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)

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)

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 fundamental tenet of contemporary sociobiology, namely the assumption of a single process of evolution involving the selection of genes, is critically examined. An alternative multiple-level, multiple-process model of evolution is presented which posits that the primary process that operates via selection upon the genes cannot account for certain kinds of biological phenomena, especially complex, learned, social behaviours. The primary process has evolved subsidiary evolutionary levels and processes that act to bridge the gap between genes and these complex behaviours. The (...) subsidiary levels are development, individual animal learning, and socioculture itself. It is argued that individual learning is pivotal to the derivation and biological analysis of culture. The differences between cultural and noncultural societies are stressed. It is concluded that such a multiple-level model of evolution can form the basis for reconciling opposing sides in the sociobiology debate. (shrink)

In this book Professor Baldry describes this development from Homer to Cicero when, although the traditional divisions and prejudices still remained string, the ...

The unity of the group mind is a psychoplastic unity. In the group mind subjects are integrated through an object and not objects through a subject. It follows, among many much more important consequences, that a scientific analysis and arrangement of the law relating to corporations should proceed in the manner practically indicated in the Law of Limited Companies, Corporations Sole, Trusts, Bankruptcy, Local Government, and so forth, that is to say, by the estatificatian of interests and not by the (...) pretended incorporation of people. (shrink)

There are many passages in ancient literature which depict an imaginary existence different from the hardships of real life-an existence blessed with Nature's bounty, untroubled by strife or want. Naturally this happy state is always placed somewhere or sometime outside normal human experience, whether ‘off the map’ in some remote quarter of the world, or in Elysium after death, or in the dim future or the distant past. Such an imaginary time of bliss in the past or the future has (...) become known as the ‘golden age’. This is the name which modern scholars generally give to the ancient belief. The phrase is often echoed by modern poets. The same language has been transferred from the unknown to the known, and it has become a commonplace to describe an outstanding period of history or literature as a ‘golden age’. (shrink)

What credentials does evolutionary epistemology have as science? A judgement based on past performance, both in terms of advancing an empirical programme and further ng theory construction, is not much. This paper briefly outlines some of the research areas, both theoretical and empirical, that can be developed and that might secure for evolutionary epistemology a future in evolutionary biology.