It is no longer possible to claim that the biological characteristics of the future adult are already determined at conception. After all, a zygote may develop into a hydatidiform mole rather than into a human being. The development of an individual human person is determined by genetically and nongenetically coded molecules within the embryo, together with the influence of the maternal environment. Consequently, it is an error to regard the zygote's chromosomal (and other) DNA as sufficient to determine the uniqueness (...) of the future individual. (shrink)

While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall. A market in organs from living donors is one such option. The market should be ethically supportable, and have built into it, for example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.Statistics can be dehumanising. The following numbers, however, have (...) more impact than most: as of 24th November, during 2002 in the United Kingdom, 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.1 It is difficult to estimate how many people die prematurely for want of donor organs. “In the world as a whole there are an estimated 700 000 patients on dialysis . . . . In India alone 100 000 new patients present with kidney failure each year”2 . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . …. (shrink)

There is a strong tendency in the scholarly and sub-scholarly literature on terrorism to treat it as something like an ideology. There is an equally strong tendency to treat it as always immoral. Both tendencies go hand in hand with a considerable degree of unclarity about the meaning of the term ‘terrorism’. I shall try to dispel this unclarity and I shall argue that the first tendency is the product of confusion and that once this is understood, we can see, (...) in the light of a more definite analysis of terrorism, that the second tendency raises issues of inconsistency, and even hypocrisy. Finally, I shall make some tentative suggestions about what categories of target may be morally legitimate objects of revolutionary violence, and I shall discuss some lines of objection to my overall approach. (shrink)

Research ethics committees—animal ethics committees for animal-based research and institutional research boards for human subjects—have a key role in research governance, but there has been little study of the factors influencing their effectiveness. The objectives of this study were to examine how the effectiveness of a research ethics committee is influenced by committee composition and dynamics, recruitment of members, workload, participation level and member turnover. As a model, 28 members of AECs at four universities in western Canada were interviewed. Committees (...) were selected to represent variation in the number and type of protocols reviewed, and participants were selected to include different types of committee members. We found that a bias towards institutional or scientific interests may result from a preponderance of institutional and scientist members, an intimidating atmosphere for community members and other minority members, recruitment of community members who are affiliated with the institution and members joining for reasons other than to fulfil the committee mandate. Thoroughness of protocol review may be influenced by heavy workloads, type of review process and lack of full committee participation. These results, together with results from the literature on research ethics committees, suggested potential ways to improve the effectiveness of research ethics committees. (shrink)

When Huck Finn embarks upon his hilarious education of the slave Jim in the moral vagaries of the monarchies of Europe, he takes himself to be propounding the merest common sense. He may have thought large‐scale villainy restricted to autocracies, but his creator was clearly not so naive. More to the present point, Huck ends his discourse on princely rule with remarks that show he was not merely cataloguing the fact of widespread royal vice, but willing to countenance it as (...) necessary. As he puts it, ‘kings is kings, and you got to make allowances. Take them all around, they're a mighty ornery lot’. (shrink)

Just war theory entails that some wars may be morally unjustifiable, and hence citizens may be right to object morally to their government''s waging of a war and to their being compelled to serve in it. Given the evils attendant upon even justified war, this fact sharply restricts any obligation to die for the state, and raises important questions about the appropriate state response to selective conscientious objectors. This paper argues that such people should be legally accommodated, and discusses objections (...) to doing so, in particular, the possible erosion of the state''s capacity to wage justified war, the unfairness of granting such exemptions from military service, and the impossibility of determining genuinely conscientious objection. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

In his bookMinimal Rationality (1986), Christopher Cherniak draws deep and widespread conclusions from our finitude, and not only for philosophy but also for a wide range of science as well. Cherniak's basic idea is that traditional philosophical theories of rationality represent idealisations that are inaccessible to finite rational agents. It is the purpose of this paper to apply a theory of idealisation in science to Cherniak's arguments. The heart of the theory is a distinction between idealisations that represent reversible, solely (...) quantitative simplifications and those that represent irreversible, degenerate idealisations which collapse out essential theoretical structure. I argue that Cherniak's position is best understood as assigning the latter status to traditional rationality theories and that, so understood, his arguments may be illuminated, expanded, and certain common criticisms of them rebutted. The result, however, is a departure from traditional, formalist theories of rationality of a more radical kind than Cherniak contemplates, with widespread ramifications for philosophical theory, especially philosophy of science itself. (shrink)

This paper begins with a discussion of different definitions of “terrorism” and endorses one version of a tactical definition, so-called because it treats terrorism as involving the use of a quite specific tactic in the pursuit of political ends, namely, violent attacks upon the innocent. This contrasts with a political status definition in which “terrorism” is defined as any form of sub-state political violence against the state. Some consequences of the tactical definition are explored, notably the fact that it allows (...) for the possibility of state terrorism against individuals, sub-state groups and other states. But a major problem for the tactical definition is the account to be given of “the innocent.” In line with justwar thinking, the idea of “the innocent” is unpacked in terms of the concept of non-combatants and this in turn is treated as the category of those who are not prosecuting the harm that allows for a legitimate violent response. Problems with this approach are explored, with particular reference to criticisms made by Gregory Kavka. The recent drive to expand the class of those who may be legitimately attacked is subjected to scrutiny. Particular attention is paid to the role of “collective responsibility” and “deserving your government” in these arguments. (shrink)

There is a strong tendency in the scholarly and sub-scholarly literature on terrorism to treat it as something like an ideology. There is an equally strong tendency to treat it as always immoral. Both tendencies go hand in hand with a considerable degree of unclarity about the meaning of the term ‘terrorism’. I shall try to dispel this unclarity and I shall argue that the first tendency is the product of confusion and that once this is understood, we can see, (...) in the light of a more definite analysis of terrorism, that the second tendency raises issues of inconsistency, and even hypocrisy. Finally, I shall make some tentative suggestions about what categories of target may be morally legitimate objects of revolutionary violence, and I shall discuss some lines of objection to my overall approach. (shrink)

Linda Zagzebski’s book on epistemic authority is an impressive and stimulating treatment of an important topic. 1 I admire the way she manages to combine imagination, originality and argumentative control. Her work has the further considerable merit of bringing analytic thinking and abstract theory to bear upon areas of concrete human concern, such as the attitudes one should have towards moral and religious authority. The book is stimulating in a way good philosophy should be -- provoking both disagreement and emulation. (...) I agree with much of what she says, and have been instructed by it, but it will be of more interest and relevance here if I concentrate upon areas of disagreement. Perhaps they are better seen as areas, at least some of them, where her emphases suggest a position that seems to me untenable, but that she may not really intend. In that event, I will be happy to have provoked a clarification or the dispelling of my misunderstanding. My focus will be upon problems in her account of communal authority and autonomy, especially with respect to religious and political authority. Here my worry is that she places too much trust in trust and not enough in what I call selective mistrust. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in (...) the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

C A Winch; Education, Literacy and the Development of Rationality, Journal of Philosophy of Education, Volume 17, Issue 2, 30 May 2006, Pages 187–200, https://d.

It is a theorem of Rowbottom [12] that ifκis measurable andIis a normal prime ideal onκ, then for eachλ<κ,In this paper a natural structural property of ideals, distributivity, is considered and shown to be related to this and other ideal theoretic partition relations.The set theoretical terminology is standard and background results on the theory of ideals may be found in [5] and [8]. Throughoutκwill denote an uncountable regular cardinal, andIa proper, nonprincipal,κ-complete ideal onκ.NSκis the ideal of nonstationary subsets ofκ, andIκ= (...) {X⊆κ∣∣X∣<κ}. IfA∈I+ −I), then anI-partitionofAis a maximal collectionW⊆,P ∩I+so thatX∩ Y ∈IwheneverX, Y∈W, X≠Y. TheI-partitionWis said to be disjoint if distinct members ofWare disjoint, and in this case, fordenotes the unique member ofWcontainingξ. A sequence 〈Wα∣α<η} ofI-partitions ofAis said to be decreasing if wheneverα<β<ηandX∈Wβthere is aY∈Wαsuch thatX⊆Y.. (shrink)

It is argued that fundamental to Piaget's life works is a biologically based naturalism in which the living world is a nested complex of self-regulating, self-organising (constructing) adaptive systems. A structuralist-rationalist overlay on this core position is distinguished and it is shown how it may be excised without significant loss of content or insight. A new and richer conception of the nature of Piaget's genetic epistemology emerges, one which enjoys rich interrelationships with evolutionary epistemology. These are explored and it is (...) shown how a regulatory systems evolutionary epistemology may be embedded within genetic epistemology. (shrink)

The question I wish to explore is this: Does idealism conflict with common sense? Unfortunately, the answer I give may seem like a rather banal one: It depends. What do we mean by ‘idealism’ and ‘common sense?’ I distinguish three main varieties of idealism: absolute idealism, Berkeleyan idealism, and dualistic idealism. After clarifying what is meant by common sense, I consider whether our three idealisms run afoul of it. The first does, but the latter two don’t. I conclude that while (...) Moore’s famous common sense critique is sound against external world skepticism, against Berkeleyan idealism and dualist idealism it is unavailing. (shrink)

To what extent should scientists, doctors and the community be constrained in their decision-making by a duty to posterity? How should we as a community balance our desire to benefit the present generation against the need not to irretrievably harm our successors? These questions are discussed with particular reference to genetic research and treatment that may have great potential for people suffering from genetic disease but may cause inherited changes in future generations, either deliberately or inadvertently. We conclude that the (...) community should take account of the interests of its successors but this should not immobilise us in the decisions we make for the present. (shrink)

C A Wringe; Reply to Antony Flew, Journal of Philosophy of Education, Volume 13, Issue 1, 30 May 2006, Pages 149–158, https://doi.org/10.1111/j.1467-9752.1979.t.

If we consult the Anthologia Lyrica of E. Diehl and the Geschichte der griechischen Literatur of Schmid-Stählin, we find that they consider as genuine the three epigrams on Hermae which the Palatine Anthology attributes to Anacreon. The question of the authenticity of these epigrams has been for long a matter of dispute, but we may shed further light on it if we take into account the spread of the cult of Hermes in Attica and Anacreon's visit, or possibly visits, to (...) Athens. (shrink)

Originally published in 1981, this book provides a detailed account of the emergence of the children's rights movement, and analyses the concept of a right. It considers the justifications which may be sought when rights are claimed. Particular attention is given to the problem which arises when different rights are seen to be in conflict with each other or with other kinds of moral consideration. These arguments are then examined with regard to such special features of children as their incomplete (...) but developing rationality and their material dependence on adults. (shrink)

C A Wringe; Pupils’ Rights, Journal of Philosophy of Education, Volume 7, Issue 1, 30 May 2006, Pages 103–115, https://doi.org/10.1111/j.1467-9752.1973.tb00475.

C A Wringe; Pupils’ Rights, Journal of Philosophy of Education, Volume 7, Issue 1, 30 May 2006, Pages 103–115, https://doi.org/10.1111/j.1467-9752.1973.tb00475.

C A Wringe; Reply to Antony Flew, Journal of Philosophy of Education, Volume 13, Issue 1, 30 May 2006, Pages 149–158, https://doi.org/10.1111/j.1467-9752.1979.t.

We live together in one natural, if complex, world, and our scientific knowledge of it ought to be correspondingly unified. But currently the sciences collectively form a very complex structure, partly interrelated, partly unrelated, and partly incompatible. How is this condition explained, and what may we expect of unity in science?

Chad A Witt, Ramsey R Hachem Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA: The role of donor-specific antibodies to human leukocyte antigens and the burden of antibody-mediated rejection in lung transplantation remain enigmatic. Over the past several years, evidence has been emerging that humoral immunity plays an important role in the development of both acute and chronic lung allograft dysfunction. Multiple case reports and case series have identified (...) lung allograft recipients with clinical findings consistent with acute AMR. However, there is currently no widely accepted definition for AMR in lung transplantation, and this has been a significant barrier to furthering our understanding of this form of rejection. Nonetheless, the development of DSA after transplantation has consistently been identified as an independent risk factor for persistent and high-grade acute cellular rejection and CLAD. This has raised the possibility that chronic AMR may be a distinct phenotype of CLAD although evidence supporting this paradigm is still lacking. Additionally, antibodies to lung-restricted self-antigens have been associated with primary graft dysfunction early and the development of CLAD late after transplantation, and emerging evidence underscores significant interactions between autoimmunity and alloimmunity after transplantation. There is currently an active International Society for Heart and Lung Transplantation working group that is developing an operational definition for AMR in lung transplantation. This will be critical to improve our understanding of this form of rejection and conduct clinical trials to identify optimal treatment strategies. This review will summarize the literature on DSA and AMR in lung transplantation and discuss the impact of antibodies to self-antigens on lung allograft dysfunction. Keywords: antibody-mediated rejection, donor-specific antibodies, lung transplantation. (shrink)

Bradford C Bemiss, Chad A WittDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA: Chronic rejection is a major cause of death after the first year following lung transplantation. Bronchiolitis obliterans is the most common pathologic finding on biopsy, characterized by fibrous granulation tissue, which obliterates the lumen of the bronchiole. Clinically, in the absence of tissue for pathology, BO syndrome refers to a progressive irreversible drop in the forced (...) expiratory volume in 1 second. Recently, a broader definition of chronic rejection, termed "chronic lung allograft dysfunction", has been used to encompass a more inclusive definition of posttransplant dysfunction. Recently, the lung transplant community has come to realize that chronic rejection may be the final common result after repetitive epithelial insults. Acute rejection, infection, and alloreactivity to mismatched HLA antigens are a few of these insults that damage the surface of the bronchioles. Recent evidence of autoimmunity to the normally hidden structural proteins collagen V and K-α1 tubulin have been correlated with a BO phenotype as well, perhaps correlating the epithelial damage with a mechanism for developing BO lesions. Many immunomodulatory medications and treatments have been studied for effectiveness for the treatment of chronic lung allograft dysfunction. New drugs, which more precisely target the immune system, are being developed and tested. Further study is required, but recent advances have improved our understanding of the pathogenesis and potential intervention for this common and deadly complication of lung transplantation.Keywords: lung transplant, bronchiolitis obliterans syndrome, rejection. (shrink)

Schrödinger logics are logical systems in which the principle of identity is not true in general. The intuitive motivation for these logics is both Erwin Schrödinger's thesis (which has been advanced by other authors) that identity lacks sense for elementary particles of modern physics, and the way which physicists deal with this concept; normally, they understandidentity as meaningindistinguishability (agreemment with respect to attributes). Observing that these concepts are equivalent in classical logic and mathematics, which underly the usual physical theories, we (...) present a higher-order logical system in which these concepts are systematically separated. A classical semantics for the system is presented and some philosophical related questions are mentioned. One of the main characteristics of our system is that Leibniz' Principle of the Identity of Indiscernibles cannot be derived. This fact is in accordance with some authors who maintain that quantum mechanics violates this principle. Furthermore, our system may be viewed as a way of making sense some of Schrödinger's logical intuitions about the nature of elementary particles. (shrink)

In view of the present state of development of non classical logic, especially of paraconsistent logic, a new stand regarding the relations between logic and ontology is defended In a parody of a dictum of Quine, my stand May be summarized as follows. To be is to be the value of a variable a specific language with a given underlying logic Yet my stand differs from Quine’s, because, among other reasons, I accept some first order heterodox logics as genuine alternatives (...) to classical logic I also discuss some questions of non classical logic to substantiate my argument, and suggest that may position complements and extends some ideas advanced by L Apostel. (shrink)

Objectives: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies.Design and participants: Cross-sectional postal survey of doctors in Victoria.Results: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the (...) definition of euthanasia.Conclusions: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. (shrink)

Hume's doctrine of natural belief allows that certain beliefs are justifiably held by all men without regard to the quality of the evidence which may be produced in their favour. Examples are belief in an external world and belief in the veracity of our senses. According to R. J. Butler, Hume argues in the Dialogues that belief in God is of this sort. More recently John Hick has argued that for some people it is as natural to believe in God (...) as to believe in an external world. I shall first inquire what Hume understands by reasonable belief and by natural belief. I shall then use the results of this investigation to argue, against Butler, that belief in God is not a natural belief; and against Hick, more briefly, that his thesis is not viable in as far as it depends upon Hume's doctrine of natural belief. These discussions are important to the philosophy of religion since by means of natural beliefs it could be urged that belief in God is something justifiable without reference to reason or evidence: a position which would be of immense value to the theist. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Preoccupation with LTP as a putative memory mechanism may have retarded the consideration of pathological modulation of synaptic plasticity in clinical disorders where memory dysfunction is not a primary feature. Encouraged by Shors & Matzel's review, we consider the relationship between stress, synaptic plasticity, and depressive disorder.

Recent results have shown that the relative activation of muscles is different for isometric contractions and for movements. These results exclude an explanation of muscle activation patterns by a combination ofreciprocal and coactivation commands. These results also indicate that joint stiffness is not uniquely determined and that it may be different for isometric contractions and movements.

A hippocampal patient is described who shows preserved item recognition and simple recognition-based recollection but impaired recall and associative recognition. These data and other evidence suggest that contrary to Aggleton & Brown's target article, Papez circuit damage impairs only complex item-item-context recollection. A patient with perirhinal cortex damage and a delayed global memory deficit, apparently inconsistent with A&B's framework, is also described.

Health checks identify disease in individuals without a medical indication. More and more checks are offered by more providers on more risk factors and diseases, so we may speak of an omnipresence of health checks. Current ethical evaluation of health checks considers checks on an individual basis only. However, omnipresent checks have effects over and above the effects of individual health checks. They might give the impression that health is entirely manageable by individual actions and strengthen the norm of individual (...) responsibility for health to the point where people hold themselves and others responsible for health outcomes they cannot reasonably be held accountable for. This process of so-called ‘over-responsibilization’ may result in increased feelings of guilt over health, decreased health solidarity and unfairly distributed health outcomes. Moreover, effects on privacy and peace of mind may be observed. Taking into account all possible harms and benefits of health checks in their ethical evaluation requires evaluation of health checks on an individual basis as well as on the level of all checks. Therefore, we urge the amendment of existing ethical evaluation to include the effects of an omnipresence of health checks. We make a first attempt at the formulation of amended criteria. (shrink)

Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices. Providers unanimously formulate a (...) number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)

Health checks or health screenings identify disease in people without a specific medical indication. So far, the perspective of health check users has remained underexposed in discussions about the ethics and regulation of health checks. In 2017, we conducted a qualitative study with lay people from the Netherlands. We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Participants consider a good predictive value the most important characteristic of (...) a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark. (shrink)

Policy makers call upon researchers from the natural and social sciences to collaborate for the responsible development and deployment of innovations. Collaborations are projected to enhance both the technical quality of innovations, and the extent to which relevant social and ethical considerations are integrated into their development. This could make these innovations more socially robust and responsible, particularly in new and emerging scientific and technological fields, such as synthetic biology and nanotechnology. Some researchers from both fields have embarked on collaborative (...) research activities, using various Technology Assessment approaches and Socio-Technical Integration Research activities such as Midstream Modulation. Still, practical experience of collaborations in industry is limited, while much may be expected from industry in terms of socially responsible innovation development. Experience in and guidelines on how to set up and manage such collaborations are not easily available. Having carried out various collaborative research activities in industry ourselves, we aim to share in this paper our experiences in setting up and working in such collaborations. We highlight the possibilities and boundaries in setting up and managing collaborations, and discuss how we have experienced the emergence of ‘collaborative spaces.’ Hopefully our findings can facilitate and encourage others to set up collaborative research endeavours. (shrink)

Alzheimer's disease is characterized by plaques of amyloid-beta peptide, cleaved from amyloid-beta protein precursor . Our hypothesis is that lifespan profiles of AD-associated mRNA and protein levels in monkeys would differ from mice and that differential lifespan expression profiles would be useful to understand human AD pathogenesis. We compared profiles of AbetaPP mRNA, AbetaPP protein, and Abeta levels in rodents and primates. We also tracked a transcriptional regulator of the AbetaPP gene, specificity protein 1 , and the beta amyloid precursor (...) cleaving enzyme . In mice, AbetaPP and SP1 mRNA and their protein products were elevated late in life; Abeta levels declined in old age. In monkeys, SP1, AbetaPP, and BACE1 mRNA declined in old age, while protein products and Abeta levels rose. Proteolytic processing in both species did not match production of Abeta. In primates, AbetaPP and SP1 mRNA levels coordinate, but an inverse relationship exists with corresponding protein products as well as Abeta levels. Comparison of human DNA and mRNA sequences to monkey and mouse counterparts revealed structural features that may explain differences in transcriptional and translational processing. These findings are important for selecting appropriate models for AD and other age-related diseases. (shrink)

The sporadic nature of Alzheimer's disease argues for an environmental link that may drive AD pathogenesis; however, the triggering factors and the period of their action are unknown. Recent studies in rodents have shown that exposure to lead during brain development predetermined the expression and regulation of the amyloid precursor protein and its amyloidogenic beta-amyloid product in old age. Here, we report that the expression of AD-related genes [APP, BACE1 ] as well as their transcriptional regulator were elevated in aged (...) monkeys exposed to Pb as infants. Furthermore, developmental exposure to Pb altered the levels, characteristics, and intracellular distribution of Abeta staining and amyloid plaques in the frontal association cortex. These latent effects were accompanied by a decrease in DNA methyltransferase activity and higher levels of oxidative damage to DNA, indicating that epigenetic imprinting in early life influenced the expression of AD-related genes and promoted DNA damage and pathogenesis. These data suggest that AD pathogenesis is influenced by early life exposures and argue for both an environmental trigger and a developmental origin of AD. (shrink)

In this basically expository paper we discuss the role of logic and mathematics in researches concerning the ontology of scientific theories, and we consider the particular case of quantum mechanics. We argue that systems of logic in general, and classical logic in particular, may contribute substantially with the ontology of any theory that has this logic in its base. In the case of quantum mechanics, however, from the point of view of philosophical discussions concerning identity and individuality, those contributions may (...) not be welcome for a specific interpretation, and an alternative system of logic perhaps could be used instead of a classical system. In this sense, we argue that the logic and ontology of a scientific theory may be seen as mutually influencing each other. On the one hand, logic contributes to shape the general features of the ontology of a theory; on the other hand, the theory also puts constraints on the possible understanding of ontology and, respectively, on possible systems of logic that may be the underlying logic of the theory. (shrink)

The use of high hypothetical payoffs has been justified by the realism and relevance of large monetary consequences and by the impracticality of making high cash payments. We argue that subjects may not be able to imagine how they would behave in high payoff situations.

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)