The right not to know is underappreciated in policy-making. Despite its articulation in medical law and ethics, policy-makers too easily let other concerns override the right not to know. This observation is triggered by a recent decision of the Dutch government on embryo selection for Huntington’s disease. This is a monogenetic debilitating disease without cure, leading to death in early middle age, and thus is a likely candidate for preimplantation genetic diagnosis. People possibly affected with the Huntington gene do not (...) always want to know their genetic status themselves, which is very burdensome knowledge. For prospective parents, this creates a difficulty in having unaffected children through embryo selection without knowing their own genetic status. A solution is provided by the exclusion test: it allows embryo selection while honouring the parents’ right not to know. The Dutch government however disallowed the exclusion test and chose to allow PGD on Huntington only for parents who test themselves first. To avoid “unnecessary” in-vitro fertilisation procedures for unaffected parents, prospective parents are “forced to know” before they can conceive through embryo selection. This article analyses the scope of the right not to know in the context of embryo selection against Huntington’s disease. It concludes that the right not to know implies that PGD against Huntington should be allowed by means of the exclusion test. (shrink)

On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees (...) for Termination of Life on Request and Euthanasia and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia. (shrink)

There has been a move in medicine towards patient-centred care, leading to more demands from patients for particular therapies and treatments, and for wish-fulfilling medicine: the use of medical services according to the patient's wishes to enhance their subjective functioning, appearance or health. In contrast to conventional medicine, this use of medical services is not needed from a medical point of view. Boundaries in wish-fulfilling medicine are partly set by a physician's decision to fulfil or decline a patient's wish in (...) practice. In order to develop a better understanding of how wish-fulfilling medicine occurs in practice in The Netherlands, a qualitative study (15 semistructured interviews and 1 focus group) was undertaken. The aim was to investigate the range and kind of arguments used by general practitioners and plastic surgeons in wish-fulfilling medicine. These groups represent the public funded realm of medicine as well as privately paid for services. Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’. (shrink)

abstract Applied ethics engages with concrete moral issues. This engagement involves the application of philosophical tools. When the philosophical tools used in applied ethics are problematic, conclusions about applied problems can become skewed. In this paper, I focus on problems with the idea that comparison cases must be exactly alike, except for the moral issue at hand. I argue that this idea has skewed the debate regarding the moral distinction between killing and letting die. I begin with problems that can (...) arise from attempts to produce comparison cases that are exactly alike, except for the moral issue at hand. I then argue that attempts to produce such examples are doomed to failure. Finally, I argue that abandoning concerns about similarity advances the debate regarding the moral distinction between killing and letting die. (shrink)

In some medical cases there is a moral distinction between killing and letting die, but in others there is not. In this paper I present an original and principled account of the moral distinction between killing and letting die. The account provides both an explanation of the moral distinction and an explanation for why the distinction does not always hold. If these explanations are correct, the moral distinction between killing and letting die must be taken seriously in medical contexts. Defeasibly, (...) when an agent kills she takes responsibility, but when an agent lets die she does not take responsibility. Therein lies the moral distinction between killing and letting die. The distinction, however, is defeated when an agent is already responsible for the surrounding situation. In such cases, killing does not involve taking any further responsibility and letting die does not avoid taking any responsibility. Medical examples are frequently complicated because patients' autonomous choices impact upon medical practitioners' surrounding responsibility. (shrink)

Recent studies indicate that the processing of an unexpected word is costly when the initial, disconfirmed prediction was strong. This penalty was suggested to stem from commitment to the strongly predicted word, requiring its inhibition when disconfirmed. Additional studies show that comprehenders rationally adapt their predictions in different situations. In the current study, we hypothesized that since the disconfirmation of strong predictions incurs costs, it would also trigger adaptation mechanisms influencing the processing of subsequent strong predictions. In two experiments, participants (...) made speeded congruency judgments on two-word phrases in which the first word was either highly constraining or not. We manipulated the proportion of disconfirmed predictions in highly constraining contexts between participants. The results provide additional evidence of the costs associated with the disconfirmation of strong predictions. Moreover, they show a reduction in these costs when participants experience a high proportion of disconfirmed strong predictions throughout the experiment, indicating that participants adjust the strength of their predictions when strong prediction is discouraged. We formulate a Bayesian adaptation model whereby prediction failure cost is weighted by the participant’s belief about the likelihood of encountering the expected word, and show that it accounts for the trial-by-trial data. (shrink)

Developments in biotechnology present difficult social and ethical challenges that need to be resolved by regulators among others. One crucial problem for regulators of new technologies is to ensure that regulation is both clear and sufficiently flexible to respond to new developments. This is particularly difficult to achieve in contentious fields such as medical biotechnology. In the European Union there is a divergence in the solutions to this problem which has lead to different regulatory frameworks for medical biotechnology. This paper (...) compares and contrasts the British and Dutch regulatory frameworks for the selection of embryos by preimplantation genetic diagnosis as an example of the regulation of medical biotechnology. Some of the outcomes of the regulatory choices and possible reasons behind the divergent frameworks are discussed, such as the ethical outlooks and political systems in these countries. (shrink)

Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices. Providers unanimously formulate a (...) number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)

_Seeing the World through Children’s Eyes_ brings an overarching emphasis on ‘seeing’ to early years research and provides an opportunity to see and hear from leading researchers in the field concerning how they work with visual methodologies in their early years research.

Health checks or health screenings identify disease in people without a specific medical indication. So far, the perspective of health check users has remained underexposed in discussions about the ethics and regulation of health checks. In 2017, we conducted a qualitative study with lay people from the Netherlands. We asked what participants consider characteristics of good and bad health checks, and whether they saw a role for the Dutch government. Participants consider a good predictive value the most important characteristic of (...) a good health check. Information before, during and after the test, knowledgeable and reliable providers, tests for treatable disease, respect for privacy, no unnecessary health risks and accessibility are also mentioned as criteria for good health checks. Participants make many assumptions about health check offers. They assume health checks provide certainty about the presence or absence of disease, that health checks offer opportunities for health benefits and that the privacy of health check data is guaranteed. In their choice for provider and test they tend to rely more on heuristics than information. Participants trust physicians to put the interest of potential health check users first and expect the Dutch government to intervene if providers other than physicians failed to do so by offering tests with a low predictive value, or tests that may harm people, or by infringing the privacy of users. Assumptions of participants are not always justified, but they may influence the choice to participate. This is problematic because choices for checks with a low predictive value that do not provide health benefits may create uncertainty and may cause harm to health; an outcome diametrically opposite to the one intended. Also, this may impair the relationship of trust with physicians and the Dutch government. To further and protect autonomous choice and to maintain trust, we recommend the following measures to timely adjust false expectations: advertisements that give an accurate impression of health check offers, and the installation of a quality mark. (shrink)

Standard models of adolescent risk taking posit that the cognitive abilities of adolescents and adults are equivalent, and that increases in risk taking that occur during adolescence are the result of socio emotional differences in impulsivity, sensation seeking, and lack of self-control. Fuzzy-trace theory incorporates these socio emotional differences. However, it predicts that there are also cognitive differences between adolescents and adults, specifically that there are developmental increases in gist-based intuition that reflects understanding. Gist understanding, as opposed to verbatim-based analysis, (...) generally has been hypothesized to have a protective effect on risk taking in adolescence. Gist understanding is also an essential element of informed consent regarding risks in medical decision- making. Evidence thus supports the argument that adolescents’ status as mature minors should be treated as an exception rather than a presumption, because accuracy in verbatim analysis is not mature gist understanding. Use of the exception should be accompanied by medical experts’ input on the bottom-line gist of risks involved in treatment. (shrink)

Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a ‘right to die’. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD is legally (...) permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor’s freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups. (shrink)

Introducing Dialogic Pedagogy presents some of the ideas of Russian philosopher Mikhail Bakhtin concerning dialogism in a way that will engage and inspire those studying early childhood education. By translating the growing body of dialogic scholarship into a practical application of teaching and learning with very young children, this book provides readers with alternative ways of examining, engaging and reflecting on practice in the early years to provoke new ways of understanding and enacting pedagogy. This text combines important theoretical ideas (...) with a practical application to support practitioners who are keen to promote creativity and agency through ethical self-other relations. It provides unique insights into the amazing world of the youngest child, and offers enriched understandings of the profound impact of adults in their journey of becoming (or bildung). Key points covered include: Investigating dialogic philosophy and its application to early childhood education, with an emphasis on notions of justice, democracy, ethics and answerability Considering the relationship between dialogism and pedagogical approaches Theorising a range of approaches to relevant early childhood practice, as pedagogy This accessible and readable guide offers sound theoretical principles with practical suggestions for early years' settings. The book is supplemented by an extensive online video resource website that will bring these revolutionary ideas to life.. (shrink)

The foundation of the Christian counselling movement -- Christian counselling in the UK -- The aims of Christian counselling -- Integrating psychological and biblical truth -- Sigmund Freud--the founding father of psychotherapy -- The individual psychology of Alfred Adler -- Abraham Maslow--the man with new age tendencies -- Carl Rogers--a man who believed in himself -- Albert Ellis--the aggressive atheist -- The Bible's verdict on psychological 'truth' -- The case against Larry Crabb -- Self-esteem: the secular foundation -- Self-esteem and (...) the Christian counselling movement -- Self-esteem dogma in the light of scripture. (shrink)

The Great Psychotherapy Debate: Models, Methods, and Findings comprehensively reviews the research on psychotherapy to dispute the commonly held view that the benefits of psychotherapy are derived from the specific ingredients contained in a given treatment (medical model). The author reviews the literature related to the absolute efficacy of psychotherapy, the relative efficacy of various treatments, the specificity of ingredients contained in established therapies, effects due to common factors, such as the working alliance, adherence and allegiance to the therapeutic protocol, (...) and effects that are produced by different therapists. In each case, the evidence convincingly corroborates the contextual model and disconfirms the prevailing medical model. (shrink)

The second edition of The Great Psychotherapy Debate has been updated and revised to include a history of healing practices, medicine, and psychotherapy, an expanded theoretical presentation of the contextual model, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.

Cardiovascular health checks test risk factors for cardiovascular disease. They are offered to improve health: in case of an increased risk, participants receive lifestyle advice and medication. With this review, we investigate what is known about the reasons why people do or do not test for CVD risk factors. To what extent do these reasons relate to health monitoring and/or improvement? And do reasons differ in different contexts in which health checks are offered? We conducted a literature search and included (...) 22 papers in which we identified a broad range of motives. We conclude that people have reasons to test related to health improvement and reasons other than health improvement, practical reasons related to the way health checks are offered play an important role and motives should be understood in the context of the situation in which health checks are offered. Our results are relevant for public health officials and providers of health checks: first, if people undergo testing for reasons unrelated to health, this could explain why participation in health checks does not necessarily lead to health improvement. Second, efforts to improve uptake not necessarily serve justice and may hamper informed consent. (shrink)

Truth depends in some sense on reality. But it is a rather delicate matter to spell this intuition out in a plausible and precise way. According to the theory of truth-making this intuition implies that either every truth or at least every truth of a certain class of truths has a so-called truth-maker, an entity whose existence accounts for truth. This book aims to provide several ways of assessing the correctness of this controversial claim. This book presents a detailed introduction (...) to the theory of truth-making, which outlines truth-maker relations, the ontological category of truth-making entities, and the scope of a truth-maker theory. The essays brought together here represent the most important articles on truth-making in the last three decades as well as new essays by leading researchers in the field of the theory of truth and of truth-making. (shrink)

Big Ideas for Little Kids includes everything a teacher, a parent, or a college student needs to teach philosophy to elementary school children from picture books. Written in a clear and accessible style, the book explains why it is important to allow young children access to philosophy during primary-school education. Wartenberg also gives advice on how to construct a "learner-centered" classroom, in which children discuss philosophical issues with one another as they respond to open-ended questions by saying whether they agree (...) or disagree with what others have said. (shrink)

In 'Een handvol filosofen' staan de filosofen centraal die sinds de oprichting van de Vrije Universiteit in 1880 aan deze instelling verbonden zijn geweest. Het gaat hierbij niet alleen om de inhoud van hun werk, maar ook om de personen zelf. Er waren filosofiedocenten die zich met de universiteit identificeerden en zich volledig konden ontplooien. Er waren er echter ook voor wie dit niet gold, die geïsoleerd of in gewetensnood raakten. Veel filosofiestudenten waren actief betrokken bij wat er in hun (...) faculteit gebeurde. Zij namen initiatieven, protesteerden soms tegen de gang van zaken en kozen partij in conflictsituaties. Sinds het eind van de jaren zestig van de twintigste eeuw verloor de Vrije Universiteit geleidelijk haar christelijk karakter. Tegenwoordig werken alle stafleden vanuit hun eigen motivatie mee aan een hoofdzakelijk seculier geworden universiteit, die ruimte biedt voor religieuze en levensbeschouwelijke diversiteit. (shrink)

Formulating sound and acceptable embryo research policy remains challenging especially in a pluralistic world. This challenge has acquired a new dimension of complexity with the advent of so-called embryo models, which are derived from stem cells. In this article, we present a normative strategy to facilitate the process of sound policy-making in the field of human embryology. This strategy involves seeking neutral agreements on higher level theories and doctrines as well as seeking agreements on the level of concrete policy proposals. (...) We call this strategy: going high and low. By going high and low, the plurality of reasonable moral and epistemic convictions of stakeholders involved in the domain of human embryology is respected while the process of policy-making in this area is improved. (shrink)

Health checks identify disease in individuals without a medical indication. More and more checks are offered by more providers on more risk factors and diseases, so we may speak of an omnipresence of health checks. Current ethical evaluation of health checks considers checks on an individual basis only. However, omnipresent checks have effects over and above the effects of individual health checks. They might give the impression that health is entirely manageable by individual actions and strengthen the norm of individual (...) responsibility for health to the point where people hold themselves and others responsible for health outcomes they cannot reasonably be held accountable for. This process of so-called ‘over-responsibilization’ may result in increased feelings of guilt over health, decreased health solidarity and unfairly distributed health outcomes. Moreover, effects on privacy and peace of mind may be observed. Taking into account all possible harms and benefits of health checks in their ethical evaluation requires evaluation of health checks on an individual basis as well as on the level of all checks. Therefore, we urge the amendment of existing ethical evaluation to include the effects of an omnipresence of health checks. We make a first attempt at the formulation of amended criteria. (shrink)

Shrek! focuses on an issue in the philosophy of language, a relatively new area of philosophical investigation that first emerged during the twentieth century. Some philosophers disagree with the claim that you cannot separate the descriptive and evaluative elements of linguistic statements. This is because they take descriptive statements to be the basic elements of language, to which our subjective attitudes get attached later in a contingent manner. At its most basic level language presents a symbolic picture of facts in (...) the world. Shrek! presents what philosophers call a thought experiment that purports to show that the descriptive and evaluative contents of sentences are really distinct. The chapter ends by suggesting how to discuss the philosophy of language with children. (shrink)

In Daniel Manus Pinkwater's quirkily illustrated book, The Big Orange Splot, a strange accident leads a man to change his life. The book presents an important claim that the existentialists and other philosophers have embraced: That the life of conformity is one that people ought to avoid, despite its attractiveness. Instead of living a life just like everyone else and fulfilling expectations that others have for us, our lives should resemble the transformed facades of all the homes on Mr. Plumbean's (...) street: reflections of our own, individual dreams. (shrink)

The chapter talks about Shel Silverstein's The Giving Tree, which is a favorite of many children, adults, and teachers. The story of a relationship between a boy and a tree is charming for, despite the vicissitudes of the relationship, the two end up together at the end, with the boy — now an old man — sitting contentedly on the tree — itself reduced to a mere stump. The book raises an important issue in the field of environmental ethics. It (...) asks us to recognize that between childhood and old age, people operating within the Western tradition of ethics are not mindful of the value that the non‐human beings in their environment have for them as well as for future generations. Harkening to such warnings, environmental ethicists have attempted to raise important issues about our relationship with the other beings that make up our world. (shrink)

Margaret Wise Brown's The Important Book, which is a childrens' picture book, provides an excellent opportunity to discuss metaphysics. The book opens up for our reflection the viability of a certain metaphysical account of the nature of objects. In making a distinction between the important feature or property of an object and all the others that it simply is or has, The Important Book operates with the assumption that all objects have what metaphysicians call an essential property. As the book (...) has it, while there are many things that are true of any object, only one is essential to it. These other things are accidents or non‐essential properties of the object. Essentialism is the metaphysical view that objects have one property — their essential property — that cannot change while the object remains the same thing. (shrink)

Robert Mursch's picture book, The Paper Bag Princess, inverts many of the gender roles traditionally found in fairy tales: It's a prince (Roland) who gets abducted in this story, not a princess, though it's the princess (Elizabeth) who must come to the rescue and save him. Although these reversals are a source of the book's humor, they also underscore claims made in feminist philosophy, the specific branch of social and political philosophy considered in this chapter. Feminist philosophers and literary scholars (...) have pointed out that happy endings reassert harmful gender norms. Elizabeth's rejection of Roland marks her as a truly feminist hero, for she won't let him treat her in a demeaning manner even though she has staked her own life on saving him. With this story, you can hopefully steer children into a discussion of gender bias and oppression, and how traditional stories function to support it. (shrink)

The Sneetches by Theodor Geisel (otherwise known as Dr Seuss) is a satirical story that targets illicit discrimination. The book presents its parable about discrimination by depicting a society in which one group discriminates against another group because of an easily perceptible difference between them. The real irrationality of discrimination in both The Sneetches and real life is that it is based on the false claim that members of the discriminated‐against group are inferior to members of the discriminating group. The (...) book ends with all of the Sneetches playing with one another, paying no attention to the presence or absence of stars on their bellies. The lesson that children draw from The Sneetches is clear: Discriminating against people in a different social group is wrong. (shrink)

"This comprehensive volume - containing 27 chapters and contributions from six continents - presents and discusses key principles, perspectives, and practices of social learning in the context of sustainability. Social learning is explored from a range of fields challenged by sustainability including: organizational learning, environmental management and corporate social responsibility; multi-stakeholder governance; education, learning and educational psychology; multiple land-use and integrated rural development; and consumerism and critical consumer education. An entire section of the book is devoted to a number of (...) reflective case studies of people, organizations and communities using forms of social learning in moving towards sustainability. 'This book brings together a range of ideas, stories, and discussions about purposeful learning in communities aimed at creating a world that is more sustainable than the one currently in prospect....The book is designed to expand the network of conversations through which our society can confront various perspectives, discover emerging patterns, and apply learning to a variety of emotional and social contexts.' From the Foreword by Fritjof Capra, co-founder of the Center of Ecoliteracy. 'Joining what is so clear and refreshing in this book with the larger movements toward a critically democratic and activist education that is worthy of its name, is but one step in the struggle for sustainability. But it is an essential step if we are to use the insights that are included in this book.' From the Afterword by Michael Apple, author of 'Educating the ""Right"" Way: Markets, Standards, God, and Inequality'.". (shrink)

THE NATURE OF ART is a collection of 29 seminal, historically-organized readings that are focused on a basic philosophical question: What is Art? Including writings from the Western tradition'both Continental and Analytic traditions'as well as non-Western, minority, and feminist writings, this volume provides students with a rich set of resources to explore this matter both broadly and deeply. Introductions to each reading situate the selection amidst each respective thinker's body of work and the greater philosophical context in which the remarks (...) arose. Reading questions accompany each selection, drawing students' attention to key points to be encountered. Hailed by reviewers and adopters for its clarity and rigor, Wartenberg's THE NATURE OF ART offers a lively and engaging introduction to the philosophy of art. (shrink)

"Among the foremost Catholic philosophers of his generation. He has utilized the fullness of the Catholic intellectual tradition to brilliantly take the measure of modern philosophical thought... This volume is an expression of Robert Wood's singular philosophical outlook." -Jude Dougherty, dean emeritus, school of philosophy, The Catholic University of America.