BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

In the light of the contemporary resurgence of Druidism, this article explores the heyday of the invention of Druidism in the West during the Romantic period. It demonstrates the way in which the construction of Druidism, as the heir of the Patriarchal tradition of the Old Testament and of Primordial religion, played a significant role in the construction of British self-identity from 1750-1850, in contrast to the marginal role which neo-Druidism plays in contemporary British self-understanding. The article explores the perceived (...) connection between Druidism and the great stone circles of Stonehenge and Avebury. (shrink)

An inquiry into the nature of the universe draws out the implications of the quantum theory and argues that our universe is only one among many possible universes and that other universes may exist.

There have been many claims that quantum mechanics plays a key role in the origin and/or operation of biological organisms, beyond merely providing the basis for the shapes and sizes of biological molecules and their chemical affinities. These range from Schr¨odinger’s suggestion that quantum fluctuations produce mutations, to Hameroff and Penrose’s conjecture that quantum coherence in microtubules is linked to consciousness. I review some of these claims in this paper, and discuss the serious problem of decoherence. I advance some further (...) conjectures about quantum information processing in bio-systems. Some possible experiments are suggested. © 2004 Elsevier Ireland Ltd. All rights reserved. (shrink)

Institute of Theoretical Astronomy, University of Cambridge, Cambridge, UK 3fS. received 28th August 1970, in final revised form 1st July 1971..

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

Aim To explore the views in non-Western cultures about ending the lives of damaged newborns.Method 254 university students from India and 150 from Kuwait rated the acceptability of ending the lives of newborns with genetic defects in 54 vignettes consisting of all combinations of four factors: gestational age ; severity of genetic defect ; the parents’ attitude about prolonging care ; and the procedure used .Results Four clusters were identified by cluster analysis and subjected to analysis of variance. Cluster I, (...) labelled ‘Never Acceptable’, included 4% of the Indians and 59% of the Kuwaitis. Cluster II, ‘No Firm Opinion’, had little variation in rating from one scenario to the next; it included 38% of the Indians and 18% of the Kuwaitis. In Cluster III, ‘Parents’ Attitude+Severity+Procedure’, all three factors affected the ratings; it was composed of 18% of the Indians and 16% of the Kuwaitis. Cluster IV was called ‘Severity+Parents’ Attitude’ because these had the strongest impact; it was composed of 40% of the Indians and 7% of the Kuwaitis.Conclusions In accordance with the teachings of Islam versus Hinduism, Kuwaiti students were more likely to oppose ending a newborn's life under all conditions, Indian students more likely to favour it and to judge its acceptability in light of the different circumstances. (shrink)

In this sweeping survey, acclaimed science writers Paul Davies and John Gribbin provide a complete overview of advances in the study of physics that have revolutionized modern science. From the weird world of quarks and the theory of relativity to the latest ideas about the birth of the cosmos, the authors find evidence for a massive paradigm shift. Developments in the studies of black holes, cosmic strings, solitons, and chaos theory challenge commonsense concepts of space, time, and matter, and demand (...) a radically altered and more fully unified view of the universe. (shrink)

The author is primarily concerned with the explanation of behavior in regard to (1) the mecanical model, (2) the effects of physical-organic processes on behavior, (3) the lack of understanding between philosophers and psychologists as to sufficient conditions for predicting a behavioral event, (4) conditions leading to expalantions of behavior that could predict behavior exclusive of any antecedent psychological behavior, and (5) variations of the mechanical-model introducing differing sorts of explanation. (staff).

Paperback reissue of a book first published in 1991. The authors demonstrate how the materialistic and mechanistic world-view that has dominated western culture and science during the last few centuries is being challenged by the findings of modern physics, ranging from relativity to quantum physics. Includes a bibliography and an index. British-born, Davies is a well-known physicist and has written many other books including 'The Mind of God', winner of the 1992 Eureka Science Book Prize. He is currently professor of (...) mathematical physics at the University of Adelaide. Gribbin trained as an astrophysicist and is now a full-time science writer in Britain. (shrink)