Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the (...) effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. (shrink)
Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the (...) effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. (shrink)
There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.
This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria (...) sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment. (shrink)
Newborn screening involves a complex logistical process, which depends on the close cooperation of many professionals, such as midwives, laboratory technicians, general practitioners and pediatricians. These professionals may encounter moral problems in the process, which have not been systematically studied before. This study fills this gap. We conducted interviews with 36 professionals involved in NBS in the Netherlands and made an inventory of the moral problems they encounter, as well as of the ways in which they tend to respond to (...) them. The moral problems professionals encounter stem from interpersonal conflicts and intrapersonal conflicts. Given the complexity of the work of NBS professionals, the study suggests that the moral problems that occur on the work floor cannot easily be solved by means of offering better or more stringent policy guidelines. Rather, it should be appreciated that professionals contribute significantly to shaping the morality of NBS with the help of their daily choices, and they should be supported in carrying out this task—for example with the help of a moral training or regular multidisciplinary moral deliberation, facilitated by an ethicist. (shrink)
Andalus and Sefarad: On Philosophy and Its History in Islamic Spain. By Sarah Stroumsa. Princeton: Princeton University Press, 2019. Pp. xxi + 220. $35, £28.
Recent research in the educational context has focused not only on academic achievement but also on subjective well-being (SWB) as both play a major role in students’ lives. Whereas the determinants of academic achievement have been extensively investigated, little research has been conducted on school-related determinants of SWB in comparison with other students’ characteristics. In the present cross-sectional study, we set out to investigate whether perceived school climate predicts school grades and SWB above and beyond other variables that are important (...) for SWB and academic achievement. A sample of 767 8th and 9th grade students (n = 361 female adolescents; age: M = 14.07 years, SD = 0.92) completed measures of SWB, perceived school climate, test anxiety, self-efficacy, and interest. Grade point average (GPA) indicated students’ academic achievement. Data were analyzed with latent structural equation models in which GPA and SWB were regressed on the school climate variables and students’ characteristics. Results indicated that a positive school climate as well as self-efficacy and the worry component of test anxiety predicted SWB and/or GPA after all other variables were controlled for. Directions for future research and the importance of school climate variables on adolescents’ SWB and academic achievement are discussed. (shrink)
This article examines the relation between the critical theory of Moishe Postone and the philosophy of Theodor Adorno. While the former is clearly influenced by the latter, these influences mostly stay implicit. When explicit, he does not so easily put his own thought in line with Adorno’s and is highly critical of him. I will investigate the ways in which ideas from Adorno made their way into Postone’s work, but also where the latter diverts from them. As will be shown, (...) Postone’s critical theory runs into a problem when one examines the immanent ground of his critical norm, freedom. Adorno, on the contrary, does succeed in employing the same norm in his own immanent critique. I will conclude that the problem Postone encounters can be avoided by being more of an ‘Adornian’, and that his theory allows this. (shrink)
The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the practice (...) of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)
The Diagnostic and Statistical Manual of Mental Disorders has elicited numerous criticisms throughout its history. Its particularly controversial status has not been resolved by the recent release of the DSM-5 ; rather, the new edition has amplified debates in psychiatry as well as philosophy and the wider public. To a certain extent, such controversies are to be expected because of the influential role the DSM plays in science and health care. Researchers have often been required to use the DSM classification (...) to get funded and published, clinicians need to use it for diagnosis, and patients need a DSM code to get reimbursed for treatment.1 Classification in psychiatry shapes the course of research... (shrink)
Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage (...) and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)
Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)
Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic (...) trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts. (shrink)
This collection features eleven original essays, divided into three thematic sections, which explore the work of Wilfrid Sellars in relation to other twentieth-century thinkers. Section I analyzes Sellars’s thought in light of some of his influential predecessors, specifically Ludwig Wittgenstein, Rudolf Carnap, John Cook Wilson, and Kazimierz Ajdukiewicz. The second group of essays explores from different perspectives Sellars’s place within the analytic tradition, including his relation with analytic Kantianism and analytic pragmatism. The book’s final section extracts some of the most (...) significant lessons Sellars’s work has to offer for contemporary philosophy. These chapters address his views on inference, his views on truth and its connection to recent discussions about truth-relativism and truth-pluralism, his conception of self-knowledge, and his theory of perceptual experience. (shrink)
People struggling with addiction are neither powerless over their addiction, nor are they fully in control. Lewis vigorously objects to the brain disease model of addiction, because it makes people lose belief in their self-efficacy, and hence hinders their recovery. Although he acknowledges that there is a compulsive state in addiction, he objects to the claim that this compulsion is carved in stone. Lewis argues that the BDMA underestimates the agency of addicted people, and hence hinder their recovery. Lewis’s work (...) offers us a very much to be welcomed neurobiology of recovery. It offers addicted people a hopeful and respectful narrative for their recovery that treats them as agents rather than as damaged brains. However, I argue that overestimating people’s agency can also result in people losing belief in their self-efficacy. Lewis’s strong focus on the agency of addicted people might not match their experiences of struggle, hence reinforcing their feelings of guilt when they fail to control their use. I propose to replace the notion of addiction as a disease with a notion of a disease-like stage in addiction. I call this stage the duress stage in addiction, in which the addictive behaviour is largely impervious to the agent’s values and to available techniques of self-control. However, the agent can overcome this stage by developing new techniques of self-control, by building on their self-concept and belief in self-efficacy, by changing their environments and habits, and by engaging in projects that are meaningful to the agent. (shrink)
Background In Scandinavia 13–28% of gynecology patients have experienced abuse in health care in their life time, which contradicts the ethical obligations not to harm the patient and to protect the patient's dignity. Concerning learning to act ethically, scholars have emphasized the importance of combining theoretical and practical dimensions. This article explores Forum Play as a way of learning to act ethically in abusive situations in health care. Method Ten health-care workers participating in a Forum Play course took part in (...) this study. To explore participants' experiences of Forum Play, semi-structured interviews were conducted and processed by using the grounded theory analysis techniques of coding and constant comparison. Results The analysis resulted in the core category “developing response–ability.” It encompasses the processes bringing about the ability to respond adequately to situations where abuse occurs and the conditions for these processes, as well as the participants' achieved understanding of the third person's potential to act in a situation with a power imbalance. Forum Play allows participants to reflect on both verbal and body language, and gives them time to enact and think through issues of moral agency. Conclusion The simulated reality of Forum Play offers a platform where learning to act ethically in abusive situations in health care is facilitated by providing a safe space, suspending constricting structural conditions such as hierarchies and lack of time, fostering moral imagination, allowing creativity in developing and trying out a variety of acting alternatives, and reflecting upon the observed and experienced situation. (shrink)
Excerpt: How does subjective well-being change over the life course and what concepts do people draw upon when they answer questions about their well-being? Does well-being indeed change or are people endowed with a set level of happiness around which their well-being fluctuates? These are some of the questions this paper will address with a focus on three domains of life: family, work, and health.
This article gives an overview of the influence of the work of Michel Foucault on the philosophy of Agamben. Discussed are Foucault’s influence on the Homo Sacer cycle, on (the development) of Agamben’s notion of power (and on his closely related notion of freedom and art of life), as well as on Agamben’s philosophy of language and methodology. While most commentaries focus on Agamben’s interpretation of Foucault’s concept of biopower, his work also contains many interesting references to Foucault on freedom (...) and possibilities—and I think that it is here that Foucault’s influence on Agamben is most deeply felt. This article focuses on the shifts Agamben takes while looking for the Entwicklungsfähigkeit in the work of Foucault. (shrink)
Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and (...) an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives. (shrink)
When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of the (...) data, and how the data is presented to the scientific and wider societal community. Highly stigmatized research subjects, like substance‐dependent parents, are especially at risk of encountering indirect harm, because the prejudice against them is so persistent. In this paper we discuss two forms of indirect harm. First, researchers have to be aware how their results will be preceived by society. Even when subjects are presented in an objective way, further, out of porportion stigmatization can occur. Researchers sometimes try to counteract this by whitewashing their results, at the risk of downplaying their respondents’ problems. The second risk researchers face is that their own normative judgements influence how they question such parents, report results and interpret statements. Researchers’ own normative judgements may influence the way they present their subjects. This article reviews a broad range of research that exhibits such indirect harms, discussing how and why indirect harms occur and formulating corresponding recommendations on how to prevent them. (shrink)
BackgroundTranscranial direct current stimulation targeting the primary motor hand area may induce lasting shifts in corticospinal excitability, but after-effects show substantial inter-individual variability. Functional magnetic resonance imaging can probe after-effects of TDCS on regional neural activity on a whole-brain level.ObjectiveUsing a double-blinded cross-over design, we investigated whether the individual change in corticospinal excitability after TDCS of M1-HAND is associated with changes in task-related regional activity in cortical motor areas.MethodsSeventeen healthy volunteers received 20 min of real or sham TDCS on separate (...) days in randomized order. Real and sham TDCS used the classic bipolar set-up with the anode placed over right M1-HAND. Before and after each TDCS session, we recorded motor evoked potentials from the relaxed left first dorsal interosseus muscle after single-pulse transcranial magnetic stimulation of left M1-HAND and performed whole-brain fMRI at 3 Tesla while participants completed a visuomotor tracking task with their left hand. We also assessed the difference in MEP latency when applying anterior-posterior and latero-medial TMS pulses to the precentral hand knob.ResultsReal TDCS had no consistent aftereffects on mean MEP amplitude, task-related activity or motor performance. Individual changes in MEP amplitude, measured directly after real TDCS showed a positive linear relationship with individual changes in task-related activity in the supplementary motor area and AP-LM MEP latency.ConclusionFunctional aftereffects of classical bipolar anodal TDCS of M1-HAND on the motor system vary substantially across individuals. Physiological features upstream from the primary motor cortex may determine how anodal TDCS changes corticospinal excitability. (shrink)
This paper gives insight into the Islamic bioethical discussion on harvesting and using human embryonic and adult stem cells. It describes some of the Islamic legal mechanisms involved in the bioethical discourse among Muslims. As the contemporary Islamic bioethical discourse is very diverse, the paper focuses on the critical discussion of related resolutions of the Saudi-based Islamic Fiqh Academy due to the esteem in which the IFA is held in the Islamic world and the pertinence of their rulings on this (...) issue. This study discusses the different sources of human adult and embryonic stem cells and their use from an Islamic perspective, while questioning some directions the Islamic bioethical discourse has taken. The paper invites interested parties to deliberate the use of some of the legal means resorted to in the ongoing Islamic bioethical discourse. (shrink)
ABSTRACTThis is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task, an Emotional Visual Search Task, and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: (...) evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying... (shrink)
This article presents estimates of the global cost of collective and interpersonal violence for the period of one year. This includes war, terrorism, homicides, assaults and domestic violence against women and children. The cost of conventionally defined interpersonal violence, that is, homicides and assault, are about 7.5 times higher than the cost due to war and terrorism. I also estimate the costs of non-fatal domestic violence against children and women and suggest that these costs are much higher than the combined (...) costs of homicide, assault, terrorism and war. The main reason is that the prevalence of these types of violence is very high: possibly as many as 16 per cent of all children are punished using violent methods and about 12 per cent of all women experience intimate partner violence. Richer societies have lower levels of violence, and there is evidence that prevalence rates have been declining over time. However, it is often unclear why this is the case. Much of the evidence from violence red... (shrink)
TheoryDigital technologies have become an integral part of everyday life that children are exposed to. Therefore, it is important for children to acquire an understanding of these technologies early on by teaching them computational thinking as a part of STEM. However, primary school teachers are often reluctant to teach CT. Expectancy-value theory suggests that motivational components play an important role in teaching and learning. Thus, one hindrance to teachers’ willingness to teach CT might be their low expectancies of success and (...) high emotional costs, e.g., anxiety towards CT. Thus, introducing preservice teachers to CT during their university years might be a promising way to support their expectancies and values, while simultaneously alleviating their emotional costs. Prior CT competences might contribute to these outcomes.AimsWe investigated whether a specifically designed seminar on CT affected preservice teachers’ expectancies and values towards programming.Method: A total of 311 German primary school and special education preservice teachers took part in the study. The primary school preservice teachers received a seminar on CT and programming with low-threshold programming tasks, while the special education teachers served as a baseline group. The seminar was specifically designed to enhance expectancies and values and decrease emotional costs, following implications of research on expectancy-value theory.ResultsThe preservice teachers who visited the seminar gained higher expectancies and values towards CT and programming compared to the baseline group. Moreover, their emotional costs decreased. CT was positively related to change in expectancies and values and negatively related to emotional costs.DiscussionInterventions with low-threshold programming tasks can support primary school preservice teachers in finding trust in their abilities and values towards CT. Moreover, their anxiety towards CT and programming can be alleviated. Thus, first steps in preparing preservice teachers to teach CT in their future classrooms can be taken in university. (shrink)
