In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on (...) these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (shrink)

Background and aim With the increasing interest in lifestyle, health and consequences of unhealthy lifestyles for the healthcare system, a new kind of solidarity is gaining importance: lifestyle solidarity. While it might not seem fair to let other people pay for the costs arising from an unhealthy lifestyle, it does not seem fair either to punish people for their lifestyle. However, it is not clear how solidarity is assessed by people, when considering disease risks or lifestyle risks. The aim of (...) this study was to investigate the degree of solidarity with lifestyle as well as with other factors that are related to health outcomes—for example, old age—and the relation between this degree of solidarity and various characteristics. Methods This cross-sectional study is part of the Dutch longitudinal SMILE study. Data on the degree of solidarity with different lifestyles and old age, and the relation between the degree of solidarity and various demographic and other variables were obtained in a questionnaire survey. Results Solidarity with smokers and overweight people was moderate, as was solidarity with older people. Respondents were ambivalent about athletes. Respondents who were younger, male and highly educated, and those with a healthy lifestyle, a small social network, high quality of life and an internal locus of control, showed low solidarity. Conclusions Solidarity with an unhealthy lifestyle and old age is moderate and the degree of solidarity varies among the different subgroups. (shrink)

Romans 7: 14 if. has traditionally been one of the most frequently discussed passages in the whole of the Pauline Corpus. Nevertheless, this pericope has attracted attention more because it is consistently regarded as a crucial part of Paul's theology, than because of its intrinsic exegetical problems. The main issue is whether the ‘split personality’ and the weakness of will should be regarded as essential to the life of the believing Christian; or, rather, as characteristic for those who are not (...) ‘in Christ’ and therefore beyond the power of his Spirit. For the systematic theologian, the question of whether the first person singular in these verses should be understood in an autobiographical sense is a subordinate one. However this particular question is answered, we are still confronted by the main issue. (shrink)

Much has been said about the need for improving the current definitions of scientific authorship, but an aspect that is often overlooked is how to formulate and communicate these definitions to ensure that they are comprehensible and useful for researchers, notably researchers active in international research consortia. In light of a rapid increase in international collaborations within natural sciences, this article uses authorship of this branch of sciences as an example and provides suggestions to improve the comprehensibility of the definitions (...) of authorship in natural sciences. It assesses whether the definition of authorship provided by the European Code of Conduct for Research Integrity can deal with current issues and problems of scientific authorship. Notably, problems that are experienced in project groups with researchers coming from multiple countries. Using theories developed by Jürgen Habermas and Robert Merton, a normative framework is developed to articulate ethical authorship in natural sciences. Accordingly, enriching the current definition of authorship with normative elements and using discipline-specific metaphors to communicate them are introduced as possible ways of improving the comprehensibility of the definition of authorship in international environments. Finally, this article provides a proposal to be considered in the future revisions of the European Code of Conduct for Research Integrity. (shrink)

Much has been said about the need for improving the current definitions of scientific authorship, but an aspect that is often overlooked is how to formulate and communicate these definitions to ensure that they are comprehensible and useful for researchers, notably researchers active in international research consortia. In light of a rapid increase in international collaborations within natural sciences, this article uses authorship of this branch of sciences as an example and provides suggestions to improve the comprehensibility of the definitions (...) of authorship in natural sciences. It assesses whether the definition of authorship provided by the European Code of Conduct for Research Integrity can deal with current issues and problems of scientific authorship. Notably, problems that are experienced in project groups with researchers coming from multiple countries. Using theories developed by Jürgen Habermas and Robert Merton, a normative framework is developed to articulate ethical authorship in natural sciences. Accordingly, enriching the current definition of authorship with normative elements and using discipline-specific metaphors to communicate them are introduced as possible ways of improving the comprehensibility of the definition of authorship in international environments. Finally, this article provides a proposal to be considered in the future revisions of the European Code of Conduct for Research Integrity. (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)

Suppose “chicken” eggs could be produced by quasi‐chickens—genetically engineered humps of living chicken‐flesh that do nothing but lay eggs. Would there be anything amiss with that? Animal ethicists invoke the notion of animal integrity in order to give intellectual content to the intuition that there would be. On inspection, ‘integrity’ isn't everything its proponents want it to be. Yet there's enough in it to make reasoned argument possible.

The present article puts forward a behavioral disinhibition hypothesis stating that, often, at least some levels of behavioral disinhibition are needed to overcome people’s inhibition to intervene in dilemmatic situations in which they have to choose between different actions with good reasons for each of the actions involved. Results reported indeed show that people to whom disinhibited behaviors were salient or people with stronger predispositions toward behavioral disinhibition were more likely to intervene in trolley and footbridge dilemmas.

BackgroundReducing the number of animals used in experiments has become a priority for the governments of many countries. For these reductions to occur, animal-free alternatives must be made more available and, crucially, must be embraced by researchers.MethodsWe conducted an international online survey for academics in the field of animal science (N = 367) to explore researchers’ attitudes towards the implementation of animal-free innovations. Through this survey, we address three key questions. The first question is whether scientists who use animals in (...) their research consider governmental goals for animal-free innovations achievable and whether they would support such goals. Secondly, responders were asked to rank the importance of ten roadblocks that could hamper the implementation of animal-free innovations. Finally, responders were asked whether they would migrate (either themselves or their research) if increased animal research regulations in their country of residence restricted their research.ResultsWhile nearly half (40%) of the responders support governmental goals, the majority (71%) of researchers did not consider such goals achievable in their field within the near future. In terms of roadblocks for implementation of animal-free methods, ~ 80% of the responders considered ‘reliability’ as important, making it the most highly ranked roadblock. However, all other roadblocks were reported by most responders as somewhat important, suggesting that they must also be considered when addressing animal-free innovations. Importantly, a majority reported that they would consider migration to another country in response to a restrictive animal research policy. Thus, governments must consider the risk of researchers migrating to other institutes, states or countries, leading to a ‘brain-drain’ if policies are too strict or suitable animal-free alternatives are not available.ConclusionOur findings suggest that development and implementation of animal-free innovations are hampered by multiple factors. We outline three pillars concerning education, governmental influence and data sharing, the implementation of which may help to overcome these roadblocks to animal-free innovations. (shrink)

Women often embody the central values and practices of their religious tradition. When they leave their community, women find a part of the “religious tapestry” remaining with them long after their disengagement. In this article, we draw from research in the UK and Finland to explore women’s efforts to unlearn parts of their former religious belonging. We draw on in total thirty-five interviews with women who disengaged from the Mormon Church, Jehovah’s Witnesses and Conservative Laestadianism. We conceptualize un/learning as a (...) multi-layered process consisting of both un-learning and re-learning. We explore women’s narratives about negotiating bodily limits, conduct and belonging, and understand these as suggesting experiences of a threefold un/learning: gendered, spatial-social and epistemic. We argue that examining gendered and embodied un/learning helps to understand women’s disengagement processes from minority Christian traditions in Western and Northern European secularized contexts such as the UK and Finland. (shrink)

Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a ‘right to die’. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD is legally (...) permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor’s freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups. (shrink)

In this position paper, we describe a number of methodological and philosophical challenges that arose within our interdisciplinary Digital Humanities project CatVis, which is a collaboration between applied geometric algorithms and visualization researchers, data scientists working at OCLC, and philosophers who have a strong interest in the methodological foundations of visualization research. The challenges we describe concern aspects of one single epistemic need: that of methodologically securing (an increase in) trust in visualizations. We discuss the lack of ground truths in (...) the (digital) humanities and argue that trust in visualizations requires that we evaluate visualizations on the basis of ground truths that humanities scholars themselves create. We further argue that trust in visualizations requires that a visualization provides provable guarantees on the faithfulness of the visual representation and that we must clearly communicate to the users which part of the visualization can be trusted and how much. Finally, we discuss transparency and accessibility in visualization research and provide measures for securing transparency and accessibility. (shrink)

What is the relevance of an analytical philosophy of history to the practice of history? There are four fundamental criticisms of the existing analytical philosophy: analytical philosophers have concentrated on old, dualistic traditions of history; they have not provided sufficient empirical validation for their explanatory theories; they have paid little attention to the preliminary operations necessary to the writing of historical explanation; and they have ignored important stages of growth within the study of history. These are criticisms of the existing (...) apragmatic philosophies of history, which lack a necessary empirical basis and become static, tied to one research tradition within historical scholarship. A pragmatic philosophy of history would focus on the growth of historical scholarship. The "History of Society," a name for the global approach to history, operates under the rules of comparative history. In the framework of a typology of the comparative method, types of difference and contrast refer back to the dominating types of macrocausality, generality, and inclusion. The logic of historical explanations is greatly determined by the choice of a particular type of comparative history. A pragmatic analysis demonstrates that a plurality of shades of meaning are possible in historical explanation, and that the traditional apragmatic dualist theory of a tension between the global and particular provides insufficient description. (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)

According to the traditional conception of morality one's feeling of guilt is appropriate if and only if one has culpably done wrong. The feeling must involve this propositional content. In recent literature, however, two opposite developments can be discerned. First there is a tendency to expand the range of things one can appropriately feel guilty about. So, for example, it is argued that there is nothing wrong in feeling guilt about actions done involuntarily, or done by others, or about thoughts (...) which just happen to the subject of the feeling . This position is criticized on the ground that guilt is a painful emotion and should therefore be suffered only if it is deserved. On the other hand, there are also arguments in the literature to the effect that agent regret should be substituted for guilt , and that the range of appropriate guilt feelings should be limited . The main objection to Williams's proposal is that it would mean an impoverishment of the moral world: guilt feeling implies, as agent regret does not, the recognition that one could and should have acted otherwise. As to Gibbard's position, it is demonstrated that it is based on a disputable metaethics. In addition to that, it is argued that Gibbard's view of guilt feeling as an adaptive syndrome is untenable. (shrink)

Liberal political philosophy emphasizes the benefits of membership in a cultural group and, in the opinion of this challenging book, neglects its harmful, oppressive aspects. Andrew Kernohan argues that an oppressive culture perpetuates inegalitarian social meanings and false assumptions about who is entitled to what. Cultural pollution harms fundamental interests in self-respect and knowledge of the good and is diffuse, insidious, and unnoticed. This cultural pollution is analogous to environmental pollution, and though difficult to detect, is nonetheless just as real. (...) The book's conclusion is that a liberal state committed to the moral equality of persons must accept a strong role in reforming our cultural environment. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

Thanks to the kind cooperation of Mrs. Elise Harding-Davis, director of the North American Black Historical Museum and Cultural Centre, we are able to reproduce the score of this famous melody which features so prominently in Sartre's Nausea. This museum is located in Amherstburg, Ontario, some thirty kilometers southwest of the Ambassador Bridge which links Detroit, Michigan with Windsor, Ontario. Shelton Brooks, who composed the melody in 1910, was a descendent of black slaves who made their way to freedom by (...) way of "the underground railway" and settled in Southwestern Ontario. He was born in Amherstburg; toured widely in Canada, the United States and Europe and he finally settled in Fontana, California where he died in 1975 at age 86. In the conclusion of Nausea Roquentin identifies him incorrectly as a New York Jew and refers to the singer as black. In fact the composer was an Afro-Canadian while the singer was New Yorker Sophie Tucker, who was Jewish. (shrink)

This is the first book that pays systematic attention to ontological issues impinging on this question.

We prove linear and polynomial growth properties of sets and functions that are existentially definable in the ordered group of integers with divisibility. We determine the laws of addition with order and divisibility.

We prove linear and polynomial growth properties of sets and functions that are existentially definable in the ordered group of integers with divisibility. We determine the laws of addition with order and divisibility.