Noncompliance exasperates health care professionals, leaves them worrying about the effective outcome of medical care, and results in noncompliant patients being labelled as 'difficult' or 'troublesome'. It is suggested that professionals who label a patient as noncompliant are following convenient paternalistic principles rather than considering the impact of a prescribed regimen on an individual patient. In this paper, the author considers autonomy and respect to be foremost in patient care. Further, compliance does not necessarily indicate that both professional and patient (...) have developed a collaborative understanding relationship. Noncompliance is described as a lack of recognition by the health care professional of the meaning of the regimen to the patient. Treatment interventions will be most successful when the patient participates in the prescription. Without acknowledgement of the patient as an equal partner, and listening to his or her narrative, care will be, at best, paternalistic. Les soignants peuvent devenir exasperes par les malades qui n'acquiescent pas à leur traitement. Cela laisse les soignants souciant des résultats de leurs soins et abouti à ce que les malades sont qualifiés de difficiles ou insoumis. On propose ici que le personnel qui traite les malades d'insoumis suit des principes paternalistes plutôt que de considérer les suites des regimes prescrits pour les particuliers. Dans cet article l'auteur considère l'autonomie et le respet comme primordiaux pour les soins. L'acqiescement ne veut pas toujours dire que malades et infirmiers/ères ont développés des rapports collaborateurs. Le refus d'acquiescer est aperçu comme un manque de reconnaissance par la personne soignante de la significance du traitement médical du malade. Les interventions réussissent le mieux quant les malades participent à leurs soins. Si l'on n'accepte pas les malades comme partenaires en écoutant leurs récits, les soins sont au plus du paternalisme. Die Ablehnung der verordneten Behandlung durch die Patienten kann das Pflege personal zur Verzweiflung bringen und den Ausgang der Behandlung in Frage stellen und führt dazu, die Patienten als schwierig oder problematisch einzustrafen. Hier wird die Ansicht vertreten, dass das Pflegepersonal, das Patienten als unkooperativ oder ablehnend bezeichnet, einem paternalistischen Prinzip folgt und nicht an die Wirkung denkt, die die verschriebene Behandlung auf einzelne Patienten hat. In diesem Artikel bezeichnet die Autorin die Selstbestimmung der Patienten und den Respekt ihnen gegenüber als das Wichtigste in der Krankenpflege. Fügsamkeit deutet nicht unbedingt auf eine Zusammenarbeit zwischen Patienten und Pflegenden hin. Zuwiderhandlung der Patienten wird als Mangel an Verständnis von Seiten des Pflegepersonals gesehen, das die Bedeutung, die die Behandlung für Patienten hat, nicht einzuschatzen weiss. Die Behandlung wird nur dann den grösstmöglichen Erfolg bringen, wenn die Patienten daran teilnehmen. Wenn Patienten nicht als gleichberechtigte Partner angesehen werden, deren Meinungen gehört und respektiert werden, ist die Pflege höchstens patemalistisch. (shrink)

This article blends cultural history and theoretical psychology in a discussion of new treatment methods for psychiatric casualties that emerged early in World War II. It draws on philosophical hermeneutics and Hacking's historical ontology to clarify how our interpretation of this history inevitably reflects current struggles making sense of PTSD while efforts to understand this history can enrich present-day reflections about war neurosis and the social good. 2012 APA, all rights reserved).

This interview with N. Katherine Hayles, one of the foremost theorists of the posthuman, explores the concerns that led to her seminal book How We Became Posthuman, the key arguments expounded in that book, and the changes in technology and culture in the ten years since its publication. The discussion ranges across the relationships between literature and science; the trans-disciplinary project of developing a methodology appropriate to their intersection; the history of cybernetics in its cultural and political context ; (...) the changed role for psychoanalysis in the technoscientific age; and the altering forms of mediated ‘embodiment’ in the posthuman context. (shrink)

In this age of DNA computers and artificial intelligence, information is becoming disembodied even as the "bodies" that once carried it vanish into virtuality. While some marvel at these changes, envisioning consciousness downloaded into a computer or humans "beamed" _Star Trek_-style, others view them with horror, seeing monsters brooding in the machines. In _How We Became Posthuman,_ N. Katherine Hayles separates hype from fact, investigating the fate of embodiment in an information age. Hayles relates three interwoven stories: how information (...) lost its body, that is, how it came to be conceptualized as an entity separate from the material forms that carry it; the cultural and technological construction of the cyborg; and the dismantling of the liberal humanist "subject" in cybernetic discourse, along with the emergence of the "posthuman." Ranging widely across the history of technology, cultural studies, and literary criticism, Hayles shows what had to be erased, forgotten, and elided to conceive of information as a disembodied entity. Thus she moves from the post-World War II Macy Conferences on cybernetics to the 1952 novel _Limbo_ by cybernetics aficionado Bernard Wolfe; from the concept of self-making to Philip K. Dick's literary explorations of hallucination and reality; and from artificial life to postmodern novels exploring the implications of seeing humans as cybernetic systems. Although becoming posthuman can be nightmarish, Hayles shows how it can also be liberating. From the birth of cybernetics to artificial life, _How We Became Posthuman_ provides an indispensable account of how we arrived in our virtual age, and of where we might go from here. (shrink)

The cyborg that Donna Haraway appropriated in ‘Manifesto for Cyborgs’ as a metaphor for political action and theoretical inquiry has ceased to have the potency it did 20 years ago. While Haraway has turned from a central focus on technoculture to companion species, much important cultural work remains to be done, especially in networked and programmable media. Problems with the cyborg as a metaphor include the implication that the liberal humanist subject, however problematized by its hybridization with cybernetic mechanism, continues (...) as a singular entity operating with localized agency. In a word, the cyborg is not networked enough to encompass the emergent possibilities associated with the Internet and the world-wide web and other phenomena of the contemporary digital era. Instead I propose the idea of the cognisphere. As operational concept and suggestive metaphor, the cognisphere recognizes that networked and programmable media are not only more pervasive than ever before in human history but also more cognitively powerful. It is closely associated with what many researchers regard as a major insight: the idea that the physical world is fundamentally computational. While these scientists regard computation as a physical process, the cultural critic is apt to see it as an over-determined metaphor. The binary choice between seeing the computational universe as a literal description of the physical world and reading it as an over-determined metaphor misses a crucial aspect of contemporary cultural dynamics: the interaction between means and metaphor, technology and cultural presupposition. Taking this dynamic into account leads to a more complete understanding summed up in the aphorism, ‘What we make and what we are co-evolve together.’. (shrink)

N. Katherine Hayles is known for breaking new ground at the intersection of the sciences and the humanities. In Unthought, she once again bridges disciplines by revealing how we think without thinking—how we use cognitive processes that are inaccessible to consciousness yet necessary for it to function. Marshalling fresh insights from neuroscience, cognitive science, cognitive biology, and literature, Hayles expands our understanding of cognition and demonstrates that it involves more than consciousness alone. Cognition, as Hayles defines it, is applicable (...) not only to nonconscious processes in humans but to all forms of life, including unicellular organisms and plants. Startlingly, she also shows that cognition operates in the sophisticated information-processing abilities of technical systems: when humans and cognitive technical systems interact, they form “cognitive assemblages”—as found in urban traffic control, drones, and the trading algorithms of finance capital, for instance—and these assemblages are transforming life on earth. The result is what Hayles calls a “planetary cognitive ecology,” which includes both human and technical actors and which poses urgent questions to humanists and social scientists alike. At a time when scientific and technological advances are bringing far-reaching aspects of cognition into the public eye, Unthought reflects deeply on our contemporary situation and moves us toward a more sustainable and flourishing environment for all beings. (shrink)

RFID tags, small microchips no bigger than grains of rice, are currently being embedded in product labels, clothing, credit cards, and the environment, among other sites. Activated by the appropriate receiver, they transmit information ranging from product information such as manufacturing date, delivery route, and location where the item was purchased to (in the case of credit cards) the name, address, and credit history of the person holding the card. Active RFIDs have the capacity to transmit data without having to (...) be activated by a receiver; they can be linked with embedded sensors to allow continuous monitoring of environmental conditions, applications that interest both environmental groups and the US military. The amount of information accessible through and generated by RFIDs is so huge that it may well overwhelm all existing data sources and become, from the viewpoint of human time limitations, essentially infinite. What to make of these technologies will be interrogated through two contemporary fictions, David Mitchell's Cloud Atlas and Philip K. Dick's Ubik. Cloud Atlas focuses on epistemological questions — who knows what about whom, in a futuristic society where all citizens wear embedded RFID tags and are subject to constant surveillance. Resistance takes the form not so much of evasion (tactical moves in a complex political Situation) but rather as a struggle to transmit information to present and future stakeholders in a world on the brink of catastrophe. Ubik, by contrast, focuses on deeper ontological questions about the nature of reality itself. Both texts point to the necessity to reconceptualize information as ethical action embedded in contexts and not merely as a quantitative measure of probabilities. (shrink)

Researchers in artificial intelligence and robotics often include a timeline stretching into the future in which they predict the convergence between human and artificial intelligence. Ray Kurzweil, for example, predicts that in a mere 100 years humans and intelligent machines will become indistinguishable from one another, both ceasing to have permanent corporeal forms. This article argues that the one thing we can know for sure about the future is that when it arrives, it will be different from what we imagined. (...) The cultural work that predictions like Kurzweil’s perform is less to prognosticate the future than to shape our understanding of what it means to be human in the present. Working from the ‘sense-think-act’ paradigm foundational to work in artificial intelligence and robotics, this article argues that predictions in all three areas feed back to affect how the human is envisioned in the present. The reconfigurations these predictions bring about are to downplay consciousness, embodied cognition, and evolutionary inertia. The article concludes by critically evaluating contemporary resistances to the posthuman, especially in the writings of Rodney Brooks and Francis Fukuyama. (shrink)

For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such exposure. However, in (...) recent years the increasingly globalized nature of the world’s economy, society and culture, combined with anthropogenic climate change and the evolution of antibiotic resistance, has begun to shift the boundaries that previously defined the categories of person threatened by many exogenous threats to health. In doing so, these factors expose both new and forgotten similarities between persons, and highlight the need for global cooperative responses to the existential threats posed by climate change and the evolution of antimicrobial resistance. In this article, we argue that these emerging health threats, in demonstrating the similarities that exist between even distant persons, provides a catalyst for global solidarity, which justifies, and provides motivation for, the establishment of solidaristic, cooperative global health infrastructures. (shrink)

The recent and ongoing refugee crisis in Europe highlights conflicting attitudes about the rights of migrants and refugees to health care in transition and destination countries. Some European and Scandinavian states, such as Germany and Sweden, have welcomed large numbers of migrants, while others, such as the U.K., have been significantly less open. In part, this is because of reluctance by certain national governments to incur what are seen as the high costs of delivering aid and care to migrants. In (...) response to these assumptions, some theorists have argued that the appropriate way to view the health needs of migrants is not in terms of rights, but in terms of the interests of destination and transition countries—and have argued that providing care to migrants and refugees will generate benefits for their host countries. However, self‐interest alone is less effective at motivating the provision of care for health deprivations that do not pose a threat to third parties, or to migrants and refugees in poor or distant countries. In this paper, I argue that while self‐interest is unlikely in itself to motivate the provision of all necessary health care to all migrants and refugees, and may risk stigmatizing already vulnerable persons, it can provide the foundation upon which such motivations can be built. My goal is therefore to show how and why a more just approach to the provision of health care to migrants can and should be derived from narrower, self‐interested commitments to preserving citizen health. (shrink)

With roots in Greek drama, mimesis has recently undergone expansion into an unexpected domain: microbial resistance to viruses. Research revealed that bacteria copy portions of the DNA of attacking viruses and incorporate them into their own DNA. When a virus attacks again, the bacteria generate matching RNA sequences that, together with the Cas9 protein, enable them to recognize the virus and cut its DNA. This process satisfies the requisites for mimesis, thus justifying the name microbiomimesis. It exemplifies nonconscious cognition, a (...) capacity that all lifeforms possess to process and interpret information in contexts that connect it with meaning. In 2012 Jennifer Doudna and Emmanuelle Carpentier coauthored a paper showing that the bacterial defense of RNA/cas9 can be programmed to work as a gene editing tool. So was born CRISPR-Cas9, a technology now routinely used to edit genes by detecting their precise location and modifying them. Never has mimesis been so controversial and laden with implications for the futures of human and nonhuman lifeforms on the planet; what lessons can its traditions offer? (shrink)

Although there has long been a division in studies of consciousness between a focus on neuronal processes or conversely an emphasis on the ruminations of a conscious self, the long-standing split between mechanism and meaning within the brain was mirrored by a split without, between information as a technical term and the meanings that messages are commonly thought to convey. How to heal this breach has posed formidable problems to researchers. Working through the history of cybernetics, one of the historical (...) sites where Claude Shannon’s information theory quickly became received doctrine, we argue that the cybernetic program as it developed through second-order cybernetics and autopoietic theory remains incomplete. In this article, we return to fundamental questions about pattern and noise, context and meaning, to forge connections between consciousness, narrative and media. The thrust of our project is to reintroduce context and narrative as crucial factors in the processes of meaning-making. The project proceeds along two fronts: advancing a theoretical framework within which context plays its properly central role; and demonstrating the importance of context by analyzing two fictions, Stanislaw Lem’s His Master’s Voice and Joseph McElroy’s Plus, in which context has been deformed by being wrenched away from normal human environments, with radical consequences for processes of meaning-making. (shrink)

The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its (...) promise for salvation. However, once the device was implanted, patients described being placed into a liminal state of being neither sick nor healthy, with no culturally scripted role. Consideration of end-of-life decisions was complicated by the uncertainties about how patients with LVADs die. Pre-implantation communications among patient, family, and clinicians should take into account the impact of the technology on meaning, identity, and patient experience. (shrink)

Volume 20, Issue 10, October 2020, Page 72-74.

Analysing the demands of global justice for the distribution of resources is a complex task and requires consideration of a broad range of issues. Of particular relevance is the effect that different distributions will have on global population growth and individual welfare. Since changes in the consumption and distribution of resources can have major effects on the welfare of the global population, and the rate at which it increases, it is important to establish meaningful principles to ensure a just distribution (...) of resources. In order to establish such principles we must consider the scope of any reproductive rights, and rights to other goods, such as food and health care, as well as examine the extent of duties correlating to those rights. In addition to the impact that distributions of global goods have on the welfare of current generations, it is also important to consider what duties we have, if any, to future generations. -/- The final version of this paper is available to download here: http://dx.doi.org/10.1002/9780470015902.a0024140. (shrink)

The number of women living with HIV/AIDS is increasing worldwide, and there is an urgent public health need to develop new user-initiated HIV prevention methods, including microbicides. Although funding for microbicide development has increased since 2000, financial support is provided predominantly by governmental agencies and private foundations. Many donors, including the US Agency for International Development and the US National Institutes of Health, have policies that restrict how research funds may be used. Among these are the now-rescinded Mexico City Policy, (...) elements of the US Foreign Assistance Act, and restrictions on non-study-related care. The effect of these restrictions on the design and conduct of clinical research is poorly understood. As part of a recent mapping exercise conducted by the Global Campaign for Microbicides, we reviewed the impact of donor restrictions on seven HIV prevention trials. We found considerable confusion within the HIV prevention field as to whether and how Mexico City and other policies affect the use of research funds. We also found that these donor-imposed policies limited the level of care provided to trial participants and the types of capacity building projects undertaken. (shrink)

On 30 June 2021, Ohio state Governor, Mike DeWine, signed a Bill which would enact the state's budget for the next two years. In addition to its core funding imperatives, the Bill also contained an amendment significantly expanding entitlements of health care providers to conscientiously object to professional duties to provide controversial health care services. This amendment has been heavily criticised as providing the means to allow health care providers to discriminate against a wide range of persons by denying them (...) access to often contested services such as abortion and contraception. In this paper, we examine the implications of this amendment and situate it in relation to other legislative actions intended to guarantee absolute rights to conscientious objection. In doing so, we argue that the entitlements extended to health care providers by these Bills are overly broad and ignore their potential to allow significant harm to be caused to clients. We then argue that if health care providers should have rights to conscientiously object, then any legislation intended to protect such rights should be limited, specific, and parsimonious. Where it is not, the ideological liberty of HCPs treads dangerously on the physical freedom of their clients. (shrink)

Between the 14 and 18 March 2016, the Institute for Ethics, History and Theory of Medicine, in cooperation with the Institute for Sociology at Ludwig-Maximilians-University, Munich, hosted an interdisciplinary workshop on migrant and refugee health in Germany and the UK. Fifteen participants from four countries met to discuss ethical issues surrounding the health of migrants and refugees in Europe, with particular emphasis on a comparison of the different approaches taken by Germany and the UK. This report provides an overview of (...) the structure and purpose of the workshop, an outline of the topics discussed, its outcomes, and its objectives moving forward. (shrink)

Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended (...) to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies. (shrink)

Physicians play a critical role in preventing and treating firearm injury, although the scope of that role remains contentious and lacks systematic definition. This piece aims to utilize the fundamental principles of medical ethics to present a framework for physician involvement in firearm violence. Physicians' agency relationship with their patients creates ethical obligations grounded on three principles of medical ethics — patient autonomy, beneficence, and nonmaleficence. Taken together, they suggest that physicians ought to engage in clinical screening and treatment related (...) to firearm violence. The principle of beneficence also applies more generally, but more weakly, to relations between physicians and society, creating nonobligatory moral ideals. Balanced against physicians' primary obligations to patient agency relationships, general beneficence suggests that physicians may engage in public advocacy to address gun violence, although they are not ethically obligated to do so. A fourth foundational principle — justice — requires that clinicians attempt to ensure that the benefits and burdens of healthcare are distributed fairly. (shrink)