Judges face difficult choices when the birth and genetic mothers of a child are separate people who dispute maternal access; the views of the general population may help them. Fifty women were asked whether, if they were infertile and could have only one child, they would prefer to be birth mothers (to carry a baby which was not genetically theirs) or genetic mothers (to have another woman carry their genetic baby). Similarly, fifty men were asked about their preference for a (...) partner's child. In both groups the strength of preferences was measured using a lottery technique. The direction and strength of preferences was similar between men and women, and approximately equally divided between birth and genetic motherhood. These attitudes should be taken into account by those adjudicating custody disputes between such mothers. (shrink)

This letter responds to a letter by Moti Gorin in the same issue, September‐October 2024, of the Hastings Center Report.

Amidst the misinformation climate about trans people and their health care that dominates policy and social discourse, autonomy‐based rationales for gender‐affirming care for trans and nonbinary youth are being called into question. In this commentary, which responds to “What Is the Aim of Pediatric ‘Gender‐Affirming’ Care?,” by Moti Gorin, we contextualize the virulent ideas circulating in misinformation campaigns that have become weaponized for unprecedented legal interference into standard health care. We conclude that the current legal justifications for upending gender‐affirming care (...) gloss over how this health care field meets conventional evidentiary standards and aligns protocols with most other fields of medicine. Refusal to offer gender‐affirming care is more harmful than centralizing trans and nonbinary people's health autonomy. (shrink)

In terms of intervening in embodied experience, medical treatment is wonder-full in its ambition and its metaphysical presumption; yet, wonder’s role in clinical medicine has received little philosophical attention. In this paper, I propose, to doctors and others in routine clinical life, the value of an openness to wonder and to the sense of wonder. Key to this is the identity of the central ethical challenges facing most clinicians, which is not the high-tech drama of the popular conceptions of medical (...) ethics but, rather, the routine of patients’ undramatic but unremitting demands for the clinician’s time and respectful attention. Wonder (conceived as an intense and transfiguring attentiveness) is a ubiquitous ethical source, an alternative to the more familiar respect for rational autonomy, a source of renewal galvanizing diagnostic imagination, and a timely recalling of the embodied agency of both patient and clinician. (shrink)

A unifying theory of general anesthetic-induced unconsciousness must explain the common mechanism through which various anesthetic agents produce unconsciousness. Functional-brain-imaging data obtained from 11 volunteers during general anesthesia showed specific suppression of regional thalamic and midbrain reticular formation activity across two different commonly used volatile agents. These findings are discussed in relation to findings from sleep neurophysiology and the implications of this work for consciousness research. It is hypothesized that the essential common neurophysiologic mechanism underlying anesthetic-induced unconsciousness is, as with (...) sleep-induced unconsciousness, a hyperpolarization block of thalamocortical neurons. A model of anesthetic-induced unconsciousness is introduced to explain how the plethora of effects anesthetics have on cellular functioning ultimately all converge on a single neuroanatomic/neurophysiologic system, thus providing for a unitary physiologic theory of narcosis related to consciousness. (shrink)

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

The ongoing debate on the ethics of using artificial intelligence (AI) in military contexts has been negatively impacted by the predominant focus on the use of lethal autonomous weapon systems (LAWS) in war. However, AI technologies have a considerably broader scope and present opportunities for decision support optimization across the entire spectrum of the military decision-making process (MDMP). These opportunities cannot be ignored. Instead of mainly focusing on the risks of the use of AI in target engagement, the debate about (...) responsible AI should (i) concern each step in the MDMP, and (ii) take ethical considerations and enhanced performance in military operations into account. A characterization of the debate on responsible AI in the military, considering both machine and human weaknesses and strengths, is provided in this paper. We present inroads into the improvement of the MDMP, and thus military operations, through the use of AI for decision support, taking each quadrant of this characterization into account. (shrink)

Continued concern for animal welfare may be alleviated when welfare would be monitored on farms. Monitoring can be characterized as an information system where various stakeholders periodically exchange relevant information. Stakeholders include producers, consumers, retailers, the government, scientists, and others. Valuating animal welfare in the animal-product market chain is regarded as a key challenge to further improve the welfare of farm animals and information on the welfare of animals must, therefore, be assessed objectively, for instance, through monitoring. Interviews with Dutch (...) stakeholder representatives were conducted to identify their perceptions about the monitoring of animal welfare. Stakeholder perceptions were characterized in relation to the specific perspectives of each stakeholder. While producers tend to perceive welfare from a production point of view, consumers will use visual images derived from traditional farming and from the animals’ natural environments. Scientists’ perceptions of animal welfare are affected by the need to measure welfare with quantifiable parameters. Retailers and governments (policy makers) have views of welfare that are derived from their relationships with producers, consumers, non-governmental organizations (NGOs), and scientists. All interviewed stakeholder representatives stated that animal welfare is important. They varied in the extent to which they weighted economic considerations relative to concern for the animals’ welfare. Many stakeholders emphasized the importance of communication in making a monitoring system work. Overall, the perspectives for the development of a sustainable monitoring system that substantially improves farm animal welfare were assessed as being poor in the short term. However, a reliable system could be initiated under certain conditions, such as integrated chains and with influential and motivated stakeholders. A scheme is described with attention points for the development of sustainable monitoring systems for farm animal welfare in the long term. (shrink)

Research shows that commitment-based interventions are among the most effective strategies to encourage pro-environmental behaviors, but methods to elicit commitments from a large number of individuals are often costly and unrealistic. Predictions requests—a commitment-type strategy—are an effective mass-communication strategy and have the potential to influence pro-environmental behavior among large audiences. This research is the first to demonstrate that prediction requests in a consumer behavior context influence preference for environmentally friendly products. In addition, this research examines the role of individual and (...) contextual factors in influencing the efficacy of prediction requests. Study 1 shows that exposure to an advertisement with a prediction request leads to increased preferences for environmentally sustainable household cleaning products, compared to a control advertisement, and that this effect is greater when the prediction request is paired with an audience cue . Study 2 indicates that the effect of prediction requests on preference for sustainable products is greater for individuals with interdependent self-construal. Substantive implications and directions for future research are discussed. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

The concept of natural behavior is a key element in current Dutch policy-making on animal welfare. It emphasizes that animals need positive experiences, in addition to minimized suffering. This paper interprets the concept of natural behavior in the context of the scientific framework for welfare assessment. Natural behavior may be defined as behavior that animals have a tendency to exhibit under natural conditions, because these behaviors are pleasurable and promote biological functioning. Animal welfare is the quality of life as perceived (...) by the animal. Animals have evolved cognitive-emotional systems (“welfare needs”) to deal with a variable environment. Animals do not only have so-called physiological needs such as the need for food, water, and thermal comfort. They also need to exercise certain natural behaviors such as rooting or nest-building in pigs, and scratching or dust-bathing in poultry. All needs must be taken into account in order to assess overall welfare. The degree of need satisfaction and frustration can be assessed from scientific information about the intensity, duration, and incidence of (welfare) performance criteria such as measurements of behavior and/or (patho)physiology. Positive welfare value relates to how animals are inclined to behave under natural conditions, in preference tests, and in consumer-demand studies. Negative welfare value relates to stress, frustration, abnormal behavior, aggression, and reduced fitness. Examples are given to illustrate how the need to perform natural behaviors can be assessed following the general principles for welfare assessment, providing a first approximation of how different natural behaviors affect animal welfare. (shrink)

In studying the thinkers discussed, we have generally used (translations of) their writings. The very breadth of this study makes one dependent upon ...

The notion of patients’ duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients’ duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient (...) is always liable to be an opportunity cost in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one’s own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights-based approaches, and that a preferable alternative might be sought through the notion of a “virtuous patient” contributing to a problem-solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. (shrink)

The International Classification of Functioning, Disability and Health (ICF), designed by the WHO, attempts to provide a holistic model of functioning and disability by integrating a medical model with a social one. The aim of this article is to analyze the ICF’s claim to holism. The following components of the ICF’s complexity are analyzed: (1) health condition, (2) body functions and structures, (3) activity, (4) participation, (5) environmental factors, (6) personal factors, and (7) health. Although the ICF claims to be (...) holistic, it presupposes a monistic materialistic ontology. We indicate some limitations of this ontology, proposing instead: (a) a pluralistic–holistic ontology (PHO) and (b) a multidimensional view of the human being, with individual and environmental aspects, in relation to three levels of reality implied by the PHO. For the ICF to attain its holistic claim, the interactions between its components should be based on (a) and (b). (shrink)

Medical screening is justified on the strength of the assumption that the earlier disease is detected, the better it is for the patient. On examination, however, the assumption turns out to be severely flawed, and inadequate anyway, since it is not only the patient with whom we should be concerned, but healthy people as well. Instead of making assumptions about the ill, we should prove a test's overall benefit to the individual taking it before we recommend it.

One of the dominant themes of the symposium from which this collection of articles arose was the ontological status of consent. Is consent a particular state of mind? Is it the signification of that state of mind via a conventionally recognized act? Or, is consent a normative concept that evaluates not only the presence of a state of mind or act, but also the appropriateness of that state of mind or act in the particular circumstances?

Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or (...) moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to “veto” their social responsibility to take part in clinical research. (shrink)

How should we shape the practice of pastoral care, especially in the context of bioethical counseling? Martin Luther grounded it in a mutual dialogue of brethren. Friedrich Schleiermacher transformed this Protestant understanding according to the modern ideals of freedom and responsibility for oneself. In response to the other basic question of pastoral care: What is the human soul?, Sigmund Freud overcame the Platonic model undergirding Schleiermacher's account. Whoever seeks to care for his own soul and the soul of the other (...) should learn from Freud. One of the most fruitful consequences of such study lies in the formation of a mature religiosity. Another such consequence concerns the pastor's aspiring to an attitude of self-control in counseling. Building one's own competence on the experience and the knowledge of Freud can help one counteract the temptation to transfer one's own (unconscious) wishes onto the conversation partner and conversely to ward off transference from the other onto oneself. On the level of ideals and ultimate principles, however, Christian pastors, unlike Freud, will not see fate and the anonymous forces of Eros and Thanatos, as the ultimate last horizons of human self-understanding. Instead, the good news of sinful man's justification by God transcends even the limits of human existence imposed by fate. (shrink)

Heisenberg's position-measurement-momentum-disturbance relation is derivable from the uncertainty relation σ(q)σ(p) ≥ h/2 only for the case when the particle is initially in a momentum eigenstate. Here I derive a new measurement-disturbance relation which applies when the particle is prepared in a twin-slit superposition and the measurement can determine at which slit the particle is present. The relation is d × Δp ≥ 2h/π, where d is the slit separation and Δp = DM(Pf, Pi) is the Monge distance between the initial (...) Pi(p) and final Pf(p) momentum distributions. (shrink)

Geleitwort von Prof. P. Nicki -- Dr. Hermann Freund im Gespräch mit Prof. Dr. Dr. Hinderk M. Emrich -- Die Angst und der existentielle Sprung -- Die neue Zeit -- Der gedachte Gott -- Wie kommt das Ich zum Du? - Hysterie als Lebensform -- Was heisst, sich entscheiden? - Zur Theologie der Freiheit -- Re-formation der Reformation -- Das metaphysische und zugleich dämonische Wesen des Schlosses in Franz Kafkas Schloss-Roman -- Nachwort von Wolfgang Teichert: Epiphanie oder wo sprechende Philosophie (...) und Theologie aufhören müssen -- Literatur -- Verzeichnis der Mitwirkenden -- Abbildungsverzeichnis. (shrink)