Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

BackgroundNew disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future.MethodsPatients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available (...) knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences.ResultsA substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs.ConclusionsMost of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells. (shrink)

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

Based on two case studies of the design of electronic communication networks developed in the public and private sector, this article explores the barriers within current design cultures to account for the needs and diversity of users. Whereas the constraints on user-centered design are usually described in macrosociological terms, in which the user–technology relation is merely understood as a process of the inclusion or exclusion of users in design, the authors suggest that it is important to adopt a semiotic approach. (...) Moreover, they argue that we need to take into account the gender identity of designers to understand how design practices in ICT prioritize male users. The article shows how configuring the user as “everybody” and the use of the “I-methodology” are important constraints in the development of technologies that aim to reach users in all their diversity. (shrink)

This article contributes to Science and Technology Studies on vulnerability by putting cyborgs at center stage. What vulnerabilities emerge when technologies move under the skin? I argue that cyborgs face new forms of vulnerability because they have to live with a continuous, inextricable intertwinement of technologies and their bodies. Inspired by recent feminist studies on the lived intimate relationships between bodies and technologies, I suggest that sensory experiences, material practices, and cartographies of power are important heuristic tools to understand the (...) vulnerabilities of hybrid bodies. Based on an analysis of how patients in the Netherlands and the United States cope with appropriate and inappropriate implantable cardioverter defibrillator shocks, I describe how defibrillators introduce two new kinds of vulnerabilities: vulnerability as an internal rather than an external threat, and as harm you may try to anticipate but can never escape. Despite these vulnerabilities, some heart patients don’t position themselves as passive victims of faulty machines. They actively engage in material practices of resilience by using magnets to stop inappropriate shocks. I conclude that anticipating and taming the improper working of technologies inside bodies constitutes a new form of invisible labor that is crucial to diminishing the existential uncertainties of cyborgs. (shrink)

In the last fifteen years, testing has attracted much attention in science and technology studies. Most researchers have focused almost exclusively on testing in the laboratory, specifically designed test locations, and, for medical technologies, the clinic. What counts as testing has largely been described in terms of the activities of scientific experts. This is not to say that science and technology studies have completely neglected other institutional discourses. Journalistic texts have been a favorite research site for scholars in science and (...) technology studies, particularly those seeking to understand the dynamics of public controversies on science and technology. Although most constructivist studies of science and media relations have treated journalistic texts as secondary to scientific texts, other scholars have dismissed this hierarchy. In this article, scientific texts and journalistic texts are considered equally important locations in which to analyze the testing of technologies. Based on a case study on the testing of a new contraceptive technology for men, the article shows that what counts as successful testing is not solely in the hands of scientific experts. In the case of male contraceptive technologies, journalists have contested the claims of scientific experts, particularly their claims about the cultural feasibility of the new technology. (shrink)

Studies of drug development have described the role of clinical trials in the selection of drug profiles. This article presents a case study of the development of hormonal drugs in the 1920s and 1930s to illustrate that clinical trials have a more extensive role than is assumed. Clinical trials are instrumental in mediating the relationships between the pharmaceutical industry, the laboratory, and the clinic, resulting in a network of actors collectively creating medical knowledge, drugs, and markets for these drugs.

The role of users in innovation processes has gained increasing attention in innovation studies, technology studies, and media studies. Scholars have identified users and use practices as a source of innovation. So far, however, little insight has been generated in innovation processes in which communities of users are the driving force in all phases of the innovation process. This article explores the conceptual vocabularies of innovation studies and actor— network theory and discusses their adequacy for describing and understanding the dynamics (...) of user-initiated innovation processes in which community and innovation are closely intertwined. The authors introduce the concept of community innovation and argue for its relevance for understanding the full dynamics of innovations initiated and shaped by user collectives. The article elaborates a qualitative case study of Wireless Leiden, a local wireless network infrastructure in the Dutch town of Leiden initiated, designed, and maintained by a local community of users. (shrink)

Recognizing the importance of health‐promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client–provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client–provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic‐level and broader social and health (...) policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in‐depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as ‘good’ or ‘bad’. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers’ and clients’ negotiated relationships are explored, but this is couched within both local and system‐level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. (shrink)

The aim of this study was to explore stakeholder perceptions of the contribution of an Automatic Milking System (AMS) to sustainable development of organic dairy production in Denmark and the Netherlands. In addition, reasons for the current difference in AMS use on organic dairy farms between both countries were explored. To answer above mentioned aims, farmers and advisors in both countries were interviewed using a focus group approach. Questions of the interviews were based on a literature review on sustainability issues (...) affected by introduction of AMS. Participants expressed no moral problems regarding AMS use. They, however, pointed out uncertainty about the economic gain, difficulties with grazing, adaptation problems to technology, and image problems towards consumers. The latter results from a reduction in grazing time affecting both animal welfare and product quality. The participants did not recognize eutrophication, as result of high stocking density on farmstead lots, as a problem caused by AMS. The milk quality problem related to AMS use, although acknowledged as crucial towards consumers, was not prioritized very highly, especially not by the farmers in both countries. All groups were, however, unanimous in their perception of how important image was as far as the consumers are concerned. The perception analysis revealed that Dutch participants were more concerned about the economic payoff of AMS use, and showed more reluctance towards enlargement than Danish ones. In addition, they acknowledged the small-scale naturalness of organic production. These differences in perception could possibly explain observed differences in AMS use in organic dairy production between Denmark and the Netherlands. (shrink)

The aim of this study was to explore stakeholder perceptions of the contribution of an Automatic Milking System (AMS) to sustainable development of organic dairy production in Denmark and the Netherlands. In addition, reasons for the current difference in AMS use on organic dairy farms between both countries were explored. To answer above mentioned aims, farmers and advisors in both countries were interviewed using a focus group approach. Questions of the interviews were based on a literature review on sustainability issues (...) affected by introduction of AMS. Participants expressed no moral problems regarding AMS use. They, however, pointed out uncertainty about the economic gain, difficulties with grazing, adaptation problems to technology, and image problems towards consumers. The latter results from a reduction in grazing time affecting both animal welfare and product quality. The participants did not recognize eutrophication, as result of high stocking density on farmstead lots, as a problem caused by AMS. The milk quality problem related to AMS use, although acknowledged as crucial towards consumers, was not prioritized very highly, especially not by the farmers in both countries. All groups were, however, unanimous in their perception of how important image was as far as the consumers are concerned. The perception analysis revealed that Dutch participants were more concerned about the economic payoff of AMS use, and showed more reluctance towards enlargement than Danish ones. In addition, they acknowledged the small-scale naturalness of organic production. These differences in perception could possibly explain observed differences in AMS use in organic dairy production between Denmark and the Netherlands. (shrink)

There was more to Blaise Pascal than his "wager," an argument about the existence of God. In this accessible study, philosopher Douglas Groothuis introduces readers to Pascal's life as well as the breadth of his intellectual pursuits, overviewing the key points of his Pensées and exploring his views on culture, politics, and more.

In Think 7, Nigel Warburton attacked Pascal's famous wager on the existence of God. Here, Douglas Groothuis resurrects Pascal to defend the wager.

I'd rather not be an idiot and neither would you. One useful tool in avoid idiocy and figuring out what's true is to be aware of logical fallacies. Some errors in thinking are so common that they have been named in infamy. This article is an anti-idiocy vaccine to immunize you to common fallacies such as poisoning the well, begging the question, false dichotomy, and others, in order to give you a better shot at avoiding fallacy and finding out what's (...) true. (shrink)

Philosophy in only seven sentences? -- Protagoras, man is the measure of all things -- Socrates, the unexamined life is not worth living -- Aristotle, man by nature desires to know -- Augustine, you have made us for yourself, and our hearts are restless until they rest in thee -- Descartes, I think, therefore I am -- Pascal, the heart has reasons, that reason knows nothing of -- Kierkegaard, the greatest hazard of all, losing one's self, can occur very quietly (...) in the world, as if it were nothing at all -- What about these seven sentences? or a final provocation. (shrink)

ABSTRACTEmpathy is an underexplored dimension of the moral life. What if we could enter a machine that let us feel another person's subjective life? What kind of effect would that have on our moral awareness? Since this cannot be done, I suggest several ways to increase empathy and deepen our moral sensitivities.

The postmodern rejection of essentialism does not mean that feminist theorists must abandon all categorizations of women. Indeed, while it is important to deconstruct identities and highlight the differences among women, we need to arrive at some notion of gender identity for political purposes. In paying careful attention to the distinction between nominal essences and real essences, the author shows that the category of women can be maintained without resorting to the problems of traditional essentialism. The author argues that the (...) marginalization of women is a product of culturally determined identities rather than ontological differences between men and women.Le refus postmoderne de l’essentialisme ne signifie pas que la théorie féministe doive abandonner toutes catégorisations de femmes. En effet, bien qu’il soit important de déconstruire les identités et mettre en valeur les différences parmi les femmes, il faut en arriver à une certaine notion d’identité sexuelle pour des raisons politiques. Se laissant guider par la distinction entre essences nominale et réelle,l’auteure montre que la catégorie de femme peut être maintenue tout en éludant les problèmes de l’essentialisme traditionnel. L’auteure soutient que la marginalisation des femmes est le produit d’identites determinées culturellement plutôt que de différences ontologiques entre hommes et femmes. (shrink)

The postmodern rejection of essentialism does not mean that feminist theorists must abandon all categorizations of women. Indeed, while it is important to deconstruct identities and highlight the differences among women, we need to arrive at some notion of gender identity for political purposes. In paying careful attention to the distinction between nominal essences and real essences, the author shows that the category of women can be maintained without resorting to the problems of traditional essentialism. The author argues that the (...) marginalization of women is a product of culturally determined identities rather than ontological differences between men and women.Le refus postmoderne de l’essentialisme ne signifie pas que la théorie féministe doive abandonner toutes catégorisations de femmes. En effet, bien qu’il soit important de déconstruire les identités et mettre en valeur les différences parmi les femmes, il faut en arriver à une certaine notion d’identité sexuelle pour des raisons politiques. Se laissant guider par la distinction entre essences nominale et réelle,l’auteure montre que la catégorie de femme peut être maintenue tout en éludant les problèmes de l’essentialisme traditionnel. L’auteure soutient que la marginalisation des femmes est le produit d’identites determinées culturellement plutôt que de différences ontologiques entre hommes et femmes. (shrink)

This festschrift collects a number of insightful essays by a group of accomplished Christian scholars, all of who have either worked with or studied under Hendrik Hart during his 35-year tenure as Senior Member in Systematic Philosophy at the Institute for Christian Studies, Toronto, Canada.

Research has shown high levels of housing precarity among government-assisted refugees connected to difficult housing markets, limited social benefits, and other social and structural barriers to positive settlement. The COVID-19 pandemic has likely exacerbated this precarity. Research to date demonstrates the negative consequences of the COVID-19 pandemic for refugees and low-income households, including both health-related issues and economic challenges, that may exacerbate their ability to obtain affordable, suitable housing. In this context, we examined Syrian government-assisted refugees’ experiences during the pandemic, (...) asking: how the COVID-19 pandemic has impacted Syrian refugees’ experiences of housing stability. To examine this issue, we interviewed 38 families in Calgary, London, and Fredericton. Using a qualitative descriptive methodology for analysis and interpretation, we found the liminality of settling as a GAR has been compounded by isolation, further economic loss, and new anxieties during the pandemic. Ultimately, for many participants, the pandemic has thwarted their housing stability goals and decreased their likelihood of improving their housing conditions. Based on our findings, we discuss potential policy and practice relevant solutions to the challenges faced by refugees in Canada during the pandemic and likely beyond. (shrink)