Volume 20, Issue 6, June 2020, Page 70-72.

At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely (...) interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach. (shrink)

Background Community advisory boards have expanded beyond high-income countries and play an increasing role in low- and middle-income country research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. Methods We searched five databases for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed (...) articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. Results Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa, China, and Thailand having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. Conclusions Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs. (shrink)

Introduction: Screen-based and mobile technology has grown at an unprecedented rate. However, little is understood about whether increased screen-use affects executive functioning, the range of mental processes that aid goal attainment and facilitate the selection of appropriate behaviors. To examine this, a systematic review was conducted.Method: This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A comprehensive literature search was conducted using Web of Science, MEDLINE, PsycINFO and Scopus databases to identify (...) articles published between 2007 and March 2020, examining the use of mobile technologies on aspects of EF in healthy adults aged 18–35 years. In total 6079 articles were screened by title, and 39 screened by full text. Eight eligible papers were identified for inclusion. Our methods were pre-registered on the PROSPERO international prospective register of systematic reviews.Results: A total of 438 participants were included across the eight studies. Five of the eight studies examined more than one EF. Five studies measured inhibition, and four studies measured decision-making. Smartphone use was negatively associated with inhibition and decision-making. Working memory performance was found to be improved by increased time engaging in video games and by refraining from smartphone use prior to bedtime. Quality assessments indicated high risk of methodological biases across the studies and a low quality of evidence for determining the relationship between technology use and executive functioning.Conclusions: This review highlights the scarcity of the literature in this area. It presents a call for rigorous and objective research to further our understanding of the impact of mobile technology on different aspects of executive function. (shrink)

Literacy is an essential skill. Learning to read is a requirement for becoming a self-providing human being. However, while spoken language is acquired naturally with exposure to language without explicit instruction, reading and writing need to be taught explicitly. Decades of research have shown that well-structured teaching of phonological awareness, letter knowledge, and letter-to-sound mapping is crucial in building solid foundations for the acquisition of reading. During the COVID-19 pandemic, children worldwide did not have access to consistent and structured teaching (...) and are, as a consequence, predicted to be behind in the development of their reading skills. Subsequent evidence confirms this prediction. With the best evidence-based practice in mind, we developed an online version of a well-structured early literacy training program for 5-year-old children. This 2-week online Reading Camp program is designed for pre-K children. It incorporates critical components of the fundamental skills essential to learning to read and is taught online in an interactive, multi-sensory, and peer-learning environment. We measure the participants’ literacy skills and other related skills before and after participating in the online Reading Camp and compare the results to no-treatment controls. Results show that children who participated in the online Reading Camp improved significantly on all parameters in relation to controls. Our results demonstrate that a well-structured evidence-based reading instruction program, even if online and short-term, benefits 5-year-old children in learning to read. With the potential to scale up this online program, the evidence presented here, alongside previous evidence for the efficacy of the in-person program, indicates that the online Reading Camp program is effective and can be used to tackle a variety of questions regarding structural and functional plasticity in the early stages of reading acquisition. (shrink)

More widespread farming of species not typically used as livestock may be part of a sustainable approach for promoting human health and economic prosperity in a world with an increasing population; a current example is peccary farming in the Neotropics. Others have argued that species that are local to a region and which are usually not farmed should be considered for use as livestock. They may have a more desirable nutrient profile than species that are presently used as livestock. It (...) may also reduce the pressure from hunting on other wild species, and cause less environmental damage than exotic species. We propose a sentiocentric utilitarian framework that could be used to decide whether species that are local, but generally not used as livestock, should be farmed. To illustrate the use of our decision-making framework, we employ two contrasting neotropical case studies: the Spotted Paca (Cuniculus paca) and the Capybara (Hydrochoerus hydrochaeris). We argue that it may be acceptable to use non-sentient species that are typically not farmed as livestock. However, research should determine whether farming them offers human, environmental or sustainability benefits. In addition, we recommend that if invertebrate species are considered for farming, research should be conducted to determine the likelihood that they are sentient. Finally, given the ethical failings of current livestock farming practices, we argue that a high bar must be met if ‘new’ species that are sentient are to be farmed. (shrink)

The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim is (...) to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompasses the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency. (shrink)

Universal Grammar (UG) can be interpreted as a constraint on the form of possible grammars (hypothesis space) or as a constraint on acquisition strategies (selection procedures). In this response to Herschensohn we reiterate the position outlined in Epstein et al. (1996a, r), that in the evaluation of L2 acquisition as a UG- constrained process the former (possible grammars/ knowledge states) is critical, not the latter. Selection procedures, on the other hand, are important in that they may have a bearing on (...) development in language acquisition. We raise the possibility that differences in first and second language acquisition pertaining to both attainment of the end-state and course of development may derive from differences in selection procedures. We further suggest that for these reasons age effects in the attainment of nativelike proficiency must necessarily be separated from UG effects. (shrink)

In this chapter, I offer an overview of current scholarly debates on Plato's Lysis. I also argue for my own interpretation of the dialogue. In the Lysis, Socrates argues that all love is motivated by the desire for one’s own good. This conclusion has struck many interpreters as unattractive, so much so that some attempt to reinterpret the dialogue, such that it either does not offer an account of interpersonal love, or that it offers an account on which love is, (...) in fact, an other-regarding state. Others, notably Vlastos, criticize Socrates’ theory as implausibly and repellently egoistic. I maintain, against the first group, that Socrates is indeed offering an egoistic theory of love. I argue, against the second, that, while Socrates’ theory may be repellent, it possesses considerable explanatory power and avoids certain weaknesses which infect contemporary approaches to love. (shrink)

Translator's Preface LA LOGIQUE DE HUSSERL, etude sur "Logique for- melle et logique transcendentale" the original of the present translation, was published ...

Contemporary argumentation theory or informal logic is the appropriate logical basis of qualitative inquiry. The communicative principles of cooperation and charity are essential within argumentation theory. An optimal observance of these principles, for strategical reasons for example, is of methodological relevance to qualitative research. In addition, an ethically motivated optimalization of the observance may also enhance methodological quality, especially dialogical intersubjectivity or openness. Moreover, this ethically motivated observance may be supported by a philosophy of life, which may stimulate opting for (...) qualitative inquiry and promote its methodological quality. (shrink)

The standard medical case report often reduces patients and caregivers to complexes of medical facts and clinical decisions. Restructuring the genre itself to acknowledge the human dimensions of both patients and physicians allows questions of human values to regain their stature as integral components of the discourse.

The objective of this study is to evaluate if use of a patient decision aid, when choosing between a repeat cesarean or a trial of labor after a cesarean, reduces medical liability exposure. The authors conclude that use of a PDA conferred liability protection when potential jurors were presented with a hypothetical malpractice claim against an obstetrician following a TOLAC.

Although the most common understanding of suicide is intentional self-killing, this conception either rules out someone who lacks mental capacity being classed as a suicide or, if acting intentionally is meant to include this sort of case, then what it means to act intentionally is so weak that intention is not a necessary condition of suicide. This has implications in health care, and has a further bearing on issues such as assisted suicide and health insurance. In this paper, I argue (...) that intention is not a necessary condition of suicide at all. Rather, I develop a novel approach that deploys the structure of a homicide taxonomy to classify and characterise suicides to arrive at a conceptually robust understanding of suicide. According to my analysis of suicide, an agent is the proximate cause of his death. Suicide is ‘self-killing,’ rather than ‘intentional self-killing.’ Adopting this understanding of suicide performs several functions: We acquire an external standard to assess diverging analyses on specific cases by appealing to homologous homicides. Following such a taxonomy differentiates types of suicides. This approach has application in addressing negative connotations about suicide. As a robust view, adding intention is an unnecessary complication. It is more consistent with psychological and sociological assessments of suicide than ‘intentional self-killing.’ It has useful applications in informing public policy. This paper’s focus is on classifying types of suicides, rather than on the moral permissibility or on underlying causes of suicidal ideation and behaviour. (shrink)

"In recent years, we have grown accustomed to philosophical language that is intensely self-conscious and rhetorically thick, often tragic in tone. It is enlivening to read Bergson, who exerts so little rhetorical pressure while exacting such a substantial effort of thought.... Bergson's texts teach the reader to let go of entrenched intellectual habits and to begin to think differently—to think in time.... Too much and too little have been said about Bergson. Too much, because of the various appropriations of his (...) thought. Too little, because the work itself has not been carefully studied in recent decades."—from Thinking in Time Henri Bergson, whose philosophical works emphasized motion, time, and change, won the Nobel Prize for Literature in 1927. His work remains influential, particularly in the realms of philosophy, cultural studies, and new media studies. In Thinking in Time, Suzanne Guerlac provides readers with the conceptual and contextual tools necessary for informed appreciation of Bergson's work. Guerlac's straightforward philosophical expositions of two Bergson texts, Time and Free Will and Matter and Memory, focus on the notions of duration and memory—concepts that are central to the philosopher's work. Thinking in Time makes plain that it is well worth learning how to read Bergson effectively: his era and our own share important concerns. Bergson's insistence on the opposition between the automatic and the voluntary and his engagement with the notions of "the living," affect, and embodiment are especially germane to discussions of electronic culture. (shrink)

: This essay examines the increasing commodification of the body with respect to tissues, gametes, and embryos. Such commodification contributes to a diminishing sense of human personhood on an individual level, even as it erodes commitments to human flourishing at the societal level. After the case for social harm resulting from the increasing commodification of the body is made, the question becomes whether that harm is best remedied by following any of three approaches by which government traditionally seeks to promote (...) the flourishing of its citizens. The author concludes that it is not, and that what is needed is a pragmatic and somewhat casuistic approach to the regulation of contested commodities--that which legal scholar Margaret Jane Radin calls "incomplete commodification.". (shrink)

DNA sequence variation is abundant in wild populations. While molecular biologists use genetically homogeneous strains of model organisms to avoid this variation, evolutionary biologists embrace genetic variation as the material of evolution since heritable differences in fitness drive evolutionary change. Yet, the relationship between the phenotypic variation affecting fitness and the genotypic variation producing it is complex. Genetic buffering mechanisms modify this relationship by concealing the effects of genetic and environmental variation on phenotype. Genetic buffering allows the build-up and storage (...) of genetic variation in phenotypically normal populations. When buffering breaks down, thresholds governing the expression of previously silent variation are crossed. At these thresholds, phenotypic differences suddenly appear and are available for selection. Thus, buffering mechanisms modulate evolution and regulate a balance between evolutionary stasis and change. Recent work provides a glimpse of the molecular details governing some types of genetic buffering. BioEssays 22:1095–1105, 2000. © 2000 John Wiley & Sons, Inc. (shrink)

In this essay Suzanne Rice examines Aristotle's ideas about virtue, character, and education as elements in an Aristotelian conception of good listening. Rice begins by surveying of several different contexts in which listening typically occurs, using this information to introduce the argument that what should count as “good listening” must be determined in relation to the situation in which listening actually occurs. On this view, Rice concludes, there are no “essential” listening virtues, but rather ways of listening that may (...) be regarded as virtuous in the context of particular concrete circumstances. (shrink)

The Wisconsin card-sorting test (WCST) is a commonly used clinical tool for the detection of frontal lobe dysfunction, specifically executive dysfunction. Patients with lesions outside the frontal lobes sometimes show deficits on the WCST, however, and some researchers have implicated hippocampal dysfunction as the cause of the deficit. But a critical role for the hippocampus seems to be untenable because amnesic patients with bilateral medial temporal lobe (MTL) lesions perform the WCST normally. In the case of epileptic patients, an alternative (...) explanation of the card-sorting impairment is the propagation of abnormal discharges from MTL to frontal lobe structures, causing remote interference with executive circuits. (shrink)

In the VIBeS study, Pierson et al. (2024) observe that the views of U.S. bioethicists do not align with views of clinicians or with broader U.S. public opinion. They also note that the bioethics co...

L’ouvrage de L. Giovannetti (G.) est composé de trois parties : la première porte sur la notion d’εἶδος dans les dialogues de maturité, et les deux suivantes proposent une analyse détaillée de trois sections du Théétète (151-157, 181-183, 184-187) et de deux sections du Sophiste (251-254, 259-263) — analyse qui montre de quelle manière les caractéristiques de l’ εἶδος déployées dans la première partie continuent de jouer un rôle central au sein de ces dialogues. L’auteur cherche à montrer, co...

Greely argues that surrogates for living human brains in vivo might be of tremendous benefit to understanding human brain function—and eventually to curing devastating brain diseases—without...