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)

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...

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 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)

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)

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...

The McGurk illusion occurs when listeners hear an illusory percept, resulting from mismatched pairings of audiovisual speech stimuli. Hearing a third percept—distinct from both the auditory and visual input—has been used as evidence of AV fusion. We examined whether the McGurk illusion is instead driven by visual dominance, whereby the third percept, e.g., “da,” represents a default percept for visemes with an ambiguous place of articulation, like/ga/. Participants watched videos of a talker uttering various consonant vowels with and without audios (...) of/ba/. Individuals transcribed the CV they saw or heard. In the V-only condition, individuals predominantly saw “da”/“ta” when viewing CVs with indiscernible POAs. Likewise, in the AV condition, upon perceiving an illusion, they predominantly heard “da”/“ta” for CVs with indiscernible POAs. The illusion was stronger in individuals who exhibited weak/ba/auditory encoding. In Experiment2, we attempted to replicate these findings using stimuli recorded from a different talker. The V-only results were not replicated, but again individuals predominately heard “da”/“ta”/“tha” as an illusory percept for various AV combinations, and the illusion was stronger in individuals who exhibited weak/ba/auditory encoding. These results demonstrate that when visual CVs with indiscernible POAs are paired with a weakly encoded auditory/ba/, listeners default to hearing “da”/“ta”/“tha”—thus, tempering the AV fusion account, and favoring a default mechanism triggered when both AV stimuli are ambiguous. (shrink)

Cultural diversity is an inescapable reality and a concern in many businesses where it can often raise ethical questions and dilemmas. This paper aims to offer suggestions to certain problems facing managers in dealing with cultural diversity through the inspiration of Thomas Aquinas. Although he may be perceived as a voice from the distant past, we can still find in his writings helpful and original ideas and criteria. He welcomes cultural differences as a part of the perfection of the universe. (...) His systemic approach leads one to place the problem in its proper context, and to reflect on it from the perspective of virtue ethics, with a central role for practical wisdom and giving primacy to neighborly love and natural moral law. Rather than a set of rigid standards with no consideration of diversity Aquinas focuses on the common human ground, which allows for the indispensable dialogue between different positions. When dealing with practical questions, the problem is one of finding the right balance between general principle and cultural specifics, tolerance, and dialogue, always guided by practical wisdom. In this way, Aquinas’ approach is neither rigid ethical universalism with no consideration for diversity nor moral relativism with no place for any transcultural and absolute morals. (shrink)

This paper establishes a dialogue between the later works of Wittgenstein, those of Cavell and the novels of J. M. Coetzee concerning the problem of violence, authority and the authoritative voice. By drawing on J. M. Coetzee's Waiting for the Barbarians and Diary of a Bad Year, the paper discusses lessons and insights on the nature of violence and the ways in which it can be accepted as “normal.” The term “normalization” is used in order to show how violence and (...) cruelty can become a “form of life” that develops according to its own actors, cultural practices and legitimacies. (shrink)

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)

A ‘companions in guilt’ strategy against moral error theory aims to show that the latter proves too much: if sound, it supports an implausible error-theoretic conclusion in other areas such as epistemic or practical reasoning. Christopher Cowie [2016 Cowie, C. 2016. Good News for Moral Error Theorists: A Master Argument Against Companions in Guilt Strategies, Australasian Journal of Philosophy 94/1: 115–30.[Taylor & Francis Online], [Web of Science ®] [Google Scholar]] has recently produced what he claims is a ‘master argument’ against (...) all such strategies. The essence of his argument is that CG arguments cannot work because they are afflicted by internal incoherence or inconsistency. I argue, first, that Cowie's master argument does not succeed. Beyond this, I argue that there is no good reason to think that any such argument—one that purports to identify an internal incoherence in CG arguments—can succeed. Second, I argue that the main substantive area of disagreement between error theorists and CG theorists essentially concerns the conceptual profile of epistemic reasons—specifically, whether they are strongly categorical—not the ontological question of whether such reasons exist. I then develop an argument in favour of the CG theorist's position by considering the moral error theorist's arguments in support of the conceptual claim that moral reasons are strongly categorical. These include, notably, criticisms made by Joyce [2011] and Olson [2014] of Finlay's [2008] ‘end relational’ view of morality, according to which moral reasons are relative to some end or standard, hence not strongly categorical. Examining these criticisms, I argue that, based on what moral error theorists have said regarding the conceptual profile of moral reasons, there is a strong case to be made that moral reasons are strongly categorical if and only if epistemic reasons are. (shrink)

In this essay, my aim is to explain Vātsyāyana’s solution to a problem that arises for his theory of liberation. For him and most Nyāya philosophers after him, liberation consists in the absolute cessation of pain. Since this requires freedom from embodied existence, it also results in the absolute cessation of pleasure. How, then, can agents like us be rationally motivated to seek liberation? Vātsyāyana’s solution depends on what I will call the Pain Principle, i.e., the principle that we should (...) treat all aspects of our embodied existence as pain. If we were to follow this advice, we would come to apply the label of pain to all aspects of our embodied existence, including pleasure. This would undermine our attachment to our own embodied existence. I show that this fits with Vātsyāyana’s general theory of motivation. According to this theory, by manipulating the labels using which we think about the world and ourselves, we can induce radical shifts in our patterns of motivation. (shrink)

Paul of Aegina's (fl.c. 630)Pragmateiais the only extant Greek medical text from antiquity that discusses the extraction of arrows and small missiles. In his book on surgery, Paul details how to extract arrows according to their properties and the parts of the body which they have wounded (6.88). He prefaces his instructions by describing how arrows differ in their material, figure, size, number, mode, and power. Paul's account of arrow varieties appears to reflect the environment of his medical practice, seventh-century (...) Alexandria, for he refers to Egyptian arrow types when listing the material composition and sizes of different arrows. (shrink)

This compilation analyzes the differences between the concepts of ‘social responsibility’ and ‘business ethics’, which are often erroneously interpreted to be the same. It explains that social responsibility is a characteristic but just one of the many aspects of the much wider concept of business ethics. The collection includes contributions from experts from diverse fields such as industry, academia, and non-governmental organizations, who present the theoretical underpinning of the concepts, along with real-life case studies dealing with the varied, hands-on experiences (...) of leaders from different industries. (shrink)

This article tries to seek a solution to the problem of NPA in the small scale industries under the present circumstances of banking and insurance working together under the same roof. What is stressed in this article is the pressing need of the small-scale entrepreneur for becoming aware and educated in modern business management holding a professional attitude toward rational decision-making and banks have to facilitate that process as a part of the credit policy sold by them.

Aerobic mitochondria serve as the power sources of eukaryotes by producing ATP through oxidative phosphorylation (OXPHOS). The enzymes involved in OXPHOS are multisubunit complexes encoded by both nuclear and mitochondrial DNA. Thus, regulation of respiration is necessarily a highly coordinated process that must organize production, assembly and function of mitochondria to meet an organism's energetic needs. Here I review the role of OXPHOS in metabolic adaptation and diversification of higher animals. On a physiological timescale, endocrine‐initiated signaling pathways allow organisms to (...) modulate respiratory enzyme concentration and function under changing environmental conditions. On an evolutionary timescale, mitochondrial enzymes are targets of natural selection, balancing cytonuclear coevolutionary constraints against physiological innovation. By synthesizing our knowledge of biochemistry, physiology and evolution of respiratory regulation, I propose that we can now explore questions at the interface of these fields, from molecular translation of environmental cues to selection on mitochondrial haplotype variation. BioEssays 28: 890–901, 2006. © 2006 Wiley periodicals, Inc. (shrink)

This paper interrogates the routine and unproblematic use of terms such as in biomedical and anthropological discourse. A typical depiction of the social factors that explain the practice of in India is to put together the supply side factors (such as protection offered by the government for the production of generic drugs, especially in the small scale sector, and expansion of the number of drug store outlets), with the increasing demand for allopathic drugs. The paper provides an ethnographic account of (...) the intricate connections between households and biomedical practitioners in urban neighbourhoods in Delhi. It breaks away from the conventional opposition drawn between the practices of physicians and the beliefs of their patients, and suggests that what constitutes the medical environments of these neighbourhoods is the product of medical practices, household economies and concepts of disease. Thus pharmaceutical use is determined as much by practices of dispensation and by how practitioners understand what constitutes therapy as by household understanding of the normal and the pathological. This paper uses both quantitative data and narrative interviews to provide an in-depth understanding of the circulation of pharmaceuticals within the life worlds of the urban poor. (shrink)

This paper deals with issues related to character building and human values, both in personal and work life. The focus of the author is value-centred management, which has been discussed along two aspects of the human self, that is, the micro self and macro self. Here, the author tries to highlight the importance of both 'selves' in the organizational context. In the concluding part of the paper the author presents the authenticity of Kautilya's views on the macro self in the (...) context of the present business scenario. The author attempts to portray the transition created by the market economy, which cannot provide an exclusively painless solution. Moreover, he advocates culturing of self-discipline in corporate life, which can bring about qualitative improvement, both in work and personal life. 'Work with integrity and serve with love' is the philosophy the author presents in this paper. (shrink)

Book Information World Poverty and Human Rights. World Poverty and Human Rights Thomas Pogge Cambridge Polity Press 2002 vii + 284 Paperback US$28, £18 By Thomas Pogge. Polity Press. Cambridge. Pp. vii + 284. Paperback:US$28, £18.

This article uses critical discourse analysis to examine how the higher COVID-19 infection rates among South Asians in general, and Punjabis more specifically, have been represented by conservative politicians and their representatives as a consequence of cultural and religious practices. Two counter-narratives are discussed. The first substitutes the negative image of the Sikh Punjabi Canadian community with a celebratory and positive view of Sikh humanitarianism and community service. The second attributes the high numbers to class attributes such as precarious jobs, (...) poverty-level wages, employment insecurity, lack of sick days, over-crowded housing, racism and lack of access to healthcare. We argue that the conservative explanation as well as the first counter-narrative reveal continuities in culturalist understandings of South Asian immigrants, albeit in slightly different ways. The second counter-narrative represents a discursive resistance by advancing a structural analysis of health and disease in immigrant communities. (shrink)