Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council (...) in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also ‘the condition of equal voice’. (shrink)

Hospitalization significantly impacts the lives of older people, both physically and psychosocially. There is lack of observation studies that may provide an embodied understanding of older patients’ experiences in its context. The aim of this single case study was to reach a deeper understanding of one older patient’s lived experiences of hospitalization. The study followed a phenomenological embodied enquiry design and the qualitative observation method of shadowing was used. In April 2011, one older patient was shadowed for 7 days, 5–7 (...) h per day. To facilitate understanding in the reader the experiences are first presented in a story and subsequently analyzed by means of the lifeworld framework. The findings show that hospitalization is experienced as ambiguous safety, disconnected time, the feeling of being partially involved, and the struggle to re-attune to the body. (shrink)

Phenomenological healthcare research should include the lived experiences of a broad group of healthcare users. In this paper it is shown how shadowing can give a voice to people in vulnerable situations who are often excluded from interview studies. Shadowing is an observational method in which the researcher observes an individual during a relatively long time. Central aspects of the method are the focus on meaning expressed by the whole body, and an extended stay of the researcher in the phenomenal (...) event itself. Inherent in shadowing is a degree of ambivalence that both challenges the researcher and provides meaningful insights about the phenomenon. A case example of a phenomenological study on the experiences of elderly hospital patients is used to show what shadowing yields. (shrink)

Background:More and more adults in their fifties and sixties are confronted with the need to support their ageing parents. Although many aspects of filial caregiving have been researched, a well-documented and comprehensive overview of the caregiving experience is lacking.Aim:This study aims for a better understanding of the caregiving experience of adult children by generating an overview of main themes in international research.Method:A literature review of qualitative studies, focusing on the experiences of adult children caring for their ageing parents, was performed. (...) The electronic EBSCO databases Academic Search Premier, CINAHL and PsycINFO, and Google Scholar were searched to identify relevant qualitative studies published between 2000 and 2017. The ‘SPIDER’ eligibility criteria directed the approach. The quality of studies included was screened with the assessment sheet designed by Hawker and colleagues. The experiences reported were analysed and themes were synthesized.Ethical consideration:Ethical requirements were respected in every phase of the research process.Findings:Nineteen qualitative studies met the inclusion criteria. The quality of the relationship with the parent appears to be an important determinant of the children’s caregiving experience. Within this context, three themes were found: caregiving as an emotional rollercoaster, a normatively demanding experience and an opportunity for personal development.Discussion:Children caring for their ageing parents have to deal with a wide range of contradicting and conflicting norms and values. Implications for healthcare professionals and future research have been discussed.Conclusion:Caring for ageing parents is a continuous quest for giving the best possible care and living up to one’s personal values, within the context of the parent’s declining health. Professionals who support filial caregivers should address not only practical responsibilities but also the normative questions and moral considerations caregivers are dealing with. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

The notion of cognitive act is of importance for an epistemology that is apt for constructive type theory, and for epistemology in general. Instead of taking knowledge attributions as the primary use of the verb 'to know' that needs to be given an account of, and understanding a first-person knowledge claim as a special case of knowledge attribution, the account of knowledge that is given here understands first-person knowledge claims as the primary use of the verb 'to know'. This means (...) that a cognitive act is an act that counts as cognitive from a first-person point of view. The method of linguistic phenomenology is used to explain or elucidate our epistemic notions. One of the advantages of the theory is that an answer can be given to some of the problems in modern epistemology, such as the Gettier problem. (shrink)

In this paper a corporate social responsibility audit is developed following the underlying methodology of the quality award/excellence models. Firstly the extent to which the quality awards already incorporate the development of social responsibility is examined by looking at the Malcolm Baldrige National Quality Award and the European Quality Award. It will be shown that the quality awards do not yet include ethical aspects in relation to social responsibility. Both a clear definition of social responsibility and an improved audit instrument (...) are required. A definition and an audit instrument are developed which stimulate movement in that direction and help organisations to reflect on their position in relation to social responsibility. (shrink)

On the basis of both published and unpublished manuscripts written from 1914 to 1917, this article gives an overview of Lev Vygotsky’s early ideas. It turns out that Vygotsky was very much involved in issues of Jewish culture and politics. Rather surprisingly, the young Vygotsky rejected all contemporary ideas to save the Jewish people from discrimination and persecution by creating an autonomous state in Palestine or elsewhere. Instead, until well into 1917, Vygotsky proposed the rather traditional option of strengthening the (...) spiritual roots of the Jews by returning to the religious writings. Socialism was rejected, because it merely envisioned the compulsory redistribution of material goods and ‘man lives not by bread alone’. It was only after the October Revolution that Vygotsky switched from arguments in favour of the religious faith in the Kingship of God to the communist belief in a Radiant Future. (shrink)

Questions the dominant biological approach of explaining animal development as entirely genetic by exploring the explanatory value of investigating environmental influences.

Many political theorists, philosophers, social scientists, and other academics engage in political activism. And many think this is how things ought to be. In this essay, I challenge the ideal of the politically engaged academic. I argue that, quite to the contrary, political theorists, philosophers, and other political thinkers have a prima facie duty to refrain from political activism. This argument is based on a commonsense moral principle, a claim about the point of political thought, and findings in cognitive psychology.

ABSTRACT Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in (...) medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

We study several modal languages in which some (sets of) generalized quantifiers can be represented; the main language we consider is suitable for defining any first order definable quantifier, but we also consider a sublanguage thereof, as well as a language for dealing with the modal counterparts of some higher order quantifiers. These languages are studied both from a modal logic perspective and from a quantifier perspective. Thus the issues addressed include normal forms, expressive power, completeness both of modal systems (...) and of systems in the quantifier tradition, complexity as well as syntactic characterizations of special semantic constraints. Throughout the paper several techniques current in the theory of generalized quantifiers are used to obtain results in modal logic, and conversely. (shrink)

The label ‘Translational Research’ (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the lab bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific research. The rhetorical as well as moral force of the label TR obscure, however, that it is actually used in very different ways. In (...) this paper, we analyse the scientific discourse on TR, with the aim to disentangle and critically evaluate the different meanings of the label. We start with a brief reconstruction of the history of the concept. Subsequently, we unravel how the label is actually used in a sample of scientific publications on TR and examine the presuppositions implied by different views of TR. We argue that it is useful to distinguish different views of TR on the basis of three dimensions, related to (1) the construction of the ‘translational gap’; (2) the model of the translational process; and (3) the cause of the perceived translational gap. We conclude that the motive to make society benefit from its investments in biomedical science may be laudable, but that it is doubtful whether the dominant views of TR will contribute to this end. (shrink)

Four experiments examined the strategies that individuals develop in sentential reasoning. They led to the discovery of five different strategies. According to the theory proposed in the paper, each of the strategies depends on component tactics, which all normal adults possess, and which are based on mental models. Reasoners vary their use of tactics in ways that are not deterministic. This variation leads different individuals to assemble different strategies, which include the construction of incremental diagram corresponding to mental models, and (...) the pursuit of the consequences of a single model step by step. Moreover, the difficulty of a problem (i.e. the number of mental models required by the premises) predisposes reasoners towards certain strategies. Likewise, the sentential connectives in the premises also bias reasoners towards certain strategies, e.g., conditional premises tend to elicit reasoning step by step whereas disjunctive premises tend to elicit incremental diagrams. (shrink)

Due to the terrorist attacks of 9/11 and the anthrax letters of a few weeks later, the concept of dual use has spread widely in the life sciences during the past decade. This article is aimed at a clarification of the dual use concept and its scope of application for the life sciences. Such a clarification would greatly facilitate the work of policymakers seeking to ensure security while avoiding undesirable interventions of government in the conduct of science. The article starts (...) with an overview of the main developments in life sciences in relation to dual use. This is illustrated by discussions on synthetic biology and dual use. The findings lead to a reconsideration of the dual use concept. An area in need of further attention is to what extent threats and intentions should have impact on the definition of dual use. Possible threats are analyzed against the background of the phenomenon of securitization of health care and life sciences: considering these sectors of society in security terms. Some caveats that should be taken into account in a dual use policy are described. An acceptable, adequate and applicable definition of the dual use concept could help researchers, universities, companies and policy makers. Such a definition should build upon, but go beyond, the view developed in the influential Fink-report, which concentrates on the so-called ‘experiments of concern’, e.g. experiments that enhance the virulence of pathogens (National Research Council of the National Academies 2004) It will be argued that—in addition to these more technical aspects—a definition of dual use should include the aspect of threats and intentions. (shrink)

Recent research suggests that one can have the feeling of being the cause of an action’s outcome, even in the absence of a prior intention to act. That is, experienced self-agency over behavior increases when outcome representations are primed outside of awareness, prior to executing the action and observing the resulting outcome. Based on the notion that behavior can be represented at different levels, we propose that priming outcome representations is more likely to augment self-agency experiences when the primed representation (...) corresponds with a person’s behavior representation level. Three experiments, using different priming and self-agency tasks, both measuring and manipulating the level of behavior representation, confirmed this idea. Priming high level outcome representations enhanced experienced self-agency over behavior more strongly when behavior was represented at a higher level, rather than a lower level. Thus, priming effects on self-agency experiences critically depend on behavior representation level. (shrink)

Bowman-Smart and colleagues (2023) argue that techniques to screen and analyze the fetal genome are rapidly evolving, and are sometimes already offered commercially. These new developments will all...

This paper attempts to liberate the concept of "spirituality" from its apolitical consumerized present, and suggests that our thinking about selves as well as about secularity and religion must recognize its debts to Orientalist practices.

The philosophical aspects of Greek medicine are now more widely appreciated, not only by historians of science and medicine but also by students of philosophy in a more narrow sense. There has also been a greater appreciation of the fact that Greek medical writers not only reflect a derivative awareness of developments in philosophy but that they also actively contributed to the formation of philosophical thought more strictly defined, for instance by developing concepts and methodologies for the acquisition of knowledge (...) and understanding. Yet the consequences of this for a renewed study of the formation of Greek philosophy have yet to be drawn; and disciplinary boundaries between historians of medicine on the one hand and philosophers and historians of philosophy on the other still pose obstacles to an integrated account of Greek thought that takes on board the contributions by the medical writers. Some preliminary remarks may therefore be in order. (shrink)

In most Western countries, health law bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyse these factors and construe a development theory existing of three phases, or ideal‐typical models. In the moralistic‐paternalistic model, there is almost no health law of explicit medical ethics and the little law there is is usually based on traditional morality, combined with (...) paternalist motives, the objections to this modal are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms. In the liberal model, which is now dominant on most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product‐oriented rather than practice‐oriented; they use the same conceptual categories, they focus on the minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also result in a certain one‐sidedness. In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again. (shrink)

The impact of philosophy of science on biology is slight. Evolutionary biology, however, is nowadays an exception. The status of the neo-Darwinian theory of evolution is seriously challenged from a methodological perspective. However, the methodology used in the relevant discussions is plainly defective. A correct application of methodology to evolutionary theory leads to the following conclusions. The theory of natural selection is unfalsifiable in a strict sense of the term. This, however, does not militate against the theory, because no scientific (...) theory whatever is testable in this way. Under a more liberal testability criterion, the theory is surely testable. None the less, certain research programs may tend to make the theory untestable in practice. It has often been argued that the tautologous character of the principle of natural selection, allegedly the focus of evolutionary theory, makes the theory untestable through circular reasoning. Actually, the principle is only a tautology if ‘fitness’ is wrongly defined in terms of actual survival. But even then circular reasoning need not ensue. Evolutionary principles do not permit, without additional information, the derivation of statements about evolutionary events concerning particular species or populations. If this were a reason to criticize the theory , any other scientific theory would be inadequate by the same token. (shrink)

Offers a practical philosophy of the life sciences, showing how scientific reasoning can, in limited contexts, be translated into the language of philosophy, and how science can correct the philosophy of science.

Why is a Reformational philosophy needed in Africa? It is necessary, because something is missing in African Christianity. Most Western missionaries taught Africans a “broken” or dualistic worldview. This caused a divorce between traditional culture and their new Christian religion. The Christian faith was perceived as something remote, only concerned with a distant past and a far-away future . It could not become a reality in their everyday lives. It could not develop into an all-encompassing worldview and lifestyle. Because Reformational (...) philosophy advocates the Biblical, holistic approach of a comprehensive worldview, it is welcomed on our continent. It contains a healing and liberating message to our bleeding and lost continent. What Africans, however, neither want nor can afford, is an ivory tower philosophy, playing intellectual games; a philosophy which does not do or change anything. They want a philosophy which is a “marriage” between abstract ideas and the facts on the ground. They need a Christian philosophy with compassion that may even contribute to the alleviation of their poverty! (shrink)

Newborn screening consists of taking a few drops of blood from a baby's heel in the first week of life and testing it for a list of disorders. In the United States and most countries in Europe, newborn screening programs began in the 1960s and 1970s with screening for phenylketonuria (PKU), a rare metabolic disease that causes severe and irreversible mental retardation unless treated before problems arise. As knowledge about rare diseases expanded and new screening technologies were introduced—such as the (...) tandem mass spectrometer and high‐performance liquid chromatography—the same blood sample could be used to test for a whole list of disorders. In general, screening programs in most countries have tended to expand, but in different countries they have expanded in different ways. Regulation also varies. In some states, screening is mandatory, whereas in others—Wyoming and Maryland—parents are asked for their informed consent. Germany and France have adopted an explicit informed consent procedure, whereas other European countries have a more informal “opt‐out” procedure that does not require signing an informed consent form. Whether newborn screening requires informed consent is an ongoing issue in bioethics. In this article, we will focus on the tension between informed consent and the problem of compliance in newborn screening. Asking for informed consent—allowing parents to opt out—is often thought to pose a threat to compliance. Building on the work of Onora O'Neill on informed consent and trust, however, as well as on work she coauthored with Neil Manson, we will argue that informed consent procedures may actually help maintain trust in newborn screening and may therefore support compliance. (shrink)

Various philosophers and evolutionary biologists have recently defended the thesis that species are individuals rather than sets. A decade of debates, however, did not suffice to settle the matter. Conceptual analysis shows that many of the key terms involved are ambiguous. Current disagreements should dissolve once this is recognized. Explication of the concepts involved leads to new programs for philosophical research. It could also help biology by showing how extant controversies concerning evolution may have conceptual rather than factual roots.

Whether its title, ύπέρ τοῦ μ γεννᾶν is authentic or not, the work transmitted as ‘Book X’ of Aristotle's History of Animals deals with a wide range of possible causes for failure to conceive and generate offspring. It sets out by saying that these causes may lie in both partners or in either of them, but in the sequel the author devotes most of his attention to problems of the female body. Thus he discusses the state of the uterus, the (...) occurrence and modalities of menstruation, the condition and position of the mouth of the uterus, the emission of fluid during sleep , physical weakness or vigour on awakening after this nocturnal emission, the occurrence of flatulence in the uterus and the ability to discharge this, moistness or dryness of the uterus, wind-pregnancy, and spasms in the uterus. Then he briefly considers the possibility that the cause of infertility lies with the male, but this is disposed of in one sentence: if you want to find out whether the man is to blame, the author says, just let him have intercourse with another woman and see whether that produces a satisfactory result . The writer also acknowledges that the problem may lie in a failure of two otherwise healthy partners to match sexually, or as he puts it, to ‘run at the same pace’ ἲσοδρομῆσαι during intercourse, but he does not go into this possibility at great length , and he proceeds to discuss further particulars on the female side. (shrink)

In his own day, the name of Pierre Bayle was as famous as that of any philosopher in Europe. Yet despite his vast influence on the eighteenth century and the Enlightenment, Bayle's name was eclipsed by those of other, more methodical thinkers of his age, eliciting the following remark from one modern scholar, J.C. Laursen: 'Why do professional philosophers spend so much time on Descartes and so little time on Pierre Bayle, when Bayle was clearly the better philosopher?'In the past (...) decades a surge of new interest in Bayle has led to the rediscovery of the depth of his philosophical thought as well as the extent of his influence-yet the scholarly debate is shadowed by deep uncertainty as to how to tackle his eclectic writings, especially the expansive historical-philosophical publication that became one of the Enlightenment's best-sellers: the Dictionnaire Historique et Critique, first published in 1696 and counting more than six million words.This volume provides an important new study of both Bayle and the Dictionnaire. (shrink)