According to Jewish law, to make a judgment that a life has no purpose and is not worth saving is contrary to the concept of justiceTraditional medical practice dictates that when patients are unable to eat or drink enough to sustain their basic nutritional requirements, artificial feeding and hydration is indicated. Common clinical examples of this problem are patients with senile dementia and those in a persistent vegetative state . In recent decades, however, the practice of mandating (...) class='Hi'>artificial feeding has been increasingly questioned. A combination of legal, ethical, and clinical considerations has resulted in broad support for withholding and withdrawing artificial nutrition. The guiding ethical principle in the current clinical standards is that patient autonomy must be honoured. In the context of an incompetent adult , advance directives or surrogate decision making are legally binding. Such requests to withhold artificial nutrition are considered appropriate and even encouraged.1 Such a view, however, is not unanimous. For example, Catholic writers have questioned the current consensus. The New Jersey Catholic Conference has written that withholding nutrition and hydration from such patients “ultimately results in starvation, dehydration, and death,” and that withdrawing such basic care from patients who are not dying but in a PVS “is a clear statement that the patient’s life has no moral value”.2 This question is also of great concern in Jewish law . In contrast to secular medical ethics, halachah requires that artificial feeding be given to patients with dementia or in a PVS. The following discussion gives an overview of the pertinent arguments that have led to the consensus in secular ethics that artificial feeding may be withheld from the severely demented and the halachic considerations that argue against this practice.CLINICAL ARGUMENTS IN FAVOUR OF WITHHOLDING ARTIFICIAL FEEDINGThe most obvious …. (shrink)

In this article, we examine the emergence of a concept of medical feeding that emphasizes artificiality and medical technology. We discuss how this concept has been created in specific contrast to the daily provision of food and water; medical definitions retain clear disjunctures with cultural and religious beliefs surrounding food, gendered aspects of eating and feeding, and the everyday practices of social and family life in the United States. We begin with an examination of the historical processes involved (...) in creating artificial nutrition and hydration as a medical concept, including the evolution of terminology and practices in relation to technology advancement, legal cases, and public discourse. We.. (shrink)

The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical (...) and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family. (shrink)

A Palestinian administrative detainee in Israel asked for the author to care for him as an independent physician while in hospital on two hunger strikes, lasting 66 and 55 days, respectively. Hunger striking is placed in the context of other forms of food refusal and artificial feeding. The various perspectives on the challenge of the medical care of hunger strikers are reviewed, as seen by the state, the public, the doctor and the patient. Institutional statements on the management (...) of hunger strikers are reviewed and the local political considerations are highlighted. In conclusion, a trusting doctor–patient relationship is presented as the crucial element for securing a successful outcome, preserving the prisoner's life and dignity with no significant political damage incurred by the State. (shrink)

Breastfeeding is analogous to pregnancy as an experience, in its exclusiveness to women, and in its cost and the effects it has on equitable share of labor. Therefore, the history of formula feeding provides useful insights into the future of full ectogenesis, which could evolve into a more severe version of what formula feeding is today: simplify life for some women and provide couples with a more equitable share of work at the cost of stigma, guilt and a (...) daily diet of studies purporting to show the benefits of natural pregnancy. Making pregnancy an optional route to motherhood would make women's life trajectory more similar to men's and thus put pressure on women to compete with men on the ground shaped by men's preferences. Despite being a treasured experience of many women today, bearing children could become the luxury of the few, the province of the very poor and a choice working women will pay a high price for as women who choose pregnancy become stigmatized as self-indulgent or unprofessional and penalized for it in the workplace. At the same time, scarce societal resources that could be used to support pregnant women and working mothers would instead be directed toward proving to women or even forcing them to gestate children "the right way." While not necessarily threatening on its own, when added to formula feeding, IVF, stem-cell produced ova and sex robots, full ectogenesis could diminish men's stake in women's wellbeing and even existence. (shrink)

The response to feeding needs in advanced dementia patients is a subject of ethical inquiry. Advanced dementia is the debilitating result of a range of neurodegenerative diseases. As this terminal illness progresses, patients develop mild to severe dysphagia that can make swallowing difficult. Of the two available options, artificial tube feeding or oral hand feeding, an estimated one-third of these patients will receive artificial tube feeding. However, observational studies have failed to validate the clinical (...) benefits of tube feeding. Ethics of care, the feminist philosophical perspective, and Ubuntu philosophy offer arguments for the choice of oral hand-feeding as a preferrable first option by caregivers as far as possible. These moral theories acknowledge that human beings can be dependent for long periods, mostly early and later years of life. Both views reflect an approach that draws people into a system of interdependent caring relationships. They encourage hand feeding as a way of exhibiting solidarity and respecting human dignity even at the end of life. (shrink)

This collection of essays by some of the most prominent Catholic bioethicists addresses the Pope s statements, the moral issues surrounding artificial feeding and hydration, the refusal of treatment, and the ethics of care for those at the ...

In lieu of an abstract, here is a brief excerpt of the content:FEEDING THE COMATOSE AND THE COMMON GOOD IN THE CATHOLIC TRADITION ROBERT BARRY, O.P. University of Illinois Ohampaign-Urbana, IlUnoi8 AA RECENT convention :sponsored by the Catholic Health Associaition in Boston, Laurence J. O'Connell, vice-president for ethics and theology, ma.de the following comments: I am concerned that some of those who are legitimately alarmed by the potential abuses associated with the public policy that authorizes the withholding and withdrawing (...) of mechanical means of nutrition and hydration are sometimes publicly misrepresenting the Catholic moral tradition. In other words, in their well-intentioned and perfectly legitimate efforts to avoid the slippery-slope-that is, the wrongful withholding or withdrawing of nutrition or hydration from vulnerable dasses of patients-those advocates are placing the Roman Catholic moral tradition itself on the slippery slope. It is mistaken to say it is the church's teaching that we may never withhold or withdraw artificial nutrition and hydration. It is mistaken to uncritically refer to the removal of medically engineered nutrition in all cases as starvation-that is, the willful withholding of nutrition as morally obligatory. It is mistaken to say that the ethical standards of a single Catholic hospital are necessarily coextensive with the ethical standards of the Catholic Church. Just because an individual Catholic facility, for whatever reason, uniformly refuses to allow the withholding or withdrawing of technological feeding, does not mean that the Church itself disallows such withholdings or withdrawals.1 It is not clear how the Catholic moral tradition can be put on the " slippery slope " by opposing certain forms of with1 "Church and State Overlap in Ethical Debate", American Medicai News. February 27, 1987. p. I. 1 ROBERT BARRY, O.P. drawal of feeding from specific classes of patients. Dr. O'Connell has misrepresented the thought of most of those who oppose the recent American Medical Association's new opinion which holds that artificially administered nutrition and fluids can be removed from terminally ill patients, even when they are not imminently dying.2 There are no Catholic moralists who claim that it is always and everywhere morally wrong to withhold or withdraw feeding from patients. However, there are a number of moralists as well as bishops who now hold it to be wrong to withhold or withdraw feeding in those cases where the withholding or withdrawal becomes the fundamental and underlying cause of death. O'Connell is p11obably correct in saying that the policies of one hospital do not necessarily deteJ1IDine the moral doctrines of the universal Church, but neither does one national organization such as the Catholic Health Association with only a loose affiliation with the magisterial hierarchy of the Church necessarily do this either. The debate over the provision of,aissisted feeding is a debate over whether iit is morally legitimate ito withdraw feeding so 1tihat.t:he primary and fundamental reason why the person dies is that withdrawal. It is a debate over whether those with a certain " quality of life " can be permitted to be killed by omission. It is a debate over whether feeding provided by routine nursing measures that can significantly sustain the life is a medical treatment that should he governed by the criteria governing other treatments, or whether it is an 2 "Withholding or Withdrawing Life Prolonging :Medical Treatment" adopted by the Council on Ethical and Judicial.Affairs of the.Amercian Medical.Association on March 15, 1987, In its pertinent parts, it stated: The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the choice of the patient, or his family or legal representative if the·patient to act in his own behalf, should prevail. Life prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition or hydration. In treating a terminally ill or irreversibly comatose patient, the physician should determine whether the benefits of treatment outweigh its burdens..At all times, the dignity of the patient should be maintained.•. FEEDING THE COMATOSE 8 aspect of normal care, like protection from exposure or hygienic care, that is to be accorded to all patients. In this piece, I wish to review the thoughts of some... (shrink)

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter (...) of conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction. (shrink)

Respecting and encouraging autonomy in the elderly is basic to the practice of geriatrics. In this paper, we examine the practice of cardiopulmonary resuscitation (CPR) and "artificial" feeding in a geriatric unit in a general hospital subscribing to jewish orthodox religious principles, in which the sanctity of life is a fundamental ethical guideline. The literature on the administration of food and water in terminal stages of illness, including dementia, still shows division of opinion on the morality of withdrawing (...) nutrition. We uphold the principle that as long as feeding by naso-gastric (N-G) or percutaneous endoscopic gastrostomy (PEG) does not constitute undue danger or arouse serious opposition it should be given, without causing suffering to the patient. This is part of basic care, and the doctor has no mandate to withdraw this. The question of CPR still shows much discrepancy regarding elderly patients' wishes, and doctors' opinions about its worthwhileness, although up to 10 percent survive. Our geriatric patients rarely discuss the subject, but it is openly ventilated with families who ask about it, who are then involved in the decision-making, and the decision about CPR or "do-not-resuscitate" (DNR) is based on clinical and prognostic considerations. (shrink)

We have created the homunculus and have seen the monstrous being. Forty days the sperm lay buried in manure and each day at noon the Master turned his magnet across it, muttering foreign words. Then, on the fortieth day he showed me the resemblance of a man, but it was transparent, without a corpus. He told me we should feed the loathsome object for exactly forty weeks, and all this time allow it to lie in its bed of manure in (...) a continual and even temperature, so that its every member might develop. This we did, much against my will. And it grew into a human child, though much smaller than any born of Woman. Now, my friends ask me to make one for them That they may be as horrified as I. I would do so for their admiration, except that I am merely the apprentice of the Master, and I am afraid. (shrink)

Withdrawing Artificial Nutrition and Hydration in the neonatal intensive care units has long been controversial. In France, the practice has become a legal option since 2005. But even though, the question remains as to what the stakeholders’ experience is, and whether they consider it ethically appropriate. In order to contribute to the debate, we initiated a study in 2009 to evaluate parental and health care professionals perspectives, after they experienced WAHN for a newborn. The study included 25 cases from (...) 5 different clinical neonatology departments. We interviewed both the parents and some of the HCP who cared for the baby, at least 6 months after this latter deceased. We proceeded through in-depth individual qualitative interviews. Content was analyzed for themes and patterns that emerged from the data. Some parents expressed that WANH offered an opportunity to the family to spend a few demedicalized days with the baby before she dies, without any tubes and machines, and to be well supported by the HCP during this palliative stage. But others evaluated the practice in retrospect as a terrible ordeal. All said that, at least, the time of waiting for death to ensue should not last too long. After a few days, it becomes unbearable because of the transformation of the baby’s appearance and because they, as parents, began to wonder if she was not dying from starvation rather than from her initial disease. An important proportion of HCP also expressed some kind of ethical unease. This was due to the psychological violence involved in the decision for a human being to stop feeding a little one, and also to the difficulty to deal with the fundamental intention behind the decision of WANH: indeed, could it be claim that it does not presuppose the intention of provoking the infant’s death? The discussion focuses on the point to know if WANH can be considered as a source of progress from an ethical point of view, particularly in comparison with earlier practices—that in France could involve active euthanasia by lethal injection. We argue that when HCP are merely focused on avoiding that WAHN could be construed as a way of intending to hasten the baby’s death, the practice is at risk to be implemented in a way that becomes ethically counterproductive. Focusing on this intention easily distract the clinical teams from what should be their ultimate concern, namely the baby’s comfort during the dying process, as well as the support owned to her parents. To conclude, we suggest that the ethical priorities, when WANH is decided, should be the support due to the patient and her family on the one hand, and, on the other hand to implement it in such a way that at least the baby seems to have died of her initial disease and never of starvation. This means that HCP have a duty to control the timing of death, even though this might be incompatible with the worry to avoid the intention of hastening the baby’s death. (shrink)

Patients with advanced dementia suffer from severe cognitive and functional impairment, including eating disorders. The focus of our research is on the issue of life-sustaining treatment, specifically on the social and ethical implications of tube feeding. The treatment decision, based on values of life and dignity, involves sustaining lives that many people consider not worth living. We explore the moral approach to caring for these patients and review the history of the debate on artificial nutrition and hydration showing (...) the impact of the varying perceptions of the value of these patients' lives on changing norms. We argue that in light of the value of solidarity, decisions about life-sustaining treatment for patients with advanced dementia should be made on a case by case basis, as with any other patient, in consideration of the medical implications of the intervention which might best serve the goals of care for the individual patient. (shrink)

“My first long haul flight that didn’t fill up and an empty row for me. I have been blessed by the algorithm ”. The phrase ‘blessed by the algorithm’ expresses the feeling of having been fortunate in what appears on your feed on various social media platforms, or in the success or virality of your content as a creator, or in what gig economy jobs you are offered. However, we can also place it within wider public discourse employing theistic conceptions (...) of AI. Building on anthropological fieldwork into the ‘entanglements of AI and Religion’, this article will explore how ‘blessed by the algorithm’ tweets are indicative of the impact of theistic AI narratives: modes of thinking about AI in an implicitly religious way. This thinking also represents continuities that push back against the secularisation thesis and other grand narratives of disenchantment that claim secularity occurs because of technological and intellectual progress. This article will also explore new religious movements, where theistic conceptions of AI entangle technological aspirations with religious ones. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores whether one such tradition—halachic Judaism—in fact demands the use of artificial nutrition and hydration in this setting. Traditional arguments have been advanced holding that treatment can be withheld in persons (...) who are dying, in individuals whose condition causes great suffering, or in the event that the treatment would produce suffering. Individuals with advanced dementia can be considered to be dying, often suffer as a result of their dementia, and are likely to suffer from the use of a feeding tube. Given these observations and the absence of a compelling case for distinguishing between tube feeding and other forms of medical treatment, traditional Judaism appears compatible with withholding artificial nutrition for individuals with advanced dementia. (shrink)

Experimental cattle aided agricultural scientists throughout the nineteenth and twentieth centuries in their efforts to produce beef and milk more efficiently for the growing human populations of the United States. Feed experiments were especially important for understanding how and what cattle needed to eat to better produce this food. However, as experts dedicated their time toward creating the most “economical” rations, their organism of focus shifted. This essay describes how scientific efforts to understand feed conversion in livestock became increasingly focused (...) on the role of ruminant microorganisms over the course of the twentieth century. Highlighting media coverage of fistulated cows and the design of artificial rumens, I argue that the scientific shift from macro- to microorganism was contemporaneously embraced and, in turn, funded by agricultural chemical companies to better market animal feed products by the postwar period. (shrink)

In this paper, I reflect on the puzzle that machine learning presents to social theory to develop an account of its distinct impact on social reality. I start by presenting how machine learning has presented a challenge to social theory as a research subject comprising both familiar and alien characteristics (1.). Taking this as an occasion for theoretical inquiry, I then propose a conceptual framework to investigate how algorithmic models of social phenomena relate to social reality and what their stochastic (...) mode of operation entails in terms of their sociality (2.). Analyzed through a theoretical lens that relies on central tenets of sociological systems theory, I find that machine learning implies a distinct epistemic transformation, based on how algorithmic modeling techniques process meaning as represented in data embedded in vector space. Building on this characterization, I introduce my conceptualization of stochastic technology as distinct from mechanistic technologies that rely on causal fixation (3.). Based on this understanding, I suggest that real-world applications of machine learning are often characterized by a constitutive tension between the stochastic properties of their outputs and the ways in which they are put to use in practice. Focussing on the large language models LaMDA and ChatGPT, I examine the epistemological implications of LLMs to account for the confusion of correlation and causality as the root of this tension. Next, I illustrate my theoretical conception by way of discussing an essay on image models by German media artist Hito Steyerl (4.). Following a critical reflection on Steyerl's characterization of Stable Diffusion as a “white box ”, I finally propose to conceive ofmachine learning-based technologies as stochastic contingency machines that transform social indeterminacy into contingent observations of social phenomena (5.) In this perspective, machine learning constitutes an epistemic technology that operates on meaning as extractable from data by means of algorithmic data modeling techniques to produce stochastic accounts of social reality. (shrink)

Romanis and Adkins discuss pregnancy loss in relation to artificial amnion and placenta technology (AAPT) for treatment of extremely preterm infants.1 I agree with the authors that AAPT, although it is expected to provide better care for extremely preterm infants, will also be challenging for parents. I, therefore, commend Romanis and Adkins for promoting a more holistic care that includes parents and pregnant persons. However, I believe that they create two false dichotomies, one between the pregnant person/parent and the (...) fetus/child and one between current neonatal intensive care unit (NICU) and AAPT that hinder holistic care. Romanis and Adkins correctly point out that much of the discourse and care surrounding preterm deliveries focuses mainly on the infant. I agree with Romanis and Adkins that true holistic care should also include the parents rather than focusing exclusively on the child. However, the language they use to petition for more inclusive care can be problematic and counteractive to achieve holistic care. The problem is that they accuse any fetal/child consideration of being fetal-centric and, in the same breath, they state that it is something to be challenged. This attitude is problematic as it feeds into the rhetoric of the maternal–fetal conflict. This is a common rhetoric in reproductive and neonatal care used mainly in situations …. (shrink)

The bioethical issues confronting the Jewish chaplain in a long-term care facility are critical, particularly as life-support systems become more sophisticated and advance directives become more commonplace. May an elderly competent patient refuse CPR in advance if it is perceived as a life-prolonging measure? May a physician withhold CPR or artificial nutrition and hydration (which some view as basic care and not as therapeutic intervention) from terminal patients with irreversible illnesses? In this study of Jewish ethics relating to these (...) issues, the author carefully examines the moral implications and legal precedents in the literature. Jewish ethics, affirming a 'sanctity of life' position, suggest that while an elderly person may direct in advance that CPR not be administered in most instances, in the absence of a DNR (Do Not Resuscitate) order, CPR must be performed. In reference to 'tube-feeding', while there is some debate about whether elderly patients may refuse the initiation of 'tube-feeding', there is a consensus that once initiated, it may not be withdrawn. (shrink)

Imposing artificial feeding on people with anorexia nervosa may be unethical. This seems to be Heather Draper's suggestion in her article, ‘Anorexia Nervosa and Respecting a Refusal of Life‐Prolonging Therapy: A Limited Justification.’ Although this is an important point, I shall show that the arguments supporting this point are flawed. Draper should have made a brave claim: she should have claimed that people with anorexia nervosa, who competently decide not to be artificially fed, should be respected because everybody (...) is entitled to exercise their autonomy, not only ‘in the middle’ of their life, but also at the end of it, or when their own life is at stake, because autonomy also extends to the most difficult moments of our life, and, ultimately, ‘stretches [.*T*.*T*.] far out into the distance’ at the end of it. I explain why Draper should have made the brave claim, and why she has not made it. I conclude that a defence of people's entitlement to competently refuse artificial feeding cannot rest upon the arguments developed by Draper. Whether or not we should respect competent refusal of artificial feeding depends on the normative strength that we are ready to ascribe to the principle of autonomy, to the moral relevance that we ascribe to the circumstances in which a person's autonomy is exercised, and, perhaps, eventually, on our sense of compassion. (shrink)

This polemical note looks at the ethical issue of providing artificial nutrition and hydration to patients with advanced dementia from the perspective of an Aristotelian and naturalist ethics. I argue that this issue may be considered in terms of the Aristotelian notion of eudaimonia, well-being. I present a number of facts about the conditions of human life that contribute to eudaimonia. In addition, I present a number of facts about advanced dementia as well as clarify the goals of medicine. (...) From these facts, I argue that we are not ethically obligated to provide ANH to this class of patients. (shrink)

This textbook presents a concise, accessible and engaging first introduction to deep learning, offering a wide range of connectionist models which represent the current state-of-the-art. The text explores the most popular algorithms and architectures in a simple and intuitive style, explaining the mathematical derivations in a step-by-step manner. The content coverage includes convolutional networks, LSTMs, Word2vec, RBMs, DBNs, neural Turing machines, memory networks and autoencoders. Numerous examples in working Python code are provided throughout the book, and the code is also (...) supplied separately at an accompanying website. Topics and features: introduces the fundamentals of machine learning, and the mathematical and computational prerequisites for deep learning; discusses feed-forward neural networks, and explores the modifications to these which can be applied to any neural network; examines convolutional neural networks, and the recurrent connections to a feed-forward neural network; describes the notion of distributed representations, the concept of the autoencoder, and the ideas behind language processing with deep learning; presents a brief history of artificial intelligence and neural networks, and reviews interesting open research problems in deep learning and connectionism. This clearly written and lively primer on deep learning is essential reading for graduate and advanced undergraduate students of computer science, cognitive science and mathematics, as well as fields such as linguistics, logic, philosophy, and psychology. (shrink)

Suspended sediment modeling is an important subject for decision-makers at the catchment level. Accurate and reliable modeling of suspended sediment load is important for planning, managing, and designing of water resource structures and river systems. The objective of this study was to develop artificial intelligence- based ensemble methods for modeling SSL in Katar catchment, Ethiopia. In this paper, three single AI-based models, that is, support vector machine, adaptive neurofuzzy inference system, feed-forward neural network, and one conventional multilinear regression modes, (...) were used for SSL modeling. Besides, four different ensemble methods, neural network ensemble, ANFIS ensemble, weighted average ensemble, and simple average ensemble, were developed by combining the outputs of the four single models to improve their predictive performance. The study used two-year discharge and SSL data for training and verification of the applied models. Determination coefficient and root mean square error were used to evaluate the performances of the developed models. Based on the performance measure results, the ANFIS model provides higher efficiency than the other developed single models. Out of all developed ensemble models, the nonlinear ANFIS model combination method was found to be the most accurate method and could increase the efficiency of SVM, MLR, ANFIS, and FFNN models by 19.02%, 37%, 9.73%, and 16.3%, respectively, at the verification stage. Overall, the proposed ensemble models in general and the AI-based ensemble in particular provide excellent performance in SSL estimation. (shrink)

Our synthetic review of the relevant and related literatures on the ethics and effects of using AI in education reveals five qualitatively distinct and interrelated divides associated with access, representation, algorithms, interpretations, and citizenship. We open our analysis by probing the ethical effects of algorithms and how teams of humans can plan for and mitigate bias when using AI tools and techniques to model and inform instructional decisions and predict learning outcomes. We then analyze the upstream divides that feed into (...) and fuel the algorithmic divide, first investigating access and then representation. After that, we analyze the divides that are downstream of the algorithmic divide associated with interpretation and citizenship. At present, lacking ongoing reflection and action by learners, educators, educational leaders, designers, scholars, and policymakers, the five divides collectively create a vicious cycle and perpetuate structural biases in teaching and learning. However, increasing human responsibility and control over these divides can create a virtuous cycle that improves diversity, equity, and inclusion in education. We conclude the article by looking forward and discussing ways to increase educational opportunity and effectiveness for all by mitigating bias through a cycle of progressive improvement. (shrink)

The postmodern era can be defined as a period in which absolute truths are questioned, realities are differentiated and these differences make them-selves felt strongly in social, cultural, economic, religious, etc. areas, and tech-nology is at the centre of individual and social life. In this period, con-ventio-nal lifestyles, social and cultural values, and traditional understan-dings of religiosity are being reshaped as a reflection of the search for a new reality. However, artificial intelligence, which is rapidly developing as a result (...) of the change and transformation in technological possibilities, is tho-ught to feed concerns in the context of both the opportunities it offers and the threats it poses to human values. Therefore, it is of great importance to examine the relationship between religion, which plays an important role in shaping social life, and religiosity, which is its form of practice, and the level of anxiety arou-sed by artificial intelligence, which is becoming increasingly visible in all areas of our lives. In this framework, the aim of the research is to examine religio-sity and artificial intelligence anxiety in the postmodern period in terms of various variables and to reveal the relationship between these two concepts. The study, which used the relational survey model, one of the quantitative research methods, was carried out on 450 individuals between the ages of 17-49 residing in Polatlı district of Ankara province. The data obtained as a result of the research were analysed through SPSS 22.0 statistical software. As a result of the analyses, it was determined that the participants' levels of religio-sity and artificial intelligence anxiety in the postmodern period were above the medium level. At the same time, it has been revealed that the levels of religiosity in the postmodern period are sta-tistically significantly higher for women than men, for individuals between the ages of 17-29 than those in other age groups, for single people than mar-ried people, for students, salaried employees in the public sector and sala-ried employees in the private sector than housewives, for bachelor's, mas-ter's and doctorate graduates than pri-mary, secondary and high school graduates, and for those who are interested in technological products than those who are uninterested and moderately interested. According to the monthly income level, the level of knowledge about artificial intelligence and the frequency of following the developments related to artificial intelli-gence, it was determined that the religiosity levels of individuals in the postmodern period did not differ statistically significantly. In addition, it was determined that artificial intelligence anxiety levels of the participants differed significantly according to their gender and women had higher anxiety levels than men. Again, it was determined that those with low level of knowledge about artificial intelligence had statistically significantly hig-her levels of artificial intelligence anxiety than those with medium level of knowledge and those who never follow the developments related to artifi-cial intelligence and those who rarely follow the developments related to artificial intelligence were statistically significantly higher than those who frequently and always follow the developments related to artificial intelli-gence. Similarly, it was concluded that artificial intelligence anxiety did not differ statistically significantly according to age groups, marital status, oc-cupational type, educational level, monthly income and frequency of fol-lowing technological developments. (shrink)

In the present article, I will advocate caution against developing artificial moral agents based on the notion that the utilization of preliminary forms of AMAs will potentially negatively feed back on the human social system and on human moral thought itself and its value—e.g., by reinforcing social inequalities, diminishing the breadth of employed ethical arguments and the value of character. While scientific investigations into AMAs pose no direct significant threat, I will argue against their premature utilization for practical and (...) economical use. I will base my arguments on two thought experiments. The first thought experiment deals with the potential to generate a replica of an individual’s moral stances with the purpose to increase, what I term, ’moral efficiency’. Hence, as a first risk, an unregulated utilization of premature AMAs in a neoliberal capitalist system is likely to disadvantage those who cannot afford ’moral replicas’ and further reinforce social inequalities. The second thought experiment deals with the idea of a ’moral calculator’. As a second risk, I will argue that, even as a device equally accessible to all and aimed at augmenting human moral deliberation, ’moral calculators’ as preliminary forms of AMAs are likely to diminish the breadth and depth of concepts employed in moral arguments. Again, I base this claim on the idea that the current most dominant economic system rewards increases in productivity. However, increases in efficiency will mostly stem from relying on the outputs of ’moral calculators’ without further scrutiny. Premature AMAs will cover only a limited scope of moral argumentation and, hence, over-reliance on them will narrow human moral thought. In addition and as the third risk, I will argue that an increased disregard of the interior of a moral agent may ensue—a trend that can already be observed in the literature. (shrink)

Background: In Israel, caring for people with end-stage dementia confined to home is mainly done by home care units, and in some cases by home hospice units, an alternative palliative-care service. Because life expectancy is relatively unknown, and the patient’s decision-making ability is poor, caring for this unique population raises ethical dilemmas regarding when to define the disease as having reached a terminal stage, as well as choosing between palliative and life-prolonging-oriented care. Objectives: Exploring and describing differences and similarities of (...) professional staff members’ (PSMs’) and family caregivers’ perceptions of caring for people with end-stage dementia in two different settings. Design: Qualitative research, using semi-structured interviews analyzed through a thematic content–analysis approach. Participants: Sixty-four interviews were conducted (24 PSMs and 40 family caregivers) in two care-settings—home hospice unit and home care unit. Ethical considerations: The study was approved by the Ethics Committee (BBL00118-17). Findings: We found dilemmas regarding palliative care to be the main theme, including definition of the disease as terminal, choosing “comfort” over “life-prolonging,” clarifying patients’ wishes and deciding whether or not to use artificial feeding. Discussion: Both PSMs and family caregivers deal with ethical dilemmas and have reached different conclusions, both legitimate. Comprehending dementia as a terminal disease influenced participants’ perceptions of the relevancy of palliative care for people with end-stage dementia. Discrepancies between PSMs and family caregivers in caring for people with end-stage dementia were found in both home hospice unit and home care unit environments, raising potential conflicts regarding decisions for end-of-life care. Conclusions: Communication between PSMs and family caregivers is crucial for the discussion about the discrepancies regarding the unique dilemmas of caring for people with end-stage dementia and bridging the gap between them. Lack of communication and resources can hamper the provision of an acceptable solution for quality and equality of care in the best interest of people with end-stage dementia. (shrink)

In September 1998 the Bundesrztekammer, i.e., the German Medical Association, published new principles concerning terminal medical care. Even before publication, a draft of these principles was very controversial, and prompted intense public debate in the mass media. Despite some of the critics' suspicions that the principles prepared the way for liberalization of active euthanasia, euthanasia is unequivocally rejected in the principles. Physician-assisted suicide is considered to violate professional medical rules. In leaving aside some of the notions customarily used in the (...) euthanasia debate, e.g., passive euthanasia, the principles emphasize the obligation of physicians to offer and the right of patients to receive palliative care. The principles explicitly list modalities of basic treatment that are indispensable in all cases, such as the obligation to satisfy hunger and thirst. This statement is meant to resolve the dispute on nutrition and hydration at the end of life, as it shifts the focus of care from maintaining physiological parameters to satisfying subjective needs. For patients in a persistent vegetative state, artificial feeding is held to be obligatory. Yet, the principles make reference to recent German jurisdiction which permit the stopping of artificial feeding if it is in accordance with the patient's presumed will. Additionally, the wording concerning this issue is found to remain unclear. Patients' autonomy is strengthened by explicitly welcoming advance directives as a means to ascertain patients' wills. The principles mark some changes compared to earlier documents. They deserve careful analysis and should be considered in the international debate on issues concerning the end of life. (shrink)

This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic (...) physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered. (shrink)

Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

In the case of Re M, summarised in the paper by Julian Sheather, Justice Baker faced the difficult task of weighing up objectively whether or not it was in Mâs best interests to withdraw artificial feeding and to let her die.1 The judge concluded that M was ârecognisably aliveâ, and that the advantages of continued life outweighed the disadvantages. He compared her minimally conscious state favourably to that of a persistent vegetative state .2 It was clear that (...) class='Hi'>artificial feeding would have been withdrawn if she had been in a PVS , but because she was in fact minimally conscious, the judge decided that treatment must continue. But does it make sense to treat MCS differently from PVS in this way? Is it better to be minimally conscious than unconscious? Similar questions have been raised before.3 In 2006, scientists reported results of sophisticated neuroimaging studies which suggested that some patients in persistent vegetative state , long thought to be unaware, had evidence of minimal consciousness.4 The question then was on the moral significance of this level of consciousness, and whether the presence of such evidence meant that treatment such as artificial nutrition must be continued.5 ,6There are several potential reasons why the presence of minimal consciousness might warrant continuing life-sustaining treatment. The first is that patients in minimally conscious state might have a better prognosis than those who are in PVS. There are relatively few studies …. (shrink)

Can the Hippocratic and Judeo-Christian traditions be synthesized with contemporary thought about practical reason, virtue and community to provide real-life answers to the dilemmas of healthcare today? Bishop Anthony Fisher discusses conscience, relationships and law in relation to the modern-day controversies surrounding stem cell research, abortion, transplants, artificial feeding and euthanasia, using case studies to offer insight and illumination. What emerges is a reason-based bioethics for the twenty-first century; a bioethics that treats faith and reason with equal seriousness, (...) that shows the relevance of ancient wisdom to the complexities of modern healthcare scenarios and that offers new suggestions for social policy and regulation. Philosophical argument is complemented by Catholic theology and analysis of social and biomedical trends, to make this an auspicious example of a new generation of Catholic bioethical writing which has relevance for people of all faiths and none. (shrink)

An important examination of the theological, spiritual, and ethical issues surrounding death. At the end of a life of faithfulness comes our dying. To approach it as faithfully as we have our living calls for some serious forethought. Because one of the simplest facts of life—that we all die—seems like the most complicated thing we do. Not only have advances in medical technology saved lives, but they also have prolonged death, and raise a number ethical, moral, social, and theological issues. (...) How far should we go to sustain life? Is it right to withdraw artificial feeding from the dying? Is it wrong to end the lives of those in pain? No matter who we are, dealing with these sorts of choices near the end of life is difficult to do on our own.Faithful Living, Faithful Dying: Anglican Reflections on End of Life Care brings together the wisdom of a task force created by the 72nd General Convention of the Episcopal Church to study what faithful living and faithful dying mean today. The task force’s reflections, published for the first time in this book, assist individuals, congregations, and the Church as a whole to disentangle the thicket of ethical, theological, pastoral, and policy concerns. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should (...) be developed, used and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

Patients suffering from advanced dementia present ethicists and caregivers with a difficult issue: we do not know how they feel or how they want to be treated, and they have no way of telling us. We do not know, therefore, whether we ought to prolong their lives by providing them with nutrition and hydration, or whether we should not provide them with food and water and let them die. Since providing food and water to patients is considered to be basic (...) care that is morally required, it is usually only the provision of nutrition and hydration by artificial means that is considered to require ethical justification. Building on what I call a virtue-based conception of autonomy, I argue that, at least for some patients suffering from advanced dementia, even providing food and liquid by hand is morally wrong. (shrink)

Cases of severe and enduring Anorexia Nervosa (SEAN) rightly raise a great deal of concern around assessing capacity to refuse treatment (including artificial feeding). Commentators worry that the Court of Protection in England & Wales strays perilously close to a presumption of incapacity in such cases (Cave and Tan 2017, 16), with some especially bold (one might even say reckless) observers suggesting that the ordinary presumption in favor of capacity ought to be reversed in such cases (Ip 2019). (...) -/- Those of us who worry that such trends and proposals amount to (or at least pose a serious threat of) wrongful discrimination on the grounds of disability nevertheless feel the pull of judging many SEAN service users to be incapacitous with respect to decisions regarding (perhaps amongst other things) treatments involving feeding, artificial or otherwise. But it is difficult to get to grips with exactly what their incapacity consists in. Many such service users seem able to understand, retain, use and weigh information, and express a decision (i.e. they seem, prima facie, to satisfy the ‘MacArthur’ criteria). At the very least, they do not, generally. (shrink)

It has now become a realistic prospect for smart care to be provided at home for those living with long-term conditions such as dementia. In the contemporary smart care scenario, homes are fitted with an array of sensors for remote monitoring providing data that feed into intelligent systems developed to highlight concerning patterns of behaviour or physiological measurements and to alert healthcare professionals to the need for action. This paper explores some ethical issues that may arise within such smart care (...) systems, focusing on the extent to which ethical issues can be addressed at the system design stage. Artificial intelligence has been widely portrayed as an ethically risky technology, posing challenges for privacy and human autonomy and with the potential to introduce and exacerbate bias and inequality. While broad principles for ethical artificial intelligence have become established, the mechanisms for governing ethical artificial intelligence are still evolving. In healthcare settings the implementation of smart technologies falls within the existing frameworks for ethical review and governance. Feeding into this ethical review there are many practical steps that designers can take to build ethical considerations into the technology. After exploring the pre-emptive steps that can be taken in design and governance to provide for an ethical smart care system, the paper reviews the potential for further ethical challenges to arise within the everyday implementation of smart care systems in the context of dementia, despite the best efforts of all concerned to pre-empt them. The paper concludes with an exploration of the dilemmas that may thus face healthcare professionals involved in implementing this kind of smart care and with a call for further research to explore ethical dimensions of smart care both in terms of general principles and lived experience. (shrink)

This article addresses the use of the ecological notion of ‘response diversity’ (Elmqvist et al. Frontiers in Ecology and the Environment, 1(9), 488–494, 2003) to develop a biocentric approach for natural-artificial continuums through the practice of design. The article elaborates upon examples from the project Dispersal machines, part of my postdoctoral research entitled Symbiotic tactics. Dispersal machines proposed two complementary artificial systems that were conceived to minimize the damages by a moth (Spodoptera frugiperda) on crops (corn and soy (...) predominantly) in the agroecosystems of Córdoba, Argentina. The proposals were ideated to biologically control this species by interventions that disseminate and/or host species that predate or parasitize the moth at different stages of its life cycle: a diurnal response, based on the dissemination of parasitized eggs of the moth by a minute wasp (Telenomus remus), as well as a nocturnal response, based on the placement of refuges for bats that feed on the adult moth. Considering these design interventions through the notion of ‘semethic interaction’ (Hoffmeyer 2008) as it relates to the more general term, ‘semiosphere’, the article reflects upon (de)sign as a signifying activity and design’s ‘response-ability’ (Haraway 2016), to speculate upon ways to devise and acknowledge inter-species co-adaptive possibilities. (shrink)

Der Beitrag untersucht mögliche Kriterien für die normative Bewertung der künstlichen Ernährung bei nichteinwilligungsfähigen Patienten. Der in der aktuellen Diskussion immer wieder unternommene Versuch, den verpflichtenden Charakter bestimmter Formen der Ernährung aufgrund ihrer Zuordnung zu den Kategorien „Basisbetreuung“ oder „Remedia ordinaria“ zu begründen, erweist sich als naturalistischer Fehlschluss. Die Rechtfertigung der künstlichen Nahrungs- und Flüssigkeitszufuhr setzt vielmehr—wie die jeder anderen medizinischen Maßnahme—voraus, dass ihre Durchführung medizinisch begründet und vom Patienten gewollt ist. Dies trifft grundsätzlich auch auf den nicht mehr einwilligungsfähigen (...) Patienten zu; bei diesem kommt es auf den früher erklärten oder mutmaßlichen Willen an. (shrink)

AI systems are bringing an augmentation of human capabilities to shape the world. They may also drag a replacement of human conscience in large chunks of life. AI systems can be designed to leave moral control in human hands, to obstruct or diminish that moral control, or even to prevent it, replacing human morality with pre-packaged or developed ‘solutions’ by the ‘intelligent’ machine itself. Artificial Intelligent systems (AIS) are increasingly being used in multiple applications and receiving more attention from (...) the public and private organisations. The purpose of this article is to offer a mapping of the technological architectures that support AIS, under the specific focus of the moral agency. Through a literature research and reflection process, the following areas are covered: a brief introduction and review of the literature on the topic of moral agency; an analysis using the BDI logic model (Bratman 1987); an elemental review of artificial ‘reasoning’ architectures in AIS; the influence of the data input and the data quality; AI systems’ positioning in decision support and decision making scenarios; and finally, some conclusions are offered about regarding the potential loss of moral control by humans due to AIS. This article contributes to the field of Ethics and Artificial Intelligence by providing a discussion for developers and researchers to understand how and under what circumstances the ‘human subject’ may, totally or partially, lose moral control and ownership over AI technologies. The topic is relevant because AIS often are not single machines but complex networks of machines that feed information and decisions into each other and to human operators. The detailed traceability of input-process-output at each node of the network is essential for it to remain within the field of moral agency. Moral agency is then at the basis of our system of legal responsibility, and social approval is unlikely to be obtained for entrusting important functions to complex systems under which no moral agency can be identified. (shrink)

Providing food and water, even by tube, is in principle an ordinary and proportionate means of preserving life. The Congregation for the Doctrine of the Faith made that clear in its August 1, 2007 statement on the matter. However, a pressing question remains: What about oxygen? Food and water are necessary for life. Is not oxygen equally necessary? So why did the CDF not also declare the use of a mechanical ventilator to be in principle an ordinary and proportionate means (...) of preserving life? Conversely, if the use of a ventilator is extraordinary means, then why is the artificial provision of food and water proportionate means? Is there an inconsistency here? The author argues that there is not. (shrink)

Researchers in artificial intelligence and robotics often include a timeline stretching into the future in which they predict the convergence between human and artificial intelligence. Ray Kurzweil, for example, predicts that in a mere 100 years humans and intelligent machines will become indistinguishable from one another, both ceasing to have permanent corporeal forms. This article argues that the one thing we can know for sure about the future is that when it arrives, it will be different from what (...) we imagined. The cultural work that predictions like Kurzweil’s perform is less to prognosticate the future than to shape our understanding of what it means to be human in the present. Working from the ‘sense-think-act’ paradigm foundational to work in artificial intelligence and robotics, this article argues that predictions in all three areas (sensing, thinking, acting) feed back to affect how the human is envisioned in the present. The reconfigurations these predictions bring about are to downplay consciousness, embodied cognition, and evolutionary inertia. The article concludes by critically evaluating contemporary resistances to the posthuman, especially in the writings of Rodney Brooks and Francis Fukuyama. (shrink)