In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of (...) care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter. (shrink)

The possibility of employing human enhancement interventions to aid in future space missions has been gaining attention lately. These possibilities have included one of the more controversial kinds of enhancements: biomedical moral enhancement. However, the discussion has thus far remained on a rather abstract level. In this paper we further this conversation by looking more closely at what type of interventions with what sort of effects we should expect when we are talking about biomedical moral enhancements. We suggest that a (...) more grounded way to picture moral enhancement, at least in the near term, is to envision a form of cognitive enhancement that also provides some moral benefits by heightening the enhanced person's capability for acting according to their own subjective moral code. While this concept of moral adherence enhancement also has relevance for the moral enhancement discussion more widely, in this paper we apply it specifically in the context of space missions. We argue that there are weighty reasons to consider making biomedical enhancements of the proposed kind a mandatory feature of early-phase long-distance space travel because these missions are high-stakes in nature and take place in an environment where the enhancement could be seen as conferring important advantages while negating many of the traditional arguments weighed against it. (shrink)

The role of artificial intelligence (AI) in organizations has fundamentally changed from performing routine tasks to supervising human employees. While prior studies focused on normative perceptions of such AI supervisors, employees’ behavioral reactions towards them remained largely unexplored. We draw from theories on AI aversion and appreciation to tackle the ambiguity within this field and investigate if and why employees might adhere to unethical instructions either from a human or an AI supervisor. In addition, we identify employee characteristics affecting this (...) relationship. To inform this debate, we conducted four experiments (total N = 1701) and used two state-of-the-art machine learning algorithms (causal forest and transformers). We consistently find that employees adhere less to unethical instructions from an AI than a human supervisor. Further, individual characteristics such as the tendency to comply without dissent or age constitute important boundary conditions. In addition, Study 1 identified that the perceived mind of the supervisors serves as an explanatory mechanism. We generate further insights on this mediator via experimental manipulations in two pre-registered studies by manipulating mind between two AI (Study 2) and two human supervisors (Study 3). In (pre-registered) Study 4, we replicate the resistance to unethical instructions from AI supervisors in an incentivized experimental setting. Our research generates insights into the ‘black box’ of human behavior toward AI supervisors, particularly in the moral domain, and showcases how organizational researchers can use machine learning methods as powerful tools to complement experimental research for the generation of more fine-grained insights. (shrink)

Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do (...) not believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on. (shrink)

BackgroundPatients with COVID-19 may feel under pressure to participate in research during the pandemic. Safeguards to protect research participants include ethical guidelines [e.g. Declaration of Helsinki and good clinical practice (GCP)], legislation to protect participants’ privacy, research ethics committees (RECs) and informed consent. The International Committee of Medical Journal Editors (ICMJE) advises researchers to document compliance with these safeguards. Adherence to publication guidelines has been suboptimal in other specialty fields. The aim of this rapid review was to determine whether (...) COVID-19 human research publications report compliance with these ethical safeguards.MethodsA rapid systematic literature review was conducted in MEDLINE using the search term ‘COVID-19’. The search was performed in April 2020 with no start date and repeated to include articles published in November 2020. Filters were ‘Full free text available’ and ‘English Language’. Two reviewers assessed article title, abstracts and full texts. Non-COVID-19 articles and non-clinical studies were excluded. Independent reviewers conducted a second assessment of a random 20% of articles. The outcomes included reporting of compliance with the Declaration of Helsinki and GCP, REC approval, informed consent and participant privacy.ResultsThe searches yielded 1275 and 1942 articles of which 247 and 717 were deemed eligible, from the April search and November respectively. The majority of journals had editorial policies which purported to comply with ICMJE ethical standards. Reporting of compliance with ethical guidelines was low across all study types but was higher in the November search for case series and observational studies. Reporting of informed consent for case studies and observational studies was higher in the November search, but similar for case series. Overall, participant confidentiality was maintained but some case studies included a combination of details which would have enabled participant identification. Reporting of REC approval was higher in the November search for observational studies.ConclusionsWhile the majority of journal’s editorial policies purported to support the ethical safeguards, many COVID-19 clinical research publications identified in this rapid review lacked documentation of these important safeguards for research participants. In order to promote public trust, ethical declarations should be included consistently. (shrink)

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect (...) of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable. (shrink)

This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample (...) had a concussion history, and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 ]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population. (shrink)

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect (...) of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable. (shrink)

Sartre's recollection, in Les Mots , of his first visit to the cinema is a multi-layered and ambivalent text through which Sartre proposes a number of interlocking arguments: concerning the contrast between the 'sacred' space of the theatre and the non-ceremonial space of the cinema, between the theatre as associated with paternal authority, and the cinema as associated with a clandestine bond with the mother. But the text also sets up a quasi-sociological account of the public Sartre encounters in the (...) cinema itself as revealing to him the truth of the social bond, a truth he expresses with the term 'adherence', and which he says he only rediscovered in his experience of being a prisoner in the Stalag in 1940. Rather than the basis of a sociological account of the social bond, which would seem at odds with Sartre's social philosophy, I read this as the expression of a desire for physical proximity. The space of the cinema thus develops a fantasy, and this is in continuity with the role of the cinema in the evolution traced in Les Mots , in which it is described as instigating a withdrawal into imaginary life and an indulgence in daydreaming. Through reference to Christian Metz and to Roland Barthes, whose essay 'En sortant du cinéma' is proposed as a parallel and a response to Sartre, I suggest that the 'true bond' of adherence which Sartre encounters is an unconscious rather than an epistemological truth. (shrink)

The mitigation of pandemics like that caused by the current COVID-19 virus is largely dependent on voluntary public adherence to government rules and regulations. Recent research has identified various individual covariates that account for some of the variance in compliance with COVID-19 behavioral guidelines. However, despite considerable research, our understanding of how and why these factors are related to adherence behavior is limited. Additionally, it is less clear whether disease-transmitting behaviors during a pandemic can be understood in terms (...) of more general behavioral tendencies. The current research has examined the utility of a behavioral-failure lens in predicting adherence to COVID-19 guidelines and in illuminating mechanisms underlying the previously established relationship between Conscientiousness and adherence. In the two studies reported here, individual variations in the predisposition to behavioral failures predicted adherence to COVID-19 measures, and mediated the relationships between Conscientiousness and adherence. The Failure Proneness questionnaire predicted compliance with COVID-19 guidelines, while the Cognitive Failure Questionnaire did not. The results of hierarchical regressions showed that COVID-19 behavior was predicted only through the intentional factors. Hence, our data lend support to the notion that noncompliance with official COVID-19 prevention guidelines is driven mainly by intentional factors related to violation of norms and rules. The theoretical and practical implications of this finding are discussed. (shrink)

According to Information-Motivation-Behavioural Skills model, accurate Information, strong Motivation and adequate Behavioural skills are prerequisites of treatment adherence. This model has been verified among chronically ills patients, usually suffering from one particular disorder. No studies report how the model fits data from a more diverse group. The aim of the study was to analyze adherence and its barriers in a group of three hundred patients suffering from various, common chronic disorders. They filled out IMB and Adherence Questionnaire. (...) Information and Motivation correlated moderately. Behavioural Skills was the strongest predictor of adherence. An additional relationship was found: Information and Motivation interacted and the role of either of these dimensions vanished if the indices of the other were high enough. The relationships between IMB dimensions and adherence were confirmed in a varied clinical sample. Behavioural skills must be considered when working with non-adherent patients, as they are the strongest predictor of adherence. Other interventions may be limited to either Information or Motivation only if there is a chance of raising one of them to extreme levels. This may be useful with special cases, when increasing both is problematic. (shrink)

Introduction: The actions taken by the government to deal with the consequences of the coronavirus diseases 2019 pandemic caused different levels of restriction on the mobility of the population. The need to continue offering physical exercise to individuals after stroke became an emergency. However, these individuals may have barriers to adhere to the programs delivered remotely. There is a lack of evidence related to adherence, attendance, safety, and satisfaction of remote exercise programs for this population.Objective: The aim was to (...) evaluate adherence and barriers to attend a remote physical exercise program for individuals after stroke. We aimed to identify adherence and attendance rate of the remote physical exercise program ; to identify the safety of a remote physical exercise program ; and to identify the overall experience to participate in a remote program.Materials and methods: This is a longitudinal study, including 36 stroke survivors who already attended a face-to-face physical exercise program prior to the COVID-19 pandemic. The remote physical exercise program included sessions for 2 days/week for a duration of 22 weeks, with a total of 44 sessions, which were delivered asynchrony via recorded video sessions. As outcome measures, we performed two questionnaires to identify attendance, barriers, safety, and overall experience related to the program.Results: The adherence rate was 86. The attendance rate was 19, with a total of 8 sessions. The main barriers for lower attendance rate were as follows: lack of motor skills and physical fitness to workout in 80 reports, followed by no exercise companion in 44 reports. The remote physical program has been shown to be safe, and the overall experience was positive from the perspectives of the participants and the family members.Conclusion: Although the adherence rate was high, the attendance rate was low on the remote physical exercise program. The main barriers to attending the program remotely reflect the need of tailoring individually an asynchrony mode of delivering the sessions to individuals after stroke. Our results also indicate how the COVID-19 impacted the health conditions of stroke survivors. The program was safe, and the overall experience indicated a change in the mental, physical, and social health of individuals after stroke and their family members. (shrink)

When Keats identified truth and beauty, he surely intended mere extensionality. I myself have never had much trouble with either half of the equivalence. Others have considerable difficulty. A case in point is the Watson-Allaire-Cummins interpretation of Berkeley's idealism, which I shall refer to henceforth as the inherence account. That account is put forward to answer an extremely perplexing question in the history of philosophy: Why did Berkeley embrace idealism, i.e., why did he hold that esse est percipi, that to (...) be is to be perceived, indeed that what is perceived must be perceived in order to exist? In essence, the IA answers these questions very simply and elegantly: perceived qualities are, for Berkeley, qualities of the mind in the same sense that, in the tradition of substance metaphysics, blue is a quality of a blue flower; just as the blue of the flower is inseparable from it, so the perceived blue is inseparable from the mind that perceives it. (shrink)

Hu Fuming was born in Wuxi county, Jiangsu Province. In 1958 he graduated from the Journalism Department at Beida and in 1961 received a graduate degree in philosophy from People's University. Later he became an associate dean and associate professor in the Department of Politics and Philosophy. Afterwards, he worked in the Propaganda Department of the Jiangsu provincial Party committee. He's currently a member of the Standing Committee of the Jiangsu Party Committee, and president and professor at the Jiangsu Provincial (...) Party School. He also helped draft the editorial, under the title of special commentator, "Practice is the sole criterion of truth," published on May 11, 1978, in Enlightenment Daily. (shrink)

Selections from Deng Xiaoping, long expected by the people across the country, is now off press. It is a major event of the political life of the people in our country. The book is the product of a great period of historical change. By pooling the collective wisdom of the Party, it sums up the experience of history, gives expression to the people's demands and aspirations, and bears both far-reaching historical significance and major significance for immediate guidance.

Presumed catholic or christian influence inside the french speaking green party of Belgium is a very strong stereotype since 1981. Nevertheless no scientific work has ever proved that supposition. Starting from a large survey among the 2 500 Ecolo's members, the authors examine and analyze the inventory of fixtures. They present the main features of the members and distinguish the outlines of catholic and non-catholic's members.

We develop a theory of compliance with corporate governance codes by combining insights from agency, network and reputation theories. Subsequently, we test this theory using a unique dataset with fine-grained compliance information for the book year 2004 as to 130 Dutch stock-listed corporations. We find partial support for our theory.

Probably nothing is more complicated, misunderstood, and thus damaged, in a way of speaking, than the viewpoint of "one divides into two" when criticism is being made of the various fallacies spread by Lin Biao and the "gang of four." Some people hold that Lin and the gang's activities to split the Party and their philosophy of making others suffer were related to this viewpoint and thus conclude that this viewpoint is one-sided. Others are of the opinion that this viewpoint (...) constitutes the philosophical base for the ultra-Left line. Such ideas circulate even among a part of the philosophy researchers. It is necessary to repudiate the gang's distorted and subjective explanation and application of the viewpoint "one divides into two"; so is the exposure of a certain simplistic tendency in our previous propaganda work. However, it is inappropriate to view the distortion and simplification as something inherent in the proposition that "one divides into two." After all, is such a proposition scientific or not? Should it be seen as a "mistake" or a "heresy" that ought to be taken out from Marxism-Leninism and Mao Zedong Thought? This, of course, is an issue of theoretical principle and must be clarified through discussion. (shrink)

Much literature surrounding medical technology and adherence posits that technology is a mechanism for social control. This assumes that the medical establishment can take away patients' agency. Although power relationships and social control can play a key role, medical technology can also serve as an agentive tool to be utilized. We (1) offer the alternative framework of Actor Network Theory to view medical technology, (2) discuss the literature on medication adherence and technology, (3) delve into the ramifications of (...) looking at adherence as a network and (4) use Digital Pills as a case study of dispersed agency. (shrink)

Failure to follow prescribed treatment has devastating consequences for those who are seriously and persistently mentally ill. Nurses, therefore, try to get clients to take psychotropic medication on a long-term basis. The goal is either compliance or adherence. Although current nursing literature has abandoned the term compliance because of its implications of coercion, in psychiatric nursing practice with patients suffering from serious long-term mental illness compliance and adherence are in fact different goals. The ideal goal is adherence, (...) which requires the patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support (...) the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

Poor adherence to medication is a persistent problem in the practice of medicine, which gives rise to problems for individual patients, for the healthcare system as a whole, and in some cases, for third parties and for public health. There has been some progress in understanding the causes and solutions but much more work needs to be done. To develop the ethical responses to adherence, the problems need to be analysed more precisely. It is argued that, given that (...) one pressing concern is whether poorly adherent patients are being unfairly blamed or stigmatised, it is necessary to pay attention not just to the content of claims about adherence, but to the rhetoric of how these are presented. A necessity-concerns framework does much to advance understanding and ethics but may have certain pitfalls, and an approach based on micro-economic modelling may help to refine understandings of the position of the patient. It is also argued that a more sophisticated understanding of the ethical issues will be gained by recognising two problems: first, poor adherence to medications per se; second, poor knowledge about adherence to medications. These are related, but give rise to distinct ethical concerns. (shrink)

The problem of the current research is to develop an instrument that accurately measures individuals' adherence or nonadherence to both Protestant Ethic and contemporary work values. The study confirms that the traditional Protestant Ethic work values and the contemporary work values are different and the instrument used to measure the work values that individuals actually support is valid and reliable. Two scales were developed based on Protestant Ethic work values and contemporary work values. A four-point Likert scale was used (...) to indicate the extent of agreement or disagreement with statements written to represent Protestant Ethic and contemporary work values. Face and content validities of the instrument were established by using two panels of experts — one consisted of authorities in the area of work values; the other consisted of editorial critics. Reliability of the instrument was confirmed by the Kuder-Richardson and test-retest methods. Four sets of work values emerged with significant discrimination among them. (shrink)

The Medication Event Monitoring System (MEMS) is a relatively new device designed to overcome some of the disadvantages of traditional adherence-measuring techniques. MEMS has also been found useful in tracking adherence behaviour without the need to visit patients frequently. In this study each patient was given a pre-filled, labelled MEMS bottle and cap. Patients were monitored for 24 weeks. For patients specifically studied, there were periods when drug levels may have been low and some exhibited erratic medication-taking behaviour. (...) It is concluded that MEMS can measure adherence behaviour objectively, and so might be used to improve prescribing decisions, identify drug wastage and improve carer support. Further research is needed before the routine use of electronic medication monitoring can be recommended. (shrink)

BackgroundProfessional ethics is the regulation and discipline of nurses’ daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are fe...

A learning health system (LHS) seeks to establish a closer connection between clinical care and research and establishes new responsibilities for healthcare providers as well as patients. A new set of technological approaches in medication adherence monitoring can potentially yield valuable data within an LHS, and raises the question of the scope and limitations of patients’ responsibilities to use them. We argue here that, in principle, it is plausible to suggest that patients have a prima facie obligation to use (...) novel adherence monitors. However, the strength of the obligations depends considerably on the extent to which data that adherence monitors generate are, in fact, used to further the goals of LHSs. The way in which data ownership is structured in the USA poses a considerable challenge here, while the European Union framework offers a more promising alternative. (shrink)