Children and pregnant women are often excluded from clinical research. This has resulted in a paucity of evidence on how medicines work for fetuses, neonates, infants, and adolescents. It also raises bioethics, scientific, and public health concerns. For over half a century, doctors have prescribed medicines to children largely on the basis of how they work in adults, despite children’s varied physiologies and differences in how their bodies absorb and metabolize drugs. Regulations and legislation have led to an increase in (...) the number of pediatric studies and to better drug labeling. However, children at all stages of their lives often remain “therapeutic orphans” owing to insufficient evidence about how medicines work for them. (shrink)

Respect and dignity are central to moral life, and have a particular importance in health care settings such as the intensive care unit (ICU). We conducted 15 semistructured interviews with 21 participants during an ICU admission to explore the definition of, and specific behaviors that demonstrate, respect and dignity during treatment in the ICU. We transcribed interviews and conducted thematic qualitative analysis. Seven themes emerged that focused on what it means to be treated with respect and/or dignity: treated as a (...) person; Golden Rule; acknowledgement; treated as family/friend; treated as an individual; treated as important/valuable; and treated as equal. Participants described particular behaviors or actions that were considered related to demonstrating treatment with respect and dignity: listening; honesty/giving information; attention to body/modesty/appearance; caring/bedside manner; patient and family as an information source; attention to pain; and responsiveness. These behaviors provide a framework for improving experiences with care in the ICU. (shrink)

My thinking in this essay, written in 1977, reflects the 1968 Wenner-Gren Conference on Conscious Purpose and Human Adaptation, organized by Gregory, about which I wrote Our Own Metaphor, as well as later conversations, but I had not yet worked with Gregory on Mind and Nature. Here, I explore Gregory’s idiosyncratic definitions of evocative terms like “love”, “mind”, and “wisdom” in terms of a cybernetically-based epistemology. The style and context are reflective of his Father-Daughter “metalogues”, composed to explore concepts he (...) was not yet ready to define fully, one of which is quoted as an introduction. Most of the sub-headings have been added. (shrink)

Discusses mental processes, the role of humans in nature, experience, and the connection between myth, religion, and science.

"Friendship", for Aristotle, is a term with "focal meaning" which denominates relationships as casual as fellow travelers on a voyage, as permanent as spouses, and whose motives are as various as the commercial, military, religious, sexual, political and the virtuous. What can be said of all these relationships is that they involve a solidarity, a concordat, a reciprocity, which has its foundation in a common field between the parties and which produces common actions or exchanges. All friendships tend to equality (...) in the sense that they do not insist on what is due as an ultimate end; friendship, like equity, surpasses justice in the fulfillment of what is owed. Because friendship fosters solidarity and justice it is politically important as a virtue-context, according to Aristotle. Is it possible that friendship can function as a virtue-context within economic life as well? Aristotle's notion of a type of useful friendship which functions through expectation of moral behavior will be shown to provide both motive and context for the performance of acts of virtue in a business setting. (shrink)

In this study, we tested the feasibility of conducting quantitative assessments of patients’ experiences with care in the intensive care unit (ICU), in regard to treatment with respect and dignity. Patients completed the Patient Dignity Inventory, Collaborate, and selected domains from the Hospital Consumer Assessment of Health Providers and Systems Survey. Family members were additionally surveyed using the Family Satisfaction in ICU Care questionnaire. Overall, patients reported high levels of satisfaction in terms of nurses and doctors treating them with courtesy (...) and respect; however, physical aspects of care were reported to be more problematic. While this pilot study suggests some target areas for improving treatment with respect and dignity, the findings are limited since many patients were unable to participate in the survey. Future work should be directed at developing new measures that are easier to administer in this setting. (shrink)

Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

This paper presents our work on textual inference and situates it within the context of the larger goals of machine reading. The textual inference task is to determine if the meaning of one text can be inferred from the meaning of another and from background knowledge. Our system generates semantic graphs as a representation of the meaning of a text. This paper presents new results for aligning pairs of semantic graphs, and proposes the application of natural logic to derive inference (...) decisions from those aligned pairs. We consider this work as first steps toward a system able to demonstrate broad-coverage text understanding and learning abilities. (shrink)

Despite wide recognition of the importance of treating patients with respect and dignity, little is known about what constitutes treatment in this regard. The intensive care unit (ICU) is a unique setting that can pose specific threats to treatment with respect and dignity owing to the critical state of patients, stress and anxiety amongst patients and their family members, and the highly technical nature of the environment. In attempt to understand various stakeholders’ perspectives of treatment with respect and dignity, patients (...) and family members were interviewed, a wide range of health care professionals participated in focus groups, and third party observers took field notes of interactions in the ICU. This paper compares and contrasts the data that were generated using these different methods. Triangulating the data in this way contributes to a more complete and nuanced understanding of treatment with respect and dignity in the ICU. (shrink)

Although the concept of dignity is commonly invoked in clinical care, there is not widespread agreement—in either the academic literature or in everyday clinical conversations—about what dignity means. Without a framework for understanding dignity, it is difficult to determine what threatens patients’ dignity and, conversely, how to honor commitments to protect and promote it. This article aims to change that by offering the first conceptual model of dignity for patients in the intensive care unit. The conceptual model we present is (...) based on the notion that there are three sources of patients’ dignity—their shared humanity, personal narratives, and autonomy—each of which independently warrants respect. The article describes each source of dignity and draws on examples to illustrate how clinician attitudes, actions, and behaviors can either contribute to, or detract from, expressions of respect for patient dignity. (shrink)

Little is known about health care professionals’ perceptions regarding what it means to treat patients and families with respect and dignity in the intensive care unit (ICU) setting. To address this gap, we conducted nine focus groups with different types of health care professionals (attending physicians, residents/fellows, nurses, social workers, pastoral care, etc.) working in either a medical or surgical ICU within the same academic health system. We identified three major thematic domains, namely, intrapersonal (attitudes and beliefs), interpersonal (behaviors), and (...) system (contextual) factors that influence treatment with respect and dignity. Participants suggested strategies for improving treatment of patients and families in the ICU with respect and dignity, as well as the related need for enhancing respect among the multidisciplinary team of clinicians. Implementing these strategies will require innovative educational interventions and leadership. Future research should focus on the design and evaluation of such interventions on the quality of care. (shrink)

We describe an approach to textual inference that improves alignments at both the typed dependency level and at a deeper semantic level. We present a machine learning approach to alignment scoring, a stochastic search procedure, and a new tool that finds deeper semantic alignments, allowing rapid development of semantic features over the aligned graphs. Further, we describe a complementary semantic component based on natural logic, which shows an added gain of 3.13% accuracy on the RTE3 test set.

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)