BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

Marie van Loon | : In this paper, I argue that Alfred Mele’s conception of self-deception is such that it always fulfils the reasons-responsiveness condition for doxastic responsibility. This is because self-deceptive mechanisms of belief formation are such that the kind of beliefs they bring about are the kind of beliefs that fulfil the criteria for doxastic responsibility from epistemic reasons responsiveness. I explain why in this paper. Mele describes the relation of the subject to the evidence as a (...) biased relation. The subject does not simply believe on the basis of evidence, but on the basis of manipulated evidence. Mele puts forward four ways in which the subject does this. The subject could misinterpret positively or negatively, selectively focus, or gather evidence. Through these ways of manipulation, the evidence is framed such that the final product constitutes evidence on the basis of which the subject may believe a proposition that fits that subject’s desire that P. Whichever form of manipulation the subject uses, the evidence against P must be neutralized in one way or another. Successful neutralization of the evidence requires the ability to recognize what the evidence supports and the ability to react to it. These abilities consist precisely in the two parts of the reasons-responsiveness condition, reasons receptivity and reasons reactivity. In that sense, self-deceptive beliefs always fulfil the reasons-responsiveness condition for doxastic responsibility. However, given that reasons responsiveness is only a necessary condition for doxastic responsibility, this does not mean that self-deceived subjects are always responsible for their belief. | : Dans cet article, je soutiens que la conception d’auto-illusion chez Alfred Mele remplit toujours l’une des conditions de la responsabilité doxastique, à savoir la « sensibilité aux raisons ». Il en est ainsi car les mécanismes d’auto-illusion dans la formation de croyances produisent des types de croyances qui remplissent les critères pour la responsabilité doxastique quant à la sensibilité aux raisons épistémiques. J’explique pourquoi dans cet article. Mele décrit la relation du sujet à la preuve comme biaisée. Le sujet ne croit pas seulement sur la base de preuves, mais de preuves manipulées. Mele avance quatre façons qu’a le sujet de faire ceci. Le sujet peut mal interpréter positivement ou négativement, focaliser de façon sélective, ou accumuler des preuves. Par ces formes de manipulations, la preuve est formulée de sorte qu’elle produise un fondement pour la croyance en une proposition qui s’accorde avec le désir du sujet que P. Peu importe la forme de manipulation qu’emploie le sujet, la preuve contre P doit être neutralisée d’une façon ou d’une autre. Une neutralisation réussie de la preuve requiert la capacité de reconnaître ce que soutient la preuve et la capacité d’y réagir. Ces capacités consistent précisément en ces deux parties de la condition de la sensibilité aux raisons, soit la réceptivité et la réactivité aux raisons. En ce sens, les croyances d’auto-illusion remplissent toujours la condition de la sensibilité aux raisons pour la responsabilité doxastique. Toutefois, étant donné que la sensibilité aux raisons n’est une condition nécessaire que pour la responsabilité doxastique, cela ne veut pas dire que les sujets souffrant d’auto-illusion sont toujours responsables de leurs croyances. (shrink)

Ulrich Beck's best selling Risk Society established risk on the sociological agenda. It brought together a wide range of issues centering on environmental, health and personal risk, provided a rallying ground for researchers and activists in a variety of social movements and acted as a reference point for state and local policies in risk management. The Risk Society and Beyond charts the progress of Beck's ideas and traces their evolution. It demonstrates why the issues raised by Beck reverberate widely throughout (...) social theory and covers the new risks that Beck did not foresee, associated with the emergence of new technologies, genetic and cybernetic. The book is unique because it offers both an introduction to the main arguments in Risk Society and develops a range of critical discussions of aspects of this and other works of Beck. (shrink)

According to a popular view, excuses undermine blameworthiness. At the same time, philosophers commonly accept that blameworthiness is composed of two necessary conditions: a moral objectionability condition and a responsibility condition. For excuses to do their job, they must undermine at least one of these conditions. In this paper, I conclude that excuses do neither. By inference to the best explanation, I propose a view that reconciles this conclusion with the function of excuses.

Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this (...) article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices. (shrink)

It is widely believed that implicit bias is common and that it contributes, in part, to the perpetuation of systemic injustice. Hence, the existence of implicit bias raises the question: can individuals be blameworthy for their implicit bias? Here, I consider what it is about implicit bias that renders agents blameworthy. I defend the claim that, when individuals omit to engage in activities that could prevent the influence of implicit bias on their behavior, they may be blamed for their implicit (...) bias. The plausibility of my proposal depends on whether individuals are able to engage freely in such activities and on whether there exists an obligation not to be biased (broadly put). I will answer positively to the former question and open the way for an answer to the latter, and tougher, question. (shrink)

This article deals with the birth of `the virus' as an object of technoscientific analysis. The aim is to discuss the process of objectification of pathogen virulence in virological and medical discourses. Through a short excursion into the history of modern virology, it will be argued that far from being a matter of fact, pathogen virulence had to be `produced', for example in petri-dishes, test-kits and hyper-real signification-practices. The now commonly accepted objective status of `the virus' has been an accomplishment (...) of a complex ensemble of actors. Indeed, this illustrates why objectification rather than objectivity has become the main focus of science and technology studies. The objectification of `the' virus was by no means a smooth process. It involved more than five decades of highly speculative and fragmented research projects before it became actualized as a separate discipline under the heading of virology. The specific objectification of viruses took place through an inter-disciplinary de-differentiation of research questions, methodologies, techniques and technologies. The main argument of this article is that viruses only became intelligible after the establishment of a virology-assemblage. Its inauguration in the early 1950s was radical and sudden because only then could the various substrands of virological technoscience affect each other through deliberate enrolment, and engender a universal intelligibility. (shrink)

This article deals with the birth of `the virus' as an object of technoscientific analysis. The aim is to discuss the process of objectification of pathogen virulence in virological and medical discourses. Through a short excursion into the history of modern virology, it will be argued that far from being a matter of fact, pathogen virulence had to be `produced', for example in petri-dishes, test-kits and hyper-real signification-practices. The now commonly accepted objective status of `the virus' has been an accomplishment (...) of a complex ensemble of actors. Indeed, this illustrates why objectification rather than objectivity has become the main focus of science and technology studies. The objectification of `the' virus was by no means a smooth process. It involved more than five decades of highly speculative and fragmented research projects before it became actualized as a separate discipline under the heading of virology. The specific objectification of viruses took place through an inter-disciplinary de-differentiation of research questions, methodologies, techniques and technologies. The main argument of this article is that viruses only became intelligible after the establishment of a virology-assemblage. Its inauguration in the early 1950s was radical and sudden because only then could the various substrands of virological technoscience affect each other through deliberate enrolment, and engender a universal intelligibility. (shrink)

Network is a device for organizing and conceptualizing non-linear complexity. Networks defy narrative, chronology and thus also genealogy because they entail a multiplicity of traces. Networks problematize boundaries and centrality but intensify our ability to think in terms of flows and simultaneity. As a concept, network has been highly conducive to theorizing phenomena and processes such as globalization, digital media, speed, symbiosis and complexity. This in turn enables us to rethink what constitutes the foundations of intelligence, knowledge and even life (...) itself. One particularly useful application of network as a concept is the notion of the gift, which is often seen as the archetypical figure for understanding the nature of economics and social relationships. (shrink)

Recent developments in biotechnology allow for the generation of increasingly complex products out of human tissues, for example, human stem cell lines, synthetic embryo-like structures and organoids. These developments are coupled with growing commercial interests. Although commercialisation can spark the scientific and clinical promises, profit-making out of human tissues is ethically contentious and known to raise public concern. The traditional bioethical frames of gift versus market are inapt to capture the resulting practical and ethical complexities. Therefore, we propose an alternative (...) approach to identify, evaluate and deal with the ethical challenges that are raised by the increasing commercialisation of the exchange of sophisticated human tissue products. We use organoid technology, a cutting-edge stem cell technology that enables the cultivation of ‘mini-organs’ in a dish, as an example. First, we examine the moral value of organoids and recognise them as hybrids that relate to persons and their bodies as well as to technologies and markets in ambiguous ways. Second, we show that commercialisation of organoids is legitimised by a detachment of the instrumental and commercial value of organoids from their associations with persons and their bodies. This detachment is enacted in steps of disentanglement, among which consent and commodification. Third, we contend that far-reaching disentanglement is ethically challenging: (1) Societal interests could be put under pressure, because the rationale for commercialising organoid technology, that is, to stimulate biomedical innovation for the good of society, may not be fulfilled; (2) The interests of donors are made subordinate to those of third parties and the relational moral value of organoids may be insufficiently recognised. Fourth, we propose a ‘consent for governance’ model that contributes to responsible innovation and clinical translation in this exciting field. (shrink)

The presence of general intelligence poses a major evolutionary puzzle, which has led to increased interest in its presence in nonhuman animals. The aim of this review is to critically evaluate this question and to explore the implications for current theories about the evolution of cognition. We first review domain-general and domain-specific accounts of human cognition in order to situate attempts to identify general intelligence in nonhuman animals. Recent studies are consistent with the presence of general intelligence in mammals. However, (...) the interpretation of a psychometricgfactor as general intelligence needs to be validated, in particular in primates, and we propose a range of such tests. We then evaluate the implications of general intelligence in nonhuman animals for current theories about its evolution and find support for the cultural intelligence approach, which stresses the critical importance of social inputs during the ontogenetic construction of survival-relevant skills. The presence of general intelligence in nonhumans implies that modular abilities can arise in two ways, primarily through automatic development with fixed content and secondarily through learning and automatization with more variable content. The currently best-supported model, for humans and nonhuman vertebrates alike, thus construes the mind as a mix of skills based on primary and secondary modules. The relative importance of these two components is expected to vary widely among species, and we formulate tests to quantify their strength. (shrink)

Until recently, psychologists have conceptualised and studied trust in God (TIG) largely in isolation from contemporary work in theology, philosophy, history, and biblical studies that has examined the topic with increasing clarity. In this article, we first review the primary ways that psychologists have conceptualised and measured TIG. Then, we draw on conceptualizations of TIG outside the psychology of religion to provide a conceptual map for how TIG might be related to theorised predictors and outcomes. Finally, we provide a research (...) agenda for future empirical work in this area, as well as practical applications for counsellors and religious leaders. (shrink)

© 2015 Elsevier Inc.Postnatal organogenesis occurs in an immune competent environment and is tightly controlled by interplay between positive and negative regulators. Innate immune cells have beneficial roles in postnatal tissue remodeling, but roles for the adaptive immune system are currently unexplored. Here we show that adaptive immune responses participate in the normal postnatal development of a non-lymphoid epithelial tissue. Since the mammary gland is the only organ developing predominantly after birth, we utilized it as a powerful system to study (...) adaptive immune regulation of organogenesis. We found that antigen-mediated interactions between mammary antigen-presenting cells and interferon-γ -producing CD4+ T helper 1 cells participate in MG postnatal organogenesis as negative regulators, locally orchestrating epithelial rearrangement. IFNγ then affects luminal lineage differentiation. This function of adaptive immune responses, regulating normal development, changes the paradigm for studying players of postnatal organogenesis and provides insights into immune surveillance and cancer transformation. Plaks et al. (shrink)

This study investigates what professional caregivers working in nursing homes consider to be a good life for residents suffering from dementia. Ten caregivers were interviewed; special attention was paid to the way in which they deal with conflicting values. Transcripts of the interviews were analysed qualitatively according to the method of grounded theory. The results were compared with those from a similar, earlier study on ideals found in mission statements of nursing homes. The concepts that were mentioned by most interviewed (...) participants as important for a good life were ‘peace and quiet’, ‘going along with subjective experience’ and ‘no enforcement: the way the resident wants it’. A considerable overlap was found between the interviews and the mission statements; however, when compared with the mission statements, the interviews put less emphasis on individuality and on giving meaning, and more on offering residents pleasant activities. When faced with conflicting values, caregivers tend to make pragmatic and more or less intuitive decisions. Although this has its merits, it may be desirable to stimulate conscious reflection regarding conflict between different values. (shrink)