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)

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)

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)

The dimensionality of the Questionnaire for Eudaimonic Well-Being has been a topic of debate and divergent findings in the literature up to date. This study investigated the factor structure and measurement invariance of the QEWB in four culturally diverse South African samples using confirmatory factor analysis, bifactor CFA, exploratory structural equation modelling, and bifactor ESEM. Three student samples completed the English, Afrikaans, or Setswana version of the QEWB. An adult sample completed the English version. The one-factor structure revealed poor fit (...) for the student samples. Although the four-factor models generally showed slightly better fit than the three-factor models, the latter was preferred for parsimony. The bifactor ESEM model displayed good fit for the student samples, with the general factor and some specific factors attaining sufficient reliability scores, pointing to the potential use of the scale in these samples. Configural invariance between the student samples was supported, but not metric nor scalar invariance. For the adult sample, none of the models displayed good fit and the use of the QEWB in this sample is not recommended. The results point towards the existence of a global eudaimonic well-being factor and, at the same time, the interrelatedness of facets of eudaimonic well-being. It suggests that eudaimonic well-being may be represented by the same items across the three student groups. The influence of developmental phase on the manifestation and measurement of eudaimonic well-being should be explored in future. (shrink)

Clinical biobanks processing data of participants in the European Union fall under the scope of the General Data Protection Regulation, which among others includes requirements for consent. These requirements are further specified by the Article 29 Working Party —an EU advisory body currently known as the European Data Protection Board. Unfortunately, their guidance is cause for some confusion. While the GDPR allows participants to give broad consent for research when specific research purposes are still unknown, the WP29 guidelines suggest that (...) additional consent for specific uses should be obtained in addition to broad consent when this becomes applicable. This discrepancy elicits the question whether clinical biobanks can fail the requirement of consent if they obtain broad consent, but not a specific consent for each biomedical study. We analysed this discrepancy within the framework of contextual integrity, in order to describe the context-relative informational norms that govern information flows in clinical biobanks. However, our analysis demonstrates that there is no uniform set of norms that can be applied to all clinical biobanks. As such, neither the GDPR nor the WP29 guidance can act as a “one size fits all” approach to all clinical biobanks. Rather, differences between clinical biobanks—especially regarding the scientific aims and patient populations—make the case for context-relative norms that determine the appropriate type of consent. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

In recent years there has been an increasing focus on the role of instruments in the study of nature, both by historians and by philosophers of science, and even by a few art historians who are interested by the images produced by these devices.

The empiricism of eighteenth-century experimental science meant that the development of scientific instruments influenced the formulation of new concepts; a two-way process for new theory also affected instrument design. This relationship between concept and instrumentation will be examined by tracing the development of electrical instruments and theory during this period. The different functions fulfilled by these devices will also be discussed. Empiricism was especially important in such a new field of research as electricity, for it gave rise to phenomena that (...) could not have been predicted by theory alone. However, the interpretation of these phenomena, and what the natural philosopher thought he observed, were often unconsciously determined by current ideas and attitudes; the interaction between instrumentally induced phenomena and observation was more complex than was realized at the time. The shortcomings of this empirical approach will be discussed. In the case of electricity this became increasingly apparent during the latter part of the century. The many discoveries had to be placed in a unifying framework before new advances could be made. Instruments, however, continued to play an important role in scientific progress, for they made visible what was hidden in nature. (shrink)

The real impetus for the research in underwater acoustics was the German U-boat menace of World War I. Traditional naval methods were of little use against the submarine, and thus British scientists concentrated on underwater detection. This led to the development of the hydrophone , which was extensively used during the war. As this instrument had many drawbacks, a small British team started to investigate an ‘active’ detection device in 1917. This was instigated by the work of the French physicist (...) Paul Langevin, supported by his government, and was based on the reflection of underwater acoustic waves off a submarine's hull. The Royal Navy called this highly secret device ‘asdic’ . It did not become operational during World War I, and the embryo naval scientific service founded during the last year of the war, continued its development during the interwar years. The Admiralty's optimism concerning the potential effectiveness of asdics influenced British naval policy during these years.In this paper, the scientific, political and organisational factors that influenced the development of naval underwater acoustics will be discussed. World War I was the first war in which civilian scientists played an important part. Their involvement in the war had a great impact on the attitude of the Royal Navy towards scientific research, and their work on underwater acoustics was partly responsible in establishing a proper naval scientific service. Scientific development was now organised in the Navy, with the consequence of accelerating the introduction of new devices into the fleet. (shrink)

This comparative content analysis of Belgian and Swedish newspaper coverage of the ‘refugee situation’ in 2015 (N=898) revolves around responsibility indicators, news actor characteristics, and thematic emphasis. As they are a potential influential factor in the public-opinion formation process, the studying of media portrayals is an essential first step in investigating the dynamic interplay between media discourse and societal reactions. Belgium and Sweden differ with respect to migration policy, integration indicators, and the number of incoming refugees. They also differ in (...) terms of journalistic cultural values. As a result, they make for an excellent case study of intercultural differences and similarities in how refugees are reported on. Our analysis made clear that Belgian news coverage shows regional diversity, with Francophone Belgian journalists showing more tolerance towards migrants and thus tending to be more in line with their Swedish counterparts. Still, refugees are seldom allowed to speak for themselves. This warrants attention and action by news professionals. (shrink)

Belgium, and Europe in general, has seen a strong increase in the number of refugees arriving over the past three years. At the same time we also note an increasing polarization of Belgian public opinion on this subject. Among the main actors to shape this public opinion are news media, as they contribute to or combat stereotyping of (sub)groups in the population. The purpose of the current study is to analyze to which extent media consumption and trust have an impact (...) on public opinion on two minority groups – immigrants and refugees – in a representative sample of the Belgian adult population (n = 1500). We gathered data on Belgian news media consumption and trust, and attitudes on immigrants and refugees through an online questionnaire. The results indicate that Belgian adults hold more positive attitudes on immigrants than on refugees. The reading of quality online newspapers as well as high levels of trust in television and radio are correlated with a positive attitude towards both groups, whereas the consumption of commercial television and popular newspapers go along with a negative attitude. Fear of terrorism (negative relation) and a negative evaluation of media coverage of refugees (positive relation) also have a sizeable influence. In terms of regional differences within Belgium, we find that citizens in the Brussels Capital Region hold more positive attitudes towards both groups than those in Flanders and Wallonia. (shrink)

We review recent progress in the stem cell biology of the respiratory system, and discuss its scientific and translational ramifications. Several studies have defined novel stem cells in postnatal lung and airways and implicated their roles in tissue homeostasis and repair. In addition, significant advances in the generation of respiratory epithelium from pluripotent stem cells (PSCs) now provide a novel and powerful platform for understanding lung development, modeling pulmonary diseases, and implementing drug screening. Finally, breakthroughs have been made in the (...) generation of decellularized lung matrices that can serve as a scaffold for repopulation with respiratory cells derived from either postnatal or PSCs. These studies are a critical step forward towards the still distant goal of stem cell‐based regenerative medicine for diseases of lung and airways. (shrink)

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

At the beginning of 2020, COVID-19 became a global problem. Despite all the efforts to emphasize the relevance of preventive measures, not everyone adhered to them. Thus, learning more about the characteristics determining attitudinal and behavioral responses to the pandemic is crucial to improving future interventions. In this study, we applied machine learning on the multi-national data collected by the International Collaboration on the Social and Moral Psychology of COVID-19 (N = 51,404) to test the predictive efficacy of constructs from (...) social, moral, cognitive, and personality psychology, as well as socio-demographic factors, in the attitudinal and behavioral responses to the pandemic. The results point to several valuable insights. Internalized moral identity provided the most consistent predictive contribution—individuals perceiving moral traits as central to their self-concept reported higher adherence to preventive measures. Similar was found for morality as cooperation, symbolized moral identity, self-control, open-mindedness, collective narcissism, while the inverse relationship was evident for the endorsement of conspiracy theories. However, we also found a non-negligible variability in the explained variance and predictive contributions with respect to macro-level factors such as the pandemic stage or cultural region. Overall, the results underscore the importance of morality-related and contextual factors in understanding adherence to public health recommendations during the pandemic. (shrink)