Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

As the aim of the responsible robotics initiative is to ensure that responsible practices are inculcated within each stage of design, development and use, this impetus is undergirded by the alignment of ethical and legal considerations towards socially beneficial ends. While every effort should be expended to ensure that issues of responsibility are addressed at each stage of technological progression, irresponsibility is inherent within the nature of robotics technologies from a theoretical perspective that threatens to thwart the endeavour. This is (...) because the concept of responsibility, despite being treated as such, is not monolithic: rather this seemingly unified concept consists of converging and confluent concepts that shape the idea of what we colloquially call responsibility. From a different perspective, robotics will be simultaneously responsible and irresponsible depending on the particular concept of responsibility that is foregrounded: an observation that cuts against the grain of the drive towards responsible robotics. This problem is further compounded by responsible design and development as contrasted to responsible use. From a different perspective, the difficulty in defining the concept of responsibility in robotics is because human responsibility is the main frame of reference. Robotic systems are increasingly expected to achieve the human-level performance, including the capacities associated with responsibility and other criteria which are necessary to act responsibly. This subsists within a larger phenomenon where the difference between humans and non-humans, be it animals or artificial systems, appears to be increasingly blurred, thereby disrupting orthodox understandings of responsibility. This paper seeks to supplement the responsible robotics impulse by proposing a complementary set of human rights directed specifically against the harms arising from robotic and artificial intelligence technologies. The relationship between responsibilities of the agent and the rights of the patient suggest that a rights regime is the other side of responsibility coin. The major distinction of this approach is to invert the power relationship: while human agents are perceived to control robotic patients, the prospect for this to become reversed is beginning. As robotic technologies become ever more sophisticated, and even genuinely complex, asserting human rights directly against robotic harms become increasingly important. Such an approach includes not only developing human rights that ‘protect’ humans but also ‘strengthen’ people against the challenges introduced by robotics and AI [This distinction parallels Berlin’s negative and positive concepts of liberty ], by emphasising the social and reflective character of the notion of humanness as well as the difference between the human and nonhuman. This will allow using the human frame of reference as constitutive of, rather than only subject to, the robotic and AI technologies, where it is human and not technology characteristics that shape the human rights framework in the first place. (shrink)

Aim Excellent organization of the internal processes is essential for a well-functioning health care system. Particularly, the process of treatment and interaction with the patients is important because the perception of treatment and interaction has a direct relation to the patients’ satisfaction. The latter has a strong influence on the recovery of the patients. The impact of the maturity level of the treatment and interaction process on patient orientation is investigated at the example of an extensive survey of (...) hospital managers in Ukraine. -/- Method The analysis is based on an empirical data collection conducted with hospital managers and their deputies in a large Ukrainian city, which is acknowledged as a ‘model city’ with regard to a comprehensive health care reform in the country. By means of the Business Process Maturity Model (BPMM) we have tested our hypothesis that a high level of process maturity leads to a high level of patient orientation. For this purpose, we have developed a scale for measuring the level of process maturity and have checked the method on validity and reliability. A total of 79 hospital managers and deputies, who represent all public health care facilities of the city (hospitals, primary care clinics, etc.), participated in the study. -/- Results The study reveals a clear relationship between the level of maturity of the treatment and interaction process and the level of patient orientation of the respective health care facility. The variance, which is explained by the independent variable process maturity level, is 16.3 %. All formative dimensions have a strong significant influence on the construct “patient orientation”. Likewise the maturity level of the treatment and interaction process shows a strong significant influence on patient orientation. -/- Conclusion For health care facilities it is of great importance to achieve a high maturity level of the treatment and interaction process to live up to the claim of being patient oriented. The maturity of the process can be tested using the questionnaire developed in the course of our study. (shrink)

Moral reasoning traditionally distinguishes two types of evil:moral (ME) and natural (NE). The standard view is that ME is the product of human agency and so includes phenomena such as war,torture and psychological cruelty; that NE is the product of nonhuman agency, and so includes natural disasters such as earthquakes, floods, disease and famine; and finally, that more complex cases are appropriately analysed as a combination of ME and NE. Recently, as a result of developments in autonomous agents in cyberspace, (...) a new class of interesting and important examples of hybrid evil has come to light. In this paper, it is called artificial evil (AE) and a case is made for considering it to complement ME and NE to produce a more adequate taxonomy. By isolating the features that have led to the appearance of AE, cyberspace is characterised as a self-contained environment that forms the essential component in any foundation of the emerging field of Computer Ethics (CE). It is argued that this goes someway towards providing a methodological explanation of why cyberspace is central to so many of CE's concerns; and it is shown how notions of good and evil can be formulated in cyberspace. Of considerable interest is how the propensity for an agent's action to be morally good or evil can be determined even in the absence of biologically sentient participants and thus allows artificial agents not only to perpetrate evil (and fort that matter good) but conversely to `receive' or `suffer from' it. The thesis defended is that the notion of entropy structure, which encapsulates human value judgement concerning cyberspace in a formal mathematical definition, is sufficient to achieve this purpose and, moreover, that the concept of AE can be determined formally, by mathematical methods. A consequence of this approach is that the debate on whether CE should be considered unique, and hence developed as a Macroethics, may be viewed, constructively,in an alternative manner. The case is made that whilst CE issues are not uncontroversially unique, they are sufficiently novel to render inadequate the approach of standard Macroethics such as Utilitarianism and Deontologism and hence to prompt the search for a robust ethical theory that can deal with them successfully. The name Information Ethics (IE) is proposed for that theory. Itis argued that the uniqueness of IE is justified by its being non-biologically biased and patient-oriented: IE is an Environmental Macroethics based on the concept of data entity rather than life. It follows that the novelty of CE issues such as AE can be appreciated properly because IE provides a new perspective (though not vice versa). In light of the discussion provided in this paper, it is concluded that Computer Ethics is worthy of independent study because it requires its own application-specific knowledge and is capable of supporting a methodological foundation, Information Ethics. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

Moral reasoning traditionally distinguishes two types of evil: moral and natural. The standard view is that ME is the product of human agency and so includes phenomena such as war, torture and psychological cruelty; that NE is the product of nonhuman agency, and so includes natural disasters such as earthquakes, floods, disease and famine; and finally, that more complex cases are appropriately analysed as a combination of ME and NE. Recently, as a result of developments in autonomous agents in cyberspace, (...) a new class of interesting and important examples of hybrid evil has come to light. In this paper, it is called artificial evil and a case is made for considering it to complement ME and NE to produce a more adequate taxonomy. By isolating the features that have led to the appearance of AE, cyberspace is characterised as a self-contained environment that forms the essential component in any foundation of the emerging field of Computer Ethics. It is argued that this goes some way towards providing a methodological explanation of why cyberspace is central to so many of CE’s concerns; and it is shown how notions of good and evil can be formulated in cyberspace. Of considerable interest is how the propensity for an agent’s action to be morally good or evil can be determined even in the absence of biologically sentient participants and thus allows artificial agents not only to perpetrate evil but conversely to ‘receive’ or ‘suffer from’ it. The thesis defended is that the notion of entropy structure, which encapsulates human value judgement concerning cyberspace in a formal mathematical definition, is sufficient to achieve this purpose and, moreover, that the concept of AE can be determined formally, by mathematical methods. A consequence of this approach is that the debate on whether CE should be considered unique, and hence developed as a Macroethics, may be viewed, constructively, in an alternative manner. The case is made that whilst CE issues are not uncontroversially unique, they are sufficiently novel to render inadequate the approach of standard Macroethics such as Utilitarianism and Deontologism and hence to prompt the search for a robust ethical theory that can deal with them successfully. The name Information Ethics is proposed for that theory. It is argued that the uniqueness of IE is justified by its being non-biologically biased and patient-oriented: IE is an Environmental Macroethics based on the concept of data entity rather than life. It follows that the novelty of CE issues such as AE can be appreciated properly because IE provides a new perspective. In light of the discussion provided in this paper, it is concluded that Computer Ethics is worthy of independent study because it requires its own application-specific knowledge and is capable of supporting a methodological foundation, Information Ethics. (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that (...) this inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

Models of discourse and narration elaborated within the classical compositional framework have been characterized as bottom-up models, according to which discourse analysis proceeds incrementally, from phrase and sentence local meaning to discourse global meaning. In this paper we will argue against these models. Assuming as a case study the issue of discourse coherence, we suggest that the assessment of coherence is a top-down process, in which the construction of a situational interpretation at the global meaning level guides local meaning analysis. (...) In support of our hypothesis, we explore the role of executive functions (brain functions involved in planning and organization of goal-oriented behaviors) in coherence’s establishment, discussing the results of several studies on narrative abilities of patients with brain injuries. We suggest that, compared to other models of discourse processing focused on comprehension, our model is a viable candidate for an integrated account of discourse comprehension and production. (shrink)

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps (...) to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public (...) views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider (...) whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a (...) number of professional medical societies and organizations as a means for orienting the development of clinical guidelines. As a result, the method of GRADE has implications on how health care is delivered and patient outcomes. In this paper, we reveal several issues with the underlying logic of GRADE that warrant further discussion. First, the definitions of the “grades of evidence” provided by GRADE, while explicit, are functionally vague. Second, the “criteria for assigning grade of evidence” is seemingly arbitrary and arguably logically incoherent. Finally, the GRADE method is unclear on how to integrate evidence grades with other important factors, such as patient preferences, and trade‐offs between costs, benefits, and harms when proposing a clinical practice recommendation. Much of the GRADE method requires judgement on the part of the user, making it unclear as to how the framework reduces bias in recommendations or makes them more transparent—both goals of the programme. It is our view that the issues presented in this paper undermine GRADE's justificatory scheme, thereby limiting the usefulness of GRADE as a tool for developing clinical recommendations. (shrink)

Abstract - This paper primarily harps on the issue whether the admission of universals (Especially as discussed in this paper resemblance and supervenience) would impose any extra burden on the ontology. In this connection I would like to make a special mention of the fact that metaphysical issues dealt in Philosophy are quite relevant in medical ethics and management speculations or even in marketing. In this paper both the relation of Supervenience and that of Resemblance is dealt which undoubtedly helps (...) in the understanding of properties, the structure or orientation of any programming or theory. So the present paper may be a sure help in prioritization of issues in case of management study or in the removal of any disharmony generated in patients after treatment of an ailment. Keeping this in mind I have tried to analyze the almost known fact that providing an account of sameness of type is the compulsory task for any theory of Universals since unless the question of sameness of type is answered and a philosophical superstructure is unfolded the question of making or arriving at an ontology which is not unduly burdened can at all be addressed. I started with the Realist and the Nominalist. In order to arrive at this position I had first discussed about the positions of the different types of Nominalism. I have also tried to show how realism and the different forms of nominalism have made an attempt to explain the compulsory task of giving an account of sameness of type. I have seriously dealt with a very crucial point of considering resemblance as a relation and supervenience as a relation. Here one thing is stressed on namely that both supervenience and resemblance if and when considered as a dyadic universal which binds two relatas, it works as a property of a pair ( relatas). So it can very well be thought of as gaining a separate status over and above the pair that it unites. The whole discussion on a non-cumbersome ontology thus gains its strength at this point when such extra burden is ruled out by both supervenience and resemblance nominalism theory. I have made an attempt also to show that a burden less ontology can also be achieved if further questions on the issue of similarity being subjective or objective or simply as innate be addressed. (shrink)

In my ethnographic research on death and dying in contemporary Finland, I explore how Finns facing end of life due to a long-term illness or other terminal condition seek to orient themselves and make meaning with cultural tools such as imagery, language, and metaphysical thinking. My primary research material is based on extensive fieldwork at Terhokoti Hospice and in the cancer clinic of Helsinki University Hospital, where I have had numerous conversations with terminally ill patients. This paper seeks to explore (...) the way in which metaphysical aesthetics is assuming the role that religious thinking has traditionally played. When the role of institutional religion is diminishing, it becomes important to understand how emotional and spiritual resolution can be arrived at by means of aesthetics. (shrink)

In this chapter, we explore how themes of existential philosophy have been used to develop a formal orientation of psychotherapy, and we discuss the main principles of existential psychotherapy and their application in practice. We also draw upon case examples to specifically illustrate how the approach of existential psychotherapy is utilized in clinical practice. In the case examples, each patient's identify has been disguised to maintain confidentiality. The new science of meaning, represented by the chapters in this volume, (...) not only offers therapists a deep conceptual framework within which to practice older, more established techniques but should also suggest new approaches. By recognizing the centrality of meaning as sense making and acknowledging the distinction between the what and the why of sense making, therapists should be armed with a variety of epistemic and teleological tools with which to fashion therapy strategies that are unique for each individual. (shrink)

This paper revisits the “Hwang case,” which shook Korean society and the world of stem cell research in 2005 with the fraudulent claim of creating patient-specific embryonic stem cells. My goal is to overcome a human-centered, Korea-oriented narrative, by illustrating how materials can have an integral role in the construction and judgment of fraud. To this end, I pay attention to Woo Suk Hwang’s lab at Seoul National University as a whole, including human and nonhuman agents, that functioned as (...) what I call sociomaterial technology, and Gerald P. Schatten at the University of Pittsburgh, Hwang’s collaborator, who played a crucial role in demonstrating the potency of this technology to the members of the scientific community. By recasting the whole event as the “case of Hwang and Schatten,” I argue that fraud is, like all knowledge claims, a sociotechnical construct, and that matters of fraud are locally judged. Fraud leaves its mark on materials, but I show that material evidence alone never tells the whole story and instead can be used to limit the range of responsibility. (shrink)

Abstract This article proposes and outlines an integrally informed 12 Step-based therapy that is adapted for treating addicted populations. Integrated Recovery Therapy (IRT) as a therapeutic orientation is an Integral Methodological Pluralism to therapy for treating addiction. Its two main features are paradigmatic and meta-paradigmatic. The paradigmatic aspect refers to the recognition, compilation and implementation of various methodologies in a comprehensive and inclusive manner. The meta-paradigmatic aspect refers to IRT’s capacity to weave together, relate and integrate the various paradigmatic (...) practices. IRT is a meta-therapy derived from the Integrated Recovery Model, which is a comprehensive, balanced, multi-phased and multi-disciplinary clinical model designed for in-patient addiction treatment. As with the Integrated Recovery Model, IRT’s philosophy is derived from an integration of the 12-step abstinence-based philosophy, mindfulness, positive psychology, and Integral theory. It is suggested here that the application of IRT as a meta-therapy provides a truly comprehensive and integrated therapeutic orientation for therapists who treat addicted populations. -/- Keywords: Integrated Recovery Therapy, Integrated Recovery model; 12 Steps; mindfulness; Integral theory; positive psycholog. (shrink)

The present article introduces eight empirically-tested concepts that guide the crealectic practice of philosophical counseling: philosophical health, deep listening, the Creal, the possible, imparadisation, deep orientation, eudynamia , and mental heroism. The crealectic framework is grounded on a process-philosophy axiom of absolute possibility and continuous cosmological and cosmopolitical creation, termed "Creal". The approach also posits that there are three complementary modes of intelligence, namely analytic, dialectic, and crealectic, the balance of which is necessary to live a healthy human life. (...) Beyond what is physically possible and psychologically possible, an underestimated force of social and personal deployment is the philosophical possible . In a context of personal counseling and philosophical care, the crealectic approach endeavors to slowly connect the patient to a field of harmonious and generative potentiality termed eudynamia. (shrink)

This article is about an intervention or approach in mental health care that has been developed from hermeneutics, more specifically the hermeneutics of Ricoeur. In this intervention photography is used as a means to assist patients in a process of meaning making from experiences in their life world. It aims at empowerment and strengthening the agency of patients. It does so by facilitating storytelling. Mimesis, as interpreted by Ricoeur, was found to be a central concept with which we could explain (...) the therapeutic working of the approach and legitimize its ethical claims of empowerment and recovery. Another aspect is the concordance between narrative and action, as described by Ricoeur, which has a pendant in the goal orientation of the photography intervention. At the same time demonstrations and experiences from professional practice (nurses applying the intervention) will give us feedback on the theory and enrich it with new insights, e.g. on ‘iconic representation’. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

Is there a choice in sexual orientation? [Wilkerson, William S. : “Is It a Choice? Sexual Orientation as Interpretation”. In: Journal of Social Philosophy 40. No. 1, p. 97–116] argues that sexual desires require interpretation in order to be fully constituted, and therefore sexual orientation is at least partially constituted by choice. [Díaz-León, Esa : “Sexual Orientation as Interpretation? Sexual Desires, Concepts, and Choice”; In: Journal of Social Ontology] critically assesses Wilkerson’s argument, concluding that we still (...) lack a good argument for the claim that choice plays a role in sexual orientation. Here I examine Díaz-León’s response to Wilkerson. I introduce what I call the conceptual act theory of sexual orientation, and argue that even if interpretation were not necessary to constitute sexual desires, it is a necessary element to constitute what we call sexual orientation. However, I conclude that even if we agree that interpretation is involved in sexual orientation, it does not follow that there is a choice involved. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and (...) Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

Here, I examine the epistemic relation between beliefs about the nature of sexual orientation (e.g., beliefs concerning whether orientation is dispositional) and beliefs about the taxonomy of orientation categories (e.g., beliefs concerning whether polyamorous is an orientation category). Current philosophical research gives epistemic priority to the former class of beliefs, such that beliefs about the taxonomy of orientation categories tend to be jettisoned or revised in cases of conflict with beliefs about the nature of sexual (...) orientation. Yet, considering the influence of ideology on beliefs about socially significant phenomena, I argue for an epistemic reversal. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices (...) are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

It is common to distinguish moral rules, reasons, or values that are agent-relative from those that are agent-neutral. One can also distinguish moral rules, reasons, or values that are moment-relative from those that are moment-neutral. In this article, I introduce a third distinction that stands alongside these two distinctions—the distinction between moral rules, reasons, or values that are patient-relative and those that are patient-neutral. I then show how patient-relativity plays an important role in several moral theories, gives (...) us a better understanding of agent-relativity and moment-relativity, and provides a novel objection to Derek Parfit’s “appeal to full relativity” argument. (shrink)

Abstract: When I throw a ball at you, do you see it as catch-able? Do we perceive objects as edible, climbable or Q-able in general? One could argue that it is just a manner of speaking to say so: we do not really see an object as edible, we only infer on the basis of its other properties that it is. I argue that whether or not an object is edible or climbable is indeed represented perceptually: we see objects as (...) edible, and do not just believe that they are. My argument proceeds in two steps. First, I argue that in order to perform an action Q with respect to an object, we need to represent this object as Q-able and, second, I argue that we represent objects as having these properties perceptually. (shrink)

Recently, Jardas _et al_ have convincingly defended the patient preference predictor (PPP) against a range of autonomy-based objections. In this response, I propose a new autonomy-based objection to the PPP that is not explicitly discussed by Jardas _et al_. I call it the ‘objection from higher-order preferences’. Even if this objection is not sufficient reason to reject the PPP, the objection constitutes a pro tanto reason that is at least as powerful as the ones discussed by Jardas _et al._.

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, (...) and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

On my interpretation of Kant, feeling plays a central role in the mind: it has the distinct function of tracking and evaluating our activity in relation to ourselves and the world so as to orient us. In this article, I set out to defend this view against a number of objections raised by Melissa Merritt and Uri Eran. I conclude with some reflections on the fact that, despite being very different, Merritt and Eran’s respective views of Kantian feelings turn out (...) to have something potentially problematic in common: they blur the boundary between feelings and other kinds of mental states. (shrink)

While situation theory and situation semantics provide an appropriate framework for a realistic model-theoretic treatment of natural language, serious thinking on their 'computational' aspects has only recently started. Existing proposals mainly offer a Prolog- or Lisp-like programming environment with varying degrees of divergence from the ontology of situation theory. In this paper, we introduce a computational medium (called BABY-SIT) based on situations. The primary motivation underlying BABY-SIT is to facilitate the development and testing of programs in domains ranging from linguistics (...) to artificial intelligence in a unified framework built upon situation-theoretic constructs. (shrink)

A number of bioethicists have been critical of the power of the family to “veto” a patient’s decision to posthumously donate her organs within opt-in systems of organ procurement. One major objection directed at the family veto is that when families veto the decision of their deceased family member, they do something wrong by violating or failing to respect the autonomy of that deceased family member. The goal of this paper is to make progress on answering this objection. I (...) do this in two stages. First, I argue that the most plausible interpretation of what happens when a person registers as an organ donor in an opt-in system is that she gives her consent to the state to posthumously remove her organs for transplantation purposes. Call this the Authorization Account. Second, given the Authorization Account, I argue by analogy that when families veto an individual’s decision to donate and the individual’s organs are not in the end removed, neither the doctors nor the family violate the individual’s autonomy in any morally objectionable sense. Call this the Nonremoval Thesis. I argue that since the Nonremoval Thesis is true, we do not violate or fail to respect the autonomy of registered donors when we fail to remove their organs because their family has objected. (shrink)

Alix Cohen argues that the function of feeling in Kantian psychology is to appraise and orient activity. Thus she sees feeling and agency as importantly connected by Kant’s lights. I endorse this broader claim, but argue that feeling, on her account, cannot do the work of orientation that she assigns to it.

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach to characterize person-centered care (...) as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for (...) rational choice in alignment with one's values and goals). (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal (...) should be respected. (shrink)

Abstract:When I throw a ball at you, do you see it as catch‐able? Do we perceive objects as edible, climbable or Q‐able in general? One could argue that it is just a manner of speaking to say so: we do not reallyseean object as edible, we only infer on the basis of its other properties that it is. I argue that whether or not an object is edible or climbable is indeed represented perceptually: weseeobjects as edible, and do not just (...) believe that they are. My argument proceeds in two steps. First, I argue that in order to perform an action Q with respect to an object, we need to represent this object as Q‐able and, second, I argue that we represent objects as having these propertiesperceptually. (shrink)

This paper is focused on the possibility of a dialogue between Object-Oriented Ontology (OOO) and phenomenology, a dialogue concerning the problem of objects and relations. In the first part, the author shows what is interesting in OOO from a phenomenological perspective and why it should be considered as a challenge for contemporary philosophy. The second part develops the phenomenological perspective of the author, a perspective based on Merleau-Ponty’s “carnal” phenomenology, as well as some suggestions coming from the Italian school of (...) Gaetano Kanizsa. The third part is dedicated to the objections of the author to the OOO view regarding the separation between objects and relations: a separation which leads to Harman’s quadruple object. In the concluding portion, the author shows that, despite evident differences between phenomenological and OOO’s views of relations, OOO offers new starting points for phenomenological reflections, thanks to its specific focus on objects and its pluralistic view of reality. (shrink)

The sex/gender distinction is a staple of feminist philosophy. In slogan form: sex is “natural,” while gender is the “social meaning” of sex. Considering the importance of the sex/gender distinction—which, here, I neither endorse nor reject—it’s interesting to ask if philosophers working on the metaphysics of sexuality might make use of an analogous distinction. In this paper, I argue that we ought to endorse the sexual orientation/identity distinction. In particular, I argue that the orientation/identity distinction is indispensable to (...) normative explanations regarding LGBTQIA+ oppression and resistance. As a case study, I consider the oppression involved in the gentrification of historic queer neighborhoods. (shrink)

Patient-funded trials are gaining traction as a means of accelerating clinical translation. However, such trials sidestep mechanisms that promote rigor, relevance, efficiency, and fairness. We recommend that funding bodies or research institutions establish mechanisms for merit review of patient-funded trials, and we offer some basic criteria for evaluating PFT protocols.

With the ageing of the Portuguese population, there are more people in dependency situations and needing long-term care (LTC). In this context, it is important to ensure the quality of life (QoL) of those individuals, and that quality can be measured through their health-related quality of life (HRQoL) and overall well-being. Also, understanding how perceived service quality (PSQ) can be related to how people perceive their QoL is pertinent since service quality is an important factor to achieve patient health (...) outcomes. To develop this project, a LTC unit located in the district of Lisbon was chosen, the LTC unit of Arruda dos Vinhos. The main objective was to assess the relation between the PSQ, the HRQoL and the overall well-being of patients receiving LTC at the LTC unit of Arruda dos Vinhos. A project based on a case study was performed, through interviews based on the items of the SERVPERF, EQ-5D and ICECAP-O questionnaires, which were then analysed through content analysis. Results showed there is a relation between PSQ and HRQoL and between HRQoL and overall well-being. It was also possible to realise that to better evaluate the quality of this specific service, other subjects as the activities performed at the LTC unit, the physiotherapy service and the food provided, should be taken in consideration. Concluding, there is a relation between PSQ and the QoL of the patients receiving LTC at the LTC unit of Arruda dos Vinhos, when quality of life is measured through HRQoL. (shrink)

In order to determine whether current (or future) machines have a welfare that we as agents ought to take into account in our moral deliberations, we must determine which capacities give rise to interests and whether current machines have those capacities. After developing an account of moral patiency, I argue that current machines should be treated as mere machines. That is, current machines should be treated as if they lack those capacities that would give rise to psychological interests. Therefore, they (...) are moral patients only if they have non-psychological interests. I then provide an account of what I call teleo interests that constitute the most plausible type of non-psychological interest that a being might have. I then argue that even if current machines have teleo interests, they are such that agents need not concern themselves with these interests. Therefore, for all intents and purposes, current machines are not moral patients. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, (...) and health policy discuss if age should guide rationing decisions. (shrink)

Except in extraordinary circumstances, patients' clinical care should reflect their preferences. Incapacitated patients cannot report their preferences. This is a problem. Extant solutions to the problem are inadequate: surrogates are unreliable, and advance directives are uncommon. In response, some authors have suggested developing algorithmic "patient preference predictors" (PPPs) to inform care for incapacitated patients. In a recent paper, Earp et al. propose a new twist on PPPs. Earp et al. suggest we personalize PPPs using modern machine learning (ML) techniques. (...) In this paper, I argue that, contrary to Earp et al.'s claim, personalized patient preference predictors are neither technically feasible nor ethically desirable. (shrink)

Issues concerning the spatial orientation of pictures play an important, though previously neglected, role in an adequate understanding of the nature and identity of visual artworks and other pictures. Using a previous contrast ('Artworks Versus Designs', BJA Vol. 41, No. 4, October 2001), I show that differing orientations of a design naturally give rise to distinct pictures, which may be appropriated as distinct artworks by a discerning artist--which also shows that such artworks cannot be types, since they share a (...) common token. The investigation also raises some significant issues concerning artistic printmaking, and strongly suggests in addition that two new concepts of interpretation--of identifying and constitutive interpretation--are required to adequately explain the artistic phenomena that are uncovered. (shrink)

Ordinary discourse is filled with discussions about ‘sexual orientation’. This discourse might suggest a common understanding of what sexual orientation is. But even a cursory search turns up vastly differing, conflicting, and sometimes ethically troubling characterizations of sexual orientation. The conceptual jumble surrounding sexual orientation suggests that the topic is overripe for philosophical exploration. This paper lays the groundwork for such an exploration. In it, I offer an account of sexual orientation – called ‘Bidimensional Dispositionalism’ (...) – according to which sexual orientation concerns what sex[es] and gender[s] of persons one is disposed to sexually engage, and makes no reference to one’s own sex and gender. (shrink)

According to a recent account of epistemic authority proposed by Linda Zagzebski (2012), it is rational for laypersons to believe on authority when they conscientiously judge that the authority is more likely to form true beliefs and avoid false ones than they are in some domain. Christoph Jäger (2016) has recently raised several objections to her view. By contrast, I argue that both theories fail to adequately capture what epistemic authority is, and I offer an alternative account grounded in the (...) abilities that different kinds of authorities are required to possess. (shrink)

The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and (...) justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS. (shrink)

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on (...) the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)