Emerging infectious diseases such as Ebola, Hendra, SARS, West Nile, Hepatitis E and avian influenza have led to a renewed recognition of how diseases in human beings, wildlife and livestock are interlinked. The changing prevalence and spread of such infections are largely determined by human activities and changes in environment and climate—where the latter are often also caused by human activities. Since the beginning of the 21st century, these insights have been brought together under the heading of OneHealth—a concept that (...) calls for interdisciplinary collaboration between various sciences as well as professional practices to promote and protect the health of human and non-human animals and the natural environment. Just as insights from public health have led to a broadened focus for health policy and medical care, from treating individual patients to protecting and promoting population health, OneHealth calls for an even broader perspective, including a concern for the environment and animals, and for social-cultural factors that affect human, animal and environmental health. OneHealth not only covers collaborative work to understand and control zoonotic diseases, but also other ways in which interactions between animals, plants and humans may positively or negatively impact on each other’s health. Thus, studies in veterinary medicine and environmental sciences may lead to new insights in human medicine, and vice versa. Acknowledgment of the links between environmental, animal and social health is of course not a novel insight. Hippocrates already pointed to the importance of a clean environment as a requirement for good health; the early public health movements emphasized hygienic living conditions including good-quality housing, sewage systems and clean air and water; and the founders of modern medicine such as William Osler and Rudolf Virchow promoted …. (shrink)

Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept ‘medicalization’ has been introduced by Zola to refer to processes in which the labels ‘healthy’ and ‘ill’ are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally problematic? My thesis is that such a contribution is indeed morally problematic. The concept is sometimes used to express moral intuitions regarding the practice of prevention and health (...) promotion. Through analysis of these intuitions as well as some other moral concerns, I give an explication of the moral problems of medicalization within the context of preventive medicine. (shrink)

At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...) interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach. (shrink)

For contagious diseases like measles a successful immunization program can result in herd protection. Small outbreaks may still occur but fade out soon, because the possibilities for the pathogen to spread in the ‘herd’ are very small. This implies that people who refuse to participate in such a program will still benefit from the protection it offers, but they don’t do their part in maintaining protection. Isn’t that a case of freeriding—and isn’t that unfair towards all the people who do (...) collaborate? If so, that might be considered an additional ground for making vaccination mandatory or compulsory.In this paper I argue that vaccination refusal can be considered as freeriding, but that this might not be unfair. The public good of herd protection is a peculiar public good because it supervenes on private benefits that are enjoyed by all who do opt for vaccination. For vaccinated individuals, the additional benefit of herd protection comes about, as it were, for free, and hence they can’t complain that others benefit without sharing in the burdens. There are however still other grounds for making vaccination compulsory or at least for seeing refusal as a morally wrong choice. (shrink)

Environmental pollution and greenhouse gas emissions that contribute to climate change have adverse impacts on global health. Somewhat paradoxically, health care systems that aim to prevent and cure disease are themselves major emitters and polluters. In this paper we develop a justification for the claim that solidaristic health care systems should include sustainability as one of the criteria for determining which health interventions are made available or reimbursed – and which not. There is however a complication: most adverse health effects (...) due to climate change do occur elsewhere in the world. If solidarity would commit us to take care of everyone’s health, worldwide, it might imply that solidaristic health system cannot justifiably restrict universal access to their own national populations. In response we explain health solidarity is to be considered as a moral ideal. Such an ideal does not specify what societies owe to whom, but it does have moral implications. We argue that ignoring sustainability in political decision making about what health care is to be offered, would amount to betrayal of the ideal of solidarity. (shrink)

One of the societal problems in a new influenza pandemic will be how to use the scarce medical resources that are available for prevention and treatment, and what medical, epidemiological and ethical justifications can be given for the choices that have to be made. Many things may become scarce: personal protective equipment, antiviral drugs, hospital beds, mechanical ventilation, vaccination, etc. In this paper I discuss two general ethical principles for priority setting (utility and equity) and explain how these principles will (...) often point in diverging directions. Moreover, each of these principles can be understood in different, again often competing, ways. Notwithstanding these controversies and conflicts, in the context of pandemic response there are at least some points of convergence: several policies can be justified by appeal to different ethical principles and theories. Convergence may be found with respect to a focus on saving the most lives (instead of other aggregative accounts); giving priority antiviral prophylaxis and therapy for life-saving pandemic responders; and, partly depending on epidemiology of the pandemic, to prioritise vaccination of children. Although decision-making about access to intensive care will involve choices with immediate tragic implications, the ethical complexity of these choices is relatively modest (although decisions will not be easy): there are persuasive moral reasons for giving priority to patients who are expected to benefit most within the shortest time. Finally, in the last section I tentatively argue that constraints on people’s freedom, as necessary for an effective public health approach, may support giving somewhat more weight to saving the most lives, than to concerns of equity. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 16-17, February 2012.

Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses—and ultimately rejects—three such arguments. According to the ‘rule of rescue’ argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will (...) benefit from additional blood screening tests. On the ‘imposed risk’ argument, general cost-effectiveness standards do not apply when healthcare interventions impose risks on patients. This argument ignores the fact that imposing risks on patients is inevitable in healthcare and that these risks can be countered only within reasonable limits. Finally, the ‘manufacturing standard’ argument premises that general cost-effectiveness standards do not apply to procedures preventing the contamination of manufactured medical products. We contend that while this argument seems reasonable insofar as commercially manufactured medical products are concerned, publicly funded blood screening tests should respect the standards for general healthcare. We conclude that these particular arguments are unpersuasive, and we offer directions to advance the debate. (shrink)

Economics is dominated by model building, therefore a comprehension of how such models work is vital to understanding the discipline. This book provides a critical analysis of the economist's favourite tool, and as such will be an enlightening read for some, and an intriguing one for others.

Due to its emphasis on experiential interests, animal ethics tends to focus on individuals as the sole unit of moral concern. Many issues in animal ethics can be fruitfully analysed in terms of obligations towards individual animals, but some problems require reflection about collective dimensions of animal life in ways that individualist approaches can’t offer. Criticism of the individualist focus in animal ethics is not new; it has been put forward in particular by environmental ethics approaches. However, the latter tend (...) to be so far removed from the concerns of animal ethicists that both groups talk at cross purposes. We think the gap between environmental and animal ethics could be bridged by on the one hand focusing more on the collective dimensions of our concerns with animals - after all, individuals are constituted by the collective of which they are a part - and on the other hand, by showing that moral status can also be attributed to groups in an indirect way, related to the moral status of their individual members. In our paper we explore various ways of conceptualising the moral relevance of collectiveness in animal life. We draw on insights from public health ethics, as this field of inquiry has also developed - at least partly—in response to individualist approaches in human bioethics, creating more room for recognizing the value of population health, interpersonal relations, solidarity, and ways in which a collective is constituted. (shrink)

The rule of rescue holds that special weight should be given to protecting the lives of assignable individuals in need, implying that less weight is given to considerations of cost-effectiveness. This is sometimes invoked as an argument for funding or reimbursing life-saving treatment in public healthcare even if the costs of such treatment are extreme. At first sight one might assume that an individualist approach to ethics—such as Scanlon’s contractualism—would offer a promising route to justification of the rule of rescue. (...) In this chapter I argue that contractualism cannot endorse the rule of rescue, whereas a collectivist approach that appeals to group solidarity would offer support for rescue cases. The argument, however, has its limitations, and though solidarity is of central concern in shaping public healthcare, there are good reasons for not endorsing the rule of rescue as a moral basis for allocating scarce resources in clinical care. (shrink)

Control measures directed at carriers of multidrug-resistant organisms are traditionally approached as a trade-off between public interests on the one hand and individual autonomy on the other. We propose to reframe the ethical issue and consider control measures directed at carriers an issue of solidarity. Rather than asking “whether it is justified to impose strict measures”, we propose asking “how to best care for a person’s carriership and well-being in ways that do not imply an unacceptable risk for others?”. A (...) solidarity approach could include elevating baseline levels of precaution measures and accepting certain risks in cases where there is exceptionally much at stake. A generous national compensation policy that also covers for costs related to dedicated care is essential in a solidarity approach. An additional benefit of reframing the questions is that it helps to better acknowledge that being subjected to control measures is a highly personal matter. (shrink)

The title of the article in the initial online publication was mixed up with copy editing information. The original article has been corrected.

Psychologists and neuroscientists extensively rely on computational models for studying and analyzing the human mind. Traditionally, such computational models have been hand-designed by expert researchers. Two prominent examples are cognitive architectures and Bayesian models of cognition. Although the former requires the specification of a fixed set of computational structures and a definition of how these structures interact with each other, the latter necessitates the commitment to a particular prior and a likelihood function that – in combination with Bayes' rule – (...) determine the model's behavior. In recent years, a new framework has established itself as a promising tool for building models of human cognition: the framework of meta-learning. In contrast to the previously mentioned model classes, meta-learned models acquire their inductive biases from experience, that is, by repeatedly interacting with an environment. However, a coherent research program around meta-learned models of cognition is still missing to date. The purpose of this article is to synthesize previous work in this field and establish such a research program. We accomplish this by pointing out that meta-learning can be used to construct Bayes-optimal learning algorithms, allowing us to draw strong connections to the rational analysis of cognition. We then discuss several advantages of the meta-learning framework over traditional methods and reexamine prior work in the context of these new insights. (shrink)

In this paper, we explicate an underappreciated distinction between two conceptions of valuing. According to the first conception, which we call the surface-account, valuing something is exclusively a matter of having certain behavioral, cognitive, and emotional dispositions. In contrast, the second conception, which we call the layer-account, posits that valuing is constituted by the presence of certain representational mental states underlying those dispositions. In the first part of the paper, we introduce the distinction in proper detail and show that the (...) accounts have different implications regarding the valuings of agents. In the second part, we situate the accounts within the extant philosophical literature. First, we relate them to the recent debate between so-called dispositionalists and representationalists about the nature of beliefs and point out that this debate can help anticipate some of the main dialectical fault lines to be expected between surface- and layer-theorists. Second, we examine the contemporary meta-ethical debate on conceptualizing valuing, indicate that scholars have largely ignored the distinction introduced here, and outline that this oversight has substantial theoretical costs: as we show, key arguments within the meta-ethical debate require thorough re-evaluation in light of the proposed distinction. The third part of the paper illustrates the theoretical leverage of the distinction for practical research by exploring its implications for behavioral welfare economics. (shrink)

The curious philosopher often answers questions by raising further, more fundamental questions. How can this be fruitful and practical in the context of Wageningen University? Philosophy offers critical reflection on conceptual and normative assumptions in science and society, and that is necessary for responsible practices. I illustrate this by analyzing the concept of quality of life – a key value in the mission of our university – and by questioning current debates about responsibility for health.

Inleiding tot het gedachtegoed van de Griekse filosoof die het vermijden van lichamelijke pijn en geestelijke onrust als het hoogste goed beschouwde..

As many moral problems have a very complex nature, moral reasoning towards a justified decision in such cases may be as difficult. Many considerations have to be taken into account in order to reach a judgement based on good reasons. May the computer, as a tool in data processing, be of use for ethical decision-making? In this paper I will argue that we should be very careful in developing and using ethical expert-systems. Next, I will explain how the computer may (...) be a useful ‘tool’ for instruction in moral reasoning. This will be done by presenting a model for Computer Assisted Instruction in ethics. Finally, I will describe the outline of a CAI program according to this model and discuss some problems which are encountered in designing this program. (shrink)

Ecological thought has made a deep and apparently lasting impact on virtually every tradition in political theory (cf. e.g. Dobson, 2007) with the exception of libertarianism. While left- and right...

In this chapter, we discuss a specific kind of progress in economics, namely, progress that is pushed by the repeated use of mathematical models in most sub-branches of economics today. We adopt a functional account of progress to argue that progress in economics occurs via the use of what we call ‘common recipes’ and the use of model templates to define and solve problems of relevance for economists. We support our argument by discussing the case of twentieth-century business cycle research. (...) By presenting this case study in detail, we show how model templates are not only re-applied to different phenomena. We also show how scientists come up with them in the first place and how – once they are considered less useful – they are replaced with new ones. Finally, our case also illustrates that it is not only the mathematical structure that is re-used but that such a re-use also requires a shared conceptual vision of core properties of the phenomenon. If that vision is not shared anymore among economists, a model template can become useless and has to be replaced – sometimes through overcoming resistance – with a different one. (shrink)

The Representational Theory of Measurement conceives measurement as establishing homomorphisms from empirical relational structures into numerical relation structures, called models. Models function as measuring instruments by transferring observations of an economic system into quantitative facts about that system. These facts are evaluated by their accuracy. Accuracy is achieved by calibration. For calibration standards are needed. Then two strategies can be distinguished. One aims at estimating the invariant (structural) equations of the system. The other is to use known stable facts about (...) the system to adjust the model parameters. For this latter strategy, the requirement of models as homomorphic mappings is not required anymore. (shrink)

In this paper, I argue that the disjunction elimination rule presupposes the principle that a true disjunction contains at least one true disjunct. However, in some contexts such as supervaluationism or quantum logic, we have good reasons to reject this principle. Hence, disjunction elimination is restricted in at least one respect: it is not applicable to disjunctions for which this principle does not hold. The insight that disjunction elimination presupposes the principle that a true disjunction contains at least one true (...) disjunct is applied to two arguments which argue for this very principle. I show that these arguments are rule-circular since they rest on disjunction elimination. I claim that rule-circularity better explains why the arguments fail than the explanations provided by Rumfitt (2015), which, for instance, rely on controversial principles about truth. (shrink)

Templates travel because they offer a tractable format that can be used for model-building in a variety of domains. It is often because of this quality that a particular template is chosen. But one cannot assume that there are always templates ready to model a new phenomenon, and moreover, templates have also been designed at some point. A critical aspect of this designing process is the choice of the mathematical objects with which one hopes to capture this phenomenon. This means (...) that one has to assess which of the properties of different kinds of mathematical objects and which combinations of them are most appropriate. The selection of these objects is based on whether their properties enable the model to perform its function. This selection of mathematical objects is similar to the selection of materials in mechanical design. (shrink)

Scientific measurements are made objective through the use of reliable instruments. Instruments can have this function because they can - as material objects - be investigated independently of the specific measurements at hand. However, their materiality appears to be crucial for the assessment of their reliability. The usual strategies to investigate an instrument’s reliability depend on and assume possibilities of control, and control is usually specified in terms of materiality of the instrument and environment. The aim of this paper is (...) to investigate the problem of reliability for non-material instruments, the instruments being applied in the social sciences. Any possible lack of reliability of the instrument hinders the measurements of ever becoming objective. (shrink)

We provide complete classifications of algebras of partial maps for a significant swathe of combinations of operations not previously classified. Our focus is the many subsidiary operations that arise in recent considerations of the ‘override’ and ‘update’ operations arising in specification languages. These other operations turn out to have an older pedigree: domain restriction, set subtraction and intersection. All signatures considered include domain restriction, at least as a term. Combinations of the operations are classified and given complete axiomatizations with and (...) without the presence of functional composition. Each classification is achieved by way of providing a concrete representation of the corresponding abstract algebras as partial maps acting on special kinds of filters determined with respect to various induced orders. In contrast to many negative results in the broader area, all of the considered combinations lead to finite axiomatizations. (shrink)

The metrology literature neglects a strong empirical measurement tradition in economics, which is different from the traditions as accounted for by the formalist representational theory of measurement. This empirical tradition comes closest to Mari's characterization of measurement in which he describes measurement results as informationally adequate to given goals. In economics, one has to deal with soft systems, which induces problems of invariance and of self-awareness. It will be shown that in the empirical economic measurement tradition both problems have been (...) on the agenda for a long while, and that the proposed solutions to these problems provide clues for the directions in which one could develop a measurement theory that takes account of soft systems. (shrink)

Even though it is often presumed that the use of technology like medication administration technology is both safer and more effective, the importance of nurses' know‐how is not to be underestimated. In this article, we accordingly try to argue that nurses' labor, including their different forms of knowledge, must play a crucial role in the development, implementation and use of medication administration technology. Using three different theoretical perspectives (‘heuristic lenses') and integrating this with our own ethnographic research, we will explore (...) how nursing practices change through the use of medication technology. Ultimately, we will argue that ignoring (institutional) complexity and the various types of important knowledge that nurses have, will seriously complicate the implementation of medication administration technology. (shrink)

The practice of economic science is dominated by model building. To evaluate economic policy, models are built and used to produce numbers to inform us about economic phenomena. Although phenomena are detected through the use of observed data, they are in general not directly observable. To 'see' them we need instruments. More particularly, to obtain numerical facts of the phenomena we need measuring instruments. This paper will argue that in economics models function as such instruments of observation, more specific as (...) measuring instruments. In measurement theory, measurement is a mapping of some class of aspects of characteristics of the empirical world into a set of numbers. The paper's view is that economic modelling is a specific kind of mapping to which the standard account on how models are obtained and assessed does not apply. Models are not easily or simply derived from theories and subsequently tested against empirical data. Instruments are constructed by integrating several theoretical and empirical ideas and requirements in such a way that their performance meets a beforehand chosen standard. The empirical requirement is that the model should take account of the phenomenological facts, so that the reliability of the model is not assessed by post-model testing but obtained by calibration. (shrink)