BACKGROUND: The availability of costly safety measures against transfusion-transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policymaking in five Western countries. STUDY DESIGN AND METHODS: Our qualitative study involved determining which issues had been discussed in advisory committee meetings and capturing these issues in general categories. Appropriate documents were identified in (...) collaboration with local decision-making experts in Canada, Germany, the Netherlands, the United States, and the United Kingdom. The introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever were chosen as cases representing decision-making on safety measures with high costs and low or uncertain added safety. RESULTS: A broad inventory of concerns was established, including: 1) nine categories of advantages and disadvantages of candidate safety policies; 2) six kinds of difficulties in assessing risks and forecasting the effects of safety policies; 3) 13 decision-making principles; and 4) six kinds of practical barriers hampering the translation of candidate policies into decisions. CONCLUSION: Blood safety policymaking involves a wide variety of competing concerns, and approaches to reconcile these considerations are themselves contested. Developing a systematic decision-making approach requires ethical reflection on, among others, reasonable costs of safety and the value of transparency in public policy. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. Methods To identify key ethical considerations (...) arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. (...) Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs. (shrink)

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at (...) least one respect and resembles the others in several respects. Moreover, our classification shows that “health” always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as “thick concepts.” It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices. (shrink)

Thanks to developments in genomics,dietary recommendations adapted to genetic riskprofiles of individual persons are no longerscience fiction. But what are the consequencesof these diets? An examination of possibleimpacts of genetically tailor-made diets raisesmorally relevant concerns that are analogous to(medical-ethical) considerations aboutscreening and testing. These concerns oftengive rise to applying norms for informedconsent and for the weighing of burdens andbenefits. These diets also have a broaderimpact, especially because food patterns arefull of personal, social and cultural meanings.Diets will change one's food patterns (...) and one'sattitude towards food, and this may implychanges in one's identity. We argue that suchan impact does not necessarily raise moralproblems. Moral concerns are, however, relevantif collective values and shared meanings infood practices are at issue. Therefore, thedevelopment of genetically tailor-made dietsdoes not merely require emphasis on weighingpersonal benefits and burdens and on informedconsent. It also asks for attention to andmoral reflection on the collective valuesinvolved in food practices. (shrink)

Introduction It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have (...) made a 'good' screening decision. Methods We conducted 27 semi-structured interviews with the eligible CRC screening population. The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. Results Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. Conclusion Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation. (shrink)

Overzicht van het leven en de filosofische ideeën en betekenis van de Griekse wijsgeer (469-399 voor Chr.).

Overzicht van de filosofische, met name platoonse visie op de kunst, mede aan de hand van tekstfragmenten.

Many ethical concerns surrounding human genetics studies remain unresolved. We report here the situation in Cameroon.Objectives: To describe the profile of human genetic studies that used Cameroonian DNA samples, with specific focus on i) the research centres that were involved, ii) authorship, iii) population studied, iv) research topics and v) ethics disclosure, with the aim of raising ethical issues that emerged from these studies.Method: Bibliometric Studies; we conducted a PubMed-based systematic review of all the studies on human genetics that used (...) Cameroonian DNA samples from 1989 to 2009.Results and Discussion: Fifty articles were identified, involving predominantly research centres from Europe (64%) and America (32%). Only 7 (14%) Cameroonian institutions and 14 (28%) Cameroonian authors were associated with these publications.At least 52% of publications were devoted to population genetics (variation/migration patterns) amongst 30 Cameroonian ethnic groups. Very few studies concerned public health related genetic issues and only 5 (10%) references were found for hemoglobinopathies like sickle cell anaemia. Almost all DNA samples are ‘banked’ outside of the African continent.Capacity building, rights to the genetic information and benefits to the individuals, communities and populations who contribute to these studies are addressed.Conclusions: 1) Our data suggests the need for a wider debate towards building capacity and addressing ethical issues related to human genomic research in sub-Saharan Africa and specifically in Cameroon; 2) National ethical guidelines and regulations concerning the collection, use and storage of human DNA are urgently needed in Cameroon. (shrink)

Immanuel Kant states that indirect arguments are not suitable for the purposes of transcendental philosophy. If he is correct, this affects contemporary versions of transcendental arguments which are often used as an indirect refutation of scepticism. I discuss two reasons for Kant’s rejection of indirect arguments. Firstly, Kant argues that we are prone to misapply the law of excluded middle in philosophical contexts. Secondly, Kant points out that indirect arguments lack some explanatory power. They can show that something is true (...) but they do not provide insight into why something is true. Using mathematical proofs as examples, I show that this is because indirect arguments are non-constructive. From a Kantian point of view, transcendental arguments need to be constructive in some way. In the last part of the paper, I briefly examine a comment made by P. F. Strawson. In my view, this comment also points toward a connection between transcendental and constructive reasoning. (shrink)

There is increasing evidence that dynamic changes to chromatin, chromosomes and nuclear architecture are regulated by RNA signalling. Although the precise molecular mechanisms are not well understood, they appear to involve the differential recruitment of a hierarchy of generic chromatin modifying complexes and DNA methyltransferases to specific loci by RNAs during differentiation and development. A significant fraction of the genome-wide transcription of non-protein coding RNAs may be involved in this process, comprising a previously hidden layer of intermediary genetic information that (...) underpins developmental ontogeny and the differences between species, ecotypes and individuals. It is also evident that RNA editing is a primary means by which hardwired genetic information in animals can be altered by environmental signals, especially in the brain, indicating a dynamic RNA-mediated interplay between the transcriptome, the environment and the epigenome. Moreover, RNA-directed regulatory processes may also transfer epigenetic information not only within cells but also between cells and organ systems, as well as across generations. (shrink)

I present a reconstruction of F.H.C. Crick's two 1957 hypotheses "Sequence Hypothesis" and "Central Dogma" in terms of a contemporary philosophical theory of causation. Analyzing in particular the experimental evidence that Crick cited, I argue that these hypotheses can be understood as claims about the actual difference-making cause in protein synthesis. As these hypotheses are only true if restricted to certain nucleic acids in certain organisms, I then examine the concept of causal specificity and its potential to counter claims about (...) causal parity of DNA and other cellular components. I first show that causal specificity is a special kind of invariance under interventions, namely invariance of generalizations that range over finite sets of discrete variables. Then, I show that this notion allows the articulation of a middle ground in the debate over causal parity. (shrink)

A fascinating book demonstrating the influence of alchemy and esoteric traditions on the mature art of Marcel Duchamp.

Table of Contents Acknowledgments 1 Self-Consciousness and the Body: An Interdisciplinary Introduction by Naomi Eiland, Anthony Marcel and José Luis Bermúdez 2 The Body Image and Self-Consciousness by John Campbell 3 Infants’ Understanding of People and Things: From Body Imitation to Folk Psychology by Andrew N. Meltzoff and M. Keith Moore 4 Persons, Animals, and Bodies by Paul F. Snowdon 5 An Ecological Perspective on the Origins of Self by George Butterworth 6 Objectivity, Causality, and Agency by Thomas Baldwin (...) 7 At Two with Nature: Agency and the Development of Self-World Dualism by James Russell 8 Ecological Perception and the Notion of a Nonconceptual Point of View by José Luis Bermúdez 9 Proprioception and the Body Image by Brian O’Shaughnessy 10 Awareness of One’s Own Body: An Attentional Theory of Its Nature, Development, and Brain Basis by Marcel Kinsbourne 11 Body Schema and Intentionality by Shaun Gallagher 12 Living without Touch and Peripheral Information about Body Position and Movement: Studies with Deafferented Subjects by Jonathan Cole and Jacques Paillard 13 Bodily Awareness: A Sense of Ownership by M. G. F. Martin 14 Bodily Awareness and the Self by Bill Brewer 15 Introspection and Bodily Self-Ascription by Quassim Cassam 16 Consciousness and the Self by Naomi Eilan Contributors Index. (shrink)

In this essay I explore the role of dialectics for how social theory can take account of the problem of structure and agency, or, determination and freedom, in a critical and emancipatory way. I discuss the limits and possibilities of dialectical, and of anti-dialectical, criticisms of Hegelian dialectics. For this purpose, I look at Judith Butler’s discussion of dialectics and the concepts of ‘sex’ and ‘gender’ in her writings between 1987 ( Subjects of Desire ; republished 1999) and 1990 ( (...) Gender Trouble , republished 2000). Butler’s book Gender Trouble remains a key text of contemporary feminist theory. Butler formulates in this book a critique of Simone de Beauvoir’s The Second Sex based on her claim that Beauvoir makes a distinction between ‘sex’ and ‘gender’ that implies the notion of the sexed body as a pre-cultural entity. In her earlier writings, though, her evaluation of de Beauvoir had been much more positive. The change in Butler’s evaluation of de Beauvoir is part of her increasing rejection of dialectics: Butler rejected in Gender Trouble any form of Hegelian dialectics with reference to Luce Irigaray’s (1985) claim that it is ‘phallogocentric’. Although Butler subsequently returned to Hegelian themes, she seems never to have revoked this claim made in her most momentous work. I argue that this change in the theoretical structure of Butler’s argument weakens her critique of identity politics and I suggest reading Butler backwards, from Gender Trouble to the more open discussion of dialectics in her earlier texts. Drawing on Adorno’s Negative Dialectics and other formulations of critical theory, I argue that the valid aspects of the critique of Hegelian dialectics can better be formulated as a dialectical critique of dialectics (Adorno; Butler, 1987a) than as a rejection of dialectics (Derrida; Irigaray; Butler, 1990). Retracing the genealogy of Butler’s argument will be a necessary backdrop, too, for evaluating her more recent comments on the Hegelian and ‘Frankfurt School’ traditions such as her Adorno Lectures given in Frankfurt am Main, Germany, in November 2002. Key Words: Theodor W. Adorno • agency • Judith Butler • Simone de Beauvoir • dialectics • emancipation • G. W. F. Hegel • sex/gender distinction • structure • subjectivity. (shrink)