Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

We have all heard a refrain much like this one over the last decade, increasingly so, as the cost of genetic sequencing has been drastically reduced with improvements in associated techniques and technologies. Already, discoveries are being made in laboratories that can help doctors determine from which drug a particular patient will receive the most efficacious treatment. The working presumption is that, eventually, individuals’ genetic sequence information will be included in each of their personal medical records.

Purрose of the рaрer is to emphasize affinity and succession in the aррroaches of Descartes and Kierkegaard to the interpretation of key factors of their philosophical search. It could be implemented through understanding such viewpoints of both thinkers as a) appropriate reasons for human existence; b) possible factors for human freedom as a condition of self-actualization; c) original approach to prove the existence of God. Theoretical basis. The use of phenomenology and hermeneutics enable us to comprehend the key philosopher’s ideas (...) as the manifestation of their personalities. Originality. The author believes that it is quite right to refer to the philosophy of the early modern period as a form of its demand fulfillment for human development. An essential prerequisite for revealing the toрic of the article is a focus on the latest investigations of Descartes’ philosophy, which demonstrate the anthropological significance. Since Kierkegaard’s viewpoint was developed through depersonalized understanding of philosophy, related motives of their thoughts are expressed by emphasizing their personal motives of philosophizing. This affinity is reflected firstly, in distancing from depersonalized and dehumanized world view; secondly, in religion-oriented search and proof of God’s existence based on human nature. Conclusions. Due to the modern state of historical and philosophical science, it is possible to argue that Descartes and Kierkegaard had content-related philosophizing motives, which are close to current search. Interpreting Descartes’ anthropological project by Kierkegaard, the author states the accepted determining influence of Hegel’s philosophy interpretation in general and his interpretation of Descartes, in particular. This argument allows to understand Kierkegaard’s search as Hegel’s deconstruction, because further uncritical retention and reproduction of his viewpoints are evaluated as a threat to fulfill human spiritual calling. A common and important thing in the views of both thinkers is their strong interest in individual and personal aspects of human nature as a constituent factor of God’s existence. (shrink)

L'ouvrage ici presente appartient peut-etre a la derniere periode de la production d'Avicenne. Le Livre des directives et remarques supplee les parties perdues de La philosophie orientale, dernier grand projet avicennien, en ce sens qu'il tend a rearticuler science divine et science universelle, par raport a l'entreprise philosophique du Shifa'. Neanmoins les Directives ne sont aucunement un traite, mais plutot un recueil de notes sur des points controverses. Les liens entre les chapitres sont souvent tenus, parfois meme arbitraires, mais il (...) ressort pourtant de la des modifications importantes par rapport aux philosophes grecs. Les theories d'Avicenne sont ainsi toutes en faveur d'une pensee rationaliste et scientifique. L'avance scientifique des orientaux a, pour lui, ouvert a l'intelligence des voies nouvelles; les methodes grecques de pensee demeurent fondamentales, mais des exigences inconnues de leur temps demandent qu'elles soient depassees. (shrink)

Objectives: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.Methods: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm (...) patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.Results: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.Discussion: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles. (shrink)

Виходячи з запитаності в сучасній культурі метафізичного осмислення природи людини, укоріненого в філософському спадку Канта, автор зосереджує увагу на експлікації антропологічних інтенцій кантівських «Критик», акцентуючи амбівалентність позиції мислителя на проблемі автентичної форми метафізичної антропології.

Informed consent enjoys an unassailable position in both clinical and research situations as a safeguard of patients’ rights. Keeping the patient involved in the decision making process is easier when there is direct communication with the individual. The Pakistani milieu offers challenges to this process because crucial decision making is often done by family members or is left entirely up to the attending physician. There seems to be a general acceptance of this shifting of focus from the individual to other (...) players. This also raises certain ethical dilemmas for physicians who may feel uncomfortable with communication which excludes the patient or in accepting a paternalistic primary decision making role. The objective of this informal qualitative study was to ascertain physicians’ perceptions regarding the process of information delivery to the patient in the Pakistani context and the various influences acting upon it. (shrink)

This book presents and exemplifies the theory of grammar called Semantic Syntax. The grammar, which offers a syntactic theory closely connected with semantic analyses, is a direct continuation of Generative Semantics; it will re-ignite interest in that framework which flourished and promised so much in the 1960s and 1970s.

Adrian Viens, Guest Editor of this Olivieri symposium, and Julian Savulescu, the Editor of JME, set the scene for the symposium."In failing...[her] when she needed them most, it is now clear that some members of the University’s Faculty of Medicine heard her muffled cries of academic freedom from the back room, yet their response was to serve another round of drinks and turn the music up louder. With the bombshell revelations in the...affair, the plug may have been pulled on this (...) business sponsored party, and hopefully a sober re-examination of the university’s neglected role and responsibility toward independent inquiry and academic freedom can begin.1" "These guys don’t get one thing—we’re not going away. This isn’t a personal vendetta. This is something I want patients to be protected from when I’m dead, fifty years from now.2" "[The Olivieri affair is] not a mystery novel, but instead the latest skulduggery at Toronto’s Hospital for Sick Children.1" "The legal assaults which you have endured in your battle against the drug company, and in your battle against the medical establishment appear to have been fought with the type of uncommon bravery that is rarely seen. It is for this reason that our trustees have unanimously chosen to recognise you for this most prestigious award.3" "[The Olivieri affair resulted from] a fundamental misreading of the issue as a mere contractual and scientific dispute...[it is] Canada’s worst academic and research scandal in decades...[Since 1998, Olivieri has been] demoted, then restored, then harassed. She has been smeared with allegations attacking her competence, integrity, sanity and personality....4"The Olivieri affair is one of the most important events to occur in research ethics. From its dominance in the Canadian and international news media, to changes in the governance of public health, academic medicine, …. (shrink)

This book distinguishes itself in its integrated approach towards scientific research, and studies the basics of the methodology of scientific research and the organization of scientific activity from the viewpoint of systems science and system analysis. The book discusses the basics of the methodology including philosophical, psychological, epistemological and ethical/aesthetical foundations, the characteristics of scientific activity, including principles of scientific cognition, the means and methods of scientific research, the organization of a research implementation process and its chronological structure and finally, (...) the organization of a collective scientific research design. (shrink)

The article explores the informal side of the idea of the proof. The word "idea" is used in a sense dating back to Plato. Proof is understood as a precisely established connection of precisely formulated and objectively existing ideas. This connection of ideas belongs to the realm of the possible and can be present in some possible worlds and absent in others. Attempts to interpret the proof as a procedure of convincing argumentation are criticized. It is shown that the proof (...) is not necessarily convincing, and that persuasiveness may be inherent outside the proof-based forms of argument. The genesis of the idea of the proof is briefly traced from its origins to the present day. Arguments are made in favor of the thesis of the idea of the proof in Pythagorean philosophy. The question of why the idea of the proof has not been rediscovered anywhere and never is discussed. The problem of the time gap between the appearance of the proof and the exact definition of the concept of the proof in modern logic is considered. An accessible example substantiates the inseparability of the idea of the proof from its formal presentation in one or another logic. A list of some basic informal predicates of the proof is given and a brief description is given. (shrink)

This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking (...) about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (shrink)

Parents’ freedom to choose infant male circumcision is the correct policyIndividuals and groups lobbying to have infant male circumcision prohibited or restricted often argue that the practice of routinely circumcising infants is unjustified. For instance, in this issue of the journal, John Hutson argues that it is virtually impossible to justify a policy in which the medical establishment should be able to embark on a “mass circumcision” campaign of 100% of the infant male population [see page 238].1Indeed, I would be (...) hard pressed to find anyone who could rationally disagree with this contention. However, this is because no one is currently arguing for the enactment of a policy that stipulates that all healthy male infants should be routinely circumcised . Arguments seeking to support a prohibition of “routine infant circumcision”, such as the one by Hutson, are arguing against a straw man—and a pitiful one at that.2 Such arguments only serve to misconstrue the debate and avoid engaging in the real and pressing issues concerning the legitimacy of the provision of this procedure.The questions that should be considered, and the ones which I shall be interested in discussing here, are what reasons are justifiable for allowing parents to choose to have their son circumcised? After well informed and careful deliberation should parents have the freedom to choose to have their son circumcised? These are the most relevant questions to be considered because there is a growing collection of citizens, medical practitioners, and lawyers who are currently lobbying for the practice of infant male circumcision to be outlawed—for example, there is a bioethicist who argues that the criminal law should be used …. (shrink)

In classical Greek poetry there is a familiar distinction between verse which repeats line upon line, and that which forms patterns liable to closure at intervals, in stanzas or lyric sections. This is often equated with the distinction between spoken and sung verse, but the equation is only approximate. At an earlier stage all verse had some musical accompaniment—so much can be deduced from a number of passages in Homer, and is in any case implicit in the nature of quantitative (...) verse. By Hellenistic times it seems that, in new composition, the more complex lyric structures had died out, while of the simpler ones more and more were being taken over as spoken verse. In the fifth century—and this can probably be extended to at least the late sixth and most of the fourth—only two kinds of verse are known to have dispensed with music altogether in performance: the heroic hexameter and the iambic trimeter. (shrink)

In classical Greek poetry there is a familiar distinction between verse which repeats line upon line, and that which forms patterns liable to closure at intervals, in stanzas or lyric sections. This is often equated with the distinction between spoken and sung verse, but the equation is only approximate. At an earlier stage all verse had some musical accompaniment—so much can be deduced from a number of passages in Homer, and is in any case implicit in the nature of quantitative (...) verse. By Hellenistic times it seems that, in new composition, the more complex lyric structures had died out, while of the simpler ones more and more were being taken over as spoken verse. In the fifth century—and this can probably be extended to at least the late sixth and most of the fourth—only two kinds of verse are known to have dispensed with music altogether in performance: the heroic hexameter and the iambic trimeter. (shrink)