BackgroundThe introduction and wide application of non-invasive prenatal testing (NIPT) has triggered further evolution of routines in the practice of prenatal diagnosis. ‘Routinization’ of prenatal diagnosis however has been associated with hampered informed choice and eugenic attitudes or outcomes. It is viewed, at least in some countries, with great suspicion in both bioethics and public discourse. However, it is a heterogeneous phenomenon that needs to be scrutinized in the wider context of social practices of reproductive genetics. In different countries with (...) their different regulatory frameworks, different patterns of routines emerge that have different ethical implications.This paper discusses an ethics of routines informed by the perspectives of organizational sociology and psychology, where a routine is defined as a repetitive, recognizable pattern of interdependent organizational actions that is carried out by multiple performers. We favour a process approach that debunks the view – which gives way to most of the concerns – that routines are always blindly performed. If this is so, routines are therefore not necessarily incompatible with responsible decision-making. Free and informed decision-making can, as we argue, be a key criterion for the ethical evaluation of testing routines. If free and informed decision-making by each pregnant woman is the objective, routines in prenatal testing may not be ethically problematic, but rather are defensible and helpful. We compare recent experiences of NIPT routines in the context of prenatal screening programmes in Germany, Israel and the Netherlands. Notable variation can be observed between these three countries (i) in the levels of routinization around NIPT, (ii) in the scope of routinization, and (iii) in public attitudes toward routinized prenatal testing.ConclusionAn ethics of routines in the field of prenatal diagnostics should incorporate and work with the necessary distinctions between levels and forms of routines, in order to develop sound criteria for their evaluation. (shrink)

Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy—as a right and as an ideal—we (...) describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so. (shrink)

Introduction It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have (...) made a 'good' screening decision. Methods We conducted 27 semi-structured interviews with the eligible CRC screening population. The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. Results Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. Conclusion Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation. (shrink)

In the past two to three decades health behavior scientists have increasingly emphasized affect-related concepts in their attempts to understand and facilitate change in important health behaviors, such as smoking, eating, physical activity, substance abuse, and sex. This article provides a narrative review of this burgeoning literature, including relevant theory and research on affective response, incidental affect, affect processing, and affectively charged motivation. An integrative dual-processing framework is presented that suggests pathways through which affect-related concepts may interrelate to influence health (...) behavior. (shrink)

Abstract Though it has been claimed that Frege's commitment to expressions in indirect contexts not having their customary senses commits him to an infinite number of semantic primitives, Terrence Parsons has argued that Frege's explicit commitments are compatible with a two-level theory of senses. In this paper, we argue Frege is committed to some principles Parsons has overlooked, and, from these and other principles to which Frege is committed, give a proof that he is indeed committed to an infinite number (...) of semantic primitives?an intolerable result. (shrink)

In contrast to most Western countries, routine offer of prenatal screening is considered problematic in the Netherlands. The main argument against offering it to every pregnant woman is that women would be brought into a moral dilemma when deciding whether to use screening or not. This paper explores whether the active offer of a prenatal screening test indeed confronts women with a moral dilemma. A qualitative study was developed, based on a randomised controlled trial that aimed to assess the decision-making (...) process of women when confronted with a test offer. A sample of 59 women was interviewed about the different factors balanced in decision-making. Participants felt themselves caught between a need for knowledge and their unwillingness to take on responsibility. Conflict was reported between wishes, preferences and ethical views regarding parenthood; however, women did not seem to be caught in a choice between two or more ethical principles. Participants balanced the interests of the family against that of the fetus in line with their values and their personal circumstances. Therefore, we conclude that they are not so much faced with an ethical dilemma as conflicting interests. We propose that caregivers should provide the opportunity for the woman to discuss her wishes and doubts to facilitate her decision. This approach would help women to assess the meaning of testing within their parental duties towards their unborn child and their current offspring. (shrink)

Appeals to the moral authority of nature play an important role in ethical discussions about the acceptability of prenatal testing. While opponents consider testing a dangerous violation of the moral inviolable course of nature, defenders see testing as a new step in improving dominion over nature. In this study we explored the meaning of appeals to nature among pregnant women to whom a prenatal screening test was offered and the impact of these appeals on their choices regarding the acceptance of (...) screening. Contrary to theoretical debates we found that appeals to the moral authority of nature do not prevent women from welcoming the possibilities of controlling the outcomes of pregnancy, neither do they provide prima facie justification for (not) intervening in the natural course of events. Both acceptors and decliners believed in an inherent morality in nature that must be respected. They welcome the possibility of knowing more about the health of the fetus and to make their own reproductive decisions. Concerns for the quality of their child's life and for their capacity to assure a good life for their family and disabled child appear to play a central role in the decision regarding the use of screening. Appeals to nature can be interpreted as an attempt to justify beliefs regarding suffering that must be avoided and the impact that family interests may have on the decision. These findings have significant implications for ethical guidance in debates about the acceptability and boundaries of control of offspring characteristics by prenatal testing. (shrink)

ZusammenfassungDie demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

ZusammenfassungDie demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

Ignorance is trending. Politicians boast, "I'm not a scientist." Angry citizens object to a proposed state motto because it is in Latin, and "This is America, not Mexico or Latin America." Lack of experience, not expertise, becomes a credential. Fake news and repeated falsehoods are accepted and shape firm belief. Ignorance about American government and history is so alarming that the ideal of an informed citizenry now seems quaint. Conspiracy theories and false knowledge thrive. This may be the Information Age, (...) but we do not seem to be well informed. In this book, philosopher Daniel DeNicola explores ignorance -- its abundance, its endurance, and its consequences. (shrink)

This dissertation argues for a metaethical theory I call "Expressive-Assertivism." Expressive-Assertivism is a distinctive, substantial refinement of dual-use metaethical theories traditionally associated with R. M. Hare, C. L. Stevenson, and, more recently, with David Copp. If true, Expressive-Assertivism clarifies, resolves, or dissolves---without, in turn, raising additional difficulties---a number of philosophical problems, including what Michael Smith calls "The Moral Problem," which many consider to be the central organizing problem in contemporary metaethics. The following are the three most important features of Expressive-Assertivism. (...) ;1. The central tenet. The proper, literal use of an ethical sentence, such as 'Donating to charity is right', is the performance of a direct expressive illocutionary act and a direct assertive illocutionary act. Recognizing that ethical sentences can be used to both directly express a speaker's attitude and directly assert something about the world captures what is intuitively compelling about "expressivist" theories---namely, that there is some strong connection between a speaker's sincere moral utterance and his or her motivations to act---and what is intuitively compelling about "descriptivist" theories---namely, that moral utterances appear to have descriptive or cognitive content and, therefore, are truth-evaluable. The Central Tenet is the feature of Expressive-Assertivism that dissolves The Moral Problem. ;2. The generality principle. The proper, literal use of an ethical sentence directly expresses an attitude, not toward the subject of the sentence, but toward things of a more general kind, namely, things that have the property picked out by the ethical predicate . ;3. The extensionality principle. A speaker directly expresses an attitude toward things that have the property picked out by an ethical predicate whenever that predicate appears in any extensional context. Together, the Extensionality and Generality Principles shield Expressive-Assertivism from many objections to traditional expressivist theories, including "The Embedding Objection," which many consider to be the most difficult problem faced by expressivists. (shrink)

First kudos, followed by some friendly badinage, and then renewed appreciation and a look ahead. This commentary is meant to clarify main arguments, redress incorrect attributions, and strengthen an excellent contribution that draws further attention to the importance of evolutionary epidemiology. Keller & Miller (K&M), despite significant errors, have done well to further systematize the evolutionary epidemiology of psychopathology. (Published Online November 9 2006).

This dissertation is an investigation into the ground of moral objectivity. My preliminary claim is that in order to be objective, moral properties must be real properties. The following question is, what kind of properties are moral properties? A number of recent philosophers have argued that moral properties are natural properties. ''Natural" in this context means " open to investigation and discovery by the senses or by empirical science." The natural properties proposed in the recent literature are connected to the (...) property of human well-being. The main project of my dissertation is to show that natural properties are not adequate as the foundation for moral objectivity, because there is no necessary connection between any natural properties and moral properties. Another answer to the question of what kind of properties moral properties are is that they are supernatural properties. "Supernatural" in this context means "not open to investigation and discovery by the senses, or by empirical science." It is my argument that a singular supernatural being who created the world and has particular ideas about what sorts of people/actions/states of affairs are good and bad or right and wrong is the only sufficient ground for moral objectivity. Given such a being, moral properties will be real and objective. They will also be moral properties, since the originator of these properties confers value on them. Using and expanding on work in Divine Command Theory, especially that of Robert M. Adams, my original contribution to this discussion is to propose that moral properties are relational properties. The relationship is between persons, actions, states of affairs, etc., in the physical world, and the ideas, desires, character, or commands of the supernatural being. An important limitation of my dissertation project is that I do not consider any practical issues such as "How do we know whether God exists?", "How would God communicate the content of morality to us?", or "What is God like?" These are important and worthwhile questions, but are not a part of my present investigation. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im Gesundheitswesen in Zukunft weiter verschärfen. Auch Deutschland steht eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Ein nur selten in diesem Kontext besprochenes Kriterium der Verteilung von Mitteln in der Gesundheitsversorgung ist die marginale Wirksamkeit medizinischer Leistungen. Im vorliegenden Beitrag wird dieses Kriterium vorgestellt und auf seine Fairness hin untersucht. Nach der kritischen Diskussion einiger Argumente gegen den offenen Einsatz von (...) Rationierungskriterien und einer Definition von marginaler Wirksamkeit in zwei unterschiedlichen Dimensionen werden verschiedene Vorzüge und eventuelle Nachteile des Kriteriums beleuchtet. (shrink)

We describe a new class of experiments designed to probe the foundations of quantum mechanics. Using quantum controlling devices, we show how to attain a freedom in temporal ordering of the control and detection of various phenomena. We consider wave–particle duality in the context of quantum-controlled and the entanglement-assisted delayed-choice experiments. Then we discuss a quantum-controlled CHSH experiment and measurement of photon’s transversal position and momentum in a single set-up.

Integrated developmental and elemental information in teeth provide a unique framework for documenting breastfeeding histories, physiological disruptions, and neurotoxicant exposure in humans and our primate relatives, including ancient hominins. Here we detail our method for detecting the consumption of mothers’ milk and exploring health history through the use of laser ablation‐inductively coupled plasma‐mass spectrometry (LA‐ICP‐MS) mapping of sectioned nonhuman primate teeth. Calcium‐normalized barium and lead concentrations in tooth enamel and dentine may reflect milk and formula consumption with minimal modification during (...) subsequent tooth mineralization, particularly in dentine. However, skeletal resorption during severe illness, and bioavailable metals in nonmilk foods, can complicate interpretations of nursing behavior. We show that explorations of the patterning of multiple elements may aid in the distinction of these important etiologies. Targeted studies of skeletal chemistry, gastrointestinal maturation, and the dietary bioavailability of metals are needed to optimize these unique records of human health and behavior. (shrink)

BackgroundThere is evidence that direct journal endorsement of reporting guidelines can lead to important improvements in the quality and reliability of the published research. However, over the last 20 years, there has been a proliferation of reporting guidelines for different study designs, making it impractical for a journal to explicitly endorse them all. The objective of this study was to investigate whether a decision tree tool made available during the submission process facilitates author identification of the relevant reporting guideline.MethodsThis was (...) a prospective 14-week before–after study across four speciality medical research journals. During the submission process, authors were prompted to follow the relevant reporting guideline from the EQUATOR Network and asked to confirm that they followed the guideline (‘before’). After 7 weeks, this prompt was updated to include a direct link to the decision-tree tool and an additional prompt for those authors who stated that ‘no guidelines were applicable’ (‘after’). For each article submitted, the authors’ response, what guideline they followed (if any) and what reporting guideline they should have followed (including none relevant) were recorded.ResultsOverall, 590 manuscripts were included in this analysis—300 in the before cohort and 290 in the after. There were relevant reporting guidelines for 75% of manuscripts in each group; STROBE was the most commonly applicable reporting guideline, relevant for 35% (n = 106) and 37% (n = 106) of manuscripts, respectively. Use of the tool was associated with an 8.4% improvement in the number of authors correctly identifying the relevant reporting guideline for their study (p < 0.0001), a 14% reduction in the number of authors incorrectly stating that there were no relevant reporting guidelines (p < 0.0001), and a 1.7% reduction in authors choosing a guideline (p = 0.10). However, the ‘after’ cohort also saw a significant increase in the number of authors stating that there were relevant reporting guidelines for their study, but not specifying which (34 vs 29%; p = 0.04).ConclusionThis study suggests that use of a decision-tree tool during submission of a manuscript is associated with improved author identification of the relevant reporting guidelines for their study type; however, the majority of authors still failed to correctly identify the relevant guidelines. (shrink)

Throughout the Old Testament, the stories, laws, and songs not only teach a way of life that requires individuals to be moral, but they demonstrate how. In biblical studies, character ethics has been one of the fastest-growing areas of interest. Whereas ethics usually studies rules of behavior, character ethics focuses on how people are formed to be moral agents in the world. This book presents the most up-to-date academic work in Old Testament character ethics, covering topics throughout the Torah, the (...) Prophets, and the Writings, in addition to the use of the Bible in the modern world. In addition to Carroll and Lapsley, contributors are Denise M. Ackermann, Cheryl B. Anderson, Samuel E. Balentine, William P. Brown, Walter Brueggemann, Thomas B. Dozeman, Bob Ekblad, Jose Rafael Escobar R., Theodore Hiebert, Kathleen O'Connor, Dennis T. Olson, J. David Pleins, Luis R. Rivera Rodriguez, J. J. M. Roberts, and Daniel L. Smith-Christopher. (shrink)

El artículo tiene por objeto analizar la construcción del conocimiento mapuche según el discurso de kimches. Sostenemos que en la educación familiar existe un proceso de construcción de conocimientos propios como un sistema de saberes y contenidos educativos para la formación de personas. La metodología empleada es la investigación educativa. Los resultados parciales muestran una descripción acerca de la lógica de los conocimientos educativos propios, para contextualizar la enseñanza y el aprendizaje de las ciencias en el medio escolar, desde la (...) educación intercultural en contexto mapuche. The aim of this article is to analyze the construction of Mapuche knowledge based on the kimches speech. We argue that within family education, there exists a process of constructing their own knowledge, as a system of knowledge and educational contents for forming individuals. The research methodology applied corresponds to education research. Preliminary results describe the logic of individual educational knowledge from intercultural education in the Mapuche context, so as to contextualize the teaching and learning of Science in schools. (shrink)

This article investigates the use of favors by managers of BRIC firms to accomplish business goals, the ethicality of which should be determined by the moral reasoning in these countries rather than from a developed country perspective. We define a favor as an exchange of outcomes between individuals, typically utilizing one's connections, that is based on a commonly understood cultural tradition, with reciprocity by the receiver typically not being immediate, and its value being less than what would constitute bribery within (...) that cultural context. This exchange normally takes place between and among members of networks, and may involve a network outsider contacted by a network insider on behalf of another insider. We see the giver and receiver of the favor, as well as network insiders and outsiders, as stakeholders. Additionally, society could also be considered to be a stakeholder since the practice of using favors generally inhibits the development of legitimate, strong formal institutions, since the use of favors in emerging economies is rooted in cultural traditions that we view as informal institutions. Furthermore, we assert that the practice of using favors can lead to bribery which harms society as a stakeholder both morally and economically. We posit that BRIC-country managers' behaviors stem from informal, culturally based practices—jeito in Brazil, blat/sviazi in Russia, jaan-pehchaan in India, and guanxi in China. We utilize institutional theory to explain why favors are relied upon, and ISCT to support the argument that the use of favors in environments like the BRICs is generally considered ethical. (shrink)

Within bioethics as well as in broader clinical practice, support for transgender and gender‐questioning adolescent access to pubertal suppression has often relied heavily on the desire to prevent risky, self‐destructive, and suicidal behavior. We argue that framing justifications for access to puberty suppression in this way can actually be harmful to both individual patients as well as to the broader trans population. This justification for access to care makes such access precarious, limits its scope, and introduces perverse incentives to the (...) patient population that is being served. We go on to offer an alternative, positive defense of access to puberty‐blocking treatment for transgender youth grounded in the child's right to an open future. We argue that decisions related to pubertal suppression are both importantly weighty and potentially irreversible, and show why this justification is preferable to so‐called “informed consent” approaches. (shrink)

The genome is a stable repository of vastly intricate genetic information developed over eons of evolution; this information is replicated at the highest fidelity and expressed within each cell at the highest selectivity. Non‐leukemia cancers break this standard; the intricate genetic information qualitatively and progressively deteriorates, resulting in a somatic Darwinian free‐for‐all. In a process lasting several years, a genomically heterogeneous population replicates from a single cell that originally lost the ability to preserve its genomic integrity. Cells selected for their (...) abilities to proliferate and spread, while evading host defenses, inexorably expand their numbers. The clinical consequences of this become severe, as the genomically diverse cell population that evolves contains members that can evade most therapeutic approaches aimed at “the tumor cell”. BioEssays 23:1037–1046, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Shared decision-making has become a new focus of health policy. Though its core elements are largely agreed upon, there is little consensus regarding which outcomes to prioritize for policy-mandated shared decision-making.