HIV/AIDS continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Mother-to-child transmission constitutes 90% of new HIV infections among infants and young children. Most of these infections can be prevented. However, the social stigma of HIV/AIDS insidiously continues to undermine the success of prevention programs. Ironically, some attributes (...) or characteristics of prevention of mother-to-child transmission programs may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: Routine HIV testing, Six months exclusive breastfeeding, Incentives, Home visits, Location of PMTCT program, and PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed. (shrink)

Philosophical arguments often assume that the folk tends towards moral objectivism. Although recent psychological studies have indicated that lay persons’ attitudes to morality are best characterized in terms of non-objectivism-leaning pluralism, it has been maintained that the folk may be committed to moral objectivism _implicitly_. Since the studies conducted so far almost exclusively assessed subjects’ metaethical attitudes via explicit cognitions, the strength of this rebuttal remains unclear. The current study attempts to test the folk’s implicit metaethical commitments. We present results (...) of a newly developed Implicit Association Test (IAT) for metaethical attitudes which indicate that the folk generally tend towards moral non-objectivism on the implicit level as well. We discuss implications of this finding for the philosophical debate. (shrink)

BackgroundThe Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other.MethodA qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics (...) or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsFor the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals.ConclusionsThis study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education. (shrink)

BackgroundEthiopia’s 2005 abortion law improved access to legal abortion. In this study we examine the experiences of abortion providers with the revised abortion law, including how they view and resolve perceived moral challenges.MethodsThirty healthcare professionals involved in abortion provisions in Addis Ababa were interviewed. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsMost participants considered the 2005 abortion law a clear improvement—yet it does not solve all problems and has led to new dilemmas. As a main finding, the (...) law appears to have opened a large space for professionals’ individual interpretation and discretion concerning whether criteria for abortion are met or not. Regarding abortion for fetal abnormalities, participants support the woman’s authority in deciding whether to choose abortion or not, although several saw these decisions as moral dilemmas. All thought that abortion was a justified choice when a diagnosis of fetal abnormality had been made.ConclusionEthiopian practitioners experience moral dilemmas in connection with abortion. The law places significant authority, burden and responsibility on each practitioner. (shrink)

Models are not adequately evaluated simply by whether they capture the data, after the fact. Other criteria are needed. One criterion is parsimony; but utility and generality are at least as important. Even with respect to parsimony, however, the case against feedback is not as straightforward as Norris et al. present it. We use feedback consistency effects to illustrate these points.

Experiences are interpreted as conscious mental occurrences that are of phenomenal character. There is already a kind of (weak) intentionality involved with this phenomenal interpretation. A stricter conception of experiences distinguishes between purely phenomenal experiences and intentional experiences in a narrow sense. Wittgenstein’s account of psychological (experiential) verbs is taken over: Usually, expressing mental states verbally is not describing them. According to this, I believe can be seen as an expression of one’s own belief, but not as an expression of (...) a belief about one’s belief. Hence, the utterance I believe it is raining shows that I believe that it is raining, although it is not said by these words that I believe that it is raining. Thinking thoughts such as I believe it is raining, but it is not raining (a variant of Moore’s paradox) is an absurdity between what is already said by silently uttering It is not raining and what is shown by silently uttering I believe it is raining. The paper agrees with a main result of Wittgenstein’s considerations of Moore’s paradox, namely the view that logical structure, deducibility, and consistency cannot be reduced solely to propositions—besides a logic of propositions, there is, for example, a logic of assertions and of imperatives, respectively. (shrink)

relative to the actual world) of a propositional theory are defined. A theory is ‘closer to the truth’ the logically stronger its positive content and the logically weaker its negative content. This proposal delivers the same verisimilar preordering of theories that has been defined by Brink and Heidema as a ‘power ordering’. The preordering may be collapsed to a partial ordering and then embedded into a complete distributive lattice. The preordering may also be refined to a partial ordering by employing (...) the ‘convex content’ and the ‘non-convex content’ of each theory. Philosophical implications and historical relations are discussed. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.

Alexius Meinong's specific use of the term "self-presentation" had a significant influence on modern epistemology and philosophical psychology. To show that there are remarkable parallels between Meinong's account of the self-presentation of experiences and Lehrer's account of the exemplarization of experiences is one of this paper's main objectives. Another objective is to put forward some comments and critical remarks to Lehrer's approach. One of the main problems can be expressed by the following: The process of using a particular experience as (...) a sample, that is, an exemplar that we use to stand for and refer to a plurality of experiences, Lehrer calls "exemplarization". As concrete experiences are multifarious (red and round, for example), how can we single out a specific sort of experiences (the red ones) by the process of exemplarization when we use such a multifarious experience as a sample? (shrink)

It is often assumed that graphemes are a crucial level of orthographic representation above letters. Current connectionist models of reading, however, do not address how the mapping from letters to graphemes is learned. One major challenge for computational modeling is therefore developing a model that learns this mapping and can assign the graphemes to linguistically meaningful categories such as the onset, vowel, and coda of a syllable. Here, we present a model that learns to do this in English for strings (...) of any letter length and any number of syllables. The model is evaluated on error rates and further validated on the results of a behavioral experiment designed to examine ambiguities in the processing of graphemes. The results show that the model (a) chooses graphemes from letter strings with a high level of accuracy, even when trained on only a small portion of the English lexicon; (b) chooses a similar set of graphemes as people do in situations where different graphemes can potentially be selected; (c) predicts orthographic effects on segmentation which are found in human data; and (d) can be readily integrated into a full-blown model of multi-syllabic reading aloud such as CDP++ (Perry, Ziegler, & Zorzi, 2010). Altogether, these results suggest that the model provides a plausible hypothesis for the kind of computations that underlie the use of graphemes in skilled reading. (shrink)

BackgroundPregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in addressing (...) the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy.MethodWe use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication.ResultsSolidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy.ConclusionsWe conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications. (shrink)

BackgroundIn research ethics, the most basic question would always be, “which is an ethical issue, which is not?” Interestingly, depending on which ethics guideline we consult, we may have various answers to this question. Though we already have several international ethics guidelines for biomedical research involving human participants, ironically, we do not have a harmonized document which tells us what these various guidelines say and shows us the areas of consensus. In this manuscript, we attempted to do just that.MethodsWe extracted (...) the imperatives from five internationally-known ethics guidelines and took note where the imperatives came from. In doing so, we gathered data on how many guidelines support a specific imperative.ResultsWe found that there is no consensus on the majority of the imperatives and that in only 8.2 % of the imperatives were there at least moderate consensus. Of the 12 clusters, Informed Consent has the highest level of consensus and Research Collaboration and Regulatory Sanctions have the least.ConclusionThere was a lack of consensus in the majority of imperatives from the five internationally-known ethics guidelines. This may be partly explained by the differences among the guidelines in terms of their levels of specification as well as conceptual/ideological differences. (shrink)

Glenberg's conception of “meaning from and for action” is too narrow. For example, it provides no satisfactory account of the “logic of Elfland,” a metaphor used by Chesterton to refer to meaning acquired by being told something. All that we call spirit and art and ecstasy only means that for one awful instant we remember that we forget. G. K. Chesterton.

Academics and/or scholars increasingly feel that their academic voice (combined or individual) has been squelched by the demands of performativity in its various guises, and resultantly, that they have been caught up in a process of steady disempowerment. Rather, it should be their right to be free to use their positions in the pursuit of scholarship as their conscience and their expert knowledge of their subject dictate. Academics should be free to question for themselves the boundaries of their limitations, and (...) not have these i mposedon them by the state or government bureaucracy. In order to help empower academics to regain their academic voice and identity, this article transposes six of the philosophical ideas of Belgian philosopher Rudi Visker to the world of academia. It explores the possibilities of using these ideas as instruments for the promotion and maintenance of academic freedom. Key concepts: academic freedom, managerialism, institutions of higher learning, Rudi Visker. (shrink)

Religion in education in South Africa and the Netherlands: A comparative study. The aim of this article is the reconstruction and comparison of the historical evolution of the place and role of religion in education in South Africa and in the Netherlands. The article commences with an overview of the historical evolution of the place and role of religion in education, up to the present, and a discussion of the dissatisfaction and objections which could be and which have been levelled (...) against the current situation. The Netherlands has followed a more accommodating policy and practice regarding religious beliefs and diversity than the international norm. While South Africa can learn much from the Dutch approach to the problem of religion in education, this approach has also been challenged in recent times. In both systems, controversy about the accommodation of religion in education has given rise to tension between the notions of freedom, tolerance and accommodation, on the one hand, and the acknowledgement of human rights and the need for social cohesion on the other. Other considerations to be taken into account in this regard are the downsides of providing a partisan, confessional type of education that could hinder learners in maintaining themselves in the outside world. The trend in modern society is towards individualised belief systems, not collective ones. And the warning to be heeded is that the line between education and indoctrination is thin. The current Dutch model, despite the problems that it currently encounters, could provide direction in respect of all these issues. Contribution: The article concludes with an educational-philosophical perspective regarding the question as to how educationists and educators could guide learners to a state where they can independently decide about their personal religious orientation, given the fact that they are now living in a time when relativism prevails, also in terms of religion and faith. (shrink)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being unjust to those (...) on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

The present study investigated the extent to which moral disengagement and the tendency to consider moral rules as socio-conventional rules are distinct dimensions of morality, and their association with three different forms of participation in bullying. These two types of moral cognitions have been theorized in different models of morality and are usually studied independently, even if research on moral shifts suggests some possible overlaps. A group of 276 Italian students from primary and middle school completed self-reports assessing moral disengagement, (...) socio-conventional perception of moral rules, and participation in bullying as bully, defender of the victim and passive bystander. Results from structural equation modeling analysis confirmed that moral disengagement and socio-conventional comprehension of aggressions are separate and moderately connected morality dimensions. Controlling for age, gender and SES, only moral disengagement was positively associated with perpetrating bullying. These results point to moral disengagement as the critical component of moral cognitions to be addressed in interventions. (shrink)

Background In the EU, clinical assessors, rapporteurs and the Committee for Medicinal Products for Human Use are obliged to assess the ethical aspects of a clinical development program and include major ethical flaws in the marketing authorization deliberation processes. To this date, we know very little about the manner that these regulators put this obligation into action. In this paper, we intend to look into the manner and the extent that ethical issues discovered during inspection have reached the deliberation processes. (...) Methods To gather data, we used the Dutch Medicines Evaluation Board database and first searched for the inspections, and their accompanying site inspection reports and integrated inspection reports, related to central marketing authorization applications of drugs submitted to the European Medicines Agency from 2011 to 2015. We then extracted inspection findings that were purely of ethical nature, i.e., those that did not affect the benefit/risk balance of the study. Only findings graded at least major by the inspectorate were included. Lastly, to identify how many of the ethically relevant findings reach the application deliberation processes, we extracted the relevant joint response assessment reports and reviewed the sections that discussed inspection findings. Results From 2011 to 2015, there were 390 processed applications, of which 65 had inspection reports and integrated inspection reports accessible via the database of the Dutch Medicines Evaluation Board. Of the 65, we found ERFs in 37. The majority of the ERFs were graded as major and half of the time it was informed-consent related. A third of these findings were related to research ethics committee processes and requirements. Of the 37 inspections with ERFs, 30 were endorsed in the integrated inspection reports as generally GCP compliant. Day 150 joint response assessment reports and Day 180 list of outstanding issues were reviewed for all 37 inspections, and none of the ERFs were carried over in any of the assessment reports or list of outstanding issues. Conclusion None of the ethically relevant findings, all of which were graded as major or critical in integrated inspection reports, were explicitly carried over to the joint assessment reports. This calls for more transparency in EMA application deliberations on how ERFs are considered, if at all, in the decision-making processes. (shrink)