The problem of moral luck: An argument against its epistemic reduction

Whom I call 'epistemic reductionists' in this article are critics of the notion of 'moral luck' that maintain that all supposed cases of moral luck are illusory; they are in fact cases of what I describe as a special form of epistemic luck, the only difference lying in what we get to know about someone, rather than in what (s)he deserves in terms of praise or blame. I argue that epistemic reductionists are mistaken. They implausibly separate judgements of character from judgements concerning acts, and they assume a conception of character that is untenable both from a common sense perspective and with a view to findings from social psychology. I use especially the example of Scobie, the protagonist of Graham Greene's novel The Heart of the Matter, to show that moral luck is real-that there are cases of moral luck that cannot be reduced to epistemic luck. The reality of moral luck, in this example at least, lies in its impact on character and personal and moral identity. © 2009 Springer Science Media B.V

Conscience and Conscientious Objections

Musschenga, A.W. [Promotor

Prevalence of multisite musculoskeletal symptoms: a French cross-sectional working population-based study

BACKGROUND: The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population.METHODS: This study was performed on surveillance data of the cross-sectional survey (2002-2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire. RESULTS: The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb). CONCLUSIONS: The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS

Prévalence des symptômes musculo-squelettiques multi-sites dans une population de travailleurs salariés

Objectif.– La prévalence des troubles musculo-squelettiques (TMS) d’origine professionnelle ne cessent d’augmenter et bien que la très grande majorité des données disponibles sur le sujet portent sur les TMS définis par localisation anatomique, un nombre croissant de travaux témoignent de la faible prévalence des symptômes isolés et bien délimités sur un site anatomique spécifique. L’objectif de ce travail est de décrire la prévalence et les caractéristiques des symptômes musculosquelettiques (SMS) multi-sites (MS) dans une large population de travailleurs salariés français. Méthode.– Cette étude a été réalisée à partir des données de surveillance de l’enquête transversale (2002–2005) du réseau de médecin du travail dans la population des travailleurs salariés de la région des Pays-de-la-Loire (20 à 59 ans). Les données sur les SMS ont été renseignées dans la salle d’attente des médecins du travail du réseau au moyen de l’auto-questionnaire standardisé NORDIC. Résultats.– La population de l’étude comprenait 3710 salariés (58 %, soit 2162 hommes et 42 %, soit 1548 femmes) de moyenne d’âge 38,4 ans (écart-type 10,4 ans). Les catégories professionnelles représentées étaient : « ouvriers qualifiés et non qualifiés » (56 %), « professions intermédiaires » (25 %) ou « cadres » (10 %) chez les hommes et « employées » (52 %), « ouvrières qualifiées et non qualifiées » (24 %) ou « professions intermédiaires » (19 %) chez les femmes. La prévalence des SMS au cours des 12 derniers mois était de 83,8 % avec un intervalle de confiance à 95 % de [82,8–85,3] pour les hommes et de 83,9 % [82,0–85,7] pour les femmes. La prévalence des SMS subaigus (d’au moins 30 jours) au cours des 12 derniers mois était de 32,8 % [30,9–34,8] pour les hommes et de 37,3 % [34,9–39,7] pour les femmes. Deux tiers des salariés déclaraient la présence de SMS sur deux sites anatomiques ou plus (SMS-MS) et environ 20 % déclaraient la présence de SMS d’au moins 30 jours sur deux sites anatomiques ou plus (SMS-MS). Les sites anatomiques les plus fréquemment associés à d’autres SMS étaient le haut du dos, la hanche, le coude et la nuque. La majorité de ces SMS-MS était étendue sur au moins deux des trois régions anatomiques (membre supérieur, région axiale et membre inférieur). Conclusion.– La fréquence et l’étendue des SMS-MS sont considérables chez les travailleurs. Il est indispensable d’approfondir nos connaissances dans ce domaine afin de mieux comprendre leurs caractéristiques et leurs déterminants

Systemic inflammatory mediators in post-traumatic Complex Regional Pain Syndrome (CRPS I) - longitudinal investigations and differences to control groups

<p>Abstract</p> <p>Objectives</p> <p>The Complex Regional Pain Syndrome I (CRPS I) is a disease that might affect an extremity after trauma or operation. The pathogenesis remains yet unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response but neurogenic dysregulation also contributes to it. Some studies investigated the role inflammatory mediators and cytokines; however, few longitudinal studies exist and control groups except healthy controls were not investigated yet.</p> <p>Methods</p> <p>To get further insights into the role of systemic inflammatory mediators in CRPS I, we investigated a variety of pro-, anti-, or neuro-inflammatory mediators such as C-Reactive Protein (CRP), White Blood Cell Count (WBC), Interleukins 4, 6, 8, 10, 11, 12 (p70), Interferon gamma, Tumor-Necrosis-Factor alpha (TNF-α) and its soluble Receptors I/II, soluble Selectins (E, L, P), Substance-P (SP), and Calcitonin Gene-Related Peptide (CGRP) at different time points in venous blood from patients with acute (AC) and chronic (CC) CRPS I, patients with forearm fractures (FR), with neuralgia (NE), and from healthy volunteers (C).</p> <p>Results</p> <p>No significant changes for serum parameters investigated in CRPS compared to control groups were found except for CC/C (CGRP p = 0.007), FR/C (CGRP p = 0.048) and AC/CC (IL-12 p = 0.02; TNFRI/II p = 0.01; SP p = 0.049). High interindividual variations were observed. No intra-or interindividual correlation of parameters with clinical course (e.g. chronification) or outcome was detectable.</p> <p>Conclusion</p> <p>Although clinically appearing as inflammation in acute stages, local rather than systemic inflammatory responses seem to be relevant in CRPS. Variable results from different studies might be explained by unpredictable intermittent release of mediators from local inflammatory processes into the blood combined with high interindividual variabilities. A clinically relevant difference to various control groups was not notable in this pilot study. Determination of systemic inflammatory parameters is not yet helpful in diagnostic and follow-up of CRPS I</p