Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. (...) We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures. (shrink)

Prenatal screening for foetal abnormalities such as Down's syndrome differs from other forms of population screening in that the usual aim of achieving health gains through treatment or prevention does not seem to apply. This type of screening leads to no other options but the choice between continuing or terminating the pregnancy and can only be morally justified if its aim is to provide meaningful options for reproductive choice to pregnant women and their partners. However, this aim should not be (...) understood as maximizing reproductive choice per se. Only if understood as allowing prospective parents to avoid suffering related to living with (a child with) serious disorders and handicaps can prenatal screening be a publicly or collectively funded programme. The alternative of moving prenatal testing outside the healthcare system into the private sector is problematic, as it makes these tests accessible only to those who can afford to pay for it. New developments in prenatal screening will have to be assessed in terms of whether and to what extent they either contribute to or undermine the stated aim of providing meaningful options for reproductive choice. In the light of this criterion, this article discusses the introduction of the new non‐invasive prenatal test (NIPT), the tendency to widen the scope of follow‐up testing, as well as the possible future scenarios of genome‐wide screening and ‘prenatal personalised medicine’. The article ends with recommendations for further debate, research and analysis. (shrink)

The term “evolution” is often used in the administrative sciences to designate dynamic processes of change in general. In biology, evolution has a very specific meaning, namely the application of a generative variation-selective retention scheme to change. Applying this to the administrative sciences is more exacting: describing what the variation consists of, how replication of the generated variation occurs and delineating the population from which the selection is made are far from easy. While it is the intention of this special (...) issue as a whole to provide some empirical examples of evolutionary change in the public and private sectors, this introduction will lay out the main lines of thought in what is often referred to as universal Darwinism and what this means in the administrative sciences. Key concepts here are generative variation, selective retention, and selective institutional environment. According to the authors, the Darwinian scheme of evolutionary theory focuses on how new ideas or concepts arise, how they propagate and influence wider actor thinking and on how the institutional environment in which they operate affects their differential survival. This evolutionary process is an interplay between actors and replicators (sounds, images, and in this context mostly words) in which it cannot be said in advance which one is fooling the other. (shrink)

Evolutionary psychology is put forward by its defenders as an extension of evolutionary biology, bringing psychology within the integrated causal chain of the hard sciences. It is extolled as a new paradigm for integrating psychology with the rest of science. We argue that such claims misrepresent the methods and explanations of evolutionary biology, and present a distorted view of the consequences that might be drawn from evolutionary biology for views of human nature. General theses about adaptation in biology are empty (...) schemata, not laws of nature allowing the subsumption of mind under biology. Functional thinking is an indispensable tool for psychology, mostly of value in abstractive unification and as a heuristic, but it gains little from association with evolutionary notions of selection. Thus, we argue, the cherished integrative causal model evaporates, and evolutionary phraseology serves no more than rhetorical purposes. Moreover, the universality of human nature and the evolutionary irrelevance of individual variation are presented as biological truths that psychologists should respect in their approach to mind. On closer inspection, this turns out to be rather dubious biology. Psychology might conceivably be better off as a continuation of biology by different means, but evolutionary psychology does not provide the conceptual integration leading to such a happy union. (shrink)

We read commentaries on our feature article ‘The ethics of consent during labour and birth: episiotomies’1 with gratitude and interest. Nearly all commenting authors agree that consent for in-labour procedures is necessary and ideally given at the point of intervening. Both Shalowitz & Ralston and Stirrat note that this is already required by professional statements and guidelines in the USA2 and UK3, respectively, but also note that practice does not yet conform. The Americans authors helpfully emphasise the importance of multilevel (...) institutional measures for closing this gap, including consent policies and reporting mechanisms, as well as ongoing education.2 The UK writer seconds the role for education within wider shared decision-making and informed choice approaches, and generously commends our paper for close study by all maternity care providers. Others add a cautionary note. Lee applauds all our recommendations, but notes our proposals cannot fully secure autonomy because of, among others, epistemic injustice and other power differentials.4 Kumar-Hazard and Dahlen worry that opt-out consent is equal to substitute decision-making; weakens women’s rights; and is open to abuse.5 Nelson and Clough object to our willlingness to work within a flawed conceptual framework, which ought to be challenged.6 We agree that there are limits to what our proposal can do. It cannot rectify unequal distributions of epistemic credibilities, either in general or in any particular interaction. Risk communication is never neutral;7 “even the most well-meaning healthcare professionals …. (shrink)

Die Buddhistische Briefliteratur Indiens. Siglinde Dietz. Nach dem tibetischen Tanjur herausgegeben, übersetzt und erläutert. Otto Harrassowitz, Wiesbaden 1984. XV + 590 pp. DM 220.

The term “evolution” is often used in the administrative sciences to designate dynamic processes of change in general. In biology, evolution has a very specific meaning, namely the application of a generative variation-selective retention scheme to change. Applying this to the administrative sciences is more exacting: describing what the variation consists of, how replication of the generated variation occurs and delineating the population from which the selection is made are far from easy. While it is the intention of this special (...) issue as a whole to provide some empirical examples of evolutionary change in the public and private sectors, this introduction will lay out the main lines of thought in what is often referred to as universal Darwinism and what this means in the administrative sciences. Key concepts here are generative variation, selective retention, and selective institutional environment. According to the authors, the Darwinian scheme of evolutionary theory focuses on how new ideas or concepts arise, how they propagate and influence wider actor thinking and on how the institutional environment in which they operate affects their differential survival. This evolutionary process is an interplay between actors and replicators (sounds, images, and in this context mostly words) in which it cannot be said in advance which one is fooling the other. (shrink)

Many analytical studies purporting to aid decision-making are produced and yet their contribution to actual decision-making is questioned. This article focuses on how institutional structures influence the way analytical information is actually used. A variation of information criterion for quality of decision-making is developed and used to analyze what types of structures incite actors to both generate and store a variety of ideas and arguments. An international comparison on transport infrastructure planning is used to demonstrate the relevant institutional mechanisms and (...) how different structures lead to different processes of information exchange and to differing product outcomes. (shrink)

Many analytical studies purporting to aid decision-making are produced and yet their contribution to actual decision-making is questioned. This article focuses on how institutional structures influence the way analytical information is actually used. A variation of information criterion for quality of decision-making is developed and used to analyze what types of structures incite actors to both generate and store a variety of ideas and arguments. An international comparison on transport infrastructure planning is used to demonstrate the relevant institutional mechanisms and (...) how different structures lead to different processes of information exchange and to differing product outcomes. (shrink)

According to the grammar of Port-Royal it is possible to convert the noun ‘homme’ into the adjective 'humain' by adding a confused signification or connotation. Strangely enough it is stipulated that by the reversal of this process the adjective 'human' is converted into the substantive ‘humanité’ rather than the original noun ‘homme’. In this article I argue that the treatment of adjectives and substantives in the Port-Royal grammar depends strongly on the traditional Aristotelian ontology as summarized in the so-called ontological (...) square and the theory of the predicables. In connection with this it is shown that according to the Port-Royalists corresponding concrete and abstract nouns like ‘homme’ and ‘humanité’, should be in some sense equivalent. (shrink)

Inleiding in de moderne logica - met name de syllogistiek - bedoeld voor zelfstudie en inleidende academische cursussen.

The original, Dutch version of this book served in 1979 as a doctoral disserta tion in philosophy at the Free University in Amsterdam. In this preface to the - slightly revised - English translation, I wish once again to express my gratitude to my supervisors, Prof. J. van der Hoeven of the Free University and Prof. G. Nuchelmans of the University of Leiden, for their excellent and stimulating support. Professor van der Hoeven was associated with this project from the outset. (...) It was a privilege to benefit from his incisive commentaries, especially in those instances where the objective was to break through to more fundamental insights. I shall not lightly forget his friendly and heartening encouragement. I am equally grateful for my discussions with Professor Nuchelmans. I almost always tried to follow his advice, since it was based upon awesome expertness and erudition. I am happy to have found in the person of Herbert Donald Morton, Th.M., M.A., an able and enthusiastic translator. Drs. Gerben Groenewoud made the translations of a number of the Latin citations. I acknowledge permission from Routledge and Kegan Paul and the University of Toronto Press to quote from The Collected Works of John Stuart Mill. And I thank the Netherlands Organization for the Advancement of Pure Research (Z.W.O.) for fmancing this translation. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole‐genome sequencing and micro‐array based analysis enable genome‐wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre‐test information and achieving autonomous decision‐making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by (...) the International Association of Bioethics, these challenges were presented for three different areas in which these so‐called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set‐up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set‐up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct‐to‐consumer applications of the new genetics. (shrink)

The mechanisms by which sex is genetically determined are bewilderingly diverse and appear to change rapidly during evolution.(1) What makes the sex‐determining process so prone to perturbations? Two recent articles(2,3) explore theoretically the role of genetic conflict in sex determination evolution. Both studies use the idea that selection on sex‐determining genes may act differently in parents and in offspring and they suggest that the resulting conflict can drive changes in sex‐determining mechanisms. BioEssays 23:477–480, 2001. © 2001 John Wiley & Sons, (...) Inc. (shrink)

Depletion of mitochondrial endo/exonuclease G‐like (EXOG) in cultured neonatal cardiomyocytes stimulates mitochondrial oxygen consumption rate (OCR) and induces hypertrophy via reactive oxygen species (ROS). Here, we show that neurohormonal stress triggers cell death in endo/exonuclease G‐like‐depleted cells, and this is marked by a decrease in mitochondrial reserve capacity. Neurohormonal stimulation with phenylephrine (PE) did not have an additive effect on the hypertrophic response induced by endo/exonuclease G‐like depletion. Interestingly, PE‐induced atrial natriuretic peptide (ANP) gene expression was completely abolished in endo/exonuclease (...) G‐like‐depleted cells, suggesting a reverse signaling function of endo/exonuclease G‐like. Endo/exonuclease G‐like depletion initially resulted in increased mitochondrial OCR, but this declined upon PE stimulation. In particular, the reserve capacity of the mitochondrial respiratory chain and maximal respiration were the first indicators of perturbations in mitochondrial respiration, and these marked the subsequent decline in mitochondrial function. Although pathological stimulation accelerated these processes, prolonged EXOG depletion also resulted in a decline in mitochondrial function. At early stages of endo/exonuclease G‐like depletion, mitochondrial ROS production was increased, but this did not affect mitochondrial DNA (mtDNA) integrity. After prolonged depletion, ROS levels returned to control values, despite hyperpolarization of the mitochondrial membrane. The mitochondrial dysfunction finally resulted in cell death, which appears to be mainly a form of necrosis. In conclusion, endo/exonuclease G‐like plays an essential role in cardiomyocyte physiology. Loss of endo/exonuclease G‐like results in diminished adaptation to pathological stress. The decline in maximal respiration and reserve capacity is the first sign of mitochondrial dysfunction that determines subsequent cell death. (shrink)

In this article we will describe the emergence of a great number of small, regionally concentrated, innovative biotech companies. We see these organizations as “hosts” of concepts and ideas, greatly influencing their spreading over the sector. We have chosen an evolutionary perspective following individual companies in their struggle for survival, describing it as “obtaining food” and “fooling predators.” This struggle gives insight in the behavior of the biotech companies and related institutions as a “system of innovation.” One of our findings (...) is that the variety of biotech companies is conditioned by their selection environment, but that this selection environment allows great variety and even encourage variety by keeping the companies small. (shrink)

In this article we will describe the emergence of a great number of small, regionally concentrated, innovative biotech companies. We see these organizations as “hosts” of concepts and ideas, greatly influencing their spreading over the sector. We have chosen an evolutionary perspective following individual companies in their struggle for survival, describing it as “obtaining food” and “fooling predators.” This struggle gives insight in the behavior of the biotech companies and related institutions as a “system of innovation.” One of our findings (...) is that the variety of biotech companies is conditioned by their selection environment, but that this selection environment allows great variety and even encourage variety by keeping the companies small. (shrink)