This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but (...) together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

The identification of Smad proteins as molecular components of the transforming growth factor-β (TGF-β) signaling cascade has enhanced our understanding of how ligand-mediated activation of TGF-β receptors leads to modulation of target gene transcription. Recent studies have identified a distinct, structurally related class of Smads which inhibits, rather than transduces, TGF-β family signals. The molecular mechanism of action and the exact signaling pathways that are targeted by antagonistic Smads are not completely understood. These proteins appear to participate in autoregulatory negative (...) feedback loops in which signaling initiated by specific TGF-β family ligands induces the expression of an inhibitory Smad that then functions to modulate the amplitude or duration of signaling. Negative feedback circuits such as these play important roles in fine-tuning the activity of multifunctional signaling molecules during embryonic patterning and in response to pathologic stimuli in adults. BioEssays 21:382–390, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

Medical, scientific and societal progress has been such that, in a universalist humanist perspective such as the WHO’s, it has become an ethical imperative for the primary endpoints in evidence based health care research to be expressed in e.g. Quality Adjusted Life Years (QALYs). The classical endpoints of discrete health‐related functions and duration of survival are increasingly perceived as unacceptably reductionistic. The major problem in ‘felicitometrics’ is the measurement of the ‘quality’ term in QALYs. That the mental, physical and social (...) domains, each containing many dimensions and items, all contribute to QOL is uncontroversial. What is controversial, is the weight of the different dimensions in overall QOL. It has been shown to be very different between different patient populations. In human individuals, assuredly complex systems, the many dimensions and items of QOL observably interact, probably sometimes also in chaotic ways. In these conditions, the weights of isolated items in individuals become for all practical purposes meaningless. Therefore, the much used multi‐item questionnaires at best describe, but do not evaluate QOL, neither in individuals, nor in populations. For example, allergic patients treated with cetirizine scored better than those a placebo on all dimensions of the SF‐36, a standard QOL questionnaire. Here there is no serious doubt that the treatment improved QOL, because it is highly unlikely that any important dimension on which the patient groups would have scored otherwise is missing in the SF‐36. However, whether piracetam treatment of acute stroke, which improved the surrogate endpoints neurological and functional scores, also improved QOL is plausible, but will be proven only when comprehensive QOL measurement will have been done. And suppose in randomised populations of end‐stage metastatic solid cancer patients, one would compare palliative last‐line chemotherapy with only palliative care, and one would, as can be expected, find no significant differences in average survival, and chemotherapy superior for the mental domain, but inferior for the physical comfort domain: we would not know which treatment, on aggregate, would be the better. The problem is that QOL is an individual and emergent construct, the resultant of a great many intractions, and of a different order than its contributing components. Overall QOL can therefore best be captured only as the Gestalt of a global self‐assessment. Just as people in everyday life, while acting under uncertainty, make global assessments all the time, so they can seriously answer the serious question: ‘How have you been?’ A solemn, practical, non peer‐relativistic, non‐cultural, experiential, and well tolerated way to obtain such responses is Anamnestic Comparative Self Assessment (ACSA), in which the subjects' memories of the best and the worst times in their life experience define their individual scale of QOL. ACSA is thus both exquisitely idiosyncratic, and yet can in a universalist humanistic perspective be considered generic. Using both a multi‐item questionnaire and a global assessment allows by one logistic regression, to estimate the weights of the dimensions and items in populations, and thus identify those whose improvement would most contribute to the QOL of the greatest number. A combined approach to measurement of QOL is necessary to maximise the utility of QOL interventions. (shrink)

Lethal and nonlethal suicidal behaviors are major global public health problems. Much suicidal behavior occurs after the suicide victim committed a murder or other serious transgression. The present study tested a novel evolutionary model termed the Costly Apology Model against the ethnographic record. The bargaining model sees nonlethal suicidal behavior as an evolved costly signal of need in the wake of adversity. Relying on this same theoretical framework, the CAM posits that nonlethal suicidal behavior can sometimes serve as an honest (...) signal of apology in the wake of committing a severe transgression, thereby repairing valuable social relationships. To test this hypothesis, the CAM was operationalized into a set of variables, and two independent coders coded 473 text records on suicidal behavior from 53 cultures from the probability sample of the Human Relations Area Files. The results indicated that in ethnographic accounts of suicidal behavior, transgressions, punishment, and shame were relatively common, supporting the CAM, but explicit motives to apologize and evidence of forgiveness were rare, contrary to the CAM. The theoretical variables of the CAM nevertheless formed a cluster distinct from the BRM, and a subset of cases of suicidal behavior were largely related to transgressions and other CAM variables rather than BRM or other variables. Support for the CAM varied widely across cultures, but there was evidence for it in every major geographical region. Exploratory analyses suggested that the CAM is potentially more likely to occur in response to severe conflicts concerning transgressions committed against nonkin. Furthermore, in text records that involved transgressions, male suicidal behavior was most frequently associated with murder, whereas female suicidal behavior was most frequently associated with sexual transgressions. In conclusion, the results provided mixed support for the hypothesis that some instances of suicidal behavior function to send a costly signal of apology to those harmed by a transgression. (shrink)

Recently, heated discussions about artificial intelligence, creativity, and work have re-emerged. Despite the dominant focus on the novelty of this entanglement, it is rich with history. In this paper, I will first introduce creativity as a historical and socio-culturally embedded concept, looking at how and why we have invented creativity in the guises we have. The focus will mostly be on the political and ideological backdrop of these historical processes–for instance how creativity was repeatedly cast as the positive counterimage of (...) (industrial and bureaucratic) alienated labour, and hence stood in a complex relationship to automation, robotization, and so on. Based on this I will then discuss a series of scenarios that are related to the (perhaps) forthcoming automation of creativity, more specifically four ways in which automation might in different ways impact (the fields of) creative practices and labour. (shrink)

This study tested four theoretical models of leadership with data from the ethnographic record. The first was a game-theoretical model of leadership in collective actions, in which followers prefer and reward a leader who monitors and sanctions free-riders as group size increases. The second was the dominance model, in which dominant leaders threaten followers with physical or social harm. The third, the prestige model, suggests leaders with valued skills and expertise are chosen by followers who strive to emulate them. The (...) fourth proposes that in small-scale, kin-based societies, men with high neural capital are best able to achieve and maintain positions of social influence (e.g., as headmen) and thereby often become polygynous and have more offspring than other men, which positively selects for greater neural capital. Using multiple search strategies we identified more than 1000 texts relevant to leadership in the Probability Sample of 60 cultures from the Human Relations Area Files (HRAF). We operationalized the model with variables and then coded all retrieved text records on the presence or absence of evidence for each of these 24 variables. We found mixed support for the collective action model, broad support for components of the prestige leadership style and the importance of neural capital and polygyny among leaders, but more limited support for the dominance leadership style. We found little evidence, however, of emulation of, or prestige-biased learning toward, leaders. We found that improving collective actions, having expertise, providing counsel, and being respected, having high neural capital, and being polygynous are common properties of leaders, which warrants a synthesis of the collective action, prestige, and neural capital and reproductive skew models. We sketch one such synthesis involving high-quality decision-making and other computational services. (shrink)

During the 1980s many communities turned to grassroots activities to promote economic development, rather than relying on industrial recruitment strategies. We evaluate the characteristics of these projects, their benefits and costs, and obstacles they face in the development process. The data are drawn from a survey of more than one hundred communities in the United States. Self-development efforts do not appear to replace traditional rural economic development activities, but may complement them. Self-development activities produce a wide variety of jobs that (...) are taken primarily by local residents. The cost and availability of credit are major obstacles for self-development projects. Although self-development strategies should not be considered the primary economic development strategy for most rural communities, they do enable communities to build a more viable local economy. (shrink)

The use of quality of life (QOL) outcomes in clinical trials is increasing as a number of practical, ethical, methodological, and regulatory reasons for their use have become apparent. It is important, then, that QOL measurements and differences between QOL scores be readily interpretable. We study interpretation in two contexts: when determining QOL and when basing decisions on QOL differences. We consider both clinical situations involving individual patients and research contexts, e.g., randomized clinical trials, involving groups of patients. We note (...) the ethical importance of such understanding: proper interpretation and communication facilitate health care decision making. Communication that facilitates interpretation is of moral significance since better communication can attenuate ethical problems and inform choices. Much of what is communication worthy about QOL assessments is determined by the particular QOL instrument used in the assessment and how it is administered. In practice, these choices will be driven by the purpose of the assessment, but, it is argued, to maximize understanding, we should combine the information garnered from traditional standardized QOL instruments, from individualized QOL assessments, and from a recently proposed dialogic paradigm, where QOL is determined by shared conversation regarding the interpretation of texts. And, while some studies can surely succeed using abbreviated methods of administration (e.g., postal surveys may suffice for certain purposes), we will focus on methods of administration involving interviewer–respondent interaction. We suggest that during the QOL elicitation process, interviewer and respondent should engage in a two-way conversation in order to achieve a shared understanding of the “answers” to QOL “questions” and, finally, to reach a shared interpretation of the individual’s QOL. (shrink)

Data Safety and Monitoring Boards have been referred to as a “growth industry,” and this trend continues to be fueled by recent FDA guidance and the NIH's requirement that DSMBs be employed in virtually all phase III clinical trials. The widening role of DSMBs has been sporadically questioned on ethical grounds, but growth has continued, despite the fact that many of the questions endure, unanswered, save for repeated references to safeguarding the scientific integrity of trials. This may be about to (...) change. The recently appointed director of the Office for Human Research Protections , Jerry Menikoff, is on record as regarding current practices — where consent forms often promise what the DSMB has been assembled to specifically not provide — as constituting fraudulent behavior. That is, a subject may inherently rely on, to their detriment, information that has been misrepresented in the consent document. In this paper, we assemble some of the enduring questions and top them off with Menikoff's tour de force to present what we hope will be a compelling argument to require that consent forms fairly represent what the DSMB will do — and not do — with trial data as they accumulate. We argue that DSMBs should be used only in rare circumstances, and question the practice of precluding principal investigators from DSMB membership, but our main thrust is to ensure that DSMBs, when used at all, are properly described in trial consent forms. (shrink)

Data Safety and Monitoring Boards were introduced in the 1960s to monitor data in clinical trials to ensure subject safety. It was thought important that DSMB members be experts in the field of interest, but not otherwise involved in the study in order to maximize objectivity. Since then, the use of DSMBs has increased dramatically, and their scope has expanded to include scientific issues — in particular, to avoid bias that can result when trials are stopped early because of evidence (...) that one treatment has greater efficacy or causes greater harm than another; or that no treatment is likely to do better than any other. (shrink)

Das Buch eröffnet ein neues Forschungsfeld praxeologischer Demokratieforschung. Statt von bestimmten theoretischen Konzeptionen auszugehen, was Demokratie ist oder sein soll, wird untersucht, wie Demokratie praktisch gemacht wird. Wie wird der,,demos" zum Subjekt des Regierens gemacht, als politischer Akteur mit kollektivem Willen und Handlungsmacht? Das Buch verfolgt den Ansatz, nach konkreten praktischen Formen zu suchen, in denen Repräsentationen des Willens von kollektiven Subjekten hergestellt und geltend gemacht werden. Dabei entfaltet sich ein Blick auf die Multiplizität und Dynamik der Demokratie. Die Herausgebenden (...) Dr. Jan-Peter Voß ist Gastprofessor für Technik und Gesellschaft an der RWTH Aachen. Dr. Hagen Schölzel ist Universitätsassistent am Institut für Politikwissenschaft der Universität Wien. (shrink)

ArgumentThis article contributes to a global history of relativity, by exploring how Einstein’s theory was appropriated in Belgium. This may sound like a contradiction in terms, yet the early-twentieth-century Belgian context, because of its cultural diversity and reflectiveness of global conditions (the principal example being the First World War), proves well-suited to expose transnational flows and patterns in the global history of relativity. The attempts of Belgian physicist Théophile de Donder to contribute to relativity physics during the 1910s and 1920s (...) illustrate the role of the war in shaping the transnational networks through which relativity circulated. The local attitudes of conservative Belgian Catholic scientists and philosophers, who denied that relativity was philosophically significant, exemplify a global pattern: while critics of relativity feared to become marginalized by the scientific, political, and cultural revolutions that Einstein and his theory were taken to represent, supporters sympathized with these revolutions. (shrink)

This article presents results from a multidisciplinary research project on the integration and transfer of language knowledge into robots as an empirical paradigm for the study of language development in both humans and humanoid robots. Within the framework of human linguistic and cognitive development, we focus on how three central types of learning interact and co-develop: individual learning about one's own embodiment and the environment, social learning (learning from others), and learning of linguistic capability. Our primary concern is how these (...) capabilities can scaffold each other's development in a continuous feedback cycle as their interactions yield increasingly sophisticated competencies in the agent's capacity to interact with others and manipulate its world. Experimental results are summarized in relation to milestones in human linguistic and cognitive development and show that the mutual scaffolding of social learning, individual learning, and linguistic capabilities creates the context, conditions, and requisites for learning in each domain. Challenges and insights identified as a result of this research program are discussed with regard to possible and actual contributions to cognitive science and language ontogeny. In conclusion, directions for future work are suggested that continue to develop this approach toward an integrated framework for understanding these mutually scaffolding processes as a basis for language development in humans and robots. (shrink)

This study aims to reveal patterns of e-petition co-signing behavior that are indicative of the political mobilization of online “communities”. We discuss the case of We the People, a US national experiment in the use of social media technology to enable users to propose and solicit support for policy suggestions to the White House. We apply Baumgartner and Jones's work on agenda setting and punctuated equilibrium, which suggests that policy issues may lie dormant for periods of time until some event (...) triggers attention from the media, interest groups, and elected representatives. In the case study presented, we focus on 21 petitions initiated during the week after the Sandy Hook shooting in opposition to gun control or in support of policy proposals that are alternatives to gun control, which we view as mobilized efforts to maintain stability and equilibrium in a policy system threatening to change. Using market basket analysis and social network analysis we found a core group of petitions in the “support law-abiding gun owners” theme that were highly connected and four “communities” of e-petitioners mobilizing in opposition to change in gun control policies and in favor of alternative proposals. (shrink)

Human communication is often thought about in terms of transmitted messages in a conventional code like a language. But communication requires a specialized interactive intelligence. Senders have to be able to perform recipient design, while receivers need to be able to do intention recognition, knowing that recipient design has taken place. To study this interactive intelligence in the lab, we developed a new task that taps directly into the underlying abilities to communicate in the absence of a conventional code. We (...) show that subjects are remarkably successful communicators under these conditions, especially when senders get feedback from receivers. Signaling is accomplished by the manner in which an instrumental action is performed, such that instrumentally dysfunctional components of an action are used to convey communicative intentions. The findings have important implications for the nature of the human communicative infrastructure, and the task opens up a line of experimentation on human communication. (shrink)