In this paper we propose and analyze a game-theoretic model of the epistemology of peer disagreement. In this model, the peers' rationality is evaluated in terms of their probability of ending the disagreement with a true belief. We find that different strategies---in particular, one based on the Steadfast View and one based on the Conciliatory View---are rational depending on the truth-sensitivity of the individuals involved in the disagreement. Interestingly, the Steadfast and the Conciliatory Views can even be rational simultaneously in (...) some circumstances. We tentatively provide some reasons to favor the Conciliatory View in such cases. We argue that the game-theoretic perspective is a fruitful one in this debate, and this fruitfulness has not been exhausted by the present paper. (shrink)

Performance measurement systems have the potential to improve organizational outcomes, but they often come at a cost. This commentary highlights the individual, organizational, and societal costs of performance measurement systems and explores how such costs could be reduced.

Scientism, the view that only scientifically supported beliefs are epistemically justified, faces two influential problems: (1) scientism itself does not seem to be scientifically supported and hence self-referentially incoherent; and (2) scientism seems to dismiss many plausible ordinary beliefs as unjustified. In this paper, we show that both problems presuppose a needlessly narrow conception of science and that when scientism is based on a broader, more realistic conception of science neither problem arises. Furthermore, we argue that our variant of scientism (...) is still strong enough to have philosophical bite. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Objectives: To investigate why physicians label end-of-life acts as either ‘euthanasia/ending of life’ or ‘alleviation of symptoms/palliative or terminal sedation’, and to study the association of such labelling with intended reporting of these acts. Methods: Questionnaires were sent to a random, stratified sample of 2100 Dutch physicians. They were asked to label six hypothetical end-of-life cases: three ‘standard’ cases and three cases randomly selected, that varied according to type of medication, physician’s intention, type of patient request, patient’s life expectancy and (...) time until death. We identified the extent to which characteristics of cases are associated with physician’s labelling, with multilevel multivariable logistic regression. Results: The characteristics that contributed most to labelling cases as ‘euthanasia/ending of life’ were the administration of muscle relaxants or disproportional morphine. Other important factors were an intention to hasten death and a life expectancy of several months. Physicians were much more willing to report cases labelled as ‘euthanasia’ or ‘ending of life’ than other cases. Conclusions: Similar cases are not uniformly labelled. However, a physicians’ label is strongly associated with their willingness to report their acts. Differences in how physicians label similar acts impede complete societal control. Further education and debate could enhance the level of agreement about what is physician-assisted dying, and thus should be reported, and what not. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

The article describes the development of adolescents for a sense of self in a lesbian home, in order to compile guidelines for lesbian parents as well as pastoral counsellors to help and guide adolescents to develop a healthy sense of self. From the research results, it appears that there are certain positive and negative aspects of a lesbian home that influence adolescents’ sense of self. Where both parents are involved with the adolescents, share household duties equally and have a quality (...) relationship with each other and the adolescents, the adolescents are generally well-adapted, happy and able to handle challenges in order to develop a healthy sense of self. The positive influence that Christian religious certainty has on the overall development of the adolescents was also confirmed by this study. On the other hand, adolescents experience particular aspects as challenging and impeding in their development of a healthy sense of self: Conflict and criticism from the companion parents are humiliating and destructive. Stigmatising, teasing and rejection from the hetero-normative society, as a result of their parents’ sexual orientation, appear to be the largest obstacles in their psychosocial development. They react in a shy, negative and evasive way to the stigmatisation and withdraw themselves from situations that could be painful and humiliating. It also appears that the absence of a father figure and financial tension in lesbian families are impeding the adolescents’ healthy development of a sense of self. (shrink)

Thanks to the exchange of arguments, groups outperform individuals on some tasks, such as solving logical problems. However, these results stem from experiments conducted among Westerners and they could be due to cultural particularities such as tolerance of contradiction and approval of public debate. Other cultures, collectivistic cultures in particular, are said to frown on argumentation. Moreover, some influential intellectual movements, such as Confucianism, disapprove of argumentation. In two experiments, the hypothesis that Easterners might not share the benefits of argumentation (...) was tested. In Experiment 1, Japanese participants had to solve a standard logical problem individually and then in groups. They performed significantly better in groups. In Experiment 2, Japanese participants had to estimate the weight of various animals. They did so individually, then after learning of another participant's estimates, then after discussing these estimates with the other participant, and then indi.. (shrink)

The overall trend toward globalization in design, greatly enhanced by digital technologies, has raised issues and challenges on how to preserve the cultural differences and values of different societies. There is a tendency to lose touch with local cultural values when designing artefacts for global use, and social nuances and traditions risk to be flattened or stereotyped in the pursuit of developing new technologies and products for the global society. Attempts to reduce the tension between the global and the local (...) in design can be seen in the development of standards and guidelines for cross-cultural design, that are mostly focused on user interface design. However, when moving from preferences, metaphors, appearance, and navigation toward cultural models of interaction and physical design, new methodologies and tools for cross-cultural design are needed. This paper describes a poetry-inspired design method for cross-cultural sharing within the design process. The approach uses poetry to sensitize the designer to the subtleties and diversity of a culture so that the design can be given new aesthetic and cultural significance. The methodology is exemplified by actual design cases developed within the course “Cultural Sensitivity” of the Master’s Degree Program in Industrial Design at Eindhoven University of Technology, where poetry was used for uncovering underlying or implicit assumptions, intercultural differences and similarities, as well as for general sensitization of young designers. (shrink)

The International Committee of Medical Journal Editors is a working group of editors of selected medical journals that meets annually. Founded in Vancouver, Canada, in 1978, it currently consists of 11 member journals and a representative of the US National Library of Medicine. The major purpose of the Committee is to address and provide guidance for the conduct and publishing of biomedical research and the ethical tenets underpinning these activities. This advice is detailed in the Committee's Uniform Requirements for Manuscripts (...) Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication . Recently, the ICMJE has adopted an interventionist role to ensure transparency of conflict of interest revelations in the conduct and publication of industry supported research. It also pursues a policy for the lodgement with trial registries of specified details of Phase III clinical trials. Failure to comply would jeopardise publication of trial outcomes in ICMJE member journals. This policy has resulted in the coming on stream of trial registries, international agreement on trial minimal datasets and compliance with trial registration requirements. (shrink)

Why is a Reformational philosophy needed in Africa? It is necessary, because something is missing in African Christianity. Most Western missionaries taught Africans a “broken” or dualistic worldview. This caused a divorce between traditional culture and their new Christian religion. The Christian faith was perceived as something remote, only concerned with a distant past and a far-away future . It could not become a reality in their everyday lives. It could not develop into an all-encompassing worldview and lifestyle. Because Reformational (...) philosophy advocates the Biblical, holistic approach of a comprehensive worldview, it is welcomed on our continent. It contains a healing and liberating message to our bleeding and lost continent. What Africans, however, neither want nor can afford, is an ivory tower philosophy, playing intellectual games; a philosophy which does not do or change anything. They want a philosophy which is a “marriage” between abstract ideas and the facts on the ground. They need a Christian philosophy with compassion that may even contribute to the alleviation of their poverty! (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

Flow is a state of full task engagement that is accompanied with low-levels of self-referential thinking. Flow is considered highly relevant for human performance and well-being and has, therefore, been studied extensively. Yet, the neurocognitive processes of flow remain largely unclear. In the present mini-review we focus on how the brain's locus coeruleus-norepinephrine (LC-NE) system may be involved in a range of behavioral and subjective manifestations of flow. The LC-NE system regulates decisions regarding task engagement vs. disengagement. This is doneviadifferent (...) modes of baseline and stimulus-evoked norepinephrine release. We emphasize the theoretical and empirical overlap between the LC-NE system and flow. For both, a match between a person's skill and task challenge is important in order to induce high levels task-related attention. Moreover, psychophysiological indicators of LC-NE system activity, such as eye pupil diameter and arousal are also sensitive to flow states. Flow is related to arousal in an inverted U-shape. Similarly, in theories on the LC-NE system, task engagement is highest with intermediate levels of arousal. We argue that knowledge about the role of the LC-NE system in establishing the flow experience may help to gain fundamental knowledge of flow and can contribute to unifying various empirical findings on this topic. (shrink)

Editorial independence is crucial for the viability of a journal and editors have many masters - the public, the readers, the authors and the owners. Negotiating the resultant minefield requires a purposeful and independent stance. This is particularly so in instances of a relatively modern phenomenon: concerted attempts by clinical groups to influence, or even abort, publication of articles, which may threaten their practice. Moreover, modern social media facilitates this manipulation.

What is the value of an early diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to patients. Based on seven focusgroups with patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect (...) it to empower their capacity to care. They value it, for instance, with respect to whether it explains experienced complaints, allows to start a process of psychological acceptance and social adaptation to the expected degeneration, contributes to dealing with anxieties, informs adequately about when to start preparing for the end of life, informs the planning of a request for euthanasia, or allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered ‘harmful’ or ‘premature’ when recipients feel unable to act on that information in their care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the ‘harm’ that such diagnostic methods can bring about. (shrink)

We define balance games, which describe the formation of friendships and enmity in social networks. We show that if the agents give high priority to future profits over short term gains, all Pareto optimal strategies will eventually result in a balanced network. If, on the other hand, agents prioritize short term gains over the long term, every Nash equilibrium eventually results in a network that is stable but that might not be balanced.

BackgroundUnderstanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management.MethodsThis paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were (...) considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings.ResultsMyocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases.ConclusionsArtistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases. (shrink)