One barrier to optimal pain management in the neonatal intensive care unit (NICU) is how the healthcare community perceives, and therefore manages, neonatal pain. In this paper, we emphasise that healthcare professionals not only have a professional obligation to care for neonates in the NICU, but that these patients are intrinsically worthy of care. We discuss the conditions that make neonates worthy recipients of pain management by highlighting how neonates are (1) vulnerable to pain and harm, and (2) completely dependent (...) on others for pain management. We argue for a relational account of ethical decision-making in the NICU by demonstrating how an increase in vulnerability and dependence may be experienced by the healthcare community and the neonate’s family. Finally, an ethical framework for decisions around neonatal pain management is proposed, focussing on surrogate decision-making and the importance of compassionate action through both a reflective and an affective empathy. As empathy can be highly motivating against pain, we propose that, in addition to educational programs that raise awareness and knowledge of neonatal pain and pain management, healthcare professionals must cultivate empathy in a collective manner, where all members of the NICU team, including parents, are compassionate decision-makers. (shrink)

Dramatic modern advances in emergency and resuscitation medicine, starting perhaps with the development of effective mechanical ventilators in the mid-20th century, have created a large class of persons who in earlier times would almost certainly have died, but who can now go on existing, suspended at least temporarily in a state somewhere between death and the conscious life they formerly pursued. A very wide range of brain injuries lead first to coma, in which the patient shows no sign of conscious (...) awareness, or even of wakefulness, in which eye openings and closings indicate the presence of a sleep/wake cycle unconsciously mediated by structures in the brain stem. Following emergence from coma, which may take days to months or more if it happens at all, patients typically show signs of wakefulness without conscious awareness – they are then in a so-called vegetative state (VS). For many this state becomes permanent, but some go on to a more recently described condition called the minimally conscious state (MCS), in which signs of conscious awareness can be detected by careful neurological examination (see Laureys & Tononi, 2009, chapter 14). A very few such persons ultimately progress to more or less full recovery, but another and particularly horrifying possible outcome is the “locked-in” state, in which a patient is fully conscious but has extremely little or no capacity for voluntary motor action. A famous modern example is that of Jean-Dominique Bauby, author of The Diving Bell and the Butterfly, who suffered a stroke to his upper brainstem and awakened 20 days later to find himself fully conscious but capable only of blinking his left eye. A tiny fraction of surgical patients find themselves in similarly terrifying conditions caused by the combination of muscle relaxants with insufficient levels of anesthetic agents (Kelly et al., 2007, p. 387 n. 18). (shrink)

Thus Hegel's philosophy did not, as it were, merely paint "gray on gray." Not surprisingly, however, contemporary interest in this "ultimate philosophy" is due chiefly to the suggestive expansion of its insights, rather than to any desire for systematic reconstruction. In a discretionary way, Hegelian problems and patterns have gained a new lease in the fields of social and religious thought and among those for whom classical political theory is not a dead exercise. One might say that Hegel (...) remains vital because he continues to raise polemical questions. When a giant structure of human speculation is superseded—a fate which some feel, wrongly I think, that Hegel tacitly acknowledged for his own philosophy—but survives in membris disjectis, anthologies tend to be compiled for partisan purposes. Karl Löwith reminds us that this was the destiny of the fragile Hegelian balance in the hands of the philosopher's immediate disciples. The last generation has seen a renewal of this Kulturkampf, but now on the far side of total war, Marxism, and religious crisis. The opposition of "What did Hegel mean?" and "What does Hegel mean for us?" is posed and reposed. I personally feel—as a historian of ideas—that some intellectual mischief is caused by the failure to raise the two questions in mutual rapport. (shrink)

(2006). The Social Theory of Anti‐Liberalism. Critical Review of International Social and Political Philosophy: Vol. 9, The Political Theory of John Gray, pp. 137-154.

A model of the neuropsychology of anxiety is proposed. The model is based in the first instance upon an analysis of the behavioural effects of the antianxiety drugs (benzodiazepines, barbiturates, and alcohol) in animals. From such psychopharmacologi-cal experiments the concept of a “behavioural inhibition system” (BIS) has been developed. This system responds to novel stimuli or to those associated with punishment or nonreward by inhibiting ongoing behaviour and increasing arousal and attention to the environment. It is activity in the BIS (...) that constitutes anxiety and that is reduced by antianxiety drugs. The effects of the antianxiety drugs in the brain also suggest hypotheses concerning the neural substrate of anxiety. Although the benzodiazepines and barbiturates facilitate the effects of γ-aminobutyrate, this is insufficient to explain their highly specific behavioural effects. Because of similarities between the behavioural effects of certain lesions and those of the antianxiety drugs, it is proposed that these drugs reduce anxiety by impairing the functioning of a widespread neural system including the septo-hippocampal system (SHS), the Papez circuit, the prefrontal cortex, and ascending monoaminergic and cholinergic pathways which innervate these forebrain structures. Analysis of the functions of this system (based on anatomical, physiological, and behavioural data) suggests that it acts as a comparator: it compares predicted to actual sensory events and activates the outputs of the BIS when there is a mismatch or when the predicted event is aversive. Suggestions are made as to the functions of particular pathways within this overall brain system. The resulting theory is applied to the symptoms and treatment of anxiety in man, its relations to depression, and the personality of individuals who are susceptible to anxiety or depression. (shrink)

Participants compared the mental capacities of various human and nonhuman characters via online surveys. Factor analysis revealed two dimensions of mind perception, Experience and Agency. The dimensions predicted different moral judgments but were both related to valuing of mind.

Mind perception entails ascribing mental capacities to other entities, whereas moral judgment entails labeling entities as good or bad or actions as right or wrong. We suggest that mind perception is the essence of moral judgment. In particular, we suggest that moral judgment is rooted in a cognitive template of two perceived minds—a moral dyad of an intentional agent and a suffering moral patient. Diverse lines of research support dyadic morality. First, perceptions of mind are linked to moral judgments: dimensions (...) of mind perception (agency and experience) map onto moral types (agents and patients), and deficits of mind perception correspond to difficulties with moral judgment. Second, not only are moral judgments sensitive to perceived agency and experience, but all moral transgressions are fundamentally understood as agency plus experienced suffering—that is, interpersonal harm—even ostensibly harmless acts such as purity violations. Third, dyadic morality uniquely accounts for the phenomena of dyadic completion (seeing agents in response to patients, and vice versa), and moral typecasting (characterizing others as either moral agents or moral patients). Discussion also explores how mind perception can unify morality across explanatory levels, how a dyadic template of morality may be developmentally acquired, and future directions. (shrink)

This paper is about how to interpret and evaluate purported evidence for predicativism about proper names. I aim to point out some underappreciated thorny issues and to offer both predicativists and non-predicativists some advice about how best to pursue their respective projects. I hope to establish three related claims: that non-predicativists have to posit relatively exotic, though not entirely implausible, polysemic mechanisms to capture the range of data that predicativists have introduced ; that neither referentialism nor extant versions of predicativism (...) can offer a very plausible account of the interpretive possibilities for singular unmodified definite descriptions containing names ; and that the most plausible version of predicativism would treat bare names as non-anaphoric definite descriptions. (shrink)

The uncanny valley—the unnerving nature of humanlike robots—is an intriguing idea, but both its existence and its underlying cause are debated. We propose that humanlike robots are not only unnerving, but are so because their appearance prompts attributions of mind. In particular, we suggest that machines become unnerving when people ascribe to them experience, rather than agency. Experiment 1 examined whether a machine’s humanlike appearance prompts both ascriptions of experience and feelings of unease. Experiment 2 tested whether a machine capable (...) of experience remains unnerving, even without a humanlike appearance. Experiment 3 investigated whether the perceived lack of experience can also help explain the creepiness of unfeeling humans and philosophical zombies. These experiments demonstrate that feelings of uncanniness are tied to perceptions of experience, and also suggest that experience—but not agency—is seen as fundamental to humans, and fundamentally lacking in machines. (shrink)

Proponents of the predicate view of names explain the reference of an occurrence of a name N by invoking the property of bearing N. They avoid the charge that this view involves a vicious circularity by claiming that bearing N is not itself to be understood in terms of the reference of actual or possible occurrences of N. I argue that this approach is fundamentally mistaken. The phenomenon of ‘reference transfer’ shows that an individual can come to bear a name (...) in virtue of the referential practices of a group of speakers. I develop a picture of name-bearing which captures this fact by treating the extension of name as a function of the way that extension is represented in the presuppositions of groups of speakers. I show that though there is a form of circularity inherent in this approach, it is not vicious circularity. (shrink)

According to models of objectification, viewing someone as a body induces de-mentalization, stripping away their psychological traits. Here evidence is presented for an alternative account, where a body focus does not diminish the attribution of all mental capacities but, instead, leads perceivers to infer a different kind of mind. Drawing on the distinction in mind perception between agency and experience, it is found that focusing on someone's body reduces perceptions of agency but increases perceptions of experience. These effects were found (...) when comparing targets represented by both revealing versus nonrevealing pictures or by simply directing attention toward physical characteristics. The effect of a body focus on mind perception also influenced moral intuitions, with those represented as a body seen to be less morally responsible but more sensitive to harm. These effects suggest that a body focus does not cause objectification per se but, instead, leads to a redistribution of perceived mind. (shrink)

The popularity of ‘food sovereignty’ to cover a range of positions, interventions, and struggles within the food system is testament, above all, to the term’s adaptability. Food sovereignty is centrally, though not exclusively, about groups of people making their own decisions about the food system—it is a way of talking about a theoretically-informed food systems practice. Since people are different, we should expect decisions about food sovereignty to be different in different contexts, albeit consonant with a core set of principles (...) (including women’s rights, a shared opposition to genetically modified crops, and a demand for agriculture to be removed from current international trade agreements). In this paper we look at the analytical points of friction in applying ideas of food sovereignty within the context of Indigenous struggles in North America. This, we argue, helps to clarify one of the central themes in food sovereignty: that it is a continuation of anti-colonial struggles, even in post-colonial contexts. Such an examination has dividends both for scholars of food sovereignty and for those of Indigenous politics: by helping to problematize notions of food sovereignty and postcoloniality, but also by posing pointed questions around gender for Indigenous struggles. (shrink)

Drawing on previous models of anxiety, intermediate memory, the positive symptoms of schizophrenia, and goal-directed behaviour, a neuropsychological hypothesis is proposed for the generation of the contents of consciousness. It is suggested that these correspond to the outputs of a comparator that, on a moment-by-moment basis, compares the current state of the organism's perceptual world with a predicted state. An outline is given of the information-processing functions of the comparator system and of the neural systems which mediate them. The hypothesis (...) appears to be able to account for a number of key features of the contents of consciousness. However, it is argued that neitherthis nor any existing comparable hypothesis is yet able to explain why the brain should generate conscious experience of any kind at all. (shrink)

Talk about time travel is puzzling even if it isn't obviously contradictory. Philosophers however are divided about whether time travel involves empirical paradox or some deeper metaphysical incoherence. It is suggested that time travel requires a Parmenidean four-dimensionalist metaphysical conception of the world in time. The possibility of time travel is addressed (mainly) from within a Parmenidean metaphysical framework, which is accepted by David Lewis in his defence of the coherence of time travel. It is argued that time travel raises (...) formidable difficulties which are not satisfactorily resolved by Lewis's ingenious defence of time travel. Objections to time travel considered include: (1) travel to other times is impossible because there is nowhere (or “nowhen”) to go to; (2) the problem that upon setting out on a journey to the past a time machine will collide with itself; (3) time travel generates a mysterious temporal dualism between experiential time and physical time; (4) travel to the past permits reverse causation, raising the possibility of causal loops and attendant problems arising, for example, from the prospect of empirical contradiction and the possibility of someone being one of their ancestors. (shrink)

Pain is commonly explained in terms of the perceptual activity of a distinct sensory modality, the function of which is to enable us to perceive actual or potential damage to the body. However, the characterization of pain experience in terms of a distinct sensory modality with such content is problematic. I argue that pain is better explained as occupying a different role in relation to perception: to indicate when the stimuli that are sensed in perceiving anything by means of a (...) sensory modality exceed a significant level of intensity. Viewing the system underlying pain experience as an integral and functionally integrated feature of all the senses provides a new perspective on the diverse forms of pain, what it is like to experience pain and the contrasting natures of pain and pleasure. (shrink)

The framework of plateaus, dips, and leaps shines light on periods when individuals may be inventing new methods of skilled performance. We begin with a review of the role performance plateaus have played in experimental psychology, human–computer interaction, and cognitive science. We then reanalyze two classic studies of individual performance to show plateaus and dips which resulted in performance leaps. For a third study, we show how the statistical methods of Changepoint Analysis plus a few simple heuristics may direct our (...) focus to periods of performance change for individuals. For the researcher, dips become the marker of exploration where performance suffers as new methods are invented and tested. Leaps mark the implementation of a successful new method and an incremental jump above the path plotted by smooth and steady log–log performance increments. The methods developed during these dips and leaps are the key to surpassing one's teachers and acquiring extreme expertise. (shrink)

Predicativism about names—the view that names are metalinguistic predicates—has yet to confront a foundational issue: how are names represented in the lexicon? I provide a positive characterization of the structure of the lexicon from the point of view Predicativism. I proceed to raise a problem for Predicativism on the basis of that characterization, focusing on cases in which individuals have names which are spelled the same way but pronounced differently. Finally, I introduce two potential strategies for solving the problem, and (...) offer reasons not to be optimistic about either. (shrink)

Call an account of names satisfactionalist if it holds that object o is the referent of name a in virtue of o’s satisfaction of a descriptive condition associated with a. Call an account of names minimally descriptivistif it holds that if a competent speaker finds ‘a=b’ to be informative, then she must associate some information with ‘a’ which she does not associate with ‘b’. The rejection of both positions is part of the Kripkean orthodoxy, and is also built into extant (...) versions of the file-picture of reference. In this paper, I argue that the rejection of minimal descriptivism only follows from the rejection of satisfactionalism given certain implausible assumptions about the nature of competence with a proper name. I do this by showing that considerations internal to the file-picture - in particular the idea that competence with a proper name constitutes an ‘epistemically rewarding’ relation to its bearer - motivate an acceptance of minimal descriptivism. (shrink)

There has recently been emphasis put on providing two-factor accounts of monothematic delusions. Such accounts would explain (1) whether a delusional hypothesis (e.g. someone else is inserting thoughts into my mind) can be understood as a prima facie reasonable response to an experience and (2) why such a delusional hypothesis is believed and maintained given its implausibility and evidence against it. I argue that if we are to avoid obfuscating the cognitive mechanisms involved in monothematic delusion formation we should split (...) the first factor (1 above) into two factors: how abnormal experience can give rise to a delusional ‘proto-hypothesis’ and how a ‘proto-hypothesis’ in consort with normal experiences and background information, can be developed into a delusional hypothesis. In particular I will argue that a schizophrenic is faced with the unusual requirement of having to identify an introspectively accessible thought as one's own, and that this requirement of identification is the central experiential abnormality of thought insertion, auditory verbal hallucination, and alien control (i.e. passivity symptoms). Additionally, I will consider non-experiential factors which are required for the formation of a delusional hypothesis. (shrink)

When Gilles Deleuze, in his book on Michel Foucault, asks, ‘who would think of looking for life among the archives?’, he uncovers something particular to Foucault's philosophy, but also to his own: a commitment to the question of what it means to think, and think politically. Although Foucault and Deleuze, who first met in 1952, immediately felt fondness for each other, a growing animosity had settled into the friendship by the end of the 1970s – a rift deepened by theoretical (...) differences. Notwithstanding these difficulties, Foucault and Deleuze shared a love for Nietzsche, as well as a curious fascination with Kant. Kant's influence, which was met with more opposition, is precisely the tension I tease out in this article, showing how Foucault critiques Kant's a priori through his own concept of the historical a priori, along with regularity and resistance, while Deleuze and Guattari, if more obliquely, critique Kant's a priori by further developing Foucault's notion of the historical a priori through their own method of pragmatics, particularly in three chapters of A Thousand Plateaus, namely ‘The Geology of Morals’, ‘Postulates of Linguistics’ and ‘On Several Regimes of Signs’. What I am interested in, then, is Deleuze and Guattari's treatment of redundancy, a concept mentioned seventy times in A Thousand Plateaus. Although not one of their main or most developed concepts, redundancy is a thread that can be traced back to Deleuze's first book, Empiricism and Subjectivity. Moreover, their more developed concepts, for example the diagram, the abstract machine, becoming, micro-politics and the ritornello, as well as their political philosophy, are grounded in their understanding of redundancy, which moves their philosophy beyond mapping out the conditions of possibility and demonstrating that the historical a priori emerges as a contingent function of its own expression to the genesis of thought. (shrink)

Constraints and dependencies among the elements of embodied cognition form patterns or microstrategies of interactive behavior. Hard constraints determine which microstrategies are possible. Soft constraints determine which of the possible microstrategies are most likely to be selected. When selection is non-deliberate or automatic the least effort microstrategy is chosen. In calculating the effort required to execute a microstrategy each of the three types of operations, memory retrieval, perception, and action, are given equal weight; that is, perceptual-motor activity does not have (...) a privileged status with respect to memory. Soft constraints can work contrary to the designer's intentions by making the access of perfect knowledge in-the-world more effortful than the access of imperfect knowledge in-the-head. These implications of soft constraints are tested in two experiments. In experiment 1 we varied the perceptual-motor effort of accessing knowledge in-the-world as well as the effort of retrieving items from memory. In experiment 2 we replicated one of the experiment 1 conditions to collect eye movement data. The results suggest that milliseconds matter. Soft constraints lead to a reliance on knowledge in-the-head even when the absolute difference in perceptual-motor versus memory retrieval effort is small, and even when relying on memory leads to a higher error rate and lower performance. We discuss the implications of soft constraints for routine interactive behavior, accounts of embodied cognition, and tool and interface design. (shrink)

Diverse lines of evidence point to a basic human aversion to physically harming others. First, we demonstrate that unwillingness to endorse harm in a moral dilemma is predicted by individual differences in aversive reactivity, as indexed by peripheral vasoconstriction. Next, we tested the specific factors that elicit the aversive response to harm. Participants performed actions such as discharging a fake gun into the face of the experimenter, fully informed that the actions were pretend and harmless. These simulated harmful actions increased (...) peripheral vasoconstriction significantly more than did witnessing pretend harmful actions or to performing metabolically-matched non-harmful actions. This suggests that the aversion to harmful actions extends beyond empathic concern for victim harm. Together, these studies demonstrate a link between the body and moral decision making processes. (shrink)

The nature/nurture debate is not dead. Dichotomous views of development still underlie many fundamental debates in the biological and social sciences. Developmental systems theory offers a new conceptual framework with which to resolve such debates. DST views ontogeny as contingent cycles of interaction among a varied set of developmental resources, no one of which controls the process. These factors include DNA, cellular and organismic structure, and social and ecological interactions. DST has excited interest from a wide range of researchers, from (...) molecular biologists to anthropologists, because of its ability to integrate evolutionary theory and other disciplines without falling into traditional oppositions. The book provides historical background to DST, recent theoretical findings on the mechanisms of heredity, applications of the DST framework to behavioral development, implications of DST for the philosophy of biology, and critical reactions to DST. (shrink)

The theme of this year’s Spindel Conference was Social Ontologies of Race. This editorial introduction serves as both a general introduction to the topic of racial ontology and an introduction to this volume’s contributions. I will first explain some central ideas for discussions of ontology in general. I will then make some basic taxonomic distinctions common to discussions of racial ontology and suggest some clarifications. I will then go on to discuss the five contributions to this volume.

Keeley has recently argued that the philosophical issue of how to analyse the concept of a sense can usefully be addressed by considering how scientists, and more specifically neuroethologists, classify the senses. After briefly outlining his proposal, which is based on the application of an ordered set of individually necessary and jointly sufficient conditions for modality differentiation, I argue, by way of two complementary counterexamples, that it fails to account fully for the way the senses are in fact individuated in (...) neuroethology and other relevant sciences. (shrink)

Epicurus notoriously argued that death at no time is a harm because before death there is no harm and after death there is no victim. The denial that death can be a harm to the one who dies has been challenged by various claims including (1) death is eternally bad for the victim (Feldman), (2) it is before death that it is bad for the victim (Feinberg and Pitcher), (3) death is bad for the victim but at no particular time (...) (Nagel), and (4) it is at the time of death that death is bad for the victim (Lamont). Nagel's account is more plausible and is consistent with the view that the temporal location of the harm of untimely death is best understood as the time when the decedent might otherwise have lived. (edited). (shrink)

Our experiences of heat and cold are usually thought to represent states of things: their hotness and coldness. I propose a novel account according to which their contents are not states of things but processes, more specifically, the opposite processes of thermal energy being transmitted to and from the body, respectively. I call this account the Heat Exchange Model of heat perception. Having set out the evidence in support of the proposal, I conclude by showing how it provides a new (...) perspective on some old problems. (shrink)

Why games? How could anyone consider action games an experimental paradigm for Cognitive Science? In 1973, as one of three strategies he proposed for advancing Cognitive Science, Allen Newell exhorted us to “accept a single complex task and do all of it.” More specifically, he told us that rather than taking an “experimental psychology as usual approach,” we should “focus on a series of experimental and theoretical studies around a single complex task” so as to demonstrate that our theories of (...) human cognition were powerful enough to explain “a genuine slab of human behavior” with the studies fitting into a detailed theoretical picture. Action games represent the type of experimental paradigm that Newell was advocating and the current state of programming expertise and laboratory equipment, along with the emergence of Big Data and naturally occurring datasets, provide the technologies and data needed to realize his vision. Action games enable us to escape from our field's regrettable focus on novice performance to develop theories that account for the full range of expertise through a twin focus on expertise sampling and longitudinal studies of simple and complex tasks. (shrink)

Steven Nadler has argued that Spinoza can, should, and does allow for the possibility of suicide committed as a free and rational action. Given that the conatus is a striving for perfection, Nadler argues, there are cases in which reason guides a person to end her life based on the principle of preferring the lesser evil. If so, Spinoza’s disparaging statements about suicide are intended to apply only to some cases, whereas in others he would grant that suicide is dictated (...) by reason. Here, I object to Nadler’s interpretation by showing that it conflicts with Spinoza’s metaphysical psychology. Even given Nadler’s interpretation of the conatus doctrine, the possibility that reason could guide a person to commit suicide is incompatible with the conatus of the mind. Spinoza holds that the mind cannot contain an adequate idea ‘that excludes the existence of our body’. Yet, as I argue, in order for reason to guide a person voluntarily to end her life, she would need to have an adequate idea representing her death – an idea that excludes the existence of her body. For this reason, Spinoza's system rules out the possibility of rational suicide. (shrink)

The direct protection of civilians from the violence and harms of armed conflict is most often understood in fixed, identity-centred terms: of what protection is, where it is located, of who provid...

This article explores the representational practices of feminist theorising around gender and violence. Adapting Liz Kelly’s notion of the continuum of women’s experiences of sexual violence, I argue that ‘continuum thinking’ can offer important interventions which unsettle binaries, recognise grey areas in women’s experiences and avoid ‘othering’ specific communities. Continuum thinking allows us to understand connections whilst nevertheless maintaining distinctions that are important conceptually, politically and legally. However, this is dependent upon recognising the multiplicity of continuums in feminist theorising (...) – as well as in policy contexts – and the different ways in which they operate. A discussion of contemporary theory and policy suggests that this multiplicity is not always recognised, resulting in a flattening of distinctions which can make it difficult to recognise the specifically gendered patterns of violence and experience. I conclude by considering how focusing on men’s behaviour might offer one way of unsettling the contemporary orthodoxy which equates gender-based violence and violence against women. (shrink)

Fodor claims that cognitive modules can be thought of as constituting a psychological natural kind in virtue of their possession of most or all of nine specified properties. The challenge to this considered here comes from synaesthesia. Synaesthesia is a type of cross-modal association: input to one sensory modality reliably generates an additional sensory output that is usually generated by the input to a distinct sensory modality. The most common form of synaesthesia manifests Fodor's nine specified properties of modularity, and (...) hence, according to Segal (1997), it should be understood as involving an extra module. Many psychologists believe that synaesthesia involves a breakdown in modularity. After outlining how both theories can explain the manifestation of the nine alleged properties of modularity in synaesthesia, I discuss the two concepts of function which initially motivate the respective theories. I argue that only a teleological concept of function is properly able to adjudicate between the two theories. The upshot is a further application of so-called externalist considerations to mental phenomena. (shrink)

Pickeringet al’s paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected (...) by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience. (shrink)