Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

Theurgy, the ritual practice intended to free the descended soul from the body, has been considered an irrational and hence uninteresting part of late Neoplatonism. In this chapter, the author vindicates theurgy by showing that for Proclus there is an intimate relation between philosophy and theurgy. More specifically, he discusses the relevance of theurgy in Proclus’ metaphysics of causation, psychology, theology, and ethics. Theurgical symbols work because they are in fact low immanent forms. We need them, because our souls are (...) entirely descended, and theurgical excellence is the highest virtue. After a discussion of the role of theurgy in Proclus’ reading of the myth of the winged charioteer, the limits of theurgy, and the theurgical practices of purifying the soul from the body and of contemplation, the author ends with a short discussion of hymns as ‘theurgy in action’. (shrink)

This paper studies moral education in Proclus and Iamblichus. The first section analyses Proclus’ theory of moral education and its psychological underpinnings. Especially important in this context is the identification of the faculty of choice with the passive or teachable intellect. The second section investigates the implementation of this theory into practice with the help of Iamblichus’ Letter to Sopater: On Bringing up Children. The final section demonstrates how Proclus’ famous tripartite division of poetry should be understood in the context (...) of his program of moral education. (shrink)

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)

Cet article examine les opinions des néoplatoniciens tardifs sur le phénomène social de la philotimia (« amours des honneurs » ; « ambition »). Sur la base du Commentaire de l’Alcibiade de Proclus, on montre que la philotimia est une émotion qui résulte d’une compréhension imparfaite de la vraie nature de l’honneur et du pouvoir. La mauvaise philotimia pousse les ambitieux à poursuivre une carrière politique en quête de pouvoir mondain et de prestige au prix de l’étude de la philosophie. (...) La bonne philotimia, au contraire, peut les pousser à rechercher ce qui est véritablement bien et donc les mettre sur la voie de la philosophie. L’histoire fournit maints exemples de bonne et de mauvaise philotimia. Damascius, dans sa Vie d’Isidore, mobilise des théories de la bonne et de la mauvaise philotimia pour éloigner ses lecteurs de l’arène politique et les conduire vers la poursuite de la philosophie. (shrink)

In their introduction to the recent excellent volume Plato & Hesiod, the editors G.R. Boys-Stones and J.H. Haubold observe that when we think about the problematic relationship between Plato and the poets, we tend to narrow this down to that between Plato and Homer. Hesiod is practically ignored. Unjustly so, the editors argue. Hesiod provides a good opportunity to start thinking more broadly about Plato's interaction with poets and poetry, not in the least because the ‘second poet’ of Greece represents (...) a different type of poetry from Homer's heroic epics, that of didactic poetry. What goes for Plato and Hesiod goes for Proclus and Hesiod. Proclus , the productive head of the Neoplatonic school in Athens, took a great interest in poetry to which he was far more positively disposed than Plato had ever been. He wrote, for example, two lengthy treatises in reaction to Socrates' devastating criticism of poetry in the Republic as part of his commentary on that work in which he tries to keep the poets within the Platonic pale. This intriguing aspect of Proclus' thought has, as one might expect, not failed to attract scholarly attention. In Proclus' case too, however, discussions tend to concentrate on his attitude towards Homer . To some extent this is only to be expected, since much of the discussion in the Commentary on the Republic centres on passages from Homer. Proclus did not, however, disregard Hesiod: we still possess his scholia on the Works and Days, now available in a recent edition by Patrizia Marzillo. (shrink)

In our daily lives, we continuously evaluate feedback information, update our knowledge, and adapt our behavior in order to reach desired goals. This ability to learn from feedback information, however, declines with age. Previous research has indicated that certain higher-level learning processes, such as feedback evaluation, integration of feedback information, and updating of knowledge, seem to be affected by age, and recent studies have shown how the adaption of choice behavior following feedback can differ with age. The neural mechanisms underlying (...) this age-related change in choice behavior during learning, however, remain unclear. The aim of this study is therefore to investigate the relation between learning-related neural processes and choice behavior during feedback learning in two age groups. Behavioral and fMRI data were collected, while a group of young and older adults performed a probabilistic learning task consisting of 10 blocks of 20 trials each. On each trial, the participants chose between a house and a face, after which they received visual feedback. In each block, either the house or the face image had a higher probability of yielding a reward. Participants were instructed to try to maximize their gains. Our results showed that less successful learning in older adults, as indicated by a lower learning rate, corresponded with a higher tendency to switch to the other stimulus option, and with a reduced adaptation of this switch choice behavior following positive feedback. At the neural level, activation following positive and negative feedback was found to be less distinctive in the older adults, due to a smaller feedback-evaluation response to positive feedback in this group. Furthermore, whereas young adults displayed increased levels of knowledge updating prior to adapting choice behavior, we did not find this effect in older adults. Together, our results suggest that diminished learning performance with age corresponds with diminished evaluation of positive feedback and reduced knowledge updating related to changes in choice behavior, indicating how such differences in feedback processing at the trial level in older adults might lead to reduced learning performance across trials. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

Non-well-founded trees are used in mathematics and computer science, for modelling non-well-founded sets, as well as non-terminating processes or infinite data structures. Categorically, they arise as final coalgebras for polynomial endofunctors, which we call M-types. We derive existence results for M-types in locally cartesian closed pretoposes with a natural numbers object, using their internal logic. These are then used to prove stability of such categories with M-types under various topos-theoretic constructions; namely, slicing, formation of coalgebras , and sheaves for an (...) internal site. (shrink)

This article introduces a new hybrid intake procedure developed for posttraumatic stress disorder (PTSD) screening, which combines an automated textual assessment of respondents’ self-narratives and item-based measures that are administered consequently. Text mining technique and item response modeling were used to analyze long constructed response (i.e., self-narratives) and responses to standardized questionnaires (i.e., multiple choices), respectively. The whole procedure is combined in a Bayesian framework where the textual assessment functions as prior information for the estimation of the PTSD latent trait. (...) The purpose of this study is twofold: first, to investigate whether the combination model of textual analysis and item-based scaling could enhance the classification accuracy of PTSD, and second, to examine whether the standard error of estimates could be reduced through the use of the narrative as a sort of routing test. With the sample at hand, the combination model resulted in a reduction in the misclassification rate, as well as a decrease of standard error of latent trait estimation. These findings highlight the benefits of combining textual assessment and item-based measures in a psychiatric screening process. We conclude that the hybrid test design is a promising approach to increase test efficiency and is expected to be applicable in a broader scope of educational and psychological measurement in the future. (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 book provides an introduction to postphenomenology, an emerging school of thought in the philosophy of technology and science and technology studies, which addresses the relationships users develop with the devices they use.

Research skills are important for university graduates, but little is known about undergraduates’ motivation for research. In this study, self-efficacy beliefs and intrinsic motivation for several research activities were measured three times during an undergraduate research project. In order to promote self-efficacy for writing and collaboration, a collaboration script was developed and tested on half of the students. Twelve students were interviewed three times to gather in-depth information about motivational and self-efficacy beliefs. All measures except intrinsic motivation for research increased (...) significantly during the project. Interview results suggest that enactive mastery and positive social interdependence promoted self-efficacy. Feelings of relatedness seemed to promote intrinsic motivation for writing. Lack of autonomy and low perceived relevance may explain why motivation for research remained stable. The script had no impact on self-efficacy beliefs. Relatedness,... (shrink)

Introduction to collection of papers by group of scholars and ACO missionaries brought together to discuss the developments within the ACO over the past hundred years during a conference that was organised by Dr Wilbert van Saane of Haigazian University in January 2021. I will briefly summarise what strikes me as characteristic of the ACO on the basis of these articles, and conclude with a discussion of how this may contribute to further reflection in Mission Studies and World Christianity.

Within eighteenth-century debates on animal cognition we can distinguish at least three main theoretical positions: (i) Buffon’s mechanism, (ii) Reimarus’ theory of instincts, and (iii) the sensationalism of Condillac and Leroy. In this paper, I adopt a philosophical perspective on this debate and argue that in order to fully understand the justification Buffon, Reimarus, Condillac, and Leroy gave for their respective theories, we must pay special attention to the theoretical virtues these naturalists alluded to while justifying their position. These theoretical (...) virtues have received little to no attention in the literature on eighteenth-century animal cognition, but figure prominently in the justification of the mechanist, instinctive, and sensationalist theories of animal behavior. Through my philosophical study of the role of theoretical virtues in eighteenth-century debates on animal cognition, we obtain a deeper understanding of how theoretical virtues were conceptualized in eighteenth-century science and how they influenced the justification of theories of animal cognition. (shrink)

Kant’s teleology as presented in the Critique of Judgment is commonly interpreted in relation to the late eighteenth-century biological research of Johann Friedrich Blumenbach. In the present paper, I show that this interpretative perspective is incomplete. Understanding Kant’s views on teleology and biology requires a consideration of the teleological and biological views of Christian Wolff and his rationalist successors. By reconstructing the Wolffian roots of Kant’s teleology, I identify several little known sources of Kant’s views on biology. I argue that (...) one of Kant’s main contributions to eighteenth-century debates on biology consisted in demarcating biology from metaphysics. Kant rejected Wolffian views on the hierarchy of sciences, according to which propositions specifying the functions of organisms are derived from theological truths. In addition, Kant argued that organic self-organization necessitates a teleological description in order to show that self-organization does not support materialism. By demarcating biology and metaphysics, Kant made a small yet important contribution to establishing biology as a science. (shrink)

The paper uses the formalism of indexed categories to recover the proof of a standard final coalgebra theorem, thus showing existence of final coalgebras for a special class of functors on finitely complete and cocomplete categories. As an instance of this result, we build the final coalgebra for the powerclass functor, in the context of a Heyting pretopos with a class of small maps. This is then proved to provide models for various non-well-founded set theories, depending on the chosen axiomatisation (...) for the class of small maps. (shrink)

Within moral psychology, theories focusing on the conceptualization and empirical measurement of people’s morality in terms of general moral values –such as Moral Foundation Theory- (implicitly) assume general moral values to be relevant concepts for the explanation and prediction of behavior in everyday life. However, a solid theoretical and empirical foundation for this idea remains work in progress. In this study we explore this relationship between general moral values and daily life behavior through a conceptual analysis and an empirical study. (...) Our conceptual analysis of the moral value-moral behavior relationship suggests that the effect of a generally endorsed moral value on moral behavior is highly context dependent. It requires the manifestation of several phases of moral decision-making, each influenced by many contextual factors. We expect that this renders the empirical relationship between generic moral values and people’s concrete moral behavior indeterminate. Subsequently, we empirically investigate this relationship in three different studies. We relate two different measures of general moral values -the Moral Foundation Questionnaire and the Morality As Cooperation Questionnaire- to a broad set of self-reported morally relevant daily life behaviors (including adherence to COVID-19 measures and participation in voluntary work). Our empirical results are in line with the expectations derived from our conceptual analysis: the considered general moral values are poor predictors of the selected daily life behaviors. Furthermore, moral values that were tailored to the specific context of the behavior showed to be somewhat stronger predictors. Together with the insights derived from our conceptual analysis, this indicates the relevance of the contextual nature of moral decision-making as a possible explanation for the poor predictive value of general moral values. Our findings suggest that the investigation of morality’s influence on behavior by expressing and measuring it in terms of general moral values may need revision. (shrink)

Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper method, and (...) on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders. (shrink)

This paper analyzes Immanuel Kant’s views on mechanical explanation on the basis of Christian Wolff’s idea of scientific demonstration. Kant takes mechanical explanations to explain properties of wholes in terms of their parts. I reconstruct the nature of such explanations by showing how part-whole conceptualizations in Wolff’s logic and metaphysics shape the ideal of a proper and explanatory scientific demonstration. This logico-philosophical background elucidates why Kant construes mechanical explanations as ideal explanations of nature.

We argue that an adequate treatment of verb phrase anaphora must depart in two major respects from the standard approaches. First of all, VP anaphors cannot be resolved by simply identifying the anaphoric VP with an antecedent VP. The resolution process must establish a syntactic/semantic parallelism between larger units that the VPs occur in. Secondly, discourse structure has a significant influence on the reference possibilities of VPA. This influence must be accounted for. We propose a treatment which meets these requirements. (...) It builds on a discourse grammar which characterizes discourse cohesion by means of a syntactic/semantic matching procedure which recognizes parallel structures in discourse. It turns out that this independently motivated procedure yields the resolution of VPA as a side effect. (shrink)