Symmetry in biological and physical systems is a product of self-organization driven by evolutionary processes, or mechanical systems under constraints. Symmetry-based feature extraction or representation by neural networks may unravel the most informative contents in large image databases. Despite significant achievements of artificial intelligence in recognition and classification of regular patterns, the problem of uncertainty remains a major challenge in ambiguous data. In this study, we present an artificial neural network that detects symmetry uncertainty states in human observers. (...) To this end, we exploit a neural network metric in the output of a biologically inspired Self- Organizing Map Quantization Error (SOM-QE). Shape pairs with perfect geometry mirror symmetry but a non-homogenous appearance, caused by local variations in hue, saturation, or lightness within and/or across the shapes in a given pair produce, as shown here, a longer choice response time (RT) for “yes” responses relative to symmetry. These data are consistently mirrored by the variations in the SOM-QE from unsupervised neural network analysis of the same stimulus images. The neural network metric is thus capable of detecting and scaling human symmetry uncertainty in response to patterns. Such capacity is tightly linked to the metric’s proven selectivity to local contrast and color variations in large and highly complex image data. (shrink)

BackgroundFear of cancer recurrence is an important cause of suffering for cancer survivors, and both empirical evidence and theoretical models suggest that prognostic uncertainty plays a causal role in its development. However, the relationship between prognostic uncertainty and FCR is incompletely understood.ObjectiveTo explore the relationship between prognostic uncertainty and FCR among patients with ovarian cancer.DesignA qualitative study was conducted utilizing individual in-depth interviews with a convenience sample of patients with epithelial ovarian cancer who had (...) completed first-line treatment with surgery and/or chemotherapy. Semi-structured interviews explored participants’ understanding of their prognosis; experiences, preferences, and attitudes regarding prognostic information; and strategies for coping with prognostic uncertainty. Inductive qualitative analysis and line-by-line software-assisted coding of interview transcripts was conducted to identify key themes and generate theoretical insights on the relationship between prognostic uncertainty and FCR.ResultsThe study sample consisted of 21 participants, nearly all of whom reported experiencing significant FCR, which they traced to an awareness of the possibility of a bad outcome. Some participants valued and pursued prognostic information as a means of coping with this awareness, suggesting that prognostic uncertainty causes FCR. However, most participants acknowledged fundamental limits to both the certainty and value of prognostic information, and engaged in various strategies aimed not at reducing but constructing and maintaining prognostic uncertainty as a means of sustaining hope in the possibility of a good outcome. Participants’ comments suggested that prognostic uncertainty, fear, and hope are connected by complex, bi-directional causal pathways mediated by processes that allow patients to cope with, construct, and maintain their uncertainty. A provisional dual-process theoretical model was developed to capture these pathways.ConclusionAmong patients with OC, prognostic uncertainty is both a cause and an effect of FCR—a fear-inducing stimulus and a hope-sustaining response constructed and maintained through various strategies. More work is needed to elucidate the relationships between prognostic uncertainty, fear, and hope, to validate and refine our theoretical model, and to develop interventions to help patients with OC and other serious illnesses to achieve an optimal balance between these states. (shrink)

Four experiments examined how accurately participants can report the times of their own decisions. Within an auditory reaction time task, participants reported the time at which the tone was presented, they decided on the response, or the response key was pressed. Decision time reports were checked for plausibility against the actual RTs, and we compared the effects of experimental manipulations on these two measures to see whether the reported decision times showed appropriate effects. In addition, we estimated the (...) amount of error associated with individual decision time reports by checking how often participants’ decision time reports were implausibly early or late , and by using several quantitative models. Overall, the results suggest that decision time reports are not very accurate but they may be usable for some purposes. (shrink)

In this article, I present a new interpretation of the pro-life view on the status of early human embryos. In my understanding, this position is based not on presumptions about the ontological status of embryos and their developmental capabilities but on the specific criteria of rational decisions under uncertainty and on a cautious response to the ambiguous status of embryos. This view, which uses the decision theory model of moral reasoning, promises to reconcile the uncertainty about the (...) ontological status of embryos with the certainty about normative obligations. I will demonstrate that my interpretation of the pro-life view, although seeming to be stronger than the standard one, has limited scope and cannot be used to limit destructive research on human embryos. (shrink)

Lennard Davis’s Biocultural Critique of the alleged certainty of diagnosis (Davis Journal of Bioethical Inquiry 7:227−235, 2010) makes errors of fact concerning psychiatric diagnostic categories, misunderstands the role of power in the therapeutic relationship, and provides an unsubstantiated and vague alternative to the management of psychological distress via a conceptually outdated model of the relationships between physical and psychological disease and illness. This response demonstrates that diagnostic knowledge vouchsafes legitimate power to physicians, and via them relief to patients (...) who suffer from psychological distress. The history of medicine and psychiatry demonstrates that psychiatric diagnosis shares many features with physical diagnosis, while there is also reason to believe that the two types will continue to be distinct in some respects. Diagnostic categories in psychological medicine, like those in physical medicine, are provisional, probabilistic, and often uncertain. These features do not detract from the dependence on diagnosis of therapeutic efficacy in both domains. (shrink)

How should deontological theories that prohibit actions of type K — such as intentionally killing an innocent person — deal with cases of uncertainty as to whether a particular action is of type K? Frank Jackson and Michael Smith, who raise this problem in their paper "Absolutist Moral Theories and Uncertainty" (2006), focus on a case where a skier is about to cause the death of ten innocent people — we don’t know for sure whether on purpose (...) or not — by causing an avalanche; and we can only save the people by shooting the skier. One possible deontological attitude towards such uncertainty is what Jackson and Smith call the threshold view, according to which whether or not the deontological constraint applies depends on our degree of (justified) certainty meets a given threshold. Jackson and Smith argue against the threshold view that it leads to implausible paradoxical moral dilemmas in a special kind of case. In this response, we show that the threshold view can avoid these implausible moral dilemmas, as long as the relevant deontological constraint is grounded in individualistic patient-based considerations, such as what an individual person is entitled to object to. (shrink)

When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it (...) becomes part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

As is well known, Wittgenstein pointed out an asymmetry between first- and third-person psychological statements: the first, unlike the latter, involve observation or a claim to knowledge and are constitutionally open to uncertainty. In this paper, I challenge this asymmetry and Wittgenstein's own affirmation of the constitutional uncertainty of third-person psychological statements, and argue that Wittgenstein ultimately did too. I first show that, on his view, most of our third-person psychological statements are noncognitive; they stem from a subjective (...) certainty: a certainty which, though not the result of an epistemic process, is not invulnerable to error in that it is a kind of assumption. I then trace Wittgenstein's realization that some third-person psychological certainties are not merely subjective but 'objective' (which means, as he uses the word, that they are logically indubitable): in some cases, we can be as logically certain that someone else is in pain than we are about ourselves being in pain. This positively reinforces Wittgenstein's rebuttal of other mind scepticism. I conclude with a response to objections about the legitimacy of calling an assurance that is logical (i.e., that does not have uncertainty or doubt on its flipside) a 'certainty', by suggesting that the flipside is to be found in pathological cases, and most pertinently here, in cases of dyssemia: a rare disorder affecting the ability to properly express or recognize basic physical expressions of feeling. (shrink)

Food uncertainty has the effect of invigorating food-related responses. Psychologists have noted that mammals and birds respond more to a conditioned stimulus that unreliably predicts food delivery, and ecologists have shown that animals consume and/or hoard more food and can get fatter when access to that resource is unpredictable. Are these phenomena related? We think they are. Psychologists have proposed several mechanistic interpretations, while ecologists have suggested a functional interpretation: The effect of unpredictability on fat reserves and hoarding (...) behavior is an evolutionary strategy acting against the risk of starvation when food is in short supply. Both perspectives are complementary, and we argue that the psychology of incentive motivational processes can shed some light on the causal mechanisms leading animals to seek and consume more food under uncertainty in the wild. Our theoretical approach is in agreement with neuroscientific data relating to the role of dopamine, a neurotransmitter strongly involved in incentive motivation, and its plausibility has received some explanatory and predictive value with respect to Pavlovian phenomena. Overall, we argue that the occasional and unavoidable absence of food rewards has motivational effects that facilitate foraging effort. We show that this hypothesis is computationally tenable, leading foragers in an unpredictable environment to consume more food items and to have higher long-term energy storage than foragers in a predictable environment. (shrink)

The main response to the multiple crises besetting Western societis in the past decades has been the attempt of the academic and scientific as well as political circles to gain a sense of orientation—and of social cohesion—by two main modes of thinking: identity politics and evidence-based knowlegde. Regarding the latter, I argue that if scientific knowledge is reduced to facts, data and numbers, as the basis for political decisions without any alternatives, it would become a dogma propagating the truth—that (...) is, a new religion. Politicians will no longer have to struggle with other perspectives, once there is a consensus about following the line that “the numbers or the facts speak for themselves.” While many people would perhaps find in this new religion a guarantee of security in an insecure world, this sense would be illusionary. I argue that the role intellectuals should play in a spiritual crisis of this kind is paradoxically to cultivate a sense of more security by strengthening a culture of “insecureness” or docta ignorantia against the dogmas within science and religion. To create and encourage a new art of questioning and listening, and of learning to appreciate non-knowledge as the basis of coming together. This notion is found in the Greek and Christian as well as the Jewish tradition of European thought, and it continues in the works of modern thinkers such as Paul Ricoeur, Hermann Cohen, Martin Buber, Hartmut Rosa, and of philosophers who focus on the question of the ineffable. My aim is to present this quality of certainty within uncertainty by examples from different fields, including philosophy, art and psychotherapy, and to elaborate on the paradoxical question: does a troubled Geist need more trouble in order to help us find a sense of orientation through disorientation? (shrink)

The Covid-19 pandemic broke on a world whose grip on epistemic trust was already in disarray. The first months of the pandemic saw many governments publicly performing reliance on epidemiological and modelling expertise in order to signal that data would be the basis for justifying whatever population-level measures of control were judged necessary. But comprehensive data has not become available, and instead scientists, policymakers and the public find themselves in a situation where policy inputs determine the data available and vice (...) versa. This essay asks how we can live with what Amoore has termed ‘post-Cartesian doubt’ in situations of existential risk, and what kind of approach to science and data can answer the moral and human demands of a situation such as the Covid-19 pandemic. I suggest that science and policy could be able to control the pandemic better by addressing the sources of uncertainty and missing data not as gaps in the information landscape, but as individuals who are likely to be members of less-visible and less powerful groups including low-wage workers, the elderly, migrants, prisoners and others. This would shift both data use and policy toward an ethics of care, an embodied approach which asks what people need and how they behave in relation to each other, rather than how to manage population-level behaviour. This approach, I argue, is more appropriate for pandemic response than a utilitarian calculation of how many people each country should expect to lose as a result of the disease. (shrink)

In the standard volunteer’s dilemma (VoD), a single prosocial act (i.e., volunteering) yields the optimal overall outcome. Whereas the volunteer’s outcome is certain, the defector’s outcome depends on what others do. This research addressed the confounding of prosocial responses with uncertainty avoidance in the standard VoD. In Experiment 1, participants (N = 102) considered 18 hypothetical one-shot two-person VoD scenarios with certain, risky, and uncertain outcomes when volunteering. In Experiment 2, participants (N = 496) considered three hypothetical (...) one-shot two-person VoD scenarios; a certain VoD and two uncertain VoDs of which one had a lower expected collective outcome of volunteering than the certain VoD and the other a higher one. Results suggest that volunteering does not reflect a desire to avoid uncertainty but to maximize expected collective outcomes, reinforcing the assumption that the high volunteering rates we see in a standard VoD are due to social/moral preferences and social projection. (shrink)

Studies on associative learning in normals and patients need appropriate dependent measures which are sensitive enough to reflect stimulus-specific responses and also consider the context in which the conditioning takes place. Patient's fear responses, once acquired, seem to be maintained by specific cognitive biases such as individual belief systems and a tendency to stay consistent with their previous judgments.

We are surrounded by threats of environmental harm whose actual dangers to public health are scientifically unverified. It is widely presumed that under conditions of uncertainty, when it is not possible to foresee the outcomes of our actions, or to calculate the probability they will actually cause harm, we cannot be held culpable for the risks and harms our actions impose on others. It is commonly presumed, that is, that exposing others to what this paper terms ‘uncertain threats’ is (...) permissible, because conventional theories of moral responsibility understand uncertainty as implying that the effects of our actions are out of our control and, therefore, beyond our fault. In contrast, in rejecting arguments from moral luck, this paper denies that authors of uncertain threats of environmental harm are excusably ignorant, and denies that prevailing uncertainty diminishes their moral obligations or attenuates their culpability. For under conditions of uncertainty, culpability turns on the lack of due regard for others as moral equals – a consideration that neither luck nor ignorance excuses. To expose others to unconsented-to uncertain threats of harm without exercising due care to prevent possible injury is to wrongfully gamble with their welfare and their capacity for self-authorship. (shrink)

Building on findings that self-uncertainty motivates attempts to restore certainty about the self, particularly in ways that highlight one’s distinctiveness from others, we show that self-uncertainty, relative to uncertainty in general, increases creative generation among individualists. In Studies 1 to 3, high (but not low) individualists performed better on a creative generation task after being primed with self-uncertainty as opposed to general uncertainty. In Study 4, this effect emerged only among those who were (...) told that the task measured creative as opposed to analytical thinking, suggesting that the positive effects of self-uncertainty on performance are specific to tasks that bolster perceptions of uniqueness. In Study 5, self-uncertain individualists experienced a restoration of self-clarity after being induced to think about themselves as more (vs. less) creative. Implications for compensatory responses to self-uncertainty and factors that influence creativity are discussed. (shrink)

This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon (...) by the philosopher Emanuel Levinas (1906–1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable. (shrink)

Online personalized genetic testing services offer accessible and convenient options for satisfying personal curiosity about health and obtaining answers about one’s genetic provenance. They are especially attractive to healthy people who wish to learn about their future risk of disease, as Paul Mason’s case study of “Jordan” illustrates. In this response, we consider how online genetic testing services are used by people diagnosed with a common neurodegenerative disease, Parkinson’s disease, to gain a sense of certainty regarding the (...) future. (shrink)

As the younger generation, who like to pursue novelty and excitement, becomes the main consumer and the traditional consumption culture changes in China, the blind box has become a popular product among young people with its uncertain characteristics. Previous studies have mainly explored the role of uncertainty in promotion, while this paper focuses on the role of uncertainty in daily sales of blind box products. Based on the stimulus–organism–response theory, this paper conducted an online questionnaire (...) survey and an empirical analysis in China, which examined the mechanism of the positive impact of uncertainty and the moderating effect of consumption purpose. The results show that uncertainty affects consumers’ purchase intention mainly through affecting their emotional value, which is one dimension of perceived value; consumer purpose also moderates the effect of uncertainty on perceived value, and the effect of perceived value on purchase intention. The results of this study are not only of great significance for understanding the uncertain marketing and blind box products, but also have management implications for enterprises to make use of the uncertain marketing. (shrink)

The framework presented by Bayefsky and Berkman is based on having clear and accurate genetic information to offer parents, for them to either decide to prepare for birth or to terminate the...

The strength of democracy lies in its ability to self-correct, to solve problems and adapt to new challenges. However, increased volatility, resulting from multiple crises on multiple fronts – humanitarian, financial, and environmental – is testing this ability. By offering a new framework for democratic education, Teaching Democracy in an Age of Uncertainty begins a dialogue with education professionals towards the reconstruction of education and by extension our social, cultural and political institutions. -/- This book is the first (...) monograph on philosophy with children to focus on democratic education. The book examines the ways in which education can either perpetuate or disrupt harmful social and political practices and narratives at the classroom level. It is a rethinking of civics and citizenship education as place-responsive learning aimed at understanding and improving human-environment relations to not only face an uncertain world, but also to face the inevitable challenges of democratic disagreement beyond merely promoting pluralism, tolerance and agreement. -/- When viewed as a way of life democracy becomes both a goal and a teaching method for developing civic literacy to enable students to articulate and apprehend more than just the predominant political narrative, but to reshape it. This book will be of interest to scholars of philosophy, political science, education, democratic theory, civics and citizenship studies, and peace education research. (shrink)

Systemic risks are risks produced through interconnected non-wrongful actions of individuals, in the sense that an individual's action is a negligible cause of the risk. Due to scale effects of interaction, their consequences can be serious but they are also difficult to predict and assess via a risk assessment. Since we can have good reason to engage in the interconnected activities giving rise to systemic risk, we incur a concurrent collective responsibility to ensure that the risks are fairly distributed and (...) well regulated. James argues that fairness in this context requires taking reasonably available precautions ensuring for each risk-bearer a favourable ratio of expected benefits over expected losses. In sections 2 and 3 we argue that such a conception of fairness applies but only on the condition that the systemic risks created are irreversible risks and that the general background conditions of justice are imperfectly fair. When risks are reversible, compensatory justice can correct for unfairness in risk imposition. Where risks are irreversible, compensatory justice necessarily fails, giving rise to a collective responsibility to regulate fairly ex ante. Additionally, where background conditions of justice are fully fair and the systemic risk is well understood, risk bearers can be said to have consented to the systemic risk. If they are not fair, we argue that the primary political obligation should lie in fixing the fairness of the backgrounds of justice. A related reason for addressing the general background conditions of fairness is that James’ account of fairness in systemic risk imposition encounters a baseline problem. If expected risks and benefits are calculated again an unfair historic background condition, systemic risk imposition would not be fully fair. Section 4 shows why differences in evidentiary uncertainty as to probability and levels of harm and effective responses require a normatively appropriate response in the form of additional precautions. We show that the evidentiary standards set for risk-based cost-benefit analysis have a connection with deontology because they express a postulate of equal treatment in formal terms. Systemic risks can have different possible degrees of epistemological certainty due to factors of social and natural origin, such as more available research funding or higher degrees of complexity for some systemic risks but not others. These differences have to be mitigated by taking even greater precautions in difficult-to-research systemic risks. (shrink)

The purpose of this study is to take preliminary steps to unify psychoacoustic techniques with reaction-time methodologies to address the perceptual mechanisms responsible for the detection of one vs. multiple sounds. We measured auditory redundancy gains for auditory detection of pure tones widely spaced in frequency using the tools of Systems Factorial Technology to evince the system architecture and workload capacity in two different scenarios. We adopted an experimental design in which the presence or absence of a target at (...) each of two frequencies was combined factorially with two stimulus levels. Replicating previous work, results did not allow an assessment of system architecture due to a failure to observe factor influence at the level of distribution ordering for dual-target stimuli for both SOFT and LOUD scenarios. All subjects demonstrated very modest redundancy gains for the dual-target compared to the single-target stimuli, and results were similar for both LOUD and SOFT. We propose that these results can be predicted by a mental architecture that falls into the class of integrated subadditive parallel systems, using a well-supported assumption that reaction time is driven by loudness. We demonstrate that modeled loudness of the experimental sounds is highly correlated with mean reaction time, and we provide a proof-of-concept model based on Steven’s Power law that predicts both a failure of distributional ordering for dual-target stimuli and very modest redundancy gains. (shrink)

With the aggravation of population aging, home health care services are paid more and more attention by the elderly. Previous studies aim at improving service quality and reducing cost, ignoring the coordinated and sustainable development of the economy and environment. From the perspective of sustainable development, this paper first establishes a linear optimization model considering transportation, time, and carbon emission costs. However, the uncertainty of service demand is a very difficult problem for HHC research. Most of the previous (...) studies only consider the deterministic model, which has difficulty dealing with the uncertain situation. Therefore, a robust optimization model is proposed to resist uncertain disturbances by introducing a robust uncertain set response. The experimental results show that the increase of low-carbon transition cost only increases the total cost of the LO model but has a significant positive impact on the RO model. With the increase of uncertainty, the robust model will pay the cost of robustness, but it can obtain a higher service level. In addition, when the carbon tax increases, the total transportation cost does not increase but decreases, thus obtaining environmental benefits. When the carbon tax increases by 25%, the average total cost of using the RO model is reduced by 8.274%. The research results of this paper can provide enlightenment and reference for the low-carbon transformation of HHC enterprises. (shrink)

Demands for absolute or near certainty are a common way for those with a political agenda to undermine science and to delay action. Through our combined experience in science, philosophy and cultural theory, we are acquainted with these attempts to undermine science. We want to help readers figure out how to evaluate their merits or lack thereof.

This article examines Claude Lefort's writings in order to think about the ‘social’, understood as separate from the political, and in its separation, as a strictly modern ‘phenomenon’. Prior to the modern democratic revolution, the collective order was presented through the representation of power, itself identified with both law and knowledge, and referred to a transcendent source. At a first moment, the modern democratic revolution, under the sign of the general will, renders power immanent. At a second moment, it (...) separates power from law and, above all, knowledge, such that three domains emerge, each with its own logic, its own notion of representation, its own divisions. The ‘social’, in a sense, arises between these two moments. At one level, it appears as an event in, and in consequence an object of, knowledge, once knowledge need no longer be, primarily, a knowledge of power or law, that is the enunciation of the principles by which the latter establish the order, coherence and sense of the world. At another level the ‘social’ emerges as a response to the difficulties presented by a strictly political representation of societal order–difficulties in no small part due to the revolutionaries’ inability to countenance the separation between the three domains. In this regard the ‘social’ appears as a presupposition that serves to stabilize an inherently conflictual political order. It is, however, an ‘empty’ presupposition, without determinate content, and therefore also a source of uncertainty. While this emptiness proves a stimulus for the construction of new savoirs, it also accounts for the fragility of all discourses that would speak in its name (social science, social theory, sociology). The article concludes with a few words about the ‘death of the social’. (shrink)

Every choice we make is set against a background of massive ignorance about our past, our future, our circumstances, and ourselves. Philosophers are divided on the moral significance of such ignorance. Some say that it has a direct impact on how we ought to behave - the question of what our moral obligations are; others deny this, claiming that it only affects how we ought to be judged in light of the behaviour in which we choose to engage - the (...) question of what responsibility we bear for our choices. Michael Zimmerman claims that our ignorance has an important bearing on both questions, and offers an account of moral obligation and moral responsibility that is sharply at odds with the prevailing wisdom. His book will be of interest to a wide range of readers in ethics. (shrink)

In this study, 10 hematologists and 10 lung oncologists were interviewed regarding the information they provide to patients in four situations of uncertainty: determining the treatment that is in the patient’s best interest; recurrence or progression of the patient’s disease; determining when to withdraw life-prolonging treatment; discussing death, addressing questions such as whether the patient will die from the disease, and when. The primary finding is that delivery of information to patients with low survival rates can be improved (...) by more and better disclosure by physicians at an earlier stage. The crucial point for physicians is to ascertain the wishes of patients, to learn what to reveal about what patients should expect, short term and long term, as death approaches. (shrink)

In the traditional conception of science one assumes that science produces results which are certain and precise. It is argued that this picture is flawed and needs to be replaced with a view where uncertainty and imprecision are an integral part of the scientific enterprise. Uncertainty is still poorly understood by many practising scientists. However, several developments in science indicate that some epistemological uncertainty, e.g. due to processes of abstraction and idealization, will always follow advances in (...) scientific knowledge. There are also other developments that indicate some principal ontological uncertainties, i.e. uncertainties that are due to how the world is. Complexity is one such example. Remarks on post-normal science are thus included. This paper argues, therefore, that scientific uncertainty is a multi-dimensional concept, and that it is unavoidable because it is often the result as much as the cause of new knowledge. (shrink)

The practice of evidence based medicine has changed the role of the physician from information dispenser to gatherer and analyser. Studies and controlled trials that may contain unknown errors, or uncertainties, are the primary sources for evidence based decisions in medicine. These sources may be corrupted by a number of means, such as inaccurate statistical analysis, statistical manipulation, population bias, or relevance to the patient in question. Regardless of whether any of these inaccuracies are apparent, the uncertainty of their (...) presence in physician information should be disclosed to the patient. These uncertainties are not, however, shared by physicians with patients, and have caused a direct increase in patient responsibilities and mistrust. Only when disclosure of uncertainty becomes commonplace in medical practice will the physician/patient relationship evolve to a level of greater understanding and satisfaction for both the physician and patient. (shrink)

Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude that (...) cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy. (shrink)