Category: Musings (Page 6 of 18)

Genetic risk information: lines and stage directions

23 April, 2019 / Pär Segerdahl / 0 Comments

Outside of their practical contexts, simple messages quickly lose their meaning. Recall what it is like to find an old Post-it Note: “Don’t forget the disk!” – What disk? The risk is great that we invent a context. Incomprehensible messages awaken our imagination.

Similarly, messages about genetic risk need practical contexts that make the information meaningful and prevent nightmarish imaginations. The information needs to become part of a larger drama. Otherwise, we begin to fantasize: “Greatly increased risk of breast cancer.” – What do they mean, “greatly increased”? What do they mean, “breast cancer”? What do they mean, “risk”?

The difficulty of understanding and benefitting from genetic risk information is probably partly due to lack of context. The potential for generating risk information is growing rapidly. All this information is waiting for its dramas: contexts where people can ask concrete questions and get practical advice. Educational methods for explaining percentages cannot replace the loss of context. People who get genetic risk information need to know more about the disease they are at risk of developing. They may want to know if they should notify the employer of the risk. They may want to know if something can be done to reduce the risk. They may want to know what it is like to live with the disease, or with the risk of getting it. How is the family affected? Can you work having the disease? Should one worry or is it reasonable to hope that one will not get the disease? And so on.

In short, well-functioning genetic risk information has two dimensions. First, an individual dimension: “You have a greatly increased risk of…” Secondly, a general dimension: Practical instructions on a wide variety of issues that people need to know more about, and about which they otherwise begin to fantasize.

To speak the language of the theater: The individual dimension (the simple risk message) is the lines. The general dimension is the stage directions. Genetic risk information consists of both lines and stage directions.

When we discuss whether genetic risk information empowers people to influence their future health or just worries them, when we discuss the difficulty of understanding risk information, we should be clearly aware of these two dimensions of the information. Are we discussing the lines or the stage directions? Or are we discussing the lines together with the stage directions?

Which dimension of genetic risk information is most relevant to the individual? Perhaps the lines are merely a reason for moving on to the stage directions. The dramatic risk lines may speak mainly to the healthcare staff, while the individual above all needs the stage directions.

One could not work at a theater without distinguishing between lines and stage directions. Perhaps something similar applies to genetic risk information.

Pär Segerdahl

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Sometimes you do not want to be taken seriously

1 April, 2019 / Pär Segerdahl / 0 Comments

What does taking something seriously mean? Seriously, I do not think there is a given answer. A common view, however, is that serious questions must have given answers: definitive either/or answers. Without either/or answers, truth seeking degenerates into irresponsible chattering. Embryo destruction is either murder or not murder (banging one’s fist on the table). Embryo research is either permissible or not permissible (banging one’s fist on the table).

Seriousness is polarized, one could say. If I were to take polarized seriousness seriously, which seems reasonable since nothing could be more serious than seriousness itself, I would have to ask: Is seriousness polarized or not? Either it is polarized or it is not polarized! I say this resolutely, banging my fist on the table. However, the question itself is polarized. My resolution and categorical banging suddenly appear comically embarrassing. My gestures seem to run ahead of me, answering the question I thought I asked seriously by making them. What happened? Did I reach the limit of seriousness, beyond which I no longer can ask serious questions about seriousness without ending up in self-contradiction?

Perhaps I just reached the limit of small seriousness, where great seriousness can begin. Contradicting myself need not be as bad as it sounds. Perhaps I did not even know I existed until I contradicted myself. My polarized reasoning ran aground. The sunken rock was myself. Self-contradiction allowed self-discovery. For we are not dealing with two contradictory propositions, so that we must seriously investigate which of them is the true proposition and which of them is the false proposition. I was contradicted by how I myself banged my fist on the table and said, resolutely, “either-or.”

Let us be grateful for the self-contradiction. It can open our eyes to another seriousness: the seriousness of self-reflection, where we, as Confucius says, turn around and seek the cause of our failure within ourselves. Thank you, dear self-contradiction. You may be embarrassing, but just for that reason I know that I am alive and not just a propositional machine that easily can be replaced by an online chatbot!

Why do I bring up these remarkable things? Perhaps because it would be tragic if we misunderstood contemplative thinking as superfluous in an empirically founded age. Schopenhauer said something similar: “Pure empiricism is related to thinking as eating is to digestion and assimilation. When empiricism boasts that it alone has, through its discoveries, advanced human knowledge, it is as if the mouth should boast that it alone keeps the body alive.”

Trying seriously to write a blogpost about seriousness, however, is risky. For blogposts are easily circulated as mere opinions. If you were to render the content of this post, you would almost certainly be forced to polarize it as a delimited position that is either true or false. If we followed Schopenhauer’s advice, however, we would give ourselves plenty of time to quietly digest, through thinking, the strange things said in the post. Such peaceful and quiet digestion of thoughts is beyond the capacity of chatterboxes and chatbots.

Do not misunderstand my joking style. It is meant seriously to avoid being taken seriously. The Chinese thinker, Chuang Tzu, did not want to be perceived as a pedant, so he said to his audience, “I’m going to try speaking some reckless words to you and I want you to listen to them recklessly.”

Chuang Tzu was a great thinker who did not want to be taken seriously as a small one.

Pär Segerdahl

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Reality surpasses our concepts

20 March, 2019 / Pär Segerdahl / 0 Comments

After thinking for some time about donation of human eggs and embryos to stem cell research, I want to express myself as in the headline. Reality surpasses our concepts of it. This is not as strange as it sounds. For, if our concepts already reflected reality, then no one would need to do research, or to think. Just talking would be sufficient. An endless flood of words could replace all sincere aspirations to understand life and the world.

So what is it about donation to research that makes me want to express myself as in the headline? Everyone knows that blood donation is a gift to patients. This makes blood donation humanly understandable. People want to help fellow human beings in need, even strangers. But what about donation of eggs and embryos to stem cell research? Conceptually, the donation does not go to patients in need, but to researchers. This makes it difficult to understand donation to research. Are we to assume that people feel sorry for researchers and that they therefore want to support them by donating to them? Why do donors support research?

Not only does the concept of “donation to research” make donation difficult to understand from a human point of view. The concept also causes donation to appear suspiciously exploitative. The recipient of the donation is more powerful than the donor is. Moreover, if research results are commercialized, the recipient can make a profit on the work that the donation enables, without the donor receiving any share of it. So not only does literal faith in the concept of “donation to research” make a free will to donate difficult to understand. The donation also looks suspicious. Some argue that we should prevent an increasingly capitalized life science sector from exploiting self-sacrificing donors in this way.

Nevertheless, there are people who freely donate to research. Why? I guess it often is because they use research merely as an intermediary, to be able to give to patients. The patient is equally important in donation to research as in blood donation, although the concept does not reflect this relationship. Let me give an unexpected example of intermediaries.

About one kilogram of bacteria lives in our intestinal tract. Without these bacteria, our bodies would not be able to absorb many of the nutrients in the food we eat. When we swallow the food, these bacteria are in a sense the first diners, and our bodies have to wait patiently until they have finished eating. Even if we know this, we rarely think that we are swallowing food in order to allow bacteria in the stomach to eat first. We eat without being aware of the work that these “intermediaries” in the stomach have to do, in order for the nutrients to become available to the body.

The concept of “eating” does not reflect this relationship between bacteria and us. This is not a shortcoming of the concept. On the contrary, it would be very unpleasant if the concept reflected the bacteria’s work in our guts. Who would then want to say, “Let us sit down and eat”? However, problems arise if we have too much literal faith in concepts. Our vocabulary will then begin to impose limitations on us. Our own language will shrink our otherwise open minds to mental caves, where the words cast shadows on the walls.

Researchers, then, can be seen as intermediaries between donors and patients. I hope I do not upset sensitive minds if I suggest that researchers are the bacteria that we need to make donated material available to future patients’ bodies. That is why people donate to research. They sense, more or less intuitively, that research functions as an intermediary. “Donation to research” is at heart a gift to patients.

It is even more complicated, however, for research alone cannot act as intermediary. The task is too great. For the donation to become a gift to patients, a capitalized life science sector is needed, and a healthcare system, and much else. Moreover, just as the beneficiary function of bacteria in our stomachs requires a diet that regulates the balance between bacteria, this system of intermediaries, extending from donor to patient, needs regulation and monitoring, so that all the actors work harmoniously together. We cannot allow quacks to sell dangerous or inefficient drugs to the sick, and we cannot allow researchers to access donated material in any way they see fit.

Donation to research is a striking example of how reality surpasses our concepts. When we succeed in overcoming our literal faith in concepts – when we discover the way out of the cave and see the light – then donation to research finally becomes humanly understandable. The donor uses research to be able to give to patients. Moreover, donation to research ceases to appear as a suspicious transaction between unequal parties, since the donor uses the relatively powerful direct recipient to give to a more understandable recipient: the patient. Trying to counteract exploitation by paying the donor large sums, or by giving the donor a share of the profit, would tie the donor to the wrong recipient: the one emphasized in the concept.

As mentioned, the donor uses not only research to reach the patient, but a whole system of intermediaries, such as industry, healthcare and governmental control. This system of beneficial societal bacteria is therefore, to some extent, subordinate to the donor’s will to help patients. Or rather, the subordination is an aspect of the relationship, as is bacteria’s subordination to human eating. If we want to, we can always see the opposite aspect as well. Who really eats first and who last? Who really uses whom? The questions lack definitive answers, for the aspects change into one another.

With this post, I wanted to suggest the possibility of a bigger seeing, which we can learn to use wisely in our thinking when we discover how conceptually purified standpoints easily shrink our minds to mental caves.

Pär Segerdahl

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Why do we pay for genetic information that we do not use?

5 February, 2019 / Pär Segerdahl / 0 Comments

About half a million people around the world have purchased direct-to-consumer genetic tests. A large majority say that they are willing to pay for the genetic information, even if the results do not reveal anything of clinical value. If so, why do they want to buy genetic information about themselves?

Many say they want health-relevant information. One can guess that they want information that helps them to live healthier: How should a person with my genes eat and exercise? However, the test results do not seem to motivate any changed behavior. Thus, people pay for genetic information, but they do not use it.

Alessandra Gorini and Gabriella Pravettoni reflect on the psychology behind consumers’ seemingly strange behavior. What makes so many buy genetic information that they will not use? In addition to the difficulty of understanding statistical information, they suggest that consumers may want to signal to themselves that everything is fine. People are generally optimists when it comes to risk. Most people think that they themselves are at less risk than others are to suffer from disease or other adverse events. Most also have a tendency to interpret information as confirming what they already believe.

What consumers of genetic tests pay for, then, is a positive signal to themselves. When they read the test results, optimistic and self-confirming cognitive processes are immediately activated: Look, I’m safe!

Gorini and Pravettoni argue that this self-signaling consumption of genetic information is problematic. The information is not used effectively. What can we do about it?

Rather than regulating the market of direct-to-consumer genetic tests, the authors propose that we should increase consumers’ knowledge and awareness, to help them use genetic information more effectively. However, if consumers are satisfied with the positive signal they sought and bought, are they motivated to acquire knowledge that can interfere with the signal?

Pär Segerdahl

Alessandra Gorini and Gabriella Pravettoni. 2016. Why do we pay for information that we won’t use? A cognitive-based explanation for genetic information seeking. European Journal of Human Genetics 24: 625. doi:10.1038/ejhg.2015.188

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Larger and smaller sized ethics

29 January, 2019 / Pär Segerdahl / 0 Comments

Ethics can be about big, almost religious questions. Should scientists be allowed to harvest stem cells from human embryos and then destroy the embryos? Ethics can also be about narrower, almost professional issues. How should the development of embryonic stem cell lines be regulated? The latter question is similar to the question: How should the aircraft industry be regulated?

Larger and smaller ethics can have difficulties understanding each other, even though they often need to talk. For example, larger ethics can be suspicious of medical research and the pharmaceutical industry, and overlook how meticulously responsible they most often are. And how rigorously supervised they are, as the aircraft industry. Neither the drug nor the aircraft industry can be carefree about safety issues!

Smaller ethics can also be suspicious of larger ethics. Medical research and industry, with their professional attitudes, can experience larger ethical questions as being as vague and distant as nebulae. This fact, that larger and smaller ethics have difficulties even hearing each other, creates the need for a simpler, more sincerely questioning attitude, which never settles within any limits, whether they are narrower or wider. Remember that even larger perspectives often degenerate into regulations of how people should think. They shrink.

Medical research and industry need regulation, it is as important as the safety work in the aircraft industry. However, we need also to think big about human life and life in general. In order to keep ethics alive, a beginner’s attitude is needed, constantly renewed sincerity. Does it sound difficult? All we need to do is to ask the questions we really wonder about, instead of hiding them behind a confident facade.

Nothing could be easier. The question is if we dare. The sincerest questions open up the biggest perspectives.

Pär Segerdahl

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The human being is not only a category

9 January, 2019 / Pär Segerdahl / 0 Comments

We often use words as categories, as names of classes of things or individuals in the world. Humans and animals. Englishmen and Germans. Capitalists and Communists. Christians and Muslims. I want to highlight a difficulty we may encounter if we try to handle the problem of human violence from such an outward looking perspective.

Something that easily happens is that we start looking for the ideal subcategory of humans, whom we cannot accuse of any violence. If we only found a truly peaceful group of humans, somewhere in the world, we could generalize it to all humanity. We could create an evidence-based humanity, finally living peacefully. We could wipe out the problem of violence! However, where do we find the nonviolent humans who, on scientific grounds, could guide the rest of humanity to peace?

One problem here is that if we find some peaceful humans, perhaps on the British Isles, or in the Himalayas, then we must convert all other humans on the surface of this planet to the peaceful category. That does not sound promising! On the contrary, it sounds like a recipe for war.

Already the search for evidence seems violent, since it will repeat not just one, but all accusations of violence that ever were directed at groups of people. After all, there are:

violent Christians
violent Muslims
violent Capitalists
violent Anti-Capitalists
violent Germans
violent Englishmen

Moreover, there are violent trombonists. We also know that there are violent democrats, as well as violent anti-democrats. Lately we have been surprised to learn that even Buddhists can persecute humans and burn down temples and mosques. How about that! Even Buddhists are violent. The project to create an evidence-based, peaceful humanity seems hopeless.

However, let us turn this around. After all, we are all humans:

Christians are humans
Muslims are humans
Capitalists are humans
Anti-Capitalists are humans
Germans are humans
Englishmen are humans

Trombonists are humans, as are democrats, anti-democrats and Buddhists. We are all humans. Does it not sound hopeful when we acknowledge the fact that we are all humans? It certainly does sound full of promise. But why?

Is it perhaps because we stop opposing humans and instead speak more grandiosely about the human as one big universal category? I do not think so. After all, the problem was, from the beginning, that there are:

violent humans

It is not difficult to distrust the human as a universal category. Would it not be best if the human simply disappeared from this overburdened planet? Is it not horrible that we are all these humans, intruding on nature? In fact, there are those who propose that we should transgress the human category and become post-human. As though the solution were an unborn category.

No, the hope we felt emerged, I think, precisely because we stopped talking about human beings as a category. Notice the word we humans. What does it mean to talk about us humans? I think it means that we no longer speak of the human as a category in the world, not even grandiosely as a universal category. Rather, the human is, more intimately, “all of us,” “you and me,” “each one of us.”

When we talk about the human from within, we do not accuse the human as a worldly category to be violent. Rather, we see the violence in ourselves. I see it in me; you see it in you. We see the violence in each one of us; we see it in all of us. The responsibility thereby naturally becomes our own human responsibility. That is where the hope we felt emanated, I believe. It came from the internal perspective on the human. This nearness to ourselves made acknowledging that we are all humans sound full of promise.

I stop here. I just wanted to remind you of the fact that the human being is not only a worldly category with which to calculate and experiment. The category of the human can make us blind to ourselves as intimately alive, and thereby to the violence in us and to our responsibility for it.

I just hope this reminder did not trigger further violence: “What!? Are you suggesting that the problem lies in me? How impudent! Please, don’t include me in your pathetic we.”

Pär Segerdahl

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Dangers of moral words

11 December, 2018 / Pär Segerdahl / 0 Comments

The philosopher Bernard Williams distinguished between thick ethical concepts such as “brave” and “brutal,” which have both descriptive and evaluative content, and thin ethical concepts such as “right” and “wrong,” which are purely evaluative. “Murder” and “exploitation” are thick ethical concepts that sometimes play a central role in ethical debate. They have descriptive content combined with a negative evaluation: murder and exploitation are wrong.

This duality of thick moral words, their descriptive/normative Janus face, makes them an impelling part of the vocabulary of most, if not all, ideological movements. If you oppose X, and can demonstrate that X, in fact, involves murder or exploitation (descriptive aspect), then you have immediately demonstrated that X must be opposed (normative aspect). Thick ethical concepts are often used in conflictual situations to legitimize violent actions against people who are described as intriguing, murderous, exploitive, and much else. Since the words are taken to describe reality as it is, such bad individuals must be watched over and, if necessary, acted against.

Thick moral words thus easily lend themselves to functioning as ideological firearms. Their descriptive aspect allows taking aim. Their evaluative aspect says, “Fire!” I want to mention three further dangers of thick ethical concepts.

Dogmatism. The first is that it is difficult to raise questions about their applicability, since it can appear as if you questioned the evaluative component. Let us say that you raise the question if embryo destruction really constitutes murder. In the eyes of those who take this description for reality, you appear like a treacherous person who shrewdly argues that murder might be right! Simply raising the question, no matter how open-mindedly you do it, places you in the firing line. Your very open-mindedness speaks against you: “Murder is not something to be open-minded about!”

Righteousness. A second troublesome feature is that thick ethical concepts produce instant goodness in any ideological movement. Any ideology is on the right side, regardless of which side it is on, since it fights for what its moral vocabulary unites with the good, and fights against what its vocabulary unites with the bad. Any ideology has the right and the duty to act resolutely against what its dualistic vocabulary picks out as impermissible features of reality. – Which side for peace are you on?

Suffering. A third problem is that thick moral words produce suffering in the form of gnawing suspicions and fears. Since we are not omniscient, there is much we do not know, for example, about embryonic stem cell research. Thick ethical concepts here tend to appear in our heads as stand-ins for reality. They appear in the form of an inner voice that tells us what stem cell research is. This is not a purely descriptive “is,” but a double-edged one, for what the voice in the head says the research is can be a nightmarish, “It is murder.” Since we are ignorant of much, but not of our anxiety, we cannot shake off the worrying double-edged concepts that spin in the head. They seem validated by the gnawing anxiety they produce, and we suffer without end, caught in a whirlpool of thick descriptive/normative moral language.

In pointing out dangers of thick moral words, I am not questioning their descriptive or evaluative content. Murder is a reality and it is a serious crime; the same is true of exploitation. I am just pointing out that the dual nature of thick moral words can turn our heads. Moral language can make us violent, dogmatic, righteous, and anxious about issues that perhaps exist mainly in our descriptions of reality.

I think most of us have fallen into such dark pits.

Pär Segerdahl

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Contemplative conversations

19 November, 2018 / Pär Segerdahl / 0 Comments

When we face new sensitive and worrying issues, there is an instinctive reaction: this must be debated! But is debate always the right way, if we want to take human concerns seriously?

That some are worried about new research and technology, is a fact. That others are not worried, is also a fact. Suppose these people handle their differences by debating with each other. What happens?

What happens is that they leave the actual world, which varies as much as people are different, and end up in a universal world of rational reasons. Those who worry must argue for their concerns: All sensible people should feel worried! Those who are not worried must provide weighty counter-arguments: No sensible person should feel worried!

Debate thus creates an either/or conflict from what was only a difference. Polarization increases the fear, which amplifies the desire to be absolutely right. Everyone wants to own the uniquely compelling reason that everyone should obey. But since we are different, the debate becomes a vertiginous hall of mirrors. It multiplies exaggerated world images in which we lose ourselves and each other.

The worry itself, as trembling human fact, is forgotten. The only thing that engages us is the weighty reason for, or against, being worried. The only thing that interests us is what everyone should feel. Is that taking human concerns seriously? Is it taking ourselves seriously?

If a child is worried, we do not ask the child to argue for its worries, and we do not comfort the child by refuting it. We take care of the child; we take care of its worries, as compassionate parents.

I play with the idea that we and our societies would be in better shape if we more often avoided the absolute world of reasons. Through its universality, it appears, of course, like a utopia of peace and unity among rational beings. In fact, it often creates polarization and perplexes us with its exaggerated images of the world. Arguing for the right cause in debate is perhaps not always as noble as we take it to be.

We are, more often than we think, like children. That is, we are human. Therefore, we need, more often than we think, to take care of ourselves. As compassionate parents. That is another instinct, which could characterize conversations about sensitive issues.

We need to take care of ourselves. But how? What is the alternative to debate? For want of better words: contemplative conversations. Or, if you want: considerate conversations. Rather than polarizing, such an open spirit welcomes us all, with our actual differences.

Perhaps that is how we become adults with regard to the task of living well with each other. By tenderly taking care of ourselves as children.

Pär Segerdahl

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Speaking to 5-year-olds about research (By Sara Frygner-Holm)

23 October, 2018 / Pär Segerdahl / 0 Comments

How should we talk to children about research? And how should we go about recruiting them to studies? For children to become research participants, their parents must consent. Regulation states children should also give assent themselves, to as great extent as possible. Our ethics committees require us to provide them with age-appropriate information. Health care providers and researchers think the system works well and is ethically “correct.”

From recruiting numerous children for various research projects, I have some thoughts on the subject. I have put together countless information letters for children of various ages; all reviewed and approved by the ethics committee. But what, exactly, is “age-appropriate information”? With support from developmental psychology and some paediatric research, the ambitious paediatric researcher can get it right. On a group level, that is. We can estimate what the average kid of a certain age group understands. But how appropriate is the “age-appropriate” information for individual children? In his poem Till eftertanke, Søren Kirkegard wrote “To help someone, I must indeed understand more than they do, but first and foremost understand what they understand.”

Today, I value a slow and calm recruiting process. I talk to the children about what research is, most 5-year-olds actually have an idea. We speak about what the project is about, and what we want them to contribute. Perhaps we draw or look at pictures. I tell them that it is absolutely fine to change your mind and leave at any time, and that no one will be angry or upset with them if they do. And then we talk some more… Lastly, and most importantly, I ask the child to tell me what we talked about, and what we agreed upon. It takes some time to understand their understanding. Give yourself that time.

Not until I understand that the child has understood do I ask them to sign the consent form.

Sara Frygner-Holm

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Supporting clinicians to trust themselves

3 October, 2018 / Pär Segerdahl / 0 Comments

Suppose that you want to learn to speak a language, but the course is overloaded by grammatical terminology. During the lessons, you hardly hear any of the words that belong to the language you want to learn. They drown in technical, grammatical terms. It is as if you had come to a course on general linguistic theory, not German.

When clinicians encounter healthcare ethics as a subject of education, they may have similar experiences. As adult humans they already can feel when everything is alright in a situation. Or when there is a problem; when attention is needed and action must be taken. (We do it every day.) However, to handle the specific challenges that may arise in healthcare, clinicians may need support to further develop this already existing human ability.

Unfortunately, healthcare ethics is typically not presented as development of abilities we already have as human beings. Instead, it is presented as a new subject. Being ethical is presented as having the specific knowledge of this subject. Ethics then seems to be about reasoning in terms of abstract ethical concepts and principles. It is as if you had come to a course on general moral theory, not healthcare ethics. And since most of us do not know a thing about moral theory, we feel ethically stupid and powerless, and lose our self-confidence.

However, just as you don’t need linguistic theory to speak a language, you don’t need moral theory to function ethically. Rather, it is the other way around. It is because we already speak and function ethically that there can be such intellectual activities as grammar and moral theory. Can healthcare ethics be taught without putting the cart before the horse?

A new (free to download) book discusses the issue: Rethinking Health Care Ethics. The book is a lucid critique of healthcare ethics as a specific subject; a critique that naturally leads into constructive suggestions for an alternative pedagogy. The book should be of high interest to teachers in healthcare ethics, to ethicists, and to anyone who finds that ethics often is presented in ways that make us estranged from ourselves.

What most impresses me in this book is its trust in the human. The foundation of ethics is in the human self, not in moral theory. Any adult human already carries ethics in the self, without verbalizing it as specific ethical concepts and principles.

Certainly, clinicians need education in healthcare ethics. But what is specific in the teaching is the unique ethical challenges that may arise in healthcare. Ethics itself is already in place, in the living humans who are entering healthcare as a profession.

Ethics should not be imposed, then, as if it were a new subject. It rather needs support to grow in humans, and to mature for the specific challenges that arise in healthcare.

This trust in the human is unusual. Distrust, feeding the demand for control, is so much more common.

Pär Segerdahl

Scher, S. & Kozlowska, K. 2018. Rethinking Health Care Ethics. Palgrave

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Category: Musings (Page 6 of 18)

Genetic risk information: lines and stage directions

Sometimes you do not want to be taken seriously

Reality surpasses our concepts

Why do we pay for genetic information that we do not use?

Larger and smaller sized ethics

The human being is not only a category

Dangers of moral words

Contemplative conversations

Supporting clinicians to trust themselves

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