Background: Ethics consultation is used regularly by some doctors, whereas others are reluctant to use these services.Aim: To determine factors that may influence doctors to request or not request ethics consultation.Methods: A survey questionnaire was distributed to doctors on staff at the University Community Hospital in Tampa, Florida, USA. The responses to the questions on the survey were arranged in a Likert Scale, from strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree to strongly agree. Data (...) were analysed with the Wilcoxon test for group comparisons, the χ2 test to compare proportions and a logistic regression analysis.Results: Of the 186 surveys distributed, 121 were returned, giving a 65% response rate. Demographic data were similar between the groups saying yes and no . No statistically significant differences were observed between the user and non-user groups in terms of opinions about ethics consultants having extensive training in ethics or participating in ethics educational opportunities. On the issue “Ethics committee members or consultants cannot grasp the full picture from the outside”, the non-users were neutral, whereas the users somewhat disagreed . Even more significant was the difference between surgeons and non-surgeons, where, by logistic regression analysis, surgeons who believed that ethics consultants could not grasp the full picture from the outside were highly likely to not use . Non-users of ethics consultations thought that it was their responsibility to resolve issues with the patient or family . Users of ethics consultation believed in shared decision making or the importance of alternate points of view .Implications: Ethics consultations are used by doctors who believe in shared decision making. Doctors who did not use ethics consultation tended to think that it was their responsibility to resolve issues with patients and families and that they were already proficient in ethics. (shrink)

The NHS is an institution of great importance to everybody in the UK - not only doctors, nurses and other health professionals, but also to patients, carers and their families. However, problems within the NHS are regularly reported in the media and we are all anxious about waiting lists, about whether potential illnesses will be identified treated in time, about bleeding to death on trollies in corridors or being struck down by antibiotic-resistant superbugs. This engaging book aims to explore (...) and simplify the issues from both sides of the NHS - professionals and patients - and to improve mutual understanding of the problems, which will hopefully spark an open debate about the future of health service provision. The book uses an innovative fictionalized account of the experiences of 'case study' individuals in the healthcare system, including a GP with depression, a woman with MS and a hospital manager whose wife has cancer. This book will be essential and enjoyable reading for anyone workingwithin the healthcare system, as well as patients and their families and anyone interested in the workings of the NHS. (shrink)

This doctoral dissertation investigates the notion of physical necessity. Specifically, it studies whether it is possible to account for non-accidental regularities without the standard assumption of a pre-existent set of governing laws. Thus, it takes side with the so called deflationist accounts of laws of nature, like the humean or the antirealist. The specific aim is to complement such accounts by providing a missing explanation of the appearance of physical necessity. In order to provide an explanation, I recur to fields (...) that have not been appealed to so far in discussions about the metaphysics of laws. Namely, I recur to complex systems’ theory, and to the foundations of statistical mechanics. The explanation proposed is inspired by how complex systems’ theory has elucidated the way patterns emerge, and by the probabilistic explanations of the 2nd law of thermodynamics. More specifically, this thesis studies how some constraints that make no direct reference to the dynamics can be a sufficient condition for obtaining in the long run, with high probability, stable regular behavior. I hope to show how certain metaphysical accounts of laws might benefit from the insights achieved in these other fields. According to the proposal studied in this thesis, some regularities are not accidental not in virtue of an underlying physical necessity. The non-accidental character of certain regular behavior is only due to its overwhelming stability. Thus, from this point of view the goal becomes to explain the stability of temporal patterns without assuming a set of pre-existent guiding laws. It is argued that the stability can be the result of a process of convergence to simpler and stable regularities from a more complex lower level. According to this project, if successful, there would be no need to postulate a (mysterious) intermediate category between logical necessity and pure contingency. Similarly, there would be no need to postulate a (mysterious) set of pre-existent governing laws. Part I of the thesis motivates part II, mostly by arguing why further explanation of the notions of physical necessity and governing laws should be welcomed (chapter 1), and by studying the plausibility of a lawless fundamental level (chapters 2 and 3). Given so, part II develops the explanation of formation of simpler and stable behavior from a more complex underlying level. (shrink)

This essay explores Thomas Browne's Pseudodoxia epidemica, with its lengthy book on 'errors' in animal lore. In the limited critical literature on Browne's natural history, this author is generally seen as stumbling towards a zoological idiom and clearing away the emblematic 'clutter' of earlier writers on natural history—Gesner, Aldrovandi, Topsell or Franzius. This essay proposes that Browne is working with a more complex set of co-ordinates in his thought, beyond his experimental inclinations and his Aristotelian assumptions. It will explore the (...) extent to which his studies of animals emerge from, and duplicate, the presumptions of his biblical hermeneutics, and it will suggest that Browne regularly exports terms from scriptural exegesis—the categories of the literal, the figurative, and the emblematic—into his investigations of the natural world. (shrink)

Most people know precious little about the risks and benefits of participating in a clinical trial--a medical research study involving some innovative treatment for a medical problem. Yet millions of people each year participate anyway. Patients at Risk explains the reality: that our current system intentionally hides much of the information people need to make the right choice about whether to participate. Witness the following scenarios: -Hundreds of patients with colon cancer undergo a new form of keyhole surgery at leading (...) cancer centersnever -Tens of thousands of women at high risk of developing breast cancer are asked to participate in a major research study. They are told about the option of having both breasts surgically removed but not told about the option of taking a standard osteoporosis pill that might cut the risk of getting breast cancer by one-half or more. Patients at Risk written by two nationally prominent experts, is the first book to reveal the secrets that many in the research establishment have fought long and hard to keep from patients. It shows why options not commonly knownincluding getting a new treatment outside of a research studycan often be the best choice. It explains how patients can make good decisions even if there is only limited information about a treatments effect. And it does this through the eye-opening stories of what is happening daily to thousands of people. Day after day, we are learning how little we know about what really works. Headlines regularly announce that a previously unquestioned treatmenthormone replacement therapy, drugs such as Vioxx or Celebrexmay now be much riskier than we thought. The latest book in a surge of recent books criticizing the medical establishment (but the first to look at clinical trials specifically), Patients at Risk helps to empower patients to survive in a world of medical uncertainty, and makes positive recommendations for systemic reform. (shrink)

Background Medical ethics deals with the ethical obligations of doctors to their patients, colleagues and society. The annual reports of Sri Lanka Medical Council indicate that the number of complaints against doctors has increased over the years. We aimed to assess the level of knowledge, attitude and practice regarding medical ethics among doctors in three teaching hospitals in Sri Lanka. Methods A hospital-based cross-sectional study was conducted among doctors using a pre-tested self-administered, anonymous questionnaire. Chi Squared (...) test, and ANOVA test were used to identify the significance of association between level of knowledge and selected factors. Results Most doctors had a poor level of knowledge on medical ethics, with postgraduate trainees showing significantly higher level of knowledge. The average knowledge on medical ethics among doctors was significantly different between the three hospitals. Over 95% had a favourable attitude towards gaining knowledge and advocated the need for training. The majority indicated awareness of unethical practices. 24.6% of respondents stated that they get a chaperone ‘sometimes’ during patient examination while 3.5% never do. The majority responded that they never accept gifts from pharmaceutical companies in recognition of their prescribing pattern. 12–41% of doctors participated in the study acknowledged that they ‘sometime’ engaged in unethical practices related to prescribing drugs, accepting gifts from pharmaceutical companies and when obtaining leave. Conclusion Most doctors had a poor level of knowledge of medical ethics. Postgraduate trainees had a higher level of knowledge than other doctors. The majority showed a favourable attitude towards gaining knowledge and the need of training. Regular in-service training on medical ethics for doctors would help to improve their knowledge on medical ethics, as well as attitudes and ethical conduct. (shrink)

To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively minor afflictions, (...) thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients’ preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study (...) investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study (...) investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Over the YearsKimberly RockerMy daughter was diagnosed with an Ependymoma brain tumor in 1986 at the age of 19 months. Our journey began when we realized that we had become concerned about her falling. For example, we were staying at a lodge with a large stone fi replace and both my husband and myself were careful to cover the area with pillows from the couch. Then there were the (...) sporadic “jokes” from strangers who would say, “what has she been drinking?” as she walked past with a slight stagger in her gait. We took her to the pediatrician who listened to my concerns and then watched her walk in a narrow hallway. Surprisingly, she didn’t seem to stagger and she walked very “toddler–like” down the hall. We learned later that this tighter area would help compensate for my daughter’s lack of balance. We were told that she simply needed to develop her gross motor skill more and that she would outgrow it and I was simply an over–concerned first time mom. Unfortunately, the pediatrician failed to recall that my daughter had been walking since she was 11 ½ months old and the current lack of coordination and balance was actually a regression in her motor skills. This negative change in her abilities should have been seen as a red flag.I still couldn’t shake the nagging feeling that something was wrong. Since our doctor had been unresponsive to my concerns, I made an appointment with another doctor. I told my husband that if the new doctor is just as unconcerned about our daughter’s gross motor skills, then I would let it go. The new doctor refrained from making judgments about my parenting skills and concerns. She listened carefully as I described the situation. She examined my daughter and watched her walk in the large hospital hallway. Her next step, one that our regular doctor failed to do, was to measure her head circumference. The measurement exceeded the 100–percentile mark. They were immediately concerned and ordered a CT scan right away. The diagnosis was a brain tumor and due to the size and location, they didn’t expect her to live. We called family and said our beautiful little girl was very sick and was going to die.As a parent, we often know our children well. This can be both a help and a hindrance. Since the changes in our daughters walking skills declined gradually over several months, it was difficult for us to see just how far she had declined. We have a [End Page 25] video of our daughter taken just a few weeks before her diagnosis. I have only watched it a couple of times because it is difficult to see. It is painfully obvious that there is something terribly wrong. It does make me question our parenting and ability to know what is best for our child’s well being. Add to that a doctor that made you feel very inadequate as a parent, it was hard to have the confidence to question the doctor. But, that small quiet voice kept getting louder, demanding to be heard.My daughter will be 29 years old this August. One thing I remember very clearly during that first year is that I just wanted to know that somewhere there was another child who survived to live a happy, healthy life. At that time, it was difficult to find. During those first few months after our diagnosis, we met three other families who had daughters with brain tumors, Nina, Larissa and Wendy. My daughter is the only one still alive. We thank God for the gift of life He gave to our daughter but are full of sorrow for the families that suffered such a difficult loss. There were many miracles and many challenges along the way regarding her recovery. I believe our story can give hope to families as they struggle with this terrible diagnosis.One of our first miracles was the fact that the neurosurgeons were able to remove all visible evidence of the tumor. This is rarely the case since removing the tumor can also damage healthy areas of... (shrink)

abstractBackground: Evidence shows both a tendency for research participants to conflate research and clinical care and a limited public understanding of research. Conflation of research and care by participants is often referred to as the therapeutic misconception. Despite this evidence, few studies have explicitly asked participants, and especially minors, to explain what they think research is and how they think it differs from regular medical care. Methods: As part of a longer semistructured interview evaluating assent and parental permission for (...) research, adolescent research participants (n = 177), including adolescents with illnesses and healthy volunteers, and their parents (n = 177) were asked to describe medical research in their own words and say whether and how they thought being in medical research was different from seeing a regular doctor. Qualitative responses were coded and themes were identified through an iterative process. Results: When asked to describe medical research, the majority described research in terms of its goals of helping to advance science, develop treatments and medicines, and help others; fewer described research as having the goal of helping particular research participants, and fewer still in terms of the methods used in research. The majority of teen and parent respondents said being in research is different than seeing a regular doctor and explained this by describing different goals, different or more procedures, differences in the engagement of the doctors/researchers, and differences in logistics. Conclusions: Adolescents participating in clinical research and their parents generally describe medical research in terms of its goals of advancing science and finding new medicines and treatments, sometimes in combination with helping the enrolled individuals. The majority perceive a difference between research and regular medical care and described these differences in various ways. Further exploration is warranted about how such perceived differences matter to participants and how this understanding could be used to enhance informed consent and the overall research experience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Experiences of an Obese PatientChristine R. BrassIn the middle of an annual pelvic exam, the gynecologist said to me, “You should apply to be on ‘The Biggest Loser.’” I was too stunned and embarrassed to mutter anything more than a [End Page 88] comment that I didn’t think that, being quite introverted, I was a good candidate for a reality TV show. She argued with me about that. I (...) felt blindsided, intensely vulnerable, and dumbstruck—completely unable to respond—and later, when the shock wore off, incandescent with impotent rage.Four years later, I still don’t have words to adequately describe my outrage at this comment. It was only the second time I’d see this medical professional. The first time was the previous year, when she had been filling in for my regular doctor who was on maternity leave. At neither appointment did this physician ask me any questions about my lifestyle, whether or not I saw a primary care physician, or even if I had any concerns that day. She was very brisk, efficient and did not engage in conversation. Such a statement coming from a health care provider, who did not seek to understand or gather more information, surprised and dismayed me.Other incidents where physicians’ statements were not helpful:• Pediatrician: “Well, my wife has had great success with Weight Watchers.”—I was age 12, about 5’5 and weighted about 145 lbs. at that time. If you look at photos of me at the time, you would see I was not overweight.• Orthopedic Surgeon: “If you want her to look better, make her lose weight.”—This was directed to my mother. I was 19, weighed about 200 lbs., and in his office as per his directions to come back in seven years to see if the surgery he had done on my neck needed more attention.• Internist: “How did you get all those stretch marks?”—I was age 24, weighed approximately 220 lbs., and had lost and gained 50 or so pounds several times as a teenager and in college.• Gynecologist: “Lose weight and your periods will be regular.”—I was age 27, weighed 227 lbs. and my periods, which started at age 15, had never been regular.• Another Orthopedic Surgeon: “You don’t have to worry about osteoporosis; everything you do is a weight–bearing exercise.”—I was age 42 and weighed 300 lbs. This was after follow up surgery to remove pins from a broken ankle that had healed and I had asked about whether or not I should have a bone density test.Coming from a genetic heritage of predominately tall, large–boned people, I was tall and proportionally large compared to other girls my age until high school, when the others caught up. I was told I had to “watch my weight” by family members from my pre–teen years. Enforced dieting ensued, with little result because I wasn’t fat. I did not begin to be overweight until my junior and senior years of high school. I was 5’7” when I graduated from high school and weighed 187. By the time I graduated from college, I was no taller but 50 lbs. heavier. Now, nearing my 40th high school reunion, I am 120 lbs heavier than that. During the intervening years, I have done Weight Watchers®, TOPS®, medically–supervised programs (group and individual), and other popular diets, with periodic but temporary success, and hypnosis and aversion therapy, with no success at all.Over the years, I have been insulted, verbally abused, even bullied, because of my weight. I have been treated as though I am invisible, worthless, and stupid—a pariah. As a result, I have felt invisible, worthless, and stupid, even though I know I am none of those things. I have experienced and been treated for clinical depression. The descent into depression began in my late teen years, which was the time when I started gaining excess weight.In 2004, under medical supervision, I lost 70 lbs. over four–month period. I was delighted to finally lose a substantial amount of weight and feel physical lighter. My diabetes medications were significantly reduced, and... (shrink)

Doctors and nurses at the neonatal intensive-care unit at The University Hospital, Rigshospitalet, in Copenhagen, Denmark regularly find themselves in ethically challenging and potentially distressing situations concerning the life of ill newborn babies. In collaboration with the neonatal intensive-care unit, my project was to develop a method that could stimulate systematically dialogical moral inquiry within everyday clinical practice. My four months of ethnographic fieldwork at the neonatal intensive-care unit generated four fundamental themes that make up the scaffold of the (...) developed model for ethical deliberation and decision making. The model is a reflective tool to be used by health care professionals in situ. It provides a structured and a systematic framework for dialogue that can clarify the obscurities of a case and give argumentative support for ethical decisions. This article explains how the 4C model was developed and whereof it consists. (shrink)

Doctors are regularly confronted with requests for sterilisation of mentally handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a model for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select and classify certain factors which could enable us to arrive at an (...) ethically justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting competence, and six minor criteria: conception risk, IQ, age, personality, medical aspects and prognosis and finally support and guidance for the mentally handicapped person. The major criteria give rise to a "situation of necessity". In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical order. They can only be considered once the major criteria have created a "situation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, where efficient contraception is the end and irreversible sterilisation is the means. (shrink)

Unavailability of published data and studies focused on young researchers in Europe and research integrity issues reveals that clear understanding and stance on this subject within European area is lacking. Our study provides information on attitudes and experiences of European researchers at early career stages, based on a limited sample of respondents. The study provides both quantitative and qualitative results for the examined issues. The data suggest that awareness and interest of the younger researchers surveyed in research integrity issues is (...) high, however, it is often based on self-initiatives, with many of the respondents not having adequate training or any possibility to obtain it. Our attitude survey conducted within the European Council of Doctoral Candidates and Junior Researchers indicates that only 22 % of respondents had an opportunity to obtain relevant training, and that only one third believed that institutions and supervisors regularly paid attention to it. Further, we noted certain differences between disciplines. The study also reveals that many younger researchers felt they faced problems due to the misconduct of their senior colleagues and the existing institutional culture. The results of the study indicate a need for better prevention mechanisms, training and raising awareness activities. Preferably, junior researchers should be given an active role in shaping the integrity culture. It should be noted that the presented results should be considered in the context of the limitations stemming from the small-scale survey. This paper encourages further research activities on research integrity practices to provide stronger evidence on the attitudes and experiences of young researchers in Europe and other parts of the world. (shrink)

Based on two years’ ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients’ mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients’ mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians’ income structures are the most crucial (...) factors in inducing patients’ mistrust. Hospitals’ heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians’ reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians’ attitudes toward and interaction with patients may also affect patients’ sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem. (shrink)

In Britain doctors and others concerned with the treatment of offenders in prison may consult the Butler Report (see Focus, pp 157) and specialist journals, but these sources are concerned with the system in Britain only. In America the situation is different, both in organization and in certain attitudes. Dr Peter L Sissons has therefore provided a companion article to that of Dr Paul Bowden (page 163) describing the various medical issues in prisons. The main difference between the treatment (...) of offenders in prisons in America and in Britain lies in the nature of the federal system which means that each state may operate a different system in a variety of prisons and prison medical services are as various. Nationally, the prison systems are 'structured to treat and cure the offender'. Therefore it follows that the prison medical officer is only one of the professionals concerned with this 'cure' of the offender. This principle also applies to any form of research: medical research in prisons is part of a programme which covers a wide field of social and judicial research. The prison medical officer (where there is one) has of course to look after sick prisoners, and the American idea of 'cure' is also expressed in the need for more corrective surgery where, for example, it is necessary to remove physical impediments to social rehabilitation. But a doctor is only found on the staff of those institutions which are large: in the smaller prisons there may be only first-aid facilities, and no specially appointed doctor in the community. Moreover medicines are often dispensed by medical auxiliaries who are sometimes prisoners themselves. Finally, in America prisoners are regularly invited to volunteer as subjects for medical and social research for which they are paid. In short, although it is hoped to 'cure' a prisoner he is a criminal first and a patient second. (shrink)

§1. Introduction. This paper deals with aspects of my doctoral dissertation which contributed to the early development of model theory. What was of use to later workers was less the results of my thesis, than the method by which I proved the completeness of first-order logic—a result established by Kurt Gödel in his doctoral thesis 18 years before.The ideas that fed my discovery of this proof were mostly those I found in the teachings and writings of Alonzo Church. This may (...) seem curious, as his work in logic, and his teaching, gave great emphasis to the constructive character of mathematical logic, while the model theory to which I contributed is filled with theorems about very large classes of mathematical structures, whose proofs often by-pass constructive methods.Another curious thing about my discovery of a new proof of Gödel's completeness theorem, is that it arrived in the midst of my efforts to prove an entirely different result. Such “accidental” discoveries arise in many parts of scientific work. Perhaps there are regularities in the conditions under which such “accidents” occur which would interest some historians, so I shall try to describe in some detail the accident which befell me.A mathematical discovery is an idea, or a complex of ideas, which have been found and set forth under certain circumstances. The process of discovery consists in selecting certain input ideas and somehow combining and transforming them to produce the new output ideas. The process that produces a particular discovery may thus be represented by a diagram such as one sees in many parts of science; a “black box” with lines coming in from the left to represent the input ideas, and lines going out to the right representing the output. To describe that discovery one must explain what occurs inside the box, i.e., how the outputs were obtained from the inputs. (shrink)

Trust constitutes a fundamental strategy to deal with risks and uncertainty in complex societies. In line with the vast literature stressing the importance of trust in doctor–patient relationships, trust is therefore regularly suggested as a way of dealing with the risks of medical artificial intelligence (AI). Yet, this approach has come under charge from different angles. At least two lines of thought can be distinguished: (1) that trusting AI is conceptually confused, that is, that we cannot trust AI; and (2) (...) that it is also dangerous, that is, that we should not trust AI—particularly if the stakes are as high as they routinely are in medicine. In this paper, we aim to defend a notion of trust in the context of medical AI against both charges. To do so, we highlight the technically mediated intentions manifest in AI systems, rendering trust a conceptually plausible stance for dealing with them. Based on literature from human–robot interactions, psychology and sociology, we then propose a novel model to analyse notions of trust, distinguishing between three aspects: reliability, competence, and intentions. We discuss each aspect and make suggestions regarding how medical AI may become worthy of our trust. (shrink)

Zealous nudging can deteriorate into paternalistic bullshitting. To the extent that William Simkulet’s paper is a reminder against that danger, it does us good service.1 Simkulet, however, makes the far bolder claims that nudging just is bullshitting and that—since bullshitting deviates from truthfulness, and truthful disclosure is essential for valid consent—nudging invalidates informed consent. These bolder claims involve a set of errors. The problem starts with Simkulet’s formal definition of ‘bullshit’, which says that conveying x while intending one’s audience to (...) believe y is sufficient for bullshit. This, however, is not true since the bullshitter’s not caring whether x is true is constitutive of bullshitting, and hence a necessary condition. Why, we then ask, must such lack of care be the case with the doctor who nudges? It is at least prima facie easy and intuitive to think of scenarios in which the ethical doctor is staunchly committed to telling the truth while simultaneously acting on additional motives regarding the expected effects of what is said. If the doctor cares about saying only truths, he is not a bullshitter. Having communicative motivations that transcend the trivial motive of transmitting the truth of the literal content of what is said is normal and indeed normative in conversations of regular people.2 …. (shrink)

The essays in this volume convince me of something which, until now was only a hypothesis of mine. Academic discourse, and perhaps American university discourse in particular, possesses an extraordinary ability to absorb, digest, and neutralize all of the key, radical or dramatic moments of thought, particularly, a fortiori, of contemporary though. Marxism in the United States, though marginalized, remains deafly dominant and exercises a fascination that we have not seen in Europe since the Russian Proletkult of the 1930s. Post-Heideggerian (...) "deconstructivism" though esoteric, is welcomed in the United States as an antidote to analytic philosophy or, rather, as a way to valorize, through contrast, that philosophy. Only one theoretical breakthrough seems consistently to mobilize resistances, rejections and deafness: psychoanalysis—not as the "plague" allowed by Freud to implant itself in America as a "commerce in couches" but rather as that which, with Freud and after him, has led the psychoanalytic decentering of the speaking subject to the very foundations of language. It is this latter direction that I will be exploring here, with no other hope than to awaken the resistances and, perhaps, the attention of a concerned few, after the event .For I have the impression that the "professionalism" discussed throughout the "Politics of Interpretation" conference is never as strong as when professionals denounce it. In fact, the same preanalytic rationality unites them all, "conservatives" and "revolutionaries"—in all cases, jealous guardians of their academic "chairs" whose very existence, I am sure, is thrown into question and put into jeopardy by psychoanalytic discourse. I would therefore schematically summarize what is to follow in this way:1. There are political implications inherent in the act of interpretation itself, whatever meaning that interpretation bestows. What is the meaning, interest, and benefit of the interpretive position itself, a position from which I wish to give meaning to an enigma? To give a political meaning to something is perhaps only the ultimate consequence to he epistemological attitude which consists, simply, of the desire to give meaning. This attitude is not innocent but, rather, is rooted in the speaking subjects' need to reassure himself of his image and his identity faced with an object. Political interpretation is thus the apogee of the obsessive quest for A Meaning.2. The psychoanalytic intervention within Western knowledge has a fundamentally deceptive effect. Psychoanalysis, critical and dissolvent cuts through political illusions, fantasies, and beliefs to the extent that they consist in providing only one meaning, an uncriticizable ultimate Meaning, to human behavior. If such a situation can lead to despair within the polis, we must not forget that it is also a source of lucidity and ethics. The psychoanalytic intervention is, from this point of view, a counterweight, an antidote, to political discourse which, without it, is free to become our modern religion: the final explanation.3. The political interpretations of our century have produced two powerful and totalitarian results: fascism and Stalinism. Parallel to the socioeconomic reasons for these phenomena, there exists as well, another, more intrinsic reason: the simple desire to give a meaning to explain, to provide the answer, to interpret. In that context I will briefly discuss Louis Ferdinand Céline's texts insofar as the ideological interpretations given by him are an example of political delirium in avant-garde writing.Julia Kristeva,professor of linguistics at the University of Paris VII and a regular visiting professor at Columbia University, is the author of Desire in Language: A Semiotic Approach to Literature and Art and About Chinese Women.Margaret Waller, a doctoral candidate in French at Columbia University, is currently translating Kristeva's Revolution du langage poétique. (shrink)

A young man, terminally ill and in extreme suffering, asks to be removed from life support, requesting morphine first so he'll be asleep when the machine stops. His physician agrees, but the hospital's chief administrator intervenes, arguing that the morphine might itself cause death, leaving the physician open to criminal indictment for murder. To placate the administrator, the doctor and patient reach a grim compromise: life support will be disconnected first, and only after manifest signs of suffering appear will the (...) physician administer the morphine, to alleviate pain. The patient's request is ultimately respected, but many staff members feel he has been made to suffer needlessly. This is just one of many cases Ruth Macklin discusses in Enemies of Patients, an eye-opening look at the growing number of forces that are hostile to the interests of patients, including hospital administrators, lawyers who represent hospitals, insurance companies, government regulations, and even some well intentioned physicians. Macklin, a highly regarded medical ethicist, the author of Mortal Choices and the subject of a New York Times Magazine cover story, provides a behind-the-scenes look at how the patient's ethical rights are often violated. She describes, for instance, how a new breed of hospital administrator, the risk manager, acts consistently as an enemy of the patient, often urging physicians to continue aggressive, expensive treatments for critically ill patients--even when the patient and doctor agree the treatment should cease--for fear of lawsuits, bad publicity, or criminal indictment. (Macklin points out, for instance, that even though no physician has ever been convicted of a crime for withdrawing treatment from a patient in a permanent vegetative state, hospital lawyers and risk managers regularly assert that there is a danger of criminal liability in such cases.) The government also can become an enemy of patients. The most egregious case, according to Macklin, is the Federal government's "gag rule" which has prohibited health care facilities that receive Title X funds from discussing abortion with pregnant women, violating the patient's right to full information. And physicians themselves can become enemies of patients. Some, seeing themselves as fiscal gatekeepers, ration expensive health care procedures on financial rather than medical grounds. Some physicians refuse to treat patients who don't follow their advice (a cardiologist, for instance, who will not take care of patients who smoke) and others won't treat patients who pose a threat of lawsuit (such as a California woman in need of life-sustaining dialysis, who had previously sued another physician). Packed with numerous case histories drawn from the author's experience in a major urban medical center, Enemies of Patients will give readers a better understanding of their rights as patients and show them how to forge an alliance with their doctors against common enemies. (shrink)

Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of "no-blood" treatment. Many physicians, particularly so-called "sympathetic doctors", are establishing a close relationship with this religious organization. On the other hand, it is little known that this blood doctrine is being strongly criticized by reform-minded current and former JWs who have expressed conscientious dissent from the organization. Their arguments reveal religious practices that conflict with many physicians' moral standards. (...) They also suggest that a certain segment of "regular" or orthodox JWs may have different attitudes towards the blood doctrine. The author considers these viewpoints and argues that there are ethical flaws in the blood doctrine, and that the medical community should reconsider its supportive position. The usual physician assumption that JWs are acting autonomously and uniformly in refusing blood is seriously questioned. (shrink)

J. N. (Jitendra Nath) Mohanty (1928–2023). -/- Professor J. N. Mohanty has characterized his life and philosophy as being both “inside” and “outside” East and West, i.e., inside and outside traditions of India and those of the West, living in both India and United States: geographically, culturally, and philosophically; while also traveling the world: Melbourne to Moscow. Most of his academic time was spent teaching at the University of Oklahoma, The New School Graduate Faculty, and finally Temple University. Yet his (...) preeminent work in Husserlian phenomenology developed alongside his eminent work in Indian philosophy: describing his interests as “a fusion of disparate horizons.” -/- J. N. Mohanty was born September 26, 1928, in Cuttack (Odisha, East India). After graduating from high school, he went on to study both Indian and Western philosophy in Calcutta, earning bachelor’s and master’s degrees. There he read Whitehead and Kant’s First Critique; although he wanted to include mathematics in his curriculum, he was led instead to include Indian philosophy and Sanskrit. On the shelves of his teacher, Ras Vihar Das, he came upon a copy of the English translation (Ideas I, 1931) of Edmund Husserl’s classic Ideen I (1913), which presented Husserl’s ground-breaking conception of phenomenology. In 1952–1954 he left India for the first time, reaching Göttingen to study mathematics and philosophy, which earned him a doctorate in mathematics and “philosophy of mathematical sciences” (in his own words). In Göttingen, Mohanty found the powerful mathematical world that Husserl himself had earlier interacted with, where several Husserl students had formed the Göttingen school of phenomenology. During these years Mohanty studied primarily mathematics, alongside Kant and also Vedic Sanskrit. From his friend Günter Patzig, interpreter of Aristotle and Frege, Mohanty was drawn to Frege in relation to mathematical logic. He attended lectures of Heidegger, intrigued by his ontological thinking. Yet, despite the Husserlian legacy, Mohanty was completely self-taught in his studies of Husserl (as he has reported). With a doctorate in mathematics, and ideas from Kant and Frege in his philosophical background, Mohanty set about crafting his own conception of philosophy grounded in phenomenology, drawing on Husserl’s extensive work, critically sifting through Husserl’s texts and their emerging concepts of intentionality, meaning, subject, intersubjectivity, and world. In between he wrote his first book-length study: on phenomenological insights in Nicolai Hartmann and A. N. Whitehead (1958). -/- Over many decades Mohanty formulated and argued, in analytical detail, for a conception of phenomenology and its place in philosophy, later presented in a clear and concise book titled Transcendental Phenomenology: An Analytic Account (1989). Over these very decades the same scholar explored classical and recent Indian philosophy, thinking through kindred ideas of consciousness, self, and knowledge drawn from the Indian philosophical contexts. While writing on Nyāya theory of truth, he also pondered whether the world and finite individual are illusory or real, and whether Marx, Arendt, Gandhi (whom he heard speak in Calcutta), or Vinoba Bhave (with whom he marched across India for the land-grant movement) could best navigate post-Independent India’s social and svarāj or self-rule reforms. The two Mohantys, thinking through a vision of self and world, turned out to be “non-different” or “non-dual” as they each practiced critical phenomenology from both inside and outside the respective philosophical and cultural traditions. Numerous students, fellows, and colleagues or collaborators have benefited immensely from this infusion and unified approach to diversity in philosophical thought. In the 2000s, moving into retirement, Mohanty wrote two long books devoted to his understanding of Husserl and phenomenology and the calling of philosophy itself. This two-volume study shows Mohanty himself thinking through Husserl, critically, in The Philosophy of Edmund Husserl: A Historical Introduction (2008), and Edmund Husserl’s Freiburg Years: 1916–1938. As Mohanty worked on Husserl, he carefully indicated where he agreed and where he rejected or changed ideas, all part of his practice in phenomenology of “description and interpretation.” It was the same pattern he used in addressing the thought of Husserl vis-à-vis Kant or Frege or even Quine. -/- As Mohanty developed his understanding of phenomenology over the years, he wrote books on theory of meaning and the concept of intentionality, developing a model of ideal meaning and its foundation in intentionality, drawing on Husserl’s results. He followed these with the book Husserl and Frege (1982), linking the thought of those foundational figures for the “continental” and “analytic” traditions, respectively, in twentieth-century Western philosophy. Over his long career Mohanty addressed both traditions in his clear and accessible writing style. While developing his views on phenomenology, Mohanty regularly looked to “Husserl and his others,” evaluating views in Heidegger, Sartre, Merleau-Ponty, Ricoeur, and then Derrida and others in the wake of Husserl. With his background in Kant, Mohanty also looked toward Heidegger and Hegel in relation to Husserl’s later work in the Crisis (1935–38). Similarly, he looked to contemporary analytic philosophers, adjudicating his own, oft-wise Husserlian views in relation to Frege, Nagel, and others. Amid his active scholarly career, Mohanty co-founded the journal Husserl Studies, and was editorial advisor to Philosophy & Phenomenological Research, Philosophy East & West, Journal of Indian Philosophy, Sophia, among others. -/- Yet all this while Mohanty was also thinking and writing about Indian philosophy and its relation to phenomenology. In his own retrospective, Indian philosophy is “the permanent background” of his Husserlian thinking, while Kant is the recurrent Western background of his Husserlian phenomenology. Mohanty’s form of “transcendental phenomenology” evolved, in his own perspective, against the background of his studies of Navya-Nyāya on logic and Vedānta on consciousness, in Indian philosophy, and against the background of Kant’s First Critique on the transcendental, in Western philosophy. Accordingly, Mohanty’s study of logical form and of the intentionality of consciousness seeks a fusion of East and West in the conception of transcendental phenomenology. (Cf. Mohanty’s apt response to critics in The Empirical and the Transcendental (2000).) Even in the context of North American Husserl scholarship, Mohanty has exercised an earnest fusion of East and West. For the so-called East Coast and West Coast interpretations of Husserl’s crucial notion of noema both find a sympathetic spirit in J. N. Mohanty’s careful and nuanced interpretation of Husserlian transcendental phenomenology. With Mohanty the two faces of the noema are the logical (Fregean) and the phenomenal (Kantian), and these views of intentional structure join in consciousness—in a way resonant with Indian thought. -/- - David Woodruff Smith (UC Irvine) and Purushottama Bilimoria (SFSU, San Francisco; University of Melbourne) -/- For photo of Prof Mohanty visit APA online memorial_minutes2023 Courtesy of APA Memorial Minutes (& Proceedings) 2023 . (shrink)

Practitioners of disciplines whose problems are debated by moral philosophers regularly complain that the philosophers are engaged in abstract speculation, divorced from ‘real-life’ consequences and responsibilities, that it is the practitioners (doctor, research scientist, politician) who must take the decisions, and that they cannot (and should not) act in accordance with strict abstract logic.

In lieu of an abstract, here is a brief excerpt of the content:Misprision of IdentityHarold Merskey (bio)Misprision the deliberate concealment of one's knowledge of a crime...A misreading, misunderstanding, etc.A failure to appreciate the value of a thing...(Concise Oxford Dictionary)There are options in the forms of identity that Charland's subjects assume. There are options as well in the meaning of this title, which may apply severally or individually to the choices under consideration. Are those who change their identity with labels—or reject (...) labels—correctly assuming accurate descriptions, or incorrectly misleading themselves and some others? In which of these cases are observation and intervention ethical, and do they pose demands on medical ethicists, or should they simply be ignored?Types of AutonomyParticipants in chat rooms on the Internet may justifiably be considered to be individuals who are seeking a current method of communication to promote a view of themselves, or ideas that they possess, or projects that they endorse. In this they may resemble others who have used more traditional methods of presenting their ideas, their claims, their wares, hard merchandise, literary material, or political or philosophical propositions to the public at large. These others may be sales persons, advertisers, poets, singers, clowns, buskers, politicians, preachers, missionaries, learned public speakers, television presenters, news commentators (but not necessarily reporters), and anyone indeed who talks to other people in public about matters that she or he wishes to bring forward. They have a point they want to make. They may be grouping themselves as 'survivors' or pro-anorexia, or Multiple Personality Disorder victims, but they are not necessarily operating as patients who are looking for a fiduciary relationship with physicians or other health care practitioners. It is thus a long step to turn them into individuals who may have a claim on the doctor–patient relationship.Do we wish to undertake research on them? Research or study in the first instance for these circumstances must be in the field of social science. The rules of what it is ethical for a sociologist to do apply first. The rules of situations where one person has more power and the other depends on that individual for assistance without exploitation may differ considerably from case to case. In so far as there may be some special rules as to what is fair, reasonable, just, kind, merciful, or prudent to study individuals who expose themselves and their interests publicly, this is perhaps best done first by reference to standards for journalists.That criterion may be too lenient a standard for most health professionals because journalists seem to be quite willing to expose the subjects of their observations to public obloquy and to [End Page 351] present information about many individuals—information that the persons themselves do not consent to see in the public domain, but that the journalist, having acquired, feels entitled to make known. Still there are believed to be some standards that journalists observe and these tend to protect the weak and the more vulnerable, although that does not mean that they are regularly followed. They tend to emphasize not printing material that is salacious or very lewd and would have personal reference, but they do not withhold comparable information if they consider that it is accurate and describes the behavior of individuals who are of interest to the public which, in certain circumstances, may mean almost anybody.So up to this point it seems that our normal respect for the autonomy of the individual in chat rooms can be balanced against our interest in freedom of speech, which leads to open and very broadly based publication of information and observations.The Burden of the LabelOnce the medical label is affixed, a different level of stringency begins to apply to what may be studied or published. Because we feel that individuals' self-esteem is at risk and perhaps their lives, we hesitate to make cutting or pejorative comments about distressed people. Such diagnoses as cancer or depression may be held back from the patient (and, certainly, in the case of depression, even more may be kept from others around the patient). Likewise unspoken thoughts may be automatically acknowledged and, like radical material, may be carefully segregated and... (shrink)

The laws concerning driving licences and epilepsy in different countries are very diverse with regard to the criteria for issuance or renewal of licences, and also the methods of evaluating fitness. In 2011, a law was issued in Italy implementing the European directives on driving licences, including provisions for mandatory notification that a driver is epileptic. This was established regardless of the European rules that require compulsory notification only of patients. The Federation of Italian Boards of Physicians has made recommendations (...) against mandated physician reporting, resulting in a current confusion between legal and ethical recommendations to medical doctors. The mandatory notification enacted by Italian law raises ethical concerns about disparities in access to care and possible violations of the right to confidentiality of patient information. Moreover, the law discussed here fails to emphasise the importance of physicians ensuring compliance by the patient, by sharing the correct information about the risks associated with illegal driving and by obtaining information from the patient through regular check-ups. An urgent revision of the law is required to implement the duty of the physician to provide information and to ensure that the rule about mandatory notification should be erased in favour of optional self-reporting by epileptics as the preferred way to notify the licensing authority. The implementation of these measures could correct the dichotomy between the law and the ethical recommendations for medical doctors and protect the rights of people with epilepsy as well as those of any other patients whose pathology or impairment could imply a risk to the community. (shrink)

This cross sectional study was carried out among the workers of British American Tobacco Company, Dhaka with a view to explore their nutritional status, personal hygiene and health seeking behavior as because they are working on a tobacco processing company. The sample size was 179 which were selected purposively. The study showed that out of 179 respondents 89 (49.7%) were in the age groups of 30-39 years and the mean age of the respondents were 31.99 ± 6.01 years. A large (...) number of respondents (55.9%) had monthly family income of Taka 10001-20000 and the mean family income was Taka 12776.54 ± 5230.13. Maximum respondents (73.7%) were Muslim, more than half (54.2%) were shift in charge, 39.1% of the respondents consisted of 4 family members, 43.6% respondents were accustomed to other type of eating habit and 38.5% respondents knew that malnutrition was the effect of lack of proper nutrition, 59.8% of the respondents knew that night blindness was the disease due to malnutrition, most of the respondents (91.6%) performed duties to maintain health, majority (62.0%) respondents used to do nothing to maintain healthcare for their children and 35.9% visited doctor’s single time in a month, 40.2% of the respondents told regular tooth brushing as type of healthy habits. Majority (64.8%) respondents used to brush twice a day, majority (50.8%) respondents used to wash hand after toileting, majority (62.08%) respondents used to bath daily, 43.0% and 31.8% of the respondents told that dysentery and diarrhea was due to eating without proper hand washing respectively. Majority (53.6%) respondents informed that they learned about personal hygiene from television, 45.8% respondents understood that use of safe water in every work as sanitation. Majority (50.84%) came from nuclear family; most (84.92%) had exercise habit and 40.22% had education level of class VIII. Most (75.42%) of the respondents had semi pucca houses and majority (69.83%) of the respondents used only water as materials for hand washing. This study provided some important information which might help the concerned authority to take appropriate measures to improve the health status of the workers. (shrink)

Practitioners of disciplines whose problems are debated by moral philosophers regularly complain that the philosophers are engaged in abstract speculation, divorced from ‘real-life’ consequences and responsibilities, that it is the practitioners (doctor, research scientist, politician) who must take the decisions, and that they cannot (and should not) act in accordance with strict abstract logic.

In lieu of an abstract, here is a brief excerpt of the content:176 HISTORY OF PHILOSOPHY to be accounted for in some way. Goldsmith takes no cognizance of these categorical statements. Secondly, there is no support for Goldsmith's conclusion to be found in Hobbes's comment at the end of De Corpore. A cursory reading of the passage makes it clear that the comments concerning other hypotheses refer only to Part IV of De Corpore and not to the whole system as (...) Goldsmith suggests. Indeed the earlier parts are said to comprise the "theorems" of the systems, and the only way Hobbes suggests they might be found corrigible is if a mistake in deduction has occurred. Finally, Goldsmith pays insufficient attention to Hobbes's account of the process of analysis and sometimes seems to confuse it with the imaginary annihilation of the world which Hobbes uses as an expository device in expounding his concept of space. As Hobbes describes the process it begins with a phenomenal whole which is subjected to continued conceptual analysis until unanalyzable elements are reached. These logically primitive notions are referred to by Hobbes as "the most universal things" and as "first principles" which are "manifest of themselves" or "known to nature" (E. W. I, 69), all of which strongly suggests that they are coguized and not simply posited. Goldsmith mentions these descriptions of Hobbes's first principles in Chapter I, but presents no arguments to justify his abandoning them in favor of "suppositions or assumptions." When Goldsmith moves to Hobbes's political theory, he is on much firmer ground. The sections concerning human nature and natural law are generally excellent, particularly the account in Chapter IV of the relations between the various laws of nature. The treatment throughout this part of the book is exhaustive, although the point of some extended discussions is not very clear. There is a long discursive section in Chapter v on contraetarian thought which seems quite unrelated to anything it follows or precedes. And there are some curious allotments of emphasis. While Hobbes's "economic policy," which is a peripheral matter, is given a section to itself, the concept of obligation, which has been the focus of so much dispute in recent years and which is a central concern, is dealt with only by implication and in passing. In general Goldsmith accepts the traditional interpretation which sees the laws of nature as primarily prudential precepts found out by reason. These precepts are said to be like the "laws" of physics with respect to man's behavior in that they indicate regularities about the world which are ignored at one's own risk. Goldsmith suggests that the possible knowledge of God as a first cause serves only to reinforce man's awareness of the total causal nexus. The laws of nature are, properly speaking, laws only when they become civil regulations under the authority of a sovereign. The final chapter of the book attempts to assess the success of Hobbes's endeavor to create a science of politics by the "test" of its ability to explain the political phenomena of law, religion, and history. This is followed by eight appendices in which various disputes with other interpreters are briefly argued. The book contains an adequate index and a selected bibliography. There is a mistake on page 16, where the reference to De Corpore, Part I, should read Part II. PAUL J. JOHNSON California State College at San Bernardino Jean Chapelain, soixante-dix-sept lettres inddites ~ Nicolas Heinsius. Publi~es...avec une introduction et des notes par Bernard Bray. (La Haye: Martinus Nijhoff, 1966. Pp. wii -t- 467. --~ Archives Internationales d'Histoire des Id~s, 13.) A reviewer must admit at once that Jean Chapelain was no philosopher, that his letters have few general ideas, that a collection of them possesses no a priori right to be reviewed in a journal devoted to the history of philosophy. However, the present volume, edited and annotated by a member of the staff of the University of Utrecht, doctor of letters of BOOK REVIEWS 177 Amsterdam, appears in the series of the International Archives of the History of Ideas, published under the direction of P. Dibon of Nijmegen and R. Popkin of the University of California... (shrink)

Richard, a sixty‐seven‐year‐old man, has been admitted to Midtown University Center for difficulty breathing. He has a significant medical history that includes pulmonary fibrosis and subsequent heart failure, and he depends on supplemental oxygen to breathe. Upon admission and after discussing his prognosis with his family and doctors, Richard decided to sign a do‐not‐resuscitate order stating that if his heart stops or he stops breathing, he does not want to undergo cardiopulmonary resuscitation or other life‐sustaining measures. On his third (...) day in the hospital, the nurse practitioner who is caring for Richard notices that his breathing is becoming more labored and that his blood pressure is steadily dropping. She thinks he requires closer observation and treatment in the cardiac intensive care unit. Dr. P, the physician in the intensive care unit at the time, Dr. P does not want to accept Richard into the CICU because of his prognosis and his DNR order. He believes that Richard should be cared for on a regular hospital floor, and that the last bed in the CICU should be held for its intended user—a patient suffering a life‐threatening heart attack who requires intensive care. Should Richard be admitted to the CICU? (shrink)

The eclectic problem solving methodology used by the British Medical Association is described in this paper. It has grown from the daily need to respond to doctors’ practical queries and incorporates reference to law, traditional professional codes, and established BMA policies—all of which must be regularly assessed against the benchmark of contemporary societal expectations. The two Jehovah’s Witness scenarios are analysed, using this methodology and in both cases the four principles solution is found to concur with that of the (...) BMA’s approach. The author’s overall conclusion is that although the BMA resorts to a lengthier list of thins to consider, the solutions that emerge are often likely to coincide with the four principles approach. (shrink)

In an everyday private practice setting, regularly also existential topics will emerge from doctor-patient encounters. These are often questions of coping with life and lifestyle. To enable a thorough discussion of such topics, an implicit, and sometimes also explicit reference to a philosophical background is needed. Philosophical concepts to be used in this realm are discussed. An individual patient-doctor interaction is used as an example to demonstrate the doctor’s choice of hermeneutical and phenomenological philosophical concepts.

In an everyday private practice setting, regularly also existential topics will emerge from doctor-patient encounters. These are often questions of coping with life and lifestyle. To enable a thorough discussion of such topics, an implicit, and sometimes also explicit reference to a philosophical background is needed. Philosophical concepts to be used in this realm are discussed. An individual patient-doctor interaction is used as an example to demonstrate the doctor’s choice of hermeneutical and phenomenological philosophical concepts.

Science and expertise have been antithetical forms of knowledge in both the ancient and the modern world, but they appear identical in today’s postmodern world, especially in Science & Technology Studies literature. The ancient Athenians associated science with the contemplative life afforded to those who lived from inherited wealth. Expertise was for those lacking property, and hence citizenship. Such people were regularly forced to justify their usefulness to Athenian society. Some foreign merchants, collectively demonised in Plato’s Dialogues as ‘sophists’, appeared (...) so insulting to citizen Socrates, because they dared to alienate aspects of this leisured existence and repackage them as techniques that might be purchased on demand from an expert – that is, a sophist. In effect, the sophists cleverly tried to universalise their own alien status, taking full advantage of the strong analogy that Athenians saw between the governance of the self and the polis. Unfortunately, Plato, the original spin doctor, immortalised Socrates’ laboured and hyperbolic rearguard response to these sly and partially successful attempts at dislodging hereditary privilege. (shrink)

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

Picture this. You are having your regular medical checkup, when, all of a sudden, the physician turns to you and says: “Oh, did I remember to mention that you can now live forever?” You look at the doctor enquiringly and she goes on: “Well, it’s not actual immortality, you know, but they’ve invented this treatment—I don’t have the full details—that stops aging, getting physically older. It might not be for everyone, but you seem to be a suitable candidate. You (...) could still die of accidents and illness, of course, but they’ve calculated that with care and any luck you should live to be a thousand, as opposed to the hundred or so that you would now have. And in a millennium, techniques will advance further, so there could be more in store for you after that.”. (shrink)

On the 3rd of April, 2023, the Doctor of Philosophy, Larisa Viktorovna Anzhiganova celebrated her anniversary. She is the first and currently the only woman in the region with a degree of the Doctor of Philosophy. Her research interests are related to the study of ethnocultural problems of Khakassia, in particular, the philosophy of ethnos, ethnic culture, interethnic relations, gender studies. Her scientific activity was conducted within the walls of the N. F. Katanov Khakass State University (since 1980), Khakass Research (...) Institute for Language, Literature, and History (1994–1998). It is of particular interest due to the relevance of the topic of the doctoral dissertation “The evolution of the worldview of an ethnic group (by the example of the Khakass people)” (1999, Moscow) and other works that cover the value problems of the ethnic group, including women’s family values. The researcher pays significant attention to the issues of the Khakass’ ethnocultural foundations. An important stage in the development of scientific and organizational activities of L.V. Anzhiganova was the holding of the Interregional Сonference “Ethnic Capital: Resources and Institutional Forms”, which promises to become regular. The philosopher’s ideas played an important role in the formation of the ethnic culture of the Khakass people. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 2. © 2018 by Feminist Studies, Inc. 363 Ashley Glassburn Falzetti What Makes an Interdisciplinary Feminist Scholar? Preparing for the Unknown in a Skill-centered Curriculum I first read the 1998 special issue of Feminist Studies “Disciplining Feminism? The Future of Women’s Studies” in a monthly reading group of scholars from across the globe working on PhDs in women’s, gender, feminist, and/or queer studies (WGFQS).1 We (...) began meeting informally in the halls of the National Women’s Studies Association (NWSA) annual conference, discussing how our training compared and what sort of support was out there for scholars dissertating in WGFQS.2 What surprised us most while we re/read these articles was that the concerns about the field had not changed much in the twelve years that had passed since their original publication. Now that twenty years have passed, the concerns remain even though some of the controversies are settled. Despite claims about the impossibility of the women’s studies PhD, doctoral programs have flourished. In their introduction to the 1998 special issue, Nancy Hewitt and 1. I use WGFQS PhDs to refer to people who have earned a PhD from an interdisciplinary WGFQS doctoral program. The majority of WGFQS doctoral programs were founded on the ideals of interdisciplinarity. Some doctoral programs retained a joint-degree model that honors the multi-disciplinary origins of the field by requiring a major in a disciplinary field, such as English, history, psychology, or law. 2. The most active participants of this group included Sonja Thomas (who coordinated the discussions), Jennifer Musto, Stephanie Clare, Evangeline Heiliger, and Laura Foster. 364 Ashley Glassburn Falzetti Susan S. Lanser focus on the relationship between disciplinary formations and the possibility of formal preparation to conduct interdisciplinary research.3 As graduate programs were expanding, the role of methods in curriculum centered concerns over the efficacy of interdisciplinary training. Now that a critical mass of PhDs is trained in interdisciplinary WGFQS, a new understanding of the role of methods is emerging. Interdisciplinary feminist questions require scholars to employ new research skills regularly throughout their careers, thus preparing junior scholars to ask and answer questions well is more efficient than studying a range of methods. The Problem of Methods Throughout the early literature on WGFQS, there is slippage between discussing interdisciplinary methods and feminist methodology.4 Methods refer to the techniques researchers use to gather data, what Sally Kitch and Mary Margaret Fonow define in their study of WGFQS dissertations as “a technique for gathering evidence.”5 Feminist methodologies involve the ethical, political, and epistemological concerns that mark research as a distinctively feminist approach to inquiry. Slipping between discussions of feminist methodologies (on the dynamics of power, representation, and knowledge production) and disciplinary methods (how researchers gather data) has contributed to the sticky association of feminist interdisciplinarity as a “problem of methods.” Vivian May, one of the earliest WGFQS PhDs and former NWSA president, argues that the continued attachment to such disciplinary parameters “defused that potential” of interdisciplinarity as a means of transforming feminist modes of knowledge production.6 Arguments that feminist interdisciplinarity could be a more just or a more contextually objective 3. Nancy Hewitt and Susan S. Lanser, “Preface,” Feminist Studies 24, no. 2, special issue, “Disciplining Feminism? The Future of Women’s Studies” (Summer 1998): 236. 4. In addition to the 1998 special issue of Feminist Studies, see NWSA Journal 12, no. 2 (Summer 2000) and response essays across feminist studies journals between 2000 and 2003. 5. Sally L. Kitch and Mary Margaret Fonow, “Analyzing Women’s Studies Dissertations: Methodologies, Epistemologies, and Field Formation,” Signs: Journal of Women in Culture and Society 38, no. 1 (Autumn 2012): 99–126. 6. Vivian May, “Disciplinary Desires and Undisciplined Daughters,” NWSA Journal 14, no. 1 (Spring 2002): 144. Ashley Glassburn Falzetti 365 approach to inquiry fueled the desire to build WGFQS PhD programs; however, the concern that interdisciplinarity is always already undisciplined led many departments to rely on disciplinary methods training when designing curriculum. The focus on methods as a means to interdisciplinarity assumes that traditional disciplines are best suited to intellectual inquiry or at least that WGFQS scholars need a disciplinary rationale for... (shrink)

A forty-year-old man is brought to the emergency room by his wife at five in the morning, two hours after he fell down the stairs at home, hitting his head and injuring his arm. He tells the ER physician that he got up to get a drink of water and tripped in the dark. His speech is slurred, and he smells strongly of alcohol. Lab results reveal elevated liver enzymes, and his blood alcohol level is 0.1. His medical history is (...) unremarkable. When asked about his alcohol consumption, he says he usually has one or two drinks a night with dinner but that he drinks more on holidays and special occasions. He admits he had more to drink than usual last night because it had been a stressful day at work, but he is vague about how much he drank. His wife takes the ER physician aside and describes a very different situation. She says that her husband regularly has three or four drinks a night. She always goes to bed before he does and thinks he stays up later so he can continue to drink. She says that he often has no memory of conversations they had the night before and is concerned because he makes work-related calls at night. When asked what he does for a living, she hesitates, and then answers that he is an internist. He does not work at this hospital but works at one of its affiliated clinics. The ER doctor is concerned that his patient is an impaired physician. Yet when the admitting hospitalist, to whom he explains the situation, asks if he really wants to “go there,” he shrugs his shoulders. “I suppose,” she replies, “you might as well call an ethics consult.”. (shrink)

Nicholas Wiseman (Sevilla, 1802-Londres, 1865), primer cardenal arzobispo de Westminster, nació en Sevilla, de padres irlandeses, y es probablemente el único hijo nativo de la ciudad que ha sido honrado con el birrete rojo. Visitó su ciudad natal y su país en el invierno de 1844-45, cuando era coadjutor del Dr. Walsh, vicario de la Dr. Walsh, vicario apostólico de los Midlands. Aparte de Sevilla y y Cádiz, donde desembarcó y de donde zarpó de regreso a Inglaterra, visitó otras ciudades (...) del país, visitó otras ciudades de Andalucía, como Écija, Granada y Málaga. En Sevilla fue distinguido con el título de Doctor por la Universidad, a la que envió un ejemplar de sus libros. Estos tiempos difíciles para la Iglesia católica en España, ya que los gobiernos liberales de las Regencias de María Cristina y Espartero (1833-1843) habían puesto en práctica la venta de los bienes del clero regular, la supresión de monasterios y conventos y la abolición de los diezmos. Escribió sus impresiones de este viaje para su Dublin Review (1845), que más tarde reeditó en dos artículos de su libro Essays on Various Subjects (1853). Se trata de documentos de primera mano, pero difíciles de encontrar, de la situación de la Iglesia española en aquel momento de prueba. Son también una exposición clara y sincera de las ideas de tan insigne eclesiástico -como era él- sobre el papel de la Iglesia en el mundo. A su muerte, la ciudad de Sevilla honró su memoria dando su nombre a la calle donde había nacido. (shrink)

The term “innovation” or “innovative care” has recently gained attention in the context of the use of novel and not yet fully validated medical interventions and technologies. Most notably, there have been various incidences of medical activities insufficiently validated for its regular use in healthcare that fall into this category, such as stem cell treatments, genome sequencing for diagnostic purposes, or novel reproductive technologies. Latin American countries are among the places where new and non-validated medical activities take place, notably (...) due to a lack of clear regulations and the poor support of authorities of existent legal and ethical guidelines, which is driven by “hidden battles” on the moral status of certain interventions. The increasing importance of innovative care underlines the importance of developing a general framework for these practices. Therefore, the present chapter scrutinizes this nascent field of inquiry in Latin America and offers a conceptual framework for innovation as well as its ethical justification. As we will argue, an important use of the term “innovation” or “innovative care” is best interpreted as “new non-validated practice” and not as a research activity. Then, we will defend that responsible innovation understood as responsible new non-validated practice is ethically permissible and poses an acceptable medical option if done in exceptional circumstances—where no reasonable alternatives can be provided to an individual patient—and following special ethical principles. Finally, we focus on the peculiarities and specific difficulties the concept of new non-validated practice poses to the Latin American context. We will conclude the chapter by some remarks and recommendations we draw from our analysis for individual patients, doctors, and societies in Latin America. (shrink)

In this chapter I argue that the primary function of the current obsession with research funding is, like many extensions of neoliberalism into education, largely symbolic: it is symbolic of the hegemony of instrumental thinking and its ambition to expunge all other forms of reason from the academy and other areas of public life. Several brief case-studies illustrate and support my argument. UK academics are increasingly expected to secure external research funding, though often the amounts they must raise are small. (...) Against such insignificant sums the opportunity costs are clear, as academics are distracted from other kinds of research. The comparison with Mao Zedong’s ‘Great Leap Forward’ is irresistible: in 1958 every commune in China was required to set up small backyard furnaces to produce steel from scrap metal. Farmers, doctors, teachers and others had to neglect their regular work in order to join in. A second example: many academic research projects that secure substantial external funding actually cost the host university more than the funding brings in. Universities persist in supporting underfunded research because even inadequate external funding has value as ‘status capital’. As a symbol of instrumental reason the fixation on funding requires academics to speak the language of the new breed of pro-vice-chancellors and other senior officers who now make their career in management and administration rather than undertaking such tasks for a limited period before returning to their academic work. They speak a new language with the fluency and enthusiasm of converts. Its prominent words – transparency, accountability and performance management, show that the urge to control and discipline the academy is never far away. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Michael L. MarkPatrice Madura Ward-SteinmanI met Michael Mark at the first Philosophy of Music Education conference held at Indiana University in the summer of 1990. I was a doctoral student at IU then and had studied the writings of many of the conference presenters and so the experience of hearing and meeting them in person was a heady one, indeed. I will never forget those impressions of Phil Alperson, (...) Wayne Bowman, Allen Britton, David Elliott, Peter Kivy, Gerard Knieter, Thomas Regelski, Bennett Reimer, John Shepherd, Ann Stokes, Eleanor Stubley, Keith Swanwick, and many others.I was interested in meeting Michael after hearing his response to the presentation of one of my favorite IU professors of musicology, Austin Caswell. Caswell’s provocative paper, “How We Got into Canonicity and What it has Done to Us: An American Music Historian’s View of Music in Academia,” claimed that “the effect of canonicity on American musical life is destructive,” while Michael’s response was characterized by his style of writing that I came to recognize over the decades as distinct, calm, logical, methodical, and based in an extraordinarily wide and deep wealth of historical knowledge. While I greatly admired my rebellious and passionate professor’s views and temperament which were not unlike my own, I also appreciated hearing Michael’s measured and thoughtful response. Thus began my friendship with Michael, who, I learned, was not only a professor [End Page 92] and dean at Towson State University but also an avid big band woodwind doubler who showed interest in my doctoral research in the art of vocal jazz improvisation. That friendship lasted for almost twenty-eight years and we enjoyed memorable reunions at other conferences. For example, there was the ISPME conference held at UCLA where he invited me to dinner with his good friend and connoisseur of fine wines, Bennett Reimer, and the ISPME conference in Helsinki where, after I tripped and severely broke my ankle, requiring surgery, Michael, Estelle Jorgensen, Iris Yob, and two then-doctoral students (Kasia Bugaj and Leonard Tan) visited me in the Helsinki hospital.When I began teaching at the University of Southern California in 1995, it was fortuitous that Michael’s brother, Brian, lived in the Los Angeles area. His frequent visits allowed him to make several guest lectures to my graduate research methods classes, very welcome opportunities. After one of those lectures, I relayed the history of my family’s ballroom in the Chicago area that was open for business with big band music from 1929 until 1967. He asked if I had any artifacts from Madura’s Danceland, and when I mentioned my father’s stacks of dusty record books, newsletters, photos, and posters in our basement, he became very enthusiastic and told me that I had a “gold mine” of an archive with which to write a book about the place! As a trained quantitative researcher, I began to explore the record books to analyze trends in band pay over the Depression and World War II years.1 Over the next ten years, with help from Michael’s regular prodding and encouragement, I organized the large archive into the history of Madura’s Danceland.2 I owe this personally important accomplishment to Michael Mark.Michael invited me (in his endearing way which I could not refuse) to coauthor a music education textbook with him3 and our writing partnership went so smoothly that he invited me to co-author the 4th edition of his Contemporary Music Education.4 Although our writing styles and areas of expertise were very different, I learned much from his narrative approach which included illustrative scenarios, interviews, and the informal use of contractions, a style of writing that was not second nature for me. We wrote both books without meeting in person, except to celebrate the publication of the first at the Metropolitan Art Museum café in New York with our beloved spouses, Lois Mark and David Ward-Steinman.Dr. Michael L. Mark will long be remembered for his many books, chapters, and articles on the history of music education and his many symposium presentations; for his university teaching and administrative achievements; and for his... (shrink)

This study compares the level of ethics research published in 25 business-ethics journals and the Top-40 journals for the accounting, finance, and marketing disciplines. This research documents an increasing level of ethics research in the accounting and marketing disciplines starting in 1992. While the level of finance doctorates reported by the Association to Advance Collegiate Schools of Business (AACSB) has increased at a higher rate (40.4%) than accounting (18.4%) and marketing (32.2%) since 1995, this increase has not been reflected in (...) the level of ethics scholarship in finance. The level of ethics scholarship in finance remained relatively constant between 1987 and 2005 at an average of seven coauthor-adjusted articles per year. However, both the accounting and marketing disciplines now regularly publish approximately 50 coauthor-adjusted articles each year. (shrink)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. 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In lieu of an abstract, here is a brief excerpt of the content:Importance of Respect in Patient CareSue GibsonI have been a state-tested nurses aide (STNA) for 32 years. When I get up to go to work, I always start out with a positive attitude.After I clock in for my shift, I go to my assigned floor to start my day. I gather up all my paperwork that is necessary and I'm off and running.I feel the best way to make (...) a resident feel comfortable in their surroundings is to have the resident help in making as many decisions in their day as possible. Decision-making helps a resident feel at home. As an STNA, I am there to help them if a resident needs any kind of assistance during the shift that I am working. One of the first priority questions of the day concerns their meals. The resident selects the lunch and dinner choice. If a resident is not sure what they would like to choose for their meals, I help them choose from what is available to them. I write their selection down for the dietary department and I always thank the resident and smile as I leave the area. Now that they know what their choices are for the day, they have something to look forward to. [End Page 139]Another decision a resident has for the day is their choice of what they would like to wear for the day. He or she may have a favorite article of clothing they like to wear. They may like it because it may be their favorite color or something they really feel comfortable in. I again thank the resident on their decision-making and helping me make their day. I compliment the resident on how nice and neat they look.Showering is the next big thing of the day. Some residents love to get in the shower, while on the other hand, some residents hate to hear the word shower, let alone get into it. Some residents need a lot of encouragement to take a shower. I give the resident a choice as to when they would like to shower. All the residents have a regular shower day. If the resident is scheduled for a shower and would like to take the shower before going to bed, I tell the nurse and the shower is rescheduled for the afternoon shift. The decision is made by the resident and the resident is more likely to follow through with their decision.Activities are scheduled on a daily basis. When the activity is announced over our intercom system, I ask the residents if they would like to attend the activity and sometimes I take them to the floor the activity is being held on.Every Thursday there is a scheduled outing for either breakfast or lunch. It is my job on these outings to go with the activity staff and tend to the residents' needs, if necessary. We go out to a public restaurant and the resident chooses what they would like to eat. If they need help, I am there to help them. I'll ask them, "What are you hungry for?" or, "What sounds good to you?" I read the menu for them and give the residents time to choose what they would like. I have residents who need the food cut up for them because they cannot see well. I tell them where what food is on their plate. I sit by the resident who may need assistance or help in eating and drinking. I feel this outing is important to every resident who goes. Whether it is going out to eat, on a ride, or even to the doctor, they need to feel they have the freedom to choose to do this.It is not unusual to be physically or verbally abused by a resident on a daily basis. A resident might be angry over some little thing and the STNAs are the people they take their anger out on. I take into consideration that the residents are here for a reason, so I never take their words or actions as a personal attack on me.Staying in bed an entire shift... (shrink)

The British Medical Association and Royal College of Physicians have published new guidance, endorsed by the General Medical Council, on decision-making about clinically assisted nutrition and hydration and adults who lack capacity to consent. The development of the guidance follows a series of legal cases which has created confusion about the precise circumstances in which an application to the court is required before CANH is withdrawn which has culminated with the decision of the Supreme Court in National Health Service Trust (...) versus Y. 1 This confirmed that there is no requirement to go to court, providing there is agreement as to the patient’s best interests, the provisions of the Mental Capacity Act 2005 have been observed, and the relevant professional guidance has been followed. The new guidance covers all decisions to start, restart, continue, or stop providing CANH in patients who are not imminently dying, in circumstances where CANH is the primary life-sustaining treatment being provided. It goes beyond the category of patients in permanent vegetative state or minimally conscious state who have previously been the subject of court applications, and also covers decisions for patients with neurodegenerative conditions and patients who have suffered a sudden onset brain injury in addition to having multiple comorbidities or general frailty which is likely to impact on life expectancy. It provides a clear statement of doctors’ legal responsibilities, covers the importance of robust best interests’ assessments and sets out the process to be followed for sufficient independent scrutiny of decisions. In light of some of the identified problems with decisions about CANH, a particular focus of the guidance is on the importance of regular best interests’ assessments, and it provides detailed practical guidance about how to approach these. The development of …. (shrink)

The unprecedented development of medical informatics is constantly transforming the concept of expertise in medical sciences in a way that has far-reaching consequences for both the theory of knowledge and the philosophy of informatics. Deep medicine is based on the assumption that medical diagnosis should take into account the wide array of possible health factors involved in the diagnostic process, such as not only genome analysis alone, but also the metabolome (analysis of all body metabolites important for e.g. drug-drug interactions), (...) microbiome (i.e. analysis of all bodily microorganisms interacting with host cells) or exposome (analysis of all environmental factors triggering potentially harmful cell mutations, such as UV radiation, heavy metals, various carcinogens, etc.). Deep data analysis is of tantamount importance for personalized diagnosis but, at the same time, hardly achievable by a regular human being. However, adequately designed artificial intelligence (e.g. a deep neural network) can undeniably be of great help for finding correlations between symptoms and underlying diseases. Nowadays AI applies to nearly every aspect of medicine, starting from the data analysis of scientific literature, through the diagnostic process, to the act of communication between physicians and their patients. Medical image processing algorithms greatly enhance the chances of successful recognition of melanoma or intestinal polyps. Communication tools designed for physicians use techniques known from social media to provide users with an opportunity to consult the case with colleagues from the same discipline. Natural language processing tools significantly improve doctor-patient communication by the automation of note-taking. Is this enough to support the claim that the non-epistemic competences in medicine are becoming more and more important? Can we attribute expertise only to a person? How is medical informatics changing the way most people usually understand human-computer interactions? (shrink)