Background Notwithstanding the need to produce evidence-based knowledge on medications for pregnant women, they remain underrepresented in clinical research. Sometimes they are excluded because of their supposed vulnerability, but there are no universally accepted criteria for considering pregnant women as vulnerable. Our aim was to explore whether and if so to what extent pregnant women are vulnerable as research subjects. Method We performed a conceptual and empirical analysis of vulnerability applied to pregnant women. Analysis A conceptual analysis supports Hurst's definition (...) of vulnerability. Consequently, we argue that pregnant women are vulnerable if they encounter an identifiably increased likelihood of incurring additional or greater wrong. According to the literature, this increased likelihood could exist of four alleged features for pregnant women's vulnerability: informed consent, susceptibility to coercion, higher exposure to risk due to lack of knowledge, vulnerability of the fetus. Discussion Testing the features against Hurst's definition demonstrates that they all concern the same issue: pregnant women are only vulnerable because a higher exposure to risk due to lack of scientific knowledge comprises an increased wrong. Research Ethics Committees have a responsibility to protect the vulnerable, but a higher exposure to risk due to lack of scientific knowledge is a much broader issue and also needs to be addressed by other stakeholders. Conclusions The only reason why pregnant women are potentially vulnerable is to the extent that they are increasingly exposed to higher risks due to a lack of scientific knowledge. Accordingly, the discussion can advance to the development of practical strategies to promote fair inclusion of pregnant women in clinical research. (shrink)

A decade ago, Isham and Butterfield proposed a topos-theoretic approach to quantum mechanics, which meanwhile has been extended by Döring and Isham so as to provide a new mathematical foundation for all of physics. Last year, three of the present authors redeveloped and refined these ideas by combining the C*-algebraic approach to quantum theory with the so-called internal language of topos theory (Heunen et al. in arXiv:0709.4364). The goal of the present paper is to illustrate our abstract setup through the (...) concrete example of the C*-algebra M n (ℂ) of complex n×n matrices. This leads to an explicit expression for the pointfree quantum phase space Σ n and the associated logical structure and Gelfand transform of an n-level system. We also determine the pertinent non-probabilisitic state-proposition pairing (or valuation) and give a very natural topos-theoretic reformulation of the Kochen–Specker Theorem.In our approach, the nondistributive lattice ℘(M n (ℂ)) of projections in M n (ℂ) (which forms the basis of the traditional quantum logic of Birkhoff and von Neumann) is replaced by a specific distributive lattice $\mathcal{O}(\Sigma_{n})$ of functions from the poset $\mathcal{C}(M_{n}(\mathbb{C}))$ of all unital commutative C*-subalgebras C of M n (ℂ) to ℘(M n (ℂ)). The lattice $\mathcal{O}(\Sigma_{n})$ is essentially the (pointfree) topology of the quantum phase space Σ n , and as such defines a Heyting algebra. Each element of $\mathcal{O}(\Sigma_{n})$ corresponds to a “Bohrified” proposition, in the sense that to each classical context $C\in\mathcal{C}(M_{n}(\mathbb{C}))$ it associates a yes-no question (i.e. an element of the Boolean lattice ℘(C) of projections in C), rather than being a single projection as in standard quantum logic. Distributivity is recovered at the expense of the law of the excluded middle (Tertium Non Datur), whose demise is in our opinion to be welcomed, not just in intuitionistic logic in the spirit of Brouwer, but also in quantum logic in the spirit of von Neumann. (shrink)

There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study. We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment. Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

BackgroundLiterature shows that middle-aged and older adults sometimes experience a wish to die. Reasons for these wishes may be complex and involve multiple factors. One important question is to what extent people with a wish to die have medically classifiable conditions. Aim(1) Estimate the prevalence of a current wish to die among middle-aged and older adults in The Netherlands; (2) explore which factors within domains of vulnerability (physical, cognitive, social and psychological) are associated with a current wish to die; (3) (...) assess how many middle-aged and older adults with a current wish to die do not have a medically classifiable condition and/or an accumulation of age-related health problems.MethodsData of 2015/16 from the Longitudinal Aging Study Amsterdam were used for this cross-sectional study (1563 Dutch middle-aged and older adults aged between 57 and 99 years), obtained through structured medical interviews and self-reported questionnaires. Three experienced physicians assessed whether the participants with a current wish to die could be classified as having a medically classifiable condition and/or an accumulation of age-related health problems.ResultsN = 62 participants (4.0%) had a current wish to die. Having a current wish to die was associated with multiple characteristics across four domains of vulnerability, among which: self-perceived health, problems with memory, self-perceived quality of life and meaningfulness of life. Fifty-four participants with a current wish to die were assessed with having a medically classifiable condition, of which one was also assessed with having an accumulation of age-related health problems. Six people were assessed to have neither, and for two people it was unclear.ConclusionA small minority of middle-aged and older adults in the Netherlands have a current wish to die. Most of them can be classified with a medical condition and one person with an accumulation of age-related health problems. Furthermore, the findings show that having a current wish to die is multi-faceted. There is still a need for more knowledge, such as insight in to what extent suffering stemming from the medical classifiable disease contributes to the development of the wish to die. (shrink)

BackgroundThere is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study.MethodsWe conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands.ResultsThree themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment.ConclusionsHealthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

Kierkegaard’s Concepts is a comprehensive, multi-volume survey of the key concepts and categories that inform Kierkegaard’s writings. Each article is a substantial, original piece of scholarship, which discusses the etymology and lexical meaning of the relevant Danish term, traces the development of the concept over the course of the authorship, and explains how it functions in the wider context of Kierkegaard’s thought. Concepts have been selected on the basis of their importance for Kierkegaard’s contributions to philosophy, theology, the social sciences, (...) literature and aesthetics, thereby making this volume an ideal reference work for students and scholars in a wide range of disciplines. -/- Contents: Envy, Janne Kylliäinen; Epic, Nassim Bravo Jordán; Epigram, David R. Law; Ethics, Azucena Palavicini Sánchez; Evil, Azucena Palavicini Sánchez and William McDonald; Exception/Universal, Geoffrey Dargan; Existence/Existential, Min-Ho Lee; Experience, Jakub Marek; Fairytale, Nathaniel Kramer; Faith, William McDonald; Finitude/Infinity, Erik M. Hanson; Forgiveness, John Lippitt; Freedom, Diego Giordano; Genius, Steven M. Emmanuel; God, Paul Martens and Daniel Marrs; Good, Azucena Palavicini Sánchez; Governance/Providence, Jack Mulder, Jr.; Grace, Derek R. Nelson; Gratitude, Corey Benjamin Tutewiler; Guilt, Erik M. Hanson; Happiness, Benjamin Miguel Olivares Bøgeskov; Hero, Sean Anthony Turchin; History, Sean Anthony Turchin; Holy Spirit, Leo Stan; Hope, William McDonald; Humility, Robert B. Puchniak; Humor, Alejandro González; Hypocrisy, Thomas Martin Fauth Hansen; Identity/Difference, Claudine Davidshofer; Imagination, Frances Maughan-Brown; Imitation, Leo Stan; Immanence/Transcendence, Leo Stan; Immediacy/Reflection, Zizhen Liu; Immortality, Lee C. Barrett; Incognito, Martijn Boven. (shrink)

This reflection focuses on what insights Catholic Social Teaching can provide for corporate governance. I argue that the ‘standard’ agency theory is overly reductionist and insufficiently incorporates important economic limitations as well as human frailty. As a result, such agency theory insufficiently distinguishes firms from markets, which can easily relativize how we treat others and facilitate rationalization of unethical behavior. I then explore how three pillars of CST—human dignity, solidarity, and subsidiarity—can help overcome these limitations. CST proposes a vision of (...) the business corporation as a community of persons, working together in cooperative business relationships toward the shared purpose of contributing to human flourishing. (shrink)

Psycholinguistic studies often look at the production of referring expressions in interactive settings, but so far few referring expression generation algorithms have been developed that are sensitive to earlier references in an interaction. Rather, such algorithms tend to rely on domain-dependent preferences for both content selection and linguistic realization. We present three experiments showing that humans may opt for dispreferred attributes and dispreferred modifier orderings when these were primed in a preceding interaction (without speakers being consciously aware of this). In (...) addition, we show that speakers are more likely to produce overspecified references, including dispreferred attributes (although minimal descriptions with preferred attributes would suffice), when these were similarly primed. (shrink)

Standardisation is increasingly seen as a means to insert ethics in innovation processes. We examine the institutionalisation of responsible innovation in de jure standardisation as this is an important but unexplored research area. In de jure standardisation, stakeholders collaborate in committees to develop standards. We adopt the anticipation, inclusion, reflexivity, and responsiveness responsible innovation framework as our theoretical lens. Our study suggests that responsible standardisation processes should embody forms of these four dimensions. We investigate the institutionalisation of these dimensions and (...) identify 96 factors that can motivate, hinder, or facilitate responsible standardisation. Factors were found through in-depth interviews with managers of a standard developing organisation. These are subsequently validated/rejected using surveys completed by committee representatives. The results suggest that the social desirability of standards is not self-evident. This study could pave the way for future research on responsible standardisation processes, complementing research on legitimacy, responsible innovation, and standardisation. (shrink)

Background In the Netherlands, people can receive (limited) demedicalised assistance in suicide (DAS)—an option less well known than physician-assisted dying (PAD). Aim This study explores which trajectories people take to seek DAS, through open-coding and inductive analysis of in-depth interviews with 17 people who receive(d) DAS from counsellors facilitated by foundation De Einder. Results People sought DAS as a result of current suffering or as a result of anticipating possible prospective suffering. People with current suffering were unable or assumed they (...) would be unable to obtain PAD. For people anticipating possible prospective suffering, we distinguished two trajectories. In one trajectory, people preferred PAD but were not reassured of help by the physician in due time and sought DAS as a backup plan. In the other trajectory, people expressed a preference for DAS mainly as a result of emphasising self-determination, independence, taking their own responsibility and preparing suicide carefully. In all trajectories, dissatisfaction with physician–patient communication—for instance about (a denied request for) PAD or fearing to discuss this—influenced the decision to seek DAS. Conclusions While PAD is the preferred option of people in two trajectories, obtaining PAD is uncertain and not always possible. Dissatisfaction with physician–patient communication can result in the physician not being involved in DAS, being unable to diagnose diseases and offer treatment nor offer reassurance that people seem to seek. We plea for more mutual understanding, respect and empathy for the limitations and possibilities of the position of the physician and the patient in discussing assistance in dying. (shrink)

Contextualist theories of knowledge have received a lot of attention in the contemporary epistemological literature. The central idea of such theories is that contextual factors play an important role in determining whether a particular knowledge sentence is true or false. Thus, on contextualist theories of knowledge it might be the case that a particular subject knows a proposition in one context but fails to know that same proposition in another context—while the only thing that has changed is the context. Of (...) the extant contextualist theories of knowledge, attributer contextualism (that is, the type of contextualism that makes the context of the attributer of knowledge crucial in determining whether a subject knows a proposition) has been discussed the most. The papers in the present collection continue this focus on attributer contextualism, and offer a fairly critical treatment of this theory. Nevertheless, a number of papers also outline _new_ types of contextualism. What results is a collection of papers that, though negative towards attributer contextualism, for the most part is sympathetic towards contextualism in general. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

BackgroundIn the Netherlands, Foundation De Einder offers counselling to people who wish to be able to self-determine the timing and manner of their end of life.AimThis study explores the experiences with counselling that counselees receive from counsellors facilitated by Foundation De Einder.MethodsOpen coding and inductive analysis of in-depth interviews with 17 counselees.ResultsCounselling ranged from solely receiving information about lethal medication to combining this with psychological counselling about matters of life and death, and the effects for close ones. Counselees appreciated the (...) availability of the counsellor, their careful and open attitude, feeling respected and being reminded about their own responsibility. Some counselees felt dependent on the counsellor, or questioned their competency. Most counselees collected lethal medication. This gave them peace of mind and increased their quality of life, but also led to new concerns. Few were inclined to use their self-collected medication. Counselling contributed to thinking about if, when and how counselees would like to end their life.ConclusionHaving obtained means to end their lives can offer people feelings of reassurance, which can increase their quality of life, but can also give rise to new concerns. Next to providing information on lethal medication, counsellors can play an important role by having an open non-judgemental attitude, providing trustworthy information and being available. These positively valued aspects of counselling are also relevant for physicians taking care of patients who wish to self-determine the timing and manner of their end of life. (shrink)

The principle of philosophy, Schelling declares in his 1810 Stuttgarter Privatvorlesungen, is the Absolute or God.1 The terms are brought into close yet ambiguous proximity by this assertion. Yet how are we to think them together? It is far from clear just how the Absolute—the abstract, universal, all-encompassing name Idealism gives to what, most fundamentally, there is—and God, a name with a rather longer life story, are to be related. Are we to take it that the Absolute and God are (...) to be baldly equated? That the one is a mere term of convenience properly understood in the light of the other? That the one is a supplement or corrective that the other is in need of? And who would be the arbiter of... (shrink)

In this essay, I argue that Søren Kierkegaard’s oeuvre can be seen as a theater of ideas. This argument is developed in three steps. First, I will briefly introduce a theoretical framework for addressing the theatrical dimension of Kierkegaard’s works. This framework is based on a distinction between“performative writing strategies” and “categories of performativity.” As a second step, I will focus on Repetition: A Venture in Experimenting Psychology, by Constantin Constantius, one of the best examples of Kierkegaard’s innovative way of (...) doing philosophy. This strange and elusive book introduces the difficult and counter-intuitive notion of repetition. Repetition is a category of performativity that aims to activate the subjectivity of the reader. This performative effect is achieved by confronting the reader with an “unresolved”existential problem that is not yet drawn into clarity but is staged in all its confusions and contradictions. Kierkegaard’s pseudonym Constantius relies here on a performative writing strategy that is animated by a dialectic of advance and withdrawal. In the last and third step, I will analyze Constantius’s own reflection on the performative dimension of his text. Constantius has left several clues behind, each of which suggests that he deliberately developed a performative writing strategy. (shrink)

A central intuition many epistemologists seem to have is that knowledge is distinctively valuable. In his paper 'Radical Scepticism, Epistemic Luck and Epistemic Value', Duncan Pritchard rejects the virtue-theoretic explanation of this intuition. This explanation says that knowledge is distinctively valuable because it is a cognitive achievement. It is maintained, in the first place, that the arguments Pritchard musters against the thesis that knowledge is a cognitive achievement are unconvincing. It is argued, in the second place, that even if the (...) arguments against the thesis that knowledge is a cognitive achievement were convincing, there is another explanation of the intuition that knowledge has final value available: the question-relative treatment of knowledge. (shrink)

Privacy is valued by many. But what it means to have privacy remains less than clear. In this paper, I argue that the notion of privacy should be understood in epistemic terms. What it means to have (some degree of) privacy is that other persons do not stand in significant epistemic relations to those truths one wishes to keep private.

This article demonstrates a novel conceptualization of sublimity: the sublime in the pedestrian. This pedestrian mode of sublimity is exemplified by the Biblical Abraham, the central figure of Kierkegaard’s pseudonymous Fear and Trembling. It is rooted in the analysis of one of the foundational stories of the three monotheistic religions: Abraham’s averted sacrifice of his son Isaac. The defining feature of this new, pedestrian mode of sublimity is that is remains hidden behind what I call a total incognito. It is (...) similar to the classical ‘elevated mode of sublimity’ as developed by Burke, Kant, and Schiller insofar as it denotes two contrasting feelings at once: repulsion and attraction. It is different insofar as Kierkegaard’s pedestrian mode of sublimity remains hidden from view and can only be shown indirectly. This article expounds the new, pedestrian mode of sublimity by investigating the relation between the incognito and the sublime in Fear and Trembling. It achieves that goal by engaging three perspectives: (1) the sublime failure that comes to the fore in the incognitos of an imaginary Abraham; (2) the ‘fear without being afraid’ that is invoked by God’s incognitos; (3) the total incognito of the pedestrian which conceals Abraham’s sublimity. (shrink)

One of the hardest questions to answer for a (Neo)platonist is to what extent and how the changing and unreliable world of sense perception can itself be an object of scientific knowledge. My dissertation is a study of the answer given to that question by the Neoplatonist Proclus (Athens, 411-485) in his Commentary on Plato’s Timaeus. I present a new explanation of Proclus’ concept of nature and show that philosophy of nature consists of several related subdisciplines matching the ontological stratification (...) of nature. Moreover, I demonstrate that for Proclus philosophy of nature is a science, albeit a hypothetical one, which takes geometry as its methodological paradigm. I also offer an explanation of Proclus’ view of what is later called the mathematization of physics, i.e. the role of the substance of mathematics, as opposed to its method, in explaining the natural world. Finally, I discuss Proclus’ views of the discourse of philosophy of nature and its iconic character. (shrink)

Many philosophers are building a solid case in favour of the knowledge account of assertion (KAA). According to KAA, if one asserts that P one represents oneself as knowing that P. KAA has recently received support from linguistic data about prompting challenges, parenthetical positioning and predictions. In this article, I add another argument to this rapidly growing list: an argument from what I will call ‘reinforcing parenthesis’.

We study behind-the-scenes investor activism promoting environmental, social, and governance improvements by means of a proprietary dataset of a large international, socially responsible activist fund. We examine the activist’s target selection, forms of engagement, impact on ESG performance, drivers of success, and effects on the targets’ operations and value creation. Target firms are typically large and visible, perform well, and have high liquidity and low ESG performance. Engagement induces ESG rating adjustments: firms with poor ex ante ESG ratings experience a (...) ratings increase after complying with the activist’s demands, whereas firms with high ex ante ESG ratings experience a ratings decrease following the revelation of their ESG problems. Activism that is focused on environmental and social issues is more likely to succeed if targets are ESG-sensitive. Successful engagements boost targets’ sales. Risk-adjusted excess stock returns of successful engagements outperform those of unsuccessful engagements by 2.7%. Results are especially strong for firms with low ex ante ESG scores. Specifically, targeted firms in the lowest ex ante ESG quartile outperform matched peers by 7.5% in the year after the end of the engagement. Our results thus suggest that the activism regarding corporate social responsibility generally improves ESG practices and corporate sales and is profitable to the activist. Taken together, we provide direct evidence that ethical investing and strong financial performance, both from the activist’s and the targeted firm’s perspective, can go hand-in-hand together. (shrink)

Name der Zeitschrift: Millennium Jahrgang: 11 Heft: 1 Seiten: 69-100.

For Kierkegaard the ‘psychological experiment’ is a literary strategy. It enables him to dramatize an existential conflict in an experimental mode. Kierkegaard’s aim is to study the source of movement that animates the existing individual (this is the psychological part). However, he is not interested in the representation of historical individuals in actual situations, but in the construction of fictional characters that are placed in hypothetical situations; this allows him to set the categories in motion “in order to observe completely (...) undisturbed what these require” without caring to what extent someone has met this requirement or is able to meet it (this is the experimental part). -/- The ‘psychological experiment’ is a category of indirect communication that is developed most extensively by Frater Taciturnus, the pseudonymous author of the third part of Stages on Life’s Way. (I) Taciturnus introduces the psychological experiment as a new trajectory in modern literature that offers an alternative to poetry and speculative drama. He develops this new trajectory in praxis (in the novella ‘“Guilty?”/“Not Guilty?” A Story of Suffering: A Psychological Experiment by Frater Taciturnus’) as well as in theory (in the ‘Letter to the Reader’ that accompanies his novella). (II) Two other pseudonymous authors further enrich the conceptual field of the psychological experiment. Constantin Constantius develops the notion ‘experimenting psychology’; Johannes Climacus reflects on the reader’s contemporaneity with the character. (shrink)

This article engages with current discussions on the politics of aesthetics to theorize the role of popular art in reproducing or contesting urban orders. Specifically, we engage with scholars who have taken up the work of Jacques Rancière to understand how power structures are normalized through ‘the distribution of the sensible’. Building on and critically engaging with debates on the ‘post-political city’, we suggest that all too often scholars fall back on a binary, state-centric approach that depicts non-state popular aesthetics (...) as either revolutionary and disruptive, or as indicative of an alternative form of oppression. Drawing on our work in Kingston, Jamaica, and Rio de Janeiro, Brazil, we argue that sensorial-political, art-based urban struggles shape multiple urban orders that are distinct but not necessarily antagonistic. Applying Stuart Hall’s work on popular culture to contexts of criminal governance, we show how art is often simultaneously supportive and disruptive of urban orders. (shrink)