The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i) its interventive capacity, ii) its expansiveness and iii) its influence on the concept of disease, iv) its generalising character, v) its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its (...) factual face is evaluative. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is (...) acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

Is technology value-free or is it value-laden? How does technology affect human autonomy? These questions, viewed within the context of medicine, are the focus of attention in this article. The central argument is that we need neither to subscribe to the value-neutrality dictum nor to the all-encompassing value-ladenness thesis to explain the pertinent position of technology in medicine. Technology is constitutive of and strongly implicated in difficult questions of value. This, however, does not mean that technology is identical to (or (...) neutral to) these value-laden questions. Technology poses issues of value, but only some of these relate to technology qua technology. Hence, it makes a difference whether we discuss general questions of value posed by technology or whether we discuss the value-ladenness of technology. Admitting technological value-ladenness does not imply that we are subject to a technological imperative that reduces our autonomy, on the contrary, it explains how technology increases our responsibility. This is particularly prominent in medicine. (shrink)

According to Ramsey and colleagues the main constituent psychological processes of innovation are response to novelty, exploration, and the ability to recognize a novel solution. I fully support this view but point out that novelty reactions are often context-specific. I will expand on this and discuss the possible consequences of context-specific novelty reactions on the emergence of innovations.

--2. Bd. Des Sokrates Apologie. Kriton. Euthydemos. Menexenos. Gorgias. Menon. Bearb. von H. Hofmann.--3. Bd. Phaidon. Das Gastmahl. Kratylos. Bearb. von D. Kurz.--4. Bd. Politeia. Der Staat. Bearb. von D. Kurz.--5. Bd. Phaidros. Parmenides. Briefe. Bearb. von D. Kurz.--6. Bd. Theaitetos. Der Sophist. Der Staatsmann. Bearb. von P. Staudacher.--7. Bd. Timaios, Kritias. Philebos. Bearb. von K. Widdra.--8. Bd. Nomōn. Gesetze. Bearb. von K. Schöpsdau. 2 v.

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

Like some ethical dilemmas, this question has an obvious answer that may not be right. On first reflection, it seems entirely unreasonable and inappropriate to expect staff members to withhold supportive care. Legally, a designated surrogate has the authority to refuse pain medication on the patient's behalf, but is it ethically defensible? A patient lacking decisionmaking capacity is crying out in pain; can we really imagine just closing the door? What do we say to other patients, visitors, and staff members, (...) such as physicians, nurses, housekeepers, and dietary workers, who might hear the patient? Do we place a sign on the door, one noting that the surrogate has refused, on behalf of the patient, to authorize the administration of pain medication and that the hospital or nursing home must comply with the surrogate's decision? (shrink)

The following description is based upon an actual case in which a patient initiated legal action after suffering a complication subsequent to an invasive diagnostic procedure performed by a senior fellow. Named as codefendants were the senior fellow, attending physician, and the hospital. Because any hospital with house staff is potentially vulnerable to similar litigation, Ethics Committees at Work is addressing the questions raised by this dilemma.

The belated but formal acknowledgment of medical errors and their impact has been well documented. Curiously, the topic of management or executive mistakes in healthcare is not raised in professional meetings nor, until recently, addressed by an article in health administration journals.

Our ethics committee is revising the organization's policy on forgoing life-sustaining treatment. The current policy now includes the statement, “When life-sustaining treatment is forgone, supportive care will be provided to relieve pain and ensure the patient's comfort, unless the patient or surrogate refuses those measures.” Is it reasonable, however, for the surrogate to have the authority to refuse consent for pain medication and/or other supportive care?

It is a commonly held belief among many psychological scientists that the more plausible a hypothesis, the better it is scientifically. It is also often believed that if there are two alternative theories which are equally strong in terms of explanatory power, one should choose the plausible theory over the implausible one. The goal of this article is to challenge these assumptions. Based on Popper's philosophical views, it will be argued that psychological scientists should be encouraged to formulate implausible hypotheses (...) and theories. Examples from other scientific disciplines will be presented to illustrate this argument. 2012 APA, all rights reserved). (shrink)

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence (...) for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

This article correlates fine-grained semantic variability and change with measures of occurrence frequency to investigate whether a word’s degree of semantic change is sensitive to how often it is used. We show that this sensitivity can be detected within a short time span (i.e., 20 years), basing our analysis on a large corpus of German allowing for a high temporal resolution (i.e., per month). We measure semantic variability and change with the help of local semantic networks, combining elements of deep (...) learning methodology and graph theory. Our micro-scale analysis complements previous macro-scale studies from the field of natural language processing, corroborating the finding that high token frequency has a negative effect on the degree of semantic change in a lexical item. We relate this relationship to the role of exemplars for establishing form–function pairings between words and their habitual usage contexts. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

A widespread assumption in recent research on attitudes is that self-reported evaluations reflect conscious attitudes, whereas indirectly assessed evaluations reflect unconscious attitudes. The present article reviews the available evidence regarding unconscious features of indirectly assessed “implicit” attitudes. Distinguishing between three different aspects of attitudes, we conclude that people sometimes lack conscious awareness of the origin of their attitudes, but that lack of source awareness is not a distinguishing feature of indirectly assessed versus self-reported attitudes, there is no evidence that people (...) lack conscious awareness of indirectly assessed attitudes per se, and there is evidence showing that, under some conditions, indirectly assessed attitudes influence other psychological processes outside of conscious awareness. Implications for the concept of “implicit attitudes” are discussed. (shrink)

In a seminal article in the Journal of Medical Ethics, Søren Holm and Tuja Takala analysed two protechnology arguments in bioethics: the hopeful principle and the automatic escalator. They showed how these arguments relate to problematic arguments such as the precautionary principle and the empirical slippery slope argument, and argued that they should be used with great caution. The present article investigates the recent debate on proton beam therapy, where the hopeful principle and the automatic escalator are identified. However, the (...) debate reveals a series of other arguments that deserve similar caution. An analysis of these arguments indicates that the roots of their fallacies are to be found in the ignorance of the uncertainties about risks and benefits and an overly optimistic attitude towards technology and progress. The point is not to argue against proton therapy, but rather to point out that flawed arguments for new technologies, such as proton therapy, can actually hamper their implementation instead of promoting it. Patients deserve the best technology available, not only on the basis of the best available evidence, but also on the basis of the best arguments. (shrink)

A program for the simulation of rational social normative trust, predictive `trust,' and predictive reliance between agents will be introduced. It offers a tool for social scientists or a trust component for multi-agent simulations/multi-agent systems, which need to include trust between agents to guide the decisions about the course of action. It is based on an analysis of rational social normative trust (RSNTR) (revised version of M. Tuomela 2002), which is presented and briefly argued. For collective agents, belief conditions for (...) collective agency should be added. For the various forms of trust agents must have (at least) subjectively rational reasons to believe that the conditions of the trust account are fulfilled. A list of such reasons (of varied weights), e.g., given by empirical research, can manually be built into a parameter file or be generated by a calling program in a fixed format. From this list of reasons the program randomly generates a belief base for the agents of the artificial society. Reasons can be chained together so that one set of reasons satisfies several belief conditions. The program checks if the conditions are fulfilled for the artificial agents' social normative trust/predictive `trust'/`predictive reliance' in another agent that he will perform an action X. Each outcome is logged to a result file. In conclusion we discuss various aspects of the application of a trust component of the suggested kind in empirical research, social simulation, and multi-agent systems. (shrink)

In the past decades, affective science has overwhelmingly demonstrated the unique properties of affective information to bias our attention, memory, and decisions. At the same time, accumulating evidence suggests that neutral and affective representations rely on the same working memory substrates for the selection and computation of information and that they are therefore restricted by the same capacity limitations that these substrates impose. Here, we integrate these insights into a working memory model of affective processing (WMAP). Drawing on competitive access (...) models of working memory, we discuss its role in the various stages of affective processing, from attentional selection to maintenance and memory storage, and resulting feelings and actions. We end our overview with some open questions and future directions. (shrink)

A classical quantified modal logic is used to define a "feasible" arithmetic A 1 2 whose provably total functions are exactly the polynomial-time computable functions. Informally, one understands $\Box\alpha$ as "α is feasibly demonstrable". A 1 2 differs from a system A 2 that is as powerful as Peano Arithmetic only by the restriction of induction to ontic (i.e., $\Box$ -free) formulas. Thus, A 1 2 is defined without any reference to bounding terms, and admitting induction over formulas having arbitrarily (...) many alternations of unbounded quantifiers. The system also uses only a very small set of initial functions. To obtain the characterization, one extends the Curry-Howard isomorphism to include modal operations. This leads to a realizability translation based on recent results in higher-type ramified recursion. The fact that induction formulas are not restricted in their logical complexity, allows one to use the Friedman A translation directly. The development also leads us to propose a new Frege rule, the "Modal Extension" rule: if $\vdash \alpha$ then $\vdash A \leftrightarrow \alpha$ a for new symbol A. (shrink)

Dieser Beitrag hinterfragt das weitläufige Verständnis von Polyamorie als eine Form der Liebe beziehungsweise Beziehungsform, die (1) notwendigerweise romantische Liebesbeziehungen in einem engen Verständnis beinhaltet, das heißt einschließlich Sex, und (2) Freundschaft ausschließt. Über eine Untersuchung und Zurückweisung der These, dass romantische Liebesbeziehungen ohne Sex nicht denkbar sind, kommt der Beitrag zu einer Analyse von romantischen Liebesbeziehungen und Freundschaften. Anhand einer vergleichenden Analyse der in romantischen Liebesbeziehungen wie auch in engen Freundschaften realisierten Beziehungsgüter kann gezeigt werden, dass sich diese kaum (...) in einem normativ relevanten Sinne unterscheiden. Letztendlich kann Polyamorie damit plausiblerweise nur auf einem weiten Verständnis romantischer Liebesbeziehungen aufbauen, was das Konzept inklusiver gestaltet und in polyamoren Beziehungskonstellationen Raum für Freundschaften und nicht-sexuelle romantische Beziehungen bietet. Dieser Artikel leistet damit nicht nur einen explikativen und präzisierenden Beitrag zur philosophischen Debatte rund um Polyamorie, sondern möchte den Begriff neu prägen. (shrink)

The late 18th century is characterized by two crucial events: the rise of Goethe as a dominating literary figure and the emergence of Kant’s critical philosophy and its productive reception not only in the philosophical but also literary discourse of the time. While the Tübingen School concreatively adopted Kant’s philosophy as a system of ideas, they also critically responded to its intellectualising impulse by positing the equiprimordiality of world and Self, of art and reason. Adhering to the self-critical impulse of (...) Kant’s philosophy by positing the equiprimordiality of both the empirical world and the intelligible subject, and trying to overcome the “chorismos” between them through the classicist model of aesthetic Bildung, they argued for the co-extensiveness of the reality of both philosophy and literature. The authors investigate how the latent antagonism between these divergent traditions of the so-called Goethezeit creates the thrust behind the intellectual firework of divergent literary and philosophical discourses from around 1800, throughout the 19th and into the 20th century. (shrink)

The relationship between tax authorities and taxpayers is essential for tax compliance. The aim of the present paper was to explore systematically the determinants of this relationship and related tax compliance behaviors based on the extended slippery slope framework. We used in-depth qualitative interviews with 33 self-employed taxpayers and 30 tax auditors. Interviewees described the tax relationship along the extended slippery slope framework concepts of power and trust. However, also novel sub-categories of power (e.g., setting deadlines) and trust (e.g., personal (...) assistance) were mentioned. Furthermore, also little-studied categories of tax behavior emerged, such as accepting tax behavior e.g., being available to the tax authorities, or stalling tax behavior e.g., the intentional creation of complexity. The results comprehensively summarize the determinants of the tax relationship and tax compliance behaviors. Additionally, results highlight future research possibilities and illustrate policy interventions. (shrink)