With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives rise to (...) a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this—currently relatively unknown and unresolved—dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments. (shrink)

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

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

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

The ethical judgment of Chinese business leaders has become increasingly important particularly due to the important role that China plays in the global economy. Previous studies tend to categorize Chinese managers as more relativist and thus more lenient in their ethical judgments. In this study we survey 256 senior managers from mainland China and find that they are in fact less relativist and more idealist than the global average. A significant portion of them are absolutists which imply that these managers (...) believe that positive consequences should result from ethical decisions based on universal moral rules. Our findings question the implications made by previous researchers that among Chinese managers there is a less than clear demarcation between right and wrong. We conclude that business leaders in China would be more supportive of codes of conduct and other ethical behaviour because of the ethical position they hold. (shrink)

Theorists, historians, and artists address the precarious futurity of the notion of the future. Not long ago, a melancholic left and a manic neoliberalism seemed to arrive at an awkward consensus: the foreclosure of futurity. Whereas the former mourned the failure of its utopian project, the latter celebrated the triumph of a global marketplace. The radical hope of realizing a singularly different, more equitable future displaced by a belief that the future had already come to pass, limiting post-historical society to (...) an uneventful life of endless accumulation. Today, amidst an abundance of neofuturisms, posthumanisms, futurologies, speculative philosophies and accelerationist scenarios, there is as well an expanding awareness of a looming planetary catastrophe driven by the extractionist logic of capitalism. Despite this return to the future, the temporal horizon of our present moment is perhaps more aptly characterized by the “shrinking future” of just-in-time production, risk management, high-frequency trading, and the futures market. In Futurity Report, theorists, historians, and artists address the precarious futurity of the notion of the future itself. Contributors McKenzie Wark, China Miéville, Kerstin Stakemeier, Diedrich Diederichsen, Natascha Sadr Haghighian, Marina Vishmidt, Johannes Paul Raether, Felicity D. Scott, Silvia Maglioni, Graeme Thomson, Doreen Mende, Pedro Neves Marques, Achille Mbembe, Kodwo Eshun, Haytham El-Wardany, T. J. Demos, Ana Teixeira Pinto. (shrink)

Papineau has suggested that the Principle of Non-Contradiction is a logical law that ?verificationists? are not entitled to claim as a prioritrue. The Principle, like that of Excluded Middle, is not sufficiently grounded in the ?miserly? epistemology of verificationism to be proven in ?verificationist logic?. We examine who might be challenged by this claim: who are the ?verificationists?? We defend our candidates against Papineau's criticisms and other attacks, but this leaves the verificationist open to a different criticism.

It has always concentrated upon man, and usually the comparative approach has not been used to study the evolution of behaviour, but in the hope that ...

We distinguish three different readings of the intuitionistic notions of validity, soundness, and completeness with respect to the quantification occurring in the notion of validity, and we establish certain relations between the different readings. For each of the meta-logical notions considered we suggest that the “most natural” reading (which is not the same for all cases) is precisely the one which is required by the recent intuitionistic completeness theorems for IPC.

The paper discusses to what extent the conceptual issues involved in solving the simple harmonic oscillator model fit Wigner’s famous point that the applicability of mathematics borders on the miraculous. We argue that although there is ultimately nothing mysterious here, as is to be expected, a careful demonstration that this is so involves unexpected difficulties. Consequently, through the lens of this simple case we derive some insight into what is responsible for the appearance of mystery in more sophisticated examples of (...) the Wigner problem. (shrink)