Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts (...) on self and others. The paper shows: that the impact of incidental findings may be greater than participants at first let on; incidental findings can have significant effects on participants’ social environment; and participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. (shrink)

Priority setting is inevitable to control expenditure on expensive medicines, but citizen support is often hampered by the workings of the ‘identified victim effect’, that is, the greater willingness to spend resources helping identified victims than helping statistical victims. In this paper we explore a possible cognitive debiasing strategy that is being employed in discussions on healthcare priority setting, which we call ‘empathy counterbalancing’ (EC). EC is the strategy of directing attention to, and eliciting empathy for, those who might be (...) harmed as a result of one-sided empathy for the very ill who needs expensive treatment. We argue that governments have good reasons to attempt EC because the identified victim effect distorts priority setting in ways that undermine procedural fairness. We briefly outline three areas of application for EC and suggest some possible mechanisms that might explain how EC might work, if at all. We then discuss four potential ethical concerns with EC. First, EC might have the counterproductive effect of reducing overall citizen support for public funding of expensive medical treatments, thereby undermining solidarity. Second, EC may give rise to a ‘competition in suffering’, which may have unintended side effects for patients who feature in attempts at EC. Third, there may be doubts about whether EC is effective. Fourth, it may be objected that EC comes down to emotional manipulation, which governments should avoid. We conclude that insofar these concerns are valid they may be adequately addressed, and that EC seems a promising strategy that merits further investigation. (shrink)

BackgroundCountries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants.DiscussionResearch ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs (...) can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices.The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals.ConclusionOutcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? (shrink)

Physical environmental factors – or ‘artifacts’ – are linked to healthcare outcomes in the field of social psychology. However, the role of artifacts remains rarely examined in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts – such as provider clothing and office décor – may carry significant potential in eliciting placebo effects in clinical settings. We discuss three potential mechanisms by which artifacts may enhance or diminish placebo (or nocebo) effects: classical (...) conditioning, response expectancy, and mindsets. We propose testable hypotheses and conclude by providing innovative research designs that might help to better advance this novel research agendum. (shrink)

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the value of (...) five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7.% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

Dementia is a growing issue at the end of life that presents unique challenges for advance care planning. Advance directives are a useful and important component of end-of-life planning, but standard advance directives have less utility in cases of loss of capacity due to dementia. An advance directive designed to specifically address end-of-life issues in the setting of dementia can provide patients with increased autonomy and caregivers with improved information about the desires of the individual in question. The Dartmouth Dementia (...) Directive is a dementia-specific advance directive, available online, that seeks to address common concerns of individuals who are planning for dementia-related end-of-life care. This directive was piloted in a community-based workshop, which provided important details and perspective on the best use of dementia-specific advance directives in the greater population. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Quarterly publication discussing various topics in environmental ethics, including features, discussion papers, book reviews, editorial commentaries, and other text related to environmental philosophies. Some issues also include announcements and other news related to the environmental studies community.

Researchers from diverse disciplines, including organismal and cellular physiology, sports science, human nutrition, evolution and ecology, have sought to understand the causes and consequences of the surprising variation in metabolic rate found among and within individual animals of the same species. Research in this area has been hampered by differences in approach, terminology and methodology, and the context in which measurements are made. Recent advances provide important opportunities to identify and address the key questions in the field. By bringing together (...) researchers from different areas of biology and biomedicine, we describe and evaluate these developments and the insights they could yield, highlighting the need for more standardisation across disciplines. We conclude with a list of important questions that can now be addressed by developing a common conceptual and methodological toolkit for studies on metabolic variation in animals. (shrink)

In this article, we will describe higher order thought theories of consciousness. Then we will describe some examples from synesthesia. Finally, we will explain why the latter may be relevant to the former.

Fred Adams and Charlotte Shreve ABSTRACT: Last year Charlotte Shreve and I presented an argument that synesthesia contains evidence against higher order thought theories of consciousness. Rocco Gennaro took up the challenge and argued that H.O.T. theories like his could handle the example and dismiss the argument. Below we suggest...

Last year Charlotte Shreve and I (Adams and Shreve 2016) presented an argument that synesthesia contains evidence against higher order thought theories of consciousness. Rocco Gennaro (2016) took up the challenge and argued that H.O.T. theories like his could handle the example and dismiss the argument. Below we suggest otherwise. We think the traditional versions of H.O.T. theory are still vulnerable to our argument and we maintain that Gennaro’s version is as well.

THE MOST SACRED FREEDOM includes eight essays that were first presented at the 2014 A.V. Elliott Conference on Great Books and Ideas, the seventh annual conference sponsored by Mercer Universitys Thomas C. and Ramona E. McDonald Center for Americas Founding Principles. Together, these essays explore the great principle of religious liberty by charting its development in the Western tradition and reconsidering its place at Americas founding. The book begins with a comparison between the flood accounts in Genesis and the Mesopotamian (...) Atra-Has's and advances all the way to the 2014 Supreme Court case Burwell v. Hobby Lobby. The intervening chapters examine the contributions of figures such as Emperor Julian, Roger Williams, Cecilius Calvert, John Locke, Jean-Jacques Rousseau, and the American Founders. Contributors to the volume are Steven Grosby, Jeremiah H. Russell, Maura Jane Farrelly, Daniel Cullen, John Witte, Jr., Scott Yenor, David Ramsey, and Michael Novak. (shrink)

(2006). First thoughts: An unpublished letter from Gilbert Ryle to H. J. Paton∗. British Journal for the History of Philosophy: Vol. 14, No. 4, pp. 747-756.

This article introduces three princesses: Princess Elizabeth of Bohemia (1618-1680); her sister, Princess Sophie who became the Electress of Hanover (1630-1714); and Sophie's daughter, Sophie Charlotte, who became the first Queen of Prussia (1668-1705). After summarizing their common family background, the article presents, for each in turn, her biography and a discussion of her relation to philosophy. In each case their philosophical involvement stems from their friendships with the leading philosophers of their day; Princess Elizabeth was a friend of (...) Descartes while the Electress Sophie and Sophie Charlotte were friends of Leibniz. The article concludes that anyone who has made the acquaintance of the three princesses and has studied their interaction with their philosopher-friends will always see them as part of the history of modern philosophy. (shrink)

This volume consists of autobiographical by the following scholars, together with pictures and autographs: Raven I. McDavid, Jr., Henry M. Hoenigswald, John B. Carroll, William G. Moulton, Archibald A. Hill, Yakov Malkiel, Charles F. Hockett, Harold B. Allen, William Bright, Einar Haugen, George S. Lane, Frederic G. Cassidy, James B. McMillan, Winfred P. Lehmann, Fred W. Householder, and Dell Hymes. A master list of references, and an index of persons conclude the volume.

“The sleeper awakes” is a convention of many literary utopias from the late nineteenth and early twentieth centuries. The plots of Edward Bellamy’s Looking Backward, William Morris’s News from Nowhere, and H. G. Wells’sWhen the Sleeper Wakes all famously involve a sleeping modern everyman who awakens to a future where the conflicts and contradictions of the burgeoning capitalist society have been resolved. The Bleilers identify dozens of other speculative novels from the same period employing this very device, such as William (...) Hudson’s A Crystal Age and Alvarado Fuller’s A.D. 2000.1 Chris Ferns has argued that this trope constitutes something of a “consoling... (shrink)

Aristotle's defense of Dunamis -- Power and potentiality -- Rational and nonrational powers -- The priority of actuality -- Ontological hierarchy, normativity, and gender.

Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called ‘open notes’). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes—the potential to increase ‘nocebo effects’. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, (...) and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify ‘closed notes’, and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route. (shrink)

It is a genuine pleasure to engage with the insightful and generous comments of my colleagues. I have learned a lot from them, and I hope to continue our conversations in the future. The range of c...

In this paper I argue that from a feminist perspective well-being is most productively defined in relation to freedom, and it is with regard to questions of freedom that well-being should be pursued. Pursuing well-being from a starting point of oppression and working towards an ideal of freedom, involves two things: a reconception of the self as fundamentally relational and an emphasis on the importance of self-understanding for well-being. The former is something that has been widely acknowledged in the feminist (...) literature, where relational conceptions of the self figure centrally, and the notion of a socially situated self has been identified as one of the key contributions to living well from a feminist perspective. Self-understanding, however, has been largely ignored in feminist accounts of well-being, where the social aspects of well-being are often emphasised to the detriment of individual considerations. I argue that this can cause problems for well-being as the pursuit of freedom, but that such problems can be overcome by supplementing the relational account of the self with an emphasis on self-understanding and highlighting the interrelation between them in the pursuit of well-being qua freedom from oppression. (shrink)

This paper argues that close personal relationships play an important role in our judgments about what is fair. I start with an explanation of leading theories of fairness, highlighting the potential for further work on the grounds of fairness. Next, I offer an account of close personal relationships as having the ability to generate legitimate and reasonable expectations of one or other party to a judgment about fairness, or both. I show how and when close personal relationships can ground fairness.

This article focuses on three themes concerning determinism and indeterminism. The first theme is observational equivalence between deterministic and indeterministic models. Here I discuss several results about observational equivalence and present an argument on how to choose between deterministic and indeterministic models involving indirect evidence. The second theme is whether Newtonian physics is indeterministic. I argue that the answer depends on what one takes Newtonian mechanics to be, and I highlight how contemporary debates on this issue differ from those in (...) the nineteenth century. The third major theme is how the method of arbitrary functions can be used to make sense of deterministic probabilities. I discuss various ways of interpreting the initial probability distributions and argue that they are best understood as physical, biological etc. quantities characterising the particular situation at hand. Also, I emphasise that the method of arbitrary functions deserves more attention than it has received so far. (shrink)

This biography of Hypatia, the female philosopher and mathematician in Christian Egypt, provides background on her work and her life as an elite woman at this time. There are many myths about Hypatia, including her research, inventions and the impact of her murder, all based on a handful of contemporary resources. Through presenting the different theories and myths alongside the available evidence, this book will enable the reader to make their own interpretations about her life. Whilst the evidence does leave (...) many questions unanswered, this book provides the evidence as it stands, separating the myth from reality. There is very little published on Hypatia and she forms quite a niche market in the history of ancient Egypt. However, she is an interesting example of how multicultural Alexandria functioned at such an unstable political time, and provides anecdotal evidence of the atrocities that occurred. This book will appeal to scholars, lay people and political and religious researchers, and will show that the history of Egypt does not end at Cleopatra. (shrink)

With Hegel’s metaphysics attracting renewed attention, it is time to address a long-standing criticism: Scholars from Marx to Popper and Habermas have worried that Hegel’s metaphysics has anti-individualist and authoritarian implications, which are particularly pronounced in his Philosophy of History, since Hegel identifies historical progress with reason imposing itself on individuals. Rather than proposing an alternative non-metaphysical conception of reason, as Pippin or Brandom have done, this article argues that critics are broadly right in their metaphysical reading of Hegel’s central (...) concepts. However, they are mistaken about what Hegel’s approach entails, when one examines the specific types of states discussed by the philosopher in his Philosophy of History. Even on a traditional metaphysical reading, Hegel is not only non-authoritarian; he also makes a powerful argument concerning freedom, whereupon the freest society involves collective oversight and the shaping of social structures so as to ensure that they benefit everybody. (shrink)

This article discusses an interpretation of Kant's conception of transcendental subjectivity, which manages to avoid many of the concerns that have been raised by analytic interpreters over this doctrine. It is an interpretation put forward by selected C19 and early C20 neo-Kantian writers. The article starts out by offering a neo-Kantian interpretation of the object as something that is constituted by the categories and that serves as a standard of truth within a theory of judgment. The second part explicates transcendental (...) subjectivity as the system of categories, which is self-referential and constitutes objects, in order to then evaluate this conception by means of a comparison with Hegel's absolute subject. Rather than delineating the differences between neo-Kantian writers, the article systematically expounds a shared project, which consists in providing the ultimate foundation for judgments by means of an anti-psychologist and non-metaphysical interpretation of transcendental subjectivity. (shrink)

The neo-Kantian Hermann Cohen is famously anti-empiricist in that he denies that sensations can make a definable contribution to knowledge. However, in the second edition of Kant’s Theory of Experience (1885), Cohen considers a proposition that contrasts with both his other work and that of his followers: a Kantian who studies scientific claims to truth—and the grounds on which they are made—cannot limit himself to studying mathematics and logical principles, but needs to also investigate underlying presuppositions about the empirical element (...) of science. Due to his subjectivist approach, Cohen argues, Kant not only failed to explain how scientific observation and experiments are possible, but also misconceived the role of the ideas, particularly the idea of a system of nature. (shrink)