In recent years, reports on youth sports excesses and abuses of minors underscore the need for a safer sport environment. However, the way in which parents guide their children in dealing with winning and losing in sports is less understood. A care ethical inquiry into sport parenting might contribute to a better understanding of the role parents play in creating a safe sport environment for their children. This study applies theoretical perspectives from care ethics into practical context focusing (...) on the relationship between parents and their sporting children through the lens of relational identity. An interpretative phenomenological study was conducted into the meaning of competitiveness amongst Dutch parents of children aged eleven and twelve, who play hockey and are in the midst of transitioning from sport as a game to competitive sport. This article concludes that the meaning of competitiveness for these parents is twofold. On the one hand there is a desire to be proud of your child’s success, fuelled by meritocratic ideals. On the other hand, parents desire their child’s ongoing commitment to sport, which they consider a return investment for the sacrifices they make to support their child’s sport participation. From a care ethical stance of relational responsibility, parents should not solely view sport as a quid pro quo concept in which desires are fulfilled or battles settled, but rather as a game that is enjoyed by both parents and children. Mature sport parenting can only emerge once the tensions resulting from parental sacrifices on the one hand and the child’s loyalty to meet parental expectations on the other are overcome through dialogue and reflection, aimed at elucidating responsibilities within the relationship. More research is needed to gain insight into the significance of this relational connection for the youth sports climate. (shrink)

Even though it is often presumed that the use of technology like medication administration technology is both safer and more effective, the importance of nurses' know‐how is not to be underestimated. In this article, we accordingly try to argue that nurses' labor, including their different forms of knowledge, must play a crucial role in the development, implementation and use of medication administration technology. Using three different theoretical perspectives (‘heuristic lenses') and integrating this with our own ethnographic research, we will explore (...) how nursing practices change through the use of medication technology. Ultimately, we will argue that ignoring (institutional) complexity and the various types of important knowledge that nurses have, will seriously complicate the implementation of medication administration technology. (shrink)

Background: Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy. Objective: To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy. Setting: Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual (...) disabilities. Methods: Ethnographic field study. Ethical considerations: The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee. Findings: Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.” Conclusion: Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals and ethicists (...) working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (shrink)

Care ethics as initiated by Gilligan, Held, Tronto and others has from its onset been critical towards ethical concepts established in modernity, like ‘autonomy’, alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Late modern (...) organizations, like the general hospital, codetermined by various systems are characterized by complexity and the need for complexity reduction, both permeating care practices. By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power. In the final section a proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Descartes’s Lettre Apologétique aux Magistrats d’Utrecht:New Facts and MaterialsErik-Jan BosThe lettre apologétique aux magistrats d’utrecht was Descartes’s final effort to obtain satisfaction from the Municipality or ‘Vroedschap’ of Utrecht. In 1643 the Vroedschap had condemned Descartes’s Epistola ad Dinetum and Epistola ad Voetium in defence of Descartes’s opponent Gisbertus Voetius (1589–1676), professor of Theology at the University of Utrecht.1 In the Lettre apologétique Descartes requests (...) the Utrecht Vroedschap to revoke their condemnation, to clear his name and to reconsider Voetius’s position.The Lettre apologétique receives little attention in modern editions of Descartes’s works. Adam and Tannery give both the French and the Latin version of the Lettre apologétique, but with scanty annotation and an unsatisfactory introduction (AT VIIIB).2 The only other edition of the Lettre apologétique is provided by Verbeek, in La Querelle d’Utrecht (1988), but it does not go beyond Adam and Tannery’s edition.3In 1992, however, Verbeek noted that the Lettre apologétique could not possibly date from 1645, which was the hypothesis of Adam and Tannery and still is the [End Page 415] prevailing view.4 This raises once again the question of the real date of the Lettre apologétique as well as of the history of the text. In this essay I propose a new date and a new account of the history of the text. I also draw attention to the Dutch version of the Lettre apologétique, which Descartes sent to the Utrecht Vroedschap in 1648, but first I will give a short survey of Descartes’s dispute with Voetius.1. THE UTRECHT QUARRELIf we are to believe Descartes in his Lettre apologétique, it was Voetius who started the quarrel in 1639 by accusing him of atheism in several disputations, an accusation to which Voetius stuck throughout the affair.5 Descartes admits he is not mentioned in the writings of the Utrecht theologian, but “[Voetius] counted among the characteristics of atheism everything he knew to be commonly attributed to me” (AT VIIIB 205). A few years later, in 1641, Voetius called the adherents of the New Philosophy atheists outright. In a reaction to Descartes’s champion in Utrecht, the professor of medicine Henricus Regius (1598–1679), who claimed Aristotelian philosophy to be of no use for explaining natural phenomena, Voetius warned that the rejection of traditional philosophy would lead to scepticism and eventually to disbelief. With Descartes’s help Regius furnished a reply, in which he insinuated that it was, instead, the obscurities in Neo-Scholastic thought which led to the denial of God.6 This answer elicited protest from the University Senate. On the Senate’s request the Utrecht Vroedschap confiscated Regius’s book and forbade the teaching of any ideas deviating from Aristotle. Regius having been silenced, Descartes proceeded in a personal capacity. He vehemently attacked Voetius, first in the Epistola adDinetum, then in an elaborate work, the Epistola ad Voetium. The latter was meant as a response to a book opposing Descartes published by the professor of philosophy in Groningen, Martin Schoock (1614–1669), a friend of Voetius.7 The Vroedschap then condemned the works and Descartes became [End Page 416] subject to criminal charges. Thanks to his influential friends, Descartes was never put on trial, yet he felt that his reputation had been badly damaged. Several times he demanded satisfaction from the Utrecht Vroedschap, but to no avail.Until recently, the texts published in the polemic between Descartes and Voetius were considered to be of no more than anecdotal value in Descartes’s biography. It is only for the past decade that their philosophical relevance has been recognized. From what seemed to be unpromising material, various scholars have presented new perspectives on both Voetius and Descartes.8 They have shown that the objections raised by Voetius and Schoock against Cartesian philosophy prove to be more fundamental and to the point than formerly believed. Although Descartes never made a serious attempt on his own to meet Voetius on philosophical grounds, his writings are interesting because he brings forward theoretical positions which before he had... (shrink)

The current public health crisis has exposed deep cracks in social equality and justice for marginalised and vulnerable communities around the world. The reported rise in the number of ‘do not resuscitate’ orders being imposed on people with disabilities has caused particular concerns from a human rights perspective. While the evidence of this is contested, this article will consider the human rights implications at stake and the dangers associated with using ‘quality of life’ measures as determinant of care in (...) class='Hi'>medical decision-making and triage assessments. (shrink)

Humoralism, the view that the human body is composed of a limited number of elementary fluids, is one of the most characteristic aspects of ancient medicine. The psychological dimension of humoral theory in the ancient world has thus far received a relatively small amount of scholarly attention. Medical psychology in the ancient world can only be correctly understood by relating it to psychological thought in other fields, such as ethics and rhetoric. The concept that ties these various domains together (...) is character (êthos), which involves a view of human beings focused on clearly distinguishable psychological types that can be recognized on the basis of external signs. Psychological ideas based on humoral theory remained influential well into the early modern period. Yet, in 17th-century medicine and philosophy, humoral physiology and psychology started to lose ground to other theoretical perspectives on the mind and its relation to the body. This decline of humoralist medical psychology can be related to a broader reorientation of psychological thought in which the traditional concept of character lost its central position. Instead of the focus on types and stable character traits, a perspective emerged that was primarily concerned with individuality and transient passions. (shrink)

Maimonides, one of the most celebrated rabbis in the history of Judaism, was a prolific author of influential Arabic philosophical and medical treatises and two of the most important works on Jewish law. _Medical Aphorisms_ is the best known and most comprehensive of his works, and Gerrit Bos offers here a masterful English translation with detailed annotations. _Medical Aphorisms_ consists of approximately 1500 maxims compiled by Maimonides from the treatises of Galen, the renowned ancient Greek physician. Maimonides arranges the (...) aphorisms into twenty-five treatises, organizing them by traditional medieval subspecialties such as gynecology, hygiene, and diet. He also includes a section examining unusual cases from Galen and offers a critical analysis of Galen’s theories. The first of six volumes, _Medical Aphorisms_ provides tantalizing insights into the work of Galen, as it draws on treatises of Galen that no longer exist and shines a light into the world of medieval and ancient medicine. It will be a rich and valuable resource for students and scholars working in the history of medicine, Jewish studies, and medieval Arabic culture. (shrink)

A reliable edition of medical fragments in Hebrew and/or Arabic script from the Cairo Geniza, especially those dealing with pharmacology, can only be accomplished if the editors are trained in medieval Judeo-Arabic, Arabic philology, and paleography and have a thorough knowledge of all the secondary sources and studies. Allowing too many faulty readings otherwise, editions of these fragments cannot be considered credible.

In recent years, sports have achieved rapid development worldwide, and the global economy has been significantly improved and improved. With the in-depth development of the two, the connection between sports and the economy has also become closer. Sports economy is a new type of economic form bred by specialization of sports organization, participation in consumerization, and profit-oriented operation under the condition of market economy. And the development of sports economy cannot be developed at once; it (...) needs healthy and sustainable development. In order to find a better way to study the healthy and sustainable development of sports economy, this paper uses deep learning network algorithm and supports vector machine learning algorithm to build a mental model. It then uses the model to analyze various indicators of the sports industry in a province in China. This article is looking for information and summarizes the province’s sports data from 2017 to 2021. The sports indicators of this experiment include regional GDP, total output of sports industry, sports practitioners, local financial sports expenditures, the number of policies, the number of people participating in physical exercise, and fitness venues and facilities. The realization results show that these variables develop at a relatively small rate under normal conditions, and then predict the data in the next few years under the healthy and sustainable development of the next few years through the mental model. The growth rates of various indicators of the sports economy have increased significantly, and they have been optimized by about 20% compared with the normal development. (shrink)

The purposes of this study are to extract the essence from the in-depth study of entrepreneurial spirit and the exploration of China’s sports culture construction, find out the beneficial parts in line with China’s sports culture construction, and put forward operational suggestions and countermeasures for dealing with the relationship between entrepreneurial spirit and sports culture to help China’s sports culture construction move toward a new level. This exploration discusses the influence of entrepreneurial spirit on sports (...) culture from the perspective of cognitive regulation, and explores the importance of entrepreneurial spirit from the aspects of social psychology, system, economy, and ethics. The structure of sports culture is analyzed, and the role of entrepreneurial spirit in promoting the construction of sports culture is expounded. Moreover, a questionnaire survey is conducted to investigate the impact of entrepreneurial spirit on the construction of sports culture from the cognitive regulation perspective. The results show that most people agree with the development of the entrepreneurial spirit and positively impact the promotion of entrepreneurial spirit. Most people are not satisfied with the attention and level of sports culture construction. In China’s sports culture, the proportion of the entrepreneurial spirit is still tiny. Thereby, entrepreneurial spirit education must be vigorously promoted to enhance the integration of entrepreneurial spirit and sports culture. The entrepreneurial spirit needs to be introduced in the construction of sports culture. It is essential to do a good job in promoting entrepreneurial spirit, improving the supporting facilities related to sports culture and strengthening the correlation between sports culture and the entrepreneurial spirit. By discussing the influence of entrepreneurial spirit on sports culture, this exploration puts forward relevant opinions for developing sports culture. It is expected that they can have some reference values. This exploration provides new ideas for promoting the combination of sports culture construction and the dissemination of entrepreneurial spirit, which has crucial theoretical and practical significance. (shrink)

This essay frames the question of responsibility as a problem of agency in relation to the systems and structures of globalization. Responsibility is a “shattered concept” when considered too narrowly as a problem of act, agency, and individual freedom. Constructively, the essay introduces Dietrich Bonhoeffer as the most promising theological dialogue partner for rethinking the meaning of responsibility today. His challenge is to find a way of talking about responsibility that does not collapse into individualism or become ensconced within a (...) univocal logic that subsumes socioeconomic, cultural, and religious differences within itself. The claim is that Bonhoeffer’s reflections on the center, boundaries, and limits of responsibility are helpful today to Christian people struggling with an increasingly exhausted concept of responsibility, when linear agent-act-consequence connections to distant others and far away harms are increasingly difficult to trace. (shrink)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

Industrialisation, urbanisation and economic development have produced unprecedented improvements in human health. They have also produced unprecedented exploitation of Earth’s life support systems, moving the planet into a new geological epoch, the Anthropocene—one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role—the environmental threats that will shape human health in this century represent a ‘perfect moral storm’ challenging the ethical theories of the last. The US conservationist Aldo (...) Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the ‘land community’, the ecosystems we live within and depend upon; moving us from ‘conqueror’ to ‘plain member and citizen’ of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself—in a way irreducible to the welfare of its members—it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the ‘stability’ of the community requires intergenerational justice. The resulting vision of justice in healthcare—one that takes climate and environmental justice seriously—could offer health workers an ethic fit for the future. (shrink)

Background The legitimacy of conscientious objection to abortion continues to fuel heated debate in Italy. In two recent decisions, the European Committee for Social Rights underlined that conscientious objection places safe, legal, and accessible care and services out of reach for most Italian women and that the measures that Italy has adopted to guarantee free access to abortion services are inadequate. Nevertheless, the Ministry of Health states that current Italian legislation, if appropriately applied, accommodates both the right to conscientious objection (...) and the right to voluntary abortion. Main body One empirical argument used to demonstrate that conscientious objection does not create barriers to abortion is the “no correlation” argument, which the Italian Committee for Bioethics employed to demonstrate that no association exists between conscientious objection and waiting times for voluntary abortion in Italy and to support the weak form of conventional comprise adopted by the Italian legislation to balance the conflict between women’ autonomy and healthcare professionals’ moral integrity. Conversely, we showed how the “no correlation” argument fails to demonstrate the absence of a relationship between the number of conscientious objectors and waiting times for voluntary abortion, and that the limitations of the “no correlation” argument itself demonstrate how it is still difficult to describe the real effect of conscientious objection on the access to abortion services and to evaluate the suitability of conventional compromise to effectively balance conflicting moral principles. Conclusion Further studies are needed to better describe the relationship between conscientious objection and waiting times for voluntary abortion. If new evidence would show that the increasing proportion of objectors does undermine the efficacy of the Italian law and the right of a woman to freely obtain a voluntary abortion, new ways will need to be found to address the conflict between moral principles and restrict the protection accorded to the principle of moral integrity. This would inevitably imply the need to constrain and to redefine the terms and conditions for claiming conscientious objection. (shrink)

In the traditional system of Chinese families, individuals are embedded in the institution of the family with defined obligations to enhance family development. As a consequence of the male-biased sex ratio at birth in China since the 1980s, an increasing number of surplus rural males have been affected by a marriage squeeze becoming involuntary bachelors. Under China’s universal heterosexual marriage tradition, family development of rural involuntary bachelors has largely been ignored, but in China’s gender-imbalanced society, it is necessary to adopt (...) a family-based approach to identify and study the plight of rural involuntary bachelors. Studies on gender imbalance indicate that these men face multiple risks from the perspectives of their life course, the family life cycle, and the family ethic. To a certain extent, these risks are caused by a conflict between the individual’s family life and family ethics and are mainly reflected in problems concerning marriage, health, and old-age support. Not only do these vulnerabilities affect the individual and family development across the whole life cycle but also pose major risks to social development in the face of strong gender imbalance. In order to deal with risks faced by rural involuntary bachelors, core ethical principles, including autonomy, beneficence, and justice, need to be adopted. Through adjustments to informal support provided by the family and formal support provided by policy-makers, risk of uncertainty in family development faced by rural involuntary bachelors could be reduced. (shrink)

How did “science,” once a term used to refer to universal knowledge, come to be applied to the epistemic practices of particular civilizational and racial groups? This essay approaches this question by examining the life and writings of John Augustus Abayomi Cole, a Sierra Leonean medical practitioner and public intellectual who in the late nineteenth century used the term “science” to describe African knowledge systems. Cole’s writing on science in Africa was explicitly anti-imperial and grounded in a critique of (...) the “materialism” of European society. While reminding Africa’s European conquerors of the folly of their civilizing mission, Cole at the same time urged the “Europized” elite of Sierra Leone’s capital of Freetown to adapt themselves to African spiritual and scientific life. The essay argues that marginal intellectuals like Cole, whose thought was shaped by several interlocking local and intercontinental forces, were instrumental in generating the concept of civilization-specific science. (shrink)

This article presents an analysis of contractual relations in sport from the standpoint of the Croatian legislative system. Due to the complexity of the subject matter, the author considers only a small fragment of it - the significance and the role of sport in Croatian society and the law of contracts „as a cornerstone on which „sports law“ has been built and which is of primary importance in most areas where there is an interface between sport and the law, (...) irrespective of whether the sport is being played at an elite level or at a more humble one“. Bearing in mind the limited extent of this article, the autor tries to provide some clarifications and some guidance on how to deal with the designation and the determination of the applicable law for contracts in the sporting context. Considering that there are different legal regimes which may come into play with regard to the designation of the law applicable to contracts in the sporting context, the author first presents the determination of the applicable law according to the Rome I Regulation and then according to the Croatian Arbitration Act, Swiss Private International Law Act and the CAS Code of Sports-related Arbitration, as the most common in sports practice. Then, the author deals with contracts concluded with minor athletes and the determination of the law applicable to some preliminary questions. Finally, the author presents her perception of the problems encountered and some suggestions for the improvement of the existing legal framework. (shrink)

Providing health care in the most cost-effective way has become a priority in recent years. This book tackles the important issue of the potential conflict between economic expediency and the welfare of individual patients. Contributors examine different attitudes to this complex problem, along with a variety of legal and historical perspectives. The book addresses particular aspects of health care, such as medical expert systems, general practice, medical education, and clinical decision-making where the direct involvement of doctors in allocating (...) scarce and expensive resources is perhaps most obvious. (shrink)

This study examined the perceived effects of examination special centres on teaching and learning of English language and the quality of education in Nsukka Local Government Area, Enugu State, Nigeria. The study employed a descriptive survey design. All the 123 English language teachers from 31 secondary schools, five secondary school principals, three religious priests and three traditional leaders in Nsukka Local Government Area of Enugu State, Nigeria were sampled for the study. The researchers developed a 15-item-structured questionnaire for data collection (...) from the 31 teachers; while 3 structured interview questions were used to elicit responses from the principals, religious priests and traditional leaders. Mean and standard deviation were used to analyse the data collected with questionnaire; while the oral interview was analysed qualitatively through thematic analysis. The study revealed that examination special centres have detrimental effect on the teaching and learning of English language in secondary schools and the quality of education in Nsukka Local Government Area, Enugu State, Nigeria. It was recommended among others that private and public secondary schools, and tutorial centres that have been turned into examination special centres should be closed down by Enugu State Ministry of Education. (shrink)

À l'heure où le débat sur la fin de vie resurgit, Bernard Sportès nous ouvre de nouveaux horizons, dépasse les arguments simplistes et nous aide à comprendre tabous et angoisses. Son analyse, ancrée dans son expérience des fins de vie, nous rappelle que cet accompagnement ultime doit bien rester un soin. Sa vision humaniste se refuse à ces morts administrées selon des critères médicaux prédéfinis, auxquelles il oppose une mort accompagnée, assistée jusqu'aux derniers instants. Cette proposition, nouvelle dans ce vieux (...) débat, prend acte de l'évolution de nos mœurs et place le respect de la volonté au-dessus de toute autre considération. Prééminence d'une volonté trop souvent confondue avec de simples opinions. Émerge ainsi la possibilité qu'une aide à mourir s'inscrive dans la poursuite d'une prise en charge. Le législateur devra l'organiser dans la confiance en la maturité des soignants et des patients, s'éloigner du réglementaire, encourager une pensée collective et supervisée. Nos fins de vies réclament une République fraternelle qui n'abandonne personne, une médecine d'équipe qui résiste au modèle industriel où on l'entraine. Bernard Sportès nous livre finalement un message simple : nous ne mourrons pas mieux tant que nous n'aurons pas bâti cette médecine de la personne qu'il décrit et propose."--Page 4 of cover. (shrink)

This book is devoted to the so-called moral virtues, especially those moral virtues of which Christian tradition upholds that they are given by God to the faithful. For instance patience, humility and justice. There are not only different interpretations of these infused moral virutes, but it is also not unambiguous in the theology of Aquinas how these virtues are related to the virtues human beings acquire on their own accord. What is the relationship with Scripture, how do these virtues clour (...) the imitation of Christ, and what do these virtues tell about the moral life of non-Christians? (shrink)

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes (...) and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

Felicitas Kraemer draws on the experiences of patients undergoing deep-brain stimulation to propose two distinct and potentially conflicting principles of respect: for an individual's autonomy , and for their authenticity. I argue instead that, according to commonly-invoked justifications of respect for autonomy, authenticity is itself in part constitutive of an analysis of autonomy worthy of respect; Kraemer's argument thus highlights the shortcomings of practical applications of respect for autonomy that emphasise competence while neglecting other important dimensions of autonomy such as (...) authenticity, since it shows that competence alone cannot be interpreted as a reliable indicator of an individual's capacity for exercising autonomy. I draw from relational accounts to suggest how respect for a more expansive conception of autonomy might be interpreted for individuals undergoing DBS and in general. (shrink)

In a recent article, Wilkinson puts forward the notion of identity-relative paternalism. According to Wilkinson’s final formulation of this principle, ‘[i]ndividuals should be prevented from doing to future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others’.1 In medical ethics, it is usually assumed that hard paternalism, that is, acting against a competent person’s wishes for their own benefit, is not justified. According (...) to Mill’s harm principle, we may only limit people’s freedom if they cause harm to others.2 Harm to self is not a sufficient reason for overriding competent persons’ decisions. Wilkinson, however, draws on Parfit’s reductionist view of personal identity to argue that sometimes, patients’ future selves are sufficiently disconnected from their present selves to treat future selves like different persons. If a competent person’s medical decision negatively affects a future self, this should be treated like a case of harm to others. Thus, overriding competent persons’ decisions in such cases—and treating them against their will—could be justified. In this commentary, I point out two problems with this approach. First, I demonstrate that the cases Wilkinson’s argument is based on are not examples of harm to others but rather cases of surrogate decision making gone wrong, …. (shrink)

The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of particular conditions. (...) This paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person’s own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction. (shrink)

A large part of the explainable AI literature focuses on what explanations are in general, what algorithmic explainability is more specifically, and how to code these principles of explainability into AI systems. Much less attention has been devoted to the question of why algorithmic decisions and systems should be explainable and whether there ought to be a right to explanation and why. We therefore explore the normative landscape of the need for AI to be explainable and individuals having a right (...) to such explanation. This exploration is particularly relevant to the medical domain where the (im)possibility of explainable AI is high on both the research and practitioners’ agenda. The dominant intuition overall is that explainability has and should play a key role in the health context. Notwithstanding the strong normative intuition for having a right to explanation, intuitions can be wrong. So, we need more than an appeal to intuitions when it comes to explaining the normative significance of having a right to explanation when being subject to AI-based decision-making. The aim of the paper is therefore to provide an account of what might underlie the normative intuition. We defend the ‘symmetry thesis’ according to which there is no special normative reason to have a right to explanation when ‘machines’ in the broad sense, make decisions, recommend treatment, discover tumors, and so on. Instead, we argue that we have a right to explanation in cases that involve automated processing that significantly affect our core deliberative agency and which we do not understand, because we have a general moral right to explanation when choices are made which significantly affect us but which we do not understand. (shrink)

According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe two (...) distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread “joint” approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. (shrink)

Mitochondrial replacement techniques (MRTs) usually aim to prevent the genetic transmission of maternally inherited mitochondrial diseases. Until now, only the UK and Australia have implemented specific legal regulations of MRTs. In both countries, clinical trials on these techniques are only permissible for cases with a high risk of severe mitochondrial disease in the offspring. However, these techniques can also be applied to treat infertility, especially for older women with impaired oocyte quality. In some countries without legal regulation of these techniques, (...) MRTs are already offered for this purpose. Yet, this application of MRTs has received insufficient attention in the bioethical literature so far.In this paper, I examine whether there are ethical reasons to prohibit trials on MRTs in the context of infertility when they are permitted for preventing mitochondrial disease. Allowing MRTs in one context but not the other might be justified either because their application in the context of mitochondrial disease (1) is supported by a more convincing evidence base, (2) has a higher potential benefit or (3) has a lower risk. I compare both applications of MRTs with respect to these three factors. I conclude that there is no convincing reason to prohibit clinical trials on MRTs for infertility when they are permitted in the context of mitochondrial disease. (shrink)

Patients with mental illness, and depression in particular, present clinicians and surrogate decision-makers with complex ethical dilemmas when they refuse life-sustaining non-psychiatric treatment. When treatment rejection is at variance with the beliefs and preferences that could be expected based on their premorbid or “authentic” self, their capacity to make these decisions may be called into question. If capacity cannot be demonstrated, medical decisions fall to surrogates who are usually advised to decide based on a substituted judgment standard or, when (...) that is not possible, best interest. We propose that in cases where the patient meets the widely accepted cognitive criteria for capacity but is making decisions that appear inauthentic, the surrogate may best uphold patient autonomy by following a “restorative representation” model. We see restorative representation as a subset of substituted judgement in which the decision-maker retains responsibility for deciding as the patient would have, but discerns the decision their “truest self” would make, rather than inferring their current wishes, which are directly influenced by illness. Here we present a case in which the patient’s treatment refusal and previously undiagnosed depression led to difficulty determining the patient’s authentic wishes and placed a distressing burden on the surrogate decision-maker. We use this case to examine how clinicians and ethicists might better advise surrogates who find themselves making these clinically and emotionally challenging decisions. (shrink)

Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply the work of Thomas (...) Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide. (shrink)

Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one’s inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings’ concept of engrossment, Meyers’ account of broad empathy, and Baart’s concept of perspective-shifting. Based on these accounts, we explain that care ethics promotes a (...) conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care. (shrink)

Recent criticism of the role of respect for autonomy in bioethics has focused on that principle's status as ‘dogma’ or ‘ideology’. I suggest that lying beneath many applications of respect for autonomy in medical ethics are some influential dogmas — propositions accepted, not as explicit premises or as a consequence of reasoned argument, but simply because moral problems are so frequently framed in such terms. Furthermore, I will argue that rejecting these dogmas is vital to secure and protect an (...) autonomy worthy of respect. The concept of autonomy that is widely applied in clinical ethics emphasises decision-making competence, at the expense of considering the authenticity of those decisions. Respect for such autonomy is interpreted in largely synchronic and individual terms — concerned with the isolated decisions of individual agents — and thus neglects the diachronic and social dimensions of many moral dilemmas arising in the health care context. I will examine how these unwritten rules lead to an impoverished understanding of respect and a systematic neglect in bioethics of certain kinds of ethical consideration, and draw on insights from feminist and communitarian work on autonomy to sketch an alternative approach to understanding respect, modelled on the norms of respectful conversation — a respect that is firstly concerned with engaging with the another as a potential giver and bearer or reasons, and working with them to promote both individual and social flourishing. (shrink)

Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this (...) article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices. (shrink)

In a recent paper, Hugh McLachlan argues from a deontological perspective that the most ethical means of distributing scarce supplies of an effective vaccine in the context of an influenza pandemic would be via an equal lottery. I argue that, even if one accepts McLachlan's ethical theory, it does not follow that one should accept the vaccine lottery. McLachlan's argument relies upon two suppressed premises which, I maintain, one need not accept; and it misconstrues vaccination programmes as clinical interventions targeted (...) solely at protecting the health of vaccinated individuals, rather than as public health interventions targeted at protecting the health of the population as a whole. (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)

During the last decades, in different places and under different circumstances, some physicians and other health professionals have supported state violence. The Holocaust is a prime example for how doctors can cooperate with the state to plan, give ideological support to and implement violent policies. As a consequence of the Industrial Revolution, people gained access to health promotion and health protection, not as an achievement of the welfare state, but as a tool necessary to maintain healthy and more productive workers. (...) Gradually, all social strata, employees and their relatives gained access to health coverage. Physicians as a group increased in number and changed the structure of their profession by establishing a symbiotic relationship with the state. Between the state and the medical class, different models of cooperation can be distinguished. In general, we can affirm that with the implementation of a public health system, greater interdependence among the state and the medical class was established. In the case of authoritarian or totalitarian regimes, the support of the medical class for violent policies depends on the degree of previous cooperation. National Socialist Germany and the Soviet Union are two striking examples of totalitarian states in which strong public health systems and subsequent close cooperation between the medical class and the state can be observed. In both countries, violent state policies were quickly accepted and integrated into medical practice. Practices such as forced sterilization, murder of patients or experimentation with prisoners were prevalent under National Socialism. The abuse of psychiatry as tool for exerting power was common in the Soviet Union. South American dictatorships constitute examples of totalitarian states with weak previous cooperation between the medical class and the state, as they did not have strong public health systems. In those countries, support for state violence can be found, such as participation of health care professionals in torture or abduction of babies, but cooperation was not as strong as in Nazi Germany or the Soviet Union. In other cases in which no strong previous relationship existed between medicine and the state, authoritarian regimes were not accompanied by medical support for violence, such as in the case of the Rwandan genocide or in Cambodia, where doctors were persecuted and murdered based on their membership of the bourgeois class. (shrink)

Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. In this (...) article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices. (shrink)

Definition of the problem The reform of German guardianship law coming into force in 2023 will remove the term “well-being” from the law. This is intended to emphasise that the legal guardian should be guided by the subjective wishes of the person rather than by an objective understanding of well-being. This article analyses the understanding of well-being underlying the reformed guardianship law in comparison to common conceptions of well-being in philosophy and medical ethics, aiming to promote interdisciplinary understanding between (...) ethics and law. Arguments The justification for the reform emphasises that the law is based on a subjective understanding of well-being. However, this understanding does not correspond to philosophical subjective theories of well-being, according to which only things that a person desires can contribute to her well-being. In contrast, the guardianship law assumes that the fulfilment of certain wishes can lead to objective harm to the person and thus impair her well-being. Negative consequences for the objective well-being of a person are only relevant insofar as they indicate a limit to following current wishes that are based on a natural will and are not an expression of self-determination. Conclusion While the term “well-being” is removed from reformed guardianship law, the law implicitly contains an understanding of well-being comparable to a hybrid conception of well-being from a medical ethics perspective. According to this conception, fulfilment of a person’s wishes generally contributes to her well-being, although certain objective criteria are also taken into consideration. (shrink)

As a 52-year-old academic and mother of three, this research explores the ethics of the question ‘do I have time to go skateboarding?’ Using the themes of time, injury, ageing and learning, it explores the question in relation to Simone de Beauvoir’s ethics of ambiguity. The approach employs autoethnographic and sensory methods to document the authors own experience of learning to skateboard in her late forties and uses learning to skateboard as a vehicle from which to consider time and productivity. (...) Embracing Beauvoir’s ethics of transcendence in navigating the psychological burden of ageing and informing the ongoing methodological approach required for making time to play, the author subverts ideas of progression and knowledge acquisition from childhood to adulthood and explores instead the converse transition from adult to child. The article draws conclusions about the value of lifelong learning and what expanded ideas about productivity mean for our ethical positioning in the world. How being in the skatepark together requires an ethical contract between skateboarders, an unambiguous ethics of being together where adhering to a system of unwritten rules means that everyone has enough space to stay safe. Risk and the time implications of injury are explored throughout in terms of the choices we make at different stages of our lives as we navigate a balance between personal desire and social good. (shrink)

Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but also authenticity; (...) the ability to determine for oneself what is good for oneself.2 Furthermore, our relationships support or undermine both capacity and authenticity, and autonomous expression manifests throughout evolving relationships. This invites us to view respect differently—as an ongoing conversation with another person, capable of holding values that may move us. In Smajdor’s terminology, it requires that we recognise them. We describe how we operationalise this in our research. Three broad arguments usually support respect for autonomy.2 One—owed to JS Mill—holds that permitting individuals free choice promotes utility of all, by helping them fulfil ideas of the good, demonstrating ‘experiments in living’. Another draws from Kant’s categorical imperative; its Formula of Humanity holds that the capacity to determine our own values gives us reason to act, and we ought, therefore, to treat others’ values with the respect we show our own. Lastly, many simply assume ‘liberal neutrality’—an intrinsic value in people being permitted to pursue the …. (shrink)

Aim To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. Design A questionnaire about attitudes towards PAS, including prioritisation of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. Participants All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Main outcome measures (...) Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. Results The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (shrink)

The detection of moving targets is to detect the change area in a sequence of images and extract the moving targets from the background image. It is the basis. Whether the moving targets can be correctly detected and segmented has a huge impact on the subsequent work. Aiming at the problem of high failure rate in the detection of sports targets under complex backgrounds, this paper proposes a research on the design of an intelligent background differential model for training (...) target monitoring. This paper proposes a background difference method based on RGB colour separation. The colour image is separated into independent RGB three-channel images, and the corresponding channels are subjected to the background difference operation to obtain the foreground image of each channel. In order to retain the difference of each channel, the information of the foreground images of the three channels is fused to obtain a complete foreground image. The feature of the edge detection is not affected by light; the foreground image is corrected. From the experimental results, the ordinary background difference method uses grey value processing, and some parts of the target with different colours but similar grey levels to the background cannot be extracted. However, the method in this paper can better solve the defect of misdetection. At the same time, compared with traditional methods, it also has a higher detection efficiency. (shrink)