In the last two decades, the term “quality-of-life” has become popular in medicine and health care. There are, however, important differences in the meaning and the use of the term. The message of all quality-of-life talk is that medicine and health care are not valuable in themselves. They are valuable to the extent that they contribute to the quality of life of patients. The ultimate aims of medicine and health care are not health or prolongation of life as such, but (...) preservation or improvement of the quality of life. The primary aims of medicine and health care, such as the prolongation of life, can – but need not always – come into conflict with the ultimate ones: medical treatments do not always benefit a patient. In this article I will, first, summarize the results of my explorations of the use and the meaning of the term “quality-of-life.” The use and the meaning of the term turn out to depend on the contexts of medical decisionmaking in which it is used. I will show that there are at least three different concepts of quality-of-life. Second, I will argue that the different concepts of quality-of-life are not unrelated. They point to different components of and/or conditions for happiness. Third, I will analyze the relation between the three concepts of qualityof-life, health and happiness. (shrink)

A special issue on ‘Private Autonomy and Public Paternalism’ constitutes the first part of this issue. Guest-editors are Annette Dufner and Michael Kühler, both from the University of Munster, Germany. It is often assumed that personal autonomy is a ‘private’ matter in the sense that it is based primarily on a person’s subjective characteristics and capabilities. At the same time, the literature mainly deals with paternalism as a problem of the ‘public’ sphere, for example by focusing on the dangers that (...) threaten the autonomy of individuals as citizens, such as state paternalism. However, it is widely acknowledged nowadays that personal autonomy can only develop and flourish if conditions in the social and relational sphere are favourable, which means that personal autonomy is not so private after all. At the same time, it should be clear that paternalism not only relates to our behaviour in the public sphere, but also to how we behave in more private social spheres, like family, frien. (shrink)

Overzicht van de geschiedenis, ontwikkelingen en toekomst van de ethiek als wetenschappelijke discipline in Nederland.

DISCOURSE; EXPRESSION (i) 'Discourse' is a word with a variety of meanings. One of the more useful is as an omnibus word covering both thought and talk. ...

The paper begins with a defence of a new definition of privacy as the absence of undocumented personal knowledge. In the middle section, I criticise alternative accounts of privacy. Finally, I show how my definition can be worked into contemporary American Law.

Evolutionary developmental biology (evo-devo) has undergone dramatic transformations since its emergence as a distinct discipline. This paper aims to highlight the scope, power, and future promise of evo-devo to transform and unify diverse aspects of biology. We articulate key questions at the core of eleven biological disciplines—from Evolution, Development, Paleontology, and Neurobiology to Cellular and Molecular Biology, Quantitative Genetics, Human Diseases, Ecology, Agriculture and Science Education, and lastly, Evolutionary Developmental Biology itself—and discuss why evo-devo is uniquely situated to substantially improve (...) our ability to find meaningful answers to these fundamental questions. We posit that the tools, concepts, and ways of thinking developed by evo-devo have profound potential to advance, integrate, and unify biological sciences as well as inform policy decisions and illuminate science education. We look to the next generation of evolutionary developmental biologists to help shape this process as we confront the scientific challenges of the 21st century. (shrink)

This paper presents a qualitative study investigating the application of physiotherapists’ professional ethics in practice with respect to touch, intimacy, and corporeality during therapy, based on the experiences of elderly patients. As the relationship in a physiotherapy session is multidimensional, the study considered three levels: physical contact, verbal contact, and the conditions in which the therapy took place. The aim of this study was to find out what values are of importance to older people during a physiotherapy session, with emphasis (...) on the categories of touch, corporeality, and intimacy. The studied group consisted of sixteen male and female physiotherapy patients aged between sixty-six and ninety-two years. The study was conducted according to the grounded theory methodology. The research material consisted of transcriptions of free targeted interviews, which were subjected to a process of coding and analysis. As a result of data analyses, three superior categories have been identified—safety, anxiety, interpersonal relationship—and three a priori categories stemming from the characteristic features of the study area—touch, corporeality, and intimacy. The a priori categories did not appear independently in statements made by the respondents, but instead seemed to be components of superior categories. The most important values indicated by the respondents concerned the interpersonal relationship with their physiotherapist and the feeling of safety and care. In terms of touch, corporeality, and intimacy, the respondents indicated, among others, the importance of predictability, a sense of security, privacy, and acceptance of the body. (shrink)

Several decades of behavioral research have established that variations in socioeconomic status are related to differences in cognitive performance. Neuroimaging and psychophysiological techniques have recently emerged as a method of choice to better understand the neurobiological processes underlying this phenomenon. Here we present a systematic review of a particular sub-domain of this field. Specifically, we used the PICOS approach to review studies investigating potential relationships between SES and scalp event-related brain potentials. This review found evidence that SES is related to (...) amplitude variations in a diverse range of ERPs: P1, N1, N2, Error-Related Negativities, N400, auditory evoked potentials, negative difference waves, P3 and slow waves. These ERPs include early, mid-latency and late potentials that reflect a broad range of cognitive processes. In this review, all SES effects on ERPs appeared to reflect an impairment or a less efficient form of task-related neural activity for low-SES compared to high-SES individuals. Overall, these results confirm that a wide variety of distinct neural processes with different functional meanings are sensitive to SES differences. The findings of this review also suggest that the relationship between SES and some ERP components may depend on the developmental stage of study participants. Results are further discussed in terms of the current limitations of this field and future avenues of research. (shrink)

Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted (...) to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. (shrink)

Talking Politics is a philosophical examination of some of the basic concepts of political discourse. Its primary focus is on the ordinary ; on what is said by politicians, in newspapers and by people in pubs, rather than on the works of political theorists. This is a work of , but not on political theory. Talking Politics is: * Invaluable as a source of reference for students, and contains a detailed index * Arranged thematically, around topics such as `Nation'. Each (...) entry has copious cross-references and suggestions for further reading A. W. Sparkes is uniquely qualified to write such a book, combining some thirty years' teaching as a philosopher with wide experience of, and a life-long fascination with, politics. His attitude is that of a critical, but uncynical, observer. (shrink)

The phenomenological calculus is a relational paradigm for complex systems, closely related in substance and spirit to Robert Rosen’s own approach. Its mathematical language is multilinear algebra. The epistemological exploration continues in this paper, with the expansion of the phenomenological calculus into the realm of anisotropy.

In Thucydides' account of Melesander's expedition with six ships to Caria and Lycia there appears to me to be a difficulty which is universally ignored by commentators and fudged by translators. Thucydides describes the purpose of the expedition.

In Thucydides' account of Melesander's expedition with six ships to Caria and Lycia there appears to me to be a difficulty which is universally ignored by commentators and fudged by translators. Thucydides describes the purpose of the expedition.

I should like to draw attention to a metrical phenomenon observable in the hexameters of Callimachus and propound a ‘law’ which so far as I know has not been remarked on before; the accompanying discussion involves some refinements to our understanding of the metrical effect of proclitics of general importance to Greek metrical studies. In analysing the data I have made use of some standard statistical methods which could in my view be used throughout the whole field of Greek metrical (...) studies with great profit . The analysis also provides some detailed evidence useful for a comparison of Callimachus, Apollonius Rhodius, Theocritus, and Aratus, and the earlier writers by whom the Hellenistic poets were influenced. (shrink)

The text as published runs:The elegiacs on side of this fragmentary piece of papyrus are identifiable as by Callimachus, probably from the Aetia, and these lines too are undoubtedly by the same author, and almost certainly from the same work. Verse 5 is a surprise, for it was thought until the discovery of this papyrus to be by Euripides; however the only source for this attribution is Stobaeus , in whom it appears as the first line of a two-line quotation. (...) It is not unusual in Stobaeus for two originally unconnected lines to be mistakenly combined ’, CQ N.s. i , 18–19). (shrink)

The text as published runs:The elegiacs on side of this fragmentary piece of papyrus are identifiable as by Callimachus, probably from the Aetia, and these lines too are undoubtedly by the same author, and almost certainly from the same work. Verse 5 is a surprise, for it was thought until the discovery of this papyrus to be by Euripides; however the only source for this attribution is Stobaeus, in whom it appears as the first line of a two-line quotation. It (...) is not unusual in Stobaeus for two originally unconnected lines to be mistakenly combined ’, CQ N.s. i, 18–19). (shrink)

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust (...) at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. (shrink)

There is a widespread belief, more often implied than explicitly asserted, that Hume considered all necessary propositions to be analytic.Of course Hume did not use the analytic-synthetic distinction explicitly. This only come to the forefront with Kant; and it is Kant who is probably the main source of the above-mentioned belief. Kant ascribed to Hume the view that mathematical propositions are, in his terminology, analytic. If this is correct, then since mathematics was for Hume the paradigm of a body of (...) necessary truths, it is plausible to infer that he considered necessary propositions to be one and all analytic. The absence in Hume's writings of the analytic-synthetic terminology is by no means decisive: though he did not have the terms he may well have possessed the concepts, as evidenced by his use of them. (shrink)

OBJECTIVES: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. DESIGN: Semi-structured interviews administered to GPs and patients. SETTING AND SAMPLE: Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The sample comprised twenty-one general practitioners and seventeen patients recruited by participating GPs. (...) RESULTS: In practice, acting for the good of the patient not only accommodates the views of patients and GPs on expertise and knowing best, but also responds to the particular details of the clinical situation. Patients had a complex understanding of the expertise necessary for medical practice, describing a contextual domain in which they were expert, and which complemented the scientific expertise of their GPs. General practitioners identified multiple sources for their expertise, of which experience was the most significant. The role of the GP included responding to individual patients and particular clinical problems and ranged from the assumption of responsibility through to the proffering of medical advice. CONCLUSION: This study found that GPs acting for the good of their patients covered a variety of GP actions and patient preferences. Beneficence was not justified by presumed patient vulnerability or the inability of patients to understand medical problems, but furthered through a recognition of the different areas of expertise contributed by both parties to the consultation. (shrink)

This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow (...) biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health. (shrink)

The paper has two main aims. The first is to reformulate Hempel's version of the thesis of the symmetry of explanation and prediction, as regards the deductive covering-law model, so as to generalise it and make it no longer subject to some of the criticisms which have been directed at it (Section II). The second aim is to consider, with special critical reference to Hempel's recent treatment in Aspects of Scientific Explanation (New York and London, 1965), some central criticisms of (...) both the constituent parts of the above symmetry thesis, viz. that adequate explanations are potentially predictive (Section III), and that adequate predictive arguments are potentially explanatory (Section IV). (shrink)