Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

In the present essay we attempt to reconstruct Newtonian mechanics under the guidance of logical principles and of a constructive approach related to the genetic epistemology of Piaget and García (Psychogenesis and the history of science, Columbia University Press, New York, 1989). Instead of addressing Newton’s equations as a set of axioms, ultimately given by the revelation of a prodigious mind, we search for the fundamental knowledge, beliefs and provisional assumptions that can produce classical mechanics. We start by developing our (...) main tool: the no arbitrariness principle, that we present in a form that is apt for a mathematical theory as classical mechanics. Subsequently, we introduce the presence of the observer, analysing then the relation objective–subjective and seeking objectivity going across subjectivity. We take special care of establishing the precedence among all contributions to mechanics, something that can be better appreciated by considering the consequences of removing them: (a) the consequence of renouncing logic and the laws of understanding is not being able to understand the world, (b) renouncing the early elaborations of primary concepts such as time and space leads to a dissociation between everyday life and physics, the latter becoming entirely pragmatic and justified a-posteriori (because it is convenient), (c) changing our temporary beliefs has no real cost other than effort. Finally, we exemplify the present approach by reconsidering the constancy of the velocity of light. It is shown that it is a result of Newtonian mechanics, rather than being in contradiction with it. We also indicate the hidden assumption that leads to the (apparent) contradiction. (shrink)

Autonomy of people on the autism-spectrum has only been very rarely conceptually explored. Autism spectrum is commonly considered a hetereogenous disorder, and typically described as a behaviorally-defined neurodevelopmental disorder associated with the presence of social-communication deficits and restricted and repetitive behaviors. Autism research mainly focuses on the behavior of autistic people and ways to teach them skills that are in line with social norms. Interventions such as therapies are being justified with the assumption that autists lack the capacity to be (...) self-reflective and to be “author of their lives”. We question this assumption, as some empirical research shows that autists are aware of their strengths and are critical about social norms, we take this as a starting point to reconsider the beliefs about autistic people’s capacities. As a theoretical framework, we draw on Berlin’s idea of positive and negative liberty as he clearly distinguishes between one’s own developed preferences and the simple absence of interference. By drawing on the concept of positive liberty, we illustrate that a lot of autists are aware of their own needs, and usually do not deny their own needs, values and interests. This makes them less prone than non-autistic people to adapt their preferences to external influences, which might be seen as sticking to an authentic way of living. Our analysis shows that many autists are hindered to be autonomous due to unjustified interference, unreflected assumptions about their self-determination, or by paternalistic actions. These observations contribute to a better understanding when help and interference are justified and a more differentiated understanding of autonomy of autistic people. (shrink)

Informed consent enjoys an unassailable position in both clinical and research situations as a safeguard of patients’ rights. Keeping the patient involved in the decision making process is easier when there is direct communication with the individual. The Pakistani milieu offers challenges to this process because crucial decision making is often done by family members or is left entirely up to the attending physician. There seems to be a general acceptance of this shifting of focus from the individual to other (...) players. This also raises certain ethical dilemmas for physicians who may feel uncomfortable with communication which excludes the patient or in accepting a paternalistic primary decision making role. The objective of this informal qualitative study was to ascertain physicians’ perceptions regarding the process of information delivery to the patient in the Pakistani context and the various influences acting upon it. (shrink)

In his thesis 'Para uma Teoria Geral dos Homomorfismos' (1944) the Portuguese mathematician José Sebastião e Silva constructed an abstract or generalized Galois theory, that is intimately linked to F. Klein’s Erlangen Program and that foreshadows some notions and results of today’s model theory; an analogous theory was independently worked out by M. Krasner in 1938. In this paper, we present a version of the theory making use of tools which were not at Silva’s disposal. At the same time, we (...) tried to keep in mind, so much as possible, the gist of his standpoint. (shrink)

Parents’ freedom to choose infant male circumcision is the correct policyIndividuals and groups lobbying to have infant male circumcision prohibited or restricted often argue that the practice of routinely circumcising infants is unjustified. For instance, in this issue of the journal, John Hutson argues that it is virtually impossible to justify a policy in which the medical establishment should be able to embark on a “mass circumcision” campaign of 100% of the infant male population [see page 238].1Indeed, I would be (...) hard pressed to find anyone who could rationally disagree with this contention. However, this is because no one is currently arguing for the enactment of a policy that stipulates that all healthy male infants should be routinely circumcised . Arguments seeking to support a prohibition of “routine infant circumcision”, such as the one by Hutson, are arguing against a straw man—and a pitiful one at that.2 Such arguments only serve to misconstrue the debate and avoid engaging in the real and pressing issues concerning the legitimacy of the provision of this procedure.The questions that should be considered, and the ones which I shall be interested in discussing here, are what reasons are justifiable for allowing parents to choose to have their son circumcised? After well informed and careful deliberation should parents have the freedom to choose to have their son circumcised? These are the most relevant questions to be considered because there is a growing collection of citizens, medical practitioners, and lawyers who are currently lobbying for the practice of infant male circumcision to be outlawed—for example, there is a bioethicist who argues that the criminal law should be used …. (shrink)

Is there an effect of depressed mood on the interpretation of ambiguity? Are depressed individuals biased to interpret ambiguous information in a negative manner? We used a cross-modal semantic priming task to look for evidence of a negative interpretative bias. Participants listened to ambiguous prime sentences (e.g., Joan was stunned by her final exam mark) and made lexical decisions to target words presented immediately after the sentence offset or after a delay of 1000 ms or 2000 ms. For the semantically (...) related targets, the target was negatively related (distress), positively related (success), or neutrally related (grades) to the ambiguous prime. The experiment was conducted with and without a negative mood induction. The expectation was that depressed participants would be more likely to consider the negative interpretations of the ambiguous primes and would therefore experience larger priming effects for negatively related targets. Although there were large priming effects for all semantically related targets, there was no evidence of a negative interpretative bias. (shrink)

Problems concerning future populations help us better understand what it is for one possible future, or world, to be morally better than another. The repugnant conclusion challenges traditional forms of consequentialism, including utilitarianism. A key issue is whether, per the traditional view, we make things morally better by creating additional people whose lives are worth living and by creating nonidentical better-off people in place of less well-off but distinct people. Or can we, instead, make things morally better only by making (...) things better for some particular person or another? Is the structure of morality aggregative in nature or instead person-affecting in nature? While the latter, non-traditional view may tempt us, it also seems to give rise to the nonidentity problem and various inconsistency objections. Can those problems be resolved? Questions raised by Parfit and others decades ago remain unsettled today but as critical as ever. (shrink)

We demonstrate that the key components of cognitive architectures (declarative and procedural memory) and their key capabilities (learning, memory retrieval, probability judgment, and utility estimation) can be implemented as algebraic operations on vectors and tensors in a high‐dimensional space using a distributional semantics model. High‐dimensional vector spaces underlie the success of modern machine learning techniques based on deep learning. However, while neural networks have an impressive ability to process data to find patterns, they do not typically model high‐level cognition, and (...) it is often unclear how they work. Symbolic cognitive architectures can capture the complexities of high‐level cognition and provide human‐readable, explainable models, but scale poorly to naturalistic, non‐symbolic, or big data. Vector‐symbolic architectures, where symbols are represented as vectors, bridge the gap between the two approaches. We posit that cognitive architectures, if implemented in a vector‐space model, represent a useful, explanatory model of the internal representations of otherwise opaque neural architectures. Our proposed model, Holographic Declarative Memory (HDM), is a vector‐space model based on distributional semantics. HDM accounts for primacy and recency effects in free recall, the fan effect in recognition, probability judgments, and human performance on an iterated decision task. HDM provides a flexible, scalable alternative to symbolic cognitive architectures at a level of description that bridges symbolic, quantum, and neural models of cognition. (shrink)

The relevance of the research is that the information and computer communications of scientific and educational activity as a factor of the development of the information society are analyzed. Statement of the task - the modern stage of the socio-political development of Ukraine is characterized by the unprecedented pace of development of a new information and communication arrangement of scientific and educational activities in society and, as a result, its development as informational and civic. Object of research - information and (...) computer communications of scientific and educational activity as a complex social, cultural and economic phenomenon. The subject of research is the influence of the information society on the development of information and computer communication of scientific and educational activities. Analysis of recent publications and research. The author focuses on the analysis of the problems of the informational society, which was investigated in the works of I. Wallerstain, Z.Bzhezynsky, D. Bell, J.Gelbreyt, P.Drucker, A.Lazarevich, A.Porter, O.Toffler, and R.Hatcheson, as well as in the works of domestic scientists - V. Andrushchenko, V.Voronkova, O.Kivlyuk, M.Kyrychenko, A.Punchenko, D.Sviridenko. Selection of unexplored parts of the general problem. Unsolved earlier part of the general problem. Setting objectives. Representatives of the modern scientific and educational environment did not notice in due time that with the advent of the computer in the world fundamental concepts of education, man, science, the Universe, temporal measurements of time, tendencies of the development of the modern world have changed significantly. Education determines the pace of world development, and the ownership of its markets began an unprecedented rigorous competition. Information and knowledge have become a tremendous wealth, an intangible asset to the development of nations and states. Methodology of the research - the use of synergistic and axiological methods that contribute to deep penetration into the essence of the object and subject of research. Scientific novelty of the research. This scientific study involves addressing the socio-philosophical meaning of the concept of information and computer communications of scientific and educational activity as a factor in the development of the information society. Presenting the main material : the problems concerning the global informatization of the society that stimulated all processes of international cooperation of people have been revealed; due to the development of the information and communication sphere, the needs of management systems of the states, societies and their citizens in various informational services have been determined, radical changes in all security systems of socio-political relations; the historical tendency of development of industrial, then - postindustrial and informational society on the basis of the concept of J.Masuda is analyzed; it was disclosed that the progress of the information and education problem requires us to improve considerably the educational information and communication systems and technologies of education; the directions of improvement of information and computer communications of scientific and educational activity as the factor of development of the information society are substantiated. Conclusions - the concept of information and computer communications of scientific and educational activity as a factor of development of the information society is formed. The result of the research is the development of the directions of reforming the education system in Ukraine and the use of concepts for the introduction of computer information and communication technologies for these purposes. (shrink)

This book analyses the state of development of Muslims at the regional level. It explains the linkages between the findings of global, national, and state-level studies with regard to the current status of Muslims and broadens understanding of Muslims and their participation in virtually all major sectors, including the economy, housing, demography, health, migration, state policy, and affirmative action. The book presents the challenges faced by the community and reflects upon the socio-economic and educational conditions of Muslims in Telangana State. (...) It presents a comparative analysis of mortality data, maternal health, delivery care, and child immunization, as well as reproductive health aspects and children’s nutritional status. It shares valuable insights into the impacts of emigration and internal migration on health among local Muslims and presents a detailed analysis of data from the Census of India, NSSO, and Commission of Inquiry on Socio-Economic and Educational Status of Muslims regarding the social, economic, and demographic situation of Muslims in Telangana, as well as their opportunities for development under the newly formed state government. The book would be of great interest to scholars and researchers in development economics, sociology, politics, history, cultural studies, minority studies, Islamic studies, and policy studies, as well as policymakers, civil society activists, and those working in media and journalism. (shrink)

Good medical practice requires evidence of effectiveness to address deficits in care, strive for further improvements, and justly apportion finite resources. Nevertheless, the potential of palliative care is still held back by a paucity of good evidence. These circumstances are largely attributable to perceived ethical challenges that allegedly distinguish dying patients as a special client class. In addition, practical limitations compromise the quality of evidence that can be obtained from empirical research on terminally ill subjects.This critique aims to appraise the (...) need for focused research, in order to develop clinical and policy decisions that will guide health care professionals in their care of dying patients. Weighted against this need are tenets that value the practical and ethical challenges of palliative care research as unique and insurmountable. The review concludes that, provided investigators compassionately apply ethical principles to their work, there is no justification for not endeavouring to improve the quality of palliative care through research. (shrink)

By using a tomographic approach to quantum states, we rise the problem of nonlocality within a single particle (single degree of freedom). We propose a possible way to look for such e®ects on a qubit. Although a conclusive answer is far from being reached, we provide some re°ections on the foundational ground.

The article explores the informal side of the idea of the proof. The word "idea" is used in a sense dating back to Plato. Proof is understood as a precisely established connection of precisely formulated and objectively existing ideas. This connection of ideas belongs to the realm of the possible and can be present in some possible worlds and absent in others. Attempts to interpret the proof as a procedure of convincing argumentation are criticized. It is shown that the proof (...) is not necessarily convincing, and that persuasiveness may be inherent outside the proof-based forms of argument. The genesis of the idea of the proof is briefly traced from its origins to the present day. Arguments are made in favor of the thesis of the idea of the proof in Pythagorean philosophy. The question of why the idea of the proof has not been rediscovered anywhere and never is discussed. The problem of the time gap between the appearance of the proof and the exact definition of the concept of the proof in modern logic is considered. An accessible example substantiates the inseparability of the idea of the proof from its formal presentation in one or another logic. A list of some basic informal predicates of the proof is given and a brief description is given. (shrink)

Packing optimization problems have a wide spectrum of real-word applications. One of the applications of the problems is problem of placement of containers with spent nuclear fuel on the storage platform. The solution of the problem can be reduced to the solution of the problem of finding the optimal placement of a given set of congruent circles into a multiconnected domain taking into account technological restrictions. A mathematical model of the prob-lem is constructed and its peculiarities are considered. Our approach (...) is based on the mathematical modelling of rela-tions between geometric objects by means of phi-function technique. That allowed us to reduce the problem solving to nonlinear programming. Today, an important scientific problem is the problem of creating conditions for safe storage of spent nuclear fuel. In the process of creating any dry spent nuclear fuel storage, the following main stages can be identified: site selection, storage design, construction, operation and decommissioning. A full check for compliance of the repository and its elements with these standards usually begins at the design stage. At the stage of site selection, the inspection for compliance with safety standards is carried out only in terms of the impact of the repository as a whole on the environment. This approach cannot be considered fully appropriate, because, taking into account, for example, all the climatic features of the future storage site, it is possible to adjust the thermal storage regimes of spent nuclear fuel. Similarly, it can be considered necessary to analyze and select the shape of the storage site in order to accommo-date the maximum possible number of spent fuel containers. Such a choice, obviously, should be made taking into ac-count the norms of nuclear, radiation and thermal safety, as well as in compliance with technological limitations. The problem of finding the optimal placement of containers taking into account the given technological limitations can be formulated in the form of the problem of optimization of geometric design. Therefore, the purpose of the study is to build a mathematical model of the problem and study its characteristics to develop effective methods of solution. The proposed approach is based on mathematical modeling of relations between geometric objects using the method of phi-functions. This allowed to reduce the solution of the problem to the problem of nonlinear programming. (shrink)

The House of Lords in F v West Berkshire Health Authority [1989] considered the lawfulness of providing care and treatment for a mentally incapacitated adult. They did not, however, directly consider the use of restraint to enable the provision of care in the face of resistance from the patient. The law has since had good cause to give consideration to this important issue. This paper establishes the present law in the context of using restraint to deliver care. Although the legal (...) principles established have derived from what might be considered to be “hard cases”, life-and-death cases, they apply to all aspects of routine medical, dental and nursing care. Further, the paper considers the recent government proposals and the effect those proposals may have on the routine care of such patients. (shrink)

Can we refer to objects which do not exist? Searle says that we cannot. He postulates an ‘axiom of existence’ such that, if an object does not exist, we cannot refer to it. This ‘axiom of existence’ could be taken simply as a way of defining the notion of ‘reference’; we would not count a reference to a non-existent object as a ‘reference’ in the philosophical sense; or perhaps it might count as a reference but not as a ‘successful’ or (...) ‘consummated’ reference, to use the terminology which Searle sometimes adopts. Whichever way we take Searle's doctrine I wish to argue that it is objectionable. The conceptual scheme he advocates obscures the truth. But I do not deny that there is a temptation to resort to it, and I hope to show that, where lawyers have yielded to the temptation, pernicious doctrines have resulted. (shrink)

Name der Zeitschrift: Das Mittelalter Jahrgang: 20 Heft: 1 Seiten: 80-95.