I defend an empirically-oriented approach to the analysis and remediation of social injustice. My springboard for this argument is a debate—principally represented here between Tommie Shelby and Elizabeth Anderson, but with much deeper historical roots and many flowering branches—about whether racial-justice advocacy should prioritize integration (bringing different groups together) or community development (building wealth and political power within the black community). Although I incline toward something closer to Shelby’s “egalitarian pluralist” approach over Anderson’s single-minded emphasis on integration, many of Shelby’s (...) criticisms of integrationism are misguided, and his handling of the empirical literature is profoundly unbalanced. In fact, while both Shelby and Anderson defend the importance of social science to their projects, I’ll argue that each takes a decidedly unempirical approach, which ultimately obscures the full extent of our ignorance about what we can and ought to do going forward. A more authentically empirical tack would be more epistemically humble, more holistic, and less organized around what I’ll call prematurely formulated “Grand Unified Theories of Social Change.” I defend a more “diversified experimentalist” approach, which rigorously tests an array of smaller-scale interventions before trying to replicate and scale up the most promising results. (shrink)

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in (...) medicine, and what are the virtues that are likely to promote and sustain them? -/- Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. -/- Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. -/- Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice. (shrink)

This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There (...) are four primary mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice. (shrink)

Biological sex should be “acknowledged” and “accepted”—but which responses to gender dysphoria might this preclude? Trans-identified people may factually acknowledge their biological sex and regard transition as purely palliative. While generally some level of self-deception and even a high level of nonlying deception of others are sometimes justified, biological sex is important, and there is a nontrivial onus against even palliative, nonsexually motivated cross-dressing. The onus is higher against co-opting the body, even in a minor and/or reversible way, to make (...) a false communication concerning one’s sex. Hardest to defend is the destruction of sexual–reproductive functions and causally downstream functions such as lactation: due to the transcendent nature of sexual–reproductive functions, an appeal to the “principle of totality” here is misplaced. This is not to say that social, and milder medical, transition is absolutely excluded even for severe unmanageable dysphoria, nor that subsequent to any transition, detransition is necessarily required. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease (...) to other members of the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

This article looks at the question of sin and disease in bioethics with a spiritual-theological analysis from the book of Job. The biblical figure Job is an innocent and just man who suffered horrendously. His dialogues with others—his wife, his friends, and God—can give many valuable insights for patients who suffer and for those who interact with them. Family, friends, physicians, nurses, chaplains, and pastoral workers can learn from Job how to communicate properly with sufferers. The main question for Job (...) was how to maintain the tension between God’s justice and God’s mercy and not yield to the temptation of cursing God but to speak well of Him in moments of difficulties. (shrink)

Background Professional communities such as the medical community are acutely concerned with negligence: the category of misconduct where a professional does not live up to the standards expected of a professional of similar qualifications. Since science is currently strengthening its structures of self-regulation in parallel to the professions, this raises the question to what extent the scientific community is concerned with negligence, and if not, whether it should be. By means of comparative analysis of medical and scientific codes (...) of conduct, we aim to highlight the role of negligence provisions in codes of conduct for scientists, and to discuss the normative consequences for future codes of conduct. -/- Methods We collected scientific and medical codes of conduct in a selection of OECD countries, and submitted each code of conduct to comparative textual analysis. -/- Results Negligence is invariably listed as an infraction of the norms of integrity in medical codes of conduct, but only rarely so in the scientific codes. When the latter list negligence, they typically do not provide any detail on the meaning of ‘negligence’. -/- Discussion Unlike codes of conduct for professionals, current codes of conduct for scientists are largely silent on the issue of negligence, or explicitly exclude negligence as a type of misconduct. In the few cases where negligence is stipulated to constitute misconduct, no responsibilities are identified that would help prevent negligence. While we caution against unreasonable negligence provisions as well as disproportionate sanctioning systems, we do argue that negligence provisions are crucial for justified trust in the scientific community, and hence that there is a very strong rationale for including negligence provisions in codes of conduct. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within (...) healthcare organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

In the literature, the pragmatic dimension of metaphors has been clearly acknowledged. Metaphors are regarded as having different possible uses, especially pursuing persuasion. However, an analysis of the specific conversational purposes that they can be aimed at achieving in a dialogue and their adequacy thereto is still missing. In this chapter, we will address this issue focusing on the classical distinction between the explanatory and persuasive uses of metaphors, which is, however, complex to draw at an analytical level and often (...) blurred and controversial also from a theoretical point of view. Building on the analysis of explanation in different theories and fields of study, we show how it can be conceived as characterized by a cognitive and a pragmatic dimension, where the transference of understanding is used pragmatically for different dialogical goals - such as informing, making a joint decision, and most importantly persuading. In this sense, the cognitive effects of understanding are not incompatible with a persuasive dialogical purpose. This theoretical proposal will be applied to examples drawn from the medical context, to show how a pragmatic approach to explanation can account for the complexity of the cases that can be found in actual dialogical contexts. (shrink)

Reflection is widely acknowledged to play a crucial role in enhancing the competence of medical professionals. Developed countries have given importance to implementing reflective practices for professional development. In developing countries, reflective practices are not given much importance as a tool for professional growth. This article aims to uncover the existing practices of reflection and the challenges faced by medical professionals working at a government hospital in Nepal. It also promotes the practice of reflection to improve daily professional (...) practice. This article aims to uncover the existing practices of reflection and the challenges faced by medical professionals working at a government hospital in Nepal. This qualitative study utilized Narrative Inquiry as the research method and conducted semi-structured, in-depth interviews with two medical professionals selected through purposive sampling followed by content analysis of the collected data. The study was based on the theories of social constructivism and transformative learning. After analyzing the data, three significant themes emerged: empathizing through reflection, change in practice through reflection, and barriers to reflective practices. The study identified several barriers to reflective practices, including a negative attitude, sociocultural contexts, and a lack of support from the medical community. It is crucial to encourage self-reflection for medical professionals to enhance their professional growth and promote lifelong learning. This study provides valuable insights into the significance of reflective practices in the professional development of medical personnel, particularly in developing countries. (shrink)

Metaphors can be used as crucial tools for reaching shared understanding, especially where an epistemic imbalance of knowledge is at stake. However, metaphors can also represent a risk in intercultural or cross-cultural interactions, namely in situations characterised by little or deficient common ground between interlocutors. In such cases, the use of metaphors can lead to misunderstandings and cause communicative breakdowns. The conditions defining when metaphors promote, and hinder understanding have not been analyzed in detail, especially in intracultural contexts. This study (...) proposes an analysis of metaphors identified within an Italian corpus of diabetes care interviews. Through a coding scheme capturing the types and the probative weights of the linguistic evidence that can be used to detect misunderstandings, the communicative effectiveness of metaphors is indirectly assessed. The quantitative and qualitative analyses show a positive correlation between metaphor use and problematic understanding. A more detailed scrutiny of the interlocutors’ roles and topics of the metaphors points out that most of the problematic metaphors are used by patients, while most of the problematic ones used by providers concern non-clinical matters. These results can be explained as resulting from incorrect presumptions of common ground between the interlocutors. (shrink)

The European Medical Information Framework project, funded through the IMI programme, has designed and implemented a federated platform to connect health data from a variety of sources across Europe, to facilitate large scale clinical and life sciences research. It enables approved users to analyse securely multiple, diverse, data via a single portal, thereby mediating research opportunities across a large quantity of research data. EMIF developed a code of practice to ensure the privacy protection of data subjects, protect the interests (...) of data sharing parties, comply with legislation and various organisational policies on data protection, uphold best practices in the protection of personal privacy and information governance, and eventually promote these best practices more widely. EMIF convened an Ethics Advisory Board, to provide feedback on its approach, platform, and the EcoP. The most important challenges the ECoP team faced were: how to define, control and monitor the purposes for which federated health data are used; the kinds of organisation that should be permitted to conduct permitted research; and how to monitor this. This manuscript explores those issues, offering the combined insights of the EAB and EMIF core ECoP team. For some issues, a consensus on how to approach them is proposed. For other issues, a singular approach may be premature but the challenges are summarised to help the community to debate the topic further. Arguably, the issues and their analyses have application beyond EMIF, to many research infrastructures connected to health data sources. (shrink)

Current COVID-19 pandemic and previous SARS/MERS outbreaks have caused a series of major crises to global public health. We must integrate the large and exponentially growing amount of heterogeneous coronavirus data to better understand coronaviruses and associated disease mechanisms, in the interest of developing effective and safe vaccines and drugs. Ontologies have emerged to play an important role in standard knowledge and data representation, integration, sharing, and analysis. We have initiated the development of the community-based Coronavirus Infectious Disease Ontology (CIDO). (...) As an Open Biomedical Ontology (OBO) library ontology, CIDO is an open source and interoperable with other existing OBO ontologies. In this article, the general architecture and the design patterns of the CIDO are introduced, CIDO representation of coronaviruses, phenotypes, anti-coronavirus drugs and medical devices (e.g. ventilators) are illustrated, and an application of CIDO implemented to identify repurposable drug candidates for effective and safe COVID-19 treatment is presented. (shrink)

The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing. Objective: This study examines the role of wireless, electronic, medical records and com- munications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.

In the last two decades we have witnessed considerable efforts directed towards making electronic healthcare records comparable and interoperable through advances in record architectures and (bio)medical terminologies and coding systems. Deep semantic issues in general, and ontology in particular, have received some interest from the research communities. However, with the exception of work on so-called ‘controlled vocabularies’, ontology has thus far played little role in work on standardization. The prime focus has been rather the rapid population of terminologies at (...) the level of fine detail. In this paper, we argue that more efforts are needed on the side of both research and standardization to ensure that the coding systems used in electronic healthcare records enjoy a semantics that is coherent with the semantics of the record. We propose realist ontology as a method to bring about this coherence by means of a robust system of top-level ontological categories. (shrink)

In recent years, the opioid crisis in the United States has sparked significant discussion on doctor–patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when (...) describing chronic pain, narrating symptoms and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions. (shrink)

The article discusses the role and importance of storytelling in the context of creating and maintaining organisational culture in the healthcare sector. Medical institutions are constantly solving complex tasks related to the provision of high-quality medical care and interaction with patients and staff. In this regard, storytelling is an important tool, aimed at strengthening cultural values and adjusting goals. The study examines the nature of organisational culture, its main components and culture, its main components and the peculiarities of (...) its formation and maintenance in medical institutions. Organisational culture affects all aspects of business processes and is an important element of corporate identity, in particular in the healthcare sector. healthcare. The authors determine that storytelling as a communication tool has become an important part of business communication and management in recent decades part of business communication and management practice in recent decades. Storytelling can be used to form common values and create meaningful narratives that promote cultural change and support the organisational organisational identity of healthcare facilities. Stories in healthcare facilities reveal the specifics and uniqueness of the organisation, help to distinguish it from competitors from competitors and create a competitive advantage in the market. They form the organisation’s identity and the loyalty of employees and customers. Storytelling has an impact on on the organisational culture of a medical institution, promotes stability and highlights the unique character of the organisation character of the organisation; it allows to form values, beliefs and needs of of employees based on the institution’s mission. Storytelling is important for understanding medical discourse and the system of narratives in healthcare organisations. It supports or discredits official narratives or discredit them, depending on the perception of stakeholders. It is important that storytelling in healthcare facilities is accessible to all stakeholders and promote internal identification and loyalty to the institution. Thus, storytelling is an essential tool for building and maintaining organisational culture in healthcare facilities, helping to create a unique identity and competitive advantage. The article aims to stimulating discussion of the experience of using storytelling and further research of this important aspect of management in the healthcare sector. of healthcare enterprises. (shrink)

This letter was submitted to the Senate Standing Committee on Legal and Constitutional Affairs, Government of Canada, on 29th January, 2021, as final debate over Bill C-7 was being undertaken in the Senate regarding MAiD and the strong opposition to the legislation expressed across the Canadian disability community. It draws on our individual and joint work on eugenics, well-being, and disability.

Dans le diagnostic du cancer, la précocité du diagnostic est généralement un élément valorisé. Selon la croyance commune, un cancer détecté tôt aura plus de chance d’être traitable. Or, cette conception des avantages du diagnostic précoce mène dans certains cas au phénomène de surdiagnostic, soit le fait de diagnostiquer un cancer à des individus qui n’en ont pas encore un et qui sont potentiellement en voie de le développer. Dans cet article, nous défendrons d’abord que le phénomène de surdiagnostic est (...) lié en majeure partie à notre connaissance grandissante du cancer, et au fait que ces nouvelles connaissances causent des biais dans les processus de dépistage, conduits en vue de trouver un cancer. Afin de remédier à cette problématique, nous tenterons de montrer que le fait de simplement modifier notre approche du cancer et le vocabulaire médical associé permettrait de réduire les cas de surdiagnostics. (shrink)

Much has been written about the ethics of sex selection. This article thoroughly explores the ethical arguments put forth in the literature both for and against non-medical sex selection using sperm sorting. While most of these arguments come from philosophers, feminist scholars, social scientists and members of the healthcare community, they are often echoed in empirical studies that have explored community values. This review is timely because the first efficacious method for sex selection via sperm sorting, MicroSort, is currently (...) in clinical trials and moving closer to FDA approval for marketing in the USA. While the clinical trials are currently focused on the use of MicroSort to avoid X-linked genetic diseases, MicroSort can also be used to satisfy parental preferences. (shrink)

A compilation of 16 papers selected from two UNESCO Bangkok Bioethics Roundtables, with research and policy dialogues from different countries in the region. It includes papers on informed consent, ethics committees, communication, organ transplants, traditional medicines and sex selection.

This study assessed the professional variables of academic staff in African varsities and their readiness to Utilise Internet-Based Channels for Research Communication in an era of Covid-19. Drawing from Maslow’s hierarchy of needs theory, the study was guided by four null hypotheses. The quantitative research method based on the virtual cross-sectional survey design was adopted. A total of 8,591 academics in African universities were the targeted demographic of this study. However, data were collected from a virtual snowball sample of (...) 1,977 respondents (males, N = 1347; females, N = 630) from 24 African countries. A validated electronic survey, with three major aspects, was employed for data collection. The e-survey was released on the Association of African Universities' Telegram forum, which includes 1,622 participants from diverse African nations and regions. Members of the forum, who are all academics, were invited to complete the survey and publish it on their universities' internet-based forums. Coded data were analysed using descriptive and inferential statistics such as the Kruskal Wallis Non-parametric test. The non-parametric test was used because the data failed to meet the normality assumptions required to perform a parametric test. Results indicated, amongst others, that there are considerable variances in staff preparedness to use internet-based channels for research communication based on their educational credentials, educational qualification, rank and areas of research interest. According to the survey, academics with a doctoral degree; grade II lecturers; staff with 3 to 6 years of service; and staff in the medical sciences demonstrated a higher propensity of readiness to use internet-based channels for research communication. Based on these findings key theoretical, practical and research implications are discussed. (shrink)

Health development is faced with a variety of important issues including health status disparities; double burden of disease; quality, equity and affordability of health services; community protection in the field of medicine and food; and clean and healthy life behavior. Methods: The method used in this short communication is descriptive-comparative where we review Safety Culture in Indonesian Health Services in five aspects, namely Health Services for the Poor, nutritional problems that are never complete, Extraordinary Events of Communicable Diseases, Poor (...) health in Disaster areas, and finally the number of health workers still lacking and comparing the problem of Human Resources Health problems in Indonesia according to WHO (2011) and the Indonesian Ministry of Health (2009). Results: The results obtained in this brief communication are that we get new information in the form of problems encountered in Safety Culture in Indonesian Health Services, examples of cases that occur, policies taken by the government in handling them and the results obtained after the implementation of the policy. All of these are reviewed in five aspects. Conclusion: The conclusion we can take in this brief communication is that health problems that occur in Indonesia have not been resolved even though the government has implemented policies related to these problems but has not been resolved to date. (shrink)

Background: Hazardous use of alcohol is a public health problem which accounts for 4.0% of global burden of disease. There are very few studies about alcohol consumption trend among tribal in Bangladesh. We investigated the pattern and trend with reasons for alcohol use in Hill Tract dwellers with the aim to increase the awareness of this problem. Objective: To identify the pattern of alcohol use and its effect among the tribal so that effective measures can be taken to eliminate the (...) social evil. Materials and method: This cross-sectional study was conducted among tribal community of Chittagong Hill Tracts, Rangamati district, Bangladesh between June 2014 to February 2015. Out of 846 people coming in ‘Naniarchor’ and ‘Langadu’ upazila health complexes 716 (84.6%) constituted the study group. The CAGE test was used as a screening test in determining alcohol dependence. Results: The prevalence of alcohol consumption among tribal is 48.9%. Rural areas (65%) are the most vulnerable area. Home-made alcohol (61%) was the most patronized alcoholic beverage. Most of the cases (82%) started alcohol before 30 years of age and 46% participants took alcohol daily. To get pleasure is the commonest factor for taking alcohol (57%). Physical and mental degenerations were found in most of the alcoholic cases (88%). Conclusion: The results of the present study are likely to increase the awareness of the problem in hill areas and help the concerned authorities to shape the requisite alcohol control policies in these regions. (shrink)

Background: Leprosy is a chronic granulomatous infectious disease having major burden on humans over thousands of years. If untreated, it results in permanent damage to various systems and organs. So we designed this study to evaluate the neurological complications in early stage in adult leprosy patients. Objective: The aim of this study was to find out the pattern of neurological manifestations among adult leprosy patients. Materials and Methods: This cross-sectional hospital-based study on 85 adult tribal leprosy patients was conducted in (...) a district level health care facility from January to December 2014 using simple, direct, standardized questionnaire including history and neurological examinations. Results: The commonest age group affected was 18–30 years (62.4%). Male group was predominant (68.2%). Majority cases (66%) had multibacillary leprosy. At first visit 72.7% cases with neurological findings could not be diagnosed correctly by primary health care personnel. More than six months were required for correct diagnosis in 61.2% cases. Numbness was the commonest (74.5%) neurological symptom. In upper limb, motor findings were predominant with wasting in 50.9% cases. In lower limb, sensory findings were predominant with stock pattern sensory impairment being the commonest (56.4%). Ulnar nerve was the commonest peripheral nerve to enlarge with tenderness. Facial nerve was the commonest cranial nerve involved. All cases with multiple cranial nerves involvement were of multibacillary type. Due to physical disability 92.7% cases lost their jobs. (shrink)

Background: Leprosy is a chronic granulomatous infectious disease having major burden on humans over thousands of years. If untreated, it results in permanent damage to various systems and organs. So we designed this study to evaluate the neurological complications in early stage in adult leprosy patients. Objective: The aim of this study was to find out the pattern of neurological manifestations among adult leprosy patients. Materials and Methods: This cross-sectional hospital-based study on 85 adult tribal leprosy patients was conducted in (...) a district level health care facility from January to December 2014 using simple, direct, standardized questionnaire including history and neurological examinations. Results: The commonest age group affected was 18–30 years (62.4%). Male group was predominant (68.2%). Majority cases (66%) had multibacillary leprosy. At first visit 72.7% cases with neurological findings could not be diagnosed correctly by primary health care personnel. More than six months were required for correct diagnosis in 61.2% cases. Numbness was the commonest (74.5%) neurological symptom. In upper limb, motor findings were predominant with wasting in 50.9% cases. In lower limb, sensory findings were predominant with stock pattern sensory impairment being the commonest (56.4%). Ulnar nerve was the commonest peripheral nerve to enlarge with tenderness. Facial nerve was the commonest cranial nerve involved. All cases with multiple cranial nerves involvement were of multibacillary type. Due to physical disability 92.7% cases lost their jobs. Conclusion: In this study neurological involvement was found associated with severe disability. ! (shrink)

Pragmatic presupposition is analyzed in this paper as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for making a presupposition can be represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely as the conclusion of an underlying presumptive reasoning that does not or may not contain contradictions with other presumptions, including the ordering of the hierarchy of presumptions. Presumptions are in turn (...) analyzed considering their nature and their hierarchy, namely their object and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between communicative infelicities or misunderstandings deriving from presuppositional failures and the underlying system of presumptions and presumptive reasoning. This approach can be applied to the investigation of communicative problems within the medical context, and more precisely the communication in diabetes cases. (shrink)

Thirty years after the rise of the evidence-based medicine (EBM) movement, formal training in philosophy remains poorly represented among medical students and their educators. In this paper, I argue that EBM’s reception in this context has resulted in a privileging of empiricism over rationalism in clinical reasoning with unintended consequences for medical practice. After a limited review of the history of medical epistemology, I argue that a solution to this problem can be found in the method of (...) the 2nd-century Roman physician Galen, who brought empiricism and rationalism together in a synthesis anticipating the scientific method. Next, I review several of the problems that have been identified as resulting from a staunch commitment to empiricism in medical practice. Finally, I conclude that greater epistemological awareness in the medical community would precipitate a Galenic shift toward a more epistemically balanced, scientific approach to clinical research. (shrink)

The historical relationship between health care professionals and people with disabilities is fraught, a fact all the more troubling in light of the distinctive roles clinicians play in both establishing and responding to that which is considered normal or abnormal by society at large. Those who wish to improve their clinical practice might struggle, however, to keep up with developments across numerous disability communities as well as the ever-growing body of disability studies scholarship. To assist with this goal, I offer (...) an overview of recent disability theory, outline a set of responsibilities clinicians have to disability communities, and provide recommendations for clinicians who hope to justly treat patients with disabilities and improve their care and health outcomes. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, (...) by bringing medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of (...) psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the (...) current way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

his article develops a set of recommendations for the psychiatric and medical community in the treatment of mental disorders in response to the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, DSM-5. We focus primarily on the limitations of the DSM-5 in its individuation of Complicated Grief, which can be diagnosed as Major Depression under its new criteria, and Post-Traumatic Stress Disorder (PTSD). We argue that the hyponarrativity of the descriptions of these (...) disorders in the DSM-5, defined as the abstraction of the illness categories from the particular life contingencies and personal identity of the patient (e.g., age, race, gender, socio-economic status), constrains the DSM-5's usefulness in the development of psychotherapeutic approaches in the treatment of mental disorders. While the DSM-5 is useful in some scientific and administrative contexts, the DSM's hyponarrativity is problematic, we argue, given that the DSMs are designed to be useful guides for not only scientific research, but also for the education of medical practitioners and for treatment development. our goal therefore is to offer suggestions for mental health practitioners in using the DSM-5, so that they can avoid or eliminate the problems that may stem from the limitations of hyponarrativity. When such problems are eliminated, we believe that effective psychotherapeutic strategies can be developed, which would be successful in repairing the very relationships that are strained in mental disorder: the patient's relationship to herself, her physical environment, and her social environment. (shrink)

In 1959 two French neurologists, Pierre Mollaret and Maurice Goullon, coined the term coma dépassé to designate a state beyond coma. In this state, patients are not only permanently unconscious; they lack the endogenous drive to breathe, as well as brainstem reflexes, indicating that most of their brain has ceased to function. Although legally recognized in many countries as a criterion for death, brain death has not been universally accepted by bioethicists, by the medical community, or by the public. (...) I this paper, I defend brain death as a biological concept. I challenge two assumptions in the brain death literature that have shaped the debate and have stood in the way of an argument for brain death as biological. First, I challenge the dualism established in the debate between the body and the brain. Second, I contest the emphasis on consciousness, which prevents the inclusion of psychological phenomena into a biological criterion of death. I propose that the term organism should apply both to the functioning of the body and the brain. I argue that the cessation of the organism as a whole should take into account three elements of integrated function. Those three elements are: 1) the loss of integrated bodily function; 2) the loss of psychophysical integration required for processing of external stimuli and those required for behavior; and, 3) the loss of integrated psychological function, such as memory, learning, attention, and so forth. The loss of those three elements of integrated function is death. (shrink)

The collaboration of Language and Computing nv (L&C) and the Institute for Formal Ontology and Medical Information Science (IFOMIS) is guided by the hypothesis that quality constraints on ontologies for software ap-plication purposes closely parallel the constraints salient to the design of sound philosophical theories. The extent of this parallel has been poorly appreciated in the informatics community, and it turns out that importing the benefits of phi-losophical insight and methodology into application domains yields a variety of improvements. L&C’s (...) LinKBase® is one of the world’s largest medical domain ontologies. Its current primary use pertains to natural language processing ap-plications, but it also supports intelligent navigation through a range of struc-tured medical and bioinformatics information resources, such as SNOMED-CT, Swiss-Prot, and the Gene Ontology (GO). In this report we discuss how and why philosophical methods improve both the internal coherence of LinKBase®, and its capacity to serve as a translation hub, improving the interoperability of the ontologies through which it navigates. (shrink)

Despite being assailed for decades by disability activists and disability studies scholars spanning the humanities and social sciences, the medical model of disability—which conceptualizes disability as an individual tragedy or misfortune due to genetic or environmental insult—still today structures many cases of patient–practitioner communication. Synthesizing and recasting work done across critical disability studies and philosophy of disability, I argue that the reason the medical model of disability remains so gallingly entrenched is due to what I call the (...) “ableist conflation” of disability with pain and suffering. In an effort to better equip healthcare practitioners and those invested in health communication to challenge disability stigma, discrimination, and oppression, I lay out the logic of the ableist conflation and interrogate examples of its use. I argue that insofar as the semiosis of pain and suffering is structured by the lived experience of unwelcome bodily transition or variation, experiences of pain inform the ableist conflation by preemptively tying such variability and its attendant disequilibrium to disability. I conclude by discussing how philosophy of disability and critical disability studies might better inform health communication concerning disability, offering a number of conceptual distinctions toward that end. (shrink)

Douglas Walton’s work is extremely vast, multifaceted, and interdisciplinary. He developed theoretical proposals that have been used in disciplines that are not traditionally related to philosophy, such as law, education, discourse analysis, artificial intelligence, or medical communication. Through his papers and books, Walton redefined the boundaries not only of argumentation theory, but also logic and philosophy. He was a philosopher in the sense that his interest was developing theoretical models that can help explain reality, and more importantly interact (...) with it. For this reason, he proposed methods that have been used for analyzing different types of dialogical interactions, and modeling procedures for regulating them. (shrink)

In accordance with the critical women’s health literature recounting the ways that women are encouraged to submit themselves to various sorts of health “imperatives”, I investigate the messages tacitly conveyed to women in “campaigns for the cure” and breast cancer awareness efforts, which, I argue, overemphasizes a “positive attitude”, healthy lifestyle, and cure rather than prevention of this life-threatening disease. I challenge that the message of hope pervading breast cancer discourse silences the despair felt by many women, furthers a tacit (...) blaming for disease infliction via a rhetoric of personal responsibility, underemphasizes other cogent health determinants like environmental toxicity, and undermines legitimate critiques of current biomedical practices like widespread mammography. While finding a cure for breast cancer is a laudable and worthwhile healthcare goal that can understandably be shared by women’s health activists, corporate sponsors, and the medical community, this paper resists the current formation of campaigns for the cure and “pink ribbon activism” in general. (shrink)

Medical students commonly learn how to administer pelvic exams by practicing on unconscious patients, often without first obtaining explicit consent from patients to do so. While twenty-one states currently have laws that require teaching hospitals to obtain consent from patients to participate in this educational experience, opposition from the medical community has stymied legislative progress. In this paper, I respond to the two most common reasons offered to oppose legislation, which appeal to (1) the educational benefits of these (...) exams, or (2) protecting institutional autonomy. Kantian ideas about autonomy help to illuminate the problematic ways in which these arguments supplant the importance of women’s choices over how their bodies are used while seeking medical treatment. Ultimately, neither argument offers sufficient reason to oppose laws that require explicit consent before administering training pelvic exams. (shrink)

Psychedelics are currently being studied intensively for the treatment of various psychiatric disorders. Ayahuasca, a plant-based extract originating from the Amazonian area, is traditionally consumed in ritualistic group events. The related indigenous traditions date back hundreds of years and have amassed vast amounts of knowledge on the therapeutic use of psychedelic and non-psychedelic plant-based substances. -/- These traditions require a prospective ceremony facilitator to undergo years of intensive training to acquire knowledge, mental power or self-confidence, stability, sensitivity, intuitive treatment outcome (...) prediction skills, musical skills, and sufficient physical strength. These qualities of a facilitator, in the presence of integrity and love, largely determine treatment outcomes. -/- In Europe, predominantly in the first decade of the 2000s and in the early 2010s, some individuals began building connections with diverse indigenous groups and syncretic churches of the Amazonia in an attempt to find cures for their treatment-resistant psychiatric conditions. Small circles of other patients in need of similar treatment formed around them. This led to the formation of decentralized, diverse local ceremony cultures that either followed the principles of the traditional lineages of their origin or synthesized various influences. -/- These unofficial ceremony contexts appeared to complement official healthcare systems, offering efficient methods unavailable in the medical context and correcting the consequences of medical malpractice and neglect. These ceremony contexts appeared highly communal, were largely based on volunteering, and contained mechanisms for self-correcting possible emerging issues. They seemed to function as systems for collecting, preserving, storing, and distributing knowledge of psychedelic therapy methods; in other words, systems for knowledge base building and innovation. -/- doi: 10.13140/RG.2.2.27385.85602. (shrink)

The advance of scientific approaches to life has recorded a plethora of successes as well as failures. Man being at the center of its experiment is tossed toe and fro by the result of its inquiry. Predictions are that in the nearest time, humanity might be living absolutely under the directives of Technology based on Artificial intelligence. At present, Technology based on Artificial Intelligence is quickly finding its way into various areas of life including health and social services. This spread (...) and or interplay connotes the relinquishing of health responsibilities from man to sensor technology as well as dependency on the data and result of this technology. This effort questions this unethical dependency as well as raises moral issues associated with the use of Technology base on artificial intelligence on psychiatric patient. It dabbles into medical values such as; autonomy of the patient cum consent, Kantian universal principle and its implication to implementing the universal usage of technology in mental health care services, and so on. The work of Patricia A. Arean (2016) titled Mobile Technology for Mental Health Assessment gave an in-depth analysis of the available approaches, doting advantages of sensor technology on psychiatric patient. The paper applied the analytic, descriptive and prescriptive method of philosophy to achieve its objective. To this end, it is in the view of this work imperative for the mental-medical community to consider reflectively these issues and the philosophic recommendations provided herein. (shrink)

This article is in a larger textbook of articles on Medical Ethics. It identifies a number of values that underlie professional commitments to confidentiality that are involved in protecting or promoting the client's (1) privacy, (2)social status, (3) economic advantages, (4) openness of communications, (5) seeking professional help, (6) trust in professionals, (7) autonomous control over personal information. The problem of making exceptions to confidentiality commitments is also examined.

As the Zika virus pandemic continues to bring worry and fear to health officials and medical scientists, Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have recommended that residents of the Zika-infected countries, e.g., Brazil, and those who have traveled to the area should delay having babies which may involve artificial contraceptive, particularly condom. This preventive policy, however, is seemingly at odds with the Roman Catholic Church’s position on the contraceptive. As least since the promulgation (...) of Paul VI’s 1968 encyclical, Humanae Vitae, the Church has explicitly condemned artificial birth control as intrinsic evil. However, the current pontiff, Pope Francis, during his recent visit to Latin America, remarked that the use of artificial contraception may not be in contradiction to the teaching of Humanae Vitae while drawing a parallel between the current Zika Crisis and the 1960’s Belgian Congo Nun Controversy. The pope mentioned that the traditional ethical principle of the lesser of two evils may be the doctrine that justified the exceptions. The authors of this paper attempt to expand the theological rationale of the pope’s suggestion. In so doing, the authors rely on casuistical reasoning as an analytic tool that compares the Belgian Congo Nun case and the given Zika case, and suggest that the former is highly similar to, if not the same as, the latter in terms of normative moral feature. That is, in both cases the use of artificial contraception is theologically justified in reference to the criteria that the doctrine of the lesser of two evils requires. The authors wish that the paper would provide a solid theological-ethical ground based on which condom-use as the most immediate and effective preventive measure can be recommended in numerous Catholic hospitals as well as among Catholic communities in the world, particularly the most Zika-affected and largest Catholic community in the world, Brazil – 123 million present Brazilian citizens are reported to be Roman Catholic. (shrink)

Homeopathic medications are used by millions, and hundreds of millions of dollars are spent on these remedies in the USA alone. In the UK, the NHS covers homeopathic treatments. Nonetheless, homeopathy is held in considerable disrepute by much of the medical and scientific community.Many proponents of homeopathy are well aware of these criticisms but remain unimpressed. The differences of opinion run deep, and the debate seems deadlocked. We aim to shed some light on this situation. We briefly recap some (...) of the major arguments on each side, but we try to go further by making explicit an underlying philosophical presupposition. In particular, we will claim that there is an important principle, which has ancient roots going back at least to Occam, some version of which constrains all empirical reasoning.We call this constraint the simplicity principle.We argue that this is not something specific to a scientific paradigm, but that, all of us, including proponents of homeopathy, are themselves deeply committed to the simplicity principle. However, once the simplicity principle is made explicit and applied to homeopathy, allegiance to homeopathy is clearly seen as irrational. The point is not merely the lack of clinical trials supporting homeopathy; rather, belief in the efficacy of homeopathy leaves a mountain of unexplained mysteries, and thereby flies in the face of the simplicity rule that guides the homeopaths’ own reasoning and arguments. If nothing else, we hope that defenders of homeopathy will gain a greater understanding of why critics are so deeply reluctant to accept the efficacy of homeopathic interventions – and that this reluctance is not mere stubbornness or artificial allegiance to western medicine. Finally, we also hope thereby to illustrate the usefulness of philosophy in unearthing presuppositions in seemingly deadlocked debates. (shrink)

A medical intervention is a medical procedure or application intended to relieve or prevent illness or injury. Examples of medical interventions include vaccination and drug administration. After a medical intervention, adverse events (AEs) may occur which lie outside the intended consequences of the intervention. The representation and analysis of AEs are critical to the improvement of public health. Description: The Ontology of Adverse Events (OAE), previously named Adverse Event Ontology (AEO), is a community-driven ontology developed to (...) standardize and integrate data relating to AEs arising subsequent to medical interventions, as well as to support computer-assisted reasoning. OAE has over 3,000 terms with unique identifiers, including terms imported from existing ontologies and more than 1,800 OAE-specific terms. In OAE, the term ‘adverse event’ denotes a pathological bodily process in a patient that occurs after a medical intervention. Causal adverse events are defined by OAE as those events that are causal consequences of a medical intervention. OAE represents various adverse events based on patient anatomic regions and clinical outcomes, including symptoms, signs, and abnormal processes. OAE has been used in the analysis of several different sorts of vaccine and drug adverse event data. (shrink)

The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors (...) indicate different circumstances as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice. (shrink)

We introduce the Vital Sign Ontology (VSO), an extension of the Ontology for General Medical Science (OGMS) that covers the consensus human vital signs: blood pressure, body temperature, respiratory rate, and pulse rate. VSO provides a controlled structured vocabulary for describing vital sign measurement data, the processes of measuring vital signs, and the anatomical entities participating in such measurements. VSO is implemented in OWL-DL and follows OBO Foundry guidelines and best practices. If properly developed and extended, we believe the (...) VSO will find applications for the EMR, clinical informatics, and medical device communities. (shrink)