Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new ‘medical cosmology’ in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the conceptualisation of disease. (...) Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive ‘right’ to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego. (shrink)

After presenting a variety of arguments in support of the idea that ordinary names are indexical, I respond to John Perry's recent arguments against the indexicality of names. I conclude by indicating some connections between the theory of names defended here and Wittgenstein's observations on naming, and suggest that the latter may have been misconstrued in the literature.

The theory of personal identity should illuminate and be illuminated by the theory of personality, of which it is a part. I believe that Locke's theory succeeds in this more than that of any other great philosopher, and the modifications which it may need are not fundamental ones. The problems raised by Butler and Flew can be made to disappear.

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

After presenting a variety of arguments in support of the idea that ordinary names are indexical, I respond to John Perry's recent arguments against the indexicality of names. I conclude by indicating some connections between the theory of names defended here and Wittgenstein's observations on naming, and suggest that the latter may have been misconstrued in the literature.

In Fiction, Truth and Literature, Lamarque and Olsen argue that if a critic claims or attempts to prove that the outlook of a work of literature is true or false, he is not engaging in literary or aesthetic appreciation. This paper argues against this position by adducing cases where literary critics discuss the truth or falsity of a work’s view, when their opinions are obviously relevant to the work’s aesthetic assessment. The paper considers in detail the way factual errors damage (...) a work’s aesthetic standing, and shows that Lamarque and Olsen’s alternative account of the role of propositional truths in literature only looks plausible because it considers a restricted range of examples. Finally, it considers the role intention, date and genre play in discussions of the aesthetic damage done by literal falsehood. (shrink)

The concept of supererogation is an act that it is right to do but not wrong not to do. The moral trinity of the deontic logic excludes such acts from moral theory. A moral theory that is based on duty or obligation unqualified seems inevitably to make all good acts obligations, whether construed from a teleological or deontological point of view. If supererogation is a moral fact, no moral theory can survive without acknowledging it. One way to distinguish supererogation from (...) obligation that is not arbitrary is to draw the line of obligation at death and dismemberment. Such a limit to obligation is often implicit in moral theory. Inclusive obligation requires us all to be heroes all of the time. The moral limit to obligation is one of Hobbes's teachings. Though it is seldom noted in contemporary political and moral theory, it is, for example, implied in Rawls's definition of ‘supererogation.’ In this definition it is said that heroic supererogation would be a duty but for the high cost associated with it. This cost is the risk of life and limb;.it distinguishes supererogation from both benevolence and obligation.A supererogation is a good act with a high cost. The goodness of the act, however determined, must be proportionate to the cost to the agent. If life is risked, life or something deemed no less valuable must be gained. The intention to effect such important goods for others is sufficient for an act to be supererogatory even if it fails.If moral reality is inevitably vague, complex, and incomplete, then it is no surprise that moral theory is that way, too. The challenge is that moral theory be no more vague, complex, and incomplete than necessary and in ways justified by the nature of moral reality. A science, Aristotle advised, can be no more precise than its subject matter permits. (shrink)

An attitude which hopes to derive aesthetic pleasure from an object is often thought to be in tension with an attitude which hopes to derive knowledge from it. The current article argues that this alleged conflict only makes sense when the aesthetic attitude and knowledge are construed unnaturally narrowly, and that when both are correctly understood there is no tension between them. To do this, the article first proposes a broad and satisfying account of the aesthetic attitude, and then considers (...) and rejects twelve reasons for thinking that deriving knowledge from something is incompatible with maintaining an aesthetic attitude towards it. Two main conclusions are drawn. 1) That the representational arts are often in a good position to communicate non-propositional knowledge about human beings. 2) That while our desire to obtain pleasure from a work's manifest properties, and our desire to obtain knowledge from it, are not the same motive, the formal similarities between them are sufficiently impressive to warrant both being seen as elements of the aesthetic attitude. (shrink)

The influence of Goethe on Wittgenstein is just beginning to be appreciated. Hacker and Baker, Westphal, Monk, and Haller have all drawn attention to significant affinities between the two men's work, and the number of explicit citations of Goethe in Wittgenstein's texts supports the idea that we are not dealing simply with a matter of deeplying similarities of aim and method, but of direct and major influence. These scholarly developments are encouraging because they help to place Wittgenstein's work within an (...) important tradition of German letters which goes far beyond his contemporaries and immediate forebears in Vienna; and they show that Wittgenstein's profound interest in literature and music is ceasing to be merely a matter of biographical anecdote, and is being used to illuminate some of the most central areas of his work. (shrink)

Besides its intrinsic interest, the definition of ‘game’ is important for three reasons. Firstly, in Wittgenstein's Philosophical Investigations ‘game’ is the paradigm family resemblance concept. If he is wrong in thinking that ‘game’ cannot be defined, then the persuasive force of his argument against definition generally will be considerably weakened. This, in its turn, will have important consequences for our understanding of concepts and philosophical method. Secondly, Wittgenstein's later writings are full of analogies drawn from games—chess alone is mentioned scores (...) of times—and a proper understanding of ‘game’ can lead us to exercise more caution when considering the parallels between games and non-games. Thirdly, games and play are intriguingly and closely related to art and ritual, and an analysis of games can throw considerable light on both of the latter. (shrink)

Research suggests that institutions affect the levels of corruption in a country. We take these arguments a step further and examine whether it is the presence of inclusive institutions and/or the credible and consistent implementation of institutions that matter, as regards corruption. We use a novel approach to theoretically conceptualise and empirically operationalise institutions along two analytically distinct dimensions: the nature of the institutions (the de jure dimension), and the extent to which they are credibly and consistently implemented over time (...) (the de facto dimension), using a panel dataset for 148 countries covering 2012 to 2018. We find that formal institutions are most effective in reducing corruption when the rules are credibly and consistently implemented. Furthermore, this effect appears to operate differently at different levels of national income. The nature of the formal institutions appears important across income levels, but particularly so at the upper middle income level, while the credible and consistent implementation of these institutions is primarily influential at upper middle income levels. We explain why this may be the case and elaborate on the policy implications. (shrink)

Among bioethicists and members of the public, genetics is often regarded as unique in its ethical challenges. As medical researchers and clinicians increasingly combine genetic information with a range of non-genetic information in the study and clinical management of patients with common diseases, the unique ethical challenges attributed to genetics must be re-examined. A process of genetic routinisation that will have implications for research and clinical ethics, as well as for public conceptions of genetic information, is constituted by the emergence (...) of new forms of genetic medicine, in which genetic information is interpreted in a multifactorial frame of reference. Although the integration of genetics in medical research and treatment may be a helpful corrective to the mistaken assumptions of genetic essentialism or determinism, the routinisation of genetics may have unintended consequences for the protection of genetic information, perceptions of non-genetic information and the loss of genetic research as a laboratory for exploring issues in research and clinical ethics. Consequently, new ethical challenges are presented by the increasing routinisation of genetic information in both biomedical and public spheres. (shrink)

The idea underlying this article was that the humanities in general and business ethics in particular should be more firmly embedded in business management programs. A number of areas have been identified for students to use as topics for research projects in management ethics. These ranged from Biblical and classical times to the present day. Some were drawn from sources that were less well known e.g. the De consolatione philosphiae ‘The Consolation of Philosophy’ by Boethius 524 AD. This was chosen (...) partly for its ethical content, but also because Boethius was magister officiorum i.e. head of the civil service. Aelfred the Great (849–899) King of Wessex (he who burnt those cakes) was chosen because he promoted the intellectual, moral and spiritual qualities that were to serve as guidelines for his executives. Nineteenth century literature (Dickens, Thackeray, Trollope and Galsworthy) was also chosen as a source of topics for research projects in business ethics. The writer acknowledges the work of earlier writers in the fields of management, organisation theory, and business ethics. (shrink)

Realities are structured categorially, and comprehension of our internal and external conditions do not appear to be global or unitary. Rather, both human and non human animals function within their worlds and understand these by categorizing their experiences. Drawing upon many areas of life, the authors consider the ontological, mereological and multi-faceted structure of experience to explore how an understanding of categories can further knowledge.

Goethe and Wittgenstein -- Criticism without theory -- Wittgenstein's romantic inheritance -- Arnold and the socratic personality -- The dissolution of goodness : measure for measure and classical ethics -- Lamarque and Olsen on literature and truth -- The definition of 'art' -- Poetry and abstraction -- Larkin's 'Aubade'.

BackgroundDepressive disorders are a common form of psychiatric illness and cause significant disability. Regulation authorities, the medical profession and the public require high safety standards for antidepressants to protect vulnerable psychiatric patients. Ketamine is a dissociative anaesthetic and a derivative of a hallucinogen. Its abuse is a major worldwide public health problem. Ketamine is a scheduled drug and its usage is restricted due to its abuse liability. Recent clinical trials have reported that ketamine use led to rapid antidepressant effects in (...) patients suffering from treatment-resistant depression. However, various flaws in study designs, and possible biased reporting of results, may have influenced those findings. Further analyses of ketamine use are needed to ensure patient safety.DiscussionThe use of ketamine in research and treatment of depressive disorders is controversial. Recently, mental health professionals raised ethical concerns about an ongoing ketamine trial in the UK. Also, a Canadian agency reviewed the existing evidence and did not recommend prescribing ketamine to treat depressive disorders. Findings obtained from tightly controlled research settings cannot be easily translated to clinical practice as substance abuse is commonly comorbid with depressive disorders. An effective antidepressant should reduce severity of depressive symptoms without liability problems. Although the US FDA has not approved the use of ketamine to treat depressive disorders, some psychiatrists offer off-label repeat prescription of ketamine. Prescribing ketamine for treating depressive disorders requires substantial empirical evidence. Clinicians should also consider research findings on ketamine abuse. Depressive disorders can be chronic conditions and the current evidence does not rule out the risk of substance abuse after repeat prescription of ketamine. Off-label ketamine use in treating depressive disorders may breach ethical and moral standards, especially in countries seriously affected by ketamine abuse. This article presents two real-world clinical vignettes which highlight ethical principles and theories, including autonomy, nonmaleficience, fidelity and consequentialism, as related to off-label ketamine use.ConclusionWe urge clinicians to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine. (shrink)

This article analyses the challenges for the strategies and practices of transformational development in a changing context. This reflection is based on contributions received during the process of dialogues and regional consultations, realised from August 2012 until March 2014, of the ACT Alliance, an international coalition of churches and faith-based organisations (FBOs) working in the areas of humanitarian response, development and advocacy. The main processes that affect the changing development context are addressed, such as the ongoing globalisation as well as (...) the consequences, mainly regarding the shrinking space for civil society. It discusses the concepts of human development and of transformational development, based on a people-centred development vision, a human rights-based approach and advocacy, which addresses the root causes and effects of poverty, inequality and injustice. Transformational development practices, from Latin America, are presented and analysed. The article concludes that the changing development context also offers opportunities, especially regarding regional and global alliances of FBOs, civil society organisations and of social movements. (shrink)

The theory of personal identity should illuminate and be illuminated by the theory of personality, of which it is a part. I believe that Locke's theory succeeds in this more than that of any other great philosopher, and the modifications which it may need are not fundamental ones. The problems raised by Butler and Flew can be made to disappear.