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)

This paper signifies the inevitability of the responsible practices of leadership into the relation with the subordinates in the Indian organizations. The theme of this study revolves around the responsibility and ethical approach of the top management which directly or indirectly influence the job-related attitudinal behavior of employees. To analyze it empirically, a questionnaire is designed and 138 middle-level managers from four private sector telecom companies in India rated their superiors on 11 items of leadership scale. This study used internal (...) consistency reliability, Pearson correlation, and exploratory factor analysis as statistical techniques. Factor analysis of the scores on such items yielded two dimensions. The paper examines the impact of leadership of managers upon their subordinates in the context of enhancing job satisfaction, affective commitment, and knowledge performance. The results of the study are not completely substantiating empirically to the theory that ethical attitude of leaders enhance commitment and satisfaction of subordinates in Indian context. (shrink)

It is easier to resist at the beginning than at the end.– Leonardo da VinciPhysicians often believe that a conscious commitment to ethical behavior and professionalism will protect them from industry influence. Despite increasing concern over the extent of physician-industry relationships, physicians usually fail to recognize the nature and impact of subconscious and unintentional biases on therapeutic decision-making. Pharmaceutical and medical device companies, however, routinely demonstrate their knowledge of social psychology processes on behavior and apply these principles to their marketing. (...) To illustrate how pharmaceutical marketing strategies use psychological techniques to promote targeted therapies, we draw on the relevant social psychology literature on conflicts of interest and on the six principles of influence articulated by the eminent social psychologist Robert Cialdini. Hospitals, professional organizations, medical educators, and other stakeholders must also draw on social psychology to respond effectively to commercial activities that compromise good medical practice. (shrink)

Pharmaceutical and medical device companies apply social psychology to influence physicians' prescribing behavior and decision making. Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry's routine marketing strategies, which rely on the illusion that the (...) industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame rather than gratitude will reduce conflicts of interest. If greater academic prestige accrues to distant rather than close relationships with industry, then a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession's improper dependence on industry. (shrink)

In contemporary philosophy, various attempts have been made in relation to placing our minds or mental states in the natural world or nature. In this context, there is a clear divide between naturalism and anti-naturalism, materialism and immaterialism, etc. Driven by the influence of naturalistic turn in philosophy and scientism, many philosophers have tried to put forth various naturalistic accounts of the relationship between mind and natural world. However, many of these accounts are naturalistic based on the modern scientific conception (...) of nature which has been hailed as the dominating conception of nature. John McDowell in his magnum opus Mind and World, while criticizing modern scientific account of the relationship between mind and world, has not resorted back to anti-naturalism. Instead, he has tried to give us certain clues to develop an account of an alternative form of naturalism which is at the same time radically different from both scientific naturalism and mysterious anti-naturalism. In this paper, I will try to search for an alternative naturalism following McDowell and examine to what extent this account is tenable. In this context, we shall discuss various approaches to understand the relation between reason/normativity (which is one of the significant constituting elements of our mind) and natural world. (shrink)

This article traces the history of the earliest bilateral tax treaties which were concluded prior to World War I. There are currently over 3000 bilateral tax treaties in existence and their fundamental concepts and terms can be traced back to the earliest treaties. This article explores the political and economic context of the early treaties to understand why countries entered into tax treaties. Tax treaties play an important role in facilitating economic integration and as the European Union and other regional (...) blocs seek to establish a single market, the historical context of tax treaties can assist in understanding their role in modern international economic relations. (shrink)

The main purpose of this article is to broaden U.S. scholars' awareness of the similarities and differences of gender literature in another part of the world. In providing this partial review of gender scholarship in India, the authors hope to foster critical reflection on the inequities of global knowledge production and consumption and the role of U.S. academic institutions and scholars in this project. The article is written not by scholars who are based in India but by those who are (...) based in U.S. academies. Given their location, linguistic and cultural competencies, and scholarly expertise, the review, at best, can be described as a glimpse of gender scholarship in India. The four sections of this article feature theoretical and methodological issues, the women's movement, and violence against women in India. (shrink)

The medical profession is under a state of increasing scrutiny. Recent high profile scandals regarding substantial industry payments to physicians, surgeons, and medical researchers have raised serious concerns over conflicts of interest. Amidst this background, the public, physicians, and policymakers alike appear to make the same assumption regarding conflicts of interest; that doctors who succumb to influences from industry are making a deliberate choice of self-interest over professionalism and that these doctors are corrupt. In reality, a myriad of evidence from (...) social science indicates that influence from conflicts of interest often occurs on a subconscious and unintentional level. This poses an important issue, since such conflicts can steer wellintentioned physicians away from their primary professional goal to provide the best medical advice and treatment possible. (shrink)

Study of theories of inference with reference to Liṅgaparāmarśavāda in Nyāyasiddhāntadīpa of Śaśadhara, treatise on Navya-Nyāya.

Many contemporary philosophers, such as Akeel Bilgrami, Crispin Wright, Christine Korsgaard, and Mrinal Miri, have explicitly discussed the relevance of self-knowledge in relation to the discourse of normativity. This book addresses the notion of self-knowledge as relevant in the formation of moral identity.

As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in (...) New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (shrink)

Sanskrit treatise on Yoga and meditation according to the fundamentals of Nātha sect.

In this paper, we would like to discuss Wittgenstein’s critique of the idea that a person’s experiences are necessarily private, and these experiences can only be expressible in a private language. Taking a clue from Wittgenstein, we intend to say that the person’s experiences though private, can also be known by others. In the following sections 243 of his Philosophical Investigations, Wittgenstein argues against the possibility of a private language about the subject’s inner experiences. He contends that by coining names/words (...) to name sensations and our inner experiences, we cannot create a private language. If we have a list of names, that cannot function as a language. We need predicate terms; we need the syntax to link the words in the form of a sentence. If we use private names and use the predicates from the language that everyone knows, then the private words will acquire public status like the terms ‘pain’ and ‘sensation.’ These terms are already part of the public language, and if private experiences like pain and sensation cannot be made public, we would not have these terms in our language at all. This is the reason why any application of words is public, and therefore, there is no possibility of a private language. Wittgenstein concentrates on the public rules that govern the correct application for the use of words. And the expressions are meaningful only when these are used according to rules of grammar; if these expressions do not follow any rules of grammar, these are simply meaningless. (shrink)

Many real-world optimization problems usually require a large number of conflicting objectives to be optimized simultaneously to obtain solution. It has been observed that these kinds of many-objective optimization problems often pose several performance challenges to the traditional multi-objective optimization algorithms. To address the performance issue caused by the different types of MaOPs, recently, a variety of many-objective particle swarm optimization has been proposed. However, external archive maintenance and selection of leaders for designing the MaOPSO to real-world MaOPs are still (...) challenging issues. This work presents a MaOPSO based on entropy-driven global best selection strategy to solve the many-objective software package restructuring problem. EMPSO makes use of the entropy and quality indicator for the selection of global best particle. To evaluate the performance of the proposed approach, we applied it over the five MaOSPR problems. We compared it with eight variants of MaOPSO, which are based on eight different global best selection strategies. The results indicate that the proposed EMPSO is competitive with respect to the existing global best selection strategies based on variants of MaOPSO approaches. (shrink)

(1991). The Effect of a Package of Some Curricular Strategies on the Study Habits of Rural Primary School Students: a year long study. Educational Studies: Vol. 17, No. 3, pp. 261-271.

The crystallization behaviour of Fe 70.8 Nb 3.7 Cu 1 Al 2.7 Mn 0.7 Si 13.5 B 7.6 alloy prepared in the form of amorphous ribbons by melt-spinning technique was studied using differential scanning calorimetry and the temperature variation in resistivity. An X-ray diffaction and transmission electron microscopy study showed the formation of f -Fe and/or Fe 3 nanoparticles after the first stage of crystallization. The activation energy for this nanophase formation was 68 kcal mol m 1 . The brittleness (...) of the alloy increased with the formation of nanoparticles after heat treatment. Superior soft magnetic properties were achieved when the material was heat treated at 790 K for 15 min. The particle size at the optimum heat treatment condition for superior soft magnetic properties was found to be 6.0 - 0.5 nm which was less compared than for the Fe-Nb-Cu-Si-B system. The observed coercivity value at the optimum heat treatment condition was found to be 0.32 A m m 1 . The presence of Al in the alloy reduced the particle size and the magnetic anisotropy energy of the system, which resulted in superior soft magnetic properties of the heat-treated materials. (shrink)

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of (...) MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)

In the Indian context; contributed articles.

In this paper, we will discuss solipsism and the limits of experience in the light of Wittgenstein’s TLP. One cannot draw the limits of experience without bringing in the notion of the experiencer. That is to say, the notion of self is very relevant to the discussion on the limits of experience. Solipsism means that ‘I’ is the only reality, and what I experience is all that I could know. We will focus on solipsism from two points of view, the (...) empirical point of view and the transcendental point of view. The empirical approach to solipsism makes the self as a matter of its experience. However, from the transcendental point of view, the transcendental or metaphysical self becomes the transcendental ground of our experiences. In the second section, we will discuss the relationship between solipsism and realism. Then how the self is related to the world will be discussed in the third section. For Wittgenstein, the self ‘I' is neither causally nor logically related to the world. This self is the metaphysical subject, and it is the limit of the world. In the fourth section, we will discuss the importance of the limit-self. The limit-self is not the matter or object of experience; rather, it is the ground of our world's experience. For Wittgenstein, it is not an item of the world; rather, it is the limit of the world. The limit-self cannot be described in language, and thus it is beyond our language. It is the limit of our language and also the limit of the world. Then, we will critically analyze the limit of experience, and the metaphysical self is placed on the limit of experience. This self is the non-solipsistic self. (shrink)

Expression is the central concept in Wittgenstein’s philosophy of mind, and our experiences are reflected in our bodily expressions or gestures, facial expressions, behaviors and linguistic expressions. It seems true that we have no access of other people’s experiences but we can know or talk about them in so far as they are the common experiences of all. This inaccessibility of other’s experiences may create a genuine thinking that one’s experiences are private and the first person present tense psychological utterances (...) are not descriptive at all. They are understood solely as expressive and expression is the outer concept of a mental phenomenon. In this paper, an attempt will be made on the basis of Wittgenstein’s critique of the relationship between the concepts of experience and expression we shall argue that certain uses of the dichotomy between the inner and the outer are mistakes. According to Wittgenstein, the inner is not a set of experiences which are or are not expressed by our immediate (primitive) expressions or linguistic expressions rather it is the capacity of the subject to express himself genuinely. (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 habitual action is not only undertaken on a regular basis but also is personalized which has moral significance when we evaluate action and personality. For Aristotle, inculcating virtues through habitual action could develop a moral character. The naturalistic or behaviouristic perspective and the non-naturalistic perspective are two ways to interpret this Aristotelian theoretical position. The naturalistic thesis maintains that habit and character formation is inherently present in the form of disposition in human beings and could be causally related to (...) the neurophysiological function of the brain process. On the other hand, the non-naturalistic thesis upholds a teleological account of the formation of moral character which is grounded in the power of will. This paper, which delves into Aristotle’s notion of habit and its role in the formation of moral character, examines these two theoretical perspectives in order to substantiate the relationship between habits and moral character formation. It also analyses the logical relationship between habits and moral character to show how the moral character is developed by strengthening the power of will. (shrink)

The habitual action is not only undertaken on a regular basis but also is personalized which has moral significance when we evaluate action and personality. For Aristotle, inculcating virtues through habitual action could develop a moral character. The naturalistic or behaviouristic perspective and the non-naturalistic perspective are two ways to interpret this Aristotelian theoretical position. The naturalistic thesis maintains that habit and character formation is inherently present in the form of disposition in human beings and could be causally related to (...) the neurophysiological function of the brain process. On the other hand, the non-naturalistic thesis upholds a teleological account of the formation of moral character which is grounded in the power of will. This paper, which delves into Aristotle’s notion of habit and its role in the formation of moral character, examines these two theoretical perspectives in order to substantiate the relationship between habits and moral character formation. It also analyses the logical relationship between habits and moral character to show how the moral character is developed by strengthening the power of will. (shrink)

This paper is a study of Gandhi’s “Hind Swaraj” to bring out the philosophical significance of the concept of Swaraj. Gandhi has laid down his philosophy of life in this work which defines the concept of self-rule and also the concept of political and economic freedom. The Hind Swaraj is Gandhi’s manifesto for Indian freedom struggle since it lays down the principles of Satyagraha, namely Satya and Ahimsa. In this paper, an attempt is made to show how Gandhi harmonizes the (...) political and economic freedom with spiritual freedom. Gandhi emphasizes the soul-force as the new principle for the emancipation of the Indian masses in addition to their economic and political freedom. (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)

The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)