Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the pediatric (...) oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (shrink)

This essay is a brief evaluation of Evert-Jan Viedder's study of conflict in the miracle stories in Matthew 8 and 9. His use of his own conflict model to interpret the conflict between Jesus and the leaders of Israel which is reflected in Matthew 8 and 9, and which at the same time serves as a transparency for the conflict between the community of Matthew and the Pharisees in the post-AD 70 period, is discussed critically in terms of his (...) epistemological perspectives and methodological procedures. (shrink)

In the debate about actions in virtual environments two interdependent types of question have been pondered: What is a person doing who acts in a virtual environment? Second, can virtual actions be evaluated morally? These questions have been discussed using examples from morally dubious computer games, which seem to revel in atrocities. The examples were introduced using the terminology of “virtual murder” “virtual rape” and “virtual pedophilia”. The terminological choice had a lasting impact on the debate, on the way action (...) types are assigned and on how moral evaluation is supposed to be conducted. However, this terminology and its theoretical consequences, while sometimes resulting in correct results, lead to absurd results when applied across the board. It will be suggested that these absurd consequences can be avoided by a different answer to the question what people in virtual worlds are doing. Alleged virtual actions are first and foremost the creation and modification of data-structures and the resulting output in computer hardware. Such modifications of data structure and imagery can be performed with different intentions, purposes and styles, which will influence the type and moral evaluation of a user’s actions. This reinterpretation allows for a more complex analysis of the moral reasons for praiseworthiness or blameworthiness of actions in virtual environments. This analysis takes not just harm and effects on character into account but the peculiar ways in which speech acts can be morally wrong: e.g. agitatory, deceptive, bullshitting. (shrink)

This paper develops elements of a phenomenological account of how interpersonal care contributes to the structure of intentionality. It does so by reflecting on a first-person account of parental grief by the poet and thinker Denise Riley. Her autobiographical notes on the aftermath of the death of her adult son revolve around a marked experience of altered temporal flow. By relating what she considers to be an almost unspeakable alteration in her experience of time, Riley unearths a level of nuanced (...) phenomenological reflection that can inform philosophical studies of lived time and intentionality. The paper will build on Riley's observations on altered temporal experience in grief to explore the entanglement of temporality and intersubjectivity in the constitution of intentionality. By doing so, the paper demonstrates that and how a phenomenological study of grief can directly speak to key concerns of the philosophy of mind and of interdisciplinary consciousness studies. (shrink)

Complex vocal learning, the capacity to imitate new sounds, underpins the evolution of animal vocal cultures and song dialects and is a key prerequisite for human speech and song. Due to its relevance for the understanding of cultural evolution and the biology and evolution of language and music, the trait has gained much scholarly attention. However, while we have seen tremendous progress with respect to our understanding of its morphological, neurological and genetic aspects, its peculiar phylogenetic distribution has remained elusive. (...) Intriguingly, animals as distinct as hummingbirds and humpback whales share well-developed vocal learning capacity in common with humans, while this ability is quite limited in nonhuman primates. Yet, solving this ‘vocal learning conundrum’ may shed light on the constraints ancestral humans overcame to unleash their vocal capacities. To this end I consider major constraints and functions that have been proposed. I highlight an especially promising ecological constraint, namely the spatial dimensionality of the environment. Based on an informal comparative review, I suggest that complex vocal learning is associated with three-dimensional habitats such as air and water. I argue that this is consistent with recent theoretical advances—i.e., the coercion-avoidance and dimensionality hypotheses—and with the long-standing hypothesis that mate choice is a major driver of the evolution and origin of complex vocal learning. However, I stress that multiple functions may apply and that quantitative phylogenetic comparative methods should be employed to finally resolve the issue. (shrink)

We construct bounded degree acyclic Borel graphs with large Borel chromatic number using a graph arising from Ramsey theory and limits of expander sequences.

This chapter considers four areas in the differences between Vygotsky's concept of reason and ‘Enlightenment rationality’ in its familiar characterisation. These areas cover: (1) foundationalism and anti‐foundationalism, (2) the conception of science, (3) the conception of development and (4) idealism and materialism. The last is developed more by Ilyenkov, although, given its Hegelian and Spinozist provenance, it can be reasonably interpreted as part of the general direction of Vygotsky's work. Two indications of the importance of Hegel for understanding Vygotsky are: (...) first, the absence of an unbridgeable epistemological chasm between thought and world, and second, the conception of development as a non‐linear process embedded in historical resources. Marx's and Hegel's ideas of history and development influenced every aspect of Vygotsky's thinking on concepts. Vygotsky's work provides no blueprint for teachers and educational administrators, but it does provide a frame of ideas within which questions concerning education can fruitfully be pursued. (shrink)

In recent years, the problem of value has been drastically pushed away towards the periphery of the discipline of literary studies. More and more, this fact has come to be experienced as a source of frustration and misunderstandings.1 In this article, I would like to show the great extent to which a value-oriented approach is in fact inevitable. By the same token, however, I will also indicate the disturbing ambiguities that the consideration of the value-dimension may reveal. The example I (...) will use for my demonstration, the case of the French photographic novel , is fairly straightforward , but at the same time it betrays my slightly polemical intentions, since this genre is undoubtedly held in low esteem both within and without the domain of literary scholarship.It seems reasonable to assume that our twentieth century, with its turbulent successions of competing fashions and trends, has radically affected the concept of value, that is, the dialectical game of valorization and devalorization. The notion of value has of course become subject to “devaluations” on the content-level, as the mixtures and the instabilities of the criteria called on clearly lattest.2 In addition—and more important—value has been disobjectified, that is, snatched from the object of the judgment and located on the side of the judging subject. Jan Baetens teaches French at the Vlaamse Economische Hogeschool . He is the author of three books: Aux frontiers du récit: “Fable” de Robert Pinget comme “nouveau nouveau roman” ; Hergé écrivain: microlectures de Tintin ; and Les Mesures de l’excès: notes pour un traverse de “Eglogues” de Renaud Camus et al. . He is currently at work on the various aspects of grammatextuality in literature and the comics. (shrink)

Purpose The purpose of this paper is two-fold. First, it explores the extent to which diversity of connectivity or the connection through multiple internet access points may facilitate online privacy behavior. Second, it explains the diversity of connectivity-online privacy behavior link in terms of information literacy. Design/methodology/approach Situated in the context of urban poor youth in the Philippines, this paper used a quantitative approach, specifically an interview-administered survey technique. Respondents were from three cities in Metro Manila. To test for indirect (...) relationship, survey data were analyzed using bootstrapping technique via SPSS macro PROCESS. Findings Urban poor youth with diversified connection to the internet engaged in online privacy behavior. The more the youth are connected to the internet through diverse modalities, the more this fosters cautious online privacy behavior. In addition, information literacy explained how diversity of connectivity facilitated online privacy behavior. It suggests that differences in online privacy behavior may result from the extent of basic know-how of navigating online information. In the context of the urban poor in the Global South, the youth are constantly negotiating ways to not only connect to the internet but also acquire digital skills necessary for protective online behaviors. Originality/value To date, this is one of the few papers to contribute to conversations about online privacy among youth in the Global South. It broadens the literature on social determinants of online privacy behavior that is crucial for designing policy interventions for those in the margins. (shrink)

The identification of Smad proteins as molecular components of the transforming growth factor-β (TGF-β) signaling cascade has enhanced our understanding of how ligand-mediated activation of TGF-β receptors leads to modulation of target gene transcription. Recent studies have identified a distinct, structurally related class of Smads which inhibits, rather than transduces, TGF-β family signals. The molecular mechanism of action and the exact signaling pathways that are targeted by antagonistic Smads are not completely understood. These proteins appear to participate in autoregulatory negative (...) feedback loops in which signaling initiated by specific TGF-β family ligands induces the expression of an inhibitory Smad that then functions to modulate the amplitude or duration of signaling. Negative feedback circuits such as these play important roles in fine-tuning the activity of multifunctional signaling molecules during embryonic patterning and in response to pathologic stimuli in adults. BioEssays 21:382–390, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

Introduced with the hope of reducing refereeing errors and increasing “football justice”, the Video Assistant Referee has attracted much criticism from players and spectators alike. Drawing o...

BackgroundExpanded access is the use of investigational drugs (IDs) outside of clinical trials. Generally it is performed in patients with serious and life-threatening diseases who cannot be treated satisfactorily with authorized drugs. Legal regulations of expanded access to IDs have been introduced among others in the USA, the European Union (EU), Canada and Australia. In addition, in the USA an alternative to expanded access is treatment under the Right-to-Try law. However, the treatment use of IDs is inherently associated with a (...) number of ethically relevant problems.Main textThe objective of this article is to present a coherent framework made up of eight requirements which have to be met for any treatment use of an ID to be ethical. These include a justified need for the use of an ID, no threat to clinical development of the ID, adequate scientific evidence to support the treatment, patient’s benefit as the primary goal of the use of an ID, informed decision of a patient, fair access of patients to IDs, independent review, as well as the dissemination of treatment results.ConclusionsWhile this framework is essentially consistent with the legal regulations of expanded access of the USA, the EU, Canada and Australia, it is substantially wider in scope because it addresses some important issues that are not covered by the regulations. Overall, the framework that we developed minimizes the risks and threats, and maximizes potential benefits to each of the four key stakeholders involved in the treatment use of IDs including patients, doctors, drug manufacturers, and society at large. (shrink)

Can the law benefit from an evolutionary perspective? This little book shows how the idea of survival of the fittest can help explain legal development and the rise and fall of legal institutions. The reader is invited to join in on a journey of discovery in which the world of Darwin is connected to the topics of legal change, convergence of law, legal complexity, law in hip-hop music and the adoption of the price-payment rule. Exploring these five themes from an (...) evolutionary angle indisputably upsets our traditional view of the law, but it does fit the author's view of academia as a place for cross-disciplinary research steered by curiosity. (shrink)

The rapid development of empirical science and theoretical grounds related with them, results in many theories on the origin, evolution and nature of the world, sometimes interpreted as contradictory to the theological conception. Consequently, under the influence of these achievements, within theology itself, an opinion about autonomy of both domains and their complementarity seems to be more and more popular. Facing this relation, it is theology that should present the possibility of such understanding of the revealed truths that they could (...) coexist with scientific discoveries. Based directly on biblical texts, the sophiological vision of origin and nature of the world seems to be very interesting among other theological conceptions regarding this topic. The present article attempts to confront the sophiology’s presumptions on the eternal creative Wisdom with scientific thesis on the world’s nature, its development and on human existence in order to demonstrate the possibility of coexistence of these discourses with no contradiction. (shrink)

According to Alexander Sarch, criminal culpability is a special kind of culpability, which moreover comes in degrees.1 This paper critically examines his acc...

Theories of modality which invoke possible worlds have recently been challenged by accounts that appeal to dispositional properties. A prominent strand of the accounts maintains that there is an intimate link between dispositions and possibility. The link is said to be captured by the proposition that, at first approximation, a state of affairs is possible just in case there is some actual disposition whose manifestation is the state. Focusing on the most detailed exposition and defence of this approach, put forward (...) by Barbara Vetter, I critically examine the adequacy of the view of dispositional properties on which it rests and which seems to be required by any plausible dispositionalist account of possibility. In the course of doing so, I offer arguments in favour of the causal nature of dispositions. (shrink)

The sacred and the revolution Leszek Kołakowski and othersThe author examines the relationship between the sphere of the sacred and the phenomenon of the revolution. He points to the distinctiveness of Leszek Kołakowski’s position as compared to the views articulated by other representatives of the so-called Warsaw school of the history of ideas. He claims that Kołakowski’s philosophical programme, which takes into account the sacred and mythical dimension of the socio-political diagnoses, can help us to understand the Russian Revolution of (...) 1917 as well as other revolutionary movements and processes of the 20th century. He demonstrates that the sacred is an inherent aspect of the revolutionary mentality. Also, he argues that the ideologies which turned against religion in the name of the struggle with religious superstitions, in the end became quasi-religious. As a matter of fact, the revolutionary utopia may be perceived as a kind of crypto-religion involving such elements of the mythical thinking as a belief in the cognition of history, an assumption that the latter may be started anew, a belief in the possibility of the secular eschatology, etc. (shrink)