Financial donor incentives: Problems with pilots, 2018
The dispute regarding incentives in organ donation has been going on for years but has not yet re... more The dispute regarding incentives in organ donation has been going on for years but has not yet reached a conclusion. To resolve the debate, scholars have advocated pilot studies. However, these proposals leave many questions unanswered. I will address the most pressing questions, which concern the concept of neutrality, the variety of incentives, limitations of pilot studies, fairness in outcomes, the naturalistic fallacy, donor profiles, public communication, and reversibility. My analysis shows that the proposed pilot studies will not mitigate today's moral paralysis regarding incentives in organ donation. These pilot experiments will not provide us with normative answers, unless satisfactory solutions can be found for the problems raised. Basically, to settle the debate, the normative debate itself must be strengthened.
On April 15th, 2003, the first crossover kidney transplantation took place in The Netherlands. In... more On April 15th, 2003, the first crossover kidney transplantation took place in The Netherlands. In September of the same year, a national database was established to facilitate kidney exchange between two donor-recipient couples. During 2004, kidneys from living donors will be exchanged between the seven university medical centers in The Netherlands. One of the conditions for successfully implementing this program was the need to address the ethical and psychologic implications involved. In this article we will discuss the ethical and psychologic considerations that are accompanying the practical preparations for the first Dutch crossover transplantation program. We identified five topics of interest: the influence of "donation by strangers" on the motivation and willingness of donor-patient couples, the issue of anonymity, the loss of the possibility of "medical excuses" for unwilling donors, the view that crossover is a first step to commercial organ trade, and the interference with existing organ donation programs. We concluded that whether viewed separately or in combination, these issues do not impede the efficient organization of a crossover program or raise worrying ethical issues.
Page 1. Medische Psychologie & Psychotherapie Rapport 2003.01 Mens (dood of leven... more Page 1. Medische Psychologie & Psychotherapie Rapport 2003.01 Mens (dood of levend) of dier? Attitudes over en morele implicaties van orgaanverwerving. Visak T, Kranenburg LW, Hilhorst MT, Busschbach JJV, Zuidema W, Weimar W, IJzermans JNM, Passchier J ...
Retractions solicited by authors following the discovery of an unintentional error—what we hencef... more Retractions solicited by authors following the discovery of an unintentional error—what we henceforth call a “self-retraction”—are a new phenomenon of growing importance, about which very little is known. Here we present results of a small qualitative study aimed at gaining preliminary insights about circumstances, motivations and beliefs that accompanied the experience of a self-retraction. We identified retraction notes that unambiguously reported an honest error and that had been published between the years 2010 and 2015. We limited our sample to retractions with at least one co-author based in the Netherlands, Belgium, United Kingdom, Germany or a Scandinavian country, and we invited these authors to a semi-structured interview. Fourteen authors accepted our invitation. Contrary to our initial assumptions, most of our interviewees had not originally intended to retract their paper. They had contacted the journal to request a correction and the decision to retract had been made by journal editors. All interviewees reported that having to retract their own publication made them concerned for their scientific reputation and career, often causing considerable stress and anxiety. Interviewees also encountered difficulties in communicating with the journal and recalled other procedural issues that had unnecessarily slowed down the process of self-retraction. Intriguingly, however, all interviewees reported how, contrary to their own expectations, the self-retraction had brought no damage to their reputation and in some cases had actually improved it. We also examined the ethical motivations that interviewees ascribed, retrospectively, to their actions and found that such motivations included a combination of moral and prudential (i.e. pragmatic) considerations. These preliminary results suggest that scientists would welcome innovations to facilitate the process of self-retraction.
DOELSTELLING Nierdonatie bij leven levert medisch en maatschappelijk gezien veel voordelen op, ma... more DOELSTELLING Nierdonatie bij leven levert medisch en maatschappelijk gezien veel voordelen op, maar toch willen of kunnen niet alle nierpatiënten op de wachtlijst en/of hun naasten zich opgeven voor het nierdonatie bij leven programma. De doelstelling van het project ‘Nierdonatie bij leven: psychologische en ethische aspecten’ is het verkrijgen van meer inzicht in de kennis en acceptatie van nierdonatie bij leven. Het gaat hierbij om kennis en acceptatie onder proefpersonen die daadwerkelijk in aanmerking komen voor nierdonatie/ transplantatie bij leven, dat wil zeggen (1) patiënten met eindfase nierfalen op de wachtlijst voor een niertransplantatie en (2) de mensen uit hun omgeving; de potentiële donoren. Het benaderen van deze groepen is de strategie om uit te vinden of, en onder welke voorwaarden, uitbreiding van het nierdonatie bij leven programma praktisch haalbaar en ethisch verdedigbaar is. VRAAGSTELLINGEN Het project omvat twee vraagstellingen. De eerste vraagstelling is: wa...
In het nieuwe zorgstelsel, dat is gebaseerd op gereguleerde concurrentie, worden artsen gestimule... more In het nieuwe zorgstelsel, dat is gebaseerd op gereguleerde concurrentie, worden artsen gestimuleerd om reclame te maken voor hun eigen diensten. Daarmee gaat het overheidsbeleid in tegen de traditionele medische professionele ethiek. Ook op andere gebieden van de medische professionele ethiek, bijvoorbeeld het verstrekken van informatie aan de patiënt, signaleren we veranderingen. Dat roept twee belangrijke vragen op die centraal staan in dit artikel: (1) hoe moeten we de veranderingen in de medische professionele ethiek beoordelen en (2) wie kan en mag de medische professionele ethiek bepalen?
We zullen eerst de idealen schetsen die beginnende Geneeskunde studenten koesteren met betrekking... more We zullen eerst de idealen schetsen die beginnende Geneeskunde studenten koesteren met betrekking tot het beroep van arts. Vervolgens zullen we iets zeggen over de idealen van de huidige artsen. De artseneed typeert niet alleen de ethische kern van de professie, maar wil daaraan ook alle artsen binden. Daarmee vertegenwoordigt de eed zelf al een belangrijk ideaal. Daarna richten we onze aandacht op één bepaald specialisme, namelijk dat van de huisarts.
In this article, an ethical analysis of an educational programme on renal replacement therapy opt... more In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme.
Progress in transplantation (Aliso Viejo, Calif.), 2009
In Europe, living kidney donation rates differ considerably from country to country. These differ... more In Europe, living kidney donation rates differ considerably from country to country. These differences are related to deceased kidney donation rates: countries with higher deceased donation rates have lower living donation rates. Despite the differences, all countries have one thing in common, namely, the shortage of kidneys for transplantation. Living kidney donation is a good option to alleviate these shortages. In our center, 60% to 70% of all kidney transplants come from living donors. This article describes various strategies that may have contributed to these high living donation rates: team attitude, educational materials and meetings, and alternative donation programs (exchange donation, domino-paired donation, Good Samaritan donation). Also described are some less conventional strategies for increasing rate of living kidney donation that are not used in the Netherlands but may offer some good perspectives (e.g., the "Norwegian approach" and home-based educational ...
Personal appearance and physical beauty are becoming increasingly important in our societies and,... more Personal appearance and physical beauty are becoming increasingly important in our societies and, as a consequence, enter into the realm of medicine and health care. Adequate and just health care policies call for an understanding of this trend. The core question to be addressed concerns the very idea of beauty. In the following, a conceptual clarification is given in terms of beauty's meaning, value and function (i.e. beauty that is used instrumentally, and beauty that is attained). Furthermore, some relevant distinctions are drawn between physical and artistic beauty, and physical beauty in a human sense. The core idea for this is formed by a Kantian notion of the beauty concept. It is argued that beauty judgements should be understood as relative to persons and their contexts. Physical beauty should be taken seriously when it is understood in this deeper sense of being related to the shaping of a person's identity.
Financial donor incentives: Problems with pilots, 2018
The dispute regarding incentives in organ donation has been going on for years but has not yet re... more The dispute regarding incentives in organ donation has been going on for years but has not yet reached a conclusion. To resolve the debate, scholars have advocated pilot studies. However, these proposals leave many questions unanswered. I will address the most pressing questions, which concern the concept of neutrality, the variety of incentives, limitations of pilot studies, fairness in outcomes, the naturalistic fallacy, donor profiles, public communication, and reversibility. My analysis shows that the proposed pilot studies will not mitigate today's moral paralysis regarding incentives in organ donation. These pilot experiments will not provide us with normative answers, unless satisfactory solutions can be found for the problems raised. Basically, to settle the debate, the normative debate itself must be strengthened.
On April 15th, 2003, the first crossover kidney transplantation took place in The Netherlands. In... more On April 15th, 2003, the first crossover kidney transplantation took place in The Netherlands. In September of the same year, a national database was established to facilitate kidney exchange between two donor-recipient couples. During 2004, kidneys from living donors will be exchanged between the seven university medical centers in The Netherlands. One of the conditions for successfully implementing this program was the need to address the ethical and psychologic implications involved. In this article we will discuss the ethical and psychologic considerations that are accompanying the practical preparations for the first Dutch crossover transplantation program. We identified five topics of interest: the influence of "donation by strangers" on the motivation and willingness of donor-patient couples, the issue of anonymity, the loss of the possibility of "medical excuses" for unwilling donors, the view that crossover is a first step to commercial organ trade, and the interference with existing organ donation programs. We concluded that whether viewed separately or in combination, these issues do not impede the efficient organization of a crossover program or raise worrying ethical issues.
Page 1. Medische Psychologie & Psychotherapie Rapport 2003.01 Mens (dood of leven... more Page 1. Medische Psychologie & Psychotherapie Rapport 2003.01 Mens (dood of levend) of dier? Attitudes over en morele implicaties van orgaanverwerving. Visak T, Kranenburg LW, Hilhorst MT, Busschbach JJV, Zuidema W, Weimar W, IJzermans JNM, Passchier J ...
Retractions solicited by authors following the discovery of an unintentional error—what we hencef... more Retractions solicited by authors following the discovery of an unintentional error—what we henceforth call a “self-retraction”—are a new phenomenon of growing importance, about which very little is known. Here we present results of a small qualitative study aimed at gaining preliminary insights about circumstances, motivations and beliefs that accompanied the experience of a self-retraction. We identified retraction notes that unambiguously reported an honest error and that had been published between the years 2010 and 2015. We limited our sample to retractions with at least one co-author based in the Netherlands, Belgium, United Kingdom, Germany or a Scandinavian country, and we invited these authors to a semi-structured interview. Fourteen authors accepted our invitation. Contrary to our initial assumptions, most of our interviewees had not originally intended to retract their paper. They had contacted the journal to request a correction and the decision to retract had been made by journal editors. All interviewees reported that having to retract their own publication made them concerned for their scientific reputation and career, often causing considerable stress and anxiety. Interviewees also encountered difficulties in communicating with the journal and recalled other procedural issues that had unnecessarily slowed down the process of self-retraction. Intriguingly, however, all interviewees reported how, contrary to their own expectations, the self-retraction had brought no damage to their reputation and in some cases had actually improved it. We also examined the ethical motivations that interviewees ascribed, retrospectively, to their actions and found that such motivations included a combination of moral and prudential (i.e. pragmatic) considerations. These preliminary results suggest that scientists would welcome innovations to facilitate the process of self-retraction.
DOELSTELLING Nierdonatie bij leven levert medisch en maatschappelijk gezien veel voordelen op, ma... more DOELSTELLING Nierdonatie bij leven levert medisch en maatschappelijk gezien veel voordelen op, maar toch willen of kunnen niet alle nierpatiënten op de wachtlijst en/of hun naasten zich opgeven voor het nierdonatie bij leven programma. De doelstelling van het project ‘Nierdonatie bij leven: psychologische en ethische aspecten’ is het verkrijgen van meer inzicht in de kennis en acceptatie van nierdonatie bij leven. Het gaat hierbij om kennis en acceptatie onder proefpersonen die daadwerkelijk in aanmerking komen voor nierdonatie/ transplantatie bij leven, dat wil zeggen (1) patiënten met eindfase nierfalen op de wachtlijst voor een niertransplantatie en (2) de mensen uit hun omgeving; de potentiële donoren. Het benaderen van deze groepen is de strategie om uit te vinden of, en onder welke voorwaarden, uitbreiding van het nierdonatie bij leven programma praktisch haalbaar en ethisch verdedigbaar is. VRAAGSTELLINGEN Het project omvat twee vraagstellingen. De eerste vraagstelling is: wa...
In het nieuwe zorgstelsel, dat is gebaseerd op gereguleerde concurrentie, worden artsen gestimule... more In het nieuwe zorgstelsel, dat is gebaseerd op gereguleerde concurrentie, worden artsen gestimuleerd om reclame te maken voor hun eigen diensten. Daarmee gaat het overheidsbeleid in tegen de traditionele medische professionele ethiek. Ook op andere gebieden van de medische professionele ethiek, bijvoorbeeld het verstrekken van informatie aan de patiënt, signaleren we veranderingen. Dat roept twee belangrijke vragen op die centraal staan in dit artikel: (1) hoe moeten we de veranderingen in de medische professionele ethiek beoordelen en (2) wie kan en mag de medische professionele ethiek bepalen?
We zullen eerst de idealen schetsen die beginnende Geneeskunde studenten koesteren met betrekking... more We zullen eerst de idealen schetsen die beginnende Geneeskunde studenten koesteren met betrekking tot het beroep van arts. Vervolgens zullen we iets zeggen over de idealen van de huidige artsen. De artseneed typeert niet alleen de ethische kern van de professie, maar wil daaraan ook alle artsen binden. Daarmee vertegenwoordigt de eed zelf al een belangrijk ideaal. Daarna richten we onze aandacht op één bepaald specialisme, namelijk dat van de huisarts.
In this article, an ethical analysis of an educational programme on renal replacement therapy opt... more In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme.
Progress in transplantation (Aliso Viejo, Calif.), 2009
In Europe, living kidney donation rates differ considerably from country to country. These differ... more In Europe, living kidney donation rates differ considerably from country to country. These differences are related to deceased kidney donation rates: countries with higher deceased donation rates have lower living donation rates. Despite the differences, all countries have one thing in common, namely, the shortage of kidneys for transplantation. Living kidney donation is a good option to alleviate these shortages. In our center, 60% to 70% of all kidney transplants come from living donors. This article describes various strategies that may have contributed to these high living donation rates: team attitude, educational materials and meetings, and alternative donation programs (exchange donation, domino-paired donation, Good Samaritan donation). Also described are some less conventional strategies for increasing rate of living kidney donation that are not used in the Netherlands but may offer some good perspectives (e.g., the "Norwegian approach" and home-based educational ...
Personal appearance and physical beauty are becoming increasingly important in our societies and,... more Personal appearance and physical beauty are becoming increasingly important in our societies and, as a consequence, enter into the realm of medicine and health care. Adequate and just health care policies call for an understanding of this trend. The core question to be addressed concerns the very idea of beauty. In the following, a conceptual clarification is given in terms of beauty's meaning, value and function (i.e. beauty that is used instrumentally, and beauty that is attained). Furthermore, some relevant distinctions are drawn between physical and artistic beauty, and physical beauty in a human sense. The core idea for this is formed by a Kantian notion of the beauty concept. It is argued that beauty judgements should be understood as relative to persons and their contexts. Physical beauty should be taken seriously when it is understood in this deeper sense of being related to the shaping of a person's identity.
Het doel van dit rapport is het leveren van bouwstenen voor de explicitering van een integraal ma... more Het doel van dit rapport is het leveren van bouwstenen voor de explicitering van een integraal maatschappelijk ethisch toetsingskader voor biotechnologische ontwikkelingen. Het doel van een dergelijk integraal kader is om de ethisch maatschappelijke afwegingen die een rol spelen bij biotechnologie zichtbaar te maken en daarmee een zelfstandige positie te geven binnen de evaluatie van biotechnologie, zowel binnen als buiten de juridische toetsingspraktijk. Bovendien moet een integraal maatschappelijk ethisch toetsingkader structuur geven aan de voortgaande maatschappelijke discussie over de ethische aanvaardbaarheid van bepaalde biotechnologische ontwikkelingen. De twee essentiële bouwstenen voor een integraal maatschappelijk ethisch toetsingskader voor biotechnologische ontwikkelingen zijn (a) de verbreding van risico naar waardenaantastingen en (b) de analyse en prioritering van onderzoeksdoelen op basis van de waarde van deze doelen
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