Deterministic models in population dynamics often are really approximations to stochastic models, justified by an appeal to the law of large numbers. It is proposed to call such models pseudodeterministic. Four questions are discussed in this article: (1) What errors may be made by equating deterministically predicted values to expectations? (2) When, and in what sense, may numbers be assumed to be large? (3) How large are the variances, coefficients of variations, etc., as assigned to the variables in the stochastic (...) versions of the models? (4) What role may pseudodeterministic models play in empirical research, where problems of statistical reliability arise?As an example, a modified Nicholson-Bailey model of the interaction between insect parasitoids and their hosts is discussed; the modification consists of assigning a random (density-independent) mortality to the parasitoid population. A stochastic version of this model is discussed. The expectation of the final host density is compared with the value computed from the deterministic model. The latter value is systematically lower than the former. The magnitude of the difference depends on parameter values. The variability to be expected with the stochastic model is characterized by the coefficient of variation of the final host density; its dependence on parameter values and initial conditions is discussed. It is concluded that it is worthwhile in practical applications to estimate parasitoid mortality, and that the coefficient of variation in real situations may be far from negligible. (shrink)

Psychiatric disorders present distinct clinical challenges which are partly attributable to their multifactorial aetiology and the absence of laboratory tests that can be used to confirm diagnosis or predict risk. Psychiatric disorders are highly heritable, but also polygenic, with genetic risk conferred by interactions between thousands of variants of small effect that can be summarized in a polygenic risk score. We discuss four areas in which the use of polygenic risk scores in psychiatric research and clinical contexts could have ethical (...) implications. First, there is concern that clinical use of polygenic risk scores may exacerbate existing health inequities. Second, research findings regarding polygenic risk could be misinterpreted in stigmatising or discriminatory ways. Third, there are concerns associated with testing minors as well as eugenics concerns elicited by prenatal polygenic risk testing. Fourth, potential challenges that could arise with the feedback and interpretation of high polygenic risk for a psychiatric disorder would require consideration. While there would be extensive overlap with the challenges of feeding back genetic findings in general, the potential clinical use of polygenic risk scoring warrants discussion in its own right, given the recency of this possibility. To this end, we discuss how lay interpretations of risk and genetic information could intersect. Consideration of these factors would be necessary for ensuring effective and constructive communication and interpretation of polygenic risk information which, in turn, could have implications for the uptake of any therapeutic recommendations. Recent advances in polygenic risk scoring have major implications for its clinical potential, however, care should be taken to ensure that communication of polygenic risk does not feed into problematic assumptions regarding mental disorders or support reductive interpretations. (shrink)

Subjects enrolled in studies testing high risk interventions for incurable or progressive brain diseases may be vulnerable to deficiencies in informed consent, such as the therapeutic misconception. However, the definition and measurement of the therapeutic misconception is a subject of continuing debate. Our qualitative pilot study of persons enrolled in a phase I trial of gene transfer for Parkinson disease suggests potential avenues for both measuring and preventing the therapeutic misconception. Building on earlier literature on the topic, we developed and (...) tested an interview guide that focuses on how the subjects decided to participate, emphasizing the integration of subjects’ various statements that are relevant to assessing the therapeutic misconception, rather than evaluating them as isolated statements. The results indicate that a subject’s understanding of the purpose of research is best explored in juxtaposition to the subject’s motivation for participating. (shrink)

Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)

This study examined the ethical issues experienced by nurses working in a small group of elderly persons’ care settings in the UK, using a survey questionnaire previously used in other countries for examining the cultural aspects of ethical issues. However ‘culture’ relates not only to ethnicity but also the organizational culture in which care is delivered. Nurses working in elderly persons’ care settings described a range of issues faced when caring for elderly terminally ill people, which illustrated the different needs (...) of patients, relatives, professionals and society. These issues related to the unique needs of elderly people (such as dementia sufferers) and could have an impact on patients’ quality of death. (shrink)

BackgroundCommunity engagement within biomedical research is broadly defined as a collaborative relationship between a research team and a group of individuals targeted for research. A Community Advisory Board is one mechanism of engaging the community. Within genomics research CABs may be particularly relevant due to the potential implications of research findings drawn from individual participants on the larger communities they represent. Within such research, CABs seek to meet instrumental goals such as protecting research participants and their community from research-related risks, (...) as well as intrinsic goals such as promoting the respect of participants and their community. However, successful community engagement depends on the degree to which CABs legitimately represent and engage with communities targeted for research. Currently, there is little literature describing the use of CABs in genomics research taking place in developing countries, and even less in the field of genomics research relating to mental illness. The aim of this article is to describe and consider the contributions made by a researcher-driven, population-specific CAB in a genomics of schizophrenia research project taking place in South Africa, from the perspective of the research team.DiscussionFour broad discussion topics emerged during the CAB meetings namely: 1) informed consent procedures, 2) recruitment strategies, 3) patient illness beliefs and stigma experiences, and 4) specific ethical concerns relating to the project. The authors consider these discussions in terms of their contributions to instrumental and intrinsic goals of community engagement.SummaryThe CAB gave valuable input on the consent processes and materials, recruitment strategies and suggested ways of minimizing the potential for stigma and discrimination. All of these contributions were of an instrumental nature, and helped improve the way in which the research took place. In addition, and perhaps more importantly, the CAB made a unique and important contribution relating to intrinsic functions such as promoting the respect and dignity of research participants and their community. This was particularly evident in ensuring sensitivity and respect of the community’s traditional beliefs about schizophrenia and its treatment, and in this way promoting a respectful relationship between the research team and the participants. (shrink)

Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by participants during (...) this consent process? 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent. Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape, and older participants, were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness nor education were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit. These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies. (shrink)

Seeking consent for genetic and genomic research can be challenging, particularly in populations with low literacy levels, and in emergency situations. All of these factors were relevant to the MalariaGEN study of genetic factors influencing immune responses to malaria in northern rural Ghana. This study sought to identify issues arising in practice during the enrolment of paediatric cases with severe malaria and matched healthy controls into the MalariaGEN study.

Bioethics has made remarkable progress as a scholarly and applied field. A mere fledgling in the 1960s, it is now firmly established in hospitals, medical schools, and government agencies and boasts a number of professional associations and a handsome collection of journals.

Sellars claims completeness for both the “manifest” and the “scientific images” in a way that tempts one to assume that they are independent of each other, while, in fact, they must share at least one common element: the language of individual and community intentions. I argue that this significantly muddies the waters concerning his claim of ontological primacy for the scientific image, though not in favor of the ontological primacy of the manifest image. The lesson I draw is that we (...) need to re-assess the aims of ontology. (shrink)

Ethical arguments about caregiver responsibility and the limits of client autonomy rely on best evidence about the risks and benefits of medical interventions. But when the evidence is unclear, or when the peer-reviewed literature presents conflicting accounts of the evidence, how are clinicians and their clients to recommend or decide the best course of action? Conflicting evidence about the outcomes of home and hospital birth in the peerreviewed literature offers an opportunity to explore this question. We present the contrary evidence (...) and describe the social and cultural elements that influence the production of the science of birth, including professional, publication, and critical bias. We then consider how the science of birth has been used an misused in making ethical arguments about preferred place of birth. We conclude with a number of recommendations about the responsible use of the evidence, arguing for an “ethics of information” that can be drawn on to guide caregivers and clients in the use of evidence for clinical decision making. (shrink)

Okay, Professor Turner is not Rodney King. He is not responding to bioethicists and social scientists running amuck, setting automobiles aflame, and pelting each other with rocks and broken bottles. He does not come right out and ask, “Why can't we all just get along?” But in its academic way, Turner's essay is an effort to negotiate a truce in the interdisciplinary squabbles that plague bioethics, a plea to move bioethics beyond the “misleading” and “unhelpful” “demarcation of disciplinary goals” that (...) leads to “dichotomous thinking” and “polemical accusations.”. (shrink)

Subjects enrolled in studies testing high risk interventions for incurable or progressive brain diseases may be vulnerable to deficiencies in informed consent, such as the therapeutic misconception. However, the definition and measurement of the therapeutic misconception is a subject of continuing debate. Our qualitative pilot study of persons enrolled in a phase I trial of gene transfer for Parkinson disease suggests potential avenues for both measuring and preventing the therapeutic misconception. Building on earlier literature on the topic, we developed and (...) tested an interview guide that focuses on how the subjects decided to participate, emphasizing the integration of subjects’ various statements that are relevant to assessing the therapeutic misconception, rather than evaluating them as isolated statements. The results indicate that a subject’s understanding of the purpose of research is best explored in juxtaposition to the subject’s motivation for participating. (shrink)

The tendency towards an increasing integration of the informational web into our daily physical world (in particular in so-called Ambient Intelligent technologies which combine ideas derived from the field of Ubiquitous Computing, Intelligent User Interfaces and Ubiquitous Communication) is likely to make the development of successful profiling and personalization algorithms, like the ones currently used by internet companies such as Amazon, even more important than it is today. I argue that the way in which we experience ourselves necessarily goes through (...) a moment of technical mediation. Because of this algorithmic profiling that thrives on continuous reconfiguration of identification should not be understood as a supplementary process which maps a pre-established identity that exists independently from the profiling practice. In order to clarify how the experience of one’s identity can become affected by such machine-profiling a theoretical exploration of identity is made (including Agamben’s understanding of an apparatus, Ricoeur’s distinction between idem- and ipse-identity, and Stiegler’s notion of a conjunctive–disjunctive relationship towards retentional apparatuses). Although it is clear that no specific predictions about the impact of Ambient Intelligent technologies can be made without taking more particulars into account, the theoretical concepts are used to describe three general scenarios about the way wherein the experience of identity might become affected. To conclude, I argue that the experience of one’s identity may affect whether the cases of unwarranted discrimination resulting from ubiquitous differentiations and identifications within an Ambient Intelligent environment, will become a matter of societal concern. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 (...) years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

Background: The banking of biological samples raises a number of ethical issues in relation to the storage,export and re-use of samples. Whilst there is a growing body of literature exploringparticipant perspectives in North America and Europe, hardly any studies have been reportedin Africa. This is problematic in particular in light of the growing amount of research takingplace in Africa, and with the rise of biobanking practices also on the African continent. Inorder to investigate the perspectives of African research participants, we (...) conducted a studywith research participants in a TB study in the Western Cape, South Africa. Methods: Semi-structured interviews were conducted using an interview guide which drew on the mostprominent themes expressed in current literature on sample storage, re-use and exportation.Interviews were conducted in Afrikaans and subsequently translated into English by the sameinterviewer. Interviews were transcribed verbatim and analysed qualitatively. Results: The results of our study indicate that the majority of participants were supportive of givingone-time consent to the storage and re-use of their samples. The concept of research being fora "good cause" was a central prerequisite. Additionally, a significant minority requested thatthey be re-contacted if a future use was not stipulated on the original consent. There was alsoconsiderable variation in how participants understood the concept of a 'good cause', withparticipants describing three distinct categories of research, of which two were generallythought to constitute 'good cause' research. Research that was for-profit was considered tofall outside the spectrum of 'good cause' research. Participants displayed confidence in theabilities of the researchers to make future decisions regarding sample use, but seemedunaware of the role of ethics committees in either this process or more generally. Conclusions: Participants expressed a wide and complex range of views about issues of sample storage andre-use, and they showed a great deal of trust in researchers. Participants' willingness to havetheir samples stored and re-used is consistent with findings from existing studies. However,in contrast to existing literature, participants were generally not in favour of for-profitresearch. Further research needs to be done to explore these ideas in other communities, bothin South Africa and other countries. (shrink)

Since the introduction of the U.S. Sarbanes-Oxley Act in 2002 and several other national corporate governance codes, whistleblowing policies have been implemented in a growing number of companies. Existing research indicates that this type of governance codes has a limited direct effect on ethical or whistleblowing behaviour whereas whistleblowing policies at the corporate level seem to be more effective. Therefore, evidence on the impact of (inter)national corporate governance codes on the content of corporate whistleblowing policies is important to understand their (...) indirect impact on whistleblowing behaviour. This study analyzes the contents of whistleblowing policies, and parts of corporate codes of conduct and codes of ethics, describing such policies of 56 leading European companies. By classifying the contents in seven categories, an exploratory framework was created. General contents often identified were: applicability to all employees, a group-wide scope and an authoritative tone. The most common general violations to report were breaches of internal policies and external regulations or laws. The more specific violations most frequently mentioned were criminal offences and dangers to health and safety or the environment. Contacts to report to were the direct or indirect supervisors, a compliance officer or a confidential "hotline" facility. A confidentiality guarantee was common and anonymous reporting was often possible, though sometimes discouraged. Protection against retaliation is stated by ensuring that retaliation will not happen, prohibiting it or making it punishable. The requirement of good faith was frequently given. Finally, investigation of the report was often guaranteed. Surprisingly little information is given on the treatment of whistleblowers reporting an unfounded complaint in good faith, or reporting a violation they were involved in. The study's findings are most relevant to companies without a whistleblowing policy or those that intend to benchmark their policies, and to pan-European standard setters. (shrink)

Since the introduction of the U.S. Sarbanes-Oxley Act in 2002 and several other national corporate governance codes, whistleblowing policies have been implemented in a growing number of companies. Existing research indicates that this type of governance codes has a limited direct effect on ethical or whistleblowing behaviour whereas whistleblowing policies at the corporate level seem to be more effective. Therefore, evidence on the impact of (inter)national corporate governance codes on the content of corporate whistleblowing policies is important to understand their (...) indirect impact on whistleblowing behaviour. This study analyzes the contents of whistleblowing policies, and parts of corporate codes of conduct and codes of ethics, describing such policies of 56 leading European companies. By classifying the contents in seven categories, an exploratory framework was created. General contents often identified were: applicability to all employees, a group-wide scope and an authoritative tone. The most common general violations to report were breaches of internal policies and external regulations or laws. The more specific violations most frequently mentioned were criminal offences and dangers to health and safety or the environment. Contacts to report to were the direct or indirect supervisors, a compliance officer or a confidential “hotline” facility. A confidentiality guarantee was common and anonymous reporting was often possible, though sometimes discouraged. Protection against retaliation is stated by ensuring that retaliation will not happen, prohibiting it or making it punishable. The requirement of good faith was frequently given. Finally, investigation of the report was often guaranteed. Surprisingly little information is given on the treatment of whistleblowers reporting an unfounded complaint in good faith, or reporting a violation they were involved in. The study’s findings are most relevant to companies without a whistleblowing policy or those that intend to benchmark their policies, and to pan-European standard setters. (shrink)

Sickle cell disease is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been investigated (...) are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis and possible TAP. The majority of the 89 participants were urban dwellers , women , Christian and single , with a secondary/tertiary education . The majority would consider PND for SCD; almost half would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons while those who found TAP acceptable cited fear of having an affected child and the poor quality of the affected child's health . Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life. (shrink)

The cell assembly as a simple attractor cannot explain many cognitive phenomena. It must be a highly structured network that can sustain highly structured excitation patterns. Moreover, a cell assembly must be more widely distributed in space than on a square millimeter.

ABSTRACTIn the present study, we refer to Carr's theory on the nature of educational practice for evaluating teaching as a praxis in relation to two major changes, i.e. ubiquitous learning and massive communication caused by MOOCs. With regard to the first change, we argue that the teacher is faced with the problem of encouraging the learners to get involved in the educational activities. The second change has resulted in a reduction of teacher’s agency and loss of teaching legitimacy and hence (...) its natural feature as a morally committed action. In addition, massive communication has affected the potential encounters between teacher and student considered as the ‘Other’ and has replaced conversation with texting. We highlight the significance of teacher-student conversation as an essential element for developing reflection and self-reflection capacities. Finally, we discuss that the responsibility of teaching is beyond designing and implementing education technically through MOOCs. (shrink)

Recently, the attitude and performance of the physician have been questioned and new codes of medical ethics have been introduced. Any ethics proposed for the future is a scenario reflecting the composer''s selectivity. Envisaged ethics of truthful, non-paternalistic, responsible physician-patient interaction will have far-reaching implications for autopsy, euthanasia, abortion, suicide, genetic engineering, transplantation, clinical trials, status of the psychiatric patient, physician immunity and liability. Conflicts between personal and societal medical ethics may continue to be insoluble. A possible projection of the (...) physician''s ethics on that of the politician is discussed. A new medical ethics should encompass principles of different creeds and be supranational. (shrink)

Chaplains often describe their work in health care as “translation” between the world of the patient and the world of hospital medicine. Translators usually work with texts, interpreters with words. However, when chaplains use this metaphor, it describes something other than a discrete task associated with the meaning of words. While medical professionals focus on patients' medical conditions, chaplains seek to read the whole person, asking questions about what people's lives are like outside of the hospital, what they care about (...) most, and where they find joy and support in the world. Chaplains offer a supportive presence that serves to remind patients and caregivers that people are more than just their medical conditions or their current collection of concerns. Some chaplains are skilled at translating patients' experiences and sources of meaning in real time, allowing medical teams to better understand the person they are treating. “Translation” is also defined as metamorphosis. Chaplains provide this sort of translation when they are alone with patients, listening to their deepest concerns, helping them redefine their lives. (shrink)

In sharp contrast with Heidegger's insistence that the metaphysics of presence, in particular the objectivation of beings in terms of their being “ready at hand” culminating in the techno‐scientific world‐view, be destructed and overcome in light of a more fundamental thinking of “presencing” or “coming into presence” (Anwesen), the philosophy of the infinitely Other introduced (or should we say: rearticulated) by Emmanuel Levinas marks a radical rupture with all ontology. Indeed, it breaks away from every thought of Being, from the (...) notion of the event or eventhood (Ereignis) of Being, but also from the notion of the gift implied in Heidegger's formula that Being “is” what “there is,” that Being “is” what essentially “gives,” or, finally, that Being “is” (what is) fundamentally given (Es gibt das Sein). From the publication of his earliest phenomenological studies in the 1930s and late 1940s onwards, but especially since the appearance, in 1961, of his first major book Totalité et Infini: Essai sur l'extériorité (Totality and Infinity: An Essay on Exteriority), Levinas has left no doubt that the central concern of his philosophical thinking was to leave the parameters – indeed, the very “climate” – of Heideggerian thought behind. This flight, as it were, not merely from ontology but also from Heidegger's later thinking‐of (Andenken) of Being consists, in its first phase, in the reorientation rather than destruction or deconstruction of traditional Western philosophy – a tradition which, according to Levinas, has been by and large a philosophy of the Same (le Même) – in the direction of the Other (l'Autre) or, more precisely, other human beings (autrui). At first glance, therefore, Levinas's first major work is characterized by the attempt to establish ethics as the genuine first philosophy. The ethical relation here is at once the primum intelligibele that puts an end to the essential arbitrariness and the anarchy of the world of opinions and truths, of appearances and idealized constructs. For all its apparent abstraction, it signals itself in the concrete event of obligation, more specifically in the introduction of a responsibility that precedes and exceeds contracts and rules, reciprocity and recognition, norms and conventions. In Totality and Infinity this relation of the self to the other is described in terms of the asymmetrical structure of discourse, of dialogue, and, most importantly, of the face‐to‐face with the other's visage. For, so the argument goes, it is solely in the face‐to‐face that the Desire (désire) for the other arouses, provokes, or evokes. It is in this singular relation without relation alone that the self is accused and made responsible. (shrink)

Coping with stress has been primarily investigated as an individual-level phenomenon. In work settings, however, an individual’s exposure to demands is often shared with co-workers, and the process of dealing with these demands takes place in the interaction with them. Coping, therefore, may be conceptualized as a multilevel construct. This paper introduces the team coping concept and shows that including coping as a higher-level team property may help explain individual-level outcomes. Specifically, we investigated the effects of exposure to danger during (...) deployment on burnout symptoms in military service members and examined to what extent this relationship was moderated by individual-level and team-level functional coping. We hypothesized that the relationship between individuals’ exposure to danger and burnout is contingent on both. In line with our predictions, we found that service members who were highly exposed to danger, and did not engage in much functional coping, suffered most from burnout symptoms, but only when their teammates did not engage in much functional coping either. When their teammates did engage in much functional coping, the effect of exposure to danger on burnout was buffered. Hence, team members’ coping efforts functioned as a resilience resource for these service members. (shrink)

`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

In this issue of The Journal of Clinical Ethics, we offer a variety of perspectives on the moral and medical responsibilities of professionals with regard to a woman’s choice of where she will birth her baby. The articles in this special issue focus on place of birth, but they have larger resonance for clinicians whose decisions about providing the best possible care require them to sort through evidence, consider their own possible biases and the limitations of their training, and balance (...) the wishes of their patients with the demands of colleagues, hospitals, and insurers. The articles published in this special issue of The Journal of Clinical Ethics will help those who wrestle with such dilemmas in everyday clinical decision making. (shrink)

In order to provide an alternative to the Cartesian myth that knowledge of our thoughts and sensations is "given," Sellars posits a community of "Rylean ancestors" - humans at an early stage of conceptual development who possess a language containing sophisticated concepts about the physical world and about their own language and behavior, but who lack any concepts of thoughts or sensations. Sellars's presentation of this thought experiment leaves many important details sketchy. In the following dialogue, we offer our differing (...) assessments of how well those details could be filled out. TT questions how the Rylean hypothesis could provide a plausible account of human thought and sensory experience at any stage of human conceptual development. WdeV responds to TT's challenge by filling out the picture of what the Ryleans' conceptual world would look like. TT and WdeV debate the merits and the plausibility of the resulting picture. (shrink)

The rule of law offers legal certainty, laying down boundaries to the state's playing field. The precautionary approach stipulates that the absence of scientific certainty is no reason not to act to prevent harm. Here, uncertainty frames action. The precautionary approach potentially expands the state's playing field, and this expansion might well undermine the precepts of the rule of law. The certainty-uncertainty axis exposes a tension between the rule of law and the precautionary approach in what Ulrich Beck has termed (...) the world risk society in second modernity. It is this tension that is the focus of analysis in this article. (shrink)

This article seeks to illustrate the relevance of social theory for the study and practice of law. As social theory reports on changes that influence societal structures, the question for lawyers is how these changes affect law and what this means for its role and function. To this end, the article draws on Ulrich Beck's theory of the risk society and reflexive modernization to provide the relevant perspective. This theory reports upon and explains the so-called side effects of modernization that (...) take the shape of environmental, industrial and political risks. It is these side effects that constitute the problem in risk society and dealing with them demands a reflexive approach towards modernization. The article seeks to highlight the relevance of this theory for law by placing it in the tradition of social contacts theory. It does so by reformulating the central problem of the risk society and by identifying the main social actors who would be party to a "new" social contract. The article then identifies and formulates the instruments of negotiation, at which point it becomes clear what the role of law may be. It concludes with a tentative indication of what the main terms of the social contract could look like. (shrink)

This article seeks to illustrate the relevance of social theory for the study and practice of law. As social theory reports on changes that influence societal structures, the question for lawyers is how these changes affect law and what this means for its role and function. To this end, the article draws on Ulrich Beck’s theory of the risk society and reflexive modernization to provide the relevant perspective. This theory reports upon and explains the so-called side effects of modernization that (...) take the shape of environmental, industrial and political risks. It is these side effects that constitute the problem in risk society and dealing with them demands a reflexive approach towards modernization. The article seeks to highlight the relevance of this theory for law by placing it in the tradition of social contacts theory. It does so by reformulating the central problem of the risk society and by identifying the main social actors who would be party to a “new” social contract. The article then identifies and formulates the instruments of negotiation, at which point it becomes clear what the role of law may be. It concludes with a tentative indication of what the main terms of the social contract could look like. (shrink)

Logical frameworks for analysing the dynamics ofinformation processing abound [4, 5, 8, 10, 12, 14, 20, 22]. Some of these frameworks focus on the dynamics of the interpretation process, some on the dynamics of the process of drawing inferences, and some do both of these. Formalisms galore, so it is felt that some conceptual streamlining would pay off. This paper is part of a larger scale enterprise to pursue the obvious parallel between information processing and imperative programming. We demonstrate that (...) logical tools from theoretical computer science are relevant for the logic of information flow. More specifically, we show that the perspective of bare logic [13, 18] can fruitfully be applied to the conceptual simplification of information flow logics. Part one of this program consisted of the analysis of 'dynamic interpretation' in this way, using the example of dynamic predicate logic [10]; the results were published in [7]. The present paper constitutes the second part of the program, the analysis of 'dynamic inference'. Here we focus on Veltman’s update logic [22]. Update logic is an example of a logical framework which takes the dynamics of drawing inferences into account by modelling information growth as discarding of possibilities. This paper shows how information logics like update logic can fruitfully be studied by linking their dynamic principles to static 'correctness descriptions'. Our theme is exemplified by providing a sound and complete HoarelPratt style deduction system for update logic. The Hoare/Pratt correctness statements use modal propositional dynamic logic as assertion language and connect update logic to the modal propositional logic S5. The connection with S5 provides a clear link between the dynamic and the static semantics of update logic. The fact that update logic is decidable was noted already in [2]; the connection with S5 provides an alternative proof. The S5 connection can also be used for rephrasing the validity notions of update logic and for performing consistency checks. In conclusion, it is argued that interpreting the dynamic statements of information logics as dynamic modal operators has much wider applicability. In fact, the method can be used to axiomatize quite a wide range of information logics. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This (...) theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the pediatric (...) oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (shrink)

Love, sex, and physical intimacy are some of the most desired goods in life and they are increasingly being sought on dating apps such as Tinder, Bumble, and Badoo. For those who want a leg up in the chase for other people’s attention, almost all of these apps now offer the option of paying a fee to boost one’s visibility for a certain amount of time, which may range from 30 min to a few hours. In this article, I argue (...) that there are strong moral grounds and, in countries with laws against unconscionable contracts, legal ones for thinking that the sale of such visibility boosts should be regulated, if not banned altogether. To do so, I raise two objections against their unfettered sale, namely that it exploits the impaired autonomy of certain users and that it creates socio-economic injustices. (shrink)

The tendency towards an increasing integration of the informational web into our daily physical world (in particular in so-called Ambient Intelligent technologies which combine ideas derived from the field of Ubiquitous Computing, Intelligent User Interfaces and Ubiquitous Communication) is likely to make the development of successful profiling and personalization algorithms, like the ones currently used by internet companies such as Amazon , even more important than it is today. I argue that the way in which we experience ourselves necessarily goes (...) through a moment of technical mediation. Because of this algorithmic profiling that thrives on continuous reconfiguration of identification should not be understood as a supplementary process which maps a pre-established identity that exists independently from the profiling practice. In order to clarify how the experience of one’s identity can become affected by such machine-profiling a theoretical exploration of identity is made (including Agamben’s understanding of an apparatus , Ricoeur’s distinction between idem - and ipse -identity, and Stiegler’s notion of a conjunctive–disjunctive relationship towards retentional apparatuses ). Although it is clear that no specific predictions about the impact of Ambient Intelligent technologies can be made without taking more particulars into account, the theoretical concepts are used to describe three general scenarios about the way wherein the experience of identity might become affected. To conclude, I argue that the experience of one’s identity may affect whether the cases of unwarranted discrimination resulting from ubiquitous differentiations and identifications within an Ambient Intelligent environment, will become a matter of societal concern. (shrink)

What, at this historical moment "after Auschwitz," still remains of the questions traditionally asked by theology? What now is theology's minimal degree? This magisterial study, the first extended comparison of the writings of Theodor W. Adorno and Emmanuel Levinas, explores remnants and echoes of religious forms in these thinkers' critiques of secular reason, finding in the work of both a "theology in pianissimo" constituted by the trace of a transcendent other. The author analyzes, systematizes, and formalizes this idea of an (...) other of reason. In addition, he frames these thinkers' innovative projects within the arguments of such intellectual heirs as Jürgen Habermas and Jacques Derrida, defending their work against later accusations of "performative contradiction" (by Habermas) or "empiricism" (by Derrida) and in the process casting important new light on those later writers as well. Attentive to rhetorical and rational features of Adorno's and Levinas's texts, his investigations of the concepts of history, subjectivity, and language in their writings provide a radical interpretation of their paradoxical modes of thought and reveal remarkable and hitherto unsuspected parallels between their philosophical methods, parallels that amount to a plausible way of overcoming certain impasses in contemporary philosophical thinking. In Adorno, this takes the form of a dialectical critique of dialectics in Levinas, that of a phenomenological critique of phenomenology, each of which sheds new light on ancient and modern questions of metaphysics, ethics, and aesthetics. For the English-language publication, the author has extensively revised and updated the prize-winning German version. (shrink)

Bruno Latour is among the most important figures in contemporary philosophy and social science. His ethnographic studies have revolutionized our understanding of areas as diverse as science, law, politics and religion. To facilitate a more realistic understanding of the world, Latour has introduced a radically fresh philosophical terminology and a new approach to social science, ‘Actor-Network Theory’. In seminal works such as Laboratory Life, We Have Never Been Modern and An Inquiry into Modes of Existence, Latour has outlined an alternative (...) to the foundational categories of ‘modern’ western thought Ð particularly its distinction between society and nature Ð that has major consequences for our understanding of the ecological crisis and of the role of science in democratic societies. Latour’s ‘empirical philosophy’ has evolved considerably over the past four decades. In this lucid and compelling book, Gerard de Vries provides one of the first overviews of Latour’s work. He guides readers through Latour’s main publications, from his early ethnographies to his more recent philosophical works, showing with considerable skill how Latour’s ideas have developed. This book will be of great value to students and scholars attempting to come to terms with the immense challenge posed by Latour’s thought. It will be of interest to those studying philosophy, anthropology, sociology, science and technology studies, and almost all other branches of the social sciences and humanities. (shrink)

It is commonly assumed that many, if not most, adult children have moral duties to visit their parents when they can do so at reasonable cost. However, whether such duties persist when the parents lose the ability to recognise their children, usually due to dementia, is more controversial. Over 40% of respondents in a public survey from the British Alzheimer’s Society said that it was “pointless” to keep up contact at this stage. Insofar as one cannot be morally required to (...) do pointless things, this would suggest that children are relieved of any duties to visit their parents. In what appears to be the only scholarly treatment of this issue, Claudia Mills has defended this view, arguing that our duties to visit our parents require a type of relationship that is lost when parents no longer remember who their children are. This article challenges Mills’ argument. Not only can children be duty-bound to visit parents who have lost the ability to recognise them, I argue that many children do in fact have such duties. As I show, these duties are grounded in any special interests that their parents have in their company; the fact that visiting their parents might allow them to comply with generic duties of sociability; and/or the fact that such visits allow them to express any gratitude that they owe their parents. (shrink)

For decades, the discussion on children’s competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children’s interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children’s competence to consent, however, is currently not assessed in a standardized way. (...) Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children’s competence. (shrink)

This book uses the phenomenological interpretive approach of Paul Ricoeur to shed new light on New Testament eschatological expectation. Peter C. de Vries argues for a metaphorical reading of the apocalyptic discourse of Mark 13, based upon neither the author’s intention nor the reader’s reception but latent meaning present in the text itself.

New Zealand’s curriculum, in terms of its approach to technological literacy, attempts to deliver a sound, philosophy-­based understanding of the nature of technology. The curriculum’s main authors claim that it conforms well to Mitcham’s (2014) categorization of different aspects of technology’s nature. Nevertheless, taking advantage of the existing literature of the philosophy of technology, this paper will reveal that the intended urriculum, though an admirable approach, still has a number of points needing improvement, and there are also certain gaps to (...) be bridged in the claimed conformity. This analysis primarily makes use of the method initiated by Nia and De Vries (2016a), based upon Mitcham’s suggested framework and other philosophers’ opinions as to the nature and various features of technology. (shrink)