Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If (...) medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role?Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our (...) analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

European Journal of Philosophy, Volume 30, Issue 1, Page 148-168, March 2022.

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract for health (...) research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

Previous studies show that medical students in clinical training face ethical problems that are not often discussed in the literature. In order to make teaching timely and relevant for them, it is important to understand what medical students perceive as ethical problems, as various factors may influence their perception, including cultural differences and working environment. The purpose of this qualitative study was to explore students’ perceptions of what an ethical problem is, during their clinical training in the hospital, and compare (...) the results from two different countries. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools, in Indonesia and the Netherlands. Data were interpreted and analyzed using content analysis. We found that students in both settings encounter problems which are closer to their daily work and responsibilities as medical students and perceive these problems as ethical problems. Indonesian students perceived substandard care and inequity in healthcare as ethical problems, while Dutch students perceived that cases which are not matters of life and death are less worthy to discuss. Our study suggests that there might be a gap between ethical problems that are discussed in class with teachers, and problems that students actually encounter in practice. Teachers should be aware of the everyday situations in clinical training which may be perceived by students as ethically problematic and should acknowledge and discuss these ethical problems with students as part of the learning processes in ethics education. (shrink)

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their (...) healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. (shrink)

BackgroundConsent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and (...) health-related data for observational research.MethodsWe conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues.ResultsSudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients’ data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives.ConclusionsSudden cardiac arrest patients’ donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants’ data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

This book focuses on the idea of a modus vivendi as a way of governing political life and addressing problems characterized by pluralism or deep-rooted diversity. The individual essays illustrate both the merits and the limitations of a political theory of modus vivendi; how it might be interpreted and developed; specific challenges entailed by articulating it in a convincing form; what its institutional implications might be; and how it relates to other seminal issues and concepts in political theory; such as (...) legitimacy, toleration, the social contract, etc. The book makes a significant contribution to the discussion on the scope and limits of liberal political theory, and on how to deal politically with deep-rooted diversity. (shrink)

In the _Nichomachean Ethics_, Aristotle defines three kinds of friendship: utility, pleasure, and virtue. The characters in the films of Sean Baker fit into none of these categories. Friendship is central to all of Baker’s films, but it takes the non-Aristotelian form of “friends, no matter what,” which I interpret as a description of the aporia of friendship, of an impossible friend, or a friend in the realm of fantasy. In other words, friends are only friends when they resist everything (...) friends are supposed to do. Betrayal, lies, and complications sit at the heart of this new definition. One mechanism for this kind of friendship is _mourning_. Friends are only friends when friendship is mourned, or when it is part of a crypt, or a vault for losses that are too traumatic to confront fully, as set out in the work of Sigmund Freud, Jacques Derrida, Nicolas Abraham and Mária Török, and developed by Laurence Rickels. This reading of mourning puts a particular spin on fantasy, for if fantasy is generally assumed to be about wish-fulfillment, then when fantasy reaches into the crypt for inspiration, it is retooled into a vehicle for confronting what is too hard to face. This is the function of friendship in Baker’s films: his friends are Judas figures going against their friends in order to keep their friendship alive. In _Tangerine_ (2015), two transgender sex workers in West Hollywood develop their friendship around a fight over a man. In _Starlet_ (2012), a young woman hides a secret from her elderly female friend, and this friendship is only saved when another actress betrays this secret. In these films, friendship is paradoxically formed by attempting to ruin friendship. Thought on fantasy and mourning will help in defining this type of non-Aristotelian friendship, as well as Freud’s work on the “ambivalence of feeling” from his writing on the First World War. (shrink)

Alan Turing is often portrayed as a materialist in secondary literature. In the present article, I suggest that Turing was instead an idealist, inspired by Cambridge scholars, Arthur Eddington, Ernest Hobson, James Jeans and John McTaggart. I outline Turing’s developing thoughts and his legacy in the USA to date. Specifically, I contrast Turing’s two notions of computability (both from 1936) and distinguish between Turing’s “machine intelligence” in the UK and the more well-known “artificial intelligence” in the USA. According to my (...) proposed historical interpretation, Turing did not view computations in the real world to be exhaustively and deterministically characterized by his automatic machines from 1936. (shrink)

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on (...) measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy. (shrink)

The volume is published on the occasion of the birth centennial of Eugenio Coseriu (1921–2002). It is the first collective volume to appear in English in which various scholars present a variety of perspectives on Coseriu’s scholarly work and discuss its continuing relevance for the language sciences. Coseriu’s international reputation has suffered from his commitment to publish in languages such as Spanish, German, French, Italian, Romanian and Portuguese, to the detriment of English. As a consequence, his work is less well-known (...) outside Romance and German linguistics. The volume aims to raise the general awareness of Coseriu’s work among linguists around the world, in accordance with Coseriu’s own adage that it takes a constructive mindset (acknowledging "accomplishments and limitations") to do justice to all scholarly work in the humanities. The articles are organized into three major thematic clusters: 1) philosophy of language, 2) history of the language sciences and 3) theory and practice of "Integral Linguistics". The volume is essential reading for anyone working in these fields and for those seeking to gain deeper understanding of Coseriu’s goal to develop a unitary approach to language which takes as its point of departure the "activity of speaking". (shrink)

Despite the power of VR in immersing viewers in an experience, it generally only targets viewers via visual and auditory cues. Human beings use more senses to gather information, so expectedly, the full potential of this medium is currently not yet tapped. This study contributes in answering two research questions: How can conventional VR ads be enriched by also addressing the forgotten sense of smell?; and Does doing so indeed instill more engaging experiences? A 2 × 3 between-subjects study is (...) conducted, whereby an existing branded VR commercial is augmented with “sound” and “scents.” The power of these sensory augmentations is evaluated by inspecting emotional, cognitive and conative dimensions of customer engagement. The results identify product-scent congruence as a deal-maker, albeit product-scent incongruence is not necessarily a deal-breaker. The article concludes with further research avenues and a translation into managerial implications. (shrink)

Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

Imaginary worlds are extremely successful. The most popular fictions produced in the last few decades contain such a fictional world. They can be found in all fictional media, from novels (e.g., Lord of The Rings and Harry Potter) to films (e.g., Star Wars and Avatar), video games (e.g., The Legend of Zelda and Final Fantasy), graphic novels (e.g., One Piece and Naruto), and TV series (e.g., Star Trek and Game of Thrones), and they date as far back as ancient literature (...) (e.g., the Cyclops Islands in The Odyssey, 850 BCE). Why such a success? Why so much attention devoted to non-existent worlds? In this paper, we propose that imaginary worlds co-opt our preferences for exploration, which have evolved in humans and nonhuman animals alike, to propel individuals toward new environments and new sources of reward. Humans would find imaginary worlds very attractive for the very same reasons, and under the same circumstances, as they are lured by unfamiliar environments in real life. After reviewing research on exploratory preferences in behavioral ecology, environmental esthetics, neuroscience, and evolutionary and developmental psychology, we focus on the sources of their variability across time and space, which we argue can account for the variability of the cultural preference for imaginary worlds. This hypothesis can, therefore, explain the way imaginary worlds evolved culturally, their shape and content, their recent striking success, and their distribution across time and populations. (shrink)

In the popular imagination, the relevance of Turing's theoretical ideas to people producing actual machines was significant and appreciated by everybody involved in computing from the moment he published his 1936 paper ‘On Computable Numbers’. Careful historians are aware that this popular conception is deeply misleading. We know from previous work by Campbell-Kelly, Aspray, Akera, Olley, Priestley, Daylight, Mounier-Kuhn, Haigh, and others that several computing pioneers, including Aiken, Eckert, Mauchly, and Zuse, did not depend on Turing's 1936 universal-machine concept. Furthermore, (...) it is not clear whether any substance in von Neumann's celebrated 1945 ‘First Draft Report on the EDVAC’ is influenced in any identifiable way by Turing's work. This raises the questions: When does Turing enter the field? Why did the Association for Computing Machinery honor Turing by associating his name to ACM's most prestigious award, the Turing Award? Previous authors have.. (shrink)

In three experiments, picture quality between test items was manipulated to examine whether subjects’ expectations about the fluency normally associated with these different stimuli might influence the effects of fluency on preference or familiarity-based recognition responses. The results showed that fluency due to pre-exposure influenced responses less when objects were presented with high picture quality, suggesting that attributions of fluency to preference and familiarity are adjusted according to expectations about the different test pictures. However, this expectations influence depended on subjects’ (...) awareness of these different quality levels. Indeed, imperceptible differences seemed not to induce expectations about the test item fluency. In this context, fluency due to both picture quality and pre-exposure influenced direct responses. Conversely, obvious, and noticed, differences in test picture quality did no affect responses, suggesting that expectations moderated attributions of fluency only when fluency normally associated with these different stimuli was perceptible but difficult to assess. (shrink)

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be available, at least within (...) privately funded health care. (shrink)

To Aristotle, spoken words are symbols, not of objects in the world, but of our mental experiences related to these objects. Presently there are two major strands of interpretation of Aristotle’s concept of the linguistic sign. First, there is the structuralist account offered by Coseriu (Geschichte der Sprachphilosophie. Von den Anfängen bis Rousseau, 2003 [1969], pp. 65–108) whose interpretation is reminiscent of the Saussurean sign concept. A second interpretation, offered by Lieb (in: Geckeler (Ed.) Logos Semantikos: Studia Linguistica in Honorem (...) Eugenio Coseriu 1921–1981, 1981) and Weidemann (in: Schmitter (Ed.) Geschichte der Sprachtheorie 2. Sprachtheorien der abendländischen Antike, 1991), says that Aristotle’s concept of the linguistic sign is similar to the one presented in Ogden and Richard’s (The meaning of meaning: A study of the influence of language upon thought and of the science of symbolism, 1970 [1923]) semiotic triangle. This paper starts off with an introductory outline of the so-called phýsei-thései discussion which started during presocratic times and culminated in Plato’s Cratylus. Aristotle’s concept of the linguistic sign is to be regarded as a solution to the stalemate position reached in the Cratylus. Next, a discussion is offered of both Coseriu’s and Lieb’s analysis. We submit that Aristotle’s concept of the linguistic sign shows features of both Saussure’s and Ogden and Richards’s sign concept but that it does not exclusively predict one of the two. We argue that Aristotle’s concept of the linguistic sign is based on three different relations which together evince his teleological as well empiricist point of view: one internal (symbolic) relation and two external relations, i.e. a likeness relation and a relation katà synthéken. (shrink)

Fragile X syndrome is the most common cause of inherited mental retardation in humans. The fragile X gene (FMR1) has been cloned and the mutation causing the disease is known. The molecular basis of the disease is an expansion of a trinucleotide repeat sequence (CGG) present in the first exon within the 5′ untranslated region of the FMR1 gene. Affected individuals have repeat CGG sequences of above 200. As a result the gene is not producing protein. It has been shown (...) that the FMR1 protein has RNA binding activity, but the function of this RNA binding activity is not known. The timing and mechanism of repeat amplification are not yet understood. An animal model for fragile X syndrome has been generated, which can be used to study the clinical and biochemical abnormalities caused by absence of FMR1 protein product. (shrink)

Background: Biomedical science is producing an avalanche of data about risk factors, often with a small predictive value, associated with a broad diversity of diseases. Prevention and screening are increasingly moving from public health into the clinic. Therefore, the question of which risk factors to investigate and disclose in the individual patient, becomes ethically increasingly urgent. In line with Wilson and Jungner's public health-related 10 principles for screening, it seems crucial to distinguish important from unimportant health risks.Aim: to explore the (...) ways in which clinicians distinguish important from unimportant health risks.Methods: We interviewed 36 respondents (gastroenterologists and gynaecologists/obstetrics) in 5 focus group interviews and 15 open in-depth interviews on their interpretation of what makes a health risk important.Results: Physicians primarily interpreted importance as the severity of the possible harm, less often its probability. Possibilities of prevention or reassurance strongly influenced their judgment on importance.Discussion: It is not likely that interpreting ‘important’ as ‘severe’ will help in differentiating meaningful from meaningless risk knowledge. A more fundamental change in our ways of dealing with risk may be called for. We discuss existing literature on resilience as an alternative way to deal with risk. Balancing prevention and risk reduction with resilience could be a fruitful direction. (shrink)

We propose an approach reconciling the ultimate-level explanations proposed by Savage et al. and Mehr et al. as to why music evolved. We also question the current adaptationist view of culture, which too often fails to disentangle distinct fitness benefits.

Brian Garrett claims, in defence of Gaunilo’s Perfect Island and contra Plantinga, that ‘Properly understood, the great-making qualities of an island are maximal’. This article demonstrates that they are not, thus ‘the greatest conceivable island’ remains an incoherent concept and Gaunilo’s parody fails.

The purpose of this research paper is to identify which types of corporate philanthropy (CP): cause-related marketing (CRM) or sponsorship, create higher moralcapital under two conditions: proactive or reactive (following a scandal). Results showed that CP created higher moral capital for a proactive company than for a reactive company. Both CRM and sponsorship were perceived as more sincere in the proactive company than the reactive company. However, CRM was seen as self-serving in the reactive company, but not the proactive company. (...) The study demonstrated that companies need to take into account the different types of CP, as it has an effect on their moral capital. Socially proactive firms should engage in both CRM and sponsorship philanthropy, as both types can generate high moral capital, which creates better company reputation. However, CP may not be the most effective or appropriate strategy for creating moral capital following negative publicity. (shrink)