Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

Scholars have long been captivated by the parallels between birdsong and human speech and language. In this book, leading scholars draw on the latest research to explore what birdsong can tell us about the biology of human speech and language and the consequences for evolutionary biology. They examine the cognitive and neural similarities between birdsong learning and speech and language acquisition, considering vocal imitation, auditory learning, an early vocalization phase, the structural properties of birdsong and human language, and the striking (...) similarities between the neural organization of learning and vocal production in birdsong and human speech. After outlining the basic issues involved in the study of both language and evolution, the contributors compare birdsong and language in terms of acquisition, recursion, and core structural properties, and then examine the neurobiology of song and speech, genomic factors, and the emergence and evolution of language. Contributors: Hermann Ackermann, Gabriël J.L. Beckers, Robert C. Berwick, Johan J. Bolhuis, Noam Chomsky, Frank Eisner, Martin Everaert, Michale S. Fee, Olga Fehér, Simon E. Fisher, W. Tecumseh Fitch, Jonathan B. Fritz, Sharon M.H. Gobes, Riny Huijbregts, Eric Jarvis, Robert Lachlan, Ann Law, Michael A. Long, Gary F. Marcus, Carolyn McGettigan, Daniel Mietchen, Richard Mooney, Sanne Moorman, Kazuo Okanoya, Christophe Pallier, Irene M. Pepperberg, Jonathan F. Prather, Franck Ramus, Eric Reuland, Constance Scharff, Sophie K. Scott, Neil Smith, Ofer Tchernichovski, Carel ten Cate, Christopher K. Thompson, Frank Wijnen, Moira Yip, Wolfram Ziegler, Willem Zuidema. (shrink)

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.

This study aims to further investigate the convergent validity of the recently-proposed metapersonal model and measure of self-construal, and to emphasize the discriminant validity of the metapersonal self-construal as a distinct construct, capturing a unique aspect of self-construal separate from either interdependent or independent aspects. The study looked at two questions: Does the metapersonal self-construal predict higher emotional intelligence? Do those who have higher metapersonal self-construal scores also report greater well-being? A group of 212 undergraduate students was assessed using a (...) self-construal scale that includes the new measure of metapersonal self-construal, along with scales measuring emotional intelligence and well-being. The metapersonal self-construal predicted higher emotional intelligence scores and greater well-being than either the independent or interdependent self-construals. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

To Aristotle, spoken words are symbols, not of objects in the world, but of our mental experiences related to these objects. Presently there are two major strands of interpretation of Aristotle’s concept of the linguistic sign. First, there is the structuralist account offered by Coseriu (Geschichte der Sprachphilosophie. Von den Anfängen bis Rousseau, 2003 [1969], pp. 65–108) whose interpretation is reminiscent of the Saussurean sign concept. A second interpretation, offered by Lieb (in: Geckeler (Ed.) Logos Semantikos: Studia Linguistica in Honorem (...) Eugenio Coseriu 1921–1981, 1981) and Weidemann (in: Schmitter (Ed.) Geschichte der Sprachtheorie 2. Sprachtheorien der abendländischen Antike, 1991), says that Aristotle’s concept of the linguistic sign is similar to the one presented in Ogden and Richard’s (The meaning of meaning: A study of the influence of language upon thought and of the science of symbolism, 1970 [1923]) semiotic triangle. This paper starts off with an introductory outline of the so-called phýsei-thései discussion which started during presocratic times and culminated in Plato’s Cratylus. Aristotle’s concept of the linguistic sign is to be regarded as a solution to the stalemate position reached in the Cratylus. Next, a discussion is offered of both Coseriu’s and Lieb’s analysis. We submit that Aristotle’s concept of the linguistic sign shows features of both Saussure’s and Ogden and Richards’s sign concept but that it does not exclusively predict one of the two. We argue that Aristotle’s concept of the linguistic sign is based on three different relations which together evince his teleological as well empiricist point of view: one internal (symbolic) relation and two external relations, i.e. a likeness relation and a relation katà synthéken. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their (...) healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. (shrink)

This article is the introduction to the 7th volume of the Iconicity in Language and Literature Series. First a brief historical outline of the concepts of naturalness and iconicity in linguistic theory is given. Both concepts are then separately dealt with in two sections, in which each concept is elaborated and an overview of seminal readings on naturalness and iconicity is presented. A thorough discussion is also provided of some unresolved issues in the iconicity and naturalness debates. The article rounds (...) off with a summary of the papers collected in the volume. (shrink)

Fragile X syndrome is the most common cause of inherited mental retardation in humans. The fragile X gene (FMR1) has been cloned and the mutation causing the disease is known. The molecular basis of the disease is an expansion of a trinucleotide repeat sequence (CGG) present in the first exon within the 5′ untranslated region of the FMR1 gene. Affected individuals have repeat CGG sequences of above 200. As a result the gene is not producing protein. It has been shown (...) that the FMR1 protein has RNA binding activity, but the function of this RNA binding activity is not known. The timing and mechanism of repeat amplification are not yet understood. An animal model for fragile X syndrome has been generated, which can be used to study the clinical and biochemical abnormalities caused by absence of FMR1 protein product. (shrink)

As concerns over the negative social and environmental impacts of industrial agriculture become more widespread, efforts to define and regulate sustainable agriculture have proliferated in the US. Whereas the USDA spearheaded previous efforts, today such efforts have largely shifted to Tripartite Standards Regimes (TSRs). Using a case study of the Leonardo Academy’s initiative to develop a US sustainable agriculture standard, this paper examines the standards-development process and efforts by agribusiness to influence the process. Specifically, we analyze how politics operate in (...) seemingly “depoliticized” TSRs, and how agribusiness and the USDA use “framing practices” and procedural complaints to influence the standard-development process. We contend that although governance mechanisms are a potentially powerful tool for advocates of alternative agrifood, their efficacy may be constrained by science-based requirements, an agribusiness countermovement, and a captured state. (shrink)

This introductory chapter gives an overview of the debate on realism in political theory and sets out two themes that are particularly important for this debate: the role of practice in realist political theory and the nature and place of normativity in realist political theory. These two themes are not only among the most discussed topics in the debate on possibilities to do realist political theory. Answers to the question of what more applied forms of realist political theory might look (...) like will also depend significantly on how realists specify the role of practice in political theory and the meaning of realist normative argumentation. We outline some of the main positions in the field and highlight questions that have been insufficiently addressed. Finally, we give an overview of the arguments of the articles assembled in this collection and how they contribute to the ongoing debates on the two themes. (shrink)

This target article focuses on dynamics that arise in three typical ethically complex cases in which psychiatric consultations are requested by physicians: a dying patient refuses life-prolonging treatment, an uncooperative patient demands to be allowed to go outside and smoke, and an angry patient demands to be admitted to the hospital. The discussion canvasses what is at stake morally and clinically in each of these cases and explores clinician–patient interactions, dynamics in relationships between consulting physicians and consultant psychiatrists, patient transference, (...) and physician countertransference. The article defines legalism and countertransference and argues that an ethically and clinically important consequence of these phenomena for patients is distortion of clinicians' perceptions of patients' decisions and vulnerabilities. The discussion also describes how legalism and countertransference adversely affect how clinicians treat their psychiatrist colleagues. Finally, the article suggests how the effects of legalism and countertransference can be mitigated. (shrink)

BackgroundThe emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD).AimExplore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD).MethodsSemi-structured, future scenario-based (...) interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission’s Ethics Guidelines for Trustworthy AI to structure the interviews.ResultsSix themes arose from the interviews: the ability of AI to rectify human doctors’ limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the ‘human touch’; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the ‘human touch’ in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients’ individual contexts and values, in consultation with the patient.ConclusionThe ‘human touch’ patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the ‘right to a human doctor’ is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward. (shrink)

In 2001, leaders with palliative care convened to discuss the standardization of palliative care and formed the National Consensus Project for Quality Palliative Care. In 2004, the National Consensus Project for Quality Palliative Care produced the first edition of Clinical Guidelines for Quality Palliative Care. The Guidelines were developed by leaders in the field who examined other national and international standards with the intent to promote consistent, accessible, comprehensive, optimal palliative care through the health care spectrum. Within the guidelines there (...) are eight domains to the provision of palliative care. This article focuses on the last, but very significant Domain 8—Ethical and Legal Aspects of Care. (shrink)

Humans can recollect past events in details and/or know that an object, person, or place has been encountered before. During the last two decades, there has been intense debate about how recollection and familiarity are organized in the brain. Here, we propose an integrative memory model which describes the distributed and interactive neurocognitive architecture of representations and operations underlying recollection and familiarity. In this architecture, the subjective experience of recollection and familiarity arises from the interaction between core systems and an (...) attribution system. By integrating principles from current theoretical views about memory functioning, we provide a testable framework to refine the prediction of deficient versus preserved mechanisms in memory-impaired populations. The case of Alzheimer's disease is considered as an example because it entails progressive lesions starting with limited damage to core systems before invading step-by-step most parts of the model-related network. We suggest a chronological scheme of cognitive impairments along the course of AD, where the inaugurating deficit would relate early neurodegeneration of the perirhinal/anterolateral entorhinal cortex to impaired familiarity for items that need to be discriminated as viewpoint-invariant conjunctive entities. The integrative memory model can guide future neuropsychological and neuroimaging studies aiming to understand how such a network allows humans to remember past events, to project into the future, and possibly also to share experiences. (shrink)

En el contexto político global contemporáneo, las diversas luchas sociales se están alienando entre sí hasta elpunto de que la ilusión del capitalismo como único sistema socioeconómico posible está difuminando todos los horizontesdel cambio social. En este artículo, trataremos de redefinir las causas comunes de las luchas sociales, demostrando su interseccionalidad e interdependencia. Para ello, nos ocuparemos de una serie de conceptos de la filosofía de Marx. En la introducción, examinaremos la noción de valor, afirmando que la teoría del valor (...) de Marx no es simplemente una teoría laboral del valor, sino que más bien refleja la estructura paralela de la producción y la circulación, cristalizada en la forma de valor última del dinero. Una vez obtenidas estas ideas preliminares, volveremos al fenómeno del trabajo en el capitalismo, para reinterpretar, en la primera sección del artículo, la distinción marxiana entre trabajo productivo e improductivo. A partir de ahí, se darán los primeros ejemplos concretos de la interseccionalidad de las luchas sociales contra la abstracción del capital: a saber, mostrar que las luchas de género y las raciales tienen ciertas causas comunes, enraizadas en la hegemonía gramsciana. En la segunda sección, examinaremos la distinción que Marx establece entre la subsunción formal y la real. Esta última, afirmaremos, es decisiva para entender cómo el capital estructura la cuasi-totalidad de nuestras relaciones sociales. Tras una interpretación de la película Toni Erdmann de Maren Ade, propondremos algunos medios posibles de lucha interseccional contra la subsunción real, que encontrarán su respaldo teórico en el concepto de universales subversivos. Las observaciones finales abordarán la lógica nuclear de la distribución y la acumulación del capital, un síntoma que pervive a lo largo de la historia preservado e impulsado por la omnipresencia de la ideología, y subrayarán de nuevo implícitamente la importancia de la lucha común en el descongelamiento de la emergencia de un nuevo sujeto revolucionario. (shrink)

Abstractc‐Rel is a proto‐oncogene first identified as the cellular counterpart of the v‐Rel oncogene derived from the avian reticuloendotheliosis retrovirus (REV‐T). It was subsequently discovered that c‐Rel belongs to the NF‐κB/Rel transcription factor family whose members share a common DNA recognition motif and similar signaling pathways. Despite the similarities, however, each NF‐κB/Rel member possesses unique properties with regard to tissue expression pattern, response to receptor signals and target gene specificity. These differences are fairly evident from the non‐redundant phenotypes exhibited by (...) individual NF‐κB/Rel knockout mice. Hence the work described in this review will compare and contrast the various physiological functions of c‐Rel to those of other NF‐κB members, particularly with respect to the regulation of proliferation, survival and effector functions in multiple hematopoietic and immunological cell types. The study of c‐Rel knockout mice in several disease models will also be discussed as they reveal an important role for c‐Rel in response to allergens, auto‐antigens, allo‐antigens and pathogenic infection. BioEssays 25:767–780, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Persons with profound intellectual and multiple disabilities cannot speak about their Quality of Life, which makes it necessary to involve others. In current approaches, these ‘others’ are seen as assessors trying to describe QoL as objectively as possible, which involves a reduction of their experiences, through which they develop knowledge on the QoL of the person with PIMD. The objective of this paper is to give caregivers’ knowledge on the QoL of a person with PIMD a theoretical basis that values (...) these experiences. We will argue that caregivers should be seen as witnesses, not assessors, and their statements on QoL as testimonies, not assessments. Audiences judge the trustworthiness of these witnesses intersubjectively, which implies a relationship characterized by trust and suspicion. Trust supports the witness to tell in her own words about the QoL of the person with PIMD; it demands receptivity, indicating that both the witness and the audience are willing to reconsider their perspective on QoL. Suspicion is necessary too, which helps the witness to critically approach her own interpretations and supports her to create more trustworthy testimonies. We conclude that the concept of witnessing helps to acknowledge caregivers’ experiential knowledge of QoL of a person with PIMD, which may also apply to other persons who cannot speak about their own QoL. We hope that our study will empower caregivers to give testimonies on QoL of a person with PIMD, which is crucial when complex decisions about the life of this person have to be made. (shrink)

Numerous recent discoveries in China of ancient tombs have greatly increased our knowledge of ritual and religious practices. These discoveries include excavated oracle bones, bronze, jade, stone and pottery objects, and bamboo manuscripts dating from the twelfth to fourth century BCE. Inscribed upon these artifacts are a large number of records of numerical sequences, for which no explanation has been found of how they were produced. Structural links to the Book of Changes, a divination manual that entered the Confucian canon, (...) are evident; yet, the algorithm described therein dates to the slightly later second to first century BCE. By combining archeological and statistical evidence, we propose a new methodology that enables us to reconstruct and test cleromantic techniques which can explain how these numerical sequences were generated. Dice and divination stalk use, either in combination or separately, appear in fact to have been underlying the rather stable numerical patterns in ancient China all the way back to the late Shang dynasty (1300–1046 BCE). Bringing to light such a long-standing technique, which awaits further confirmation from the ever-growing database of newly discovered numerical and textual records, can change drastically our understanding of early Chinese history and of the historical development of sophisticated arithmetical practices and the rationalization of chance. (shrink)