Health technology assessment consists of thesystematic study of the consequences of theintroduction or continued use of the technology in aparticular context, with the explicit objective toarrive at a judgment of the value or merit of thetechnology. Ideally, it is aimed at assessing allaspects of a given technology or group oftechnologies, including non-technical, e.g.socio-ethical, aspects. However, methods for assessingsocio-ethical implications of health technology arerelatively undeveloped and few mechanisms exist totake action based on the results of such evaluations.Still, the examples of cochlear (...) inplants and other cases illustratethat HTA is not a matter of merely collecting thefacts about a technology. The facts must beplausible and relevant from a particular framework,which is not always shared by different groups. It ishere that socio-ethical aspects are encountered. Ifhealth technology assessment aims to enhance theaccountability of the decision making processregarding funding and use of health technology, it isa major challenge to assessors of health technologiesto deal adequately with existing value pluralism. Inthis respect interactive evaluation may have somethingto offer. (shrink)

• Aggregates of previously isolated cells of Hydra are capable, under suitable solvant conditions, of regeneration forming complete animals. In a first stage, ecto- and endodermal cells sort out, producing the bilayered hollow structure characteristic of Hydra tissue; thereafter, heads are formed (even if the original cell preparation contained no head cells), eventually leading to the separation of normal animals with head, body column and foot. Hydra appears to be the highest type of organism that allows for regeneration of the (...) entire structure from random cell aggregates. The system is particularly useful for studying cell interactions, tissue polarity, pattern formation, and cell differentiation. (shrink)

Richard Dawkins has a dilemma when it comes to design arguments. On the one hand, he maintains that it was Darwin who killed off design and so implies that his rejection of design depends upon the findings of modern science. On the other hand, he follows Hume when he claims that appealing to a designer does not explain anything and so implies that rejection of design need not be based on the findings of modern science. These contrasting approaches lead to (...) the following dilemma: if he claims that Darwinism is necessary for rejecting design, he has no satisfactory response to design arguments based on the order in the laws of physics or the fine-tuning of the physical constants; alternatively, if Humean arguments are doing most of the work, this would undermine one of his main contentions, that atheism is justified by science and especially by evolution. In any case, his Humean arguments do not provide a more secure basis for his atheism because they are seriously flawed. A particular problem is that his argument for the improbability of theism rests on a highly questionable application of probability theory since, even if it were sound, it would only establish that the prior probability of God’s existence is low, a conclusion which is compatible with the posterior probability of God’s existence being high. (shrink)

We trace the history of the Modern Evolutionary Synthesis, and of genetic Darwinism generally, with a view to showing why, even in its current versions, it can no longer serve as a general framework for evolutionary theory. The main reason is empirical. Genetical Darwinism cannot accommodate the role of development (and of genes in development) in many evolutionary processes. We go on to discuss two conceptual issues: whether natural selection can be the “creative factor” in a new, more general framework (...) for evolutionary theorizing; and whether in such a framework organisms must be conceived as self-organizing systems embedded in self-organizing ecological systems. (shrink)

Using the evolution of the stickleback family of subarctic fish as a touchstone, we explore the effect of new discoveries about regulatory genetics, developmental plasticity, and epigenetic inheritance on the conceptual foundations of the Modern Evolutionary Synthesis. Identifying the creativity of natural selection as the hallmark of the Modern Synthesis, we show that since its inception its adherents have pursued a variety of research projects that at first seemed to conflict with its principles, but were accommodated. We situate challenges coming (...) from developmental biology in a dialectic between innovation and tradition, suggesting on the basis of past episodes that even if developmental plasticity and epigenetic inheritance are aligned with its principles the Modern Synthesis will be significantly affected. (shrink)

Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)

At least since Descartes, philosophers have been interested in the special knowledge or authority that we exhibit when we speak about our own thoughts, attitudes, and feelings. This book contends that even the best work in contemporary philosophy of mind fails to account for this sort of knowledge or authority because it does not pay the right sort of attention to the notion of expression. What's at stake is not only how to understand self-knowledge and first-person authority, but also what (...) it is that distinguishes conscious from unconscious psychological states, what the mental life of a nonlinguistic animal has in common with our sort of mental life, and how to think about Wittgenstein's legacy to the philosophy of mind. (shrink)

This is the first sustained, whole-Bible treatment on the theme of meeting God face to face. Starting with Genesis and ending with Revelation, the author systematically covers the major events in salvation history, all of which reveal the beauty of encountering God's grace in abundance.

Printbegrænsninger: Der kan printes kapitelvis.

I revise J L Mackie's first account of casual direction by replacing his notion of "fixity" by a newly defined notion of "sufficing" that is designed to accommodate indeterminism. Keeping Mackie's distinction between casual order and casual direction, I then consider another revision that replaces "fixity" with "one-way conditionship". In response to the charge that all such accounts of casual priority beg the question by making an unjustified appeal to temporal priority, i maintain that one-way conditionship explains rather that assumes (...) objective temporal dependence as well as objective casual dependence. (shrink)

Explanatory models in psychiatry reflect what clinicians deem valuable in rendering people's behavior intelligible and thus help guide treatment choices for mental illnesses. This article outlines some key scientific and ethical principles of clinical explanation in twenty-first century psychiatry. Recent work in philosophy of science, clinical psychiatry, and psychiatric ethics are critically reviewed in order to elucidate conceptual underpinnings of contemporary explanatory models. Many explanatory models in psychiatry are reductionistic or eclectic. The former restrict options for diagnostic and therapeutic paradigm (...) choice, while the latter lack a well-defined theoretical basis. These two methodological approaches stand in a dialectical relation to one another insofar as clinicians often move from one approach to its antithesis, ultimately seeking a synthesis of the two approaches that satisfies clinical needs. Pragmatic considerations can help to transcend the reductionism/eclecticism dialectic. In the absence of a completed science of mental disorders, psychiatrists must tolerate ambiguity and uncertainty as they strive to integrate diverse explanatory concepts in a rigorous and evidence-based fashion. A pragmatic explanatory model in clinical psychiatry must focus on favorable treatment outcomes for patients by respecting the pluralistic, participatory, and provisional nature of psychiatric explanation. (shrink)

Freud is often assumed to have given an explanation of how human beings acquire a morality, especially as it is manifested in the phenomenon of moral conscience. Freud himself certainly lends credence to such an interpretation of his theory, as the following passage testifies.

Critics of the conventional theory of biological evolution have asserted that while natural processes might result in some limited diversity, nothing fundamentally new can arise from “random” evolution. In response, biologists like Richard Dawkins have demonstrated that a computer program can generate a specific short phrase via evolution-like iterations starting with random gibberish. While such demonstrations are intriguing, they are flawed in that they have a fixed, prespecified future target, whereas in real biological evolution there is no fixed future target, (...) but only a complicated “fitness landscape.” In this study, a significantly more sophisticated evolutionary scheme is employed to produce text segments reminiscent of a Charles Dickens novel. The aggregate size of these segments is larger than the computer program and the input Dickens text, even when comparing compressed data. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system was significantly faster than the manual system for lung function evaluation, loan of equipment, and checking for overdue equipment. The production of correspondence was slightly slower with the computer. b. All outpatient episodes, but only 43 of 65 of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high. Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice. After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

Hume, in "An Enquiry Concerning Human Understanding", holds (1) that all causal reasoning is based on experience and (2) that causal reasoning is based on nothing but experience. (1) does not imply (2), and Hume's good reasons for (1) are not good reasons for (2). This essay accepts (1) and argues against (2). A priori reasoning plays a role in causal inference. Familiar examples from Hume and from classroom examples of sudden disappearances and radical changes do not show otherwise. A (...) priori causal reasoning is closely related to understanding causal mechanisms. One uncovers the intelligibility of a causal process by understanding its mechanism. (shrink)

In "Causes and "If P, Even If X, still Q," Philosophy 57 (July 1982), Ted Honderich cites my "The Direction of Causation and the Direction of Conditionship," journal of Philosophy 73 (April 22, 1976) as an example of an account of causal priority that lacks the proper character. After emending Honderich's description of the proper character, I argue that my attempt to account for one-way causation in terms of one-way causal conditionship does not totally lack it. Rather than emphasize the (...) singularity of an effect, as Honderich does, I emphasize the multiplicity of independent factors in a causal circumstance. (shrink)

McTaggart argues that the A series, which orders events with reference to past, present, and future, involves an inescapable contradiction. The significant difference between the earlier version of his argument (Mind, 1908) and the version in The Nature of Existence, Volume II, Chapter 33 (1927), has often gone unnoticed. His arguments are all invalid; the conclusion can be rejected without rejecting any premiss. It is therefore unnecessary to adopt any philosophical thesis about time (e.g., that some token-reflexive analysis of tensed (...) statements is adequate) to avoid McTaggart's final conclusion that time is unreal. (shrink)

Authorising euthanasia and assisted suicide with advance euthanasia directives is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer’s disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since the 2002 Dutch euthanasia law (...) was enacted. Thus far, only brief descriptions of the case have been reported in English language journals and media. We provide a detailed description of the case, review the main challenges of preparing and applying AEDs for persons with dementia and briefly assess the adequacy of the current oversight system governing AEDs. (shrink)

Identity, Morality, and Threat offers a critical examination of the social psychological processes that generate outgroup devaluation and ingroup glorification as the source of conflict. Daniel Rothbart and Karyna Korostelina bring together essays analyzing the causal relationship between escalating violence and opposing images of the Self and Other.

In “The logic of deep disagreements” (Informal Logic, 1985), Robert Fogelin claimed that there is a kind of disagreement – deep disagreement – which is, by its very nature, impervious to rational resolution. He further claimed that these two views are attributable to Wittgenstein. Following an exposition and discussion of that claim, we review and draw some lessons from existing responses in the literature to Fogelin’s claims. In the final two sections (6 and 7) we explore the role reason can, (...) and sometimes does, play in the resolution of deep disagreements. In doing this we discuss a series of cases, mainly drawn from Wittgenstein, which we take to illustrate the resolution of deep disagreements through the use of what we call “rational persuasion.” We conclude that, while the role of argumentation in “normal” versus “deep” disagreements is characteristically different, it plays a crucial role in the resolution of both. (shrink)

In this paper I discuss what triage is and how it might be applied to the preservation of endangered species. I compare the suggested application oftriage to endangered species with its application to wartime military practice, distribution of food aid, and human population control to show that the situation of endangered species is not analogous to these other suggested uses. I argue that, as far as species preservation is concemed, triage starts with the wrong norms and values: it is “human (...) chauvinistic,” giving primacy to economic, political, and sociocultural aspects that emphasize human interests without recognizing the connection between the survival of other species and the survival of humans. (shrink)