The physician-patient relationship has changed over the last several decades, requiring a systematic reevaluation of the competing demands of patients, physicians, and families. In the era of genetic testing, using a model of patient care known as the family covenant may prove effective in accounting for these demands. The family covenant articulates the roles of the physician, patient, and the family prior to genetic testing, as the participants consensually define them. The initial agreement defines the boundaries of autonomy and benefit (...) for all participating family members. The physician may then serve as a facilitator in the relationship, working with all parties in resolving potential conflicts regarding genetic information. The family covenant promotes a fuller discussion of the competing ethical claims that may come to bear after genetic test results are received. (shrink)

The physician-patient relationship has changed over the last several decades, requiring a systematic reevaluation of the competing demands of patients, physicians, and families. In the era of genetic testing, using a model of patient care known as the family covenant may prove effective in accounting for these demands. The family covenant articulates the roles of the physician, patient, and the family prior to genetic testing, as the participants consensually define them. The initial agreement defines the boundaries of autonomy and benefit (...) for all participating family members. The physician may then serve as a facilitator in the relationship, working with all parties in resolving potential conflicts regarding genetic information. The family covenant promotes a fuller discussion of the competing ethical claims that may come to bear after genetic test results are received. (shrink)

Bolzano hat seine Wahrscheinlichkeitslehre in 15 Punkten im § 14 des zweiten Teils seiner Religionswissenschaft sowie in 20 Punkten im § 161 des zweiten Bandes seiner Wissenschaftslehre niedergelegt. (Ich verweise auf die Religionswissenschaft mit 'RW II', auf die Wissenschaftslehre mit 'WL II'.) In der RW II (vgl. p. 37) ist seine Wahrscheinlichkeitslehre eingebettet in seine Ausführungen "Über die Natur der historischen Erkenntniß, besonders in Hinsicht auf Wunder", und die Lehrsätze, die er dort zusammenstellt, dienen dem ausdrücklichen Zweck, mit mathematischem Rüstzeug (...) Lehrmeinungen entgegentreten zu können, gemäß denen Wundererzählungen keine Glaubwürdigkeit zukommen könne. In der WL II (vgl. p. 171) führt Bolzano im großen und ganzen dieselben Lehrsätze an wie in der RW II, entwickelt nun aber die Wahrscheinlichkeitslehre innerhalb seiner Lehre von den Sätzen an sich. Dabei orientiert er sich zwar durchaus an den Lehrsätzen in den damaligen "Schriften über die Wahrscheinlichkeitsrechnung" (vg. WL II, p. 190), korrigiert aber dort, wo es ihm nötig erscheint (vgl. WL II, pp. 187–191), und leistet so im Grunde eine Reformulierung des elementaren Teils der Wahrscheinlichkeitslehre seiner Zeit innerhalb seiner logischen Theorie von den Sätzen an sich. — Ich bezwecke hier keine historische Studie über Bolzanos Wahrscheinlichkeitslehre, obwohl es von Interesse sein mag, herauszuschälen, worin Bolzano mit welchen Wahrscheinlichkeitstheoretikern seiner Zeit übereinstimmt, und worin nicht, insbesondere welche Schwächen von Bolzanos Wahrscheinlichkeitslehre Schwächen aller damaligen Wahrscheinlichkeitslehren waren. Eine wichtige systematische Studie über Bolzanos Wahrscheinlichkeitslehre bestünde — wie von Berg (1962, pp. 148-149) ansatzweise begonnen — in einer exakten Rekonstruktion seiner Wahrscheinlichkeitslehre innerhalb eines konsistenten logischen Systems der Sätze an sich. Ich werde im folgenden etwas bei weitem Bescheideneres, doch möglicherweise durchaus Fruchtbares versuchen, nämlich die Lehrsätze von Bolzanos Wahrscheinlichkeitslehre in die Sprache einer heutigen Wahrscheinlichkeitstheorie zu übersetzen und die übersetzten Lehrsätze dort herzuleiten, soweit dies möglich ist. Man könnte dann in einem zweiten Schritt, der hier nicht mehr unternommen wird, untersuchen, inwieweit jene Thesen, die den Herleitungstest überstanden haben, jenen Zweck erfüllen, den Bolzano ihnen ursprünglich zugedacht hat: als mathematisches Rüstzeug für seine Argumentationen gegen die Auffassung zu dienen, Wundererzählungen könnten nicht glaubwürdig sein. (shrink)

The protection of human subjects in biomedical research relies on two principal mechanisms: assessing and comparing the risks and potential benefits of proposed research, and obtaining potential subjects' informed consent. While these have been discussed extensively in the literature, no attention has been paid to whether the processes should be different when the objective of an experimental biomedical intervention is to improve individual appearance, performance, or capability rather than to prevent, cure, or mitigate disease . This essay examines this question (...) in order to ensure that subjects in biomedical enhancement research receive adequate protection. (shrink)

There are two critical steps in determining whether a medical experiment involving human subjects can be conducted in an ethical manner: assessing risks and potential benefits and obtaining potential subjects’ informed consent. Although an extensive literature on both of these aspects exists, virtually nothing has been written about human experimentation for which the objective is not to prevent, cure, or mitigate a disease or condition, but to enhance human capabilities. One exception is a 2004 article by Rebecca Dresser on preimplantation (...) genetic modification — one of the most controversial enhancement technologies — in which she states, “Under existing research ethics principles, it would be unethical for investigators to perform modifications exposing embryos expected to develop into healthy children to significant risk in exchange for a possible physical or mental enhancement.” But Dresser does not explain why such an experiment would be unethical under existing principles, and her conclusion is not self-evident. (shrink)

The United States, along with other nations and international organizations, has developed an elaborate system of ethical norms and legal rules to govern biomedical research using human subjects. These policies govern research that might provide direct health benefits to participants and research in which there is no prospect for participant health benefits. There has been little discussion, however, about how well these rules would apply to research designed to improve participants’ capabilities or characteristics beyond the goal of good health. When (...) mentioned at all in the literature, this so-called enhancement research, as opposed to research aimed at diagnosing, preventing, curing, or treating illnesses or medical conditions, is usually dismissed without explanation. (shrink)

Selection on grandparental investment is more complex than Coall & Hertwig (C&H) propose. Patterns of investment are subject to an intergenerational conflict over how resources should be distributed to maximize fitness. Grandparents may be selected to distribute resources unevenly, while their descendants will be selected to manipulate investment in their own favor. Here we outline the evolutionary basis of this conflict.

PurposeThe purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing treatment-program for women with posttraumatic stress disorder after childbirth.MethodsA prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to (...) 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used.ResultsForty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity and high rates of previous mental health treatment.ConclusionImplementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

This thought-provoking book discusses the concept of progress in economics and investigates whether any advance has been made in its different spheres of research. The authors look back at the history, successes and failures of their respective fields and thoroughly examine the notion of progress from an epistemological and methodological perspective. The idea of progress is particularly significant as the authors regard it as an essentially contested concept which can be defined in many ways – theoretically or empirically; locally or (...) globally; or as encouraging or impeding the existence of other research traditions. The authors discuss the idea that for progress to make any sense there must be an accumulation of knowledge built up over time rather than the replacement of ideas by each successive generation. Accordingly, they are not concerned with estimating the price of progress, reminiscing in the past, or assessing what has been lost. Instead they apply the complex mechanisms and machinery of the discipline to sub-fields such as normative economics, monetary economics, trade and location theory, Austrian economics and classical economics to critically assess whether progress has been made in these areas of research. -/- Bringing together authoritative and wide-ranging contributions by leading scholars, this book will challenge and engage those interested in philosophy, economic methodology and the history of economic thought. It will also appeal to economists in general who are interested in the advancement of their profession. (shrink)

We agree with Barsalou's claim about the importance of perceptual symbols in a theory of abstract concepts. Yet we maintain that the richness of many abstract concepts arises from the metaphorical mapping of recurring patterns of perceptual, embodied experience to provide essential structure to these abstract ideas.

This presentation of the main phases and features of political thought in the sixteenth century is based on an exhaustive study of contemporary writings in Latin, English, French, German and Italian. The book is divided into four parts. The first part deals with the new thought of Protestantism. The rest describes special ideas that emerged in England, France and Italy.

Is logic normative for reasoning? In the wake of work by Gilbert Harman and John MacFarlane, this question has been reduced to: are there any adequate bridge principles which link logical facts to normative constraints on reasoning? Hitherto, defenders of the normativity of logic have exclusively focussed on identifying adequate validity bridge principles: principles linking validity facts—facts of the form 'gamma entails phi'—to normative constraints on reasoning. This paper argues for two claims. First, for the time being at least, Harman’s (...) challenge cannot be surmounted by articulating validity bridge principles. Second, Harman’s challenge can be met by articulating invalidity bridge principles: principles linking invalidity facts of the form 'gamma does not entail phi' to normative constraints on reasoning. In doing so, I provide a novel defence of the normativity of logic. (shrink)

Moral reasoning traditionally distinguishes two types of evil:moral and natural. The standard view is that ME is the product of human agency and so includes phenomena such as war, torture and psychological cruelty; that NE is the product of nonhuman agency, and so includes natural disasters such as earthquakes, floods, disease and famine; and finally, that more complex cases are appropriately analysed as a combination of ME and NE. Recently, as a result of developments in autonomousagents in cyberspace, a new (...) class of interesting and importantexamples of hybrid evil has come to light. In this paper, it is called artificial evil and a case is made for considering it to complement ME and NE to produce a more adequate taxonomy. By isolating the features that have led to the appearance of AE, cyberspace is characterised as a self-contained environment that forms the essential component in any foundation of the emerging field of Computer Ethics. It is argued that this goes someway towards providing a methodological explanation of whycyberspace is central to so many of CE's concerns; and it isshown how notions of good and evil can be formulated incyberspace. Of considerable interest is how the propensity for anagent's action to be morally good or evil can be determined evenin the absence of biologically sentient participants and thusallows artificial agents not only to perpetrate evil but conversely to `receive' or `suffer from'it. The thesis defended is that the notion of entropy structure,which encapsulates human value judgement concerning cyberspace ina formal mathematical definition, is sufficient to achieve thispurpose and, moreover, that the concept of AE can be determinedformally, by mathematical methods. A consequence of this approachis that the debate on whether CE should be considered unique, andhence developed as a Macroethics, may be viewed, constructively,in an alternative manner. The case is made that whilst CE issues are not uncontroversially unique, they are sufficiently novel to render inadequate the approach of standard Macroethics such as Utilitarianism and Deontologism and hence to prompt the search for a robust ethical theory that can deal with them successfully. The name Information Ethics is proposed for that theory. Itis argued that the uniqueness of IE is justified by its beingnon-biologically biased and patient-oriented: IE is anEnvironmental Macroethics based on the concept of data entityrather than life. It follows that the novelty of CE issues suchas AE can be appreciated properly because IE provides a newperspective. In light of the discussion provided in this paper, it is concluded that Computer Ethics is worthy of independent study because it requires its own application-specific knowledge and is capable of supporting a methodological foundation, Information Ethics. (shrink)

Sense of agency refers to the sense of initiating and controlling actions in order to influence events in the outside world. Recently, a distinction between implicit and explicit aspects of sense of agency has been proposed, analogous to distinctions found in other areas of cognition, notably learning. However, there is yet no strong evidence supporting separable implicit and explicit components of sense of agency. The so-called ‘Perruchet paradigm’ offers one of the few convincing demonstrations of separable implicit and explicit learning (...) systems. We adopted this approach to evaluate the implicit–explicit distinction in the context of a simple task in which outcomes were probabilistically caused by actions. In line with our initial predictions, we found evidence of a dissociation. We discuss the implications of this result for theories of sense of agency. (shrink)

When philosophers put forward claims for or against 'property', it is often unclear whether they are talking about the same thing that lawyers mean by 'property'. Likewise, when lawyers appeal to 'justice' in interpreting or criticizing legal rules we do not know if they have in mind something that philosophers would recognize as 'justice'. J. W. Harris here examines the legal and philosophical underpinnings of the concept of property and offers a new analytical framework for understanding property and justice.

Abortion is one of the most divisive topics in healthcare. Proponents and opponents hold strong views. Some health workers who oppose abortion assert a right of conscientious objection to it, a position itself that others find unethical. Even if allowance for objection should be made, it is not clear how far it should extend. Can conscientious objection be given as a reason not to refer when a woman requests her doctor to do so? This paper explores the idea of the (...) general practitioner (GP) who declines to make a direct referral for abortion, asking the woman to see another GP instead. The purpose is to defend the claim that an appeal to conscientious objection in this way can be reasonable and ethical. (shrink)