Research Ethics, Volume 18, Issue 1, Page 64-83, January 2022. Automated, wearable cameras can benefit health-related research by capturing accurate and objective information about individuals’ daily experiences. However, wearable cameras present unique privacy- and confidentiality-related risks due to the possibility of the images capturing identifying or sensitive information from participants and third parties. Although best practice guidelines for ethical research with wearable cameras have been published, limited information exists on the risks of studies using wearable cameras. The aim of this (...) literature review was to survey risks related to using wearable cameras, and precautions taken to reduce those risks, as reported in empirical research. Forty-five publications, comprising 36 independent studies, were reviewed, and findings revealed that participants’ primary concerns with using wearable cameras included physical inconvenience and discomfort in certain situations. None of the studies reviewed reported any serious adverse events. Although it is possible that reported findings do not include all risks experienced by participants in research with wearable cameras, our findings suggest a low level of risk to participants. However, it is important that investigators adopt recommended precautions, which can promote autonomy and reduce risks, including participant discomfort. (shrink)

Måske er netop Grundtvigs forståelse af det evige en nødvendig inspiration til at se sider af kristendommen, som vi ellers fortrænger. For om nogen formulerede han både sammenhængen og det uoverstigelige svælg mellem ”nu” og ”engang”, det dennesidige og det evige - og så den modsætning, der går ned gennem det menneskelige liv mellem lys og mørke, liv og død, frelse og fortabelse. Det modsætningsfyldte i kristendommen, dens paradoks, var for Grundtvig at se gået tabt i rationalismens kritiske syn på (...) Bibelen og i romantikkens harmonitænkning Spørgsmålet er så, om det dristige og håndgribelige i Grundtvigs tale om det evige kan gøres gældende i en folkekirkelighed, hvor den teologiske refleksion over eskatologien er gledet i baggrunden. Er Grundtvigs kraftige billedverden, kampen mellem lys og mørke, fylde og meningsløshed, frelse og fortabelse, liv og død blevet uforståelig? Og kan vi igen gøre denne billedverden nærværende og meningsfyldt? (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

Hermeneutics, the study of interpretation, is an essential and valuable branch of philosophy. Hermeneutics is also a central component of the methodology of the social sciences and the humanities, for example historiography, anthropology, art history, and literary criticism. In a sequence of accessible chapters, contributors across the human sciences explain the leading concepts and ideas of hermeneutics, the historical development of the field, the importance of hermeneutics in philosophy today, and the ways in which it can address contemporary concerns including (...) intercultural relations, relations between subcultures within a single society, and relations across race and gender. Clearly structured and written in non-technical language, this Companion will be an important contribution to a growing field of study. (shrink)

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts (...) to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD. (shrink)

This volume constitutes the first collective critical study of German philosophy in the nineteenth century. A team of leading experts explore the influential figures associated with the period--including Hegel, Kierkegaard, Nietzsche, and Frege--and provide fresh accounts of the philosophical movements and key debates with which they engaged.

Emerging evidence suggests that the long-established distinction between habit-based and goal-directed decision-making mechanisms can also be sustained in humans. Although the habit-based system has been extensively studied in humans, the goal-directed system is less well characterized. This review brings to that task the distinction between conceptual and nonconceptual representational mechanisms. Conceptual representations are structured out of semantic consituents - the use of which requires an ability to perform some language-like syntactic processing. Decision making - as investigated by neuroscience and psychology (...) - is normally studied in isolation from questions about concepts as studied in philosophy and cognitive psychology. We ask what role concepts play in the "goal-directed" decision-making systems. We argue that one fruitful way of studying this system in humans is to investigate the extent to which it deploys conceptual representations. (shrink)

We take up the challenge of developing an international network with capacity to survey the world's scientists on an ongoing basis, providing rich datasets regarding the opinions of scientists and scientific sub-communities, both at a time and also over time. The novel methodology employed sees local coordinators, at each institution in the network, sending survey invitation emails internally to scientists at their home institution. The emails link to a ‘10 second survey’, where the participant is presented with a single statement (...) to consider, and a standard five point Likert scale. In June 2023, a group of 30 philosophers and social scientists invited 20,085 scientists across 30 institutions in 12 countries to participate, gathering 6,807 responses to the statement 'Science has put it beyond reasonable doubt that COVID-19 is caused by a virus'. The study demonstrates that it is possible to establish a global network to quickly ascertain scientific opinion on a large international scale, with high response rate, low opt-out rate, and in a way that allows for significant (perhaps indefinite) repeatability. Measuring scientific opinion in this new way would be a valuable complement to currently available approaches, potentially informing policy decisions and public understanding across diverse fields. (shrink)

We take up the challenge of developing an international network with capacity to survey the world’s scientists on an ongoing basis, providing rich datasets regarding the opinions of scientists and scientific sub-communities, both at a time and also over time. The novel methodology employed sees local coordinators, at each institution in the network, sending survey invitation emails internally to scientists at their home institution. The emails link to a ‘10 second survey’, where the participant is presented with a single statement (...) to consider, and a standard five-point Likert scale. In June 2023, a group of 30 philosophers and social scientists invited 20,085 scientists across 30 institutions in 12 countries to participate, gathering 6,807 responses to the statement Science has put it beyond reasonable doubt that COVID-19 is caused by a virus. The study demonstrates that it is possible to establish a global network to quickly ascertain scientific opinion on a large international scale, with high response rate, low opt-out rate, and in a way that allows for significant (perhaps indefinite) repeatability. Measuring scientific opinion in this new way would be a valuable complement to currently available approaches, potentially informing policy decisions and public understanding across diverse fields. (shrink)

Given the need for enforceable guardrails for artificial intelligence (AI) that protect the public and allow for innovation, the U.S. Government recently issued a Blueprint for an AI Bill of Rights which outlines five principles of safe AI design, use, and implementation. One in particular, the right to notice and explanation, requires accurately informing the public about the use of AI that impacts them in ways that are easy to understand. Yet, in the healthcare setting, it is unclear what goal (...) the right to notice and explanation serves, and the moral importance of patient-level disclosure. We propose three normative functions of this right: (1) to notify patients about their care, (2) to educate patients and promote trust, and (3) to meet standards for informed consent. Additional clarity is needed to guide practices that respect the right to notice and explanation of AI in healthcare while providing meaningful benefits to patients. (shrink)

Obstructive sleep apnea (OSA) severely impacts sleep and has long-term health consequences. Treating sleep apnea with continuous positive airway pressure (CPAP) not only relieves obstructed breathing, but also improves sleep. CPAP improves sleep by reducing apnea-induced awakenings. CPAP may also improve sleep by enhancing features of sleep architecture assessed with electroencephalography (EEG) that maximize sleep depth and neuronal homeostasis, such as the slow oscillation and spindle EEG activity, and by reducing neurophysiological arousal during sleep (i.e., beta EEG activity). We examined (...) cross-sectional differences in quantitative EEG characteristics of sleep, assessed with power spectral analysis, in 29 adults with type 2 diabetes treated with CPAP and 24 adults undergoing SHAM CPAP treatment (total n = 53). We then examined changes in spectral characteristics of sleep as the SHAM group crossed over to active CPAP treatment (n = 19). Polysomnography (PSG) from the CPAP titration night was used for the current analyses. Analyses focused on EEG frequencies associated with sleep maintenance and arousal. These included the slow oscillation (0.5–1 Hz), sigma activity (12–16 Hz, spindle activity), and beta activity (16–20 Hz) in F3, F4, C3, and C4 EEG channels. Whole night non-rapid eye movement (NREM) sleep and the first period of NREM spectral activity were examined. Age and sex were included as covariates. There were no group differences between CPAP and SHAM in spectral characteristics of sleep architecture. However, SHAM cross-over to active CPAP was associated with an increase in relative 12–16 Hz sigma activity across the whole night and a decrease in average beta activity across the whole night. Relative slow oscillation power within the first NREM period decreased with CPAP, particularly for frontal channels. Sigma and beta activity effects did not differ by channel. These findings suggest that CPAP may preferentially enhance spindle activity and mitigate neurophysiological arousal. These findings inform the neurophysiological mechanisms of improved sleep with CPAP and the utility of quantitative EEG measures of sleep as a treatment probe of improvements in neurological and physical health with CPAP. (shrink)

Introduction Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether (...) mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.Objectives To explore mental health clinicians’ views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates.Materials and Methods In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient’s previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity.Conclusions Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice. (shrink)

We take up the challenge of developing an international network with capacity to survey the world’s scientists on an ongoing basis, providing rich datasets regarding the opinions of scientists and scientific sub-communities, both at a time and also over time. The novel methodology employed sees local coordinators, at each institution in the network, sending survey invitation emails internally to scientists at their home institution. The emails link to a ‘10 second survey’, where the participant is presented with a single statement (...) to consider, and a standard five-point Likert scale. In June 2023, a group of 30 philosophers and social scientists invited 20,085 scientists across 30 institutions in 12 countries to participate, gathering 6,807 responses to the statement Science has put it beyond reasonable doubt that COVID-19 is caused by a virus. The study demonstrates that it is possible to establish a global network to quickly ascertain scientific opinion on a large international scale, with high response rate, low opt-out rate, and in a way that allows for significant (perhaps indefinite) repeatability. Measuring scientific opinion in this new way would be a valuable complement to currently available approaches, potentially informing policy decisions and public understanding across diverse fields. (shrink)

This paper is based on the comments I gave to Alfred Mele regarding his original Zygote Argument during my presentation at a small workshop on manipulation arguments in Budapest back in 2012. After those comments, Mele changed the conclusion of his original Zygote Argument (OZA) from a positive, explanatory conclusion to a negative, non-explanatory conclusion--and, correspondingly, redefined 'incompatibilism' so that it would no longer refer in his work to the view that determinism precludes (undermines, eliminates, destroys, etc.) free will, but (...) refers narrowly to the perhaps spurious association claim that appears in the conclusion of the revised Zygote Argument (Mele 2013+). Yet, over the last decade, Mele has made no comment in print about the changes he made, the invalidity objection that led to them, nor to the fact that his revised Zygote Argument was originally presented by me as a (non-optimal) reaction to my invalidity objection to his original Zygote Argument. To my knowledge, Mele has only mentioned this 2015 paper once, at it was not in the context of understanding manipulation arguments; it was, rather, in the context of defending his revised, non-explanatory definition of 'incompatibilism' at the opening of Aspects of Agency (p. 6, n. 4). There, Mele singles out *just this 2015 paper* as a place where they'll find what Mele degrades as a type of nonstandard/nontraditional definition of 'incompatibilism' that he rejects. This is notable because Mele provides no empirical evidence that his preferred definition is standard, and most (including Lehrer, who coined the term) reject the negative, non-explanatory, association-based definition that Mele came to endorse in the aftermath of my invalidity objection to OZA. So, if Mele had a genuine concern about philosophers who use the term 'incompatibilism', then Mele could have--and should have--named almost any leading figure in free will for this purpose (since most--including Pereboom, Vihvelin, Haji, etc.) reject the non-explanatory definition that Mele-2013+ now endorses. Yet, for untold reasons, Mele isolated the working definition of 'incompatibilism' used in one paper by one unemployed junior researcher to use as his example--even though Neil Levy had used this same definition in previously published work (eg. Levy 2011). Moreover, if Mele were genuinely interested in helping his readers understand the ambiguity of terms like 'compatibilism' and 'incompatibilism' it is a mystery that he referenced a paper in which nothing of substance hung on the definitions given to these terms -- especially considering that he might have instead pointed them to my OTHER 2015 paper, "A Critique of Vihvelin's Three-Fold Classification" in which the MAIN AIM of the paper is to expose the difficulties facing anyone who wants to define the terms 'compatibilism' and 'incompatibilism' in a way that everyone will accept (including a critique of the negative, non-explanatory "incompossibilist" definition that Mele adopted after my objection to OZA). By all appearances, Mele's main aim in citing specifically THIS paper and none of my other work was to give readers the false impression that my working definition of 'incompatibilism' played some role in my charge that his argument is invalid (which it doesn't, given that the term doesn't appear in either the premises or conclusion of that argument). Mele adds to this unseemly rhetorical campaign in his book *Manipulation Agents* where he mentions an invalidity objection in the intro (p. 84) and then discusses that objection in the final lines of Chapter 5 of the book (p. 120-121). The invalidity objection discussed here is completely pedantic, has never been seriously raised in the primary literature (and was previously addressed in multiple places my multiple philosophers, including me), and has nothing whatever to do with my invalidity objection. In other words, Mele was content to discuss an invalidity objection that no one has ever had to an argument that is clearly valid while completely ignoring the ONLY substantive invalidity objection to his argument in print. This is unfortunate, because it has led to serious confusion --including the patently false description of my invalidity objection to OZA as an objection to the revised version of the Zygote Argument that Mele adopted in *response* my objection (e.g., Capes mistakenly claims "Mickelson (2015) contends that arguments like this [i.e. like the revised Zygote Argument] are invalid. But that’s because she defines “incompatibilism” differently than I’ve defined it here" in his "Manipulation Arguments and Direct Arguments" chapter in the 2023 Wiley-Blackwell Companion to Free Will; I did not say this, and the definition of 'incompatibilism' is irrelevant to my objection). In "The Zygote Argument Is Invalid--Now What?", I simply use the invalidity of the simple 2-premise Zygote Argument as a foil to make a series of more philosophically significant points (e.g. regarding the dialectical structure of the free-will debate, the role of best-explanation reasoning, and to develop the first-ever "master manipulation argument"). Mele has yet to address my reasons for calling attention to the non-trivial invalidity of his OZA or to any of my answers to the "Now What?" question in this paper, even though this question and my proposed answers to this question are the paper's main point. For those interested in a more recent discussion of how the logical and metaphilosophical observations made in this "Now What?" paper have helped to move the free-will debate forward, I suggest looking at the discussions of the "paradigm shift" in the free-will debate that helps to explain why the free-will debate has become mired in stalemates and empty verbal disputes that are found, for example, in my contributions to the Wiley-Blackwell Companion to Free Will (Intro and Chapter 4, 2023) and my paper "Free Will, Self-Creation, and the Paradox of Moral Luck" (2019). (shrink)

_Debates in Nineteenth-Century European Philosophy _offers an engaging and in-depth introduction to the philosophical questions raised by this rich and far reaching period in the history of philosophy. Throughout thirty chapters, the volume surveys the intellectual contributions of European philosophy in the nineteenth century, but it also engages the on-going debates about how these contributions can and should be understood. As such, the volume provides both an overview of nineteenth-century European philosophy and an introduction to contemporary scholarship in this field. (...) __KEY DEBATES IN EUROPEAN NINETEENTH-CENTURY PHILOSOPHY__ Kristin Gjesdal Contributors Editor's Introduction I. Kantian Presuppositions 1. The Reception of the _Critique of Pure Reason_ in German Idealism by Rolf-Peter Horstmann 2. The Reception of the _Critique of Pure Reason_ in German Idealism: A Response to Rolf-Peter Horstmann by Paul Guyer II. Fichte 3. Fichte's Original Insight by Dieter Henrich 4. Fichte's Original Insight: Dieter Henrich's Pioneering Piece Half A Century Later by Günter Zöller III. Romanticism 5. Philosophical Foundations of Early Romanticism by Manfred Frank 6. Response to Manfred Frank, "Philosophical Foundations of Early Romanticism" by Michael N. Forster IV. Hegel 7. From Desire to Recognition: Hegel's Account of Human Sociality by Axel Honneth 8. On Honneth's Interpretation of Hegel's "Phenomenology of Self-Consciousness" by Robert B. Pippin V. Schelling 9. The Nature of Subjectivity: The Critical and Systematic Function of Schelling's Philosophy of Nature by Dieter Sturma 10. Nature as Unconditioned? The Critical and Systematic Function of Schelling's Early Works by Dalia Nassar VI. Schopenhauer 11. The Real Essence of Human Beings: Schopenhauer and the Unconscious Will by Christopher Janaway 12. Emancipation from the Will by David E. Wellbery VII. Comte 13. Auguste Comte and Modern Epistemology by Johan Heilbron 14. Why Was Comte an Epistemologist? by Robert C. Scharff VIII. Mill 15. Mill: The Principle of Liberty by John Rawls 16. John Rawls on Mill's Principle of Liberty by John Skorupski IX. Darwin 17. Darwin's Theory of Natural Selection and its Moral Purpose by Robert J. Richards 18. Response to Richards by Gabriel Finkelstein X. Kierkegaard 19. Kierkegaard's _On Authority and Revelation _ by Stanley Cavell 20. A Nice Arrangement of Epigrams: Stanley Cavell on Søren Kierkegaard by Stephen Mulhall XI. Marx 21. Marx's Metacritique of Hegel: Synthesis Through Social Labor by Jürgen Habermas 22. Epistemology and Self-Reflection in the Young Marx by Espen Hammer XII. Dilthey 23. Wilhelm Dilthey after 150 Years by Hans-Georg Gadamer 24. Gadamer on Dilthey by Frederick C. Beiser XIII. Nietzsche 25. Nietzsche's Minimalist Moral Psychology by Bernard Williams 26. Naturalism, Minimalism, and the Scope of Nietzsche's Philosophical Psychology by Paul Katsafanas XIV. Freud 27. Bad Faith and Falsehood by Jean-Paul Sartre 28. Freud by Sebastian Gardner XV. Twentieth-Century Developments 29. Analytic and Conversational Philosophy by Richard Rorty 30. Not Knowing What the Right Hand is Doing: Rorty's "Ambidextrous" Analytic Redescription of Nineteenth-Century Hegelian Philosophy by Paul Redding References for Republished Texts Accompanying Original Works. (shrink)

Joachim Ritter, ainsi que d’autres auteurs, ont tenté de justifier les sciences humaines à l’aide de la théorie de la « compensation ». Selon lui, les lettres compensent les pertes et les risques engendrés par la progression de la modernisation. La théorie de la compensation semble offrir une justification aux lettres par rapport à la dynamique du monde moderne. Ce qui prima facie paraît intéressant dans une époque où le triomphe des sciences naturelles et de la technologie est manifeste, alors (...) que les sciences humaines doivent défendre leur position. L’article examine quatre critiques à l’égard de la théorie de la compensation : cette théorie est marquée par une approche obsolète de l’histoire ; elle ne tient compte que de la fonction conservatrice des sciences humaines ; elle dégrade ces dernières en les considérant comme annexes aux changements culturels ; enfin, elle surévalue la capacité des sciences humaines à constituer un contrepoids aux pertes et aux risques engendrés par la modernisation. Disserter sur l’histoire de l’église ne compense pas la perte actuelle de la foi. Un essai sur Caspar David Friedrich ne représente pas une compensation pour un paysage ruiné. La croyance que pour chaque perte ou chaque dommage existe une compensation est probablement liée à la croyance religieuse dans le pardon ou aux arguments philosophiques en matière de théodicée. La conclusion est que les lettres ne doivent pas se justifier par des arguments utilitaires. Elles sont « utiles » car elles n’ont pas à être utiles du tout. (shrink)

À la différence de nombreuses théories de la mondialisation, qui posent ou prédisent un monde de plus en plus homogène, ici on indique la dualité du processus de mondialisation. Même d’un point de vue économique, typique de la mondialisation, il est possible de montrer que le monde n’est pas unique, mais se compose de mondes multiples . Ceci est valable dans la même mesure pour les philosophies politiques qui spéculent sur une république mondiale voire un État mondial. De plus, on (...) argumente d’un point de vue philosophicomoral en faveur de la thèse suivante : que le modernisme est caractérisé non seulement par une morale universelle mais aussi par une éthique reflétant les coutumes. (shrink)

Rapid advancements in artificial intelligence and machine learning (AI/ML) in healthcare raise pressing questions about how much users should trust AI/ML systems, particularly for high stakes clinical decision-making. Ensuring that user trust is properly calibrated to a tool’s computational capacities and limitations has both practical and ethical implications, given that overtrust or undertrust can influence over-reliance or under-reliance on algorithmic tools, with significant implications for patient safety and health outcomes. It is, thus, important to better understand how variability in trust (...) criteria across stakeholders, settings, tools and use cases may influence approaches to using AI/ML tools in real settings. As part of a 5-year, multi-institutional Agency for Health Care Research and Quality-funded study, we identify trust criteria for a survival prediction algorithm intended to support clinical decision-making for left ventricular assist device therapy, using semistructured interviews (n=40) with patients and physicians, analysed via thematic analysis. Findings suggest that physicians and patients share similar empirical considerations for trust, which were primarilyepistemicin nature, focused on accuracy and validity of AI/ML estimates. Trust evaluations considered the nature, integrity and relevance of training data rather than the computational nature of algorithms themselves, suggesting a need to distinguish ‘source’ from ‘functional’ explainability. To a lesser extent, trust criteria were also relational (endorsement from others) and sometimes based on personal beliefs and experience. We discuss implications for promoting appropriate and responsible trust calibration for clinical decision-making use AI/ML. (shrink)

Denne artikkelen tar utgangspunkt i et skille mellom samfunnsstrukturer som avgrenser legers skjønnsmessige utfoldelse på den ene siden, og profesjonens tilrettelegging for kultiveringen av erkjennelsesmessige ferdigheter på den annen. Ved å videreføre H. Grimen og A. Molanders anvendelse av S.E. Toulmins modell for praktisk resonnering i en klinisk kontekst redegjør jeg for legeskjønnets multidimensjonale, epistemiske struktur. Gjennomgangen viser hvordan skjønnsanvendelse i legerollen kan analyseres i henhold til en fagteknisk, en distributiv og en relasjonell dimensjon. Mot denne bakgrunnen diskuterer jeg så (...) spenninger som oppstår i skjæringspunktet mellom strukturering og kultivering av skjønnets ulike dimensjoner. Diskusjonen tydeliggjør at den medisinske profesjonen ikke kan betraktes som en selvtilstrekkelig premissleverandør når det gjelder å sikre adekvat kultivering av medlemmenes skjønnsutøvelse i en klinisk kontekst. Ved å synliggjøre og vektlegge de relevante profesjonseksterne bidragene i profesjonens pågående selvregulering kan befolkningens berettigete tillit til profesjonen styrkes ytterligere.Nøkkelord: strukturelt skjønn, epistemisk skjønn, profesjon, selvregulering, tillitEnglish summary: In Between Structures of Society and Profession: On Delimitation, Cultivation and Premises for Adequately Exercising Judgment in the Role as PhysicianThe point of departure of this article is a distinction between societal structures that delimit the discretion of the physician on the one hand and the profession's arrangements for the cultivation of the physician's judgment on the other. By developing H. Grimen and A. Molander's application of S.E. Toulmin's model for practical reasoning in a clinical context, the multi-dimensional epistemic structure of the physician's judgment in terms of technical, distributive, and relational judgment is accounted for. Against this backdrop, tensions emerging in the intersection between delimitation and cultivation of professional judgment in its various dimensions are discussed. The discussion clarifies that the medical profession is not a self-sufficient provider when it comes to ensuring an adequate cultivation of its members' judgment in a clinical context. It is argued that by emphasising and implementing the relevant external contributions to the profession's ongoing self-regulation, the public's justified trust in the medical profession can be strengthened. (shrink)

"Y a-t-il une intelligibilité spécifique du problème de l'institution chez Sartre? La question est rarement posée car, trop souvent, on la considère comme d'emblée réglée: Sartre n'aurait pas été capable d'envisager la dimension institutionnelle autrement que sous une forme négative, celle de la pétrification et de la bureaucratisation de l'action insurrectionnelle d'un groupe. Fruit d'un travail collectif, cet ouvrage explore différentes déclinaisons de la notion d'institution dans la réflexion sartrienne des années 1950 et 1960, en montrant son importance pour articuler (...) la question de l'histoire, de la transformation politique et d'une éthique matérialiste. Au fil de ce parcours qui fait dialoguer Sartre avec Merleau-Ponty, Mauss, Lévi-Strauss, Derrida, Riesman, Guattari et bien d'autres, se dessine une conception originale de l'institution. En tant que dynamique historique d'invention collective, elle est porteuse d'une normativité ouverte : c'est moins la stabilité figée que l'instabilité créatrice qui la définit. C'est ce paradoxe d'une 'institution instable' que les contributions ici réunies proposent d'élucider."--. (shrink)

Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (N = 15) were interviewed twice, using semi-structured in-depth interviews, analyzed by and the responses subject to interpretative-phenomenological analysis. Persons with firsthand experience of avoidant personality disorder were included in the research process. Results: The superordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering (...) the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, Ttheese findings highlight the importance, importance of being met intersubjectively as a person with intentionality and agency, even when one does not feel like one.as an agentive intentional being, even when one does not feel like one, of being met intersubjectively by a therapist. The importance of establishing an emotional bond and emergent trust for open therapeutic communication, collaboration, learning, and becoming able to build courage to begin to approach that which one fears, is emphasized. (shrink)

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A (...) smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term ‘personality,’ while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Books ReceivedThe Ahmadis: Community, Gender, and Politics in a Muslim Society. By Antonio Gualtieri. Montreal and Kingston: McGill-Queen's University Press, 2004. Pp. xvi + 192. Hardcover $65.00. Paper Cdn $24.95 / U.S. $19.95.American Knees. By Shawn Wong. Seattle and London: University of Washington Press, 2005. Pp. xxi + 229. Paper $14.95.The Art of Worldly Wisdom. By Baltasar Gracian and translated by Joseph Jacobs. Mineola, NY: Dover Publications, 2005. Pp. (...) xiii + 114. Paper $5.95.Bashō's Journey: The Literary Prose of Matsuo Bashō. Translated by David Landis Barnhill. Albany: State University of New York Press, 2005. Pp. xvii + 191. Hardcover $59.50. Paper $17.95.Bringing the Gods to Mind: Mantra and Ritual in Early Indian Sacrifice. By Laurie L. Patton. Berkeley: University of California Press, 2005. Pp. xv + 289. Hardcover $49.95/£32.50.Buddhist Inclusivism: Attitudes Towards Religious Others. By Kristin Beise Kiblinger. Burlington, VT: Ashgate Publishing Company, 2005. Pp. viii + 145. Hardcover $89.95.A Chinese Ethics for the New Century: The Ch'ien Mu Lectures in History and Culture, and Other Essays on Science and Confucian Ethics. By Donald J. Munro. Hong Kong: Chinese University Press, 2005. Pp. xlv + 158. Hardcover $33.00.Chinese Theories of Reading and Writing: A Route to Hermeneutics and Open Poetics. By Ming Dong Gu. Albany: State University of New York Press, 2005. Pp. xiv + 334. Hardcover $85.00.A Dictionary of Cantonese Slang: The Language of Hong Kong Movies, Street Gangs, and City Life. By Christopher Hutton and Kingsley Bolton. Honolulu: University of Hawai'i Press, 2005. Pp. xxiv + 492. Paper $28.00.Ghazālī and the Poetics of Imagination. By Ebrahim Moosa. Chapel Hill and London: University of North Carolina Press, 2005. Pp. xiii + 349. Hardcover $59.95. Paper $22.50.Going Forth: Visions of Buddhist Vinaya. Edited by William M. Bodiford. Honolulu: University of Hawai'i Press, 2005. Pp. x + 317. Hardcover $48.00.The Harem: Inside the Grand Seraglio of the Turkish Sultans. By N. M. Penzer. Mineola, NY: Dover Publications, 2005. Pp. 277. Paper $14.95.Ideals of the East: The Spirit of Japanese Art. By Kakuzo Okakura. Mineola, NY: Dover Publications, 2005. Pp. xiv + 106. Paper $5.95. [End Page 365]An Illustrated Chinese Materia Medica. By Jing-Nuan Wu. New York: Oxford University Press, 2005. Pp. 706. Price not given.Jews and Arabs: A Concise History of Their Social and Cultural Relations. By S. D. Goitein. Mineola, NY: Dover Publications, 2005. Pp. xv + 263. Paper $12.95.The Logic of Nothingness: A Study of Nishida Kitarō. By Robert J. J. Wargo. Honolulu: University of Hawai'i Press, 2005. Pp xi + 241. Paper $25.00.The Moral and Political Thought of Mahatma Gandhi. By Raghavan N. Iyer. New Delhi: Oxford University Press, 2000. Pp. xiii + 449. Paper Rs 520.00.Nietzsche's Epic of the Soul: Thus Spoke Zarathustra. By T. K. Seung. Lanham, MD: Lexington Books, 2005. Pp. xxviii + 370. Hardcover $83.00. Paper $27.95.Of Guilds, Companies, Corporations, and Governance: A Conceptual Sketch. By Leonardo R. Silos. Makati City, Philippines: Asian Institute of Management, 2005. Pp. xvi + 238. Price not given.The Path to Rome. By Hilaire Belloc. Mineola, NY: Dover Publications, 2005. Pp. ix + 251. Paper $12.95.The Philosophy of the Bhagavadgātā : A Study based on the Evaluation of the Commentaries of Śamkara, Rāmānuja and Madhva. By S. M. Srinivasa Chari. New Delhi: Munshiram Manoharlal Publishers, 2005. Pp. xxvi + 294. Hardcover Rs 575.00.The Philosophy of Rabindranath Tagore. By Kalyan Sen Gupta. Burlington, VT: Ash-gate Publishing Company, 2005. Pp. ix + 103. Hardcover $79.95.The Pristine Dao: Metaphysics in Early Daoist Discourse. By Thomas Michael. Albany: State University of New York Press, 2005. Pp. xi + 170. Hardcover $60.00. Paper $21.95.Three Mountains and Seven Rivers: Prof. Musashi Tachikawa's Felicitation Volume. Edited by Shoun Hino and Toshihiro Wada. Delhi: Motilal Banarsidass Publishers. 2004. Pp. xx + 903. Hardcover Rs. 1800.The Unity of Mystical Traditions: The Transformation of Consciousness in Tibetan and German Mysticism. By Randall Studstill. Leiden and Boston: Brill, 2005. Pp. xii + 304. Hardcover @89/$127.00.Writing the World: On Globalization. Edited by David... (shrink)

I Norge er ikke surrogati tillatt, og myndighetene fraråder norske statsborgere å benytte seg av surrogati i utlandet. I denne artikkelen fokuserer vi på kommersiell gestational surrogati og stiller spørsmålet: Bør man tillate at norske statsborgere benytter seg av surrogati i India? De etiske problemstillingene rundt surrogati er mange og sammensatte og blir spesielt utfordrende når tjenesten tilbys i et land med store kulturelle og økonomiske forskjeller både internt og i forhold til Norge. Vi baserer analysen og drøftingen av dette (...) etisk utfordrende spørsmålet på Beauchamps og Childress sin veletablerte metodiske tilnærming innen biomedisinsk etikk. Vi anvender de fire allmennmoralske prinsipper: respekt for autonomi, velgjørenhet, ikke-skade og rettferdighet på sakskomplekset for å synliggjøre spenningene involvert i dette etiske dilemmaet. Med full bevissthet om at det ikke finnes noen lettvinte og omkostningsfrie løsninger på dilemmaer generelt og dette spesielt, konkluderer vi med at interessene til de berørte parter, og spesielt surrogatmødrenes, kan bli bedre ivaretatt om surrogati tillates under omfattende reguleringer. Dersom man velger å gjøre praksisen illegal, vil man også miste mulighetene til å påvirke prosessen og sikre rettighetene til de involverte partene.Nøkkelord: surrogati, Norge–India, utnyttelse, autonomi, regulering av prosessenEnglish summary: Should Norwegian citizens be permitted to use surrogacy in India?Surrogacy is not permitted in Norway, and the government strongly advises against Norwegian citizens travelling abroad to have children through the use of the surrogacy industry. In this article, we focus on commercial gestational surrogacy and debate the question: Should Norwegian citizens be permitted to use surrogacy in India? The ethical concerns regarding surrogacy are complex and are especially challenging when the service is offered in a country with big cultural and economic differences both internal and in comparison to Norway. We base our analysis of this ethical, challenging question on Beauchamp’s and Childress’s well-established approach within biomedical ethics. We apply the four principles of respect for autonomy, beneficence, nonmaleficence and justice to shed light on the conflicts of interests in this ethical dilemma. With full awareness that there are no simple and correct solutions to dilemmas in general and on this issue, especially, our conclusion is that the interests of the involved parties, and especially those of the surrogate mothers, might be better attended to if surrogacy is allowed with extensive regulations. If this practice is made illegal, the opportunity to influence the process and secure the rights of the involved parties is lost. (shrink)

Background: Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role. Research question and design: We have investigated how nurses experienced their own role in decision-making processes regarding mechanical ventilation in later stages of chronic obstructive pulmonary disease and how they consider the patients’ role in these processes. We applied a qualitative (...) approach, with six focus-group interviews of nurses (n = 26). Ethical considerations: The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained. Findings: The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation. Discussion: Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses’ absence in participation in the decision about mechanical ventilation. Conclusion: To be able to advocate for the patients’ and their own right to be included in decision-making processes, nurses need an awareness of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses’ participation in decision-making processes. (shrink)

Kānûn-i şâhenşâhî -- Mukaddime -- Birinci maksat -- Ikinci maksat -- Üçüncü maksat -- Dördüncü maksat.