We read with interest Dominic Wilkinson’s article “Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?” on the utility of the Clinical Frailty Score in...

Volume 19, Issue 6, June 2019, Page 34-36.

As Alfandre and colleagues describe in “Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures”, efforts to maintain standards of care durin...

BackgroundThe expectation of pandemic-induced severe resource shortages has prompted authorities to draft and update frameworks to guide clinical decision-making and patient triage. While these documents differ in scope, they share a utilitarian focus on the maximization of benefit. This utilitarian view necessarily marginalizes certain groups, in particular individuals with increased medical needs.Main bodyHere, we posit that engagement with the disability critique demands that we broaden our understandings of justice and fairness in clinical decision-making and patient triage. We propose the capabilities (...) theory, which recognizes that justice requires a range of positive capabilities/freedoms conducive to the achievement of meaningful life goals, as a means to do so. Informed by a disability rights critique of the clinical response to the pandemic, we offer direction for the construction of future clinical triage protocols which will avoid ableist biases by incorporating a broader apprehension of what it means to be human.ConclusionThe clinical pandemic response, codified across triage protocols, should embrace a form of justice which incorporates a vision of pluralistic human capabilities and a valuing of positive freedoms. (shrink)

There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...) are bound by our ethical commitments as physicians to balance the obligations of care with the duty to teach. In order to ethically validate the model of ‘surgeon as teacher’, we propose that there must be a reconciliation of the tensions between traditional professional values in medicine with the constraints inherent in a time-bound utilitarian medical system. Ultimately, we must consciously accept that ensuring the longitudinal availability of skilled surgeons in society aligns more closely with our core ethical obligations as outlined in the social contract that medical professionals maintain with the general public than does the ethical demand to provide unreservedly individual-focused patient care. It is the duty of individual practitioners, as a necessity of lineage to maintain and fulfil our greater duties to society, to foster deontological relationships where possible within this utilitarian system while accepting short-term imperfection in our practice. There are no data in this manuscript. (shrink)

The aim of a theoretically ideal process of informed consent is to promote the autonomy of the patient and to limit unethical physician paternalism. However, in practice, the nature of the medical profession requires physicians to act as ontological decision architects—based on the medical knowledge that they acquire through their experience and training, physicians ontologically determine a subset of viable courses of action for their patient. What is observed is not an unethical physician limitation or biasing of the patient towards (...) certain treatment options that violates patient autonomy or consciously undermines informed consent, but rather a more foundational paternalism that is necessarily inherent to the physician–patient relationship. In this article we argue for a recognition of this underlying physician paternalism and posit that this necessary paternalism is not a foil to patient autonomy, but rather a foundational aspect of the duties of the medical professional within the physician–patient relationship. (shrink)

The aim of a theoretically ideal process of informed consent is to promote the autonomy of the patient and to limit unethical physician paternalism. However, in practice, the nature of the medical profession requires physicians to act as ontological decision architects—based on the medical knowledge that they acquire through their experience and training, physicians ontologically determine a subset of viable courses of action for their patient. What is observed is not an unethical physician limitation or biasing of the patient towards (...) certain treatment options that violates patient autonomy or consciously undermines informed consent, but rather a more foundational paternalism that is necessarily inherent to the physician–patient relationship. In this article we argue for a recognition of this underlying physician paternalism and posit that this necessary paternalism is not a foil to patient autonomy, but rather a foundational aspect of the duties of the medical professional within the physician–patient relationship. (shrink)

This 44-chapter volume tackles a quickly-evolving field of inquiry, mapping the existing discourse as part of a general attempt to place current developments in historical context; at the same time, breaking new ground in taking on novel subjects and pursuing fresh approaches. The term "A.I." is used to refer to a broad range of phenomena, from machine learning and data mining to artificial general intelligence. The recent advent of more sophisticated AI systems, which function with partial or full autonomy and (...) are capable of tasks which require learning and 'intelligence', presents difficult ethical questions, and has drawn concerns from many quarters about individual and societal welfare, democratic decision-making, moral agency, and the prevention of harm. This work ranges from explorations of normative constraints on specific applications of machine learning algorithms today-in everyday medical practice, for instance-to reflections on the (potential) status of AI as a form of consciousness with attendant rights and duties and, more generally still, on the conceptual terms and frameworks necessarily to understand tasks requiring intelligence, whether "human" or "A.I.". (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’.1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous, and that what is implied by its usage will certainly depend on context, particularly in medical settings. Hence, the creation of a unifying definition is less critical than clarification of the implied and intended meanings of each instance of the term’s use. We further argue that interpreting the use of terms like ‘invasiveness’ in medical practice is complicated by the embedding of each use of this term in a different ‘language game’, whereby words and their meanings are understood by an in-group familiar with …. (shrink)

In their forthcoming article, Shavelson and colleagues (2023) identify a key ethical concern associated with medical aid-in-dying (MAiD) laws in the eleven US jurisdictions where the practice is le...

Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...) not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging for healthcare (...) providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's “authentic” wishes from future “inauthentic” changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. (shrink)

In a recent opinion paper, it was argued that individuals with multiple retractions or a record of academic misconduct should not serve as editors, including as editors-in-chief, on the editorial boards of scholarly or academic journals. As a first step towards appreciating how such a policy could be applied in practice, the presence of 30 individuals listed on the Retraction Watch Leaderboard on editorial boards was screened. Six cases are highlighted to gain an appreciation of the potential reputational risks that (...) journals and publishers might incur by including individuals with a tainted academic record on editorial boards. Given the reputational, legal and other risks associated with this type of assessment and decision, more formal positioning and guidance are needed by global ethics policy-related bodies such as COPE, the ICMJE, and the CSE, even more so in journals that claim to follow these organizations’ ethical guidelines. (shrink)

Bottom of the Pyramid organizations are the ones that develop a set of capabilities that contribute to create short- and long-term sustainability values inside and outside the boundaries of BoP ecosystems. Capabilities have an important role in BoP organizations’ strategies that aim to solve BoP issues. Notwithstanding its developments, BoP research still lacks theoretical contributions for the analysis of organizations. We suggest special attention to the need of advancing knowledge on capabilities of BoP organizations because this field is scattered and (...) fragmented, misinterpreted, and still underdeveloped in the literature. We oriented our research formulating and seeking answers to our main question on what are the capabilities needed to enable organizations to create sustainability values in BoP ecosystems? We conducted an integrative review of BoP research for the period from 1998 to 2019, and we found 22 key capabilities of BoP organizations. We organized the capabilities into four major categories including BoP Responsible Consumption, BoP Responsible Business Model, BoP Responsible Management, and BoP Responsible Innovation. We advanced propositions and discussions regarding the capabilities and major categories’ popularity, interdependence and combination, short- and long-term temporal functions, sustainability roles, and effectiveness to address BoP issues. Our article organizes the field of capabilities of BoP organizations; advances contributions and implications for management, organizations, and policymaking; and opens fruitful avenues for future research. (shrink)

The purpose of the present paper is to consider the traditional interpretive problems of quantum mechanics from the viewpoint of a modal ontology of properties. In particular, we will try to delineate a quantum ontology that (i) is modal, because describes the structure of the realm of possibility, and (ii) lacks the ontological category of individual. The final goal is to supply an adequate account of quantum non-individuality on the basis of this ontology.

The aim of this work is to present the thesis “On the Ontogenetic Evolution of the Human Embryo in its Relations with Phylogenesis,” by Affonso Regulo de Oliveira Fausto, published in Brazil in 1890. To our knowledge, it was one of the first Brazilian academic works focused specifically on evolution. It was also the first doctoral thesis that addressed the topic of recapitulation in order to analyze what was then called the progressive evolution of the human species in tandem with (...) the embryological development of the individuals that would constitute the Brazilian “type.” In the present work, we analyze the author’s thesis in relation to its sources, concepts, as well as the country’s political context at the time of its publication. Fausto’s text, in which he explicitly recognized the influence of Ernst Haeckel’s recapitulation theory, represents a window to understand better a concept of nation based on science and on the idea of inexorable progress that was accepted in Brazil at the end of the nineteenth century. (shrink)

We cannot simply observe that Emile Durkheim, Claude Lévi-Strauss, and Pierre Bourdieu all received philosophical training and subsequently asserted, in surprisingly similar terms, that escaping from philosophy or breaking away from philosophical modes of thought was a necessary condition for any research in the human and social sciences, without considering whether there might be a direct relationship between the sociological ethos and a particular attitude towards philosophy. The "rupture" with philosophyis never complete: the sociologists' conception of sociology is, on the (...) contrary, heavily influenced by the negative image they have of philosophy, which they always invoke as something to be avoided or a specter that must be exorcised. The sociological perception of philosophy thus constitutes a system of oppositions, a set of likes and dislikes deeply ingrained in the minds of practitioners in the human and social sciences, and which, so to speak, form the very foundation of the discipline and its definition of its identity. By reconstructing it, this article proposes a sociological analysis of the genesis, structure, and function of the sociological unconscious. (shrink)

O artigo em questão se detém nas implicações epistemológicas da revolução copernicana de Immanuel Kant, cuja perspectiva, emergindo das fronteiras que inter-relacionam o racionalismo de Leibniz, o empirismo de Hume e a ciência positiva físico-matemática de Newton, instaura o horizonte do idealismo transcendental, estabelecendo a correlação fundamental envolvendo o sujeito e o objeto do conhecimento.

This paper explores that the topic of ethics dumping, its causes and potential remedies. In ED, the weaknesses or gaps in ethics policies and systems of lower income countries are intentionally exploited for intellectual or financial gains through research and publishing by higher income countries with a more stringent or complex ethical infrastructure in which such research and publishing practices would not be permitted. Several examples are provided. Possible ED needs to be evaluated before research takes place, and detected prior (...) to publication as an academic paper, because it might lead to a collaborative effort between a wealthier country with restrictive ethical policies and a less wealthy country with more permissive policies. Consequently, if that collaboration ultimately results in an academic paper, there are ethical ramifications of ED to scholarly communication. Institutional review board approval is central to avoid ED-based collaborations. Blind trust and goodwill alone cannot eliminate the exploitation of indigenous or “vulnerable” populations’ intellect and resources. Combining community-based participatory research using clear codes of research conduct and a simple but robust verification system in academic publishing may reduce the risks of ED-based research from being published. (shrink)

Detendo-se na investigação dos dois grandes modelos que caracterizam o pensamento político, a saber, o modelo clássico e o modelo jusnaturalista, o artigo em questão, distinguindo no âmbito daquele as teorias idealistas e realistas, empreende uma abordagem que nas fronteiras deste último sublinha desde a questão que envolve Como nasceu o Estado?, proposta pela perspectiva historicista, que traz como fundamento o homem como animal político, até a leitura racionalista, que acena com o problema Por que existe o Estado?, identificando o (...) homem como um ser naturalmente antissocial, salientando que se o bem comum determina a visão platônico-aristotélica, a leitura hobbesiana instaura uma lógica que emerge através do contrato social e assinala a tendência natural da autopreservação como fundamento da ação humana, consistindo, em suma, na transição da ordem mecânica da matéria à ordem final da vontade. (shrink)

Le recueil d'études Contempler l'infini invite le lecteur à étudier la fonction de l'acte contemplatif dans son rapport à l'espace et au temps, en s'interrogeant notamment sur la valeur et la portée épistémiques de cet acte (d'un point de vue mathématique, philosophique, phénoménologique, esthétique, artistique, linguistique et poétique) lorsqu'il se détermine en relation à une réalité représentée comme "infinie" (Dieu, âme, cosmos, etc.). Ce livre est conçu dans un contexte éminemment interdisciplinaire, l'objectif étant de comprendre comment cette articulation subtile des (...) deux concepts peut être abordée selon des méthodologies et des lexiques très différents mais bien souvent complémentaires sur le plan épistémologique. Le recueil regroupe les études et les réflexions des chercheurs français et hongrois de différentes spécialités (mathématiques, philosophie, esthétique. phénoménologie, théologie, linguistique et littérature). (shrink)

As part of a continuous process to explore the factors that might weaken or corrupt traditional peer review, in this paper, we query the ethics, fairness and validity of the request, by editors, of authors to suggest peer reviewers during the submission process. One of the reasons for the current crisis in science pertains to a loss in trust as a result of a flawed peer review which is by nature biased unless it is open peer review. As we indicate, (...) the fact that some editors and journals rely on authors’ suggestions in terms of who should peer review their paper already instills a potential way to abuse the trust of the submission and publishing system. An author-suggested peer reviewer choice might also tempt authors to seek reviewers who might be more receptive or sympathetic to the authors’ message or results, and thus favor the outcome of that paper. Authors should thus not be placed in such a potentially ethically compromising situation, especially as a mandatory condition for submission. However, the fact that they do not have an opt-out choice during the submission process—especially when using an online submission system that makes such a suggestion compulsory—may constitute a violation of authors’ rights. (shrink)

Objectives Older adults are considered one of the most vulnerable groups to COVID-19. However, previous studies on emotion and aging have found that older adults report better well-being than younger adults in global survey and daily report. To better understand older adults’ well-being during the COVID-19 outbreak, we examined age differences in daily affective experiences in this study. Method Two hundred and thirty-one participants from mainland China aged 18 to 85 were recruited to participate in the 14-day daily diary study, (...) after a pretest. Their trait affect and demographic information were measured in the pretest. Their daily affect and stress levels were measured in the daily assessments. Results We found that older adults reported lower perceived stress related to COVID-19 in daily life, compared to younger adults. The negative relationship between daily perceived stress and high arousal positive affect and the positive relationship between daily perceived stress and high arousal negative affect was weaker in older than younger adults. Discussion These results provide initial evidence of daily affective well-being across different age groups in adulthood during the COVID-19 outbreak. Such information is important for developing interventions to promote better well-being during the COVID-19 outbreak. (shrink)

Da Costa and French explore the consequences of adopting a 'pragmatic' notion of truth in the philosophy of science. Their framework sheds new light on issues to do with belief, theory acceptance, and the realism-antirealism debate, as well as the nature of scientific models and their heuristic development.

Retractions of COVID-19 literature in both preprints and the peer-reviewed literature serve as a reminder that there are still challenging issues underlying the integrity of the biomedical literature. The risks to academia become larger when such retractions take place in high-ranking biomedical journals. In some cases, retractions result from unreliable or nonexistent data, an issue that could easily be avoided by having open data policies, but there have also been retractions due to oversight in peer review and editorial verification. As (...) COVID-19 continues to affect academics and societies around the world, failures in peer review might also constitute a public health risk. The effectiveness by which COVID-19 literature is corrected, including through retractions, depends on the stringency of measures in place to detect errors and to correct erroneous literature. It also relies on the stringent implementation of open data policies. (shrink)

Sobrepondo uma concepção crítica envolvendo os fundamentos do saber às ontologias dogmáticas que se impõem ao trabalho que implica a apreensão das questões filosóficas, o projeto kantiano propõe o fim da filosofia como construção metafísica e a necessidade de se lhe atribuir uma tarefa teórica de caráter essencialmente genealógico e crítico, no sentido que encerra a legitimação do conhecimento racional através da análise das faculdades que se lhe estão atreladas, conforme assinala o artigo, que se detém nos direitos da razão (...) cuja legitimidade a lógica da verdade reconhece e cuja ilegitimidade a lógica da aparência denuncia, convergindo para as fronteiras que encerram a possibilidade da construção do conhecimento científico, à medida que, tornando o entendimento o legislador universal da natureza e circunscrevendo a utilização das categorias aos limites da experiência possível, propõe as condições necessárias para fundá-lo sobre os juízos sintéticos a priori. (shrink)

Este breve ensaio busca, por meio da análise estruturalista e distanciada indicada por Lévi-Strauss, aproximar o conjunto de funções literárias das relações presentes entre os personagens principais do mito de Orphéus e Eurydíkē, fundadores dos mistérios órficos da Antiguidade Clássica, e de Lot e sua esposa, apresentados no Livro de Gênesis. Os pontos correlacionados são: o ponto de partida da jornada de ambos os casais, a figura mítico-mágica que anuncia a saída, o olhar para trás da figura feminina e a (...) punição sobre elas exercida. (shrink)

A partir de uma investigação no campo da história cultural, o artigo analisa as representações construídas na imprensa local em torno da visita da Miss Brasil, Jussara Marquez, a uma cidade do interior mineiro, em 1950. Os métodos empregados foram a análise documental em fontes primárias e a narrativa histórica. Constatamos que a devoção dedicada pelos jornais à figura de Jussara estava ligada à necessidade de as elites locais obterem distinção social a partir da apropriação de sua imagem. Contudo, o (...) papel que esperavam dela era de uma cinderela, e não de uma cidadã. Quando a Miss Brasil se desviou da função social que lhe havia sido designada, essas mesmas elites trataram de hostilizá-la e reconduzi-la ao papel que lhe cabia naquela ordem social. (shrink)

A predominância dos temas literários e fenomenológicos nos textos sartrianos dos anos 1930 já chamou atenção de vários especialistas e comentadores da obra do autor. É notável, entretanto, como os exames dos textos dessa época contentam-se, no mais das vezes, em apontar o paralelismo ou a contemporaneidade entre fenomenologia e literatura ali presente, sem realçar a fundamentação que uma parece conferir à outra e que constitui uma das questões mais interessantes que a filosofia sartriana levanta. Há que se incluir, na (...) verdade, a estética literária de Sartre na compreensão de suas teses fenomenológicas; teses estas que, por outro lado, fornecem o solo filosófico da literatura sartriana, em termos tanto de autoria quanto de crítica. O propósito deste artigo é demonstrar, assim, uma dependência ou, se quisermos, implicação mútua entre literatura e fenomenologia não apenas central em relação àquele período da produção de Sartre como, também, determinante para seus projetos teóricos e ficcionais ulteriores. (shrink)