The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

Book reviewed in this article: Conscience and Convenience: The Asylum and its Alternatives in Progressive America. By David J. Rothman.

This article provides somephilosophical ``groundwork'' for contemporary debatesabout the status of the idea(l) of critical thinking.The major part of the article consists of a discussionof three conceptions of ``criticality,'' viz., criticaldogmatism, transcendental critique (Karl-Otto Apel),and deconstruction (Jacques Derrida). It is shown thatthese conceptions not only differ in their answer tothe question what it is ``to be critical.'' They alsoprovide different justifications for critique andhence different answers to the question what giveseach of them the ``right'' to be critical. It is arguedthat (...) while transcendental critique is able to solvesome of the problems of the dogmatic approach tocriticality, deconstruction provides the most coherentand self-reflexive conception of critique. A crucialcharacteristic of the deconstructive style of critiqueis that this style is not motivated by the truth ofthe criterion (as in critical dogmatism) or by acertain conception of rationality (as intranscendental critique), but rather by a concern forjustice. It is suggested that this concern should becentral to any redescription of the idea(l) ofcritical thinking. (shrink)

In §66 ofPhilosophical Investigations Wittgenstein looks for something common to various games and finds only an interconnecting network of resemblances. These are family resemblances. Sympathetic as well as unsympathetic readers have interpreted him as claiming that games form a family in virtue of these resemblances. This assumes Wittgenstein inverted the relation between being a member of a family and bearing family resemblances to others of that family. (The Churchills bear family resemblances to one another because they belong to the same (...) family, they don't belong to the same family because they resemble one another.) A close reading ofInvestigations gives no evidence that Wittgenstein made this mistake. Rather, family resemblances may play a role like the one criteria play for psychological terms. They give excellent but fallible evidence for membership in the extensions of some terms. (shrink)

What are the processes, from conception to adulthood, that enable a single cell to grow into a sentient adult? Neuroconstructivism is a pioneering 2 volume work that sets out a whole new framework for considering the complex topic of development, integrating data from cognitive studies, computational work, and neuroimaging.

In §50 of Philosophical Investigations Wittgenstein wrote the sentence, “There is one thing of which one can say neither that it is one metre long, nor that it is not one metre long, and that is the standard metre in Paris.” Although some interpreters have claimed that Wittgenstein’s statement is mistaken, while others have proposed various explanations showing that this must be correct, none have questioned the fact that he intended to assert that it is impossible to describe the standard (...) meter as being a meter long. Given that Wittgenstein introduces this sentence as analogous to the claim that “existence cannot be attributed to an element,” and that the preceding passages discuss a language-game the simples of which can be described by their own names, there is good reason to think that Wittgenstein did not intend to assert this infamous sentence. (shrink)

In her later writings Jean Hampton develops an expressive theory of punishment she takes to be retributivist. Unlike Feinberg, Hampton claims wrongdoings as well as punishments are expressive. Wrongdoings assert that the victim is less valuable than victimizer. On her view we are obligated to punish because we are obligated to respond to this false assertion. Punishment expresses the moral truth that victim and wrongdoer are equally valuable. We argue that Hampton's argument would work only if she held that exerting (...) power over another provides evidence (albeit defeasible) of one's greater value. This is clearly a premise that neither she nor her readers are likely to accept. (shrink)

This article addresses some methodological questions that are at stake in assessing the influence of the ideas of John Dewey on the renewal of European education in the twentieth century, using examples from the history of Dutch education. It is argued that in this kind of research the focus should not be on the process of influence as such, but rather on the activity of reception. This, in turn, requires a contextual reconstruction of the interaction between Deweyan ideas and practices (...) and existing ones. The case studies presented in this article exemplify the more general methodological observations. They not only provide an insight in the role of Deweyan ideas and practices in the development of Dutch education but also make clear for what reasons, mostly unrelated to the significance of Dewey’s work, these ideas and practices did not have any lasting influence on the development of Dutch education, both on the level of early childhood education and primary and secondary schools. (shrink)

The New Testament documents represent a variety of perceptions about the church, showing that the early church was not unitary in practise or theology. How do we explain the diversity in the early church? Existential phenomenological hermeneutics can shine insightful light on this question by utilising Heidegger’s concept of Dasein in an interpretation model. The model used the pre-structure of Dasein and its interactive circular dynamic with the hermeneutical concepts of world and phenomena to table aspects of the hermeneutic situation (...) and the resultant Dasein types as self-understanding developed from various groups’ interpretations of Jesus. In this way, the hermeneutic dynamic explains the variety of pre- and post-Easter groups. The results show that there is no objective, standard view of Jesus and no objective set of Jesus’ teachings available; no ideal Dasein type is presented for faith communities. The kerygma of the Crucified and Risen One as God’s act of salvation is the central presupposition of the church’s Dasein. The historical nature of hermeneutics cannot be denied. Historical–critical exegesis and its circular dynamic of understanding is a legitimate and sound hermeneutic model. Unhistorical hermeneutics have definite limitations and should be deemed insufficient. There is no plain meaning of any phenomenon or text, only the text or phenomenon as it is understood. Faith communities consciously partake in the hermeneutic dynamic and recognise the influence of their pre-understandings, presuppositions and prejudices which constantly be questioned and adjusted to facilitate their authentic Dasein.Contribution: This historical hermeneutical study explains that different hermeneutical situations lead to different Dasein types as various self-understandings developed according to Jesus groups’ interpretations of Jesus varied. No ideal Dasein type for faith communities is presented. These findings resonate with HTS Theological Studies focus and scope regarding historical thought in research. (shrink)

The kingdom of God was a central theme in Jesus' vision. Was it meant to be understood as Utopian as Mary Ann Beavis views it, or existential? In 1st century CE Palestine, kingdom of God was a political term meaning theocracy suggesting God's patronage. Jesus used the term metaphorically to construct a new symbolic universe to legitimate a radical new way of living with God in opposition to the temple ideology of exclusivist covenantal nomism. The analogies of father and king (...) served as the root metaphors for this symbolic universe. They are existential root metaphors underpinning the contextual symbolic universe of God's patronage in reaction to the collapse of the patronage system which left peasants destitute. Jesus' paradoxical use of the metaphor kingdom of God had a therapeutic value and gave the concept new meaning. The initial motivation for proclaiming God's patronage originated in Jesus' primary identity formation by Mary as single parent and was reinforced in his secondary identity formation by John the Baptist. From these results can be concluded that kingdom of God was not meant to be understood as utopian, but existential. In order to clarify the meaning of kingdom of God and God's patronage for the 21st century, demythologisation and deconstruction can be helpful especially by highlighting the existential meaning of the kingdom of God. (shrink)

We give a historical overview of the development of almost 50 years of empirical research on the affordances in the past and in the present. Defined by James Jerome Gibson in the early development of the Ecological Approach to Perception and Action as the prime of perception and action, affordances have become a rich topic of investigation in the fields of human movement science and experimental psychology. The methodological origins of the empirical research performed on affordances can be traced back (...) to the mid 1980’s and the works of Warren (1984, 1988) and Michaels (1988). Most of the research in Ecological Psychology performed since has focused on the actualization of discretely defined actions, the perception of action boundaries, the calculation of pi-numbers, and the measurement of response times. The research efforts have resulted in advancements in the understanding of the dynamic nature of affordances, affordances in a social context and the importance of calibration for perception of affordances. Although affordances are seen as an instrumental part of the control of action most studies investigating affordances do not pay attention to the control of the action. We conclude that affordances are still primarily treated as a utility to select behaviour, which creates a conceptual barrier that hinders deeper understanding of affordances. A focus on action-boundaries has largely prevented advancement in other aspects of affordances, most notably an integrative understanding of the role of affordances in the control of action. (shrink)

The idea that professional practices such as education should be based upon or at least be informed by evidence continues to capture the imagination of many politicians, policy makers, practitioners and researchers. There is growing evidence of the influence of this line of thought. At the same time there is a growing body of work that has raised fundamental questions about the feasibility of the idea of evidence-based or evidence-informed practice. In this paper I make a further contribution to this (...) discussion through an analysis of a number of assumptions that inform the discussion. I focus on the epistemological, ontological and praxeological dimensions of the discussion and in each domain identify a deficit. In the epistemological domain there is a knowledge deficit, in the ontological domain an effectiveness or efficacy deficit and in the practice domain an application deficit. Taken together these deficits not only raise some important questions about the very idea of evidence-based practice but also highlight the role of normativity, power and values. Against this background I outline the case for the idea of value-based education as an alternative for evidence-based education. As I am generally concerned about the expectations policy makers hold about what evidence can and should achieve in professional practices such as education, my contribution is primarily meant to provide educators and other professionals with arguments that can help them to resist unwarranted expectations about the role of evidence in their practices and even more so of unwarranted interventions in their practices. (shrink)

Philosophical Investigations, Volume 45, Issue 3, Page 252-273, July 2022.

Nagel’s constitutive moral luck is one important type of moral luck, but discussions of it have tended to focus on temperament. Luck in how aware a person is of morally relevant aspects of her situation—awareness luck—though similar in some ways, also raises different issues. Luck in temperament impacts how difficult a person finds it to behave well, while awareness luck impacts whether she even recognizes that the situation is making a moral demand on her. For this reason, awareness luck raises (...) some unique challenges for those who would deny the existence of moral luck. (shrink)

The standard models for what doctors must tell their patients are based on the idea of informed consent: physicians must provide the information that patients need to make treatment decisions. In fact, though, they usually provide considerably more information than this model requires. And rightly so: patients should receive enough information that they will not be surprised by whatever happens—unless the physician is also surprised.

In Coming to Our Senses, Michael Devitt insists that if we are going to argue about what meanings are, we should know why we care. He reasonably observes that unless we agree about this, we are likely to be arguing past one another. The meanings Devitt discusses are token meanings of individual thoughts and utterances. He holds that these meanings are properties, and that we have two purposes for attributing them to thoughts and utterances: to predict and explain a subject’s (...) behavior, and to learn about the world. If a property attributed to a thought by means of a t-clause serves either of these purposes then that property plays a semantic role. A meaning is any property that plays a semantic role. (shrink)

While there are a number of genuine philosophical topics that medical and premedical students can get out of a course on medical ethics, being an ethically sensitive health care worker requires more than knowing a variety of philosophically-interesting medical ethics questions and concepts. In addition, two goals of teaching medical ethics should be to ensure that health care workers have a healthy respect for the rights of their patients and to instill in students the importance of gathering as much information (...) as possible before making decisions that affect the lives of their patients. This paper discusses two methods by which this second goal is achieved, namely by using an in-class exercise and a procedure for delivering exams. (shrink)

The central themes of Jesus’ preaching, the kingdom and household of God, are root metaphors expressing the symbolic universe of God’s patronage subverting patronage and patriarchy structuring contemporary Mediterranean society, thus legitimising an anti-hierarchical community of faith. This dominant focus of Jesus’ message was discarded, as society’s prevalent patronage and patriarchy became the societal structure of the later faith communities. Today, patronage and patriarchy still forms the social structure for a large sector of Christian communities and many cultures, resulting in (...) inequality, injustice, exploitation and suffering. This article proposes that the only remedy for the faithful is a return to Jesus’ essential message, by investigating the social dynamics suggested by these root metaphors using metaphor theory and social scientific methods. Patronage is studied within contemporary Roman and Mediterranean aristocratic patriarchal society, forming an a-typical broad-based needle-like power pyramid with multiple similarly structured power pyramids within, based on a morality of indebtedness, honour and power. Jesus accepted God as his father and declared the advent of God’s patronage as king (kingdom of God) and father of the faithful (children of God). Within the kingdom and household of God, there was no hierarchy, except for the primate of the first born son, whom Jesus symbolises as broker for God’s patronage to all his followers. Within the faith communities there should be no hierarchy or any form of clientage other than God’s patronage. Rather, the faithful are equal and should serve each other and their communities with compassion, responsibility and justice.Contribution: The contribution of this research is its focus on similarity and dissimilarity of these patronage metaphors and their application to subvert the power dynamics of patronage and patriarchy within the community of the faithful, in order to proffer God’s patronage of a society of caring, selfless equals today. This research falls within the scope of HTS Theological studies, as it is a multi-disciplinary study of key biblical metaphors investigated with accepted methodology resulting in valid conclusions which are ethically sound. (shrink)

The ‘Hervormde’ blend of Barthian view of Scripture leads to a specifically nuanced concept of biblical truth. Biblical truth is neither knowledge, dogma or faith propositions, nor historical, scientific or geographical truth. Biblical truth is a Person, sharing in dialogue with humanity regarding a relationship of God for humanity. Biblical truth is relational and metaphorical. Its imperatives are demythologisation, and ideological and cultural critique. This concept of truth is in contrast to the truth concept of most church members, because of (...) their literal and often fundamentalist views of Scripture. In order to convey understanding of the truth concept, the ‘Hervormde’ view of Scripture should be discussed with them. A confession should be formulated for post-modern believers. (shrink)