Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)

The debates on the scientificity of social sciences in general, and sociology in particular, are recurring. From the original methodenstreitat the end the 19th Century to the contemporary controversy on the legitimacy of “regional epistemologies”, a same set of interrogations reappears. Are social sciences really scientific? And if so, are they sciences like other sciences? How should we conceive “research programs” Lakatos (1978) or “research traditions” for Laudan (1977) able to produce advancement of knowledge in the field of social and (...) human phenomena? Is the progress of knowledge in social sciences similar to the one generally observed in natural sciences? Is it possible to evaluate the relative merits of each one of these research programs? -/- These debates are important vectors of social and intellectual polarization. The historical divide between the positivist and the hermeneutics poles precedes the structure of the contemporary debate around the epistemic space of social sciences, It is not only a question of renewing the opposition between a monist view of sciences (e.g. McIntyre, 1996) and a dualistic one (e.g. Geertz, 1973) or even a trialist view of sciences (e.g. Lepenies, 1985). It is also a question of asserting dichotomies transformed into framework (including when it is a question of exceeding them): nature-culture, nomothetic-idiographic, models-narrative, structure-history, cause-reason, explanation-comprehension. -/- In this short introduction, we provide, in section 2, a first overview of this epistemological debate in social science. Section 3 proposes a different standpoint on the same questions, by introducing both ontological and methodological aspects in this basic epistemological debate. Namely, following (Hollis, 1994) oppositions of the explanation - understanding, causes - meaning, etc., types discussed in the firsts ection are comparatively examined together with oppositions of the structure - action, holism - individualism types. This allows us to discus show multi-agent design, by integrating various dimensions and standpoints in the same framework (Phan, Amblard, 2007, Chapters 1, 5, 14) can help us to shift these boundaries, and to bypass these oppositions. As model building and ontology design are at the core of this process (Phan, Amblard, 2007, Chapter 12), Section4 discusses various issues of the art of modelling, starting both from economists’ and sociologists’ current standpoints. (shrink)

La nouvelle sociologie des sciences réunit un ensemble d'études consacrées aux programmes de recherche dits " fort " et " constructiviste ". Ces programmes, véritables orthodoxies en sociologie des sciences, ont en commun de se focaliser sur le processus de la recherche et d'en donner une représentation singulière : " relativiste " pour le premier, " contingentiste " pour le second. Là où les ouvrages existants consacrés à ces programmes prennent essentiellement le parti de la description, il revendique celui de (...) l'analyse critique. Il propose une réflexion d'ensemble sur les limites de ces approches sociologiques et sur la représentation des sciences qui s'y rapportent : limites de la conception générale de l'explication sociologique et de ses applications, du caractère inédit de ses thèses et principes généraux, de la transposition de données et démarches venues de disciplines voisines, etc. L'ouvrage vient à la suite de l'affaire Sokal au cours de laquelle les représentants de la " nouvelle sociologie des sciences " ont été ouvertement pris à parti par une partie de la communauté scientifique. Il n'invite pas à l'abandon de l'analyse sociologique du processus de recherche mais à une redéfinition des modalités de cette analyse. (shrink)

-- -- ḥeleḳ 2. Sofisṭim. Soḳraṭes. Aflaṭon.

abstract Individuals tend to change their behaviour as a response to insurance. Such behavioural responses to insurance are commonly seen as ethically and morally problematic. This is especially true of effects on behaviour from social insurance. These effects have been seen as an ethical problem, associated with irresponsibility, fraud and an immoral character. This article discusses the relevance of four different types of reasons for claims that behavioural responses to social insurance are immoral. These reasons are independent reasons con‐tract related (...) reasons reasons related to fraud and reasons related to justice. I argue that reasons related to justice are most relevant, but that this type of reason does not render the individual morally blameworthy. Hence, insofar as behavioural responses to social insurance are an ethical problem it is a problem that concerns the institution, i.e. what incentives social insurance exhibits, rather than the individual, i.e. the morality of the individual responding to it. Insofar as behavioural responses to social insurance are an ethical problem it is a problem for political philosophy rather than individual ethics. (shrink)

abstract Individuals tend to change their behaviour as a response to insurance. Such behavioural responses to insurance are commonly seen as ethically and morally problematic. This is especially true of effects on behaviour from social insurance. These effects have been seen as an ethical problem, associated with irresponsibility, fraud and an immoral character. This article discusses the relevance of four different types of reasons for claims that behavioural responses to social insurance are immoral. These reasons are (1) independent reasons (2) (...) con‐tract related reasons (3) reasons related to fraud and (4) reasons related to justice. I argue that reasons related to justice are most relevant, but that this type of reason does not render the individual morally blameworthy. Hence, insofar as behavioural responses to social insurance are an ethical problem it is a problem that concerns the institution, i.e. what incentives social insurance exhibits, rather than the individual, i.e. the morality of the individual responding to it. Insofar as behavioural responses to social insurance are an ethical problem it is a problem for political philosophy rather than individual ethics. (shrink)

This paper discusses the critical necessity of teaching students about the social and ethical responsibilities of scientists. Both a university scientist and a middle school science teacher reflect on the value of teaching the ethical issues that confront scientists. In the development of the atomic bomb in the US-led Manhattan Project, scientists faced the growing threat of atomic bombs by the Germans and Japanese and the ethical issues involved in successfully completing such a destructive weapon. The Manhattan Project is a (...) prime example of the types of ethical dilemmas and social responsibilities that scientists may confront. (shrink)