In their contribution ‘Ethics of the algorithmic prediction of goal of care preferences’1 Ferrario et al elaborate a from theory to practice contribution concerning the realisation of artificial intelligence (AI)-based patient preference prediction (PPP) systems. Such systems are intended to help find the treatment that the patient would have chosen in clinical situations—especially in the intensive care or emergency units—where the patient is no longer capable of making that decision herself. The authors identify several challenges that complicate their effective development, (...) application and evaluation—and offer solutions to them. One of these issues is the question of who should ultimately use said systems. While it is undisputed that clinicians should use these AI systems for their decision-making process, there is an ongoing debate about whether next of kin should use them as well. The authors advocate that ‘’access should be provided to both clinicians and loved ones with due explanations and as desired’. We will disagree with this assessment and explain in our commentary why it is important that surrogates provide their own assessments with as little external (AI) influence as possible. Why do next of kin actually participate in the process of preference finding and treatment decision-making? A key reason is that clinicians usually …. (shrink)

Background The use of Artificial Intelligence (AI) has the potential to provide relief in the challenging and often stressful clinical setting for physicians. So far, however, the actual changes in work for physicians remain a prediction for the future, including new demands on the social level of medical practice. Thus, the question of how the requirements for physicians will change due to the implementation of AI is addressed. Methods The question is approached through conceptual considerations based on the potentials that (...) AI already offer and the focus on central normative concepts of trust, explainability, and responsibility which play an important role when implementing AI in everyday clinical practice. Conclusion Interpersonal communication will not disappear upon implementation of AI. Instead, it is much more likely that the exchange between various actors in medical practice will become increasingly important. This adds another level of complexity to practical concepts such as Shared-Decision-Making, which must be addressed in empirical research, including the involvement of AI systems as actors in communication. (shrink)

In his contribution, ‘Represent me: please! Towards an ethics of digital twins in medicine’1, Braun shows that there is a fundamental ambivalence inherent in (the interaction with) digital twins: they can either open up new freedoms for the simulated persons, or, conversely, endanger and restrict their freedom. To prevent digital twins from restricting people’s freedom, Braun suggests a strong focus on control. Braun’s focus on control is insufficient, I will argue, because his idea of control works only retroactively: it can (...) only react to restrictions of freedom that have already occurred, but it cannot prevent them, nor can it restore any lost freedom. Control is therefore insufficient to defend people’s freedom. To prove my claim, I will first use an everyday example to illustrate the fundamental ambivalence inherent in digital twins. Second, I will show that digital twins endanger people’s freedom in a hermeneutic way. Finally, I will demonstrate why controllability cannot prevent this hermeneutic endangerment. I understand digital twins, like Braun, as simulation of a person, as their dynamic and precise effigy. Simulated twins use machine-learning and artificial intelligence capabilities to make predictive analyses about the simulated person and the future development of her health. Imagine: You are eating dinner. Meanwhile, your partner lectures you about the calorie density and nutrient composition of your food, warns you that your portion size exceeds your daily calorie requirement by x calories. It calculates how your dinner will negatively impact your body mass index (BMI) and physical fitness, and predicts what the consequences will be for your overall health. Based on these data and predictions, it creates an individualised diet plan for you—and at the same time shows you by how much you could improve your vital values by sticking to that plan. This example helps to illustrate the fundamental …. (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

Clinical fields of the “sciences of the mind” (psychotherapy, psychiatry, etc.) lack integrative conceptual frameworks that have explanatory power. Mainly descriptive-classificatory taxonomies like DSM dominate the field. New taxonomies such as Research Domain Criteria (RDoC) aim to collect scientific knowledge regarding “systems” for “processes” of the brain. These terms have a supradisciplinary” meaning if they are considered in context of Systems Science. This field emerges as a platform of theories like general systems theory, catastrophe theory, synergetics, chaos theory, etc. It (...) provides a lot of abstract concepts, constructs, methods and models. We assume that these tools also enable theoretical integration in the diversified field of clinical practice in the sciences of the mind. Additionally, systems thinking in clinical psychology improves conceptual links to currently network-oriented neurobiology. However, clear definitions of systemic terms are necessary to emerge from their mainly metaphorical use. Here we revise mainly terms like “structure”, “process” and “dynamics” as they are used already in psychology, psychoanalysis, psychopathology and psychiatry in an ill-defined way. For instance, affective-cognitive structures like “life space” or “object representations” can be seen as products of mental processing. These structures, in turn, modulate dynamics of mental processes. Additionally, we suggest a coupled network concept of emotions and motivations as the main subsystem that modulates mental dynamics that results in a qualitative systemic model of the mind. Finally, we assume that a revisited systemic approach could improve interdisciplinary understanding of the mental. ystem for mental dynamics. In this context, we assume that a revisited systemic approach could improve interdisciplinary understanding of the mental. (shrink)

Since uncertainty is a major challenge in medicine and bears the risk of causing incorrect diagnoses and harmful treatment, there are many efforts to tackle it. For some time, AI technologies have been increasingly implemented in medicine and used to reduce medical uncertainties. What initially seems desirable, however, poses challenges. We use a multimethod approach that combines philosophical inquiry, conceptual analysis, and ethical considerations to identify key challenges that arise when AI is used for medical certainty purposes. We identify several (...) challenges. Where AI is used to reduce medical uncertainties, it is likely to result in (a) patients being stripped down to their measurable data points, and being made disambiguous. Additionally, the widespread use of AI technologies in health care bears the risk of (b) human physicians being pushed out of the medical decision-making process, and patient participation being more and more limited. Further, the successful use of AI requires extensive and invasive monitoring of patients, which raises (c) questions about surveillance as well as privacy and security issues. We outline these several challenges and show that they are immediate consequences of AI-driven security efforts. If not addressed, they could entail unfavorable consequences. We contend that diminishing medical uncertainties through AI involves a tradeoff. The advantages, including enhanced precision, personalization, and overall improvement in medicine, are accompanied by several novel challenges. This paper addresses them and gives suggestions about how to use AI for certainty purposes without causing harm to patients. (shrink)

Recently, a shadow has been cast over how geographical scale has been theorized. Neil Brenner has argued that scale risks becoming a empty concept because it has been conflated with other terms in geography such as place, region, and space; Marston, Jones, and Woodward have proposed doing away with scale altogether; while Wood has accused geographers of having a “scale fetish.” The following article defends the theory of scale against these various detractors and attempts to become a bulwark to support (...) the many contributions that geographers have made to effectively characterizing the socio-spatial world. I outline four ways of understanding geographical scale: measurement, size, hierarchy, and relation. I then argue for an understanding of scale that is relational because I believe it provides the most adequate language to characterize how geographers have come to understand the social ontology of the spatialworld. Moreover, I set out to show how the relational description of scale, complements other research on scale, which has shown the importance of scale in the production of geographical difference and uneven social relations. Hence, the understanding of scales relationally, allows for people to have relative positions in the world. Finally, I speculate on two implications that the understanding of scale relatively has for characterizing the effects of globalization: 1) the possibilities that this understanding has for confronting a dominant tenant in the ideology of neoliberalism; 2) the promise that it offers for forms of political resistance. (shrink)

New data-driven technologies yield benefits and potentials, but also confront different agents and stakeholders with challenges in retaining control over their data. Our goal in this study is to arrive at a clear picture of what is meant by data sovereignty in such problem settings. To this end, we review 341 publications and analyze the frequency of different notions such as data sovereignty, digital sovereignty, and cyber sovereignty. We go on to map agents they concern, in which context they appear, (...) and which values they allude to. While our sample reveals a considerable degree of divergence and an occasional lack of clarity about intended meanings of data sovereignty, we propose a conceptual grid to systematize different dimensions and connotations. Each of them relates in some way to meaningful control, ownership, and other claims to data articulated by a variety of agents ranging from individuals to countries. Data sovereignty alludes to a nuanced mixture of normative concepts such as inclusive deliberation and recognition of the fundamental rights of data subjects. (shrink)

Neuroscience is a multidisciplinary effort to understand the structures and functions of the brain and brain-mind relations. This effort results in an increasing amount of data, generated by sophisticated technologies. However, these data enhance our descriptive knowledge, rather than improve our understanding of brain functions. This is caused by methodological gaps both within and between subdisciplines constituting neuroscience, and the atomistic approach that limits the study of macro- and mesoscopic issues. Whole-brain measurement technologies do not resolve these issues, but rather (...) aggravate them by the complexity problem. The present article is devoted to methodological and epistemic problems that obstruct the development of human neuroscience. We neither discuss ontological questions nor review data, except when it is necessary to demonstrate a methodological issue. As regards intradisciplinary methodological problems, we concentrate on those within neurobiology and psychology. As regards interdisciplinary problems, we suggest that core disciplines of neuroscience can be integrated using systemic concepts that also entail human-environment relations. We emphasize the necessity of a meta-discussion that should entail a closer cooperation with philosophy as a discipline of systematic reflection. The atomistic reduction should be complemented by the explicit consideration of the embodiedness of the brain and the embeddedness of humans. The discussion is aimed at the development of an explicit methodology of integrative human neuroscience, which will not only link different fields and levels, but also help in understanding clinical phenomena. (shrink)

The Covid-19 pandemic has challenged both medicine and governments as they have strived to confront the pandemic and its consequences. One major challenge is that evidence-based medicine has struggled to provide timely and necessary evidence to guide medical practice and public policy formulation. We propose an extension of evidence-based corona medicine to an organismic systems corona medicine as a multilevel conceptual framework to develop a robust concept-oriented medical system. The proposed organismic systems corona medicine could help to prevent or mitigate (...) future pandemics by transitioning to a bifocal medicine that extends an empirical evidence-based medicine to a theory-oriented organismic systems medicine. (shrink)

Structural brain preservation (SBP) and classical cryonics are techniques aimed at preserving the human brain for potential future applications. Reluctant public discourse around these techniques may be explained with intuitive aversions identified by moral psychology. In the first part of the paper, we conjecture the existence of a self-sustaining cycle of moral condemnation of SBP and classical cryonics due to quick, affect-laden moral intuitions. In the second part, we propose an alternative framing of SBP and classical cryonics through a thought (...) experiment featuring a time machine metaphor called "Schrödinger’s chrono-cat", which might avoid triggering aversive moral intuitions and foster public discourse. We discuss the limitations of this framing and its consequences. (shrink)

In their article ‘Consent-GPT: is it ethical to delegate procedural consent to conversational AI?’, Allen et al 1 explore the ethical complexities involved in handing over parts of the process of obtaining medical consent to conversational Artificial Intelligence (AI) systems, that is, AI-driven large language models (LLMs) trained to interact with patients to inform them about upcoming medical procedures and assist in the process of obtaining informed consent.1 They focus specifically on challenges related to accuracy (4–5), trust (5), privacy (5), (...) click-through consent (5) and responsibility (5–6), alongside some pragmatic considerations (6). While the authors competently navigate these critical issues and present several key perspectives, we posit that their discussion on trust in what they refer to as ‘Consent-GPT’ significantly underestimates one vital factor: the interpersonal aspect of trust. Admittedly, this …. (shrink)

This careful and engaging introduction to Aristotle equips readers of ancient philosophy and classics with an intellectual map that will guide their further exploration within the terrains of Aristotelian philosophy and logic. The book does not seek to provide a verdict or to persuade the reader of the usefulness of Aristotle's ideas. Instead it offers a comprehensive introduction to key philosophical areas while situating the reader within the ongoing intellectual debates on Aristotle's significance and relevance. Crowley's book allows an overview (...) of Aristotle's contributions and includes discussions on the Organon, the epitome of his logical treatises, his works on biology, nature and causation, metaphysics, citizenship, ethics and eudaimonia. The book is a valuable tool for readers interested in becoming acquainted with the work of Aristotle but most importantly for those who are keen to understand his many interpretations. (shrink)

Greek art and literature follow parallel courses through the long period from Homer to Euripides. Homer and Euripides, Dipylon vases and the latest white lekythoi are as far apart from each other as it is possible for works in the same medium to be. The distance can only be explained by a similar change in the views of artists, writers, and their public.

In The Theatre of Dionysus in Athens Dr. Pickard-Cambridge includes a most useful and convenient collection of south Italian vase-paintings which have been held to throw light on the stage-settings of Greek tragedy. He concludes that they give no evidence for Athens in the fifth century and in particular do not justify the assumption that interior scenes were played in a porch in front of the central door. The second conclusion is true, but some of the vases do show that (...) the central doors could be thrown wide open to display an interior scene. The first conclusion is formally correct, but it should be remembered that the “plays came from Athens, and it is at least possible that the south Italian producers modelled themselves on Athenian producers. In any case these vases are worthy of further consideration. (shrink)

In this paper, a survey of 180 inscriptions in Tamil between 1346 CE and 1400 CE is analysed for its notions and visualization of astral themes present in the epigraphical inscriptions as well as for the calendrical practices implicit in those inscriptions. I demonstrate the rich diversity of calendrical practices employed in this period. Although there are clear local usages, the applied methods of identification show that in several cases methods from other Indian calendrical traditions have also been used. This (...) applies both to the year and the month. In contrast, the use of the weekday is not widely seen in the inscriptions of this region following the local system. The study also clarifies that the inscriptions are a useful documentary source for other astronomical observations such as eclipses and solstices undertaken in southern Indian locations in the fourteenth and fifteenth centuries. (shrink)

I will next briefly enumerate the evidence for the separate poems, beginning with the Trojan series.

The article examines the issue of public health and medical services in Algeria and analyses the role of the public and private sectors in supporting and promoting public health. Our study is based on an analysis of legal texts that highlight Algeria’s health policies. Some significant aspects of the article are: the Algerian policy of opening health services up to private investment; the lack of contribution of private health institutions in the field of medical education; and issues surrounding the organisation (...) of blood donation. The article also notes the absence of foreign investment in Algerian hospitals. (shrink)