In the debate surrounding the introduction of non-invasive prenatal testing in prenatal screening programmes, the concept of routinisation is often used to refer to concerns and potential negative consequences of the test. A literature analysis shows that routinisation has many different meanings, which can be distinguished in three major versions of the concept. Each of these versions comprises several inter-related fears and concerns regarding prenatal screening and particularly regarding NIPT in three areas: informed choice, freedom to choose and consequences for (...) people with a disability. Three of the strongest arguments raised under the flag of routinisation are assessed for their validity: the threat that NIPT poses to informed choice, the potential increase in uptake of first-trimester prenatal screening and its consequences for social pressure to participate in screening or terminate affected pregnancies, and the negative consequences for disabled people. These routinisation arguments lack empirical or normative ground. However, the results of this analysis do not imply that no attention should be paid to possible problems surrounding the introduction of NIPT. At least two problems remain and should be addressed: there should be an ongoing debate about the requirements of informed choice, particularly related to an expanded scope of prenatal screening. Also, reproductive autonomy can only be achieved when expecting parents’ options are variegated, real and valuable, so that they can continue to choose whether or not to screen or to terminate a pregnancy. (shrink)

Informed consent is a key condition for prenatal screening programmes to reach their aim of promoting reproductive autonomy. Reaching this aim is currently being challenged with the introduction of non-invasive prenatal testing (NIPT) in first-trimester prenatal screening programmes: amongst others its procedural ease—it only requires a blood draw and reaches high levels of reliability—might hinder women’s understanding that they should make a personal, informed decision about screening. We offer arguments for a renewed recognition and use of informed consent compared to (...) informed choice, and for a focus on value-consistent choices and personalized informational preferences. We argue for a three-step counselling model in which three decision moments are distinguished and differently addressed: (1) professionals explore women’s values concerning whether and why they wish to know whether their baby has a genetic disorder; (2) women receive layered medical-technical information and are asked to make a decision about screening; (3) during post-test counselling, women are supported in decision-making about the continuation or termination of their pregnancy. This model might also be applicable in other fields of genetic (pre-test) counselling, where techniques for expanding genome analysis and burdensome test-outcomes challenge counselling of patients. (shrink)

Informed consent is a key condition for prenatal screening programmes to reach their aim of promoting reproductive autonomy. Reaching this aim is currently being challenged with the introduction of non‐invasive prenatal testing (NIPT) in first‐trimester prenatal screening programmes: amongst others its procedural ease—it only requires a blood draw and reaches high levels of reliability—might hinder women’s understanding that they should make a personal, informed decision about screening. We offer arguments for a renewed recognition and use of informed consent compared to (...) informed choice, and for a focus on value‐consistent choices and personalized informational preferences. We argue for a three‐step counselling model in which three decision moments are distinguished and differently addressed: (1) professionals explore women’s values concerning whether and why they wish to know whether their baby has a genetic disorder; (2) women receive layered medical‐technical information and are asked to make a decision about screening; (3) during post‐test counselling, women are supported in decision‐making about the continuation or termination of their pregnancy. This model might also be applicable in other fields of genetic (pre‐test) counselling, where techniques for expanding genome analysis and burdensome test‐outcomes challenge counselling of patients. (shrink)

The introduction of non-invasive prenatal testing in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: to prevent increased uptake of NIPT and to promote informed choice. First, given the aim of prenatal screening, high or low uptake rates are not intrinsically desirable (...) or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women’s choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external influences on women’s personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair. (shrink)

Asking pregnant women to pay for non-invasive prenatal testing out of pocket leads to unequal access across socioeconomic strata. To avoid these social justice issues, first-trimester prenatal screening should be publicly funded in countries such as the Netherlands, with universal coverage healthcare systems that offer all other antenatal care services and screening programmes free of charge. In this reply, we offer three additional reasons for public funding of NIPT. First, NIPT may not primarily have medical utility for women and children, (...) but rather offers relevant information and reproductive options, and thus serves important autonomy interests of women. Second, public funding of NIPT can be justified because it results in a reduction of collectively borne costs associated with care and support for children with chromosomal abnormalities. It is important to note that this is not an argument for individual women to take part in screening or to terminate an affected pregnancy. However, it is a legitimate argument in policy making regarding funding arrangements for screening programmes. Finally, public funding would help to amend current misunderstandings among pregnant women, and thus to support informed consent for first-trimester prenatal screening. (shrink)

Throughout the biological and biomedical sciences there is a growing need for, prescriptive ‘minimum information’ (MI) checklists specifying the key information to include when reporting experimental results are beginning to find favor with experimentalists, analysts, publishers and funders alike. Such checklists aim to ensure that methods, data, analyses and results are described to a level sufficient to support the unambiguous interpretation, sophisticated search, reanalysis and experimental corroboration and reuse of data sets, facilitating the extraction of maximum value from data sets (...) them. However, such ‘minimum information’ MI checklists are usually developed independently by groups working within representatives of particular biologically- or technologically-delineated domains. Consequently, an overview of the full range of checklists can be difficult to establish without intensive searching, and even tracking thetheir individual evolution of single checklists may be a non-trivial exercise. Checklists are also inevitably partially redundant when measured one against another, and where they overlap is far from straightforward. Furthermore, conflicts in scope and arbitrary decisions on wording and sub-structuring make integration difficult. This presents inhibit their use in combination. Overall, these issues present significant difficulties for the users of checklists, especially those in areas such as systems biology, who routinely combine information from multiple biological domains and technology platforms. To address all of the above, we present MIBBI (Minimum Information for Biological and Biomedical Investigations); a web-based communal resource for such checklists, designed to act as a ‘one-stop shop’ for those exploring the range of extant checklist projects, and to foster collaborative, integrative development and ultimately promote gradual integration of checklists. (shrink)

Ecologists are challenged by the need to bridge and synthesize different approaches and theories to obtain a coherent understanding of ecosystems in a changing world. Both food web theory and regime shift theory shine light on mechanisms that confer stability to ecosystems, but from different angles. Empirical food web models are developed to analyze how equilibria in real multi-trophic ecosystems are shaped by species interactions, and often include linear functional response terms for simple estimation of interaction strengths from observations. Models (...) of regime shifts focus on qualitative changes of equilibrium points in a slowly changing environment, and typically include non-linear functional response terms. Currently, it is unclear how the stability of an empirical food web model, expressed as the rate of system recovery after a small perturbation, relates to the vulnerability of the ecosystem to collapse. Here, we conduct structural sensitivity analyses of classical consumer-resource models in equilibrium along an environmental gradient. Specifically, we change non-proportional interaction terms into proportional ones, while maintaining the equilibrium biomass densities and material flux rates, to analyze how alternative model formulations shape the stability properties of the equilibria. The results reveal no consistent relationship between the stability of the original models and the proportionalized versions, even though they describe the same biomass values and material flows. We use these findings to critically discuss whether stability analysis of observed equilibria by empirical food web models can provide insight into regime shift dynamics, and highlight the challenge of bridging alternative modelling approaches in ecology and beyond. (shrink)

Out of the Margin is the first book to consider feminist concerns across the whole domain of economics. In recent years there has been a tremendous increase in interest on the relation between gender and economics. Feminists have found much of concern in the way the economics has written women out of its history, built its theories around masculinist values, failed to take proper account of women and their work when measuring the economy and ignored most of the policy issues (...) that press most heavily upon women. This book is a firm rejection of this marginalized position. Including contributions from leading feminist economists from the US and Europe, the book offers a richness of new insights in addressing the absence of women, both as subject and object, in the history of economic thought. Out of the Margin also explores the philosophical roots of rational economic man, power relations and conflicts within the family, the limitations of relying on secondary data, the need for new data and research, the policy implications of neo-classical economic models and the need for fundamental research in policy making. With its range and depth of coverage, this is not only an excellent introduction to the field but also indispensible for anyone looking for an in-depth analysis of gender and economics. (shrink)

According to metaphysical coherentism, grounding relations form an interconnected system in which things ground each other and nothing is ungrounded. This potentially viable view’s logical territory remains largely unexplored. In this paper, I describe that territory by articulating four varieties of metaphysical coherentism. I do not argue for any variety in particular. Rather, I aim to show that not all issues which might be raised against coherentism will be equally problematic for all the versions of that view, which features far (...) more nuance and diversity than is typically ascribed to it. (shrink)

Der Band enthält Beiträge von Medizinern, Juristen, Philosophen und Naturwissenschaftlern aus Estland, Polen, den Niederlanden und Deutschland zu Themen der Ethik und Wissenschaftstheorie der Medizin. Diese Beiträge sind im Rahmen des «Arbeitskreises für Ethik und Wissenschaftstheorie der Medizin in Ostmitteleuropa» entstanden, der auf einer Kooperationsvereinbarung des Interdisziplinären Zentrums für Ethik der Europa-Universität Viadrina Frankfurt (Oder) und des Instituts für Geschichte und Ethik der Medizin der Universität Halle-Wittenberg beruht. Sie befassen sich u. a. mit der Gesundheitsreform in Polen, Tschechien und Ungarn, (...) mit ethischen Problemen bei Abtreibung, HIV-Infektion, Drogenkonsum, Sterbehilfe und Gentechnik sowie dem Theorie-Praxis-Verhältnis in der Medizin. (shrink)

Representing the thinking of philosophers, psychologists, sociologists, coaches, and sports writers, these essays bring together a wide range of approaches to ...

This study clarifies the need for a renewed account of the body in physiotherapy to fill sizable gaps between physiotherapeutical theory and practice. Physiotherapists are trained to approach bodily functioning from an objectivist perspective; however, their therapeutic interactions with patients are not limited to the provision of natural-scientific explanations. Physiotherapists’ practice corresponds well to theorisation of the body as the bearer of original bodily intentionality, as outlined by Merleau-Ponty and elaborated upon by enactivists. We clarify how physiotherapeutical practice corroborates Merleau-Ponty’s (...) critical arguments against objectivist interpretations of the body; particularly, his analyses demonstrate that norms of optimal corporeal functioning are highly individual and variable in time and thus do not directly depend on generic physiological structures. In practice, objectively measurable physical deviations rarely correspond to specific subjective difficulties and, similarly, patients’ reflective insights into their own motor deficiencies do not necessarily produce meaningful motor improvements. Physiotherapeutical procedures can be understood neither as mechanical manipulations of patients’ machine-like bodies by experts nor as a process of such manipulation by way of instructing patients’ explicit conscious awareness. Rather, physiotherapeutical practice and theory can benefit from the philosophical interpretation of motor disorders as modifications of bodily intentionality. Consequently, motor performances addressed in physiotherapy are interpreted as relational features of a living organism coupled with its environment, and motor disorders are approached as failures to optimally manage the motor requirements of a given situation owing to a relative loss of the capacity to structure one’s relation with their environment through motor action. Building on this, we argue that the process of physiotherapy is most effective when understood as a bodily interaction to guide patients towards discovering better ways of grasping a situation as meaningful through bodily postures and movements. (shrink)

Luitzen Egburtus Jan Brouwer founded a school of thought whose aim was to include mathematics within the framework of intuitionistic philosophy; mathematics was to be regarded as an essentially free development of the human mind. What emerged diverged considerably at some points from tradition, but intuitionism has survived well the struggle between contending schools in the foundations of mathematics and exact philosophy. Originally published in 1981, this monograph contains a series of lectures dealing with most of the fundamental topics such (...) as choice sequences, the continuum, the fan theorem, order and well-order. Brouwer's own powerful style is evident throughout the work. (shrink)

In this paper, we address the problem of truth approximation through theory change, asking whether revising our theories by newly acquired data leads us closer to the truth about a given domain. More particularly, we focus on “nomic conjunctive theories”, i.e., theories expressed as conjunctions of logically independent statements concerning the physical or, more generally, nomic possibilities and impossibilities of the domain under inquiry. We define both a comparative and a quantitative notion of the verisimilitude of such theories, and identify (...) suitable conditions concerning the (partial) correctness of acquired data, under which revising our theories by data leads us closer to “the nomic truth”, construed as the target of scientific inquiry. We conclude by indicating some further developments, generalizations, and open issues arising from our results. (shrink)

This paper clarifies Merleau-Ponty’s original account of “higher-order” cognition as fundamentally embodied and enacted. Merleau-Ponty’s philosophy inspired theories that deemphasize overlaps between conceptual knowledge and motor intentionality or, on the contrary, focus exclusively on abstract thought. In contrast, this paper explores the link between Merleau-Ponty’s account of motor intentionality and his interpretations of our capacity to understand and interact productively with cultural symbolic systems. I develop my interpretation based on Merleau-Ponty’s analysis of two neuropathological modifications of motor intentionality, the case (...) of the brain-injured war veteran Schneider, and a neurological disorder known as Gerstmann’s syndrome. Building on my analysis of Schneider’s sensorimotor compensatory performances in relation to his limitations in the domains of algebra, geometry, and language usage, I demonstrate a strong continuity between the sense of embodiment and enaction at all these levels. Based on Merleau-Ponty’s interpretations, I argue that “higher-order” cognition is impaired in Schneider insofar as his injury limits his sensorimotor capacity to dynamically produce comparatively more complex differentiations of any given phenomenal structure. I then show how Merleau-Ponty develops and specifies his interpretation of Schneider’s intellectual difficulties in relation to the ambiguous role of the body, and in particular the hand, in Gerstmann’s syndrome. I explain how Merleau-Ponty defends the idea that sensorimotor and quasi-representational cognition are mutually irreducible, while maintaining that symbol-based cognition is a fundamentally enactive and embodied process. (shrink)

Marx’s vision of unalienated production is often thought to be subject to decisive objections. This article argues that these objections rely on a misinterpretation of Marx’s position. It provides a new interpretation of Marx’s vision of unalienated production. Unlike another well-known account, it suggests that unalienated production involves realizing oneself through providing others with the goods and services they need for their self-realization. It argues that this view is appealing and that it offers a more successful response to objections than (...) previous interpretations. In doing so, it hopes to put Marx’s concern with alienation and nonalienation back on the table. (shrink)

Conceiving of nuclear energy as a social experiment gives rise to the question of what to do when the experiment is no longer responsible or desirable. To be able to appropriately respond to such a situation, the nuclear energy technology in question should be reversible, i.e. it must be possible to stop its further development and implementation in society, and it must be possible to undo its undesirable consequences. This paper explores these two conditions by applying them to geological disposal (...) of high-level radioactive waste. Despite the fact that considerations of reversibility and retrievability have received increased attention in GD, the analysis in this paper concludes that GD cannot be considered reversible. Firstly, it would be difficult to stop its further development and implementation, since its historical development has led to a point where GD is significantly locked-in. Secondly, the strategy it employs for undoing undesirable consequences is less-than-ideal: it relies on containment of severely radiotoxic waste rather than attempting to eliminate this waste or its radioactivity. And while it may currently be technologically impossible to turn high-level waste into benign substances, GD’s containment strategy makes it difficult to eliminate this waste’s radioactivity when the possibility would arise. In all, GD should be critically reconsidered if the inclusion of reversibility considerations in radioactive waste management has indeed become as important as is sometimes claimed. (shrink)

This paper addresses theoretical challenges, still relevant today, that arose in the first decades of the twentieth century related to the concept of the organism. During this period, new insights into the plasticity and robustness of organisms as well as their complex interactions fueled calls, especially in the UK and in the German-speaking world, for grounding biological theory on the concept of the organism. This new organism-centered biology understood organisms as the most important explanatory and methodological unit in biological investigations. (...) At least three theoretical strands can be distinguished in this movement: Organicism, dialectical materialism, and holistic biology. This paper shows that a major challenge of OCB was to describe the individual organism as a causally autonomous and discrete unit with consistent boundaries and, at the same time, as inextricably interwoven with its environment. In other words, OCB had to conciliate individualistic with anti-individualistic perspectives. This challenge was addressed by developing a concept of life that included functionalist and metabolic elements, as well as biochemical and physical ones. It allowed for specifying organisms as life forms that actively delimit themselves from the environment. Finally, this paper shows that the recent return to the concept of the organism, especially in the so-called “Extended Evolutionary Synthesis,” is challenged by similar anti-individualistic tendencies. However, in contrast to its early-twentieth-century forerunner, today’s organism-centered approaches have not yet offered a solution to this problem. (shrink)

Terugblik van de bekende psychiater op zijn ontwikkeling als sannyasin.

This paper provides an analysis of the intrinsic/extrinsic distinction, as applied both to properties and to relations. In contrast to other accounts, the approach taken here locates the source of a property’s intrinsicality or extrinsicality in the manner in which that property is ‘logically constituted’, and thus – plausibly – in its nature or essence, rather than in e.g. its modal profile. Another respect in which the present proposal differs from many extant analyses lies in the fact that it does (...) not seek to analyse the ‘global’ distinction between intrinsic and extrinsic properties on the basis of the ‘local’ distinction between having a property intrinsically and having it extrinsically. Instead, the latter distinction is explicated on the basis of the former. (shrink)

In recent years, biologists and philosophers of science have argued that evolutionary theory should incorporate more seriously the idea of ‘reciprocal causation.’ This notion refers to feedback loops whereby organisms change their experiences of the environment or alter the physical properties of their surroundings. In these loops, in particular niche constructing activities are central, since they may alter selection pressures acting on organisms, and thus affect their evolutionary trajectories. This paper discusses long-standing problems that emerge when studying such reciprocal causal (...) processes between organisms and environments. By comparing past approaches to reciprocal causation from the early twentieth century with contemporary ones in niche construction theory, we identify two central reoccurring problems: All of these approaches have not been able to provide a conceptual framework that allows maintaining meaningful boundaries between organisms and environments, instead of merging the two, and integrating experiential and physical kinds of reciprocal causation. By building on case studies of niche construction research, we provide a model that is able to solve these two problems. It allows distinguishing between mutually interacting organisms and environments in complex scenarios, as well as integrating various forms of experiential and physical niche construction. (shrink)

Feminist economists have demonstrated that interrogating hierarchies based on gender, ethnicity, class and nation results in an economics that is biased and more faithful to empirical evidence than are mainstream accounts. This rigorous and comprehensive book examines many of the central philosophical questions and themes in feminist economics including: · History of economics · Feminist science studies · Identity and agency · Caring labor · Postcolonialism and postmodernism With contributions from such leading figures as Nancy Folbre, Julie Nelson and Sandra (...) Harding, Toward a Feminist Theory of Economics looks set to become the book on feminist economics for some time to come and will be greatly appreciated by all those interested in gender studies, economic methodology and social theory. (shrink)

Insight problem solving is thought to underpin creative thought as it incorporates both divergent (generating multiple ideas and solutions) and convergent (arriving at the optimal solution) thinking approaches. The current literature on schizotypy and creativity is mixed and requires clarification. An alternate approach was employed by designing an exploratory web-based study using only correlates of schizotypal traits (paranoia, dissociation, cognitive failures, fantasy proneness, and unusual sleep experiences) and examining which (if any) predicted optimal performance on an insight problem-solving task. One (...) hundred and twenty-one participants were recruited online from the general population and completed the number reduction task. The discovery of the hidden rule (HR) was used as a measure of insight. Multivariate logistic regression analyses highlighted persecutory ideation to best predict the discovery of the HR (OR = 1.05; 95% CI 1.01–1.10, p = 0.017), with a one-point increase in persecutory ideas corresponding to the participant being 5% more likely to discover the HR. This result suggests that persecutory ideation, above other schizotypy correlates, may be involved in insight problem solving. (shrink)

Can some evidence confirm a conjunction of two hypotheses more than it confirms either of the hypotheses separately? We show that it can, moreover under conditions that are the same for ten different measures of confirmation. Further we demonstrate that it is even possible for the conjunction of two disconfirmed hypotheses to be confirmed by the same evidence.