Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an (...) ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond (...) its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials. (shrink)

Organic chemists have been able to develop a robust, theoretical understanding of the phenomena they study; however, the primary theoretical devices employed in this field are not mathematical equations or laws, as is the case in most other physical sciences. Instead it is diagrams, and in particular structural formulas and potential energy diagrams, that carry the explanatory weight in the discipline. To understand how this is so, it is necessary to investigate both the nature of the diagrams employed in organic (...) chemistry and how these diagrams are used in the explanations of the discipline. I will begin this paper by characterizing some of the major ways that structural formulas used in organic chemistry. Next I will present a model of the explanations in organic chemistry and describe how both structural formulas and potential energy diagrams contribute to these explanations. This will be followed by several examples that support my abstract account of the role of diagrams in the explanations of organic chemistry. In particular, I will consider both the appeal to ‘hyperconjugation’ in the explanation of alkene stability and how the idea of ‘ring strain’ was developed to explain the relative stability of cyclic compounds. (shrink)

In his pioneering work of moral phenomenology, K. E. Løgstrup offered a phenomenological articulation of a central moment of ethical life: the experience in which “one finds oneself with the life of another more-or-less in one’s hands”. In such circumstances we encounter what Løgstrup calls simply the ethical demand. Løgstrup’s preferred formulation of the content of that demand is taken from the Bible: Love thy neighbor. This neighborly love is expressed in the form of spontaneous, selfless care for the other. (...) We shall have occasion in what follows to return to the content that Løgstrup associates with the ethical demand, but my primary focus here is not its content but its distinctive modality. Løgstrup specifies that modality in a fourfold analysis: the ethical demand is radical, silent, one-sided, and unfulfillable. My concern in what follows will be with the fourth element in this analysis – or what I shall refer to simply as Løgstrup’s unfulfillability thesis. My discussion addresses three specific questions: Is it coherent to suppose that the ethical demand is unfulfillable? Why does Løgstrup hold that the ethical demand is unfulfillable? What kind of response is appropriate in the face of an unfulfillable ethical demand? (shrink)

Ordinairement les manuels de biologie débutent par une exposition des caractéristiques qui distinguent la nature organique de la nature anorganique. En définissant et en limitant aussi exactement que possible son sujet, la biologie, le biologue ne fait pas autre chose que le mathématicien. La présente étude nous montre les obstacles presque insurmontables auxquels se heurtent le biologue et le mathématicien. A les bien considérer, les anciennes distinctions entre l'organisme d'une part et la matière non-organisée ou un système statique matériel, comme (...) la machine, d'autre part, se basant sur la nutrition, la respiration, les échanges vitaux et le mouvement ne tiennent plus debout. L'auteur allègue les expériences récentes de W. M. Stanley (Rockefeller Institute à Princeton) d'où il appert qu'il peut y avoir aussi génération dans les substances qui se secrètent sous la forme de cristaux (cristaux vivants), et s'en rapporte aux fameuses expériences de Driesch sur la régénération. Il y rattache les conceptions de Jordan (Utrecht) -- rapports entre les enchaînements des causes "d'après leur caractère amboceptor"; "le dessein des causes". Les vitalistes portent surtout leur attention sur "la totalité", les mécanistes sur "les parties". Le naturaliste qui se propose uniquement la recherche des causes physico-chimiques des phénomènes physico-chimiques serait parfaitement en droit de se contenter d'une conception mécaniste de la nature. Mais cette conception mécaniste ne suffirait pas à celui qui, comme l'auteur, aspire à comprendre l'organisme dans son ensemble. (shrink)

It is customary to identify transcendental philosophy as the distinctive and original invention of Immanuel Kant. Certainly this was a view that Kant himself did much to encourage. But this chapter argues that traces of the transcendental strategy can be found already among the ancients. One such ancient precedent is associated with the Stoic doctrine of oikeiosis. It is argued that oikeiosis is best understood as a form of normative orientation associated with 'being at home ' in one's body and (...) environment, and that it involves a distinctive form of ontological self-consciousness. This chapter assesses the merits of Stoic claims that oikeiosis figures as a condition on the possibility of desire, pleasure, and even perception, and the chapter considers the case for describing these arguments as examples of transcendental investigation. (shrink)

Research suggests that institutions affect the levels of corruption in a country. We take these arguments a step further and examine whether it is the presence of inclusive institutions and/or the credible and consistent implementation of institutions that matter, as regards corruption. We use a novel approach to theoretically conceptualise and empirically operationalise institutions along two analytically distinct dimensions: the nature of the institutions (the de jure dimension), and the extent to which they are credibly and consistently implemented over time (...) (the de facto dimension), using a panel dataset for 148 countries covering 2012 to 2018. We find that formal institutions are most effective in reducing corruption when the rules are credibly and consistently implemented. Furthermore, this effect appears to operate differently at different levels of national income. The nature of the formal institutions appears important across income levels, but particularly so at the upper middle income level, while the credible and consistent implementation of these institutions is primarily influential at upper middle income levels. We explain why this may be the case and elaborate on the policy implications. (shrink)

The Many-Interacting-Worlds (MIW) approach to a quantum theory without wave functions proposed in [8] leads naturally to numerical integrators of the Schrödinger equation on comoving grids. As yet, little is known about concrete MIW models for more than one spatial dimension and/or more than one particle. In honour of Detlef Dürr, we report on a further development of the MIW approach to treat arbitrary degrees of freedom and provide a numerical proof of concept for ground states in 2d. The latter (...) is part of a systematic numerical study [22] that includes also 1d ground and excited states. With this step towards the treatment of higher degrees of freedom we hope to stimulate their further study. (shrink)

Philosophy of science is the organized expression of a growing intent among philosophers and scientists to clarify, perhaps unify, the programs, methods and results of the disciplines of philosophy and of science. The examination of fundamental concepts and presuppositions in the light of the positive results of science, systematic doubt of the positive results, and a thorough-going analysis and critique of logic and of language, are typical projects for this joint effort. It is not necessary to be committed to a (...) belief that science and philosophy are or should be one, or else that “never the twain shall meet.” If anything, there is to be expected a wholesome regard for the value of established science in furnishing a foil for philosophy and a check on its old extravagances. This does not mean that even the best-established science may not be subject to most devastating criticism by analysis of its foundations. In fact, despairing of the philosophy of the schools, science has done it largely for itself. The theories of gravitation, atomicity, electro-magnetism, evolution, relativity and quanta have all arisen through drastic revisions of complacent fundamental “truths.”. (shrink)

The death of Jesse Gelsinger in 1999 during a gene therapy trial raised many questions about the ethical review of medical research. Here, the author argues that the principle of justice is interpreted too narrowly and receives insufficient emphasis and that what we permit in terms of bodily invasion affects the value we place on individuals. Medical research is a societally supported activity. As such, the author contends that justice requires that invasive medical research demonstrates sufficiently compelling societal benefit. Many (...) consider this societal benefit to be self evident. However, medical research is a complex activity; it yields new treatments but also creates financial rewards and affects health resource allocation. As research evolves into a multibillion pound, multinational enterprise, justice requires a much broader analysis of societal benefit. Without such evaluation we risk undermining the value of bodily integrity and of research participants. (shrink)

In 385B-C of the Cratylus, Plato appears to be formulating a version of the correspondence theory of truth, in such a way that it applies not only to discourse, but to individual names as well. However commentators who have remarked on this passage, either take exception to the reasoning, or find it necessary to interpret the conclusion with qualifications that Plato never could have intended. Richard Robinson, for example, on p.328 of “A Criticism of Plato’s Cratylus”, sums up the argument (...) thus:... since statements have a truthvalue, their parts, including names, must have a truthvalue too. Therefore names are true or false.and criticises it for involving a fallacy of division. Lorenz and Mittelstrasse, by contrast, construe the argument as validly proceeding from the true-false distinction of sentences to a corresponding true-false distinction of their parts. (shrink)

The influence of John Locke's thought in Europe and America rests largely on his articulation and defence of a liberal political philosophy, and in his formulation of a theory of knowledge where experience and environment provide the exclusive starting points in the educational process. Generally he continues to be associated with the eighteenth-century 'Age of Reason' or Enlightenment, where the malleability of human nature, together with the inherent dignity and freedom of the individual, were placed at the forefront of reform (...) efforts on both sides of the Atlantic. This book argues that while Locke's concern for the enhancement of individual autonomy, religious toleration, and constitutional government was indeed fundamental to later generations, Locke himself viewed the improvement of the human condition in terms of its relationship to the ancient Christian story. In particular, Locke's larger integration 'project' was to assist his contemporaries in their efforts both to recognise and to secure the greatest happiness. Locke, in other words, was chiefly interested in life beyond the grave, in salvation, and his recommendations for the reform of politics, education and religion were all viewed by the author as instrumental to the chief business of humankind. Locke's universe was a God-directed one, where human's were set specific tasks and where reward was contingent upon behaviour in this life. Locke viewed himself as a defender of the historical faith, and his work was devoted to broadening the opportunities for individual salvation. (shrink)

BackgroundDepressive disorders are a common form of psychiatric illness and cause significant disability. Regulation authorities, the medical profession and the public require high safety standards for antidepressants to protect vulnerable psychiatric patients. Ketamine is a dissociative anaesthetic and a derivative of a hallucinogen. Its abuse is a major worldwide public health problem. Ketamine is a scheduled drug and its usage is restricted due to its abuse liability. Recent clinical trials have reported that ketamine use led to rapid antidepressant effects in (...) patients suffering from treatment-resistant depression. However, various flaws in study designs, and possible biased reporting of results, may have influenced those findings. Further analyses of ketamine use are needed to ensure patient safety.DiscussionThe use of ketamine in research and treatment of depressive disorders is controversial. Recently, mental health professionals raised ethical concerns about an ongoing ketamine trial in the UK. Also, a Canadian agency reviewed the existing evidence and did not recommend prescribing ketamine to treat depressive disorders. Findings obtained from tightly controlled research settings cannot be easily translated to clinical practice as substance abuse is commonly comorbid with depressive disorders. An effective antidepressant should reduce severity of depressive symptoms without liability problems. Although the US FDA has not approved the use of ketamine to treat depressive disorders, some psychiatrists offer off-label repeat prescription of ketamine. Prescribing ketamine for treating depressive disorders requires substantial empirical evidence. Clinicians should also consider research findings on ketamine abuse. Depressive disorders can be chronic conditions and the current evidence does not rule out the risk of substance abuse after repeat prescription of ketamine. Off-label ketamine use in treating depressive disorders may breach ethical and moral standards, especially in countries seriously affected by ketamine abuse. This article presents two real-world clinical vignettes which highlight ethical principles and theories, including autonomy, nonmaleficience, fidelity and consequentialism, as related to off-label ketamine use.ConclusionWe urge clinicians to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine. (shrink)