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...

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...

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

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)

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,... (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)

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 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...

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)

Dāvarī, Riz̤ā -- Interviews ; Islamic philosophy - Iran.

Por ocasião do centenário de nascimento de Paul Ricoeur, a Universidade de Coimbra juntou num mesmo volume um conjunto de estudos académicos em tributo a este pensador. Reuniram-se deste modo comunicações de professores, de novos investigadores e de estudantes de doutoramento em redor de temas que marcaram a receção da obra e do filósofo francês em Coimbra. Cada capítulo do presente livro demonstra a fecundidade de um pensamento que, enraizado na “tradição reflexiva”, assumindo a mensagem das “filosofias da existência”, articulando (...) Fenomenologia e Hermenêutica, adquire, hoje, crescente impacto e relevância. Esta é uma filosofia que promove o diálogo entre disciplinas, autores e culturas e supera divisões teóricas em ordem a enfrentar as exigências da praxis. O desafio da praxis fez assim emergir um pensamento exigente e, simultaneamente, capaz de dialogar com diversas áreas do saber como: a psicoterapia, a história, as neurociências, a bioética, as ciências sociais e os estudos literários. At the occasion of the Paul Ricoeur’s centenary this volume joined in tribute several scholars, young researchers, and Ph.D students around the main themes that marked the reception of the philosopher’s work in Portugal and, especially in the University of Coimbra. Each chapter demonstrates the vigour Ricoeur’s thought as it is rooted in the "reflexive tradition", as it assumed the "existentialist" horizon, as it articulated Phenomenology and Hermeneutics. This philosophical project as, today, an enormous range of influence. This is a project that promotes dialogue between disciplines, authors, and cultures, overcoming theoretical divisions in face the demands of praxis. From this rich and plural inspiration comes the ability to meet with other fields of thought, namely psychotherapy, history, neuroscience, bioethics, social sciences, and literary studies. (shrink)

Journal of Social Philosophy, EarlyView.

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)

This article intends to explore the philosophical potency in the work of the black writer Carolina Maria de Jesus (1914-1977). Carolina de Jesus is best known for her work Quarto de Despejo, diary of a favelada (1960), our approach, however, focuses specifically on her short story “Socrates Africano”, in which she deals with her experience with her grandfather Benedito and the relationship between her wisdom and that of the Greek philosopher Sócrates (5th century BC). Her reflection starts from the attempt (...) to understand the reason why her grandfather was compared to Socrates and called “African Socrates”. In this sense, we intend to expand the idea of an African Socrates and the origins of one of the African philosophical matrices, the Yoruba tradition, dialoguing with the thought of the Nigerian philosopher Sophie Oluwole (1935-2018) and her approximation between Socrates and Orunmilá, as a motto to think about the philosophical potentialities of Carolina's work and the traits of an Afro-Brazilian philosophy. (shrink)

Em 2016 comemoram-se os 200 anos de publicação da “Enciclopédia das Ciências Filosóficas” de Hegel. Esta parece ser uma ocasião especial para se poder avaliar a pertinência da “Enciclopédia” para o Brasil. Essa avaliação, aqui elaborada, conduz à percepção de que se a filosofia é pensar o presente, então a “Enciclopédia” não pode ser compreendida como contendo problemas e soluções para o Brasil, mas apenas para a velha Europa. Portanto, nessa ocasião se torna especialmente perceptível a necessidade de se abandonarem (...) as velhas categorias da Europa como instrumentos para se pensar o Brasil. (shrink)

Considerações acerca da emenda da sociologia das religiões -- Conceito da sociologia da arte.

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)

This chapter contains sections titled: Introduction Paraconsistent Logic and Latin America Thinking about Logic The Nature of Paraconsistent Logic A History of Paraconsistent Logic Philosophical Aspects of Paraconsistent Logic References Further Reading.

Livros -- Opúsculos, ensaios prefaciais e artigos -- Agostiniana -- Palavras posfaciais, cronologia, Onomástica.

Meaning (Philosophy) ; Civilization, Modern ; Postcolonialism.

This monograph offers a fresh perspective on the applicability of mathematics in science. It explores what mathematics must be so that its applications to the empirical world do not constitute a mystery. In the process, readers are presented with a new version of mathematical structuralism. The author details a philosophy of mathematics in which the problem of its applicability, particularly in physics, in all its forms can be explained and justified. Chapters cover: mathematics as a formal science, mathematical ontology: what (...) does it mean to exist, mathematical structures: what are they and how do we know them, how different layers of mathematical structuring relate to each other and to perceptual structures, and how to use mathematics to find out how the world is. The book simultaneously develops along two lines, both inspired and enlightened by Edmund Husserl’s phenomenological philosophy. One line leads to the establishment of a particular version of mathematical structuralism, free of “naturalist” and empiricist bias. The other leads to a logical-epistemological explanation and justification of the applicability of mathematics carried out within a unique structuralist perspective. This second line points to the “unreasonable” effectiveness of mathematics in physics as a means of representation, a tool, and a source of not always logically justified but useful and effective heuristic strategies. (shrink)

Background:In their daily practice, Brazilian nurses have been met with complaints from co-workers and patients, as well as bioethical dilemmas intrinsic to the profession, particularly in the cont...

Textures of the Ordinary shows how anthropology finds a companionship with philosophy in the exploration of everyday life. Based on two decades of ethnographic work among low-income urban families in India, Das shows how the notion of texture aligns ethnography with the anthropological tone in Wittgenstein and Cavell, as well as in literary texts. The book shows different routes of return to the everyday as it is corroded not only by catastrophic events but also by repetitive and routine violence within (...) everyday life itself. As an alternative to normative ethics, this book develops ordinary ethics as attentiveness to the other and as the ability of small acts of care to stand up to horrific violence. Textures of the Ordinary offers a model of thinking in which concepts and experience are shown to be mutually vulnerable. The book is an intellectually intimate invitation into the ordinary, that which is most simple yet most difficult to perceive in our lives. (shrink)

O significado hermenêutico da experiência da obra de arte -- A pertinência hermenêutica da ética aristotélica -- Para uma hermenêutica do cuidado: do mistério da saúde de H.-G. Gadamer aos novos fins da medicina -- A hermenêutica como pensamento de fronteira -- Hermenêutica filosófica e mobilidade cultural: conceitos fundamentais -- A Europa e o destino das ciências humanas -- Para uma hermenêutica da memória -- Tradição, linguagem e jogo -- A missão hermenêutica da filosofia -- Problemas da hermenêutica prática -- (...) O reconhecimento como núcleo da aplicação: de Gadamer a Ricoeur -- A linguagem da polis -- Retórica e hermenêutica. (shrink)

This chapter presents findings on a study of neuropsychological aspects of visual hallucinations with a focus on hallucinations in Parkinson's disease. The results of the study suggest that VHs in PD are a complex multifactor effect of different risk factors, primarily the dysfunctions of the visual system and the system that regulates rapid eye movement sleep and arousal. The study reported here also investigated whether the same risk factors are implicated in proneness to VHs as they are in VHs in (...) PD. The results suggest that the predisposition to VHs in the healthy young population is a multifactor effect of strikingly similar risk factors to those found in PD. However, in addition to the dysfunctions of the visual and arousal system, proneness to hallucinations in the normal population is also predicted by a specific personality profile. (shrink)