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

Born in Zambia on December 16, 1970, and currently a second-generation Canadian citizen, Farzana Doctor is a Dawoodi Bohra Muslim writer whose lineage goes back to India. Her family moved to Canada when she was 6 months old. She completed her master’s in social work in 1993 from Carlton University, Ottawa, and grew up in Whitby, Ontario. A social worker, psychotherapist, activist, and poet, Farzana is a bona fide social activist (Registered Social Worker, RWS) who has worked for a variety (...) of social organizations that deal with mental health disorders due to sexual orientation, gender identity, and fluidity; substance use and abuse; and other addiction programs for homeless youth in Toronto. She has also been running her private psychotherapy practice since 2004. The mentoring and assistance also extend to providing training to groups and cohorts in psychodynamic and therapeutic cognitive practices. In 2001, she co-produced a documentary film about the family relationships of LGBT people in Toronto’s South Asian immigrant communities called Rewriting the Script: A Love Letter to Our Families. From 2009 to 2018, she curated the Brockton Writers Series (BWS), a bi-monthly literary reading series focusing on Canadian diversity and its representation in Canadian literature. She coordinates regular reading series in Toronto’s Brockton Village neighborhood. (shrink)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescribing antidepressants and benzodiazepines for patients with emotional distress is a common practice in primary healthcare that raises certain ethical questions. This paper has three aims. First, to describe the motivations that lead general practitioners to prescribe antidepressants and benzodiazepines in these cases. Second, to reflect on the ethical implications of such prescriptions based on the four principles of biomedical ethics defined by Beauchamp and Childress (autonomy, nonmaleficence, beneficence, and justice). Finally, to propose some recommendations for the mitigation of the (...) medicalization of emotional distress in primary healthcare. Results show that general practitioners seek to alleviate patients’ suffering but their prescribing decisions are influenced by some uncertainties in clinical judgement as well as by systemic factors (patients’ pressures, time constraints, and unawareness of resources). Ethical issues arise in relation to the potential for dependence, the questionable long-term benefit of prescriptions, the uncritical fulfillment of patients’ expectations, and the impediment to address underlying social issues or to develop patients’ capabilities. Clinical consultation should be founded on effective communication between doctors and patients and a holistic care approach that acknowledges the psychological, social, and existential dimensions should replace a merely symptomatic approach. Some strategies to mitigate medicalization are proposed: the promotion of regular monitoring visits with patients and multidisciplinary collaboration, the enhancement of physicians’ knowledge about non-pharmacological interventions, as well as the establishment of an evidence-base for the effectiveness of these drugs in the primary healthcare setting. (shrink)

Building on conversation analytic research in workplace meetings, this study examines a notable and systematic variation in meeting openings observed in 52 video-recorded Japanese rehabilitation team meetings: the doctor-initiated pattern (DIP) and the other-party-initiated pattern (OIP). The analysis focuses on the multimodal organization of interaction in each opening sequence, where participants mobilize bodies, language, and objects—including technologies and documents—to accomplish stepwise transitions to the meeting proper on a moment-to-moment basis. A systematic, comparative analysis of the data reveals that participants construct (...) the DIP using a set of modular components—preparation, readiness check, and transition—which they flexibly modify through reordering, expanding, and omitting. In contrast, the OIP, observed here in cases of delayed openings, follows an alternative pattern: participants display their readiness in advance, resulting in the preemption of the readiness check. These practices illustrate a pattern of practical regularity: instead of reproducing a fixed sequence, participants adapt the structure of openings to the practical circumstances of their interaction while relying on common components and actions. By exploring both generalizable patterns and setting-specific variations, this study contributes to ongoing discussions of canonical structures of meeting openings proposed in previous research. (shrink)

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

The article addresses issues at the nexus of physician industrial action, moral agency, and responsibility. There are situations in which we find ourselves best placed to offer aid to those who may be in vulnerable positions, a behavior that is consistent with our everyday moral intuitions. In both our interpersonal relationships and social life, we make frequent judgments about whether to praise or blame someone for their actions when we determine that they should have acted to help a vulnerable person. (...) While the average person is unlikely to confront these kinds of situations often, those in the medical professions, physicians especially, may confront these and similar situations regularly. Therefore, when physicians withhold their services for whatever reason in support of industrial action, it raises issues of moral responsibility to patients who may be in a vulnerable position. Using theories of moral responsibility, vulnerability, and ethics, this paper explores the moral implications of physician industrial action. We explore issues of vulnerability of patients, as well as the moral responsibility and moral agency of doctors to patients. Determining when a person is vulnerable, and when an individual becomes a moral agent, worthy of praise or blame for an act or non-action, is at the core of the framework. Notwithstanding the right of physicians to act in their self-interest, we argue that vulnerability leads to moral obligations, that physicians are moral agents, and the imperatives of their obligations to patients clear, even if limited by certain conditions. We suggest that both doctors and governments have a collective responsibility to prevent harm to patients and present the theoretical and practical implications of the paper. (shrink)

This issue of the Philosophical Thought journal is dedicated to the interdisciplinary study of the environmental impact of war on humans and society. It contains materials from the roundtable discussion, 'War and the Environment: Ecological, Ethical and Anthropological Dimensions', which took place on 28 March 2025 at the H. Skovoroda Institute of Philosophy, National Academy of Sciences of Ukraine (moderators: Anatoliy Yermolenko, Corresponding Member of the National Academy of Science of Ukraine, Director of the H. Skovoroda Institute of Philosophy; Tetiana (...) Gardashuk, Doctor Hab. in Philosophy, Head of the Department of Logic and Methodology of Science) and thematic articles. The roundtable, which brought together philosophers, natural scientists, and other humanities experts, provided an opportunity for a broad dialogue to find answers to today's challenges. It also allowed for a deeper understanding of how war transforms the environment, the value system, and the very essence of man. The discussion covered direct and indirect environmental damage (destruction of ecosystems and habitats, natural resources, agricultural lands, pollution, and climate change) and anthropological transformations caused by war, as well as ethical, philosophical, and artistic reflections on these issues. The impact of the war on the geological environment and the country's mineral resources was highlighted. The importance of evaluating these resources for the country's socio-economic potential and post-war rebuilding was emphasized. One of the central issues was the impact of Russian aggression on Ukrainian identity, particularly in terms of destructive environmental changes. Other issues included the moral and ecological dimensions of war, and rethinking ecocide as an ethical and existential catastrophe, as well as ways to confront it. It was also noted that nature is not only a 'silent victim' of war, but also a witness to tragic events, which leaves a unique imprint on the landscape of our memory. Participants also expressed their support for holding regular roundtable discussions on the topic of “War and the Environment”. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Scrutinizing the Art of TheaterAaron Meskin (bio)IntroductionIn his 1992 address to the American Society for Aesthetics, Peter Kivy suggested that philosophers of art might do best by giving up on “grand theorizing” (that is, pursuing the definition of art).1 In its place he proposed that they pursue the “careful and imaginative philosophical scrutiny of the individual arts and their individual problems.”2 Of course John Passmore and others had said (...) similar things at earlier points,3 but philosophical aesthetics has, it seems to me, finally and robustly taken the turn toward the philosophies of the arts. Much of the best work in philosophical aesthetics over the last fifteen years or so has pursued the route Kivy suggested. James Hamilton’s The Art of Theater is part of this turn—it is careful and imaginative scrutiny of the art of theater done at the very highest level, and I am delighted to have this opportunity to comment on it.4In what follows I shall address a number of issues raised by Hamilton’s work: the definition of theatrical enactment; the place of pretending and imagining in theatrical performance; the nature of Hamilton’s “ingredients model” and its relation to more traditional accounts of the work/performance relation; the account of theatrical style on offer; and the question of what we have learned from experimental theater.But before I move on to address those aspects of the book’s content in detail, let me say something about the pedagogical significance of this work. Although there are a number of legitimate ways to teach introductory courses on aesthetics and the philosophy of art (for example, by following a historical progression or by structuring it around certain key issues), one increasingly attractive option is to teach a course that focuses on those aforementioned individual arts and their individual problems. So, for example, I used to regularly teach graduate seminars in aesthetics to students enrolled [End Page 51] in a fine arts doctoral program. These students studied music, art education, the visual arts, theater, and dance; the seminars were designed to provide them with a broad foundation in philosophical aesthetics. Since they typically had no background in philosophy, I made the effort to assign readings and topics relevant to their own artistic practices and interests. Providing them with contemporary cutting-edge philosophical material on music and the visual arts was not hard. Kivy’s work, as well as that by Jerrold Levinson, Arthur Danto, Richard Wollheim, and others, makes that fairly easy. And intriguingly—since philosophers are commonly said to have ignored the art of dance—there’s even a decent amount of recent philosophical work on that art form by such authors as Graham McFee, Frances Sparshott, and Noël Carroll and Sally Banes.5 But where to turn to for the theater students? I would often read some of Aristotle’s Poetics with them, but I have to admit that the serious students of the theater that I encountered in those seminars typically knew that text much better than I did. (Still, I hope I challenged their breezy assumptions about catharsis!) We would read Hume on tragedy together—fun, but not really so much about the theater—and sometimes a bit of Nietzsche. But there was never much to give them from contemporary philosophers on the subject—a few articles here and there, of course, but nothing that clearly laid out the big and distinctive issues that the art form of theater raises. Nothing, to put the point a bit differently, that would provide any evidence that there really was a lively and extant philosophy of theater out there, as there are lively and extant philosophies of film, music, literature, and photography. In short, for those attracted to the prospect of teaching aesthetics as the philosophies of arts, the dearth of good work on theater by contemporary philosophers has been a significant source of frustration and even a bit of an embarrassment.The book in question is not the only recent philosophical work on theater. There are fine articles on the topic by David Osipovich, David Saltz, and Paul Woodruff, among others. Hamilton himself has a string of... (shrink)

The monograph includes works of specialists and scientists - active members of the bioethical movement In Ukraine, and regular participants in national congresses on bioethics in Kyiv for the last 20 years. Over the years, bioethics has become widely used our lives It is evidenced, in particular, by the list of topics that are presented in the collective monographs, namely: philosophical and philosophical aspects of bioethics and dissemination bioethical norms and rules in various spheres of human activity. Most articles (...) include both theoretical aspects of bioethics and examples of practical application of bioethical principles. The book is intended for scientists, doctors, philosophers, jurists, teachers and students of higher educational institutions, as well as a wide range of readers who are interested in bioethical issues. (shrink)

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

The movement of middle and upper-class women demanding higher education as a path to emancipation, which ideologically began in the eighteenth century, became increasingly stronger and more organized during the nineteenth century. The University of Zurich allowed women to study in 1864, making it one of the first universities to open its doors to women. Besides Swiss women, foreign women who could not yet enroll as regular students in their own countries also studied there. Among them were Croatian women. (...) The article discusses Croatian women who earned their doctorates at the University of Zurich from 1874 until the beginning of World War I. Helene Druskowitz and Elza Kučera earned doctorates in philosophy. Vera Philippović, Ada Broch, and Zora Prica earned doctorates in English literature, while Isolde Betlheim, Zora Živković, and Katica Jakšić Musulin earned doctorates in medicine. (shrink)

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

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

Lantos and Feudtner argue that SUPPORT was an instance of CER and that CER differs from research involving unproven, experimental therapies because it exposes research subjects to the same risks patients regularly face in clinical practice. Like many defenders of SUPPORT, they formally acknowledge the study as research but want it to be thought of as clinical care. They develop an appealing argument, but it is misleading. Whatever doctors might have done in clinical practice, their choice of target range (...) within the study and for study participants was influenced by research aims. Just as in research involving unproven, experimental therapies, the care of patients in SUPPORT was altered for the goal of obtaining knowledge to help future patients. (shrink)

As a medical practitioner affiliated to the city police and responsive to the demands of legal officials, the police surgeon daily worked at the intersection between differing professional collectives and communities in the nineteenth century. Conducting physical examinations of assaulted parties, undertaking post-mortem dissections and certifying cases of mental insanity formed the cornerstone of the police surgeon’s daily diet of forensic work in Victorian Edinburgh. In addition, the police surgeon was frequently on call day or night (and in any weather) (...) to the local force. Accordingly, this practitioner often became the vital first point of medical contact with victims (and suspects) in cases of homicide or assault in the nineteenth century. Yet despite the pivotal role this practitioner occupied as a forensic expert in the Victorian city, relatively little scholarship has been dedicated to analysing the contribution and nature of the police surgeon’s medico-legal work. However, analysis of the career and life of one Scottish police surgeon—Henry Duncan Littlejohn—indicates that the experience gained from the regular practice of medical jurisprudence was vital in developing and maintaining an authoritative medico-legal presence both within and outside the courtroom. In particular, historical records suggest that the surgeon of police collaborated with constables, detectives and prosecutors to facilitate the investigation and prosecution of violent crime. Sometimes this collaboration would be procedural and routine, such as directing officers to remove bodies to the mortuary of the police chambers. At other times, these practitioners worked closely with the local force and legal officials in more complex and influential ways that blurred the professional and practical boundaries between medicine, policing and criminal investigation. Moreover, the nature of Scottish procedure in suspicious deaths also forced the police surgeon to co-operate with a diverse range of medical practitioners in the examination and certification of death, injury and lunacy in the Scottish city. Sometimes, resolving inconsistencies in medical evidence could be a core part of the police surgeon’s role when consulted by the Crown. On other occasions, working in partnership with other doctors to establish an informed, robust and objective medical opinion of a case was vital to the consolidation of the police surgeon’s medico-legal authority. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"Call me Dr. XXX!"Yilu MaDisclaimers. Names have been changed to protect the privacy of those mentioned.Scheduled to interpret for a Mandarin-speaking woman, I entered the examination room and introduced myself to the neurologist and the patient, who was accompanied by her husband, brimming with smiles and sitting on the edge of the chair."How are you, Katie?" the husband greeted the doctor, using his accented English."Call me Doctor XXX!", the (...) physician returned, her eyebrows knotted with gravity. Immediately, the friendly and light-hearted air in the room froze.This occurred many years ago at a small clinic where I usually went to interpret as a per-diem interpreter. It happened so quickly that I was totally unprepared, and honestly, shocked at the way the physician reacted to the husband. I felt bad for the patient who sat next to her husband without saying anything, being quiet throughout the interactions. She suffered from dementia and was so dependent on her husband. I also felt slightly angry at the doctor's insensitive response to a mere friendly gesture, though seemingly improper, given the conventional power dynamics between the patient and the physician and the way doctors are esteemed in the American medical culture. But the doctor could have reacted to this perceived slight and disrespect with a mere laugh or simply pretended not to have heard it.Even more distinct was the fact the doctor showed her irritation in front of a third party—me, the medical interpreter. I felt she almost directed that to me and right in my face, and yet I felt powerless, helpless, and even embarrassed. I wondered if the doctor would do the same in front of her other colleagues—physicians and nurses. She might have been more diplomatic. Was her rebuke an impulsive reaction or a deliberate projection of her power, putting the husband back into his place? Should I intervene to ameliorate the impact and explain it? What if the doctor became angry with me if I ventured, and would it worsen things despite my good intentions? All these questions were stirring around in my head. Eventually, I decided to mind my own business and stayed in my role. But this episode of her open reprimand and implicit power projection stuck in my mind then and many years after.Over the years, I moved up from a medical interpreter to the Director of the Interpreter Services Department of a major teaching hospital in Boston and worked deliberately to elevate the status of [End Page 151] medical interpreters by educating clinicians about who we are, what we do, what qualifications and trainings we have and the unique roles we play in cross-cultural communication and care delivery. We demythologized medical interpreters' traditionally reductive role of mouthpiece and advocated their full-fledged member role on the care team. Through our regular conversations and dialogues (instead of top-down teaching sessions by clinicians), medical interpreters partner and team up with physicians, nurses, social workers, chaplains, ethicists, residents, and fellows. We learn from one another to foster a culture of collaboration and mutual respect, gradually bringing about a transformation of power dynamics; medical interpreters are valued for their unique roles of language conduit, clarifier, cultural broker and patient advocate. Interpreters now are empowered to ask questions, seek clarification, and advise on care approaches before, during, and after medical encounters with confidence and teamwork spirit.One of the tangible changes that we collectively implemented is that for each patient appointment, we will allocate time for a short meeting between the interpreter and the provider in what we call a "pre-huddle"; the purpose of the quick meeting is for the provider to brief the interpreter about the patient's medical condition and the goal of treatment. The provider will use the opportunity to solicit any input from the interpreter around language and cultural challenges.The interpreter, possibly having worked with the patient before, will provide some background and context if proper and necessary. This simple process change has boosted the interpreter's morale and engagement. Both parties feel comfortable and familiar with each other's roles and moves. By working in such an environment of... (shrink)

Julia Kristeva was born in 1941 in Bulgaria. She was educated by French nuns, studied literature and worked as a journalist before going to Paris in 1966 to do graduate work with Lucien Goldmann and Roland Barthes. While in Paris she finished her doctorate in French literature, became involved in the influential journal Tel Quel, and began psychoanalytic training. In 1979 she finished her training as a psychoanalyst. Currently, Kristeva is a professor of linguistics as the University of Paris VII (...) and a regular visiting professor at Columbia University. In addition to her work as a practicing psychoanalyst and her theoretical writings, Kristeva is a novelist. (shrink)

Introduction. Healthcare workers (HCWs) should theoretically have the necessary education and environment to adopt a healthy lifestyle, and they supposedly also should have a higher participation rate in WHP programmes. HCWs are, for several reasons, considered to be a key group in health promotion, especially due to the fact that the healthcare system reaches a substantial number of people in need of lifestyle changes such as increased physical activity (PA) [5]. Furthermore, healthcare professionals are considered to be the most credible (...) source of health information [6]. HCWs' lifestyles can play an important role in increasing awareness among patients regarding lifestyle changes, because HCWs' own lifestyle habits and interests in lifestyle behaviour have been shown to positively influence their counselling practices and attitudes [6–7]. The international movement 'Health Promoting Hospitals and Health Services', which was initiated by the World Health Organization (WHO), highlights the importance of also focusing on the health and lifestyle of the employees. Methods. We conducted survey based on a standardized and adapted questionnaire that included socio-demographic data and points related to healthy lifestyle. We adhered to the latest recommendations on designing and reporting survey studies. Before conducting the study, the questionnaire was pretested among 5 experts and revised twice. The survey was conducted in Kazakh / Russian for respondents who speak two languages fluently at the choice of participants. The filling of the questionnaire took on average 45 minutes. We reported absolute numbers and percentages. Chi-square tests were used to compare responses between groups. Results were considered significant at a P value of < 0.05. Statistical analyses were performed using the application SAS OnDemand for academia (version 3.81, Carry, North Carolina, USA). Results. Our data revealed that nurses were more likely to adhere to healthy eating principles and to have a regular diet at home. GPs were more likely to consume fast food and add salt when food is not salted enough. Nurses were more likely to eat greens regularly. GPs had a stronger belief in the impact of diet on health. More nurses rated their diet as healthy. Media promotion significantly influenced GPs for changing diet towards healthier options. Eating patterns vary according to the risk of stress. Research shows that chronic stress influences the amount and types of consumed food, contributing to both overeating and malnutrition, and that stress hormones can lead to the development of obesity. GPs are more likely to have used tobacco products compared to nurses. GPs are more likely to smoke more than 10 cigarettes per day. GPs have a slightly higher belief in the necessity of a healthy lifestyle compared to nurses. GPs and nurses have different testing frequencies for Hepatitis B and C, with nurses testing more frequently. GPs are more likely to have sexual activity after drinking alcohol. Conclusion. It is known that a healthy lifestyle of doctors affects the attitude of patients and their motivation to change their lifestyle. Thus, the lifestyle patterns of health workers, as well as the understanding of the motivation of these patterns, are more likely to affect public health. (shrink)

The Institute of Higher Education of the NAES of Ukraine has celebrated the 25th anniversary of its activity. This review is dedicated to summarizing the fruit­ful academic research, methodical and educational activities of the Institute dur­ing its 25-year history, as well as to outlining the prospects for its further devel­opment. Over the years of its activity, the Institute has accumulated considerable experience in the field of fundamental and applied research of topical problems of higher education. The results of the Institute’s (...) research have formed the basis of methodological recommendations and developments, which are being used in HEIs in Ukraine. Thanks to its academic activity, the Institute has trained high-level specialists who make a significant contribution to the development of Ukrai­nian science and education. The Institute has specialized scientific councils for the defense of theses of Doctors of Science, as well as regular one-time defenses of theses for the awarding of the scientific degree of Doctor of Philosophy. The In­stitute actively cooperates with Ukrainian and foreign universities, participates in international projects aimed at the development and modernization of the higher education system. The Institute publishes three specialized scientific journals, an­nually publishes collective scientific monographs based on the results of scientific research carried out by the Institute’s departments. The Institute plays an impor­tant system-creating function in the development of higher education in Ukraine. The Institute’s work is especially important at wartime. The institute investigates the impact of the war on the system of higher education and ways of its recovery. It develops innovative teaching methods, trains specialists who meet the needs of the contemporary society, and participates in reforming higher education in Ukraine. 25 years of the Institute of Higher Education of the NAES of Ukraine – that’s 25 years of academic achievements, painstaking work and dedication to one’s job. That’s 25 years of knowledge and experience that serve for the good of the Ukrainian education. (shrink)

Our text is divided into two[aut]Skuhala Karasman, Ivana parts. In the first part an overview of the life and career of the Austrian philosopher of Croatian origin[aut]Druskowitz, Helene, Helene Druskowitz will be given. She was born near Vienna in 1856. In 1878, she received her doctoral title from the University Zurich. She was the first womanWomen from a Germanic country to receive a doctoral title in the regular way. After her return to Austria, she tried to make her career (...) as a free-lance writer and public speaker. During this time, she made some influential acquaintances (F. Nietzsche, M. von Salis-Marschlins, M. von Ebner-Eschenbach, F. C. Meyer and others). However, due to her unorthodox lifestyle and mental problems she was put in various institutionsInstitution and sanatoria in which she spent the rest of her life, from 1891 till 1918. In the second part of our text her book from 1887, Wie ist Verantwortung und Zurechnung ohne Annahme der Willensfreiheit möglich? will be analized. In this book Druskowitz defends a compatibilist position: she reconciles naturalist determinismDeterminism with the defense of responsibilityResponsibility. Her argument is based on a combination of a revised position of Schopenhauer supplemented by a moral interpretation of evolutionism. Persons are self-conscious representatives of a particular combination of naturalNatural forces which makes humans both a part of the naturalNatural world (and thus determined) but, since they are a special part of nature, and aware of it, they bear moralResponsibility responsibility. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Lisa’s StoryLisa P. (wife of patient) and Jeanne KerwinMy husband suffered from sudden onset of heart failure with a very low ejection fraction and was on IV Milrinone at the age of 47. One of the most powerful things he told me was that he was not afraid to die and therefore did not want to move forward with Milrinone. He eventually “did it for the kids.” After the (...) Milrinone drip was no longer working, he was offered an LVAD (left ventricular assist device) to keep him alive. He refused, but the doctor again convinced him to “do it for your kids” and said, “we put these devices in 80-year-olds.” He did not have time to explore any other options and reluctantly accepted the LVAD. It was implanted in May of 2014 in a very long and complicated surgery with a long and difficult recovery. He was in the hospital for a long time, and then he refused to go to rehab upon discharge, making it difficult for our family to manage, as he was extremely weak and needed care of his wound dressing. He worried about the financial [End Page 7] impact of a heart transplant and the medications required, as we were already struggling with the medical bills. He refused to have more surgery with the potential complications and never agreed to get on the transplant waiting list.After the implanted LVAD, my husband was not able to do most of what he loved in life. He couldn’t work (he was a truck driver), he couldn’t go fishing or swimming in the ocean, he couldn’t go hunting and fishing, and his overall physical condition was so poor that he couldn’t cook, garden and, most aggravating to him, he could not take a regular hot shower. The LVAD had to be covered with plastic in order to avoid getting the drive-line area wet, so bathing was a complicated process. He had trouble with stairs, had neuropathic pain in his legs from diabetes, and because of the pain medications, he felt cloudy and dizzy and slept most of the day in his recliner. I took care of him, even after I had to go back to work, and at the same time, I managed our two children (ages 9 and 12 at the time of LVAD).After almost two years of living with the LVAD, multiple hospitalizations for GI bleeds then seizures, more medications, and weekly blood draws for INR1, my husband requested that the LVAD be de-activated and that he be allowed to die of his heart failure. He described his life as “miserable.” He watched as his misery impacted his children and me. He suffered daily and had none of the joys that made life worth living for him. When we approached the cardiac team that implanted and monitored his LVAD with his request, they said “no.” They would not de-activate the LVAD because it was working. It was keeping him alive and he had no other terminal illness. His palliative doctor, who was treating his pain, also heard his request and told us to call for an “ethics consult” to determine if he would be “allowed” to have the LVAD de-activated. We got the number and called on March 31, 2016.At the time of the call to Ethics, we had no idea what “Ethics” was, other than a general definition of the word ethics as in professional behaviors and such. We did not know what to expect but we called. We would never have known to call “Ethics” if the palliative doctor had not advised us to do so, and my husband might have suffered a longer, more painful life both mentally and physically prolonged by the LVAD.We explained the request to the ethics consultant. She listened to my husband describe his daily living and his dissatisfaction with the quality of his life, his physical and emotional suffering, and his wish to rid himself of the LVAD and allow nature to take its course. There was actually no decision to be made on his part. He had already made up... (shrink)

Clinical bioethics plays a significant role in hospital settings through bioethics consultations, which focus on providing ongoing assistance in complex situations within the doctor-patient dynamic. These consultations entail regular interaction between physicians and clinical bioethicists. This situation prompts an exploration into how bioethics consultations affect physicians. The current research aims to understand the influence of bioethics consultations on physicians’ bioethical knowledge by analyzing the lexical content in their patients’ medical records. Medical records are a synthesis carried out by physicians, (...) often reflecting collaborative efforts, and capturing verbal statements indicative of thought processes suggestive of learning. The study is a sequential mixed-methods design with a retrospective descriptive approach, comparing medical records from the early years of the Department of Humanism and Bioethics’ operation (2013–2015) to the more recent ones (2019). Technical bioethical terminology such as “therapeutic effort limitation,” “futility,” “beneficence,” and “respect for autonomy” is more prevalent in recent medical records. This trend may stem from the positive impact of bioethics consultations conducted by the Department, with haptic communication serving as a particularly effective form of interaction with others during experiences of moral distress. This appears to be characteristic of cultures like those in Latin America. (shrink)

The SARS-CoV-2 pandemic has transgressed biomedical categories. According to Horton, it turned out to be a 'syndrome' that infected virtually all spheres of social life. The pandemic has created toxic social atmosphere highly unfavorable to clinical and clinic-ethical decision making. Constraints and pressures related to micro-, meso-, exo- and macro-environments framing doctors, nurses, and medical students in training were identified. These factors exacerbated moral distress (moral injury) amongst clinicians. In a joint Polish-Lithuanian project (IDUB 2020-2022) we examined predictors of (...) moral distress in pandemic clinical contexts. A survey-based, real-time, correlational and comparative study was conducted in Poland and Lithuania after the first year of pandemic with N=227 participants. Unexpected differences on regular and pandemic-type moral distress levels were found between the two national samples. Polish participants showed significantly higher moral distress levels than their Lithuanian counterparts. The following article discusses these findings and recommends the reinforcement of resilient medical decision making. (shrink)

Franz Brentano is one of the major figures of what is known as the “Austro-German” tradition. A distinctive feature of this tradition is its concern with clarity and argument, as opposed to the speculative and “jargon-laden” philosophy of the nineteenth century, which is to say—according to the Austro-German authors themselves—post-Kantian idealism. In this respect, the Austrian philosopher and Catholic priest Bernard Bolzano, inasmuch as he was anti-Kantian and anti-idealist, can be placed at the origins of Austro-German philosophy. It should be (...) noted that Bolzano was well-versed in Aristotelian philosophy and logic, as the numerous references in his Wissenschaftslehre of 1837 attest. Nonetheless, the most influential thinker in the Austro-German tradition was not Bolzano, but Brentano. From a methodological perspective, Brentano also insists on the importance of clarity and argument, and he also is opposed to speculative thinking. In the famous fourth thesis in his Habilitationsschrift, he maintains that philosophy, which includes psychology, should follow “the method of the natural sciences,” that is, it should be based on experience. In the case of psychology, this amounts to saying that it must rest on “inner perception”—in other words, it should be done from the point of view of reflexive consciousness—and free itself from any metaphysical prejudices. Brentano’s research inspired a large number of followers: probably the best-known products of the school of Brentano are Husserl’s phenomenology, Meinong’s theory of objects, the Lvov–Warsaw school of logic founded by Twardowski, and the various traditions of Gestalt psychology. Brentano himself was a student of Adolf Trendelenburg in Berlin. Trendelenburg played an important role in the renewal of Aristotelian thought in the German-speaking world: he taught the philosophy of Aristotle for almost thirty years without interruption, and was a major influence on many students. Having in this way become familiarized with the philosophy and psychology of Aristotle, Brentano wrote his famous doctoral thesis on the Aristotelian theory of categories in 1862, and his Habilitationsschrift on Aristotles’s psychology in 1867. These two works also attach great importance to the scholastic reception of Aristotle’s philosophy, especially Thomas Aquinas. This interest in Aristotle was not confined to Brentano’s youth: he published books on Aristotle throughout his life, and regularly lectured on the history of ancient and medieval philosophy. It should also be pointed out that Brentano too was a priest, but left the priesthood around 1870 after contesting the doctrine of papal infallibility. (shrink)