BackgroundNew disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future.MethodsPatients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available (...) knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences.ResultsA substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs.ConclusionsMost of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Background Older patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based on these preferences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted. Aim To describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs). Research (...) design This study adopted reflective lifeworld theory and a phenomenological design. Participants and research context A total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden. Ethical considerations The study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent. Findings Nurses’ experiences of dealing with older patients’ autonomy in EDs are characterized by moving in a conflicting uphill struggle, indicating obscure thoughts on how patient autonomy can be protected in an ethically challenging context. The phenomenon is further described with its meaning constituents: ‘Being hampered by prioritization under stress’, ‘Balancing paternalism and patient autonomy’, ‘Making decisions without consent in the patient’s best interests’ and ‘Being trapped by notions of legitimate care needs’. Conclusion Stressful work conditions and lacking organizational strategies in EDs contribute to nurses maintaining unjustified paternalistic care, regardless of the patient’s ability and medical condition, and questioning who has legitimacy for participating in decisions about care. The nurses’ protection and promotion of older patients’ autonomy is dependent on the opportunity, ability and willingness to create a patient relationship where the patient’s voice and preferences are valued as important. Consequently, strategies are needed to improve patient autonomy in EDs based on the idea of ‘relational autonomy’. (shrink)

Neuroscientific research in relation to antisocial behavior has strongly grown in the last decades. This has resulted in a better understanding of biological factors associated with antisocial behavior. Furthermore several neuroscientific instruments and interventions have been developed that have a relatively low threshold for use in the criminal justice system to contribute to prevention or reduction of antisocial and criminal behavior. When considering implementation in the criminal justice system, ethical aspects of the use of neuroscientific instruments and interventions need to (...) be taken into account. With respect to ethics in relation to neurocriminology much of the literature focuses on identifying and debating risks and value conflicts. This is important and necessary, but the positive contribution of neuroscientific applications may therefore get less attention in the ethical literature. Yet, ethicists can help criminal justice researchers and practitioners to identify ways in which neuroscience could add positively to important values in (young) offender rehabilitation. It is argued that this role of ethicists in interdisciplinary teams deserves more emphasis. As an illustration, this contribution focuses on how neuroscientific knowledge, instruments and interventions may contribute to autonomy of (young) offenders. (shrink)

In the second of our pieces on Dawkins's The God Delusion, Douglas Groothuis defends intelligent design.

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

Background It is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance (...) service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds. Methods This was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis. Results Two themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue. Conclusion Incorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service. (shrink)

A large number of Swedish public authorities produce ‘platform of values’ texts that present core values. This article presents a study of how such texts and practices, including the core values they revolve around, are legitimized. Using Van Leeuwen’s legitimation framework, three different data sets are analysed: 47 ‘platform of values’ texts, a focus group discussion with seven senior HR officers, and a quantitative questionnaire study answered by civil servants at three public authorities. The analysis shows how the existence of (...) ‘platform of values’ texts and practices is legitimized through rationalizations, above all by describing the texts as concrete means for reaching specific ends and, with regard to the choice of core values, through a custom-conformity type of authority. Thus, this article addresses discursive transformations of contemporary organizations with a particular focus on available discursive space for critical thinking in the wake of New Public Management and related developments. (shrink)

Traces the development of the samurai, both in the way they regarded themselves and their role in society.

Interpersonal respect can be differentiated into two kinds: horizontal respect, i.e. treating someone with dignity; and vertical respect, i.e. genuinely honoring someone’s merits. With the present research, we draw on motivation theory to explore their interplay in leadership relations. Specifically, we argue for a moderated mediation hypothesis in that leaders’ horizontal respect for their subordinates fundamentally speaks to subordinates’ self-determination and that the message of respectful leadership is enhanced by the vertical respect subordinates have for their leaders. As a result, (...) subordinates are more satisfied with their jobs, which should also show in a decreased willingness to leave. The proposed model was supported in two survey studies and an experimental scenario study —thus suggesting that perceived leader behavior needs to be complemented by leader standing. (shrink)

A bold and visionary book that reveals the false and catastrophically damaging images at the root of the oppression of women and the rape of Earth's resources, ...

Research integrity climate is an important factor that influences an individual’s behavior. A strong research integrity culture can lead to better research practices and responsible conduct of research. Therefore, investigations on organizational climate can be a valuable tool to identify the strengths and weaknesses of each group and develop targeted initiatives. This study aims to assess the perceptions on integrity climate in three universities in Hungary. A cross-sectional study was conducted with PhD students, postdocs, and professors from three Hungarian universities. (...) The survey included demographic questions, such as gender, age, scientific field, academic rank, and the Survey of Organizational Research Climate. A total of 432 participants completed the survey. Our results show that postdocs and assistant professors perceived integrity climate more negatively than PhD students and full professors in every survey scale. Contrarily, PhD students perceive more positively than the other groups. Disciplinary differences show that researchers in the Biomedical sciences perceive regulatory bodies to be fairer when evaluating their projects than those in the Natural sciences. Natural sciences also perceive more negatively how the department values integrity when compared to Humanities. Humanities perceive more positively Advisor/Advisee Relations than Biomedical Sciences. Our results suggest that institutions should pay more attention to early career researchers, especially insecure and temporary positions like postdocs and assistant professors. They should provide RCR resources, socialize them in RCR, and set more reasonable expectations. Moreover, department leaders should develop initiatives to foster better integrity climates. (shrink)

Based on two case studies of the design of electronic communication networks developed in the public and private sector, this article explores the barriers within current design cultures to account for the needs and diversity of users. Whereas the constraints on user-centered design are usually described in macrosociological terms, in which the user–technology relation is merely understood as a process of the inclusion or exclusion of users in design, the authors suggest that it is important to adopt a semiotic approach. (...) Moreover, they argue that we need to take into account the gender identity of designers to understand how design practices in ICT prioritize male users. The article shows how configuring the user as “everybody” and the use of the “I-methodology” are important constraints in the development of technologies that aim to reach users in all their diversity. (shrink)

This article contributes to Science and Technology Studies on vulnerability by putting cyborgs at center stage. What vulnerabilities emerge when technologies move under the skin? I argue that cyborgs face new forms of vulnerability because they have to live with a continuous, inextricable intertwinement of technologies and their bodies. Inspired by recent feminist studies on the lived intimate relationships between bodies and technologies, I suggest that sensory experiences, material practices, and cartographies of power are important heuristic tools to understand the (...) vulnerabilities of hybrid bodies. Based on an analysis of how patients in the Netherlands and the United States cope with appropriate and inappropriate implantable cardioverter defibrillator shocks, I describe how defibrillators introduce two new kinds of vulnerabilities: vulnerability as an internal rather than an external threat, and as harm you may try to anticipate but can never escape. Despite these vulnerabilities, some heart patients don’t position themselves as passive victims of faulty machines. They actively engage in material practices of resilience by using magnets to stop inappropriate shocks. I conclude that anticipating and taming the improper working of technologies inside bodies constitutes a new form of invisible labor that is crucial to diminishing the existential uncertainties of cyborgs. (shrink)

In the last fifteen years, testing has attracted much attention in science and technology studies. Most researchers have focused almost exclusively on testing in the laboratory, specifically designed test locations, and, for medical technologies, the clinic. What counts as testing has largely been described in terms of the activities of scientific experts. This is not to say that science and technology studies have completely neglected other institutional discourses. Journalistic texts have been a favorite research site for scholars in science and (...) technology studies, particularly those seeking to understand the dynamics of public controversies on science and technology. Although most constructivist studies of science and media relations have treated journalistic texts as secondary to scientific texts, other scholars have dismissed this hierarchy. In this article, scientific texts and journalistic texts are considered equally important locations in which to analyze the testing of technologies. Based on a case study on the testing of a new contraceptive technology for men, the article shows that what counts as successful testing is not solely in the hands of scientific experts. In the case of male contraceptive technologies, journalists have contested the claims of scientific experts, particularly their claims about the cultural feasibility of the new technology. (shrink)

This article argues that the influence of heteronormativity on the conceptualization of women and technology in feminist constructivist technology studies creates serious problems for the analysis. This research aims to understand the coproduction of gender and technology in society, but does not approach the two elements in a symmetrical fashion. Hence, ethnographic studies can only exemplify how the gender of technology producers is reflected in the technology created. Masculine gender identity is stabilized as a cause for the masculinity of a (...) technology that is shaped by social relationships. The criticism is fleshed out in a close examination of case study accounts of ethnographies among producers and users of technology. It is argued that a habitual reproduction of heteronormativity, present in the surrounding culture and in the technological communities studied, has prevented the adoption of approaches to the subject conducive to the objective of this feminist research. Acknowledging that destabilizing gender can undermine the critical thrust of feminist critique, the paper turns towards queer theory for ideas about how to produce criticism that does not rely on the stability of identity. The article closes with suggesting how a queer feminist approach could contribute to different readings of life with technology. (shrink)

ArgumentThis paper challenges three assumptions common in the literature on expertise: that expertise is linearly derived from scientific knowledge; that experts always align with the established institutional order; and that expertise is a property acquired by individuals. We criticize these ideas by juxtaposing three distinct expert practices involved with flood risk management in England. Virtual engineering is associated with commercial consultancy and relies on standardized software packages to assess local flood inundation. Mathematical experimentation refers to academic scientists creating new digital (...) renderings of the physical dynamics of flooding. Participatory modeling denotes research projects that aim to transform the relationships between experts and local communities. Focusing on different modes of modeling we contribute an analysis of how particular models articulate with specific politics of knowledge as experts form relationships with flood risk management actors. Our empirical study also shows how models can contribute to re-distribution of expertise in local flood risk management. (shrink)

Studies of drug development have described the role of clinical trials in the selection of drug profiles. This article presents a case study of the development of hormonal drugs in the 1920s and 1930s to illustrate that clinical trials have a more extensive role than is assumed. Clinical trials are instrumental in mediating the relationships between the pharmaceutical industry, the laboratory, and the clinic, resulting in a network of actors collectively creating medical knowledge, drugs, and markets for these drugs.

The role of users in innovation processes has gained increasing attention in innovation studies, technology studies, and media studies. Scholars have identified users and use practices as a source of innovation. So far, however, little insight has been generated in innovation processes in which communities of users are the driving force in all phases of the innovation process. This article explores the conceptual vocabularies of innovation studies and actor— network theory and discusses their adequacy for describing and understanding the dynamics (...) of user-initiated innovation processes in which community and innovation are closely intertwined. The authors introduce the concept of community innovation and argue for its relevance for understanding the full dynamics of innovations initiated and shaped by user collectives. The article elaborates a qualitative case study of Wireless Leiden, a local wireless network infrastructure in the Dutch town of Leiden initiated, designed, and maintained by a local community of users. (shrink)

PurposeMāori culture is a central aspect inAotearoa/New Zealand's national identity. Beginning in the 1970s biculturalism saw the indigenous culture and values acknowledged and incorporated in wider public discourse and policy. The purpose of this paper is to investigate whether New Zealand's cyberspace accommodates Māori. It explores how the web space is influenced by biculturalism and in turn what an understanding of this web space can tell us about biculturalism inAotearoa.Design/methodology/approachA brief introduction to biculturalism in New Zealand provides the background to (...) the investigation of the country's web space. Recent access statistics enquire whether Māori are actually connected to the internet. The exploration of the structure of the internet is informed by newspaper articles and online documents relating to the development of two Māori specific second‐level domain name spaces. A word‐frequency analysis within a sample of 21 websites provides an overview into the use of the Māori language in cyberspace.FindingsThe paper shows that although Māori have the lowest access rate to the internet compared to other ethnic groups in New Zealand, their influence on the country's web space is nonetheless far‐reaching. Developments regarding Māori language uses over the last years are generally progressive. Māori culture and ongoing social changes are increasingly accommodated on the internet – Māori have been actively shaping the web space. However, these efforts do require the support and acceptance of the wider Internet community. The linguistic and structural developments taking place online since the mid 1990s were influenced by the bicultural thinking, public discourse and practice of the time.Originality/valueThis paper draws together the Māori success‐stories in their endeavour to assert their cultural needs in New Zealand's cyberspace. It highlights that the understanding ofAotearoaas being a bicultural country influenced developments taking place online potentially will lead to a truly bicultural web space in the near future. (shrink)

Recognizing the importance of health‐promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client–provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client–provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic‐level and broader social and health (...) policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in‐depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as ‘good’ or ‘bad’. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers’ and clients’ negotiated relationships are explored, but this is couched within both local and system‐level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. (shrink)

The aim of this study was to explore stakeholder perceptions of the contribution of an Automatic Milking System (AMS) to sustainable development of organic dairy production in Denmark and the Netherlands. In addition, reasons for the current difference in AMS use on organic dairy farms between both countries were explored. To answer above mentioned aims, farmers and advisors in both countries were interviewed using a focus group approach. Questions of the interviews were based on a literature review on sustainability issues (...) affected by introduction of AMS. Participants expressed no moral problems regarding AMS use. They, however, pointed out uncertainty about the economic gain, difficulties with grazing, adaptation problems to technology, and image problems towards consumers. The latter results from a reduction in grazing time affecting both animal welfare and product quality. The participants did not recognize eutrophication, as result of high stocking density on farmstead lots, as a problem caused by AMS. The milk quality problem related to AMS use, although acknowledged as crucial towards consumers, was not prioritized very highly, especially not by the farmers in both countries. All groups were, however, unanimous in their perception of how important image was as far as the consumers are concerned. The perception analysis revealed that Dutch participants were more concerned about the economic payoff of AMS use, and showed more reluctance towards enlargement than Danish ones. In addition, they acknowledged the small-scale naturalness of organic production. These differences in perception could possibly explain observed differences in AMS use in organic dairy production between Denmark and the Netherlands. (shrink)

The aim of this study was to explore stakeholder perceptions of the contribution of an Automatic Milking System (AMS) to sustainable development of organic dairy production in Denmark and the Netherlands. In addition, reasons for the current difference in AMS use on organic dairy farms between both countries were explored. To answer above mentioned aims, farmers and advisors in both countries were interviewed using a focus group approach. Questions of the interviews were based on a literature review on sustainability issues (...) affected by introduction of AMS. Participants expressed no moral problems regarding AMS use. They, however, pointed out uncertainty about the economic gain, difficulties with grazing, adaptation problems to technology, and image problems towards consumers. The latter results from a reduction in grazing time affecting both animal welfare and product quality. The participants did not recognize eutrophication, as result of high stocking density on farmstead lots, as a problem caused by AMS. The milk quality problem related to AMS use, although acknowledged as crucial towards consumers, was not prioritized very highly, especially not by the farmers in both countries. All groups were, however, unanimous in their perception of how important image was as far as the consumers are concerned. The perception analysis revealed that Dutch participants were more concerned about the economic payoff of AMS use, and showed more reluctance towards enlargement than Danish ones. In addition, they acknowledged the small-scale naturalness of organic production. These differences in perception could possibly explain observed differences in AMS use in organic dairy production between Denmark and the Netherlands. (shrink)

Defining the lives of a majority of the world's population, the question of 'the city' has risen to the fore as one the most urgent issues of our time "e; uniting concerns across the terrain of climate policies, global financing, localised struggles and multi-disciplinary research. Deleuze and the City rests on a conviction that philosophy is crucially important for advancing knowledge on cities, and for allowing us to envisage new forms of urban life toward a more sustainable future. It gathers (...) some of the most original thinkers and accomplished scholars in contemporary urban studies, showing how Deleuze and Guattari's philosophical project is essential for our thinking through the multi-scalar, uneven and contested landscapes that constitute 'the city' today. Case studies range from the 'laboratory urbanism' of an Austrian ski resort and a 'sustainable' Swedish shopping mall to the 'urbicidal' refurbishments of Haifa. (shrink)

Neuroscientific research in relation to antisocial behavior has strongly grown in the last decades. This has resulted in a better understanding of biological factors associated with antisocial behavior. Furthermore several neuroscientific instruments and interventions have been developed that have a relatively low threshold for use in the criminal justice system to contribute to prevention or reduction of antisocial and criminal behavior. When considering implementation in the criminal justice system, ethical aspects of the use of neuroscientific instruments and interventions need to (...) be taken into account. With respect to ethics in relation to neurocriminology much of the literature focuses on identifying and debating risks and value conflicts. This is important and necessary, but the positive contribution of neuroscientific applications may therefore get less attention in the ethical literature. Yet, ethicists can help criminal justice researchers and practitioners to identify ways in which neuroscience could add positively to important values in offender rehabilitation. It is argued that this role of ethicists in interdisciplinary teams deserves more emphasis. As an illustration, this contribution focuses on how neuroscientific knowledge, instruments and interventions may contribute to autonomy of offenders. (shrink)

The mind-body problem lies at the heart of the clinical practice of both psychiatry and psychosomatic medicine. In their recent publication, Schwartz and Wiggins address the question of how to understand life as central to the mind-body problem. Drawing on their own use of the phenomenological method, we propose that the mind-body problem is not resolved by a general, evocative appeal to an all encompassing life-concept, but rather falters precisely at the insurmountable difference between.

Neuroscientific research in relation to antisocial behavior has strongly grown in the last decades. This has resulted in a better understanding of biological factors associated with antisocial behavior. Furthermore several neuroscientific instruments and interventions have been developed that have a relatively low threshold for use in the criminal justice system to contribute to prevention or reduction of antisocial and criminal behavior. When considering implementation in the criminal justice system, ethical aspects of the use of neuroscientific instruments and interventions need to (...) be taken into account. With respect to ethics in relation to neurocriminology much of the literature focuses on identifying and debating risks and value conflicts. This is important and necessary, but the positive contribution of neuroscientific applications may therefore get less attention in the ethical literature. Yet, ethicists can help criminal justice researchers and practitioners to identify ways in which neuroscience could add positively to important values in offender rehabilitation. It is argued that this role of ethicists in interdisciplinary teams deserves more emphasis. As an illustration, this contribution focuses on how neuroscientific knowledge, instruments and interventions may contribute to autonomy of offenders. (shrink)

There was more to Blaise Pascal than his "wager," an argument about the existence of God. In this accessible study, philosopher Douglas Groothuis introduces readers to Pascal's life as well as the breadth of his intellectual pursuits, overviewing the key points of his Pensées and exploring his views on culture, politics, and more.

In Think 7, Nigel Warburton attacked Pascal's famous wager on the existence of God. Here, Douglas Groothuis resurrects Pascal to defend the wager.