BackgroundThe emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD).AimExplore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD).MethodsSemi-structured, future scenario-based (...) interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission’s Ethics Guidelines for Trustworthy AI to structure the interviews.ResultsSix themes arose from the interviews: the ability of AI to rectify human doctors’ limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the ‘human touch’; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the ‘human touch’ in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients’ individual contexts and values, in consultation with the patient.ConclusionThe ‘human touch’ patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the ‘right to a human doctor’ is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward. (shrink)

Background Home-based care workers mainly work alone in the patient’s home. They encounter a diverse patient population with complex health issues. This inevitably leads to several ethical challenges. Aim The aim is to gain insight into ethical challenges related to patient autonomy in home-based care and how home-based care staff handle such challenges. Research design The study is based on a 9-month fieldwork, including participant observation and interviews in home-based care. Data were analysed with a thematic analysis approach. Participants and (...) research context The study took place within home-based care in three municipalities in Eastern Norway, with six staff members as key informants. Ethical considerations The Norwegian Agency for Shared Services in Education and Research evaluated the study. All participants were competent to consent and signed an informed consent form. Findings A main challenge was that staff found it difficult to respect the patient’s autonomy while at the same time practicing appropriate care. We found two main themes: Autonomy and risk in tension; and strategies to balance autonomy and risk. These were explicated in four sub-themes: Refusing and resisting care; when choosing to live at home becomes risky; sweet-talking and coaxing; and building trust over time. Staff’s threshold for considering the use of coercion appeared to be high. Conclusions Arguably, home-based care staff need improved knowledge of coercion and the legislation regulating it. There is also a need for arenas for ethics reflection and building of competence in balancing ethical values in recurrent ethical problems. (shrink)

The purpose of this paper is to lay bare the major problems underlying the concept of downward causation as discussed within the perspective of the present interest for phenomena that are characterized by self-organization. In our discussion of the literature, we have focussed on two questions: (1) What sorts of things are said to be, respectively, causing and caused within the context of downward causation? And (2) What is the meaning of ‘causing’ in downward causation? We have concluded that the (...) concept of ‘downward causation’ is muddled with regard to the meaning of causation and fuzzy with regard to the nature of the causes and the effects. Moreover, we have concluded that ‘causation’ in respect of ‘downward causation’ is usually understood in terms of explanation and determination rather than in terms of causation in the sense of ‘bringing about’. Thus, the term ‘downward causation’ is badly chosen. (shrink)

Speciation is a central but elusive issue in evolutionary biology. Over the past sixty years, the subject has been studied within a framework conceived by Ernst Mayr and Theodosius Dobzhansky and subsequently developed further by numerous other workers. In this “isolation” theory, the evolution of reproductive isolation is a key element of speciation; natural selection is given only secondary importance while gene flow is considered prohibitive to the process. In this paper, I argue that certain elements in this approach have (...) produced confusion and irreconcilability among students of speciation. The more prominent debates in speciation (i.e., the species definition, sympatry/allopatry, and the role of reinforcement) all derive from an inherent conflict between the “isolation” theory and Darwin's “selection” view on species and speciation (in which disruptive selection is crucial). New data, mainly from field ecology, molecular population genetics, laboratory studies with Drosophila and computer analysis, all suggest that the isolation theory may no longer be the most desirable vantage point from which to explore speciation. Instead, environmental selection in large populations, often unimpeded by ongoing gene flow, appears to be the decisive element. The traditional preoccupation with reproductive isolation has created gaps in our knowledge of several crucial issues, mainly regarding the role of environmental selection and its connection with mate selection. BioEssays 22:1134–1141, 2000. © 2000 John Wiley & Sons, Inc. (shrink)

In On Certainty, the emphasis is on the solitary individual as subject of knowledge. The importance of our dependence on others, however, is brought out in Wittgenstein's remarks about trust. In this paper, the role and nature of trust are discussed, the grammar of trust being contrasted with that of reliance. It is shown that to speak of trust is to speak of a fundamental attitude of one person towards others, an attitude which, unlike reliance, is not to be explained, (...) or assessed, by an appeal to reasons. It is, rather, because we have such a fundamental readiness to accept what we are taught by others that we can come to develop an understanding of reasons. The idea that believing something without evidence is always a weakness is shown to be a philosophical prejudice. Trust is always for something we can rightfully demand from others: misplaced trust, accordingly, is not a shortcoming on the part of the trustful person, but of the person in whom the trust was placed. The destruction of trust is a tragedy of life; in Culture and Value, Wittgenstein suggests a connection between distrust and madness. (shrink)

Background The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients’ needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff (...) struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. Methods An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. Results Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient’s formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient’s home. Conclusion The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff’s emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care. (shrink)

This work is guided by the idea that Wittgenstein's thought opens the door to a more profound break with the philosophical tradition than has been generally recognized. It brings this insight to bear on some basic problems of philosophy.

The late influential American intellectual Michael Novak was a self-declared devotee of Reinhold Niebuhr, arguably the foremost twentieth-century American theologian. Novak’s The Spirit of Democratic Capitalism (1982) was an attempt to fill the political-economic lacuna in Niebuhr’s thought. The present article offers a Niebuhrian irony–focused response to Novak’s democratic capitalism in view of climate change as probably the greatest threat facing humanity. Novak quite successfully extended Niebuhrian ideas into a theology-based vision of democratic capitalism as the only political-economic system effective (...) in widely lifting people out of poverty. Yet he failed to acknowledge human-induced climate change as beyond reasonable doubt and rooted in the predominantly American invention of a fossil energy–based capitalist political economy. This article’s thesis is that Novak’s democratic capitalism entails Niebuhrian irony: the virtue it displays about resources becomes a vice due to Novak’s irresponsible post–Spirit of Democratic Capitalism attempt to represent democratic capitalism as innocent of any dangerous climate-change implications. (shrink)

Good and Evil: an Absolute Conception, Raimond Gaita, Macmillan 1991. (Swansea Studies in Philosophy.).

Volume 27, Issue 1, March 2020, Page 89-92.

Aggleton & Brown propose that familiarity-based recognition depends on a perirhinal-medial dorsal thalamic system. However, connections between these structures are sparse or absent. In contrast, the perirhinal cortex is connected to midline/intralaminar nuclei. In a human, a lesion in this thalamic domain, sparing the medial dorsal nucleus, impaired familiarity-based recognition while sparing recollective-based recognition. It is thus more likely that the intralaminar/midline nuclei are involved in recognition.

Extensive and critical review of Perception and Reality in Kant, Husserl and McDowell, written by van Mazijk, Corijn focussing on his discussion of McDowell.

In this paper I examine one well-known attempt to justify the claim that thoughts are intrinsically structured, Evans’s justification of the Generality Constraint. I compare this with a rival account, proposed by Peaocke. I end by suggesting that a naïve, Aristotelian realist has no difficulty at all in providing a justification of the Generality Constraint, which is therefore a view that deserves serious consideration.

In the interpretive literature from the 1950's through the 1970's the term 'criterion' was thought to be a central key to the understanding of Wittgenstein's later philosophy. Later on, it was relegated from this place of honour to being one of a variety of expressions used by Wittgenstein in dealing with philosophical questions. This Element tries to account for the shifting fate of this concept. It discusses the various occurrences of the word “criteria” in the Philosophical Investigations, argues that the (...) post-Wittgensteinian debate about criteria was put on the wrong track by a problematic passage in Wittgenstein's early Blue Book, and finally gives an overview of the main contributions to this debate, trying to achieve a reconciliation between the rival conceptions. (shrink)

An introduction to philosophy of language since Frege, focusing on the 20th century.

Abstract Applied ethics is commonly carried out on the assumption that moral decisions can be handled by experts. This involves a failure to recognize that being morally serious means recognizing that one cannot hand over responsibility for certain decisions to anyone else. The idea of moral expertise is shown to be based on a misconstrual of the nature of moral discourse, one that can be overcome by following Wittgenstein's exhortation to philosophers to pay heed to the actual uses of language. (...) The sense of a moral judgment cannot be considered in isolation from what the speaker is doing in the context of utterance. The author concludes by suggesting that this discussion can provide the basis for a new reading of Anscombe's essay ?Modern Moral Philosophy? (shrink)

1. Anna Boncompagni has written a thorough, lucid and persuasive account of Wittgenstein’s use of the expression “form of life,” of its historical background and of the debate surrounding the concept. I am very largely in agreement with her argument, in particular I think her central contention that the concept of a form of life has a methodological rather than a substantive role in Wittgenstein’s thinking is insightful and important. I also think she is right in the connected claim that (...) Witt... (shrink)

Review of Peter Winch, Spinoza on Ethics and Understanding.

on Theorizing the Moving Image by Noel Carroll.

This article revisits theologian Ulrich Duchrow’s three-decade-old use of the Protestant notion of status confessionis to denounce the capitalist global economy. Scholars quickly dismissed Duchrow’s argument; however, philosopher Thomas Pogge has developed a remarkable “negative duty”—based critique of the current global economic order that might help revitalize Duchrow’s position. The article argues that sound reasons exist for the churches to declare the contemporary world economy a—provisionally termed—status confessionis minor. After explaining the inadequacy of Duchrow’s original position and summarizing Pogge’s account, (...) the article develops a twofold argument. First, Pogge’s in-depth inquiry into the world economy gives Duchrow’s call for a status confessionis a strong yet narrowing economic foundation. Second, to declare the world economy a status confessionis minor is theological-ethically justifiable if the limited though indispensable “prophetic” significance of doing so is acknowledged. Thus, Duchrow’s approach is justified, but only partially. (shrink)

To what use can causal claims established in good studies be put? We give examples of studies from which inaccurate inferences were made about target policy situations. The usual diagnosis is that the studies in question lack external validity, which means that the same results do not hold in the target as in study. That’s a label that just repeats what we already knew. We offer a deeper analysis. Our analysis points to the need for interdisciplinarity and to the demand (...) to focus not on the study – as the expression ‘external validity’ invites you to do – but on the target. The call for interdisciplinary approaches to real life problems is common since it is widely acknowledged that what happens in the real world seldom falls under the auspices of any single research domain. Our focus is on one specific real life problem: how to use causal claims from good studies to help predict whether the policies tested will work in a new situation. Our analysis of what it takes to back up these predictions points up very specific stages in the process of prediction where we are bound to get it wrong if we do not diversify our concepts, our knowledge and our methods. We isolate two reasons inferences from study to target fail. First, policy variables do not produce results on their own; they need helping factors. The distribution of helping factors is likely to be unique or local for each study, so one cannot expect external validity to be all that common. Second, researchers often give too concrete a description of the cause in the study for it to carry over to the target.ion is necessary to get causes that travel. There is no sure-fire way to guard against these problems. But the unavailability of one perfect tool does not imply there are no second best contrivances. Two general pointers for Good Practice in policy advice follow from our diagnosis: focus on the concrete details in the target and use cross discipline heuristics that diversify background knowledge. (shrink)

Michael Ayers’s Knowing and Seeing: Groundwork for a New Empiricism is a rich and detailed development of two ideas. The first is that perception presents reality to us directly in a perspicuous way. We thus acquire primary knowledge of the world: “knowledge gained by being evidently, self-consciously, in direct cognitive contact with the object of the knowledge.” (Ayers 2019, 63) The second idea is that concepts are not needed in perception. In this article, the author examines Ayers’s view. The author (...) proceeds as follows: In the first section, he identifies the target of Ayers’s attacks, conceptualism. He then describes why many philosophers have felt this conceptualist view to be attractive. In the next section, he discusses Ayers’s criticisms of conceptualism in an attempt to disentangle these criticisms from the statement of his positive view, which the author discusses in the following section. He ends by describing some problems for Ayers’s positive position that are, so he argues, the result of his vehement opposition to conceptualism. (shrink)

In A Quest for Humanity, Menno Boldt presents a persuasive new framework for achieving a human social order in the global age. Boldt explores the concept of 'the good society' as a world in which every person can realize their potential for humanity through liberty, social justice, and equal human dignity. A Quest for Humanity innovatively positions globalization as a deterministic phenomenon of expanding interdependence and shared knowledge -- resulting in ever-larger economic and political jurisdictions, but also creating social (...) and psychological links between peoples across the world. Boldt challenges mainstream certainty that Western democracy and constitutional human rights are the exemplary doctrines for the global good society. With a fresh vision designed to inspire a universal acknowledgement of human dignity, A Quest for Humanity powerfully affirms the value of each human being. (shrink)