data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well. (shrink)

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on (...) measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy. (shrink)

We argue that the prudential benefits of long-distance leisure travel can justify such trips even though there are strong and important reasons against long-distance flying. This is because prudential benefits can render otherwise impermissible actions permissible, and because, according to dominant theories about wellbeing, long-distance leisure travel provides significant prudential benefits. However, this ‘wellbeing argument’ for long-distance leisure travel must be qualified in two ways. First, because travellers are epistemically privileged with respect to knowledge about what is good for them, (...) they must look critically at their own assessment of the prudential benefits of a trip. Second, the wellbeing argument is unlikely to support prudential arguments for long-distance leisure trips made by frequent flyers. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our (...) analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract for health (...) research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their (...) healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. (shrink)

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

Background: Biomedical science is producing an avalanche of data about risk factors, often with a small predictive value, associated with a broad diversity of diseases. Prevention and screening are increasingly moving from public health into the clinic. Therefore, the question of which risk factors to investigate and disclose in the individual patient, becomes ethically increasingly urgent. In line with Wilson and Jungner's public health-related 10 principles for screening, it seems crucial to distinguish important from unimportant health risks.Aim: to explore the (...) ways in which clinicians distinguish important from unimportant health risks.Methods: We interviewed 36 respondents (gastroenterologists and gynaecologists/obstetrics) in 5 focus group interviews and 15 open in-depth interviews on their interpretation of what makes a health risk important.Results: Physicians primarily interpreted importance as the severity of the possible harm, less often its probability. Possibilities of prevention or reassurance strongly influenced their judgment on importance.Discussion: It is not likely that interpreting ‘important’ as ‘severe’ will help in differentiating meaningful from meaningless risk knowledge. A more fundamental change in our ways of dealing with risk may be called for. We discuss existing literature on resilience as an alternative way to deal with risk. Balancing prevention and risk reduction with resilience could be a fruitful direction. (shrink)

BackgroundThe emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD).AimExplore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD).MethodsSemi-structured, future scenario-based (...) interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission’s Ethics Guidelines for Trustworthy AI to structure the interviews.ResultsSix themes arose from the interviews: the ability of AI to rectify human doctors’ limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the ‘human touch’; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the ‘human touch’ in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients’ individual contexts and values, in consultation with the patient.ConclusionThe ‘human touch’ patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the ‘right to a human doctor’ is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward. (shrink)

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within (...) a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...) interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach. (shrink)

In recent years, to protect the rights and welfare of human subjects, institutions in the USA have begun to set up programmes to monitor ongoing medical research. These programmes provide routine, onsite oversight, and thus go beyond existing oversight such as investigating suspected misconduct or reviewing paperwork provided by investigators. However, because of a lack of guidelines and evidence, institutions have had little guidance in setting up their programmes. To help institutions make the right choices, we used interviews and document (...) analysis to study how and why 11 US institutions have set up their monitoring programmes. Although these programmes varied considerably, we were able to distinguish two general types. ‘Compliance’ programmes on the one hand were part of the institutional review board office and set up to ensure compliance with regulations. Investigators’ participation was mandatory. Monitors focused on documentation. Investigators could be disciplined, and could be obliged to take corrective actions. ‘Quality-improvement’ programmes on the other hand were part of a separate office. Investigators requested to be monitored. Monitors focused more on actual research conduct. Investigators and other parties received feedback on how to improve the research process. Although both types of programmes have their drawbacks and advantages, we argue that if institutions want to set up monitoring programmes, quality improvement is the better choice: it can help foster an atmosphere of trust between investigators and the institutional review board, and can help raise the standards for the protection of human subjects. (shrink)

Persons with profound intellectual and multiple disabilities cannot speak about their Quality of Life, which makes it necessary to involve others. In current approaches, these ‘others’ are seen as assessors trying to describe QoL as objectively as possible, which involves a reduction of their experiences, through which they develop knowledge on the QoL of the person with PIMD. The objective of this paper is to give caregivers’ knowledge on the QoL of a person with PIMD a theoretical basis that values (...) these experiences. We will argue that caregivers should be seen as witnesses, not assessors, and their statements on QoL as testimonies, not assessments. Audiences judge the trustworthiness of these witnesses intersubjectively, which implies a relationship characterized by trust and suspicion. Trust supports the witness to tell in her own words about the QoL of the person with PIMD; it demands receptivity, indicating that both the witness and the audience are willing to reconsider their perspective on QoL. Suspicion is necessary too, which helps the witness to critically approach her own interpretations and supports her to create more trustworthy testimonies. We conclude that the concept of witnessing helps to acknowledge caregivers’ experiential knowledge of QoL of a person with PIMD, which may also apply to other persons who cannot speak about their own QoL. We hope that our study will empower caregivers to give testimonies on QoL of a person with PIMD, which is crucial when complex decisions about the life of this person have to be made. (shrink)

Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

A concise yet rigorous introduction to logic and discrete mathematics. This book features a unique combination of comprehensive coverage of logic with a solid exposition of the most important fields of discrete mathematics, presenting material that has been tested and refined by the authors in university courses taught over more than a decade. The chapters on logic - propositional and first-order - provide a robust toolkit for logical reasoning, emphasizing the conceptual understanding of the language and the semantics of classical (...) logic as well as practical applications through the easy to understand and use deductive systems of Semantic Tableaux and Resolution. The chapters on set theory, number theory, combinatorics and graph theory combine the necessary minimum of theory with numerous examples and selected applications. Written in a clear and reader-friendly style, each section ends with an extensive set of exercises, most of them provided with complete solutions which are available in the accompanying solutions manual. Key Features: Suitable for a variety of courses for students in both Mathematics and Computer Science. Extensive, in-depth coverage of classical logic, combined with a solid exposition of a selection of the most important fields of discrete mathematics Concise, clear and uncluttered presentation with numerous examples. Covers some applications including cryptographic systems, discrete probability and network algorithms. Logic and Discrete Mathematics: A Concise Introduction is aimed mainly at undergraduate courses for students in mathematics and computer science, but the book will also be a valuable resource for graduate modules and for self-study. (shrink)

Preparing words in speech production is normally a fast and accurate process. We generate them two or three per second in fluent conversation; and overtly naming a clear picture of an object can easily be initiated within 600 msec after picture onset. The underlying process, however, is exceedingly complex. The theory reviewed in this target article analyzes this process as staged and feedforward. After a first stage of conceptual preparation, word generation proceeds through lexical selection, morphological and phonological encoding, phonetic (...) encoding, and articulation itself. In addition, the speaker exerts some degree of output control, by monitoring of self-produced internal and overt speech. The core of the theory, ranging from lexical selection to the initiation of phonetic encoding, is captured in a computational model, called WEAVER++. Both the theory and the computational model have been developed in interaction with reaction time experiments, particularly in picture naming or related word production paradigms, with the aim of accounting for the real-time processing in normal word production. A comprehensive review of theory, model, and experiments is presented. The model can handle some of the main observations in the domain of speech errors (the major empirical domain for most other theories of lexical access), and the theory opens new ways of approaching the cerebral organization of speech production by way of high-temporal-resolution imaging. (shrink)

The issue of the relation between financial derivatives, money and crisis remains one of on-going debate within Marxism. This paper takes issue with a recent contribution to this debate by Tony Norfield. We contend that the relationship between financial derivatives and the concept of ‘money’ needs to be framed in the context of a changing understanding of liquidity, and that issues of crisis and renewed accumulation are better understood though this path than via debates about speculative versus real investment and (...) productive versus unproductive capital. Indeed these latter taxonomies are being superseded by current developments within finance, and Marxian analysis needs to be attuned to these current developments. (shrink)

A central question in contemporary ethics and political philosophy concerns which entities have moral status. In this article, I provide a detailed analysis of the view that moral status comes in degrees. I argue that degrees of moral status can be specified along two dimensions: (i) the weight of the reason to protect an entity’s morally significant rights and interests; and/or (ii) the rights and interests that are considered morally significant. And I explore some of the complexities that arise when (...) we link degrees of moral status to the weight of reasons to protect bundles and/or the content and size of these bundles, in particular regarding the attribution of moral status to nonparadigmatic entities (e.g. people with severe cognitive disabilities, children, embryos and foetuses, robots, non-human animals, ecosystems, and rivers). (shrink)

In this article, I assess the prospects for the limitarian thesis that someone has too much wealth if they exceed a specific wealth threshold. Limitarianism claims that there are good political and/or ethical reasons to prevent people from having such ‘surplus wealth’, for example, because it has no moral value for the holder or because allowing people to have surplus wealth has less moral value than redistributing it. Drawing on recent literature on distributive justice, I defend two types of limitarian (...) principles of justice. First, limitarian midlevel principles draw on the limitarian thesis to specify normative commitments for guiding institutional design and individual actions. Second, the limitarian presumption draws on that thesis to specify what a just allocation of wealth requires under epistemic constraints. Such a presumption says that without substantive reasons to the contrary, we should regard a distribution as unjust if some people’s wealth exceeds the limitarian threshold. Furthermore, I will argue that we must reject a possible but implausible interpretation of limitarianism as an ideal distributive pattern. Yet both as a midlevel principle and as a presumption, limitarianism can play an important role in theorizing about justice in the real world. (shrink)

Recent instances of corporate misconduct and examples of blatant leader self-serving behavior have rekindled interest in leader personality traits as antecedents of negative leader behavior. The current research builds upon that work, and examines the relationship between leader psychopathy and leader self-serving behavior. Moreover, we investigate whether follower self-esteem affects the occurrence of self-serving behavior in leaders with psychopathic tendencies. We predict that self-serving behaviors by psychopathic leaders are more likely to occur in the interaction with followers low in self-esteem. (...) We first conducted an experimental study (N = 156), in which we manipulated follower self-esteem, measured leader psychopathy, and assessed their combined effect on leader self-serving behavior using an ultimatum game. We then conducted a multi-source field study (N = 124 leader-follower dyads) using questionnaires to assess leader psychopathy, follower self-esteem, and perceived leader self-serving behavior. Across both studies, we found that leader psychopathy was positively related to their self-serving behavior, but only when followers had low rather than high self-esteem. As expected, our studies showed that the degree to which (perceived) psychopathic traits of leaders are reflected in their behavior depends on the characteristics of their followers. Apparently, the behavioral expression of negative leader traits is not only a matter of the trait strength, but instead is the result of the interplay between leader and follower in a certain context. (shrink)

One of the new ways used by companies to demonstrate their social responsibility is to encourage employee volunteering, whereby employees engage in socially beneficial activities on company time, while being paid by the company. The reasoning is that it is good for employee motivation (internal effects) and good for the company reputation (external effects). This article reports an empirical investigation of the internal effects of employee volunteering conducted amongst employees of the Dutch ABN-AMRO bank. The study showed that (a) socio-demographic (...) characteristics from employee volunteers markedly differ from those of non-volunteers and community volunteers and (b) employee volunteering seems to have positive effects on attitudes and behavior towards the organization. (shrink)

Clifford, Dick The world outlook is rather grim. Greece is bankrupt, the efforts to cure the problem by making new loans to the banks and cutting living standards is likely only to postpone the date when bankruptcy is declared. Italy and Spain are in a similar position. Britain, Europe and the USA are loaded with debt, only a few countries like Iceland are adopting methods which are the reverse of what conventional economics requires and seem to be recovering from (...) their problems slowly. (shrink)

Throughout more than two millennia philosophers adhered massively to ideal standards of scientific rationality going back ultimately to Aristotle’s Analytica posteriora. These standards got progressively shaped by and adapted to new scientific needs and tendencies. Nevertheless, a core of conditions capturing the fundamentals of what a proper science should look like remained remarkably constant all along. Call this cluster of conditions the Classical Model of Science. In this paper we will do two things. First of all, we will propose a (...) general and systematized account of the Classical Model of Science. Secondly, we will offer an analysis of the philosophical significance of this model at different historical junctures by giving an overview of the connections it has had with a number of important topics. The latter include the analytic-synthetic distinction, the axiomatic method, the hierarchical order of sciences and the status of logic as a science. Our claim is that particularly fruitful insights are gained by seeing themes such as these against the background of the Classical Model of Science. In an appendix we deal with the historiographical background of this model by considering the systematizations of Aristotle’s theory of science offered by Heinrich Scholz, and in his footsteps by Evert W. Beth. (shrink)

Carl Knight argues that lexical sufficientarianism, which holds that sufficientarian concerns should have lexical priority over other distributive goals, is ‘excessive’ in many distinct ways and that sufficientarians should either defend weighted sufficientarianism or become prioritarians. In this article, I distinguish three types of weighted sufficientarianism and propose a weighted sufficientarian view that meets the excessiveness objection and is preferable to both Knight’s proposal and prioritarianism. More specifically, I defend a multi-threshold view which gives weighted priority to benefits directly above (...) and below its thresholds, but gives benefits below the lowest threshold lexical priority over benefits above the highest threshold. (shrink)

Despite the prominence of thresholds in theories of distributive justice, there is no general account of what sort of role is played by the idea of a threshold within such theories. This has allowed an ongoing lack of clarity and misunderstanding around views that employ thresholds. In this article, I develop an account of the concept of thresholds in distributive justice. I argue that this concept contains three elements, which threshold views deploy when ranking possible distributions. These elements are (i) (...) the level of the threshold, (ii) what constitutes the value of the threshold, and (iii) how benefits above and below the threshold must be allocated. I highlight three contributions that this particular account of thresholds makes: it clarifies the nature of the shift that occurs at the threshold; it resolves a common misunderstanding about headcount principles; and it shows how the arbitrariness objection can be met. (shrink)

Throughout the twentieth century, German writers, philosophers, theologians, and historians turned to Gnosticism to make sense of the modern condition. While some saw this ancient Christian heresy as a way to rethink modernity, most German intellectuals questioned Gnosticism's return in a contemporary setting. In No Spiritual Investment in the World, Willem Styfhals explores the Gnostic worldview's enigmatic place in these discourses on modernity, presenting a comprehensive intellectual history of Gnosticism's role in postwar German thought. Establishing the German-Jewish philosopher Jacob Taubes (...) at the nexus of the debate, Styfhals traces how such figures as Hans Blumenberg, Hans Jonas, Eric Voegelin, Odo Marquard, and Gershom Scholem contended with Gnosticism and its tenets on evil and divine absence as metaphorical detours to address issues of cultural crisis, nihilism, and the legitimacy of the modern world. These concerns, he argues, centered on the difficulty of spiritual engagement in a world from which the divine has withdrawn. Reading Gnosticism against the backdrop of postwar German debates about secularization, political theology, and post-secularism, No Spiritual Investment in the World sheds new light on the historical contours of postwar German philosophy. (shrink)

Experientialist accounts of wellbeing are those accounts of wellbeing that subscribe to the experience requirement. Typically, these accounts are hedonistic. In this article I present the claim that hedonism is not the most plausible experientialist account of wellbeing. The value of experience should not be understood as being limited to pleasure, and as such, the most plausible experientialist account of wellbeing is pluralistic, not hedonistic. In support of this claim, I argue first that pleasure should not be understood as a (...) broad term to describe valuable experiences generally. I then analyze responses to the main argument against a monistic view on the value of experience: the philosophy of swine objection. I argue that such responses deviate from the central hedonistic view that only pleasure and pain matter for wellbeing. I then argue that the argument can be avoided on a pluralistic account, and formulate a plausible candidate for an account of pluralistic experientialism, in which, besides pleasure, non-hedonic aspects of experience like novelty, compassion, and aesthetic value also contribute to wellbeing. (shrink)

In this paper, I argue that limitarian policies are a good means to further political equality. Limitarianism, which is a view coined and defended by Robeyns, is a partial view in distributive justice which claims that under non-ideal circumstances it is morally impermissible to be rich. In a recent paper, Volacu and Dumitru level two arguments against Robeyns’ Democratic Argument for limitarianism. The Democratic Argument states that limitarianism is called for given the undermining influence current inequalities in income and wealth (...) have for the value of democracy and political equality. Volacu and Dumitru’s Incentive Objection holds that limitarianism places an excessive and inefficient burden on the rich in ensuring political equality. The Efficacy Objection holds that even if limitarianism limits excessive wealth it still fails to ensure the preservation of political equality. In this paper, I will argue that both of these objections fail, but on separate grounds. I argue that the Incentive objection fails because one could appeal to limitarian policies that are different from the ones discussed by Volacu and Dumitru and which escape the problem of reduced productivity. I argue against the Efficacy Objection that limitarian policies are a partial but highly valuable step towards establishing political equality, and that they can and should complement or be complemented by other strategies. (shrink)

In the history of Jewish, Christian and Muslim culture, religious identity was not only formed by historical claims, but also by the usage of certain images: “images of God”, “images of the others”, “images of the self.”This book includes a discussion of the role of these images in society and politics, in theology and liturgy, yesterday and today.

In this article, I assess the prospects for the limitarian thesis that someone has too much wealth if they exceed a specific wealth threshold. Limitarianism claims that there are good political and/or ethical reasons to prevent people from having such ‘surplus wealth’, for example, because it has no moral value for the holder or because allowing people to have surplus wealth has less moral value than redistributing it. Drawing on recent literature on distributive justice, I defend two types of limitarian (...) principles of justice. First, limitarian midlevel principles draw on the limitarian thesis to specify normative commitments for guiding institutional design and individual actions. Second, the limitarian presumption draws on that thesis to specify what a just allocation of wealth requires under epistemic constraints. Such a presumption says that without substantive reasons to the contrary, we should regard a distribution as unjust if some people’s wealth exceeds the limitarian threshold. Furthermore, I will argue that we must reject a possible but implausible interpretation of limitarianism as an ideal distributive pattern. Yet both as a midlevel principle and as a presumption, limitarianism can play an important role in theorizing about justice in the real world. (shrink)

In The March of Unreason, Dick Taverne expresses his concern that irrationality is on the rise in Western society, and argues that public opinion is increasingly dominated by unreflecting prejudice and an unwillingness to engage with factual evidence. Discussing topics such as genetically modified crops and foods, organic farming, the MMR vaccine, environmentalism, the precautionary principle, and the new anti-capitalist and anti-globalization movements, he argues that the rejection of the evidence-based approach nurtures a culture of suspicion, distrust, and cynicism, (...) and leads to dogmatic assertion and intolerance. Science, with all the benefits it brings, is an essential part of a civilized and democratic society: it offers the most hopeful future for humankind. (shrink)

In chapter 1 of Sovereign Virtue Ronald Dworkin argues against the claim that insofar as we care about distributive equality (equality in the distribution of resources to be privately owned), what we should care about is equality of welfare. This says that a distribution of resources in a society is equal just in case it results in all members of society having the same level of welfare (utility, well-being, personal good).

In this article, I propose a novel characterization of sufficientarianism. I argue that sufficientarianism combines three claims: a priority claim that we have non-instrumental reasons to prioritize benefits in certain ranges over benefits in other ranges; a continuum claim that at least two of those ranges are on one continuum; and a deficiency claim that the lower a range on a continuum, the more priority benefits in that range have. This characterization of sufficientarianism sheds new light on two long-standing philosophical (...) debates, namely about the distinctiveness of sufficientarianism as a distributive principle and about the common objections to sufficientarianism. (shrink)