Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts (...) on self and others. The paper shows: that the impact of incidental findings may be greater than participants at first let on; incidental findings can have significant effects on participants’ social environment; and participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. (shrink)

Priority setting is inevitable to control expenditure on expensive medicines, but citizen support is often hampered by the workings of the ‘identified victim effect’, that is, the greater willingness to spend resources helping identified victims than helping statistical victims. In this paper we explore a possible cognitive debiasing strategy that is being employed in discussions on healthcare priority setting, which we call ‘empathy counterbalancing’ (EC). EC is the strategy of directing attention to, and eliciting empathy for, those who might be (...) harmed as a result of one-sided empathy for the very ill who needs expensive treatment. We argue that governments have good reasons to attempt EC because the identified victim effect distorts priority setting in ways that undermine procedural fairness. We briefly outline three areas of application for EC and suggest some possible mechanisms that might explain how EC might work, if at all. We then discuss four potential ethical concerns with EC. First, EC might have the counterproductive effect of reducing overall citizen support for public funding of expensive medical treatments, thereby undermining solidarity. Second, EC may give rise to a ‘competition in suffering’, which may have unintended side effects for patients who feature in attempts at EC. Third, there may be doubts about whether EC is effective. Fourth, it may be objected that EC comes down to emotional manipulation, which governments should avoid. We conclude that insofar these concerns are valid they may be adequately addressed, and that EC seems a promising strategy that merits further investigation. (shrink)

BackgroundCountries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants.DiscussionResearch ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs (...) can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices.The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals.ConclusionOutcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? (shrink)

Dementia is a growing issue at the end of life that presents unique challenges for advance care planning. Advance directives are a useful and important component of end-of-life planning, but standard advance directives have less utility in cases of loss of capacity due to dementia. An advance directive designed to specifically address end-of-life issues in the setting of dementia can provide patients with increased autonomy and caregivers with improved information about the desires of the individual in question. The Dartmouth Dementia (...) Directive is a dementia-specific advance directive, available online, that seeks to address common concerns of individuals who are planning for dementia-related end-of-life care. This directive was piloted in a community-based workshop, which provided important details and perspective on the best use of dementia-specific advance directives in the greater population. (shrink)

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the value of (...) five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7.% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Physical environmental factors – or ‘artifacts’ – are linked to healthcare outcomes in the field of social psychology. However, the role of artifacts remains rarely examined in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts – such as provider clothing and office décor – may carry significant potential in eliciting placebo effects in clinical settings. We discuss three potential mechanisms by which artifacts may enhance or diminish placebo (or nocebo) effects: classical (...) conditioning, response expectancy, and mindsets. We propose testable hypotheses and conclude by providing innovative research designs that might help to better advance this novel research agendum. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

Researchers from diverse disciplines, including organismal and cellular physiology, sports science, human nutrition, evolution and ecology, have sought to understand the causes and consequences of the surprising variation in metabolic rate found among and within individual animals of the same species. Research in this area has been hampered by differences in approach, terminology and methodology, and the context in which measurements are made. Recent advances provide important opportunities to identify and address the key questions in the field. By bringing together (...) researchers from different areas of biology and biomedicine, we describe and evaluate these developments and the insights they could yield, highlighting the need for more standardisation across disciplines. We conclude with a list of important questions that can now be addressed by developing a common conceptual and methodological toolkit for studies on metabolic variation in animals. (shrink)

In this article, we will describe higher order thought theories of consciousness. Then we will describe some examples from synesthesia. Finally, we will explain why the latter may be relevant to the former.

Last year Charlotte Shreve and I (Adams and Shreve 2016) presented an argument that synesthesia contains evidence against higher order thought theories of consciousness. Rocco Gennaro (2016) took up the challenge and argued that H.O.T. theories like his could handle the example and dismiss the argument. Below we suggest otherwise. We think the traditional versions of H.O.T. theory are still vulnerable to our argument and we maintain that Gennaro’s version is as well.

Fred Adams and Charlotte Shreve ABSTRACT: Last year Charlotte Shreve and I presented an argument that synesthesia contains evidence against higher order thought theories of consciousness. Rocco Gennaro took up the challenge and argued that H.O.T. theories like his could handle the example and dismiss the argument. Below we suggest...

(2006). First thoughts: An unpublished letter from Gilbert Ryle to H. J. Paton∗. British Journal for the History of Philosophy: Vol. 14, No. 4, pp. 747-756.

THE MOST SACRED FREEDOM includes eight essays that were first presented at the 2014 A.V. Elliott Conference on Great Books and Ideas, the seventh annual conference sponsored by Mercer Universitys Thomas C. and Ramona E. McDonald Center for Americas Founding Principles. Together, these essays explore the great principle of religious liberty by charting its development in the Western tradition and reconsidering its place at Americas founding. The book begins with a comparison between the flood accounts in Genesis and the Mesopotamian (...) Atra-Has's and advances all the way to the 2014 Supreme Court case Burwell v. Hobby Lobby. The intervening chapters examine the contributions of figures such as Emperor Julian, Roger Williams, Cecilius Calvert, John Locke, Jean-Jacques Rousseau, and the American Founders. Contributors to the volume are Steven Grosby, Jeremiah H. Russell, Maura Jane Farrelly, Daniel Cullen, John Witte, Jr., Scott Yenor, David Ramsey, and Michael Novak. (shrink)

This article introduces three princesses: Princess Elizabeth of Bohemia (1618-1680); her sister, Princess Sophie who became the Electress of Hanover (1630-1714); and Sophie's daughter, Sophie Charlotte, who became the first Queen of Prussia (1668-1705). After summarizing their common family background, the article presents, for each in turn, her biography and a discussion of her relation to philosophy. In each case their philosophical involvement stems from their friendships with the leading philosophers of their day; Princess Elizabeth was a friend of (...) Descartes while the Electress Sophie and Sophie Charlotte were friends of Leibniz. The article concludes that anyone who has made the acquaintance of the three princesses and has studied their interaction with their philosopher-friends will always see them as part of the history of modern philosophy. (shrink)

This volume consists of autobiographical by the following scholars, together with pictures and autographs: Raven I. McDavid, Jr., Henry M. Hoenigswald, John B. Carroll, William G. Moulton, Archibald A. Hill, Yakov Malkiel, Charles F. Hockett, Harold B. Allen, William Bright, Einar Haugen, George S. Lane, Frederic G. Cassidy, James B. McMillan, Winfred P. Lehmann, Fred W. Householder, and Dell Hymes. A master list of references, and an index of persons conclude the volume.

Aristotle's defense of Dunamis -- Power and potentiality -- Rational and nonrational powers -- The priority of actuality -- Ontological hierarchy, normativity, and gender.

“The sleeper awakes” is a convention of many literary utopias from the late nineteenth and early twentieth centuries. The plots of Edward Bellamy’s Looking Backward, William Morris’s News from Nowhere, and H. G. Wells’sWhen the Sleeper Wakes all famously involve a sleeping modern everyman who awakens to a future where the conflicts and contradictions of the burgeoning capitalist society have been resolved. The Bleilers identify dozens of other speculative novels from the same period employing this very device, such as William (...) Hudson’s A Crystal Age and Alvarado Fuller’s A.D. 2000.1 Chris Ferns has argued that this trope constitutes something of a “consoling... (shrink)

This article focuses on three recent discussions on determinism in the philosophy of science. First, determinism and predictability will be discussed. Then, second, the paper turns to the topic of determinism, indeterminism, observational equivalence and randomness. Finally, third, there will be a discussion about deterministic probabilities. The paper will end with a conclusion.

The general theme of this article is the actual practice of how definitions are justified and formulated in mathematics. The theoretical insights of this article are based on a case study of topological definitions of chaos. After introducing this case study, I identify the three kinds of justification which are important for topological definitions of chaos: natural-world-justification, condition-justification and redundancy-justification. To my knowledge, the latter two have not been identified before. I argue that these three kinds of justification are widespread (...) in mathematics. After that, I first discuss the state of the art in the literature about the justification of definitions in the light of actual mathematical practice. I then go on to criticize Lakatos’s account of proof-generated definitions—the main account in the literature on this issue—as being limited and also misguided: as for topological definitions of chaos, in nearly all mathematical fields various kinds of justification are found and are also reasonable. (shrink)

In response to Fred Adams and Charlotte Shreve’s (2016) paper entitled “What Can Synesthesia Teach Us about Higher Order Theories of Consciousness?”, previously published in Symposion, I argue that H.O.T. theory does have the resources to account for synesthesia and the specific worries that they advance in their paper, such as the relationship between concepts and experience and the ability to handle instances of ‘pop-out’ experiences.

The received wisdom in statistical mechanics is that isolated systems, when left to themselves, approach equilibrium. But under what circumstances does an equilibrium state exist and an approach to equilibrium take place? In this paper we address these questions from the vantage point of the long-run fraction of time definition of Boltzmannian equilibrium that we developed in two recent papers. After a short summary of Boltzmannian statistical mechanics and our definition of equilibrium, we state an existence theorem which provides general (...) criteria for the existence of an equilibrium state. We first illustrate how the theorem works with a toy example, which allows us to illustrate the various elements of the theorem in a simple setting. After a look at the ergodic programme, we discuss equilibria in a number of different gas systems: the ideal gas, the dilute gas, the Kac gas, the stadium gas, the mushroom gas and the multi-mushroom gas. In the conclusion we briefly summarise the main points and highlight open questions. (shrink)

Charlotte Witt extracts from this text a coherent and provocative view about sensible substance by focusing on Aristotle's account of form or essence.

ABSTRACT Testimony from victims of gendered violence is often wrongly disbelieved. This paper explores a way to address this problem by developing a phenomenological approach to testimony. Guided by the concept of ‘disclosedness’, a tripartite analysis of testimony as an affective, embodied, communicative act is developed. Affect indicates how scepticism may arise through the social moods that often attune agents to victims’ testimony. The embodiment of meaning suggests testimony should not be approached as an assertion, but as a process of (...) ‘articulating an understanding’. This account is deepened in the discussion of testimony as a communicative act. It is argued that testimony must be considered as a relational whole, and thus our aim in receiving victims’ testimony should be to honour the relational conditions under which the truth of testimony can be heard. Approaching testimony as the collaborative process of enabling an understanding to be articulated can enhance our conception of gendered violence, whilst also better serving the victims of gendered violence by helping to overcome the lack of trust and excessive scepticism with which victims’ testimony is often met. (shrink)

It is a genuine pleasure to engage with the insightful and generous comments of my colleagues. I have learned a lot from them, and I hope to continue our conversations in the future. The range of c...