Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion (...) between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

Debate over the status of medicine as an Art or Science continues. The aim of this paper is to discuss the meaning of Art and Science in terms of medicine, and to find out to what extent they have their roots in the field of medical practice. What is analysed is whether medicine is an "art based on science"; or, the "art of medicine" has lost its sheen (what with the rapid advancements of science in course of time, which has (...) made present day medicine more sophisticated). What is also analysed is whether the "science of medicine" is a pure one, or merely applied science; or the element of science in it is full of uncertainty, simply because what is accepted as "scientific" today is discarded by medical practitioners tomorrow in the light of newer evidence. The paper also briefly touches upon how, in the field of present medical education, the introduction of medical humanities or humanistic education has the potential to swing the pendulum of medicine more towards the lost "art of medicine". The paper concludes by saying that the art and science of medicine are complementary. For successful practice, a doctor has to be an artist armed with basic scientific knowledge in medicine. (shrink)

The axioms adopted by Packard (1981) and Heiner and Packard (1983) for plausibility ranking of sets of statements are critically examined. It is shown that the informational requirement of the Heiner-Packard (1983) framework is much stronger than Packard's (1981) framework and hence both axiomatic setups are examined separately. A characterization of the leximin rule is provided in Packard's framework and the nonintuitive implications of the Heiner-Packard (1983) axioms are discussed. It is also demonstrated that in both frameworks, minor variations of (...) some of the axioms convert the characterization results into logical impossibilities. (shrink)

Human computer interaction (HCI) has grown into a mature field of research. With artificial intelligence (AI) finding ubiquitous applications, HCI research is now moving ahead towards accommodating and integrating these approaches. A part of the research community is of the opinion that HCI and AI are fundamentally opposed to each other: with AI-powered devices being demonic and humans are to lose in a race against them and HCI-oriented products being human centred being the flag bearers of the human race. In (...) this paper, we look at and analyse this perspective of how HCI relates to AI and the potential HCI–AI integration. We suggest that humans evolve by having dynamic identities. We further discuss its implications on the AI critique and suggest some new perspectives on the possible integration of HCI and AI research which we hope would be useful for the community. (shrink)