Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

A comparison is made between the scientific receptions of three proposed new members of the hominin phylogenetic tree: the first finds of Neanderthal Man, those of Homo erectus, and those of Homo floresiensis. In each case, the leading scientists of the moment of discovery heavily debated the finds and neglected the meaning of those finds. At least it took/will take one generation before the meaning of those finds were/will be accepted.

Milgram’s series of obedience experiments and Zimbardo’s Stanford Prison Experiment are probably the two best-known psychological studies. As such, they can be understood as central to the broad process of psychologization in the postwar era. This article will consider the extent to which this process of psychologization can be understood as a simple overflow from the discipline of psychology to wider society or whether, in fact, this process is actually inextricably connected to the science of psychology as such. In so (...) doing, the article will argue that Milgram’s and Zimbardo’s studies are best usefully understood as twin experiments. Milgram’s paradigm of a psychology which explicitly draws its subject into the frame of its own discourse can be said to be the precondition of Zimbardo’s claim that his experiment offers a window onto the crucible of human behaviour. This will be analysed by drawing on the Lacanian concepts of acting out and passage à l’acte. The question then posed is: if both Milgram and Zimbardo claim that their work has emancipatory dimensions — a claim maintained within mainstream psychology — does a close reading of the studies not then reveal that psychology is, rather, the royal road to occurrences such as Guantanamo and Abu Ghraib? The drama of a psychology which is fundamentally based on a process of psychologization is that it turns its subjects into homo sacer of psychological discourse. (shrink)

In this study, we explain differences in support for interreligious lawful and violent protests against the religious outgroup. Combining religiosity and social identity approaches, we take three dimensions of religiosity into consideration related to support for interreligious conflict, next to relevant control characteristics. The analysis is based on survey data collected among a random sample of Muslims and Christians across the Indonesian archipelago. Our findings show that members of the Muslim community are, on average, more inclined to support interreligious conflict, (...) both lawful and violent protests. Participation in rites of passage is a crucial aspect of religious practices found to be positively related to both kinds of protest. Religious beliefs show great importance but vary in their influence: particularistic views and intratextual fundamentalism are related to support for lawful protest, whereas religiocentrism is related to support both for lawful and violent protests. In contrast, salience reduces support for violent protest. As such, the findings offer a differentiated way to understand present-day interreligious conflicts among the general population in Indonesia. (shrink)

Computer vision research involving street and road detection methods usually focuses on driving assistance and autonomous vehicle systems. In this context, street segmentation occurs in real-time, based on images centered on the street. This work, on the other hand, uses street segmentation for urban planning research to classify pavement types of a city or region, which is particularly important for developing countries. For this application, it is needed a dataset with images from various locations for each street. These images are (...) not necessarily centered on the street and include challenges that are not common in street segmentation datasets, such as mixed pavement types and the presence of faults and holes on the street. We implemented a multi-class version of a state-of-the-art segmentation algorithm and adapted it to perform street pavement classification, handling navigation along streets and angle variation to increase the accuracy of the classification. A data augmentation approach is also proposed to use preliminary results from the test instances as new ground truth and increase the amount of training data. A dataset with more than 300,000 images from 773 streets from a Brazilian city was built. Our approach achieved a precision of 0.93, showing the feasibility of the proposed application. (shrink)

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

This article presents an overview ofregulations, guidelines and societal debates ineight member states of the EC about a)embryonic and fetal tissue transplantation(EFTT), and b) the use of human embryonic stemcells (hES cells) for research into celltherapy, including `therapeutic' cloning. Thereappears to be a broad acceptance of EFTT inthese countries. In most countries guidance hasbeen developed. There is a `strong' consensusabout some of the central conditions for `goodclinical practice' regarding EFTT.International differences concern, amongstothers, some of the informed consent issuesinvolved, and the (...) questions whether anintermediary organisation is necessary, whetherthe methods of abortion may be influenced bythe possible use of EFT, and whether EFTTshould only be used for the experimentaltreatment of rare disorders. The potential useof hES cells for research into cell therapy hasgiven a new impetus to the debate about (human)embryo research. The therapeutic prospects withregard to the retrieval and research use of hEScells appear to function as a catalyst for theintroduction of less restrictive regulationsconcerning research with spare embryos, atleast in some European countries. It remains tobe seen whether the prospect of treatingpatients suffering from serious disorders withtransplants produced by therapeutic cloningwill decrease the societal and moral resistanceto allowing the generation of embryos for`instrumental' use. (shrink)

Here are the 18 guidance points contained in the UNAIDS document on Ethical Considerations in HIV Preventive Vaccine Research, reproduced by kind permission of the Joint United Nations Programme on HIV/AIDS.

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.

Any theory of information needs to comply with what we call the implementation, formalization, and representation constraints. These constraints are justified by basic considerations concerning scientific modelling and methodology. In the first part of this paper, we argue that the implementation and formalization constraints cannot be satisfied because the relation between Shannon information and IIT must be clarified. In the second part of the paper, we focus on the representation constraint. We argue that IIT cannot succeed in satisfying this constraint (...) for semantic contents without offering models for concepts, conceptual roles, and context sensitivity. In the final part of the paper, further complications are raised with respect to the distinction between consciousness and attention, which apply more specifically to the representation constraint. We conclude with some recommendations as to how IIT may succeed in solving these problems, highlighting the advantages and enormous potential of IIT as a scientific theory. (shrink)