Publications by authors named "Elselijn Kingma"

21 Publications

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Ethical Development of Artificial Amniotic Sac and Placenta Technology: A Roadmap.

Front Pediatr 2021 8;9:793308. Epub 2021 Dec 8.

Department of Philosophy, King's College London, London, United Kingdom.

In this paper we present an initial roadmap for the ethical development and eventual implementation of artificial amniotic sac and placenta technology in clinical practice. We consider four elements of attention: (1) framing and societal dialogue; (2) value sensitive design, (3) research ethics and (4) ethical and legal research resulting in the development of an adequate moral and legal framework. Attention to all elements is a necessary requirement for ethically responsible development of this technology. The first element concerns the importance of framing and societal dialogue. This should involve all relevant stakeholders as well as the general public. We also identify the need to consider carefully the use of terminology and how this influences the understanding of the technology. Second, we elaborate on value sensitive design: the technology should be designed based upon the principles and values that emerge in the first step: societal dialogue. Third, research ethics deserves attention: for proceeding with first-in-human research with the technology, the process of recruiting and counseling eventual study participants and assuring their informed consent deserves careful attention. Fourth, ethical and legal research should concern the status of the subject in the AAPT. An eventual robust moral and legal framework for developing and implementing the technology in a research setting should combine all previous elements. With this roadmap, we emphasize the importance of stakeholder engagement throughout the process of developing and implementing the technology; this will contribute to ethically and responsibly innovating health care.
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http://dx.doi.org/10.3389/fped.2021.793308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694243PMC
December 2021

Harming one to benefit another: The paradox of autonomy and consent in maternity care.

Authors:
Elselijn Kingma

Bioethics 2021 06 9;35(5):456-464. Epub 2021 Apr 9.

Department of Philosophy, King's College London, London, United Kingdom of Great Britain and Northern Ireland.

This paper critically analyses 'the paradox of autonomy and consent in maternity care'. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in consent-centred procedures, as well as in unconsented interventions, in ordinary, non-medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non-therapeutic research and transplantation medicine-both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time-and this delivers the titular paradox-the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care.
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http://dx.doi.org/10.1111/bioe.12852DOI Listing
June 2021

Client-care provider interaction during labour and birth as experienced by women: Respect, communication, confidentiality and autonomy.

PLoS One 2021 12;16(2):e0246697. Epub 2021 Feb 12.

Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands.

Introduction: Respectful Maternity Care is important for achieving a positive labour and birth experience. Client-care provider interaction-specifically respect, communication, confidentiality and autonomy-is an important aspect of Respectful Maternity Care. The aim of this study was twofold: (1) to assess Dutch women's experience of respect, communication, confidentiality and autonomy during labour and birth and (2) to identify which client characteristics are associated with experiencing optimal respect, communication, confidentiality and autonomy.

Methods: Pregnant women and women who recently gave birth in the Netherlands were recruited to fill out a validated web-based questionnaire (ReproQ). Mean scores per domain (scale 1-4) were calculated. Domains were dichotomised in non-optimal (score 1, 2,3) and optimal client-care provider interaction (score 4), and a multivariable logistic regression analysis was performed.

Results: Of the 1367 recruited women, 804 respondents completed the questionnaire and 767 respondents completed enough questions to be included for analysis. Each domain had a mean score above 3.5. The domain confidentiality had the highest proportion of optimal scores (64.0%), followed by respect (53.3%), communication (45.1%) and autonomy (36.2%). In all four domains, women who gave birth at home with a community midwife had a higher proportion of optimal scores than women who gave birth in the hospital with a (resident) obstetrician or hospital-based midwife. Lower education level, being multiparous and giving birth spontaneously were also significantly associated with a higher proportion of optimal scores in (one of) the domains.

Discussion: This study shows that on average women scored high on experienced client-care provider interaction in the domains respect, communication, confidentiality and autonomy. At the same time, client-care provider interaction in the Netherlands still fell short of being optimal for a large number of women, in particular regarding women's autonomy. These results show there is still room for improvement in client-care provider interaction during labour and birth.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246697PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880498PMC
August 2021

In defence of gestatelings: response to Colgrove.

Authors:
Elselijn Kingma

J Med Ethics 2020 Sep 8. Epub 2020 Sep 8.

Department of Philosophy, University of Southampton Faculty of Arts and Humanities, Southampton, UK

Ectogestation-that is, 'artificial' or extramammalian pregnancy-may soon be within technological reach. This confronts us with questions about the correct moral and legal attitude towards the subjects of this technology, which are called 'gestatelings'. Colgrove argues that gestatelings are a kind of newborn, and consequently should have the same moral and legal protections as newborns. This paper responds that both claims are unsupported by his arguments, which equivocate on two understandings of the term 'newborn'. Questions about the appropriate moral and legal status of gestatelings are therefore (once again, and correctly) left unanswered, but in the course of attempting to answer them, we are well advised to continue using the term gestateling.
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http://dx.doi.org/10.1136/medethics-2020-106630DOI Listing
September 2020

Parental obligation and compelled caesarean section: careful analogies and reliable reasoning about individual cases.

J Med Ethics 2020 Jun 22. Epub 2020 Jun 22.

Law School, University of Bristol, Bristol, UK.

Whether it is morally permissible to compel women to undergo a caesarean section is a topic of longstanding debate. Despite plenty of arguments against the moral permissibility of a forced caesarean section, the question keeps cropping up. This paper seeks to scrutinise a particular moral argument in favour of compulsion: the appeal to parental obligation. We present what we take to be a distillation of the basic form of this argument. We then argue that, in the absence of an exhaustive theory of parental obligation, the question of whether a labouring woman is morally obliged to undergo emergency surgery-and especially the further question of it is morally permissible for third parties to compel this-cannot be answered via ready-made theory. We propose that the most viable option for settling both questions is by analogy. We follow earlier writers in presenting an analogous case-that of fathers being compelled to undergo non-consensual invasive surgery to save their children-but expand the analogy by considering objections that appeal to the ownership of the fetus. We offer two lines of response: (1) the parthood view of pregnancy and (2) chimaera dad. We argue that it is clear in the analogous case that compulsion cannot be justified. We also offer this analogy as a useful tool for assessing whether mothers have a moral duty to undergo caesarean sections, both in general and in particular cases, even if such a duty is insufficient to warrant compulsion.
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http://dx.doi.org/10.1136/medethics-2020-106072DOI Listing
June 2020

Nine Months.

Authors:
Elselijn Kingma

J Med Philos 2020 05;45(3):371-386

University of Southampton, Southampton, United Kingdom.

When did we begin to exist? Barry Smith and Berit Brogaard argue that a new human organism comes into existence neither earlier nor later than the moment of gastrulation: 16 days after conception. Several critics have responded that the onset of the organism must happen earlier; closer to conception. This article makes a radically different claim: if we accept Smith and Brogaard's ontological commitments, then human organisms start, on average, roughly nine months after conception. The main point of contention is whether the fetus is or is not part of the maternal organism. Smith and Brogaard argue that it is not; I demonstrate that it is. This claim in combination with Smith and Brogaard's own criteria commits to the view that human organisms begin, precisely, at birth.
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http://dx.doi.org/10.1093/jmp/jhaa005DOI Listing
May 2020

Left powerless: A qualitative social media content analysis of the Dutch #breakthesilence campaign on negative and traumatic experiences of labour and birth.

PLoS One 2020 12;15(5):e0233114. Epub 2020 May 12.

Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, VU medical centre, Amsterdam, The Netherlands.

Introduction: Disrespect and abuse during labour and birth are increasingly reported all over the world. In 2016, a Dutch client organization initiated an online campaign, #genoeggezwegen (#breakthesilence) which encouraged women to share negative and traumatic maternity care experiences. This study aimed (1) to determine what types of disrespect and abuse were described in #genoeggezwegen and (2) to gain a more detailed understanding of these experiences.

Methods: A qualitative social media content analysis was carried out in two phases. (1) A deductive coding procedure was carried out to identify types of disrespect and abuse, using Bohren et al.'s existing typology of mistreatment during childbirth. (2) A separate, inductive coding procedure was performed to gain further understanding of the data.

Results: 438 #genoeggezwegen stories were included. Based on the typology of mistreatment during childbirth, it was found that situations of ineffective communication, loss of autonomy and lack of informed consent and confidentiality were most often described. The inductive analysis revealed five major themes: ''lack of informed consent"; ''not being taken seriously and not being listened to"; ''lack of compassion"; ''use of force"; and ''short and long term consequences". "Left powerless" was identified as an overarching theme that occurred throughout all five main themes.

Conclusion: This study gives insight into the negative and traumatic maternity care experiences of Dutch women participating in the #genoeggezwegen campaign. This may indicate that disrespect and abuse during labour and birth do happen in the Netherlands, although the current study gives no insight into prevalence. The findings of this study may increase awareness amongst maternity care providers and the community of the existence of disrespect and abuse in Dutch maternity care, and encourage joint effort on improving care both individually and systemically/institutionally.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233114PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217465PMC
August 2020

Neonatal incubator or artificial womb? Distinguishing ectogestation and ectogenesis using the metaphysics of pregnancy.

Bioethics 2020 05 5;34(4):354-363. Epub 2020 Apr 5.

Faculty of Humanities, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland.

A 2017 Nature report was widely touted as hailing the arrival of the artificial womb. But the scientists involved claim their technology is merely an improvement in neonatal care. This raises an under-considered question: what differentiates neonatal incubation from artificial womb technology? Considering the nature of gestation-or metaphysics of pregnancy-(a) identifies more profound differences between fetuses and neonates/babies than their location (in or outside the maternal body) alone: fetuses and neonates have different physiological and physical characteristics; (b) characterizes birth as a physiological, mereological and topological transformation as well as a (morally relevant) change of location; and (c) delivers a clear distinction between neonatal incubation and ectogestation: the former supports neonatal physiology; the latter preserves fetal physiology. This allows a detailed conceptual classification of ectogenetive and ectogestative technologies according to which the 2017 system is not just improved neonatal incubation, but genuine ectogestation. But it is not an artificial womb, which is a term that is better put to rest. The analysis reveals that any ethical discussion involving ectogestation must always involve considerations of possible risks to the mother as well as her autonomy and rights. It also adds a third and potentially important dimension to debates in reproductive ethics: the physiological transition from fetus/gestateling to baby/neonate.
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http://dx.doi.org/10.1111/bioe.12717DOI Listing
May 2020

Conference report: interdisciplinary workshop in the philosophy of medicine: parentalism and trust.

J Eval Clin Pract 2015 Jun 22;21(3):542-8. Epub 2015 Apr 22.

Department of Philosophy, Central European University, Budapest, Hungary; Center for Ethics and Law in Biomedicine, Central European University, Budapest, Hungary.

On 13 June 2014, the Centre for the Humanities and Health at King's College London hosted a 1-day workshop on 'parentalism and trust'. This workshop was the sixth in a series of workshops whose aim is to provide a new model for high-quality open interdisciplinary engagement between medical professionals and philosophers. This report briefly describes the workshop methodology and the discussions on the day.
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http://dx.doi.org/10.1111/jep.12365DOI Listing
June 2015

Interdisciplinary workshop in the philosophy of medicine: medical knowledge, medical duties.

J Eval Clin Pract 2014 Dec 2;20(6):994-1001. Epub 2014 Dec 2.

Department of Philosophy, Central European University, Budapest, Hungary.

On 27 September 2013, the Centre for the Humanities and Health (CHH) at King's College London hosted a 1-day workshop on 'Medical knowledge, Medical Duties'. This workshop was the fifth in a series of five workshops whose aim is to provide a new model for high-quality, open interdisciplinary engagement between medical professionals and philosophers. This report identifies the key points of discussion raised throughout the day and the methodology employed.
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http://dx.doi.org/10.1111/jep.12237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737224PMC
December 2014

Naturalism about health and disease: adding nuance for progress.

Authors:
Elselijn Kingma

J Med Philos 2014 Dec 4;39(6):590-608. Epub 2014 Nov 4.

University of Southampton, Highfield, Southampton, UK

The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of "health" and "disease," (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present new arguments in response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease.
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http://dx.doi.org/10.1093/jmp/jhu037DOI Listing
December 2014

Interdisciplinary workshop in the philosophy of medicine: bodies and minds in medicine.

J Eval Clin Pract 2013 Jun;19(3):564-71

Finnish Centre of Excellence in Philosophy of the Social Sciences, Department of Politics and Economic Studies, Helsinki University, Helsinki, Finland.

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http://dx.doi.org/10.1111/jep.12059DOI Listing
June 2013

Interdisciplinary workshop in the philosophy of medicine: death.

J Eval Clin Pract 2012 Oct;18(5):1072-8

Department of Philosophy, King's College, London, UK.

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http://dx.doi.org/10.1111/j.1365-2753.2012.01920.xDOI Listing
October 2012

Interdisciplinary workshop report: methodology and 'Personhood and Identity in Medicine'.

J Eval Clin Pract 2012 Oct;18(5):1057-63

Department of Philosophy, King's College London, London, UK.

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http://dx.doi.org/10.1111/j.1365-2753.2012.01917.xDOI Listing
October 2012

Interdisciplinary workshop on concepts of health and disease: report.

J Eval Clin Pract 2011 Oct;17(5):1018-22

King's College Centre for Humanities and Health/Department of Philosophy, King's College London, London, UK.

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http://dx.doi.org/10.1111/j.1365-2753.2011.01745.xDOI Listing
October 2011

Editorials about home birth--proceed with caution.

Authors:
Elselijn Kingma

Lancet 2010 Oct;376(9749):1298

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http://dx.doi.org/10.1016/S0140-6736(10)61909-5DOI Listing
October 2010

What is it to be healthy?

Authors:
Elselijn Kingma

Analysis 2007 04;67(294):128-133

Department of History and Philosophy of Science Cambridge University Free School Lane, Cambridge CB2 3RH, UK

According to Christopher Boorse's Bio-Statistical Theory (BST), 'health' is statistically normal function in a reference class, and 'health' and 'disease' are empirical, objective and value-free concepts. I demonstrate that the success of the BST depends on its choice of reference classes; different reference classes result in different accounts of health. I argue that nothing in nature empirically or objectively dictates the use of reference classes Boorse proposes. Reference classes in the BST, and the concept of health, are therefore not value-free. Nor is there a reason to favour the BST over accounts of health that use different reference classes.
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http://dx.doi.org/10.1093/analys/67.2.128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2239248PMC
April 2007

Perception of emotional facial expressions at different intensities in early-symptomatic Huntington's disease.

Eur Neurol 2006 8;55(3):151-4. Epub 2006 May 8.

Psychological Laboratory, Helmholtz Instituut, Utrecht University, The Netherlands.

Background: While there is abundant evidence that patients with Huntington's disease (HD) have an impairment in the recognition of the emotional facial expression of disgust, previous studies have only examined emotion perception using full-blown facial expressions.

Objective: The current study examines the perception of facial emotional expressions in HD at different levels of intensity to investigate whether more subtle deficits can be detected, possible also in other emotions.

Method: We compared early symptomatic HD patients with healthy matched controls on emotion perception, presenting short video clips of a neutral face changing into one of the six basic emotions (happiness, anger, fear, surprise, disgust and sadness) with increasing intensity. Overall face perception ability as well as depressive symptoms were taken into account.

Results: A specific impairment in recognizing the emotions disgust and anger was found, which was present even at low emotion intensities.

Conclusion: These results extend previous findings and support the use of more sensitive emotion perception paradigms, which enable the detection of subtle neurobehavioral deficits even in the pre- and early symptomatic stages of the disease.
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http://dx.doi.org/10.1159/000093215DOI Listing
August 2006
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