ABSTRACT:Autistic adults suffer from an alarmingly high and increasing unemployment rate. Many companies use pre-employment personality screening tests. These filters likely have disparate impacts on neurodivergent individuals, exacerbating this social problem. This situation gives rise to a bind. On the one hand, the tests disproportionately harm a vulnerable group in society. On the other, employers think that personality test scores are predictors of job performance and have a right to use personality traits in their decisions. It is difficult to say (...) whether these negative disparate impacts are a case of wrongful discrimination. Nevertheless, we will show that pre-employment personality tests prey on several features of autism in an unfair way, and for this reason, we suggest the contours of some regulation that we deem necessary. (shrink)

Putnam says that "In one way of conceiving it, realism is an empirical theory." In the present work it is maintained that, in another way of conceiving it, realism is a grammatical thesis. That is, many of the principles taken to be definitive of realism, e.g., "Truth is objective," "Truth is mind-independent," Dummett's "a thought can be true only if there is something in virtue of which it is true," are what Wittgenstein would have called "grammatical remarks." They simply call (...) attention to certain features of the grammar of truth and related concepts. Thus, e.g., it is a feature of the way we use "is true" that statements are not spoken of as true for one person and not true for another. ;The character of grammar and of grammatical remarks in general is spelled out in some detail; it is argued in particular that Wittgenstein is not intending to provide, by means of these notions, a particular account of necessary truth. He is suggesting, rather, that looking upon certain philosophical claims as grammatical is a way of "deflating" them, stripping them of their appearance of profundity. Neither can grammatical remarks imply substantive philosophical theses. This is why realism, conceived as comprising grammatical remarks, does not imply scepticism, as is often supposed, and is not itself a controversial or exciting doctrine. ;There are of course some controversial formulations of realism, versions which are not simply underwritten by grammar. Thus some philosophers have held that, because the truth conditions of a proposition are essentially independent of any evidence we may have for the proposition, truth may not be accessible at all. I believe, however, that Putnam has shown, by means of an argument which is instructively viewed as a grammatical investigation, that truth is accessible, at least to an "ideal" theory. ;Recent expressions of idealism are argued to provide helpful accounts of language use and understanding, but fail to establish that truth is nothing but warranted assertibility, or that it must in some sense "arise within us." Such a conclusion runs afoul of the grammar of truth, of which realism is shown to provide the proper account. (shrink)

This article argues that a new diagram is emerging in the criminal justice system as it encounters developments in the neurosciences. This does not take the form that concerns many ‘neuroethicists’ — it does not entail a challenge to doctrines of free will and the notion of the autonomous legal subject — but is developing around the themes of susceptibility, risk, pre-emption and precaution. I term this diagram ‘screen and intervene’ and in this article I attempt to trace out this (...) new configuration and consider some of the consequences. (shrink)

Definition of problem Newborn screening (NBS) is an internationally successful program for the secondary prevention of rare congenital diseases. At present, most of the target conditions in NBS are diagnosed by biochemical markers. Recent advances in genomic sequencing and in the bioinformatic evaluation of genetic variants will soon make it feasible however to expand NBS significantly by testing newborns directly for pathogenic variants. Yet, genomic newborn screening (gNBS) raises important ethical issues that require resolution, given that several pilot studies on (...) gNBS implementation are already underway. Given a rapidly growing scholarly engagement with the ethics of gNBS, a more systematic and comprehensive mapping of the ethical issues and considerations relevant to gNBS is needed to move the debate forward at this point. Methods In this integrative review, we survey the literature with the aim of delineating a conceptual framework for the ethics of gNBS, which organizes the ongoing debate and thereby provides guidance for further research. Here in Part II, we outline a tentative normative framework for the ethics of gNBS by systematizing the core ethical principles advanced in the literature and offer an original contribution to the debate beyond a mere survey of considerations by proposing a substantive interpretation of these principles and how they relate to each other in the gNBS context. We demonstrate the general utility of this framework for addressing the ethical issues involved in gNBS program design by drawing out its implications for some of the issues presented in Part I. Conclusion In Part I, we formulated a requirement of informed consent for gNBS. Since newborns still lack a capacity for autonomous choice and informed consent, we approach gNBS program design through the question of what renders it ethically permissible for the child’s custodians to consent to gNBS in its name. Consequently, we discuss the authority of parents as surrogate decision-makers for their child, who are bound by a duty of care towards it. We substantiate this duty (a) by discussing several rights of the child, viz., its rights to informational self-determination, genetic ignorance, privacy, and an open future, and (b) by developing a specification of the best interest standard for children as the main principle that should guide and constrain both parental decision-making and gNBS program design. Finally, we consider concerns that gNBS could result in a harmful medicalization of healthy children. (shrink)

Medical screening is justified on the strength of the assumption that the earlier disease is detected, the better it is for the patient. On examination, however, the assumption turns out to be severely flawed, and inadequate anyway, since it is not only the patient with whom we should be concerned, but healthy people as well. Instead of making assumptions about the ill, we should prove a test's overall benefit to the individual taking it before we recommend it.

Eells and Sober proved in 1983 that screening off is a sufficient condition for the transitivity of probabilistic causality, and in 2003 Shogenji noted that the same goes for probabilistic support. We start this paper by conjecturing that Hans Reichenbach may have been aware of this fact. Then we consider the work of Suppes and Roche, who demonstrated in 1986 and 2012 respectively that screening off can be generalized, while still being sufficient for transitivity. We point out an interesting difference (...) between Reichenbach’s screening off and the generalized version, which we illustrate with an example about haemophilia among the descendants of Queen Victoria. Finally, we embark on a further generalization: we develop a still weaker condition, one that can be made as weak as one wishes. (shrink)

Do cinematic representations of the natural world only put us in further remove from nature? A phenomenological approach shows that nature screened can produce a richer understanding of human–nature relations as these unfold in visual contact. If vision accesses the world in a unique relationship of sight, in which our contact with the world is defined by vision prior to any other interaction, the cinema offers a special setting for a phenomenology that seeks to draw-out the significance of human (...) relations with the world of nature that come before utility or action. A detailed analysis of the opening sequence of Terrence Malick’s The New World demonstrates how the act of viewing positions the viewer in relation to what she sees. This position, prior to action and with the impossibility to act is seen here as an ethical position, a position of responsibility in the Levinasian sense. Merleau-Ponty’s phenomenology of vision is put here to use alongside the hermeneutic phenomenology of Heidegger and the existential responsibility of Levinas, while subverting Levinas’ anthropocentrism and rejecting Heidegger’s limiting view of technology. The approach taken in this essay, of bringing phenomenology into productive and reflexive interaction with ecology and with film is dubbed an “eco-film-phenomenology.”. (shrink)

BackgroundPrevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt – Out Prenatal HIV Screening Approach, recommended by the World Health Organization lately has been adopted and translated into policy in most Sub – Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature.MethodsPapers published in English and French Languages between 1990 (...) and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review.DiscussionMost authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society. The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities.ConclusionsThe Opt – Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt – Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice. (shrink)

Is evidential support transitive? The answer is negative when evidential support is understood as confirmation so that X evidentially supports Y if and only if p(Y | X) > p(Y). I call evidential support so understood “support” (for short) and set out three alternative ways of understanding evidential support: support-t (support plus a sufficiently high probability), support-t* (support plus a substantial degree of support), and support-tt* (support plus both a sufficiently high probability and a substantial degree of support). I also (...) set out two screening-off conditions (under which support is transitive): SOC1 and SOC2. It has already been shown that support-t is non-transitive in the general case (where it is not required that SOC1 holds and it is not required that SOC2 holds), in the special case where SOC1 holds, and in the special case where SOC2 holds. I introduce two rather weak adequacy conditions on support measures and argue that on any support measure meeting those conditions it follows that neither support-t* nor support-tt* is transitive in the general case, in the special case where SOC1 holds, or in the special case where SOC2 holds. I then relate some of the results to Douven’s evidential support theory of conditionals along with a few rival theories. (shrink)

Three recent reports on genetic screening published in the United Kingdom, Denmark and the Netherlands are discussed. Comparison of the Dutch report with the Danish and the Nuffield reports reveals that the Dutch report focuses on the aim of enlarging the scope for action, emphasising protection of autonomy and self-determination of the screenee more than the other two reports. The three reports have in common that the main concern is with concrete issue such as stigmatisation, discrimination, protection of the private (...) sphere and issues linked with labour and insurance. Some potential long term consequences, however, tend to be neglected or underestimated. These omissions are pointed out. (shrink)

The Centers for Disease Control and Prevention (CDC) recently recommended that HIV screening should become routine for all adults in the United States. Implicit in the CDC proposal is the notion that pre-test counseling would be more limited than at present, and that written informed consent to screening would no longer be required. If widely implemented, routine testing would mark a tremendous shift in the US HIV screening strategy. There are a number of considerations used to determine what screening tests (...) should be routine, and HIV fits the bill in almost every regard. Yet the stigma associated with HIV infection remains, making the CDC's recommendation highly controversial. Will minimizing requirements for pre-test counseling and special written informed consent lead to unexpected or unwanted HIV testing, or do these stringent counseling and consent requirements needlessly scare people away? Will widespread and routine testing be associated with declining stigmatization, or will it drive some patients away from seeking desperately needed health care? These are high stakes questions, and we're about to find out the answers. (shrink)

This article is written in response to the idea that selective termination may be eugenic. It points out that a mixture of motives and goals may inform screening programmes and selective termination for fetal abnormality without the intention being “eugenic”. The paper locates modern genetics within the tradition of humanist medicine by suggesting that parents who choose to terminate a pregnancy because of fetal abnormalities are not making moral judgments about those who are living with these abnormalities already. Rather they (...) are making judgments about their own lives and the lives of their children in relation to this genetic disorder. It concludes by introducing several caveats about the counselling that parents receive after the results of the testing and suggests that counselling inevitably contains a directive element because of the nature of the information covered. (shrink)

This paper sets out a novel response to the ‘screening off problem’ for naïve realism. The aim is to resist the claim (which many naïve realists accept) that the kind of experience involved in hallucinating also occurs during perception, by arguing that there are causal constraints that must be met if an hallucinatory experience is to occur that are never met in perceptual cases. Notably, given this response, it turns out that, contra current orthodoxy, naïve realists need not adopt any (...) particular view about the psychological nature of hallucinatory experience to handle the screening off problem. Consequently, room opens up for naïve realists to endorse whatever theory of hallucinatory experience seems to best capture the distinctive nature of such episodes. (shrink)

The implementation of new methods of treating and preventing disease raises many question of both technical and moral character. Currently, many studies focus on developing a screening test for preeclampsia (PE), a disease complicating 2–8% of pregnancies, potentially causing severe consequences for pregnant women and their fetuses. The purpose is to develop a test that can identify pregnancies at high risk for developing PE sufficiently early in pregnancy to allow for prophylaxis. However, the question of implementing a screening test for (...) PE does not only involve an evaluation of technical feasibility and clinical efficacy, it also requires an analysis of how the test influences the conditions and choices for those tested. This study evaluates state-of-the-art techniques for preeclampsia screening in an ethical framework, pointing out the central areas of moral relevance within the context of such screening activity. Furthermore, we propose ethical guidelines that a screening programme for PE should meet in order to become an uncontroversial addition to prenatal health care. (shrink)

Expanded universal carrier screening (EUCS) entails a population‐wide screening offer for multiple disease‐causing mutations simultaneously. Although there is much debate about the conditions under which EUCS can responsibly be introduced, there seems to be little discussion about its aim: providing carrier couples with options for autonomous reproductive choice. While this links in with current accounts of the aim of foetal anomaly screening, it is different from how the aim of ancestry‐based carrier screening has traditionally been understood: reducing the disease burden (...) in the population. The reasons why the aim of EUCS is presented in terms of ‘autonomy’ rather than ‘prevention’ have not been spelled out in the literature. This paper seeks to fill this gap by considering the morally relevant similarities and dissimilarities between foetal anomaly screening, ancestry‐based carrier screening and EUCS. When carrier screening is performed in the prenatal period, enhancing autonomy appears the most appropriate aim of EUCS, as the alternative of ‘prevention through selective abortion’ would urge women to terminate wanted pregnancies. However, when screening is conducted in the preconception period, carrier couples can avoid the birth of affected children by other means than selective abortion, for instance preimplantation genetic diagnosis. To the extent that this increased control over passing on a genetic disorder raises questions of parental responsibility, it seems necessary that the account of the aims of EUCS is wider than only in terms of enhancing reproductive autonomy. (shrink)

Expanded universal carrier screening (EUCS) entails a population‐wide screening offer for multiple disease‐causing mutations simultaneously. Although there is much debate about the conditions under which EUCS can responsibly be introduced, there seems to be little discussion about its aim: providing carrier couples with options for autonomous reproductive choice. While this links in with current accounts of the aim of foetal anomaly screening, it is different from how the aim of ancestry‐based carrier screening has traditionally been understood: reducing the disease burden (...) in the population. The reasons why the aim of EUCS is presented in terms of ‘autonomy’ rather than ‘prevention’ have not been spelled out in the literature. This paper seeks to fill this gap by considering the morally relevant similarities and dissimilarities between foetal anomaly screening, ancestry‐based carrier screening and EUCS. When carrier screening is performed in the prenatal period, enhancing autonomy appears the most appropriate aim of EUCS, as the alternative of ‘prevention through selective abortion’ would urge women to terminate wanted pregnancies. However, when screening is conducted in the preconception period, carrier couples can avoid the birth of affected children by other means than selective abortion, for instance preimplantation genetic diagnosis. To the extent that this increased control over passing on a genetic disorder raises questions of parental responsibility, it seems necessary that the account of the aims of EUCS is wider than only in terms of enhancing reproductive autonomy. (shrink)

It is well known that the probabilistic relation of confirmation is not transitive in that even if E confirms H1 and H1 confirms H2, E may not confirm H2. In this paper we distinguish four senses of confirmation and examine additional conditions under which confirmation in different senses becomes transitive. We conduct this examination both in the general case where H1 confirms H2 and in the special case where H1 also logically entails H2. Based on these analyses, we argue that (...) the Screening-Off Condition is the most important condition for transitivity in confirmation because of its generality and ease of application. We illustrate our point with the example of Moore’s “proof” of the existence of a material world, where H1 logically entails H2, the Screening-Off Condition holds, and confirmation in all four senses turns out to be transitive. (shrink)

This paper explains a flaw I find in Michael Martin's argument for the view that the phenomenal properties of a hallucination are its being indiscriminable from a certain sort of veridical perception. The argument relies, I argue, on the assumption that if a certain broad mental property sometimes has a certain narrow realizer, it never has any other narrow realizer. This assumption is false. Accordingly, the argumentation fails to rule out "positive multidisjunctivism": the fundamental kind of the veridical experience is (...) a broad property, while some matching hallucinations are subjective and others are intentional. (shrink)

This paper examines a proposal to make use of IVF techniques to provide an alternative to therapeutic abortion of fetuses with genetic abnormalities. We begin by describing the proposed procedure, and then show that, considered in itself, it is morally on a par with therapeutic abortion. However, once the wider practical implications are brought into view, the proposed new procedure loses its initial appeal. The pros and cons are not sufficiently clear-cut entirely to rule out the IVF procedure, so the (...) paper concludes by indicating some further complications which may follow, should the procedure come to be adopted. (shrink)

Social scientists have documented some recent, dramatic changes in the nature of our social lives. Many scholars have thought that our reliance on technology to communicate with others is in large part responsible for that loss. However, there is also data to support the opposite conclusion—it might be the case that social networking technologies have helped, rather than hindered our social interactions. What I would like to propose is a philosophical argument, which I hope will offer a different sort of (...) answer to the questions about whether we know people in the same ways, or perhaps more or less well, than we once did, in the days before Facebook, email, and such. Whether or not technology has enhanced our social lives, it is worth considering whether coming to know another person is a different sort of exercise than it used to be, when face-to-face interactions with others were the preferred way to find out what was going on in someone else’s life. What is different in sharing my thoughts, beliefs, feelings, desires, and such with another over the Internet versus in person? Is there any kind of knowledge that is available only in a face-to-face context? If so, what is the nature of that knowledge? In philosophical terms, what I want to examine is how our knowledge of others’ minds changes with various technologies that we use to communicate the contents of our mental states. (shrink)

Definition of the problem Newborn screening is an effective measure for the early detection of rare diseases. The program currently identifies an average of one newborn out of 900 births in Germany that is affected by one of the target diseases. In the future, supplementing the measure with genomic screening would make it possible to identify those affected by numerous rare genetic conditions that can be treated and have not yet been included in established screening by expanding the catalogue of (...) target diseases. Many moral issues are raised by genomic newborn screening. Arguments The paper offers an ethical assessment of genomic newborn screening as a public health measure based on the principlist approach in biomedical ethics as advocated by Tom Beauchamp and James Childress. The principles of respect for autonomy, nonmaleficence, beneficence as well as the principle of justice are specified with regard to genomic sequencing and balanced, drawing also on work of Norman Daniels on justice in health care. Conclusion The specification of relevant norms allows the formulation of requirements for responsible genomic newborn screening and the selection of target diseases. Furthermore, the strategic significance and long-term potential of genomic newborn screening lie primarily in its function as a building block of personalized medicine. With this perspective and the requirement of justifying allocation decisions, society needs to address important issues in the ethics of public health. These issues call for democratic deliberation and transparent decision-making processes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"Terministic Screens," Social Constructionism, and the Language of Experience:Kenneth Burke's Utilization of William JamesPaul StobKenneth Burke's influence on various academic disciplines is clear in the number of books and articles published annually on his thought. It is also clear insofar as academics continue to turn to his work for insights on handling scholarly problems. That is to say, not only do we explore the dimensions of his work, we (...) also bring it to bear on current disputes in the hopes of clarifying or moving past the issues we face. His thought, in short, has a currency that transcends its historical period. "As we meet new challenges that echo the past," writes Ross Wolin, "Burke's inquiries into meaning, orientation, faction, communication, and rhetoric are as urgent today as when Burke raised them long ago and for decades after."1By bringing the terms of Burke's work to bear on current disputes, we connect him to the vocabularies and discourses that surround us. His thought becomes familiar through the lenses we employ, as we intermix his ideas with our own terminology and see his work through the language of our discussions. One example of this phenomenon is the way scholars have been describing Burke's philosophical outlook. Burke's thought, we are told, is that of a social constructionist. Edward Schiappa, for example, concludes that Burke gives us a view of the world as intersubjectively created: "Our understanding is social in the sense that our concepts are human-made and are part of a shared language. Our understanding is [End Page 130] constructed in the sense that our claims, interpretations, and orientations constitute 'conceptual fabrics' that weave together contingent sets of beliefs and social practices."2 Paul Jay turns the sentiment into a more explicitly epistemological point: "The most radical aspect of Burke's evolving theory of language at this time is his recognition that language—inherently metaphorical—constructs rather than reflects knowledge."3 James Chesebro highlights social constructionism as one of the hallmarks of Burke's dramatism: "For Burke, the realm of symbol-using is unique to the human being. Symbol-using is a solely conventional, arbitrary, and social process. It allows human beings to become self-conscious, create motives independently of physical phenomena, and ultimately to create social constructions of reality."4 Dennis Ciesielski argues that Burke's "terministic screens" define "base reality into truth-systems unique to each respective discourse community and impl[y] a neo-pragmatic, social constructionist pattern for the making of meaning."5 Finally, Robert Wess characterizes Burke's entire career as the evolution from a materialist, biological-essentialist view of the human self to a social constructionist view.6Generally speaking, "social constructionism" is a metaphor that attempts to capture the way Burke viewed the nature of the world and the function of language therein. It suggests that symbols, terms, and language form the building blocks, the bricks and mortar, of the structures of our collective life. We employ symbols that construct our social realities, similar to the way a contractor employs the materials and labor that construct a house. Consequently, the realities we face are not inherent in nature but are built up discursively and can therefore be reconstructed as we alter our discursive practices.7The social construction metaphor positions Burke's philosophical out-look in terms that are familiar to us, though not necessarily familiar to him. That is to say, the label of social constructionist is recent, and it comes not from Burke's work but from intellectual developments after he wrote the bulk of his corpus.8 We apply it to him retroactively, meshing together his intellectual milieu with our own. And as Ian Hacking reminds us, "The phrase has become code. If you use it favorably, you deem yourself rather radical. If you trash the phrase, you declare that you are rational, reasonable, and respectable."9Labeling Burke a social constructionist wraps his thought in a current metaphor, merging his perspective with a vocabulary that was not part of his project. While such a merger is not necessarily a bad thing—to some degree the process is inevitable10—a certain danger... (shrink)

Context: Some scholars have put forward constructivist world models in which the purported external world is constructed from experience (i.e., there is a constructive relation between them. However, scholars disagree about whether experience is generated by the brain and results from the perception of the purported external world (i.e., whether there are generative relations and perceptual relations. Problem: Do we need to maintain perceptual relations or generative relations in a constructivist world model? Method: I propose a world model where our (...) world is composed of a large number of screen creatures, and this is compared with the world model in the irrealist virtual world theory. There is a constructive relation in both world models, but only the second world model contains generative and perceptual relations. I provide reasons to doubt that the world model in the irrealist virtual world theory can provide sufficient reasons for involving generative or perceptual relations. Results: We should accept the world model composed of screen creatures as the model of our world; we do not need to retain perceptual or generative relations in a constructivist world model. Implications: This article points out that perceptual relations stem from a misunderstanding of certain correlations between experiences. This will generate some new ideas when considering the mind-matter problem. Constructivist content: This article discusses how to deal with generative and perceptual relations using constructivist world models. (shrink)

Health policy is increasingly confronted with the demand for financing genetic testing on inherited susceptibility to disease. Tests on polymorphism/snp associated with multicausal and chronic conditions are already offered in private commercial institutions or in academic hospitals. The increasing pressure on public health services to offer SNP testing leads to first methodological approaches for a generally valid regulatory framework applicable for inclusion or refusal of genetic tests into the public health services. Systematic search in Medline, Embase and the Web for (...) methodological papers or guidelines for the assessment of polymorphism-screening. Since genetic testing has not only clinical and economic effects on health care, but also primarily ethical consequences by profiling our understanding of “health” and “disease”, this paper gives an overview of relevant aspects and background information to consider in the assessment of genetic tests. Although 2–3 million SNPs are identified and the journals are full of reported “significant” associations between disease and mutation, only a few can be replicated unequivocally. The ACCE -framework was developed by the Center of Disease Control for the assessment of genetic testing. This standardised appraisal approach proposes collecting and evaluating: Prevalence, genotype-/phenotype-relation. Clinical presentation: natural history; the different expressions of disease. Performance of the genetic test. Implications for therapy and prevention. Conclusion for clinical applications of risk-profiling of health on their susceptibility to disease and/or for clarification of disease for therapy planning. Since genetic testing is urging its way into the health care system, the actual danger is, that population screening starts before valid evidence from big prospective studies have been carried out and delivered proofs of direct causal associations. Before diffusing into the health care system we are suggesting to take a cautious and standardised approach. (shrink)

In their article, Dees and Kwon (2013) describe the case of newborn screening for Krabbe disease and argue compellingly that a mandatory newborn screening program for this disease is problematic in several respects. Therefore, they submit, testing on Krabbe disease should only be offered on a voluntary basis, under a research protocol. In my opinion, Dees and Kwon are correct to point out the problematic character of a mandatory screening program for Krabbe disease. Their move toward a research paradigm is (...) however problematic. More specific, their proposal presents problems for the role of informed consent in Krabbe testing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Genetic Testing and Genetic ScreeningPat Milmoe McCarrick (bio)In recent years there has been an enormous expansion in the knowledge that may be gleaned from the testing of an individual's genetic material to predict present or future disability or disease either for oneself or one's offspring. The Human Genome Project, which is currently mapping the entire human gene system, is identifying progressively more genetic sequencing information (see Scope Note 17, (...) The Human Genome Project). Information obtained from genetic testing raises ethical and legal questions about its uses by society. The ethical dilemmas were foreseen two decades ago by bioethicists who asked whether questionable applications could stop "legitimate pursuits" (IV, Gaylin 1972) and whether genetic disease might come to be viewed as "transmissible" in the sense of being contagious (IV, Veatch 1974).Not only has knowledge expanded, but the practice of genetic testing and screening has greatly increased as well. For example, in the case of testing for cystic fibrosis (CF), the U.S. Congress' Office of Technology Assessment (OTA) estimates that instances of screening jumped from 9310 tests in 1991 to 63,000 tests in 1992 (I, OTA [Cystic Fibrosis] 1992). In addition, the OTA estimates that within the next few years, the six million women who become pregnant each year routinely will be informed of available CF carrier tests (I, OTA [Cystic Fibrosis] 1992).Following the recent identification of a gene linked to breast cancer, Dr. Francis Sellers Collins, director of the National Center for Human Genome Research, said that "it is not inconceivable that every woman in America may want to be screened for this gene. The economic, ethical, and counseling issues will be very daunting." Dr. Collins opines that in the near future physical examinations for 18-year-olds will include DNA testing for diseases with genetic components and that physicians, in the interests of preventive medicine, will make risk-based recommendations for a healthy life-style (IV, Breo 1993). The U.S. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research predicted as early as 1983 that before the end of the century genetic screening and counseling would become major components of both public health and individual medical care (I, U.S. President's Commission 1983). [End Page 333]The OTA defines genetic testing as "the use of specific assays to determine the genetic status of individuals already suspected to be at high risk for a particular inherited condition. The terms genetic test, genetic assay, and genetic analysis are used interchangeably to mean the actual laboratory examination of samples." In contrast, genetic screening usually uses the same assays employed for genetic testing but is distinguished from genetic testing by its target population (I, OTA [Genetic Monitoring] 1990). The National Academy of Sciences (NAS) defines screening as the systematic search of populations for persons with latent, early, or asymptomatic disease (III, NAS 1975). Some of the literature annotated for this Scope Note appears to use the terms "testing" and "screening" interchangeably.Philip Boyle of the Hastings Center points out that the language used to describe genetic variation is important and asks what words should be used: "Defects, flaws, deleterious genes, disorders, or the more neutral conditions? Using words such as normal—and its corollary, abnormal—is likely to foster stigmatization and discrimination" (III, Genetic Grammar, Boyle 1992).Areas of focus in genetic testing include: prenatal diagnosis, newborn screening, carrier screening, forensic screening, and susceptibility screening.Prenatal diagnosis discerns whether a fetus is at risk for various identifiable genetic diseases or traits. Prenatal diagnosis is made using amniotic fluid, fetal cells, and fetal or maternal blood cells obtained during amniocentesis testing; alpha fetoprotein assays or chorionic villus sampling; or ultrasound tomography, which creates fetal images on a screen. Another method, known as fetoscopy, uses a camera on a needle inserted in the uterus to view the fetus. Since prenatal screening began in 1966 (I, U.S. President's Commission 1983), the number of metabolic defects and genetic disorders that can be diagnosed prenatally has expanded greatly. There is also discussion of requiring testing for parents who are participating in an in vitro fertilization program and are at genetic... (shrink)

The advancement of genome sequencing technology and its potential application in newborn screening is being discussed in various countries. Genomic newborn screening (gNBS) can provide parents with information about their child's genetic susceptibility for known disorders. However, it also presents ethical and psychosocial challenges. This study was carried out with a view toward the possible introduction of gNBS in Germany. Due to the existing challenges, it is crucial to understand different perspectives of relevant groups in Germany before implementing gNBS. Four (...) online focus groups were conducted with parents, patient representatives, and healthcare professionals to explore perceived opportunities and challenges, as well as needs regarding a potential gNBS program. Discussions with altogether 24 participants were semi-structured using a pre-defined interview guide. Sessions were audio-visually recorded and transcripts were analyzed using a structuring qualitative content analysis combining both deductive and inductive methods. Participants expressed positive views about gNBS but also reservations about a gNBS program and posed requirements for operating conditions. One salient theme that emerged was hope for certainty through gNBS in the face of numerous uncertainties. The study complements the perspective of patient representatives, providing further insight into the subject matter. This is a valuable contribution as they possess a comprehensive understanding of the medical, psychological, and ethical considerations involved. Patient representatives placed particular emphasis on the advantages of avoiding a diagnostic odyssey and the significance of support systems. The results provide first insights into different views on gNBS in Germany. These views can inform the potential preparation of a gNBS program in Germany, particularly with regard to information and consent requirements. Implications for practice, such as informing and educating parents about gNBS during pregnancy, can be derived from the study. WHAT IS KNOWN ABOUT THIS TOPIC: Previous studies have indicated that there is significant public and—more particularly parental—interest in genomic newborn screening (gNBS). However, discrepancies exist regarding preferences for the scope of reported results, including differences between the views of healthcare professionals, parents, and the public. WHAT THIS PAPER ADDS TO THE TOPIC: This study offers insights into various perspectives on the potential implementation of gNBS in Germany, highlighting divergent views of healthcare professionals and parents, while also introducing a novel and valuable contribution by including the viewpoints of patient representatives. (shrink)

Visual disturbances are amongst the most commonly reported symptoms after a traumatic brain injury despite vision testing being uncommon at initial clinical evaluation. TBI patients consistently present a wide range of visual complaints, including photophobia, double vision, blurred vision, and loss of vision which can detrimentally affect reading abilities, postural balance, and mobility. In most cases, especially in rural areas, visual disturbances of TBI would have to be diagnosed and assessed by primary care physicians, who lack the specialized training of (...) optometry. Given that TBI patients have a restricted set of visual concerns, an opportunity exists to develop a screening protocol for specialized evaluation by optometrists—one that a primary care physician could comfortably carry out and do so in a short time. Here, we designed a quick screening protocol that assesses the presence of core visual symptoms present post-TBI. The MOBIVIS protocol takes on average 5 min to perform and is composed of only “high-yield” tests that could be performed in the context of a primary care practice and questions most likely to reveal symptoms needing further vision care management. The composition of our proposed protocol and questionnaire are explained and discussed in light of existing protocols. Its potential impact and ability to shape a better collaboration and an integrative approach in the management of mild TBI patients is also discussed. (shrink)

Although public law scholars have long addressed the problems of accountability generated by private decision-making and "privatization," they have largely ignored this phenomenon in the immigration context. Our ignorance is increasingly indefensible. Millions of employers - private parties - are required by law to screen their workers for unauthorized immigrants, and growing evidence suggests that they use their screening power to ignore workplace protections and to otherwise exploit these workers. This article is the first attempt to apply the insights generated (...) by the privatization literature to immigration law. It argues that our nation's employers have emerged as private immigration screeners who, like airport inspectors screening for ineligible entrants and law enforcement officers screening for criminal noncitizens, assist the Department of Homeland Security in identifying unauthorized workers for removal. More than just agents of exploitation, reframing employers as private screeners demonstrates that they are also agents of the state. Borrowing analytical concepts developing in the privatization literature, I argue that the high risk of abuse and the lack of readily available mechanisms for reducing that risk raise troubling implications over the kind of power that employers wield as private immigration screeners in the workplace. Reframing our nation's employers as private screeners gives theoretical coherence to the discretionary decision-making authority they actually wield, and explains why they have used that authority to exploit workers - as private parties carrying out public duties, they are incentivized to serve their own interests instead of verifying the immigration status of their workers in good faith. Examining the problem of private immigration screening also forces us to reconsider two aspects about immigration screening generally. First, although immigration law tends to reward unauthorized immigrants who lay low and tends to punish those who draw attention to themselves, I suggest that we ought to rethink this logic at least in the context of the workplace. Because workplace violations committed by employers are typically enforced by private parties, punishing unauthorized immigrants who attempt to assert these rights and thus draw attention to themselves, only encourages workplace violations by employers and fosters a culture of lawlessness. Second, thinking about how decision-making authority within immigration law should be allocated between the public and the private contributes to the current conversation over how similar decision-making authority should be allocated between federal entities and local entities. Although questions of accountability have lingered in the backdrop of the immigration federalism debate, I suggest that scholars would be well served to foreground these questions and answer them head-on. (shrink)

Innovations permeate healthcare settings on an ever-increasing scale. Health technology innovations impact our perceptions and experiences of health, care, disease, etc. Because of the fast pace these HTIs are being introduced in different healthcare settings, there is a growing societal consensus that these HTIs need to be governed by ethical reflection. This paper reports a systematic review of argument-based literature which focused on articles reporting on ethical frameworks to screen or evaluate HTIs. To do this a four step methodology was (...) followed: Literature search conducted in five electronic literature databases; Identification of relevant articles; Development of data-extraction tool to analyze the included articles; Analysis, synthesis of data and reporting of results. Fifty-seven articles were included, each reporting on a specific ethical framework. These ethical frameworks existed out of characteristics which were grouped into five common ones: Motivations for development and use of frameworks; Objectives of using frameworks; Specific characteristics of frameworks ; Ethical approaches and concepts used in the frameworks; Methods to use the frameworks. Although this multiplicity of ethical frameworks shows an increasing importance of ethically analyzing HTIs, it remains unclear what the specific role is of these analyses. An ethics of caution, on which ethical frameworks rely, guides HTIs in their design, development, implementation, without questioning their technological paradigm. An ethics of desirability questions this paradigm, without guiding HTIs. In the end, a place needs to be found in-between, to critically assess HTIs. (shrink)

Newborn screening involves a complex logistical process, which depends on the close cooperation of many professionals, such as midwives, laboratory technicians, general practitioners and pediatricians. These professionals may encounter moral problems in the process, which have not been systematically studied before. This study fills this gap. We conducted interviews with 36 professionals involved in NBS in the Netherlands and made an inventory of the moral problems they encounter, as well as of the ways in which they tend to respond to (...) them. The moral problems professionals encounter stem from interpersonal conflicts and intrapersonal conflicts. Given the complexity of the work of NBS professionals, the study suggests that the moral problems that occur on the work floor cannot easily be solved by means of offering better or more stringent policy guidelines. Rather, it should be appreciated that professionals contribute significantly to shaping the morality of NBS with the help of their daily choices, and they should be supported in carrying out this task—for example with the help of a moral training or regular multidisciplinary moral deliberation, facilitated by an ethicist. (shrink)

This book argues that, despite recent calls to arms to seek out and remove "corporate psychopaths" from the business world, efforts to eliminate the corporate psychopath presence would be illegal as well as unethical.

In 2021 and 2022, researchers carried out an implementation trial that considered how the capsule sponge test might be used to screen for Barrett’s oesophagus using a mobile clinic in East Anglia. This paper offers insights from 15 months of ethnographic fieldwork studying the trial. It aims to highlight the value of the test in offering reassurance to worried patients, particularly to those with a family history of oesophageal adenocarcinoma. It also considers the variety of aims people held for the (...) capsule sponge test, including the hope that it would address their symptoms of acid reflux, and the conflict that sometimes emerged as a result. The second half of the paper uses fieldwork carried out in virtual support groups for people with Barrett’s oesophagus to explore experiences postdiagnosis, which sometimes were defined by fear of future cancers. It describes notable differences between the care offered to people with morphological risk conditions like Barrett’s oesophagus and the care given to those with genetic risk conditions, including the provision of genetic counselling. More broadly, the paper highlights a tension between patient-centred and risk-centred medicine that is likely to grow as healthcare services continue to shift towards preventative approaches. (shrink)

No computer that had not experienced the world as we humans had could pass a rigorously administered standard Turing Test. We show that the use of “subcognitive” questions allows the standard Turing Test to indirectly probe the human subcognitive associative concept network built up over a lifetime of experience with the world. Not only can this probing reveal differences in cognitive abilities, but crucially, even differences in _physical aspects_ of the candidates can be detected. Consequently, it is unnecessary to propose (...) even harder versions of the Test in which all physical and behavioral aspects of the two candidates had to be indistinguishable before allowing the machine to pass the Test. Any machine that passed the “simpler” symbols- in/symbols-out test as originally proposed by Turing would be intelligent. The problem is that, even in its original form, the Turing Test is already too hard and too anthropocentric for any machine that was not a physical, social, and behavioral carbon copy of ourselves to actually pass it. Consequently, the Turing Test, even in its standard version, is not a reasonable test for general machine intelligence. There is no need for an even stronger version of the Test. (shrink)

If I have any objection to this book, it is to the title, in that it might narrow the audience that would benefit from it. Although the title is formally quite accurate in describing the contents, it underplays the relevance of the arguments set out herein to a very broad range of clinical arenas, for which HIV/AIDS can be a notable example. This fascinating series of essays covering the topics in the subtitle and much more, shows how valuable AIDS has (...) been as a worked example of a series of interdigitating core issues in medical ethics, as it has been in so many areas of clinical medicine, public health and public policy. Although the authors and editors underplay this wider relevance, I found myself, despite my own substantial involvement in HIV and AIDS over the past …. (shrink)

The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some (...) lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy. (shrink)

During COVID-19, private living spaces have become settings for activities usually taking place elsewhere. Work, education and leisure activities have moved in, while we have moved out and now frequently project our private interiors onto the screens of others when meeting online. We see ourselves reflected while reflecting each other, and we peek into the lives of strangers while staging our own for the world to see. If such virtual cross-extensions of public and private domains are not completely new, then (...) they have been taken to a whole new level during the pandemic. The article explores such projected interiors extended between screens and walls and the implications these have for the thinking and making of a future living space. It asks how in response to the current environmental crisis the experience of the pandemic interior might help project new spaces radically different from the ones of pre-pandemic times. Two versions of a drawing made in the early 1920s by the Swiss German artist Paul Klee evoke the experience of spatial relationships familiar from the pandemic house. Creative writing of an inflected space detected in the drawings identifies an opening in the fabric of the interior potentially leading us into a future. (shrink)

Artificial people, far from embodying the false promise of a post-racial future, come to be inscribed with signifiers of race across science fiction film and television. However, like Western philosophy’s theorisation of technology, on-screen imaginations of artificial people are overwhelmingly white. With the help of critical race theory and critical philosophies of race, this article explores what it means for an artificial person to be Black. It brings a comprehensive account of the racialisation of technology, both off- and on-screen, into (...) conversation with the work of Afrofuturist musician Janelle Monáe. Together, these complementary frameworks form the basis from which to consider Monáe’s performance as a Black android in the television series Electric Dreams (2017–18) episode “Autofac” (2018), adapted from the work of Philip K. Dick. Reading “Autofac” through Monáe’s crossover stardom enables negotiated cultural tensions of race and technology to emerge from a text that opts out of explicitly addressing the issue of race. In doing so, this article elucidates how film and television draw upon, contribute to and actively shape the inextricability of technology and race. (shrink)

This narrative ethics exploration stems from my happy prostate-specific antigen (PSA) story, though it should not have been, as I annually refuse my family physician’s recommendation to purchase PSA screening. The reason for my refusal is I teach ethics to medical students and of course must walk the talk, and PSA screening is not publicly funded in the province of Ontario, Canada. In addition, I might have taken false comfort in ‘but all you need is a good index finger’ to (...) detect prostate cancer, expounded by a senior physician at a national medical conference in 2010, and applauded by the large audience of physicians. I was compelled to begin this exploration out of survivor guilt, although I will not be a survivor for long, and as a mea culpa to the men similarly situated to me in having late diagnosis of prostate cancer, aggressive tumours and multiple metastases, but who unlike me are dead because they did not experience the physician–educator-based exceptionisms and coincidences that permit me to still be alive. Although my PSA story will always be a happy story, even when my life ends in a few years, the initiation of public funding of PSA screening for all men over 50 would make my PSA story an even happier story. (shrink)

This article draws on an empirical investigation of how Australia’s cervical screening program came to be the way it is. The study was carried out using grounded theory methodology and primarily uses interviews with experts involved in establishing, updating or administering the program. We found strong differences in experts’ normative evaluations of the program and beliefs about optimal ways of achieving the same basic outcome: a reduction in morbidity and mortality caused by invasive cervical cancer. Our analysis demonstrates how variations (...) in values and preferences associated with key concepts underpinning public health such as benefit, harm and burden led to different perspectives on the purpose of an organized cervical screening program. These variations were largely driven by different bases of professional experience. Differently conceived purposes in turn led to conflict over how the program should be operationalized. Following Frith’s model of empirical bioethics, the results of the study both draw on and inform the existing public health and screening ethics literature. (shrink)

In this article I deal with the impact of digitization on education by revisiting the ideas Neil Postman developed in regard with the omnipresence of screens in the American society of the 1980s and their impact on what it means to grow up and to become an educated person. Arguing, on the one hand, that traditionally education is profoundly related to the initiation into literacy, and on the other hand, that the screen may come to replace the book as the (...) prevailing educational medium, Postman’s theses are worth reconsidering. Moreover I propose to develop further one strain of thought in Postman’s work, viz. the interconnectedness of technological inventions, material practices and ideas regarding what education is all about. As such I analyse in great detail the differences between traditional and digital literacy by looking from a material and practical perspective at how we relate to books and screens. This is not a normative analysis, but one that aims at fleshing out differences in spaces of experience. As such I wind up with suggestions regarding the affordances that a new form of literacy, no longer based on the model of the book, might bring about. (shrink)

Empirical data can be an extremely powerful and influential tool in bioethical research. However, when researchers or policy makers look for answers to ethical questions by engaging with empirical research, there can be a tendency (conscious or unconscious) to shape, report, and use empirical research in a way that confirms their own preferred ethical conclusions. This skewing effect - what we call ‘normative bias’ - is often so subtle it falls short of clear misconduct and thus can be difficult to (...) call out. However, we argue that this subtle influence of bias has the potential to significantly influence debate and policy around highly sensitive ethical issues and must be guarded against. In this paper we share the lessons we have learned through a journey of self-reflection around the effect that normative bias can have when reporting on and referring to empirical data relating to ethical issues. We use a variety of papers from our area of the ethics of routine prenatal screening to illustrate these subtle but often powerfully distorting effects of bias. Our aim in doing so is not to criticise the work of others, as we recognise our own normative bias, but to improve awareness of this issue, remind the need for reflexivity to guard against our own biases, and introduce a new criterion - the idea of a ‘limitation prominence assessment’ - that can work as a practical way to evaluate the seriousness of the limitations of an empirical study and thus, the risks of the study being misread or misinterpreted through superficial reading. (shrink)

One prominent line of support for nudging in screening programs is the claim that nudging can help ‘bad choosers’ — that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help ‘bad choosers’ should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer (...) screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making. (shrink)

OBJECTIVES: To determine the epidemiology and the underlying pathological conditions of natural deaths among motor vehicle drivers. Sudden death while driving may cause damage to properties, other vehicles or road users. Although the Medical Commission on Accident Prevention recommended restrictions to drivers at risk of sudden death due to their medical conditions, these restrictions are useless if they do not result in greater safety to the public. DESIGN: A retrospective study of natural deaths of motor vehicle drivers. SETTING: Natural deaths (...) of motor vehicle drivers reported to the coroner for Birmingham and Solihull. SUBJECTS: 86 consecutive natural deaths of motor vehicle drivers in a five-year period between 1984 and 1988. RESULTS: Of the 86 fatalities reviewed, 80 (93%) sudden deaths were caused by ischaemic heart disease. Fifty vehicles were involved in collision with 32 properties, 20 other vehicles and six pedestrians. Fifty-one out of 80 cardiac deaths had past cardiac history and three had reported chest pain prior to the sudden death. CONCLUSION: An applied normative ethical assessment based on the basic moral principles of autonomy, justice, beneficence and non-maleficence are discussed. We conclude that medical screening of drivers has little benefit for the drivers or other persons. (shrink)

The article offers new evidence concerning a set of sculptures carved in pietra d’Aurisina for the Basilica of San Marco in Venice. The statues represent scenes of the Nativity and Childhood of Christ. Similarities in style, proportions, dimensions and raw material reveal that they belong to a single set. An analysis of stable carbon and oxygen isotopes indicates that several of the statues were carved out of blocks of stone excavated from the same precise site in the Aurisina quarry in (...) the upper Adriatic. The article takes into consideration the entire set, that is both the preserved pieces and those that were presumably designed for the original cycle but are no longer extant. A lectern angel, likewise in pietra d’Aurisina, set into the northern pulpit of San Marco, as well as four angels celebrating the birth of Christ beneath the crossing of the basilica, offer evidence to support the hypothesis that the Nativity cycle was created for the choir screen of San Marco. The screen, along with the northern and southern pulpits, was probably built at the time of Doge Ranieri Zeno (r. 1253-1268). In 1394, the choir screen was taken down and replaced by the current transenna, and the set of sculptures dismantled with it. The present article is a first attempt at piecing the Nativity cycle together and reconstructing its context in San Marco. (shrink)

Simboličko ishodište za tekst predstavlja Malevičev »Crni kvadrat«, odnosno epistemološki prijelaz u teorijskom razumijevanju spomenutog umjetničkog djela: iz fenomenološko-ontološke perspektive ka psihoanalitičkoj interpretaciji istog. Putem aplikacije Lacanovog koncepta pogleda, povlačimo paralelu između simbolike Malevičevog kvadrata i primjera ekrana kroz opozicijsko sučeljavanje televizijskog i kompjutorskog ekrana. Definiranjem razlika između televizijskog i kompjutorskog ekrana reaktualiziramo i spomenuti Lacanov koncept, te ga u redefiniranoj verziji apliciramo na primjere kompjutorskog virtualnog prostora i identitet tzv. virtualnog subjekta. Tako uspostavljen problemski motiv obrađujemo i preko razmatranja (...) dihotomnog para interaktivnost/interpasivnost, sa naglaskom na modelu HCI , interakciji čovjeka i kompjutora. Paralela između umjetničkog objekta i suvremene medijske tehnologije, a sve u vezi sa subjektom koji se pita i time sebe konstituira, putokaz je prema pitanju koje predstavlja jedan od temeljnih interesa teksta, a ono glasi: o kakvom se konstruktu subjekta, odnosno formi njegova identiteta uspostavljenoj u prostoru virtualnog, zapravo radi?Symbolical starting point of the text is »Black Square« by Kazimir Malevich, or more exactly, an epistemological transition within theoretical understanding of the mentioned artwork: from a phenomenological-ontological perspective toward psychoanalytical interpretation of it. According to application of the concept of regard by Jacques Lacan, and regarding to oppositional distinction between television screen and computer screen, I am searching for a parallel between Malevich’s Square and symbolic of the screen. Process of definition of differences between television screen and computer screen is the way of re-actualization of previously mentioned Lacan’s concept, and I make an application of it on examples of computer virtual space and so-called virtually created identity. Primal theoretical problem of the text is working out through dichotomy interactivity/interpassivity with stress on the model of HCI that is interaction of human with computer. Parallel between an artwork and contemporary media technology, regarding to a human subject under self-questioned and self-created processes, leading us toward the question which is the one of main interests in the text: what is the model of self identity created within virtual space? (shrink)

In 1947, the Cornell psychiatrist Keeve Brodman and a handful of colleagues began developing what would become one of the most widely used health questionnaires of its time—the Cornell Medical Index (CMI). A rigidly standardized form, the CMI presented 195 yes-no questions designed to capture the health status of “the total patient.” Over the following decades, Brodman’s project of standardizing medical history taking gradually evolved into a project of mathematizing and computerizing diagnosis: out of the CMI grew the Medical Data (...) Screen (MDS), one of the first computerized methods of deriving diagnoses from patient data. This essay follows the life course of these tools through the second half of the twentieth century. It argues for a genealogy of biomedical computing and computerized diagnosis that takes more seriously the continuities between computer-based digital practices and paper-based analog ones. The computerized MDS evolved from, and rested upon, paper data practices associated with questionnaires and surveys. The interlocking histories of the CMI and the MDS prompt a reconsideration of the material and temporal parameters within which the history of computerized medicine has conventionally been understood. (shrink)