Direct-to-consumer advertising (DTCA) of prescription drugs has been a heavily contested issue over the past decade, touching on several issues of responsibility facing the pharmaceutical industry. Much research has been conducted on DTCA, but hardly any studies have discussed this topic from a corporate social responsibility (CSR) perspective. In this article, we use several elements of CSR, emphasising consumer autonomy and safety, to analyse differences in DTCA practices within two different policy contexts, the United States of America and the European (...) Union (EU). Doing so results in an alternative analysis of the struggle between proponents and opponents of DTCA from a CSR perspective, adding an alternative view on this debate. (shrink)

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...) intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

Sections R1 to R3 attempt to take the sting out of hostile commentaries. Sections R4 to R5 engage Berlin and Kay and the World Color Survey to correct the record. Section R6 begins the formulation of a new theory of colour as an engineering project with a technological developmental trajectory. It is recommended that the colour space be abandoned.

In this target article the following hypotheses are discussed: (1) Colour is autonomous: a perceptuolinguistic and behavioural universal. (2) It is completely described by three independent attributes: hue, brightness, and saturation: (3) Phenomenologically and psychophysically there are four unique hues: red, green, blue, and yellow; (4) The unique hues are underpinned by two opponent psychophysical and/or neuronal channels: red/green, blue/yellow. The relevant literature is reviewed. We conclude: (i) Psychophysics and neurophysiology fail to set nontrivial constraints on colour categorization. (ii) Linguistic (...) evidence provides no grounds for the universality of basic colour categories. (iii) Neither the opponent hues red/green, blue/yellow nor hue, brightness, and saturation are intrinsic to a universal concept of colour. (iv) Colour is not autonomous. (shrink)

: According to a consensus of psycho-physiological and philosophical theories, color sensations (or qualia) are generated in a cerebral "space" fed from photon-photoreceptor interaction (producing "metamers") in the retina of the eye. The resulting "space" has three dimensions: hue (or chroma), saturation (or "purity"), and brightness (lightness, value or intensity) and (in some versions) is further structured by primitive or landmark "colors"—usually four, or six (when white and black are added to red, yellow, green and blue). It has also been (...) proposed that there are eleven semantic universals—labeling the previous six plus the "intermediaries" of orange, pink, brown, purple, and gray. There are many versions of this consensus, but they all aim to provide ontological, epistemological and semantic blueprints for the brute fact of the reality of color ordained by Nature (evolution). In contrast to this consensus, we have argued that "seeing color" is not a matter of light waves impacting on our eyes, producing sensations to be categorized and labeled in the "color space" in the brain. While electrochemical events may unproblematically be regarded as the causal precondition for seeing color, the reception of sensations in "the color space" as semantically labeled natural categories, kinds, or information, is a "just so" story: it is Wittgenstein's beetle in a box. In contrast we consider that the authority of this consensus might better be regarded not as the result of the truth-tracking of nature, but as the sociohistorical outcome of philosophical presuppositions, scientific theories, experimental practices, technological apparatus, and their feed forward into the lifeworld. The question we shall therefore explore is whether, or to what extent, we ourselves are changed, as the conditions of production of color science change. Thus we are doing a kind of anthropology at two levels: of color science itself (and its effect on our own lifeworld), and of those studied by the "anthropology of color". As befits this stance we are agnostic about the theoretical entities of color science (cf. van Fraassen 2001), and within this new context, we propose to cross-cut object-and-subject, organism-and-environment (the bedrock of color science) in socio-historical ways. Our approach is in part inspired by, but not the same as, that of Gibson, in that we wish to pursue the notion of "social affordances" (Burmudez 1995). We suggest that color has become a naturalization through science-based technologies, which, through praxes and materializations, have become the perceptual and cultural entities that structure experience and understanding in the lifeworld. It is this naturalization that we shall refer to and characterize as "the historically inflected exosomatic organ". Consequently we shall explore the historical ontology of "color" without assuming an underlying biological constant (Dupré 2001). In part 1 we show the flimsiness of the evidence for the three dimensions of color, borrowed from physics, and fine-tuned to a "standard observer" (a "spectral creature" with a phenomenal "color space"). In part 2 we address the structuring of hue through the development of color circles and color spaces. This is followed by a review of the evidence for unique hues. Again the evidence is shown to be flimsy. We then show that an isolated domain of color is a particular kind of model, not a "natural given". In part 3, after reviewing what is referred to as "the isomorphy thesis," we discuss the exemplary case study of Berlin and Kay (1969). This illustrates the pull of stadial models presupposed by their evolutionary theory of color language. The Berlin and Kay paradigm proposes that American English color terms are incorrigible and can provide the universal metalanguage. We conclude by presenting an alternative account, namely that we ourselves are changed as the conditions of production of color science change. We argue that it is better to regard "seeing-color" as a historically inflected exosomatic organ that provides social affordances for those trained to grasp them. (shrink)

In reply to Wierzbicka's advocacy of semantic primitives we argue that talk of the semantic primitives repeats the fallacies addressed in the target article at a higher level. In reply to Malcolm's plea for a Wittgensteinian grammar of colour words, we argue that he uses words like “we” and “us” too easily, falling into the trap of “silly relativism.” In reply to McManus's science of word counts, we reiterate the nineteenth-century criticism that this method is based on an illegitimate application (...) of seemingly rigorous statistical methods. (shrink)

The authors explore whether the need for ethical reflection on the part of designing engineers is dependent on the type of design process. They use Vincenti's distinction between normal and radical design and different levels of design hierarchy. These two dimensions are coupled with the concept of ill-structured problems, which are problems in which possible solutions cannot be ordered on a scale from better to worse. Design problems are better structured at lower hierarchical levels and in cases of normal design. (...) Better structured design problems require less ethical reflection on the part of designing engineers if such situations are characterized by the existence of generally accepted normative frameworks. Engineers could then deal with moral problems within the bounds of such frameworks and without the need for further reflection. On the basis of a number of empirical cases, the authors explore whether these ideas hold water. They discuss four cases ranging from a high-level radical design process to a low-level normal design process. (shrink)

"This book contains ideas to develop interdisciplinary and transdisciplinary views on economy and society. It aims to disseminate heterodox ideas on various subjects related to economics and global society. The book is organised in six parts. Part 1 contains the key lectures of Backhaus on the concept of state sciences and of Klamer on the importance of culture for economics. Parts 2- 6 contain successively contributions in the areas of economic paradigms and theories, population and society, corporate issues, environment, and (...) international relations. Examples of the content are: - the changes of family life cycles due to the rise of non-traditional households; - subjective and objective inflation rates after the introduction of the Euro; - the economics of genetic engineering; - the contribution of foreign direct investment to the economic development of host countries; - the inaccuracy of economic models applied in places characterized by extreme income disparities; - the improvement of political and corporate governance; - evolutionary thinking and emission trading; - freedom and order in the European Union; - the reform of social policy in Europe. The book provides interesting creative multi-disciplinary ideas with respect to various topical issues concerning the contemporary global society. It is highly recommended for economists and social scientists in search of broad views on social science and society.". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vitoria, Cajetan, and the ConciliaristsKatherine Elliot van LiereFrancisco de Vitoria, professor of theology at the University of Salamanca from 1526 until his death in 1546, is widely recognized as the leader of the sixteenth-century scholastic revival and one of the foremost Catholic political thinkers of his day. His surviving relectiones (the lectures given in Salamanca at the end of each university term) cover a wide range of issues from (...) the morality of cannibalism to the legality of Henry VIII’s divorce. 1 Yet modern scholarly interest in Vitoria and his disciples (collectively known as “the School of Salamanca”) has focused mainly on issues relevant to the moral and legal problems of secular nation-states. Between this century’s two great wars Spanish and American scholars took a renewed interest in Vitoria’s published relectiones, seeing in them early expressions of the doctrine of international law, and arguing that Vitoria deserved some of the credit generally given to Hugo Grotius as the inventor of this concept. 2 Since then Spanish, American, and British scholarship on Vitoria and the School of Salamanca has continued to center mainly on such issues as just war, conquest, and slavery. 3 In the 1980s Anthony Pagden [End Page 597] revisited these questions, interpreting the School of Salamanca’s neo-Scholastic teachings as part of the “ideological armature of what [was arguably] the first early modern nation state.” 4 From a similar methodological perspective, Richard Tuck and Quentin Skinner have described the neo-Thomist revival of natural law as an important influence on the development of modern legal and political concepts like the subjective theory of natural rights and the Lockean contractual theory of political obligation. 5 Most recently, Pagden and Jeremy Lawrance have edited and translated into English a selection of Vitoria’s “political writings,” which will serve as a welcome aid for future research on any of these themes. 6Yet Vitoria’s end-of-term lectures in Salamanca also discussed a number of other themes apart from the political theory of secular states. Among these, the theme of the structure and power of ecclesiastical government has so far received less attention than it deserves. 7 Ecclesiastical power, or “the power of the Church,” was one of only two subjects to which Vitoria devoted two relectiones each (the other being the famous debate about Spanish rights to dominion in America). Vitoria delivered his two lectures on ecclesiastical government, both entitled De potestate ecclesiae, in 1532 and 1533. In 1534 he lectured on the closely related theme of “the power of the pope and the council” (De potestate papae et concilii). 8 Vitoria’s treatment, in these three lectures, of the authority of the Church, the pope, and the general council is worth examining more closely not only for the intrinsic interest of these issues but perhaps even more for the light it sheds on the formation of Vitoria’s thinking about secular political power. All three relectiones preceded the two famous Relectiones de indiis (“On the American Indians”) which Vitoria delivered in [End Page 598] 1538 and 1539. For churchmen like the Dominican Vitoria, ecclesiastical and secular political power were inextricably linked; theories posited in one sphere had implications in the other, and in some cases these implications proved politically or theologically awkward enough to force a thinker back to the drawing board. The political theories about the natural origins of secular political power which Vitoria articulated in the late 1530s in his Relectiones de indiis reflect this painful process. They were not only inspired by Vitoria’s awareness of the plight of the American Indians under Spanish colonial rule; they were also shaped by his protracted struggle with the theological implications of natural law theory, a struggle which can be observed in his lectures of the early 1530s on ecclesiastical power.Observing this intellectual struggle in Vitoria’s writing affords more than just one more illustration of how all political thought is rooted in particular social contexts. For Francisco de Vitoria stood at a particularly significant juncture in the history of political thought. The position he carefully defined in the 1530s was characterized by a strong emphasis on the distinction between... (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)

In our society, where interest in Buddhist meditation is expanding enormously, numerous scientific studies are now conducted on the neurophysiological effects of meditation practices and on the neural correlates of meditative states. However, very few studies have been conducted on the experience associated with contemplative practice: what it is like to meditate -- from moment to moment, at different stages of practice -- remains almost invisible in contemporary contemplative science. Recently, 'micro-phenomenological' interview methods have been developed to help us become (...) aware of lived experience and describe it with rigour and precision. The present article presents the results of a pilot project1 aimed at applying these methods to the description of meditative experience. The first part of the article describes these methods and their adjustment for the investigation of meditative experience. The second part provides micro- phenomenological descriptions of two processes of which meditation practice enables the practitioner to become aware: the process of losing contact with the current situation and generation of virtual ones in 'mind-wandering' episodes, and the process of emergence of a thought. The third part of the article highlights the interest such descriptions may have for practitioners and for teachers of meditation, defines the status of these results, and outlines directions for further research. (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.

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)

SummaryIntense, sustained nursing lengthens inter-birth intervals and is causally linked with low natural fertility. However, in traditional settings, the effects of such nursing on fertility are difficult to disentangle from those of nutrition. Results from an prospective, direct observational study of reproductive function in well-nourished Amele women who nurse intensively and persistently but who also have high fertility are here presented. Endocrine measures show that ovarian activity resumes by median 11·0 months postpartum. Median duration of postpartum amenorrhoea is 11·3 months, (...) time to next conception is 19·0 months, and the inter-birth interval is 28·0 months. Average life time fertility is 6·8. High fertility in Amele women is due both to refractoriness of reproductive function to suckling stimuli, and to maintenance of equivalent age-specific fertility rates across the reproductive life span. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vitoria, Cajetan, and the ConciliaristsKatherine Elliot van LiereFrancisco de Vitoria, professor of theology at the University of Salamanca from 1526 until his death in 1546, is widely recognized as the leader of the sixteenth-century scholastic revival and one of the foremost Catholic political thinkers of his day. His surviving relectiones (the lectures given in Salamanca at the end of each university term) cover a wide range of issues from (...) the morality of cannibalism to the legality of Henry VIII’s divorce. 1 Yet modern scholarly interest in Vitoria and his disciples (collectively known as “the School of Salamanca”) has focused mainly on issues relevant to the moral and legal problems of secular nation-states. Between this century’s two great wars Spanish and American scholars took a renewed interest in Vitoria’s published relectiones, seeing in them early expressions of the doctrine of international law, and arguing that Vitoria deserved some of the credit generally given to Hugo Grotius as the inventor of this concept. 2 Since then Spanish, American, and British scholarship on Vitoria and the School of Salamanca has continued to center mainly on such issues as just war, conquest, and slavery. 3 In the 1980s Anthony Pagden [End Page 597] revisited these questions, interpreting the School of Salamanca’s neo-Scholastic teachings as part of the “ideological armature of what [was arguably] the first early modern nation state.” 4 From a similar methodological perspective, Richard Tuck and Quentin Skinner have described the neo-Thomist revival of natural law as an important influence on the development of modern legal and political concepts like the subjective theory of natural rights and the Lockean contractual theory of political obligation. 5 Most recently, Pagden and Jeremy Lawrance have edited and translated into English a selection of Vitoria’s “political writings,” which will serve as a welcome aid for future research on any of these themes. 6Yet Vitoria’s end-of-term lectures in Salamanca also discussed a number of other themes apart from the political theory of secular states. Among these, the theme of the structure and power of ecclesiastical government has so far received less attention than it deserves. 7 Ecclesiastical power, or “the power of the Church,” was one of only two subjects to which Vitoria devoted two relectiones each (the other being the famous debate about Spanish rights to dominion in America). Vitoria delivered his two lectures on ecclesiastical government, both entitled De potestate ecclesiae, in 1532 and 1533. In 1534 he lectured on the closely related theme of “the power of the pope and the council” (De potestate papae et concilii). 8 Vitoria’s treatment, in these three lectures, of the authority of the Church, the pope, and the general council is worth examining more closely not only for the intrinsic interest of these issues but perhaps even more for the light it sheds on the formation of Vitoria’s thinking about secular political power. All three relectiones preceded the two famous Relectiones de indiis (“On the American Indians”) which Vitoria delivered in [End Page 598] 1538 and 1539. For churchmen like the Dominican Vitoria, ecclesiastical and secular political power were inextricably linked; theories posited in one sphere had implications in the other, and in some cases these implications proved politically or theologically awkward enough to force a thinker back to the drawing board. The political theories about the natural origins of secular political power which Vitoria articulated in the late 1530s in his Relectiones de indiis reflect this painful process. They were not only inspired by Vitoria’s awareness of the plight of the American Indians under Spanish colonial rule; they were also shaped by his protracted struggle with the theological implications of natural law theory, a struggle which can be observed in his lectures of the early 1530s on ecclesiastical power.Observing this intellectual struggle in Vitoria’s writing affords more than just one more illustration of how all political thought is rooted in particular social contexts. For Francisco de Vitoria stood at a particularly significant juncture in the history of political thought. The position he carefully defined in the 1530s was characterized by a strong emphasis on the distinction between... (shrink)

The need for urgent, structural transformations to dominant food systems is increasingly recognized in research and policy. The direction these transformations take is in great part influenced by how the problem is framed and what future pathways become seen as plausible and desirable. Scientific knowledge and the organizations producing it hold considerable authority in suggesting what alternatives are or are not worth pursuing, ultimately shaping frames and in turn being shaped by them. This paper examines Brazil’s federal Agricultural Research Corporation (...) (Embrapa), a major contributor to technological advances that made Brazil into an agricultural powerhouse. We examine the ways in which Embrapa’s leadership has framed sustainable agriculture in its public communication and the wider implications for food systems transformation. Drawing from Embrapa news articles in the period 2015–2020, we identify four interrelated frames forming Embrapa’s prevalent position on sustainability. Our results show that while Embrapa promotes practices based on alternative approaches such as agroecology, its deeper framing often reflects the core assumptions driving dominant industrial food systems. This framing reinforces underlying logics of control, efficiency, and competition aligned with the productivist paradigm and excludes divergent perspectives that exist within the organization. (shrink)

Pessoa et al. (1998a) underexposed the broad and rich variety of stimuli in the amodal completion domain. The disambiguation of occluded shapes depends on very specific figural properties. Elaborations on such disambiguations of rich and complex stimuli, tied up with a visuo-cognitive origin of amodal completion, further position Pessoa et al.'s considerations on neural filling-in and the personal-subpersonal distinction.

This paper was presented at the First Conference of the ISSEI ‘Turning Points in History’, 26–30 September 1988. It belongs to Theme 1, ‘Comparative History of European Revolutions’.

BackgroundThe Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain.MethodsWe did an electronic search of seven Dutch national newspapers between January 2009 and May 2010 and conducted a content analysis.ResultsOf the 284 articles containing the term ‘euthanasia’, 24% referred to practices outside the scope of the law, mostly relating to (...) the forgoing of life-prolonging treatments and assistance in suicide by others than physicians. Of the articles with euthanasia as the main topic, 36% described euthanasia in the context of a terminally ill patient, 24% for older persons, 16% for persons with dementia, and 9% for persons with a psychiatric disorder. The most frequent arguments for euthanasia included the importance of self-determination and the fact that euthanasia contributes to a good death. The most frequent arguments opposing euthanasia were that suffering should instead be alleviated by better care, that providing euthanasia can be disturbing, and that society should protect the vulnerable.ConclusionsOf the newspaper articles, 24% uses the term ‘euthanasia’ for practices that are outside the scope of the euthanasia law. Typically, the more unusual cases are discussed. This might lead to misunderstandings between citizens and physicians. Despite the Dutch legalisation of euthanasia, the debate about its acceptability and boundaries is ongoing and both sides of the debate are clearly represented. (shrink)

A self-fulfilling prophecy in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the (...) problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

Recent developments in AI-research suggest that an AI-driven science might not be that far off. The research of for Melnikov et al. (2018) and that of Evans et al. (2018) show that automated systems can already have a distinctive role in the design of experiments and in directing future research. Common practice in many of the papers devoted to the automation of basic research is to refer to these automated systems as ‘agents’. What is this attribution of agency based on (...) and to what extent is this an important notion in the broader context of an AI-driven science? In an attempt to answer these questions, this paper proposes a new methodological framework, introduced as the Four-Fold Framework, that can be used to conceptualize artificial agency in basic research. It consists of four modeling strategies, three of which were already identified and used by Sarkia (2021) to conceptualize ‘intentional agency’. The novelty of the framework is the inclusion of a fourth strategy, introduced as conceptual modeling, that adds a semantic dimension to the overall conceptualization. The strategy connects to the other strategies by modeling both the actual use of ‘artificial agency’ in basic research as well as what is meant by it in each of the other three strategies. This enables researchers to bridge the gap between theory and practice by comparing the meaning of artificial agency in both an academic as well as in a practical context. (shrink)

Background Studies describing physicians’ experiences with sedation at the end of life are indispensible for informed palliative care practice, but they are scarce. We describe the accounts of physicians from the USA and the Netherlands, two countries with different regulations on end-of-life decisions regarding their use of sedation.Methods Qualitative face-to-face interviews were held in 2007–2008 with 36 physicians , including primary care physicians and specialists. We applied purposive sampling and conducted constant comparative analyses.Results In both countries, the use of sedation (...) was described in diverse terms, especially in the USA, and was often experienced as emotionally challenging. Respondents stated different and sometimes multiple intentions for their use of sedation. Besides alleviating severe suffering, most Dutch respondents justified its use by stating that it does not hasten death, while most American respondents indicated that it might hasten death but that this was justifiable as long as that was not their primary intention. While many Dutch respondents indicated that they initiated open discussions about sedation proactively to inform patients about their options and to allow planning, the accounts of American respondents showed fewer and less-open discussions, mostly late in the dying process and with the patient's relatives.Conclusions The justification for sedation and the openness with which it is discussed were found to differ in the accounts of respondents from the USA and the Netherlands. Further clarification of practices and research into the effect and effectiveness of the use of sedation is recommended to enhance informed reflection and policy making. (shrink)

A blockchain can be considered a technological phenomenon that is made up of different interconnected and autonomous systems. Such systems are referred to here as cyber-physical systems: complex interconnections of cyber and physical components. When cyber-physical systems are interconnected, a new whole consisting of a system of systems is created by the autonomous systems and their intercommunication and interaction. In a blockchain, individual systems can independently make decisions on joint information transactions. The decision-making procedures needed for this are executed based (...) on fault-tolerant communication and voting and consensus procedures, while the results of these decision-making procedures are stored in distributed ledgers. Due to the intercommunication, interaction, and independent decision making by autonomous systems, the new whole of a blockchain is a complex entity. Complexity science rather than the usual reductionist scientific approach can help us better understand the behaviour of the new and continuously developing whole of a blockchain as a technological phenomenon. (shrink)

We are currently in the middle of the transformation from Martin Heidegger’s modern society to a society based on digital technology. In the developing digital society, humans in their current state of ‘Being’ are increasingly surrounded by systems that are networked and run based on algorithms, software, and data. These interconnected systems function, communicate, and interact in networks and driven by these algorithms, software, and data, which give them the ability to connect, calculate, and reveal. Jointly, these systems thus create (...) a new and actual reality based on their mathematical and scientific background. In the present-day digital society, humans’ actual ‘state of Being’ is increasingly framed by what the digital technology reveals to us and enables. The transition to this new digital reality conjures up more and more questions as to whether we as humans sufficiently understand the essence of digital technology and whether we as humanity have sufficient knowledge and insight to be able to analyze and fathom the essence of the new digital ecology around us. In this article, I will use Heideggerian phenomenology as a philosophy to create a framework that will allow us to, based on phenomenological research into our current ‘Dasein’ or ‘being there’, gain deeper insight into the ‘Being’ of digital technology and the ensuing development of a digital reality for humanity as a whole. (shrink)

“New communities” are a real force in the contemporary Catholic landscape. However, a certain number of them are affected by crises of various types. Abuses of all kinds and sectarian excesses can create stigmas in the lives of communities and their members. In short, new communities are proving to be more fragile than we initially understood them to be. What are the causes of these struggles? To examine this question, the author proposes to take stock of the current situation by (...) pointing out the critical and focal elements in the life of suffering communities. This step, preliminary to all others, aims to open the door to further research and interventions. (shrink)

A hippocampal patient is described who shows preserved item recognition and simple recognition-based recollection but impaired recall and associative recognition. These data and other evidence suggest that contrary to Aggleton & Brown's target article, Papez circuit damage impairs only complex item-item-context recollection. A patient with perirhinal cortex damage and a delayed global memory deficit, apparently inconsistent with A&B's framework, is also described.

William C. Olsen, Walter E. A. van Beek, and the contributors to this volume seek to understand how Africans have confronted evil around them. Grouped around notions of evil as a cognitive or experiential problem, evil as malevolent process, and evil as an inversion of justice, these essays investigate what can be accepted and what must be condemned in order to evaluate being and morality in African cultural and social contexts. These studies of evil entanglements take local and national histories (...) and identities into account, including state politics and civil war, religious practices, Islam, gender, and modernity. (shrink)