Because our actions change, our responsibility is modified; because our responsibility is modified, we need to question the ethics of the action. Our action is situated right there between announcing a diagnosis, the theoretical and practical result of identification, the determining and naming of a fact and voicing the disease which is a human action where medical and technical expertise comes up against a life and its story. Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, is a degenerative disease (...) of the motor neurons leading to paralysis. In the absence of any curative treatment, the natural course always results in death. Since 1989, progress in the management of this disease in France has been exponential, resulting in the creation of 17 expert centres throughout the country in 2003. Guidelines have been drawn up through consensus conferences and coordination meetings. For the delicate stage of the announcement, three requirements have been adopted: the quality of receptiveness of the medical practitioner and his team, their ability to listen and to adapt to the particularities of the patient in their care; their commitment with regard to legal obligations as to how and to whom to transmit information; and the need for a multidisciplined approach to be able to rapidly support the patient and his family. Questioning in the field of applied ethics has led us to examine whether having a benevolent and non-harmful attitude towards these patients, respecting their autonomy and legal rights are parameters required in this specialized practice. Through a transversal thematic analysis of the experiences of the medical practitioners at the Centres, we would like to explore a hypothesis of the remarkable epistemological progression of the neurologist in this form of care in the pure Hippocratic tradition. Through the compassionate experience of the other by these committed doctors and their teams, we will try to outline the view of anthropological phenomenology with regard to the ALS patient, their awareness of the future paralysis of the body that is being announced, their awareness of the temporality and will characteristic of the ALS patient and of his finality that they will be accompanying. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Bittersweet Score:A Father’s Account of His Family’s 20-Year Journey After a Pediatric Brain Tumor DiagnosisChristopher RileyI hadn’t seen him for 20 years, not since the day he drilled a hole in Peter’s head and left the stainless steel drill and bloody bit on the bedside table. He figured prominently in the story I often told of that day when he, a doctor in training, [End Page 3] informed (...) my wife Kathy and me that, “Wow,” our five-year-old son had “an impressive tumor” in his brain. He announced it with the admiration I reserve for a touchdown pass or stunning sunset. Since that day, he had become a venerable physician. Back then he was the resident who met us in the ER after our pediatrician told us that the MRI of Peter’s brain was “not normal,” that “there might be a growth.” As if there might not be. I imagined that Peter’s brain might simply have an unusual shape, or that the scan revealed some undiscovered fracture and the authorities only wanted to lock me up and all with my son would be well. The thrilled young doctor slew those hopes with an ice pick: “Wow, that’s an impressive tumor.” I said, “That’s the first time anyone has used the word tumor.” The doctor appeared mortified and started over.Now 20 years later we found ourselves at the same party and I felt a compulsion to introduce myself, remind him we’d met that day in 1993, and tell him what had become of Peter and his family in the decades since he’d made that mortifying mistake, one I hoped had become for him a defining moment. To my disappointment, he didn’t seem to remember.Peter was my red-haired boy. Fearless and whip smart, he told a stream of knock-knock jokes and performed dance routines choreographed by his 8-year-old sister Rachel. Six months of headaches, vomiting and clumsy falls led to discovery of the tumor. When I phoned my parents with the news, I couldn’t speak the words, words that felt as if they spelled my boy’s doom. My body refused to pronounce them.The war for Peter’s life began with surgery. I sat with Kathy in the surgical waiting area, fearing every minute that I would see the surgeon approaching with his shoulders slumped in mortal defeat. I learned during those hours that fear of your child’s death is a physical pain, a constriction in the chest, a suffocation. At the end of that wait, the surgeon told us the tumor was out and Peter had survived. The pathology indicated the tumor was a medulloblastoma. Without additional treatment, including radiation, it was certain to come back. Kathy’s knees buckled. Having just endured one life-and-death battle, we were plunged into another. To complicate matters, Peter wasn’t waking from surgery. Even after the anesthesia wore off, Peter remained groggy, unable to move or focus his eyes.Through the following days, Peter failed to rouse or speak. Sores formed at the back of his neck where his unswallowed saliva pooled. Neurologists doubted he knew us. His doctors hoped Peter would recover but it was possible he would remain as he was indefinitely. As I sat holding his useless hand, watching his useless body, I thought I’d never loved him as much as I did now.Peter’s doctors presented two treatment options. The first consisted of relatively high doses of daily radiation, the most effective known method for preventing the return of the cancer. But radiation wasn’t good for young brains. It “shaved IQ points,” they said in wild understatement. So they offered a second, experimental option, one that reduced radiation by a third and added months of chemotherapy. The doctors hoped this new regimen would be as effective as the old but cause less cognitive damage. They asked us to choose. It seemed impossible. We gathered the scant available data. We weighed the risks. We prayed. We took a leap. Without asking him, we made a decision for Peter we knew... (shrink)

The February 1997 announcement of the birth of Dolly, the sheep cloned from a mammary cell of an adult ewe, has drawn attention to the growing ability to select, alter, or otherwise manipulate the genome of offspring. Prior to Dolly, ethical discussion of genes in reproduction had focused on negative selection: carrier screening, prenatal diagnosis, and abortion or embryo discard. After Dolly, ethical debate will have to consider the direct or positive use of genetic selection or alteration technology.The (...) principal use of genetic selection techniques in human reproduction likely will be to treat or prevent disease in offspring. In the future, however, such techniques might also be used to enhance or even diminish expected characteristics of progeny. Techniques to accomplish these goals are likely to include: selection of the nuclear genome, as occurs in somatic cell cloning; chromosomal transplants; or direct insertion or deletion of specific genes. (shrink)

The February 1997 announcement of the birth of Dolly, the sheep cloned from a mammary cell of an adult ewe, has drawn attention to the growing ability to select, alter, or otherwise manipulate the genome of offspring. Prior to Dolly, ethical discussion of genes in reproduction had focused on negative selection: carrier screening, prenatal diagnosis, and abortion or embryo discard. After Dolly, ethical debate will have to consider the direct or positive use of genetic selection or alteration technology.The (...) principal use of genetic selection techniques in human reproduction likely will be to treat or prevent disease in offspring. In the future, however, such techniques might also be used to enhance or even diminish expected characteristics of progeny. Techniques to accomplish these goals are likely to include: selection of the nuclear genome, as occurs in somatic cell cloning; chromosomal transplants; or direct insertion or deletion of specific genes. (shrink)

In November 2003, researchers at Cambridge University announced they had identified a gene associated with an elevated risk of breast and related ovarian cancers. The gene—christened EMSY in honor of a breast-cancer nurse who is the sister of the study's lead author—is particularly significant because it is linked to so-called sporadic cancers. Such cancers do not arise from hereditary mutations of the BRCA1 and BRCA2 genes, in which genes that ordinarily prevent breast and ovarian cancers are altered, often giving rise (...) to multiple cases of cancer within a family as the mutation is passed along. The Cambridge researchers determined that the presence of extra copies of EMSY in an individual may instead switch off a healthy BRCA2 gene. (shrink)

In the current era of the Sustainable Development Goals, many countries are attempting to strengthen their health system and achieving Universal Health Coverage. The Korean National Health Insurance system functions as a core element of health financing, contributing to achieving UHC by promoting public health and social security through insurance benefits for prevention, diagnosis, treatment, rehabilitation, childbirth, and health promotion. The Republic of Korea achieved 100% NHI coverage of the target population in 1989, 12 years after the introduction of (...) the social insurance system. However, poor coverage of health services and lack of financial protection are major obstacles to achieving UHC. Therefore, the Korean government announced and implemented ‘Moon Jae-in Care’ in August 2017 to enhance the coverage rate of NHI by 70%. First, this study reviews the existing health insurance system in Korea from the perspective of health financing and UHC. Second, it analyses ‘Moon Jae-in Care’, based on the main framework of UHC. Third, it considers the ethical implications of these developments, with focus on the principles of equity, fairness, autonomy, and solidarity. Although the NHI reform is expected to propel Korean health care closer to UHC, many ethical, social, and political issues remain. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:About and Beyond Comorbidity:Does the Crisis of the DSM Bring on a Radical Rethinking of Descriptive Psychopathology?Massimiliano Aragona (bio)Keywordscomorbidity, nosography, phenomenology, philosophy of scienceThe problem of psychiatric comorbidity is part of a series of difficulties of the current diagnostic system which at once were considered as a consequence of the way the system itself is organized (Aragona 2006). It was then believed that a Kuhnian reformulation of the contemporary (...) debate on the problems of the psychiatric diagnosis was very useful because it allowed clarification in a comprehensive picture of the many rivulets of conceptual research in that field.In their comments Zachar (2009) and Banzato (2009) seem to agree with my analysis of psychiatric comorbidity (Aragona 2009a) when it stresses that abnormally high frequencies of co-occurrence are to be explained, in important respects, as a consequence of the way mental disorders are operationalized in the Diagnostic and Statistical Manual of Mental Disorders (DSM; also showing the importance of conceptual clarification to deal with this sort of only apparently pure factual problems). On the contrary, they are both unconvinced of the appropriateness and/or fruitfulness of the use of the Kuhnian technical terms and theory in this context.It could be said that the major aim of the paper was to let clinicians understand the effect of conceptual decisions on what would otherwise seem as a simple empirical finding (in this case, high levels of comorbidity), and that this result seems to be achieved in any case, thus minimizing the importance of a disagreement about the philosophical terms as a pure terminological dispute. Nevertheless, in my work the Kuhnian model had a significant role in the clarification of this matter and it also suggests to the reader a range of possible consequences that are not trivial (Zachar, for example, says to be skeptical about the possibility of a crisis and also about the possibility that a new paradigm could eliminate what I call the [End Page 29] comorbidity anomaly). As a consequence, some of the Kuhnian concepts that seemed to be at odds in this context have to be considered in detail to justify my analysis and its consequences. For reasons of space, I avoid a point-by-point reply to all the comments and I concentrate my discussion on three main points. First, I discuss the background of Kuhn's definition of terms such as anomaly and paradigm, as well as my own reasons for using them. In doing so the details of the psychiatric items under study that I wanted to highlight through the use of these philosophical concepts should emerge more clearly. Second, I discuss the problem of having distinguished between artifactual and real comorbidity. Third, I reconsider some of these problems, looking for their implications for future psychopathological research.Anomalies and ParadigmsBanzato (2009) stresses that comorbidity cannot be a truly Kuhnian anomaly because it is an anticipated side effect of the initial setup of the DSM, and not some unexpected discovery that violates the paradigm-induced expectation. This is a basically correct account of the most known version of Kuhnian anomalies; that is, the tale of some evident nature's failure to conform to clear paradigm expectations, which immediately forces researchers to recognize its importance as a possible source of crisis. However, as is the case for many other Kuhnian terms, he discussed anomalies in several scripts and there are other possible versions of its meaning. In particular, Kuhn (1977, XVII) highlighted that only in very rare cases are anomalies completely unexpected and come out of blue to announce an imminent crisis that leads to a large revolution. More frequently, scientific revolutions are much more smaller, like the discovery of oxygen, and in these cases the process is so gradual that historians find it difficult to say exactly when a discovery was made and who did it. Even in these much smaller cases the usual prelude to changes of this sort is the awareness of anomaly, but here anomalies are not extraordinary events; rather, they are "countless discrepancies between theory and experiment [that] during the course of his career, every natural scientist again and again notices and passes by" (Kuhn... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Verum-factum and Practical Wisdom in the Early Writings of Giambattista VicoRobert C. MinerAs several contemporary writers have noted, Giambattista Vico defends the idea of practical knowledge, a type of knowledge that cannot be fully expressed by propositions and defies reductions to method. 1 The defense of practical knowledge, against Descartes and the rise of objectifying science, is most clearly articulated in a group of Vico’s early writings: the oration (...) De nostri temporis studiorum ratione (1709), the metaphysical book De antiquissima Italorum sapientia ex linguae latinae originibus eruenda (1710), and two rejoinders (Prima and Seconda risposte) to critics of the De antiquissima. In these texts Vico criticizes Cartesian method in terms that remind us of Aristotle, or at least the Aristotle of the Nicomachean Ethics and Politics. “If you were to import the geometrical method into practical life, you would do no more than exhaust yourself in becoming a rational lunatic” (A 7.5). 2This comment and many others like it seem to suggest that Vico is an “Aristotelian,” but any simple classification is problematic. In the same text in which Vico defends the Aristotelian topos he also announces that “the true and the made are convertible” (verum et factum convertuntur). The emphasis on the [End Page 53] role of “making” in truth seems incompatible with the Aristotelian idea of phronesis, whose knowledge is associated with praxis and cannot be reduced to techne. It would be simpler if Vico distinguished between a realm in which the verum-factum principle applied and one in which prudentia was supreme. However, Vico not only situates mathematics and experimental science within the metaphysical framework governed by verum-factum, but also implies strong connections between making and ethics. The prominence Vico assigns to making in all areas of human endeavor gives him a distinctly modern appearance in the fashion of Bacon, Galileo, and Hobbes.This gives rise to both hermeneutical and philosophical problems. Is Vico simply hesitating between the old and new? Does he coherently balance an Aristotelian perspective with the “modern” emphasis on artifice? 3 Perhaps Vico is caught in the middle of the querelle des anciens et modernes, somewhat like John Dunn’s version of Locke, a “tragic figure” who cannot reconcile his epistemological discoveries with a noninstrumentalist view of practical reason. 4 The purpose of this essay is to provide a sympathetic interpretation of Vico’s early writings on prudentia and its links to both verum-factum and rhetoric.Vico contra Rule-based EthicsThe denial that ethics is well understood as a matter of following or justifying general rules has become a commonplace among contemporary Aris-totelians and Wittgensteinians. 5 Against the Enlightenment ambition to construct a universally valid moral science, recent virtue ethics has emphasized the irreducibly contingent aspects of human life, aspects which resist the clutches of “method.” Although Descartes wrote little about morals directly, his influence can be detected in the ethical writings of Hobbes, Kant, Mill, and Sidgwick. These examples of modern moral philosophy presuppose the correctness of the Cartesian diagnosis of ancient and medieval writing on virtue. In the Discourse on Method Descartes compares previous moral teaching to “the most proud and magnificent palaces built on nothing but sand or mud.” 6 Descartes himself did not provide a rational justification of ethics, but he has had no shortage of successors who have tried to complete his foundational project. Jusnaturalism, Kantian deontology, and utilitarianism, as different as they are from one another, share the desire to ground ethics in principles as universal and certain as [End Page 54] those of mathematics. Each of these variants of post-Cartesian ethics claim to have discovered and justified such a principle or set of principles. Maxims deduced from the principle, if not the principle itself, will arguably enable moral agents to discover the right course of action in a particular situation.Vico did not live to witness the most articulate expressions of a Cartesian approach to ethics, but he did apprehend the shift in focus from prudence to method. In the De nostri temporis studiorum ratione, an oration delivered at the University of Naples in 1708 and published the following year, Vico criticizes approaches that locate... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. The (...) following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

The diagnostic moment is a moment replete with drama. As Suzanne Fleischmann has written, hearing the announcement of a serious diagnosis draws an indelible line to demarcate before and after, which will be evermore imposed on an individual’s narrative construction of her life story. We can imagine this moment, considering with apprehension the “what if?” as we attend our doctor’s appointments for the verdict on what ails us. Belief in its transformative power is impressive. That we can imagine (...) it is not surprising, as it is represented so widely in various creative work. In this paper, I turn to the presence of the diagnostic moment in fiction. I love to read. This... (shrink)

‘Time’ has been central to Zygmunt Bauman’s theory of modernity and his subsequent account of its solid and liquid variants. The experience of time in these accounts announces the coming of new opportunities, but it also signals a corrosion of our moral sensitivity. In this article, I assess Bauman’s contribution to the sociology of time and the centrality of our temporal character for his philosophical anthropology. There is a unique chance to be moral in liquid modernity, by unshackling the outdated (...) and habitual ethics of the past. The danger, however, lays in an increasingly ‘hurried life’, where a ‘nowist’ culture demands endless answers to the most banal of choices, often before these choices have even arrived. I argue that for Bauman the historical power of culture is to raise the ‘ought’ above the ‘is’. This results from our character as temporally-aware creatures. In our liquid modern times, the haste of life and its individualizing forces shift the character of that temporal awareness, endowing us with a false set of needs crafted by the market. The project of humanity itself has become, in Bauman’s diagnosis, subservient to maintaining the goals of the market. (shrink)

This article consists of three sections: the first sketches the development of calculating the timing of the New Moon from biblical times onward with special emphasis on the Byzantine/Romaniote communities; the second contains the critical edition of the announcement of the New Moon from four late medieval manuscripts, where the Judaeo-Greek text complements the Aramaic version of this announcement that was recited in Romaniote synagogues; and the third presents a philological commentary on the Judaeo-Greek version/versions of this (...) class='Hi'>announcement. Its main goal is to place the language of the announcement, that is unique for its use of the vernacular, in the context of Byzantine vernacular literature, which has primarily been preserved in poetry. While substantial differences exist between the two versions identified by the authors, the Aramaic and the Greek texts both strive to create the impression of great antiquity through the use of images associated with the Temple and by linguistic means. Dating these texts earlier than the eighth century is unlikely, though, and the Greek text does not permit a terminus ante quem. Considering its thematic content and the use of archaic language(s) as constituens textus, which can run counter to a certain modernization, we may understand this decision as symbolic act by the Romaniotes to push their claim of diaspora ancestry reaching back to Late Antiquity or possibly the Second Temple Period. Another significant strand that can be discerned in the Greek version is the strong Byzantine background being evoked for its intended audience. Through their deliberate effort to archaise their origins, the Romaniote Jews, like their Christian neighbors, display Ancient Greek as a symbol of their identity. (shrink)

Medicine maintains a distinction between the medical symptom -- the patient''ssubjective experience and expression, and the privileged medical sign -- the objective findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the undefined, medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within a sociopolitical (...) context. The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault''sideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women''shealth, illness and disease. (shrink)

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the (...) MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: the value that patients give to healthcare professionals' communication skills; the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status. (shrink)

This article consists of three sections: the first sketches the development of calculating the timing of the New Moon from biblical times onward with special emphasis on the Byzantine/Romaniote communities; the second contains the critical edition of the announcement of the New Moon from four late medieval manuscripts, where the Judaeo-Greek text complements the Aramaic version of this announcement that was recited in Romaniote synagogues; and the third presents a philological commentary on the Judaeo-Greek version/versions of this (...) class='Hi'>announcement. Its main goal is to place the language of the announcement, that is unique for its use of the vernacular, in the context of Byzantine vernacular literature, which has primarily been preserved in poetry. While substantial differences exist between the two versions identified by the authors, the Aramaic and the Greek texts both strive to create the impression of great antiquity through the use of images associated with the Temple and by linguistic means. Dating these texts earlier than the eighth century is unlikely, though, and the Greek text does not permit a terminus ante quem. Considering its thematic content and the use of archaic language(s) as constituens textus, which can run counter to a certain modernization, we may understand this decision as symbolic act by the Romaniotes to push their claim of diaspora ancestry reaching back to Late Antiquity or possibly the Second Temple Period. Another significant strand that can be discerned in the Greek version is the strong Byzantine background being evoked for its intended audience. Through their deliberate effort to archaise their origins, the Romaniote Jews, like their Christian neighbors, display Ancient Greek as a symbol of their identity. (shrink)

Fetal alcohol spectrum disorders is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions (...) with experts in the field, published literature, and medical ethicists. Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. The value for the concerned individuals of obtaining a FASD-related description of their condition – for instance, in terms of wellbeing – is not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs. (shrink)

The professor announces a surprise exam for the upcoming week; her clever student purports to demonstrate by reductio that she cannot possibly give such an exam. Diagnosing his puzzling argument reveals a deeper puzzle: Is the student justified in believing the announcement? It would seem so, particularly if the upcoming 'week' is long enough. On the other hand, a plausible principle states that if, at the outset, the student is justified in believing some proposition, then he is also justified (...) in believing that he will continue to be justified in believing that proposition. It follows from this 'confidence' principle that the student is not justified in believing the announcement, regardless of the number of days in the week. I argue that the key to resolving this dilemma is to distinguish the confidence principle from a slightly weaker principle governing the student's justified degrees of belief. Representing these degrees of belief as probabilities, and taking 'justified belief' to mean 'justified degree of belief above a certain threshold', I show that we can uphold the weaker, probabilistic analog to the confidence principle, and maintain that, provided the 'week' is long enough, the student can justifiably believe the announcement. The resulting probabilistic analysis of the story leads to a new diagnosis of the logical flaw in the student's reasoning, and suggests, finally, that even those early stages of it which are logically impeccable exhibit another kind of flaw: circularity. (shrink)

This article argues that traditional models of diagnosis are incomplete in their reliance on a models of certainty that are no longer tenable in a postmodern world. Further, it argues that the current form of diagnosis, as applied to psychiatric and affective disorders, reduces patient agency and reinscribes the effects of biopower.

The main purpose of this article is to present the methodological characteristics of a diagnostic process. A proposal is put forward to treat that process as a specific type of a research investigation. The research investigation can be represented in the notional systems of various concepts of the question logic. In this article I attempt to formulate a preliminary notional description of the diagnostic process with the use of terms being questions. Adopting this perspective of deliberations, I maintain that during (...) a diagnostic process a doctor employs a specific type of reasoning, where questions constitute lingual formulations of diagnostic problems. The article describes the structure of a diagnostic question which is used to incorporate diagnostic problems. I provide arguments for a thesis that such questions are meant to correlate information obtained on a patient’s condition. Pointing at various aspects of temporality of a diagnostic process, I intend to present its preliminary characteristics in terms of a research investigation. My deliberations are based on exemplifications in the area of medical diagnostics, mainly in cardiology. (shrink)

L'A. étudie la concurrence entre la matière, la forme et la composition de matière et de forme, pour le titre de substance première ousia dans la «Métaphysique» Z, 3 d'Aristote. L'A. s'oppose à l'interprétation qu'en donne L. Gill dans son livre «Aristotle on Substance: The Paradox of Unity», selon laquelle l'ει~δο et la composition sont toutes deux premières. L'A. propose une explication qui s'inscrit dans le cadre métaphysique de la théorie de la recherche.

This essay presents a theoretical construct upon which to base a working - "pragmatic" - definition of the History of Present Illness (HPI). The major thesis of this essay is that analysis of both the logic of hypothesis formation and literary narrative - especially detective stories - facilitates understanding of the diagnostic process. The essay examines three elements necessary to a successful development of a patient's HPI: the logic of hypothesis formation, based upon the work of the philosopher-logician, Charles Sanders (...) Peirce; the organization of knowledge in relation to structures of narrative; and the feedback necessary to the successful physician-interviewer. It concludes with a systematic description of the design of hypothesis formation within diagnoses. (shrink)

Following SOX, financial restatements increased dramatically. Prior research suggests that how investors respond to restatements, particularly those involving fraud, may mitigate or exacerbate damage suffered. We extend both accounting and management research by examining the joint effects of pre-restatement managerial reputation and the announcement of managerial corrective actions in response to a restatement on nonprofessional investors’ judgments. We find that pre-restatement managerial reputation and the announcement of managerial corrective actions jointly influence investors’ managerial fraud prevention assessments, which mediate (...) their trust in management. These trust perceptions in turn affect investors’ investment and CEO retention judgments. Our results have implications for firms that are concerned with lessening the negative consequences associated with issuing a restatement. (shrink)

### Royal College of Physicians adopts neutral position on assisted dying In March 2019, the RCP announced that it would adopt a neutral position on assisted dying, following a survey of its UK fellows and members.1 The College had previously polled members and fellows on what the RCP position should be in 2014, at that time 44.4% of respondents thought the RCP should be opposed to assisted dying; 31% thought it should be neutral or have no position; and 24.6% thought (...) it should be in favour. On the basis of these figures, the College reaffirmed its position opposing assisted dying.2 In announcing the 2019 survey, the College’s Council resolved that they would require a ‘supermajority’ of 60% to adopt a position either supporting or opposing a change in the law; if no such majority was received, the College would move to a position of neutrality. This approach was not without controversy, and a legal challenge to the Council’s decision is pending.3 In response to the question of what the RCP’s position should be, 43.4% thought the RCP should be opposed; 31.6% thought the RCP should be supportive; and 25% thought the RCP should adopt a neutral position. Without a supermajority of 60% either way, the College’s position became one of neutrality.1 ### New Jersey legalises assisted suicide for the terminally ill New Jersey has become the ninth jurisdiction in the USA to legalise physician-assisted suicide after legislation was passed by the State senate in April 2019.4 The Medical Aid in Dying for the Terminally Ill Act will permit terminally ill adults, with 6 months or less to live, to request physician assistance in ending their life. Two doctors must confirm the patient’s diagnosis, prognosis, decision-making capacity and the voluntariness of their request, and if satisfied, can prescribe lethal medication, which the patient must self-administer. …. (shrink)

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor–patient relationship. The study aims to explore the Roma’s beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated in (...) semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the “silence conspiracy” being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient’s autonomy. We identified ethical dilemmas concerning autonomy, lack of patients’ real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient’s right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community. (shrink)

In 1817, in the preface to his Rein analytischer Beweis, Bernard Bolzano revealed that he had decided to postpone the publication of any subsequent instalment of his Beyträge zu einer begründeteren Darstellung der Mathematik because of the few and ‘superficial’ reviews of its first instalment, published in 1810. Bolzano’s transcriptions of the only two known reviews of this book are conserved at the Literární archiv Památníku národního písemnictví / Muzea literatury, in Prague, together with another manuscript on his Beyträge, the (...) provenance of which was unknown to Bolzano’s scholars until recently. In this paper it is shown that this latter manuscript is a draft of an announcement that was published at the time and that was indeed written at least to some extent by Bolzano himself. This hitherto unknown announcement of Bolzano’s Beyträge not only solves the mystery surrounding that manuscript, but also helps to date the publication of this book more precisely and provides an unusual insight into what we must take Bolzano himself to have considered most noteworthy about his work, namely his study on logic. The paper includes a transcription of the manuscript and an English translation of the announcement. (shrink)

A rational reconstruction of the role of moral values in diagnostic reasoning is undertaken. In the context of a case study it is shown how value and ethical considerations come into play in the complex course of making diagnostic and therapeutic decisions.

In lieu of an abstract, here is a brief excerpt of the content:The Truth about Narrative, Or:How Does Narrative Matter?Ruth Ronen and Efrat BibermanIn the summer of 1898, a sixteen-year-old girl, intelligent and good looking, entered Freud's clinic in Vienna. The girl, whom Freud would call Dora, suffered recurrent attacks of aphonia (inability to speak) and of coughing, attacks that came on and passed off spontaneously. Freud soon discovers that Dora's illness is connected to the love affair her father is (...) having with a Frau K., a family acquaintance, while the lover's husband is courting Dora herself. In analyzing the history of Dora, Freud unfolds the course of events that brought Dora to the clinic and produces her case by means of a fragmentary discourse consisting of Dora's speech, her dreams and thoughts as revealed to Freud while the analysis was going on. The psychoanalytic discourse yet also consists of Freud's own reports and interpretations of Dora's dreams, actions and speech and of his overall understanding of her case, an understanding that undergoes a few radical changes during the analysis. When Dora decides to leave the treatment three months later, which is much too soon in Freud's view, Freud interprets her act as an act of vengeance against himself, repeating her neurotic reactions to the romantic complexity she recounted through the person of Freud. However, when Freud learns later that Dora got married and has overcome her hysterical sicknesses, he re-reads her second dream as announcing that Dora was about to tear herself free from her father (from Mr. K. she tore herself free through an act of vengeance) and "had been reclaimed once more by the realities of life."1How has the narration of the case of Dora by herself and by Freud, changed her situation from a hysterical subject who suffers from severe symptoms, to a subject "able to be reclaimed by the realities of life"? [End Page 118] How has Dora's spoken words to Freud, and his way of responding and directing her speech, changed her situation so radically? What is the power of narrative in changing or affecting the object of narration? What constitutes the "true story" of a subject and how is it affected by the narrative modes by which the story is presented? Can narrative change the facts of the matter narrated? In this paper, as part of the attempt to define the constitutive power of narrative, a power that cannot yet reduce the constituted subject to an effect of discourse (Dora after psychoanalysis surely cannot be viewed as a construct of discourse, yet is so different from what she was prior to analysis), we will examine these questions as addressed in two, apparently diverse, contexts: that of analytic aesthetics and that of psychoanalytic thought. We will show that these two perspectives tackle similar problems regarding narrativity yet choose to solve them in ways that raise important questions regarding the effects of narrative.IIt is a widely spread opinion about narrative that it creates its own world in the act of telling, that "the structures of narrative impose some kind of barrier between language and fact; rather than being directly 'mirrored', the facts, as represented in narrative, are filtered through layers of linguistic artifice."2 The diagnosis that narrative somehow distorts or constructs the events it recounts, that narration changes the modality of what is narrated, is one important implication of the booming interest in narrative in the 1980s and 90s. To understand how such an implication was drawn, requires that the nature of the interest in narrative is more closely qualified as part of the growing attention paid to the pervasiveness of narrative in discourses traditionally considered to lie outside the domain of narrative rendering, and to the naturalness of narrative presentation in extra-literary contexts. These pervasiveness and naturalness of narrative were often interpreted as reflecting the literariness or fictionality of discourses that officially claim to be committed to reality and truth.Yet, how did it come about that the discovery of narrative elements in a wide variety of contexts was interpreted as entailing the fictionalizing of these discursive contexts? As narrative entails the imposition of structure on... (shrink)

COVID-19 is unique in that it is the first global pandemic occurring amidst a crowded information environment that has facilitated the proliferation of misinformation on social media. Dangerous misleading narratives have the potential to disrupt ‘official’ information sharing at major government announcements. Using an interrupted time-series design, we test the impact of the announcement of the first UK lockdown on short-term trends of misinformation on Twitter. We utilise a novel dataset of all COVID-19-related social media posts on Twitter from (...) the UK 48 hours before and 48 hours after the announcement. We find that while the number of tweets increased immediately post announcement, there was no evidence of an increase in misinformation-related tweets. We found an increase in COVID-19-related bot activity post-announcement. Topic modelling of misinformation tweets revealed four distinct clusters: ‘government and policy’, ‘symptoms’, ‘pushing back against misinformation’ and ‘cures and treatments’. (shrink)