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)

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)

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)

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)

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)

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)

Abstract: The Knowledge-Based System for Diagnosing Breast Cancer aims to support medical students in enhancing their education regarding diagnosis and counseling. The system facilitates the analysis of biopsy images under a microscope, determination of tumor type, selection of appropriate treatment methods, and identification of disease-related questions. According to the Ministry of Health's annual report in Gaza, there were 7,069 cases of breast cancer between 2009 and 2014, with 1,502 cases reported in 2014. In an era dominated by visual information, where (...) 65% of the population are visual learners, the Knowledge-Based System serves as an effective tool to aid long-term information retention by utilizing visual and textual resources. The system features a user-friendly interface, enabling students to diagnose the disease and expand their understanding. Furthermore, it can be accessed via smartphones. The Knowledge-Based System comprises three primary components: Firstly, it provides specific patient-oriented questions to familiarize students with the questioning process. Secondly, it facilitates the analysis of biopsy sample images to determine their integrity and identify potential infections. Lastly, the system incorporates animated videos illustrating various approaches for treating breast cancer. (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)

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)

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 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)

It is more than a platitude to admit that we are always dying. It is a recognition of the fundamental finitude that marks our existence as human persons. It says something essential about the human condition. We are all born. We all die. And the very living of life is, leaving aside for the moment religious considerations, oriented toward death. Phenomenologists make much of this observation, perhaps none more so than Martin Heidegger who argues that our being-toward-death permits the ontological (...) grasping of Da-sein as a whole. Indeed for him, the“existential and ontological concept of death” is “the own most nonrelational, certain, and, as such, indefinite and not to be bypassed possibility of Da-sein.” However, if one spends much time around those who are very close to death it can begin to sound disingenuous to talk about death as one’s own most possibility. It is easy to think these patients are dying—not me. Still, the phenomenologist might claim that, vis-à-vis our being-toward-death, the difference between me and the terminally ill patient is a matter of degree and not kind. But, is this so? One may be excused for thinking not. There appears to be an important difference in the kinds of possible experiences open to us. I may experience healing if I become ill; on the other hand, the very condition of the patient with a terminal illness is defined by the impossibility of her experiencing healing. The primary aim of this paper is to argue that the terminally ill patient can, in fact, experience healing at the end of her life and in the face of impending death. I will not argue that the possibility of experiencing healing at the end of life means leaving room for divine intervention, though neither do I intend to preclude such a possibility. Rather, I will argue that healing is something that we experience quite apart from what happens to our biological make-up. While healing is often correlated with a change in the state of our bodies, it need not be. (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)

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)

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)

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)

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 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)

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)

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)

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)

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)

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)

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)

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.

An action-oriented perspective changes the role of an individual from a passive observer to an actively engaged agent interacting in a closed loop with the world as well as with others. Cognition exists to serve action within a landscape that contains both. This chapter surveys this landscape and addresses the status of the pragmatic turn. Its potential influence on science and the study of cognition are considered (including perception, social cognition, social interaction, sensorimotor entrainment, and language acquisition) and its impact (...) on how neuroscience is studied is also investigated (with the notion that brains do not passively build models, but instead support the guidance of action). A review of its implications in robotics and engineering includes a discussion of the application of enactive control principles to couple action and perception in robotics as well as the conceptualization of system design in a more holistic, less modular manner. Practical applications that can impact the human condition are reviewed (e.g., educational applications, treatment possibilities for developmental and psychopathological disorders, the development of neural prostheses). All of this foreshadows the potential societal implications of the pragmatic turn. The chapter concludes that an action-oriented approach emphasizes a continuum of interaction between technical aspects of cognitive systems and robotics, biology, psychology, the social sciences, and the humanities, where the individual is part of a grounded cultural system. (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)

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)

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple (...) reasonable models” problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (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)

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less (...) standard. While PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (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)

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)

Precision medicine functions by grouping patients along genetic, molecular, and related ‘-omics’ factors. This stratification relies on large, growing databases of patient-volunteered information. Both private companies and government bodies incentivize patients to volunteer this genetic information appealing to the creation of collaborative patient partnerships and the concept of empowerment. This paper aims to address two related questions: (1) what is the actual nature of patient participation in precision medicine research? And (2) is this participation in precision medicine (...) research really that empowering for the average patient? I contend that firstly, the nature of this participation is best conceived of as merely contributory. Contributory participation, as it will be shown, falls short of collaboration. The partnership created by participation in precision medicine research is not one of sharing values, equal say in decisions, or shared benefit. Secondly, I contend that there are important caveats to claims that patient participation in precision medicine is empowering. Empowerment is hindered by the type of participation, the practical use or actionability of genetic data, genetic literacy, the cost of precision drugs for patients that qualify for them, and bioethical considerations of informed consent. (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)

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)

The slogan “Do Your Own Research” (DYOR) is often invoked by people who are distrustful, even downright sceptical, of recognized expert authorities. While this slogan may serve various rhetorical purposes, it also expresses an ethic of inquiry that valorises independent thinking and rejects uncritical deference to recognized experts. This paper is a qualified defence of this ethic of inquiry in one of the central contexts in which it might seem attractive. I use several case studies of patient activist groups (...) to argue that these groups often engage in valuable independent research that advances biomedical knowledge. In doing so they demonstrate the value of “lay expertise” and the epistemic as well as political necessity of not simply deferring to recognized experts. I also give some reasons why patient activist groups often produce valuable biomedical knowledge: they are examples of what I call “research collectives”. Research collectives are research communities that differ from the traditional research communities we find in universities and research institutes in that their members typically lack formal relevant scientific credentials and training. But they are similar in that they have internal structures—training procedures, norms of discussion, venues for holding discussions—that facilitate the production of knowledge. I finish by suggesting that future research into the differences and similarities between research collectives and traditional research communities is required. (shrink)

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)

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)

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)

For three decades I have expounded and defended aim-oriented empiricism, a view of science which, l claim, solves a number of problems in the philosophy of science and has important implications for science itself and, when generalized, for the whole of academic inquiry, and for our capacity to solve our current global problems. Despite these claims, the view has received scant attention from philosophers of science. Recently, however, David Miller has criticized the view. Miller’s criticisms are, however, not valid.

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._.

This chapter outlines improvements and developments made to aim-oriented empiricism since "From Knowledge to Wisdom" was first published in 1984. It argues that aim-oriented empiricism enables us to solve three fundamental problems in the philosophy of science: the problems of induction and verisimilitude, and the problem of what it means to say of a physical theory that it is unified.

Objective: Patients' satisfaction is one of the most important goals in complete denture therapy, and there are many factors influencing this parameter. This study aimed to determine patient satisfaction with conventional removable complete denture made by clinical year students at the Faculty of Dentistry, Al Azhar University - Gaza. Methods: A sample of 85 patient who had conventional removable complete denture made by clinical year students at the Faculty of Dentistry Al Azhar University - Gaza filled a questionnaire (...) two months after denture insertion. The questionnaire involving four sections including personal information, history, denture evaluation in aspects of mastication, speech, aesthetics and retention, and patient comfort. Results: Of the 85 patient studied, 81% were males, and the mean age was 60.3 years SD+-9.64. The majority (n= 67, 79 %) lost their teeth because of bad oral hygiene. The overall satisfaction level was (92.1%), and patients were more satisfied with their upper denture. A significant association was found between the patient satisfaction and prior denture use experience (p=0.013). No significant correlation was established between the patient satisfaction and their gender (p=0.188), age group (p=0.640) and employment status (p=0.667).Conclusion: The patients have shown a high level of overall satisfaction. A significant association was found between the overall satisfaction level of patients and prior denture use experience. No statistically significant association was observed between the overall satisfaction level of patients and with each of age group, employment status and gender. (shrink)

Common wisdom, philosophical analysis and psychological research share the view that memory is subjectively positioned toward the past: Specifically, memory enables one to become re-acquainted with the objects and events of his or her past. In this paper I call this assumption into question. As I hope to show, memory has been designed by natural selection not to relive the past, but rather to anticipate and plan for future contingencies -- a decidedly future-oriented mode of subjective temporality. This is not (...) to say memory makes no reference to the past. But, I argue, past-oriented subjectivity is a by-product of a system designed by natural selection to help us face and respond to the "now and the next". I discuss the implications of the proposed temporal realignment for research agendas as well as the potential limitations of measures designed to explore memory by focusing on its retentive capabilities. (shrink)

What is sexual orientation? The contemporary consensus among philosophers is that it is a disposition. Unsurprisingly, recent debates about the metaphysics of sexual orientation are almost entirely intramural. Behavioral dispositionalists argue that sexual orientation is a disposition to behave sexually. Desire dispositionalists argue that it is a disposition to desire sexually. We argue that sexual orientation is not best understood in terms of dispositions to behave or dispositions to desire before arguing that dispositions tout court fail (...) to illuminate sexual orientation. We then introduce and defend the idea that sexual orientation is best understood in terms of categorical phenomenal properties of sexual arousal. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a (...) series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)