Informed consent is a key condition for prenatal screening programmes to reach their aim of promoting reproductive autonomy. Reaching this aim is currently being challenged with the introduction of non-invasive prenatal testing (NIPT) in first-trimester prenatal screening programmes: amongst others its procedural ease—it only requires a blood draw and reaches high levels of reliability—might hinder women’s understanding that they should make a personal, informed decision about screening. We offer arguments for a renewed recognition and use of informed consent compared to (...) informed choice, and for a focus on value-consistent choices and personalized informational preferences. We argue for a three-step counselling model in which three decision moments are distinguished and differently addressed: (1) professionals explore women’s values concerning whether and why they wish to know whether their baby has a genetic disorder; (2) women receive layered medical-technical information and are asked to make a decision about screening; (3) during post-test counselling, women are supported in decision-making about the continuation or termination of their pregnancy. This model might also be applicable in other fields of genetic (pre-test) counselling, where techniques for expanding genome analysis and burdensome test-outcomes challenge counselling of patients. (shrink)

The social and legal implications of forensic DNA are paramount. For this reason, forensic DNA enjoys ample attention from legal, bioethics, and science and technology studies scholars. This article contributes to the scholarship by focusing on the neglected issue of sameness. We investigate a forensic courtroom case which started in the early ’90s and focus on three modes of making similarities: creating equality before the law, making identity, and establishing standards. We argue that equality before the law is not merely (...) a principle but a practice. In the context of DNA research, equality refers to using standardized technology and procedures to identify the criminal suspect. Our case shows the work at stake in introducing a new technology into the courtroom and serves as a lens, magnifying how contingencies and uncertainties are managed and ordered in everyday court practices to arrive at an equal treatment of the suspect. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 (...) years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

To what degree has biology influenced and shaped the development of moral systems? One way to determine the extent to which human moral systems might be the product of natural selection is to explore behaviour in other species that is analogous and perhaps homologous to our own. Many non-human primates, for example, have similar methods to humans for resolving, managing, and preventing conflicts of interests within their groups. Such methods, which include reciprocity and food sharing, reconciliation, consolation, conflict intervention, and (...) mediation, are the very building blocks of moral systems in that they are based on and facilitate cohesion among individuals and reflect a concerted effort by community members to find shared solutions to social conflict. Furthermore, these methods of resource distribution and conflict resolution often require or make use of capacities for empathy, sympathy, and sometimes even community concern. Non-human primates in societies in which such mechanisms are present may not be exactly moral beings, but they do show signs of a sense of social regularity that—just like the norms and rules underlying human moral conduct—promotes a mutually satisfactory modus vivendi. (shrink)

This paper analyses the way in which discourse and argumentation may vary depending on participants’ educational level and gender. Men and women from three different educational levels (literacy, advanced level and university students) participated in discussion groups that debated about women and work, the sharing of housework and the way in which girls and boys are educated. The results showed important differences depending on participants’ educational level and gender. In general, the main differences were related to educational level, while gender (...) tended to interact with educational level, as a moderating factor. (shrink)

Until Process and Reality – An Essay in Cosmology (1929) by Alfred North Whitehead (1861-1947) was translated into Portuguese, four other works had been previously translated, proving Portuguese people had a persistent interest in the thought of a philosopher who is probably the last and most important speculative thinker of the 20th century. Yet, Processo e Realidade – Ensaio de Cosmologia hopefully stands as a turning point in Whiteheadian reception in Portugal; on the hand, it was publishe...

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...) is discussed, followed by an examination of Vygostky’s contextualist view on children’s development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults’ decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties. (shrink)

Drawing its strength from the UN Charter and UDHR, human rights ethics is a beacon of hope and a promise that requires continuous reaffirmation during these turbulent times. These two documents, with their unwavering faith in ‘fundamental human rights, in the dignity and worth of the human person, in the equal rights of men and women and of nations large and small,’ have shaped our understanding of human rights as global and universal ethics. However, this faith is now being severely (...) tested by four countercurrents: extremism, exclusionism, selectivism, and populism. These countercurrents pose significant and urgent human rights threats that activists, academics, and policymakers must confront by reasserting the basic core values of the UN Charter and UDHR. (shrink)

The validity of the conclusion to the nonlocality of quantum mechanics, accepted widely today as the only reasonable solution to the EPR and Bell issues, is questioned and criticized. Arguments are presented which remove the compelling character of this conclusion and make clear that it is not the most obvious solution. Alternative solutions are developed which are free of the contradictions related with the nonlocality conclusion. Firstly, the dependence on the adopted interpretation is shown, with the conclusion that the alleged (...) nonlocality property of the quantum formalism may have been reached on the basis of an interpretation that is unnecessarily restrictive. Secondly, by extending the conventional quantum formalism along the lines of Ludwig and Davies it is shown that the Bell problem may be related to complementarity rather than to nonlocality. Finally, the dependence on counterfactual reasoning is critically examined. It appears that locality on the quantum level may still be retained provided one accepts a newly proposed principle of nonreproducibility at the individual quantum level as an alternative of quantum nonlocality. It is concluded that the locality principle can retain its general validity, in full conformity with all experimental data. (shrink)

We investigate the problem of “wave packet reduction” in quantum mechanics by solving the Schrödinger equation for a system composed of a model measuring apparatusM interacting with a microscopic objects. The “instrument” is intended to be somewhat more realistic than others previously proposed, but at the same time still simple enough to lead to an explicit solution for the time-dependent density matrix. It turns out that,practically, everything happens as if the wave packet reduction had occurred. This is a consequence of (...) the fact that the apparatus is made up of a very large number of microsystems interacting withs. More precisely, our model shows that the “macroscopic size” of a measuring apparatus can lead by itself to a density matrix for the systemM + s which is physically equivalent to the density matrix of a statistical mixture corresponding to the reduced wave packet. (shrink)

This edition of Giraldus Odonis' Logica for the first time gives access to an important and original treatise, which has unduly been neglected since the author's death. It is also important in that it gives evidence of interesting achievements in the field of logic outside the anti-metaphysical circle surrounding Ockham.

Morality is often defined in opposition to the natural "instincts," or as a tool to keep those instincts in check. New findings in neuroscience, social psychology, animal behaviour, and anthropology have brought us back to the original Darwinian position that moral behaviour is continuous with the social behavior of animals, and most likely evolved to enhance the cooperativeness of society. In this view, morality is part of human nature rather than its opposite. This interdisciplinary volume debates the origin and working (...) of human morality within the context of science as well as religion and philosophy. Experts from widely different backgrounds speculate how morality may have evolved, how it develops in the child, and what science can tell us about its working and origin. They also discuss how to deal with the age-old facts-versus-values debate, also known as the naturalistic fallacy. The implications of this exchange are enormous, as they may transform cherished views on if and why we are the only moral species. (shrink)

In recent years, functional connectivity in the developmental science received increasing attention. Although it has been reported that the anatomical connectivity in the preterm brain develops dramatically during the last months of pregnancy, little is known about how functional and effective connectivity change with maturation. The present study investigated how effective connectivity in premature infants evolves. To assess it, we use EEG measurements and graph-theory methodologies. We recorded data from 25 preterm babies, who underwent long-EEG monitoring at least twice during (...) their stay in the NICU. The recordings took place from 27 weeks postmenstrual age until 42 weeks PMA. Results showed that the EEG-connectivity, assessed using graph-theory indices, moved from a small-world network to a random one, since the clustering coefficient increases and the path length decreases. This shift can be due to the development of the thalamocortical connections and long-range cortical connections. Based on the network indices, we developed different age-prediction models. The best result showed that it is possible to predict the age of the infant with a root mean-squared error equal to 2.11 weeks. These results are similar to the ones reported in the literature for age prediction in preterm babies. (shrink)

BackgroundCRISPR-Cas9, a technology enabling modification of the human genome, is developing rapidly. There have been calls for public debate to discuss its ethics, societal implications, and governance. So far, however, little is known about public attitudes on CRISPR-Cas9. This study contributes to a better understanding of public perspectives by exploring the various holistic perspectives Dutch citizens have on CRISPR-Cas9.MethodsThis study used Q methodology to identify different perspectives of Dutch citizens (N = 30) on the use of CRISPR-Cas9. The Q-sort method (...) aims at segmenting audiences based on the structural characteristics of their perspectives. Participants individually ranked 32 statements about CRISPR-Cas9 and discussed their rankings in small groups. By-person factor analysis was performed using PQMethod. Participants’ contributions to the discussions were used to further make sense of the audience segments identified.ResultsFive perspectives on CRISPR-Cas9 were identified: (1) pragmatic optimism (2) concerned scepticism; (3) normative optimism; (4) enthusiastic support; and (5) benevolent generalism. Each perspective represents a unique position motivated by different ranking rationales. Sorting rationales included improving health, preventing negative impacts on society, and fear of a slippery slope. Overall, there is broad, but not universal support for medical uses of CRISPR-Cas9.ConclusionsResearch on CRISPR-Cas9 should prioritise the broadly supported applications of the technology. Research and public debates on CRISPR-Cas9, its uses, its broader implications, and the governance of CRISPR-Cas9 are recommended. A discourse that includes all perspectives can contribute to the embedding of future uses of CRISPR-Cas9 in society. This study shows that Q methodology followed by group discussions enables citizens to contribute meaningfully to discourses about research. (shrink)