Ondanks al zijn twijfels staat Nietzsche vrij positief tegenover de waarde van kennis en waarheid. Maar hij is tevens sceptisch over de mogelijkheid om de waarheid te kennen. Daarom ruimte hij een grote plaats voor de kunst in, die zijn creativiteit put uit het ongeloof in de waarheid.

The aim of this paper is to make clear in what sense Hume's actually very radical scepticism can nevertheless be called moderate, and not only leaves intact the praxis in daily life but is even compatible with a — modest and experimental — form of science. The first part stresses the theoretical profoundness of Hume's scepticism, and more specifically the arguments concerning the validity of reason and those concerning some typically 'metaphysical' objects. The former culminate in the impossibility of determining (...) a criterion of correctness and consequently in the degenerating of all knowledge into probability. The latter exceed the information of the senses, are therefore 'groundless' and yet in a way ineradicable, not as explanatory principles of reason but as factual constituents of human nature. The result is an overwhelming amount of contradictions and fictions within human imagination, mainly due to the inevitable presence of two contradictory beliefs, none of which are justifiable. In the second part it is shown how Hume succeeds in conquering scepticism without actually rebutting or revoking it. He is able to do so because his scepticism had, in fact, from the very beginning been elaborated as a form of naturalism, gradually minimizing the strength as well as the importance of reason as a theory, while at the same time stressing the deeply rooted and ultimately reliable character of reason as a praxis. The achievement of this naturalistic doctrine of 'belief is threefold : first, it is a critical weapon against metaphysical fictions, second, it gives man, and even the rational philosopher, an ineradicable peace of mind, and finally, it is the foundation of a special sort of science — the critical, experimentally rooted, modest and fundamentally doubtful science of human nature. (shrink)

This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the participants (...) who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

Seroprevalence monitoring of HIV in pregnant women by anonymised unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation (...) of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymised testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymisation is explained. (shrink)

The main current application of placebo is in clinical research. The term placebo effect refers to diverse non-specific, desired or non-desired effects of substances or procedures and interactions between patient and therapist. Unpredictability of the placebo effect necessitates placebo-controlled designs for most trials. Therapeutic and diagnostic use of placebo is ethically acceptable only in few well-defined cases. While "therapeutic" application of placebo almost invariably implies deception, this is not the case for its use in research. Conflicts may exist between the (...) therapist's Hippocratic and scientific obligations. The authors provide examples in neuropsychiatry, illustrating that objective scientific data and well-considered guidelines may solve the ethical dilemma. Placebo control might even be considered an ethical obligation but some provisos should be kept in mind: (a) no adequate therapy for the disease should exist and/or (presumed) active therapy should have serious side-effects; (b) placebo treatment should not last too long; (c) placebo treatment should not inflict unacceptable risks, and (d) the experimental subject should be adequately informed and informed consent given. (shrink)