Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. Second, families (...) can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust relationships among (...) trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates. (shrink)

Background: Several countries have recently changed their model of consent for organ donation from opt-in to opt-out. We undertook a systematic review to determine public knowledge and attitudes towards these models in Europe. Methods: Six databases were explored between 1 January 2008 and 15 December 2017. We selected empirical studies addressing either knowledge or attitudes towards the systems of consent for deceased organ donation by lay people in Europe, including students. Study selection, data extraction, and quality assessment were conducted by (...) two or more reviewers independently. Findings: Awareness of the consent model was lower in opt-out countries than in opt-in countries. A majority of the public agrees with opt-in, regardless of the law in their own country. There are ambivalent attitudes regarding the opt-out system. The public tend to prefer opt-in and mandatory choice over opt-out when several options are offered. Interpretation: The assumption that people in opt-out countries are aware of the legal requirements to be excluded from the pool of potential donors is not supported by the results of this review. This is a concern, since ignorance hinders people's autonomy regarding organ donation decision-making. Higher awareness of consent model in opt-in countries may reflect greater efforts to inform the public through campaigns to motivate donation. Legal moves towards opt-out are at odds with people's expressed preferences. Main limitations of this review are the lack of data from some countries, study population heterogeneity, and methodological shortcomings. (shrink)

The ethics of deceased organ procurement (OP) is supposedly based on individual consent to donate, either explicit (opt-in) or presumed (opt-out). However, in many cases, individuals fail to express any preference regarding donation after death. When this happens, the decision to remove or not to remove their organs depends on the policy’s default option or on family preferences. Several studies show that in most countries the family plays a significant and often decisive role in the process of decision-making for OP. (...) Depending on the country, the family may be allowed to take different kinds of actions in different situations, and this may be granted either by law or by clinical practice only. This adds much complexity to the usual classification of consent policies in two categories: opt-in and opt-out. Here we propose a novel and comprehensive taxonomy of the models of consent for OP according to three variables: (1) the deceased’s wishes, if any, (2) family wishes, if any, and (3) default policies. By analysing these models of consent, we show that they rely on at least three different concepts of autonomy: individual autonomy, relational autonomy, and family autonomy. In light of this analysis, we discuss the ethical debates surrounding two policy approaches: presumed consent and family veto. (shrink)

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection (...) were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

Objectives To increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in (...) the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives. -/- Design Based on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply. -/- Main outcome measures We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. -/- Results Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%–5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out. -/- Conclusions This study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families. (shrink)

Background Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. -/- Methods Between 2017–2019, we conducted a convenience sample survey of students (n = 2006) in (...) Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. -/- Results Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support–either informed or uninformed–in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence–either informed or uninformed–among opt-out countries. -/- Conclusion Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data. (shrink)

Several European countries are approving legislative reforms moving to a presumed consent system in order to increase organ donation rates. Nevertheless, irrespective of the consent system in force, family's decisional capacity probably causes a greater impact on such rates. In this contribution we have developed a systematic methodology in order to analyse and compare European organ procurement laws, and we clarify the weight given by each European law to relatives' decisional capacity over individual's preferences (expressed or not while alive) regarding (...) the destination of his or her organs after death. In this sense, the results constitute the first comprehensive and comparative legislative mapping on European transplantation laws. (shrink)

Background: This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. Materials and Methods: A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. Results: Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have (...) expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. Conclusion: Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain. (shrink)

A feminist primer for philosophers of science -- The legacy of twentieth century philosophy of science -- What feminist science studies can offer -- Challenges from every direction -- The prospects of twenty-first century philosophy of science.

"This stunning work is without question a major contribution to Cartesian studies, to the field of early modern philosophy, and to general epistemology--original, provocative, and philosophically interesting.

The realism/antirealism controversy has gone on for centuries, and gives every indication that it will continue to go on for centuries. Dismayed, I take a closer look at it. I find that the question it poses--very roughly, whether scientific knowledge is true (approximately true, put forward as true, etc.) or only useful (empirically adequate, a convenient method of representation, etc.)--actually suppresses socially critical thought and discussion about science (e.g., concerning whether scientific knowledge is sexist or racist or socially harmful in (...) other ways, or whether scientific knowledge is useful for achieving the goals we have or the goals we ought to have). I find, as well, that two of the most important responses to the realism/antirealism controversy--that which construes it as concerned with science's aims and that which construes it as concerned with science's results--fail to make sufficient empirical or normative contact with science. As a consequence, they provide representations of science that either do not help scientists (or nonscientists) make informed decisions about science, or actually hinder these individuals from doing so. I conclude that we should either stop engaging in the realism/antirealism controversy entirely, or else engage in it in a more socially responsible way--by gathering the right kinds of empirical and normative data, and framing more helpful versions of the questions we want to ask. I end by responding to the strong objections sure to be voiced by my colleagues in philosophy of science. (shrink)

Two decades of critique have sensitized historians and philosophers of science to the inadequacies of conventional dichotomies between theory and practice, thereby prompting the search for new ways of writing about science that are less beholden than the old ways to the epistemological mores of theoretical physics, and more faithful to the actual practices not only of physics but of all the natural sciences. The need for alternative descriptions seems particularly urgent if one is to understand the place of theory (...) in contemporary molecular biology, a science where, until now, no division between theory and experiment has obtained, and where distinctions between representing and intervening, and more generally, between basic and applied science, are daily becoming more blurred.Indeed, the very division between theory and experiment threatens to slight the extensive and sophisticated theoretical analyses on which experimental work in contemporary molecular biology so often depends. My aim in this paper is to find a way of talking about theoretical practices in biology that is directly rooted in the mix of conceptual and material work that biologists do. As an example of such theoretical practices, I choose for the focus of my analysis the development of a model for gene regulation out of the experimental work of Eric Davidson and his colleagues at Cal Tech. (shrink)

In his "A New Program for Philosophy of Science?", Ronald Giere expresses qualms regarding the critical and political projects I advocate for philosophy of sciencethat the critical project assumes an underdetermination absent from actual science, and the political project takes us outside the professional pursuit of philosophy of science. In reply I contend that the underdetermination the critical project assumes does occur in actual science, and I provide a variety of examples to support this. And I contend that the political (...) project requires no more than what other academic fields even in science studies are already providing. (shrink)

ArgumentSeveral recent works in sociology examine the manufacture of public identities through the notion of celebrity. This paper explores the imagery of Charles Darwin as a nineteenth-century scientific celebrity by comparing the public character deliberately manufactured by Darwin and his friends with images constructed by the public as represented here by caricatures in humorous magazines of the era. It is argued that Darwin’s outward persona drew on a subtle tension between public and private. The boundaries between public and private were (...) blurred by the ritual of Darwin “showing” himself in the flesh, either at home to visitors or, more rarely, on public occasions. The reputation for privacy and illness that he built up added materially to this public face. By contrast, caricatures tended to depict him as an ape. These apish representations played a significant role in associating Darwin, rather than any other thinker, with the notion of evolution, and in creating an alternative public persona over which he had no direct control. (shrink)

The main message of Philosophy of Science after Feminism is twofold: that philosophy of science needs to locate science within its wider societal context, ceasing to analyze science as if it existed in a social/political/economic vacuum; and correlatively, that philosophy of science needs to aim for an understanding of scientific rationality that is appropriate to that context, a scientific rationality that integrates the ethical with the epistemic. The ideal of socially responsible science that the book puts forward, in fact, maintains (...) that sound social values as well as sound epistemic values must control every aspect of the scientific research process, from the choice of research questions to the communication and application of results. And it is this that raises troubling questions for Matt Brown, Hugh Lacey, and Libby Potter. In this paper I attempt to answer their questions and make explicit exactly what is in the offing if I succeed. (shrink)

In a number of recent articles, Nancy Fraser attempts to understand the World Social Forum within the framework of critical democratic theory. In this article, we examine the descriptive and normative aspects of Fraser’s theoretical framework, and explore the effects of projecting it upon the World Social Forum. We argue that while this theory may elucidate some features of the Forum, many of the Forum’s most challenging and innovative aspects are obscured and limited by Fraser’s framework. Not only, then, does (...) the World Social Forum elude Fraser’s conceptualization of it, but we suggest that the praxis of the Forum poses a number of serious challenges to Fraser’s critical theory of democracy and social justice. (shrink)

In a brief essay, “For an Ethics of the Cinema”, Giorgio Agamben names the film star as the twentieth century figure representing an elision of what is individual and what is collective. It is impo...

While there has been general agreement among modern philosophers of science that a purely a priori method is inappropriate to the task of establishing a theory of science, there has, unfortunately, been little comparable agreement regarding the method that is appropriate. I try to lay the foundations for such agreement. I first set out reasons for a purely empirical method for establishing a theory of science, and defend such a method against charges raised by Giere. I then develop some very (...) basic criteria for the evaluation of alternative empirical methods for establishing a theory of science, and use these criteria to evaluate the two such methods that have dominated philosophic discussion in recent years--those of Lakatos and Laudan. I end by defending a revised version of Lakatos' proposal. (shrink)

Only two of the many experiments described by Smith et al., as indicating metacognitive ability in nonhuman animals, involved metacognition as understood in the human literature. Of these, one gave negative results. In the other, one of two rhesus monkeys provided data suggesting that he might have metacognitive ability. The conjecture that any nonhuman animals have metacognitive ability is, therefore, tenuous.

I consider a way the concept of causation could be excised from chemical practice, suggested by Kitcher's view that causes are just a subset of unifying patterns which play a particular psychological role for us. Kitcherian chemistry is at first blush well equipped to handle explanatory tasks. However, it would force chemists to accept certain unifying patterns as explanatory, which they do not think are at all explanatory. This might head off some descriptive lines of enquiry and damage prospects for (...) the identification of potentially larger‐scale explanations. More important than this, to chemists, it could put them off from finding the explanatory patterns that are true—true because they get at the real structure of the chemical phenomena in the world. (shrink)

The objective of the study was to explore parental experiences of being offered participation in a previous neonatal research study involving venepuncture. The method employed was a questionnaire-based exploration of parents' attitudes in those approached to participate in a study of term and preterm immunization responses (Preterm Immunisation Study [PREMIS]). We explored experience of the initial approach, knowledge of study, venepuncture and views on research ‘in general’. In all, 59% of families responded. Highest response rates were for those participating in (...) PREMIS (87% term/69% preterm) and lowest in decliners (34% and 35%). Responding parents participating in PREMIS were well informed, positive about research and did not find the venepuncture problematic. Sixty percent of responding parents who declined PREMIS attributed their declining to the need for venepuncture. In conclusion, parents participating or declining a neonatal study involving venepuncture are different, but participating parents were well informed and seemed able to judge that participation was right for them such that in consenting families venepuncture itself is not problematic. (shrink)

There are several distinct components of the realist anti-realist debate. Since each side in the debate has its disadvantages, it is tempting to try to combine realist theses with anti-realist theses in order to obtain a better, more moderate position. Putnam attempts to hold a realist concept of truth, yet he rejects realist metaphysics and realist semantics. He calls this view internal realism. Truth is realist on this picture for it is objective, rather than merely intersubjective, and eternal. Putnam introduces (...) a concept of epistemic idealization — epistemically ideal conditions, or idealized justification — to try to ground the strong objectivity of truth without sliding into metaphysical realism. I argue that the concept of ideal conditions to which Putnam appeals does not cohere with his (anti-realist) commitment to an assertability conditions account of meaning. (shrink)

Frederick Denison Maurice.--Matthew Arnold.--Charles Bradlaugh.--Thomas Henry Huxley.--Leslie Stephen.--Harriet Martineau.--Charles Kingsley.

In September 2006, when 45 scholars and activists from 19 countries around the world gathered amid the spires and gargoyles of Oxford for a conference entitled, “Hope: Probing the Boundaries,” complex dialectics of hope and despair circulated through the meeting rooms by day, and the conversations in quadrangles and pubs late into the night. On the one hand, the remarkable social and political openings and possibilities of the previous decade, from Berlin to Johannesburg, Leningrad to the Lacandon jungle of Chiapas, (...) seemed to be ever-more constrained by political and economic forces as brutal as those that preceded them, but, on the other hand, there were the Zapatistas and a thousand other movements persisting in the belief that, to echo the mantra of the World Social Forums, “another world is possible,” and there we were from around the world, to do the work of theorizing, describing, and enacting the persistence of individual and collective hope despite grim realities. The essays developed from that conference and collected here reflect both the theoretical and philosophical underpinnings and the cultural and political praxes of “hope against hope.”. (shrink)