Personal appearance and physical beauty are becoming increasingly important in our societies and, as a consequence, enter into the realm of medicine and health care. Adequate and just health care policies call for an understanding of this trend. The core question to be addressed concerns the very idea of beauty. In the following, a conceptual clarification is given in terms of beauty's meaning, value and function (i.e. beauty that is used instrumentally, and beauty that is attained). Furthermore, some relevant distinctions (...) are drawn between physical and artistic beauty, and physical beauty in a human sense. The core idea for this is formed by a Kantian notion of the beauty concept. It is argued that beauty judgements should be understood as relative to persons and their contexts. Physical beauty should be taken seriously when it is understood in this deeper sense of being related to the shaping of a person's identity. (shrink)

Arguments against directed altruistic living organ donation are too weak to justify a ban. Potential donors who want to specify the non-related person or group of persons to receive their donated kidney should be accepted. The arguments against, based on considerations of motivation, fairness and (non-)anonymity (e.g. those recently cited by an advisory report of the Dutch Health Council), are presented and discussed, as well as the Dutch Governments response. Whereas the Government argues that individuals have authority with regard to (...) the allocation of their organs, partial considerations have not been sufficiently explored. In addition, it is argued that partial relationships govern human life, are significant and should be valued highly. These relationships are at the core of accepted living kidney donation between relatives (family members, partners, friends). Respecting the particular act of living donation goes beyond respect for autonomy; it touches upon our personal and social identity. Donation, e.g. of a kidney, is not undertaken strictly for the benefit of the recipient, but also to meet the moral standards we wish to set for ourselves. This consideration, rooted in a view of moral identity, provides the basis for many forms of directed donation that are both partial and justified. If the importance of this is not recognized, social policies can be neither adequate nor effective. (shrink)

Living kidney donation provides a promising opportunity in situations where the scarcity of cadaveric kidneys is widely acknowledged. While many patients and their relatives are willing to accept its benefits, others are concerned about living kidney programs; they appear to feel pressured into accepting living kidney transplantations as the only proper option for them. As we studied the attitudes and views of patients and their relatives, we considered just how actively health care professionals should encourage living donation. We argue that (...) active interference in peoples’ personal lives is justified - if not obligatory. First, we address the ambiguous ideals of non-directivity and value neutrality in counselling. We describe the main pitfalls implied in these concepts, and conclude that these concepts cannot account for the complex reality of living donation and transplantation. We depict what is required instead as truthful information and context-relative counselling. We then consider professional interference into personal belief systems. We argue that individual convictions are not necessarily strong, stable, or deep. They may be flawed in many ways. In order to justify interference in peoples’ personal lives, it is crucial to understand the structure of these convictions. Evidence suggests that both patients and their relatives have attitudes towards living kidney donation that are often open to change and, accordingly, can be influenced. We show how ethical theories can account for this reality and can help us to discern between justified and unjustified interference. We refer to Stephen Toulmin’s model of the structure of logical argument, the Rawlsian model of reflective equilibrium, and Thomas Nagel’s representation of the particularistic position. (shrink)

There is an increasing interest in the possibility of using nudges to promote people's health. Following the advances in developmental biology and epigenetics, it is clear that one's health is not always the result of one's own choices. In the period surrounding pregnancy, maternal choice behaviour has a significant influence on perinatal morbidity and mortality as well as the development of chronic diseases later in life. One's health is thus a matter of one's own as well as one's maternal choices. (...) Therefore, self-regarding and other-regarding nudges should be considered as viable strategies to promote health. In this article, we introduce the concept of other-regarding nudges. We use the harm principle and the principle of beneficence to justify these other-regarding nudges. We conclude by stressing the importance of a fair assessment of expectations towards the nudgee, when determining whether a nudge is aimed at preventing harm or promoting a good. (shrink)

Retractions solicited by authors following the discovery of an unintentional error—what we henceforth call a “self-retraction”—are a new phenomenon of growing importance, about which very little is known. Here we present results of a small qualitative study aimed at gaining preliminary insights about circumstances, motivations and beliefs that accompanied the experience of a self-retraction. We identified retraction notes that unambiguously reported an honest error and that had been published between the years 2010 and 2015. We limited our sample to retractions (...) with at least one co-author based in the Netherlands, Belgium, United Kingdom, Germany or a Scandinavian country, and we invited these authors to a semi-structured interview. Fourteen authors accepted our invitation. Contrary to our initial assumptions, most of our interviewees had not originally intended to retract their paper. They had contacted the journal to request a correction and the decision to retract had been made by journal editors. All interviewees reported that having to retract their own publication made them concerned for their scientific reputation and career, often causing considerable stress and anxiety. Interviewees also encountered difficulties in communicating with the journal and recalled other procedural issues that had unnecessarily slowed down the process of self-retraction. Intriguingly, however, all interviewees reported how, contrary to their own expectations, the self-retraction had brought no damage to their reputation and in some cases had actually improved it. We also examined the ethical motivations that interviewees ascribed, retrospectively, to their actions and found that such motivations included a combination of moral and prudential considerations. These preliminary results suggest that scientists would welcome innovations to facilitate the process of self-retraction. (shrink)

It is within the context of a person’s lifestory, we argue, that the idea of wearing aprosthesis assumes place and meaning. Todevelop this argument, a brightly colored hookprosthesis for children is taken as a startingpoint for reflection. The prosthesis can beseen as fitting this person perfectly, when thebodily difference is understood as positivelyadding to this person’s identity. The choicefor the prosthesis is normative in a moralsense, in that it is grounded in a person’sfundamental convictions with respect to hisbeing and living. (...) This understanding of ‘howto live’ can best be grasped – as is suggested– in contrastive terms of ‘sameness’ and‘otherness’. Striving for conformity andsimilarity would do no justice to theexperiences and ideals of unique persons, andwould come at great cost. Moreover, society isnot benefited by persons who merely conform,who copy and imitate others, but by those whowillfully live up to their own unique standards. (shrink)

To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively minor afflictions, (...) thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients’ preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results. (shrink)

Cadaveric transplantation and living transplantation exist side by side. Both practices help to alleviate organ need. They provide us with two separate moral schemes. Is it rational to keep them apart? The cadaveric system is organised along strict, impartial lines, while the living system is inherently partial and local. The ethical justification for this partial scheme seems to be that it merely supplements the cadaveric scheme: partial transplants do not come at the expense of cadaveric impartiality, but in fact significantly (...) reduce the waiting time for patients on the list for a cadaveric transplant.This seemingly peaceful coexistence is challenged by new initiatives, among them living donation list exchange, and also the LifeSharers initiative, leading to practices that undermine cadaveric impartiality. Should we bemoan this fact, or should we move on towards a new balance in the relationship between cadaveric and living transplantation practices, towards a new moral weighing of impartial and partial values? I argue, against the background of a rapid growth of living donations, that we have good, ethical reasons—not only utilitarian ones—for giving the value of partiality a more prominent place in our policies. (shrink)

Climate dynamics and trends have significant environmental and socioeconomic impacts; however, in the Benin Republic, they are generally studied with diverse statistical methods ignoring the nonstationarity, nonlinearity, and self-similarity characteristics contained in precipitation time series. This can lead to erroneous conclusions and an unclear understanding of climatic dynamics. Based on daily precipitation data observed in the six synoptic stations of Benin Republic, in the period from 1951 to 2010, we have proposed determining the local trends of precipitations, investigating precipitation nonlinear (...) dynamics, and assessing climatic shift in the study period by Ensemble Empirical Mode Decomposition and Multifractal Detrended Fluctuation Analysis method. To overcome the detrending issue in the standard MFDFA method, the EEMD algorithm is embedded into the MFDFA. The study period is subdivided into three subperiods: 1951–1970, 1971–1990, and 1991–2010. Intrinsic Mode Functions are obtained according to the climatic region in which the stations are located. Results show that precipitation variation is significantly governed by the five first IMFs, in which oscillation periods vary from 1 to 25 days. The trend curves decrease at all the synoptic stations, and their slope values vary accordingly to the subperiods. Referring to the values of the multifractal spectrum parameters, α 0, and the width of the spectrum w, consistent changes are observed regardless of the subperiods and the concerned stations. The spatial and temporal variability of precipitation indicates that the multifractal properties are good indicators for assessing changes in precipitation dynamics, and the changes in their features could be explained by the global change than by the local climate variation. Despite the observed differences in multifractal spectra properties from the three subperiods, it is not possible to verify the subdivision of 1951–2010 in three subperiods as it is done by previous studies in West Africa. Our findings can be used in the validation of global and regional climate models since a valid model should explain empirically detected scaling properties in observed data. (shrink)

Cadaveric transplantation and living transplantation exist side by side. Both practices help to alleviate organ need. They provide us with two separate moral schemes. Is it rational to keep them apart? The cadaveric system is organised along strict, impartial lines, while the living system is inherently partial and local. The ethical justification for this partial scheme seems to be that it merely supplements the cadaveric scheme: partial transplants do not come at the expense of cadaveric impartiality, but in fact significantly (...) reduce the waiting time for patients on the list for a cadaveric transplant.This seemingly peaceful coexistence is challenged by new initiatives, among them living donation list exchange, and also the LifeSharers initiative, leading to practices that undermine cadaveric impartiality. Should we bemoan this fact, or should we move on towards a new balance in the relationship between cadaveric and living transplantation practices, towards a new moral weighing of impartial and partial values? I argue, against the background of a rapid growth of living donations, that we have good, ethical reasons—not only utilitarian ones—for giving the value of partiality a more prominent place in our policies. (shrink)

There are barriers of perception between Sudanese Muslims for whom the sharia is a source of authority and identity and others who see it as an oppressive means of dominating Sudan's minority populations. I make a distinction between process and substance in law, and show that a flawed process has contributed to a perception of international law as an instrument of powerful states, which has obscured its legislative and procedural usefulness to the Sudan as a member of the United Nations. (...) Similarly a distortion of due process in Sudan's sharia has created a substance derived from the legacy of medieval Arabia rather than applied legal methodology. One consequence of this is that Sudan's Civil Wars have been given the attributes of offensive jihad against its diverse non-Muslim populations. I argue that offensive jihad was a legal construction designed to meet the challenges of medieval Arab society, with little basis in the fundamental sources of Islamic law or in contemporary legal methodology. I advocate a return to due process as a partial solution to the impasse between Muslim and non-Muslim identities in the Sudan, and show how international law can be improved by accommodating other legal traditions. (shrink)

In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on (...) these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (shrink)

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started (...) searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance. (shrink)

This paper critically evaluates the transition from crisis to development in northern Uganda from the perspective of agricultural service provision. It contributes to debates on how efforts to link relief to rehabilitation and development may bypass the underlying challenges in linking humanitarian aid to prevailing national development policies and structures. This paper is based on research into agricultural services undertaken in Pader district, northern Uganda, between 2010 and 2012. It studied the interplay between humanitarian interventions and the parallel development of (...) the government’s agricultural departments and services in northern Uganda. The article brings out how Ugandan agricultural policies do not suit the post-conflict realities of northern Uganda. The evolving policies affect power relations and processes of inclusion and exclusion in northern Uganda. As a result, at the time that the government is ready to integrate northern Uganda into the mainstream development of agricultural policy, the gap between addressing humanitarian needs and development has become larger. (shrink)

This text is an innovative exploration of philosophy and madness in the context of the critical engagement of Heidegger's phenomenological ontology with Freudian psychoanalysis. Included is a play in which, after a mental breakdown, Martin Heidegger undergoes psychoanalytic treatment from Dr. Medard Boss. Boss is essentially caught between two intellectual giants: his patient, Heidegger, who challenges him to evolve beyond traditional Freudian psychoanalysis, and his mentor, Freud, who acts as a "ghostly" consultant in facilitating Heidegger's return to health. The (...) dialogue of the play consists of actual quotes taken from the major thinkers themselves, which enhances the authenticity of this fictitious production. In addition, the theoretical perspectives of Freud, Heidegger, Boss, and Ludwig Binswanger are included to enhance the readers' background knowledge. In the process of disclosing these brilliant theorists, this book uncovers what each orientation has to offer the others."--Publisher's website. (shrink)

This text is an innovative exploration of philosophy and madness in the context of the critical engagement of Heidegger’s phenomenological ontology with Freudian psychoanalysis. Included is a play in which, after a mental breakdown, Martin Heidegger undergoes psychoanalytic treatment from Dr. Medard Boss. Boss is essentially caught between two intellectual giants: his patient, Heidegger, who challenges him to evolve beyond traditional Freudian psychoanalysis, and his mentor, Freud, who acts as a “ghostly” consultant in facilitating Heidegger’s return to health. The (...) dialogue of the play consists of actual quotes taken from the major thinkers themselves, which enhances the authenticity of this fictitious production. In addition, the theoretical perspectives of Freud, Heidegger, Boss, and Ludwig Binswanger are included to enhance the readers’ background knowledge. In the process of disclosing these brilliant theorists, this book uncovers what each orientation has to offer the others. (shrink)

El presente trabajo se propone discutir acerca de los límites entre el Análisis del Dasein de Medard Boss y la Analítica del Dasein de Martin Heidegger. Tomando como punto de partida la aparición de la dimensión orgánica en las consideraciones de Boss, se discutirá cómo es que se devela una oposición en los énfasis temáticos correspondientes a una consideración filosófica y a una psicológica del ser humano. Dicha oposición será aclarada indagando en las respectivas motivaciones de ambos programas, para (...) destacarlas como sus eminentes límites. Finalmente, comprendiendo dichas motivaciones como límites, el artículo planteará que la insistencia de lo orgánico vigente aún en Boss señalaría problemáticas que pueden competer aun a la Analítica del Dasein del mismo Heidegger. (shrink)

This paper examines Medard Boss's rejection of the Freudian unconscious. Boss's position is criticized for its failure to do justice to the clinical relevance of the unconscious and to provide adequate answers to key theoretical questions. An alternative approach to the concept of the unconscious is sought in the work of the French analyst, Jacques Lacan.

The article gives a detailed view of the existential psychoanalysis of Swiss philosopher and psychologist Medard Boss. Based on the fundamental ontology of M. Heidegger, M. Boss criticizes the psychodynamic theories of the human psyche and turns to the analysis of the problem of human nature. A person, from the Boss's point of view, can only be understood as a person in the world (being-in-the-world). Through human existence, being can manifest itself as such. This is the destination of man. (...) The basic existential category of M. Boss is the concept of "openness". The openness of existence allows us to get to know other people and respond to their own call to us. Existence is characterized by the Boss as joint, complicit, endowed with "presence", which is an ensemble of possibilities. M. Boss defines human existence through the existentials of spatiality, temporality, corporeality, eventfulness in the shared world, mood, historicity, and mortality. The realization of existence, according to the Boss, is possible only in the free choice that a person is initially endowed with, but which he may lose in the process of socialization. Blocking openness and freedom leads a person to neuroticism and illness. The article also analyzes the essence of the psychotherapeutic approach of M. Boss, which is based on the desire to understand a person through "highlighting" and openness. The article shows the opposition of existential analysis of the classical psychoanalytic tradition. (shrink)