Individuals in late adulthood are often confronted with difficulties and challenges that elicit existential questions and doubts, including religious doubts. Although research has shown that unresolved religious doubts increase the risk for depression, it remains unclear how they are related to each other in late adulthood and which mechanisms are underlying this relationship. Therefore, in a longitudinal study of 329 older adults aged 65-99 and living in a nursing home, the relation between religious doubt and depressive symptoms was explored as (...) well as the mediation effect of rumination on this relationship. The results confirmed the relation between religious doubt and the experience of depressive symptoms, with a bidirectional influence over time. However, the findings indicated that this reciprocal relationship was not mediated by rumination. The study highlights the importance of identifying older adults who experience religious doubt and who are at risk for or suffer from depressive symptoms. (shrink)

With a specific example from Norway and inspiration from Sara Ahmed’s The Promise of Happiness, this article demonstrates how today’s educational rhetoric lacks the language and will to recognise a key pedagogical dimension in education: what happens when the normative ambitions of education and students meet. At best, teaching students life skills to mitigate their mental health issues is naive. Inspired by Ahmed, such an initiative might actually work against its purpose. At a time when educational outcomes are emphasised in (...) local and international political contexts, I argue that the task of philosophy of education should be 1) to reclaim the significance of the pedagogical dimension in education and 2) to philosophise on what negative emotions such as unhappiness require of education. (shrink)

The aim of this article is to investigate the concept of care in contemporary medical practice and medical ethics. Although care has been hailed throughout the centuries as a crucial ideal in medical practice and as an honourable virtue to be observed in codes of medical ethics, I argue that contemporary medicine and medical ethics suffer from the lack of a theoretically sustainable concept of care and then discuss possible reasons that may help to explain this absence. I draw on (...) the empirical studies of Carol Gilligan on care and connectedness as ontologically situated realities in human life. Based on a philosophical elaboration of her findings on the ethics of care emphasizing relationality, I try to show how the notion of ‘relational ontology’ originating from this stream of thought may be of help in developing a medical ethics that acknowledges care as a perspective to be observed in all interactions between physicians and patients. (shrink)

An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process and (...) informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)

Parents of toddlers can find themselves overwhelmed and struggling with self-doubt when their child is willful, or is having trouble navigating difficult emotions and circumstances. Mindfulness can help! In The Little Frog Awakes, Eline Snel offers parents of children -ages 18 months--4 years--advice and tools for responding mindfully and effectively in the moment. These skills help us regain trust in ourselves and in the integral wholeness of our kids. And when we make mindfulness practice a part of daily life, (...) it gives our children a powerful message on how to recognize, name, and deal with emotions and situations. This practical guide will help you to connect with and respond mindfully to your own feelings as they arise; cultivate compassion for yourself as a parent; show you how to encourage serenity, self-confidence, and emotional regulation in your children; strengthen the bond with your kids and help all of you manage stress; be more fully present with your children, and more able to give them your undivided attention; embrace imperfection and focus on the things that really matter; and more The book and the accompanying audio include activities, practices, and stories for both you and for your toddler that cultivate mindful moments and action, and self-compassion. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole-genome sequencing and micro-array based analysis enable genome-wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre-test information and achieving autonomous decision-making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by (...) the International Association of Bioethics, these challenges were presented for three different areas in which these so-called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set-up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set-up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct-to-consumer applications of the new genetics. (shrink)

As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like. Building on an interview study of researchers’ practices and perspectives, we identified key considerations for the set-up of pathways for the detection, management and communication of (...) incidental findings in imaging research. We conducted an interview study with a purposive sample of researchers at research facilities across the Netherlands. Based on a qualitative analysis of these interviews and on existing guidelines found in the literature, we developed a prototype ethical framework, which was critically assessed and fine-tuned during a two-day international expert meeting with bioethicists and representatives from large population-based imaging studies from the United Kingdom, Germany, Sweden and Belgium. Practices and policies for the handling of incidental findings vary strongly across the Netherlands, ranging from no review of research scans and limited feedback to research participants, to routine review of scans and the arrangement of clinical follow-up. Respondents felt that researchers do not have a duty to actively look for incidental findings, but they do have a duty to act on findings, when detected. The principle of reciprocity featured prominently in our interviews and expert meeting. We present an ethical framework that may guide researchers and research ethics committees in the design and/or evaluation of appropriate pathways for the handling of incidental findings in imaging studies. The framework consists of seven steps: anticipation of findings, information provision and informed consent, scan acquisition, review of scans, consultation on detected abnormalities, communication of the finding, and further clinical management and follow-up of the research participant. Each of these steps represents a key decision to be made by researchers, which should be justified not only with reference to costs and/or logistical considerations, but also with reference to researchers’ moral obligations and the principle of reciprocity. (shrink)

This paper examines the support for diversity from a moral perspective. Combining business ethics theory with a lens of critical discourse analysis, it reconstructs the debates on the ethicality of three disability inclusion practices—positive discrimination, job adaptations, and voluntary disclosure—drawn from multi-stakeholder interviews in disability-friendly organizations. Discursive resistance to disability inclusion practices, otherwise known to work, arises out of moral beliefs characteristic of an ethic of justice, whereas support is more often informed by an ethic of care. This study contributes (...) to the literature by laying bare how ethics fuel ‘resistance to’ rather than ‘support for’ diversity and inclusion. Like prior studies, it links such resistance to the myth of individual merit, noting that some re-appropriation of an ethic of justice becomes possible when legal awareness around issues of disability is raised in the context of work. In addition, it identifies an ethic of care as holding the greatest potential for fostering workplace inclusion yet cautions for two adverse side effects that may arise when promoting corporate care: the potential of paternalism and the inclination to individualise inherent to wellbeing initiatives. (shrink)

Increasing the participation of women in top-level corporate boards is high on the agenda of policy-makers. Yet, we know little about director appointment dynamics and the drivers and impediments of women appointments. This study builds on organizational and group-level behavior theories and empirically investigates how ex-ante board structures and gender-specific board dynamics impact the representation of women on corporate boards. We study boards of listed firms in Europe between 2002 and 2019 and find a declining appointment probability for every additional (...) woman, i.e., the share of women already on the board negatively predicts the likelihood of additional women appointments. Further, we find evidence of a replacement effect, i.e., the likelihood of a woman being appointed as director is significantly larger when a woman, compared to when a man, leaves the board. We do not find spillover effects from non-executive to executive boards. These results are robust to econometric model specifications that address potential endogeneity concerns using matching and instrumental variables. Our results confirm that board director appointments are gender specific and suggest that demand-side factors such as explicit and implicit norms drive women appointments up to a certain threshold. (shrink)

Many healthy volunteers choose to take part in Alzheimer’s disease prevention studies because they want to know whether they will develop dementia—and what they can do to reduce their risk—and are therefore interested in learning the results of AD biomarker tests. Proponents of AD biomarker disclosure often refer to the personal utility of AD biomarkers, claiming that research participants will be able to use AD biomarker information for personal purposes, such as planning ahead or making important life decisions. In this (...) paper, the claim that AD biomarkers have personal utility for asymptomatic individuals is critically assessed. It demonstrates that in the absence of clinical validity, AD biomarkers cannot have personal utility and do not serve research participants’ autonomy. Over the next few years, many research groups will be confronted with participants’ preferences to learn the results of AD biomarker tests. When researchers choose to make results available upon explicit request, they should ensure adequate information provision and education, notably on the uncertain clinical significance of AD biomarker information. Routine disclosure of AD biomarkers to cognitively unimpaired individuals in research settings cannot be justified with an appeal to the personal utility of AD biomarker information. (shrink)

Asking pregnant women to (co)pay for non-invasive prenatal testing (NIPT) out of pocket leads to unequal access across socioeconomic strata. To avoid these social justice issues, first-trimester prenatal screening should be publicly funded in countries such as the Netherlands, with universal coverage healthcare systems that offer all other antenatal care services and screening programmes free of charge. In this reply, we offer three additional reasons for public funding of NIPT. First, NIPT may not primarily have medical utility for women and (...) children, but rather offers relevant information and reproductive options, and thus serves important autonomy interests of women. Second, public funding of NIPT can be justified because it results in a reduction of collectively borne costs associated with care and support for children with chromosomal abnormalities. It is important to note that this isnotan argument for individual women to take part in screening or to terminate an affected pregnancy. However, itisa legitimate argument in policy making regarding funding arrangements for screening programmes. Finally, public funding would help to amend current misunderstandings among pregnant women (eg, that they are not at risk), and thus to support informed consent for first-trimester prenatal screening. (shrink)

– This paper aims to deal with an increasing securitization and criminalisation of migration in Europe highlighting ethical implications of the current surveillance-based EU migration governance. It is shown that EU member states employ surveillance regimes to control movements across borders and to restrict migrants' access to their territories. The ethical acceptability of such practices is questioned with a particular focus on the “freedom of movement”., – In order to establish the extent to which the current EU migration governance can (...) be considered ethically justifiable, the article starts out from the right to mobility as coded in the UN Declaration of Human Rights. It is shown that the current migration governance obstructs the rights specified in Articles 13 and 14. At the same time, shortcomings of the UN declaration are discussed and the need for a better protection of the freedom of movement is suggested., – It is established that human rights are such that promote normative agency and a type of rights that trump, for example, states interests in restricting access to their territories do not outweigh individuals rights to seek asylum. In order to make this relation more clear however, the right to mobility should be made symmetric, including both a right to leave and to enter (but not a right to immigrate and settle). An extensive right to freedom of movement is advocated based on the significance of mobility for normative agency. A substantial right to mobility supports the right to seek asylum., – As of yet, ethical implications of surveillance-based border control are under-researched. (shrink)

A positive correlation between religious participation and subjective well-being has been demonstrated frequently in empirical research among Christian believers. In this article, we demonstrate that this relationship also exists in a Muslim religious context. Data are presented, collected from a sample of Muslim youngsters of Turkish and Moroccan origin, now living in The Netherlands. Analysis of variance showed that young Muslim migrants who carry out religious duties, have a better subjective well-being than those who are less religiously involved, although this (...) is more the case with men than with women. A qualitative analysis of the interview protocols revealed that female migrants suffer more from the restrictions laid upon them by religious obligations. It revealed also that the underlying factor of the relationship between religion and subjective well-being is group cohesion. Religious observance strengthens a feeling of togetherness and collective identity. (shrink)

Treating physicians have key roles to play in expanded access to investigational drugs, by identifying investigational treatment options, assessing the balance of risks and potential benefits, informing their patients, and applying to the regulatory authorities. This study is the first to explore physicians’ experiences and moral views, with the aim of understanding the conditions under which doctors decide to pursue expanded access for their patients and the obstacles and facilitators they encounter in the Netherlands. In this mixed-methods study, semi-structured interviews (...) and a questionnaire were conducted with medical specialists across the country and analysed thematically. Typically, our respondents pursue expanded access in “back against the wall” situations and broadly support its classic requirements. They indicate practical hurdles related to reimbursement, the amount of time and effort required for the application, and unfamiliarity with the regulatory process. Some physicians are morally opposed to expanded access, with an appeal to safety risks, lack of evidence, and “false hope.” Some of these moral concerns and practical obstacles may be essential targets for change, if expanded access to unapproved drugs is to become available for wider groups of patients for whom standard treatment options are not—or no longer—available, on a more consistent and equal basis. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole‐genome sequencing and micro‐array based analysis enable genome‐wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre‐test information and achieving autonomous decision‐making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by (...) the International Association of Bioethics, these challenges were presented for three different areas in which these so‐called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set‐up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set‐up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct‐to‐consumer applications of the new genetics. (shrink)

This chapter considers the semantics and pragmatics of expressive content. It begins by exemplifying the class of expressives, in the process introducing the tests that have been proposed for expressivity, focusing on the expressive adjectives fucking and damn, and on pejorative terms. The chapter then turns to specific analyses of these and other expressive items, also discussing facts related to how the particular content of some expressives can be derived from context. The chapter concludes with a discussion and overview of (...) various approaches to semantic composition with expressives. (shrink)

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses’ power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant (...) discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions. (shrink)

Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a (...) cost-effective future care that better can accommodate the needs of an aging population and promote care recipients’ independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated. (shrink)

Background: Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual. Objectives: The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway’s renamed and revised Patients’ and Service Users’ Rights Act (originally Patients’ Rights Act, 1999) and published comments which accompanying this legislation (...) from the Norwegian Ministry of Health and Care Service. Research design: A constructivist design was used, and Fairclough’s critical discourse approach was adopted to analyze the text of the Patients’ and Service Users’ Rights Act and comments. Findings: The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients’ trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as “troublesome.” Conclusion: Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient. (shrink)

As noninvasive prenatal testing is being implemented as a first-trimester prenatal screening modality in healthcare systems around the world, it raises ethical concerns. In theory, NIPT allo...

A new genre of treatises on practical seamanship emerged in eighteenth-century Britain. Authored by a group of seamen with decades of experience on the lower deck of merchant and naval vessels, these texts represented the ship as a machine, and seamanship as a form of mechanical experiment which could only be carried out by deep-sea sailors. However, as this article finds, this group of sailor–authors had only a brief moment of authoritative legitimacy before their ideas were repackaged and promoted by (...) land-bound authors and naval officers, and the progenitors of the ‘science of seamanship’ were deemed unfit participants in its ongoing practice. This article explores this brief moment, taking seriously the ideas and influences of the maritime milieu which spawned it, and arguing that the codification and circulation of ‘useful knowledge’ in eighteenth-century Britain often hardened social hierarchies. Examining seamanship forces us to question the progressivist linear trajectory of an increasingly open scientific culture during this period, and to focus instead on a repeating pattern in which the working knowledge of labourers and artisans was appropriated and its original practitioners denigrated. (shrink)

To avoid post-neurosurgical language deficits, intraoperative mapping of the language function in the brain can be complemented with preoperative mapping with functional magnetic resonance imaging. The validity of an fMRI “language localizer” paradigm crucially depends on the choice of an optimal language task and baseline condition. This study presents a new fMRI “language localizer” in Russian using overt sentence completion, a task that comprehensively engages the language function by involving both production and comprehension at the word and sentence level. The (...) paradigm was validated in 18 neurologically healthy volunteers who participated in two scanning sessions, for estimating test–retest reliability. For the first time, two baseline conditions for the sentence completion task were compared. At the group level, the paradigm significantly activated both anterior and posterior language-related regions. Individual-level analysis showed that activation was elicited most consistently in the inferior frontal regions, followed by posterior temporal regions and the angular gyrus. Test–retest reliability of activation location, as measured by Dice coefficients, was moderate and thus comparable to previous studies. Test–retest reliability was higher in the frontal than temporo-parietal region and with the most liberal statistical thresholding compared to two more conservative thresholding methods. Lateralization indices were expectedly left-hemispheric, with greater lateralization in the frontal than temporo-parietal region, and showed moderate test-retest reliability. Finally, the pseudoword baseline elicited more extensive and more reliable activation, although the syllable baseline appears more feasible for future clinical use. Overall, the study demonstrated the validity and reliability of the sentence completion task for mapping the language function in the brain. The paradigm needs further validation in a clinical sample of neurosurgical patients. Additionally, the study contributes to general evidence on test–retest reliability of fMRI. (shrink)

Simple mindfulness practices to help your child (ages 5-12) deal with anxiety, improve concentration, and handle difficult emotions—with a 60-minute audio CD of guided exercises Mindfulness—the quality of attention that combines full awareness with acceptance of each moment, just as it is—is gaining broad acceptance among mental health professionals as an adjunct to treatment. This little book is a very appealing introduction to mindfulness meditation for children and their parents. In a simple and accessible way, it describes what mindfulness is (...) and how mindfulness-based practices can help children calm down, become more focused, fall asleep more easily, alleviate worry, manage anger, and generally become more patient and aware. The book contains eleven practices that focus on just these scenarios, along with short examples and anecdotes throughout. Included with purchase is an audio CD with guided meditations, voiced by Myla Kabat-Zinn, who along with her husband, Jon Kabat-Zinn, popularized mindfulness-based stress reduction (MBSR) as a therapeutic approach. Continue your mindfulness practice with Eline Snel through her other mindfulness meditation titles, including Sitting Still Like a Frog Activity Book, which offers 75 fun mindfulness games and activities for children, and The Little Frog Awakes, which offers tools and advice for mindfully responding to younger children ages 18 months to 4 years. (shrink)

This paper considers the meaning and use of the English particle man. It is shown that the particle does quite different things when it appears in sentence-initial and sentence-final position; the first use involves expression of an emotional attitude as well as, on a particular intonation, intensification; this use is analyzed using a semantics for degree predicates along with a separate dimension for the expressive aspect. Further restrictions on modification with the sentence-initial particle involving monotonicity and evidence are introduced and (...) analyzed. The sentence-final use can be viewed as strengthening the action performed by the sentence. A formal semantics is given by making use of dynamic techniques and, in a sense, dynamically simulating the modification of certain speech acts. Some empirical and theoretical extensions of the analyses are proposed and some consequences discussed. (shrink)

If our moral beliefs rest on a mistake, as moral error theorists claim, what should we do with them? According to Richard Joyce’s revolutionary moral fictionalism, error theorists should pretend to believe moral propositions in order to keep the benefits moral thinking has for their preference satisfaction. This, he claims, frees error theory from radical practical implications. In response, I argue that implementing fictionalism would not preserve our moral practices, but disrupt them. The change from moral belief to make-belief yields (...) an unintended second revolution: a revolution in the content of morality. I show that fictionalism necessarily relies on a similar justification of moral practices as David Gauthier’s contractarianism, and consequently has similar implications for moral content. Because fictionalists engage in moral thinking purely for its instrumental value, they should only accept moral obligations that are useful to them into their fiction. This restriction is important: the most useful moral fiction departs substantially from conventional moral views. Revolutionary moral fictionalism is therefore more radical than it is promised to be. (shrink)

Background: According to Norwegian law, nurses are obligated to provide an acceptable level of health assistance to patients and their family members and to allow patients and their family members to participate in the planning of patient care and treatment. Aim: The aim of this study is to compare the perceptions of older patients undergoing haemodialysis treatment and of their next of kin and of nurses regarding patient participation in the context of haemodialysis treatment. Research design: The study adopts an (...) approach that is both comparative and explorative in nature by examining the narratives of patients, nurses and next of kin and by performing critical discourse analysis as outlined by Fairclough. Ethical considerations: Permission to carry out the research was granted by the Regional Committee for Medical and Health Research Ethics of Mid-Norway and by the participating hospitals. Informed consent and confidentiality were ensured. Findings: Two discourses were found: (a) the discourse of paternalism with the discursive practices of achieving physiological balance in patients, trusting the healthcare team and being excluded or included in the difficult end-of-life decision-making process, and (b) the discourse of patient participation, with the themes of maintaining patients’ quality of life and trusting patients. Conclusion: The participation of older patients and their next of kin was not as well integrated as social practice in dialysis units. The dominant discourse seemed to have an ideology and social practice of paternalism. However, there existed hegemonic struggles for an ideology of patient participation that involved (a) achieving physiological balance in patients versus maintaining patients’ quality of life, (b) trusting the healthcare team versus trusting the patient, and (c) being excluded versus included in the difficult end-of-life decision-making process. (shrink)

Based on conversation analysis, this study investigates central practices in what is defined as a caring interview, in the context of welfare administration. Caring refers to a helpful interviewing in reformulations of questions, taking interviewees’ difficulties to answer into consideration; a caring attitude in the framing of questions, showing understanding of clients’ circumstances and professional’s enactment of expertise in assessments of clients’ disabilities and care needs. Data include a corpus of 43 recorded interviews in which officials at the Swedish Social (...) Insurance Agency interview clients who have applied for benefits. The study adds to research on interactional sensitivity, polar questions and epistemic stance in institutional interaction. The study shows how the interviewer prioritizes confirming polar questions, takes responsibilities of knowing into account and reduces the epistemic gap to the interviewee in practices of a caring interview. This makes the interviewing markedly different from standardized and bureaucratic interviewing. (shrink)

This short essay argues that more attention should be paid to conventional norms in metaethics and metanormative theory.

Response-dependence theses are usually formulated in terms of a priori true biconditionals of roughly the form 'something, x, falls under the concept 'F' ↔ x would elicit response R from subjects S under conditions C'. Such formulations are vulnerable to conditional fallacy problems; counterexamples threaten whenever the C-conditions' coming to obtain might alter the object with respect to F. Crispin Wright has suggested that such problems can be avoided by placing the C-conditions in a proviso. This ensures that any changes (...) triggered by the C-conditions' coming to obtain will be irrelevant to the truth of the biconditional. I argue that this move leaves the equations vulnerable to counterexamples of a slightly different kind: Cases where the change is triggered, not by the C-conditions' coming to obtain, but by the response. I consider two ways to resist these counterexamples, and argue that both are insufficient. The upshot is a challenge that must be met if provisoed biconditionals are to serve their purpose. (shrink)

Background Patients with unmet medical needs sometimes resort to non-standard treatment options, including the use of unapproved, investigational drugs in the context of clinical trials, compassionate use or named-patient programs. The views and experiences of patients with unmet medical needs regarding unapproved, investigational drugs have not yet been examined empirically. Methods In this qualitative study, exploratory interviews and focus groups were held with patients with chronic or life-threatening diseases, about topics related to non-standard treatment options, such as the search for (...) non-standard treatment options, patients’ views of the moral obligations of doctors, and the conditions under which they would or would not wish to use non-standard treatment options, including expanded access to unapproved, investigational drugs. Results Respondents had very little knowledge about and/or experience with existing opportunities for expanded access to investigational drugs, although some respondents were actively looking for non-standard treatment options. They had high expectations of their treating physicians, assuming them to be aware of non-standard treatment options, including clinical trials elsewhere and expanded access programs, and assuming that they would inform their patients about such options. Respondents carefully weighed the risks and potential benefits of pursuing expanded access, citing concerns related to the scientific evidence of the safety and efficacy of the drug, side effects, drug-drug interactions, and the maintaining of good quality of life. Respondents stressed the importance of education and assertiveness to obtain access to good-quality health care, and were willing to pay out of pocket for investigational drugs. Patients expressed concerns about equal access to new and/or non-standard treatment options. Conclusion When the end of a standard treatment trajectory comes into view, patients may prefer that treating physicians discuss non-standard treatment options with them, including opportunities for expanded access to unapproved, investigational drugs. Although our respondents had varying levels of understanding of expanded access programs, they seemed capable of making well-considered choices with regard to non-standard treatment options and had realistic expectations with regard to the safety and efficacy of such options. Dutch patients might be less likely to fall prey to false hope than often presumed. (shrink)

Background: Young next of kin to patients with mental health problems are faced with many challenges. It is important to focus on the special needs of children and adolescents as next of kin to ensure their welfare and prevent harm. Research questions: We aimed to investigate young next of kin’s need for information and involvement, to examine the ways they cope with situations involving coercion related to the treatment of their relative, and to identify ethical challenges. Research design: We conducted (...) a qualitative study based on semi-structured, individual interviews. Participants and research context: Seven young next of kin aged 14–22 years participated in the study. The informants were recruited from a regional hospital trust in Norway. Ethical considerations: The study was approved by the National Data Protection Official for Research and based upon informed consent and confidentiality. Findings: The adolescents wanted more information and described a need for increased interaction with their sick relative at the hospital. They struggled to keep their relationship with their relative intact, and they described communication problems in the family. Coercive treatment was perceived in a negative way. Discussion: The study finds that there are ethical challenges at stake for young next of kin and their families other than those that are often emphasized by traditional healthcare, which often focuses on the individual patient’s rights. These challenges are related to the young next of kin’s needs for interconnectedness and for the preservation of relationships as well as challenges related to family communication and the need for information. Conclusion: The study finds a need for more family-oriented perspectives in both mental healthcare practices and healthcare ethics. (shrink)

Esta pesquisa constrói uma definição objetiva para a teoria do desenvolvimento, no âmbito do direito, em detrimento da clássica e utilitarista abordagem econômica. Desenvolve-se uma releitura dessa teoria cuja racionalidade seja justiça, com base em Aristóteles, Rawls, Dworkin e Amartya Sen. Metodologicamente, a técnica de pesquisa é teórica, o método de abordagem é dialético e o método de procedimento é monográfico. O objetivo é demonstrar que a teoria da justiça no direito do ocidente levou à sua conexão com a teoria (...) do desenvolvimento. Conclui-se que a teoria do desenvolvimento concebeu liberdade, igualdade e capacidade como seus definidores objetivos. (shrink)