The purpose of this paper is to emphasize a social phenomenon that exists in Israel: immoral medicine.In recent years, nurses have been exposed to many instances of immoral medicine in hospitals. We want to protest about the demands for money from patients who are waiting for surgical intervention, arouse the medical community’s conscience concerning these immoral activities, and improve professional and moral behaviour.

This edited book addresses four themes of contemporary importance in the experimental and applied analysis of behaviour: chronobiology (relationships between time and behaviour), the emergence of rational thinking, language, and behavioural medicine. The current empirical and theoretical status of each theme is considered in individual chapters, the authors of which are distinguished research scientists drawn from a wide range of scholarship and with a distinctive European dimension. This cultural and theoretical diversity emerges from the fact that each chapter (...) is developed from a paper originally presented by invitation at the Second European Meeting on the Experimental Analysis of Behaviour, which was held in Liège, Belgium in 1988. Within the four themes, individual topics address issues such as circadian rhythms in behaviour, temporal regulation in children and in animals, the emergence of equivalence relations in children and animals, the development of thinking in mentally retarded children, reasoning and associative learning in animals, rule'governed behaviour, theoretical issues relating language to the theory of mind, the relationship between behavioural and visceral functions, the relevance of behavioural approaches to the prevention of AIDS, and the development of self'detection skills for breast cancer. The book makes an important contribution to the literature of contemporary behaviour analysis by reviewing issues of current interest and importance from a broad theoretical base. (shrink)

Medicine, Power, and the Law demonstrates that criminal and civil justice interact with medicine and public health more than is presently understood. The book focuses on the role of healthcare practitioners and an array of other professionals across industries in identifying wrongdoers, reporting behavior, and testifying on behalf of the state or government agencies. It also covers circumstances in which law enforcement relies on medicine for evidence or support in ways that compromise medical ethics. By reporting or (...) testifying as experts, a range of people, from specialist pediatricians to flight attendants, can have a life-changing impact on individuals in the name of public health or medicine. People who work in hospitals, social work settings, and even airlines, often contribute to wrongful and aggressive criminal and civil actions against society's most vulnerable people, including parents, older adults, and people living with poverty. The book explores a number of examples, including police use of medicine as a restraint or the collection of blood as evidence and the risks of opting out of certain scientific discoveries, such as pharmaceuticals. It describes the harms that may come to those who engage in suboptimal but generally heretofore legal child-raising behaviors, and people opting to live independently as older adults. These can lead to civil and criminal charges when noticed by those in a position of power. Medicine, Power, and the Law is an important contribution for researchers and practitioners in medicine, the law, and the expanding field of bioethics. (shrink)

Commercial genetic testing offered over the internet, known as direct-to-consumer genetic testing (DTC GT), currently is under ethical attack. A common critique aims at the limited validation of the tests as well as the risk of psycho-social stress or adaption of incorrect behavior by users triggered by misleading health information. Here, we examine in detail the specific role of advertising communication of DTC GT companies from a medical ethical perspective. Our argumentative analysis departs from the starting point that DTC GT (...) operates at the intersection of two different contexts: medicine on the one hand and the market on the other. Both fields differ strongly with regard to their standards of communication practices and the underlying normative assumptions regarding autonomy and responsibility. Following a short review of the ethical contexts of medical and commercial communication, we provide case examples for persuasive messages of DTC GT websites and briefly analyze their design with a multi-modal approach to illustrate some of their problematic implications. We observe three main aspects in DTC GT advertising communication: (1) the use of material suggesting medical professional legitimacy as a trust-establishing tool, (2) the suggestion of empowerment as a benefit of using DTC GT services and (3) the narrative of responsibility as a persuasive appeal to a moral self-conception. While strengthening and respecting the autonomy of a patient is the focus in medical communication, specifically genetic counselling, persuasive communication is the normal mode in marketing of consumer goods, presuming an autonomous, rational, independent consumer. This creates tension in the context of DTC GT regarding the expectation and normative assessment of communication strategies. Our analysis can even the ground for a better understanding of ethical problems associated with intersections of medical and commercial communication and point to perspectives of analysis of DTC GT advertising. (shrink)

Trust in medicine is often conceived of on an individual level, with respect to how people rely on particular clinicians or institutions. Yet as discussions of trust during the Covid‐19 pandemic highlighted, trust decisions are not always as individual or interpersonal as this conception suggests. Rather, individual instances of trusting behavior are related to social trust, which is conceived as a willingness to be vulnerable to people in general, based on a sense of shared norms. In this essay, I (...) propose that individual and social trust are connected to each other in what can be termed a “climate of trust.” I explain how masking trends during the pandemic facilitated a “climate of distrust,” and I consider the role that clinicians might play in transforming climates of distrust into climates of trust. (shrink)

Behavior genetics is a controversial science. For decades, scholars have sought to understand the role of heredity in human behavior and life-course outcomes. Recently, technological advances and the rapid expansion of genomic databases have facilitated the discovery of genes associated with human phenotypes such as educational attainment and substance use disorders. To maximize the potential of this flourishing science, and to minimize potential harms, careful analysis of what it would mean for genes to be causes of human behavior is needed. (...) In this paper, we advance a framework for identifying instances of genetic causes, interpreting those causal relationships, and applying them to advance causal knowledge more generally in the social sciences. Central to thinking about genes as causes is counterfactual reasoning, the cornerstone of causal thinking in statistics, medicine, and philosophy. We argue that within-family genetic effects represent the product of a counterfactual comparison in the same way as average treatment effects (ATEs) from randomized controlled trials (RCTs). Both ATEs from RCTs and within-family genetic effects are shallow causes: They operate within intricate causal systems (non-unitary), produce heterogeneous effects across individuals (non-uniform), and are not mechanistically informative (non-explanatory). Despite these limitations, shallow causal knowledge can be used to improve understanding of the etiology of human behavior and to explore sources of heterogeneity and fade-out in treatment effects. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Understanding Major Turning Points in the History of Medical EthicsLaurence B. McCullough (bio)AbstractAt different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of (...) class='Hi'>medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724–1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician’s fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.Reading the Histories of Medicine, Bioethics, and Medical EthicsThere are many ways in which to read the history of medi-cine and therefore of medical ethics and bioethics. For example, the history of medicine can be usefully understood in terms of successive advances or revolutions in biomedical science and its clinical applications, with medical ethics understood as a moral response to scientific and technological change. On this reading, which has been common in the history of bioethics for the past three decades, moral response is required to address scientific and technological changes that are unprecedented and therefore threaten to outstrip society’s moral capacities [End Page 7] to understand and manage those changes well. Much recent work on the ethical, legal, and social issues raised by the genome project appeals to this reading. The history of medicine can also be read in social terms, with medicine understood as a major social institution shaped by various factors, not limited to science. In this perspective, medicine and society are understood in terms of a complex and dynamic synergy. Bioethics and medical ethics become part of this synergy and are to be explained—perhaps even explained away—by social historical factors. There are, of course, other ways to read the history of medicine and therefore of bio-ethics and medical ethics—e.g., in terms of key figures and movements that are thought to have shaped developments in crucial ways.I want to suggest another way to read these histories, namely, the successive laying open of medicine to accountability that sometimes results in key turning points in the development of medical ethics and bioethics. On this reading, ethics is understood as an intellectual and practical discipline that makes medicine as a social institution and its practitioners, physicians, morally accountable for their clinical judgment, decision making, and behavior. This differs from Robert Veatch’s (1981) reading of the history of medical ethics either as particular—informed by intellectual, moral, and experiential resources thought to be available only to physicians—or universal—informed by intellectual, moral, and experiential resources generally available in the culture (present and past). Veatch sees medical ethics as open when it is universal and closed, and unacceptable, when it is particular. I read the history of medical ethics as always universal and medicine as a social institution and practice as sometimes closed—i.e, not accountable for its scientific and moral integrity—and sometimes as open, accountable for such integrity. When medicine is “laid open,” medical ethics itself is sometimes transformed. The same may well be the case for the other health care professions. The histories of medical ethics and bioethics, therefore, can be usefully read as responses to the laying open of medicine and the health care professions generally at various times in their histories. In what follows, I examine two important examples of laying medicine open that create key turning points in the history of medical ethics—Scottish medicine from the eighteenth century and American medicine from the end of the twentieth century.The... (shrink)

The concept of moralisation of health behaviours was introduced in social psychology to describe the attribution of moral properties to habits and conditions like smoking or being a vegetarian. Moral properties are powerful motivators for people and institutions, as they may trigger blame, stigma, and appraisal, as well as the polarisation of interest and scientific hype. Here I extend the concept and illustrate how medicines and treatments can be seen as if they had moral properties, too, when they come to (...) be regarded as good or bad in the moral sense, and not just in the instrumental sense of benefiting or harming health. I propose the hydroxychloroquine (HCQ) controversy of 2020 as an example of moralisation of a medicine. HCQ and chloroquine are anti-malarial drugs, whose off-label use for Covid-19 was hotly discussed in the early months of the pandemic, both in the media and within the scientific community, and eventually dismissed when robust evidence came out. The point of the paper is to show that moralisation of health products and treatments may influence individual and institutional decisions in significant ways, and also affect research. For these reasons, it should be carefully monitored and critically assessed. (shrink)

Relationships, jobs, and health behaviors-these are what New Year's resolutions are made of. Every year millions resolve to adopt a better diet, exercise more, become fit, or lose weight but few put into practice the health behaviors they aspire to. For those who successfully begin, the likelihood that they will maintain these habits is low. Healthcare professionals recognize the importance of these, and other, health behaviors but struggle to provide their patients with the tools necessary for successful maintenance of their (...) medical regimens. The thousands of research papers that exist on patient adherence and health behavior change can leave professionals overwhelmed. This book synthesizes the results from more than 50 years of empirical research, resulting in simple, powerful, and practical guidance for health professionals who want to know the most effective strategies for helping their clients to put long-term health-relevant behavior changes into practice. It advocates a straightforward 3-ingredient model: Before a person can change, they must know what change is necessary ; desire the change ; and then have the tools to achieve and maintain the change. This book is designed to be informative and compelling, but its numerous anecdotes and examples render it engaging and entertaining, as well. Written for a practitioners and students of medicine, chiropractic, osteopathy, nursing, health education, physician assistant programs, dentistry, clinical and health psychology, marriage and family counseling, social work, school psychology, and care administrators -- and for lay persons who wish to take an active role in their health, this book brings together major empirically-based findings within the field and provides succinct, evidence-based recommendations and strategies for using these findings to make real changes. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues (...) relating to the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the “difficult” patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics meetings and (...) conversations and idea-sharing among practitioners on HEC social media. While there are a handful of papers gesturing toward a bioethical critique of behavior contracts of various types, the use of behavior contracts in the context of interpersonal conflict has not been vetted by bioethicists to determine their ethical legitimacy or efficacy. In this paper, we highlight a set of ethical concerns that we believe must be addressed before continuing or widespread implementation of behavior contracts to manage the “difficult” patient or family. (shrink)

The overarching theme of causality in behavioral genetics is discussed on epistemological grounds. Evidence is offered in favor of a continuum spectrum in causality, in contrast to discrimination between causal factors and associations. The risk of invalidating exploratory studies in behavior genetics is discussed, especially for the potential impact on those fields of medicine interested in complex behaviors.

Theoretical models for patient-physician communication in clinical practice are frequently described in the literature. Respecting patient autonomy is an ethical problem the physician faces in a medical emergency situation. No theoretical physician-patient model seems to be ideal for solving the communication problem in clinical practice. Theoretical models can at best give guidance to behavior and judgement in emergency situations. In this article the premises of autonomous treatment decisions are discussed. Based on a case-report we discuss different genuine efforts the physician (...) can do to uncover treatment refusal and respect patient autonomy in an emergency situation. Autonomy requires competence and in emergency medicine time does not allow intimate exploration of patient competence and reasons for treatment refusal. We find that the physician must base her decision on a firm theoretical base combined with a practical and realistic view of the patient's situation on a case to case basis. (shrink)

Artificial intelligence (AI) holds considerable promise for transforming clinical diagnostics. While much has been written both about public attitudes toward the use of AI tools in medicine and about uncertainty regarding legal liability that may be delaying its adoption, the interface of these two issues has so far drawn less attention. However, understanding this interface is essential to determining how jury behaviour is likely to influence adoption of AI by physicians. One distinctive concern identified in this paper is a (...) ‘negative outcome penalty paradox’ (NOPP) in which physicians risk being penalised by juries in cases with negative outcomes, whether they overrule AI determinations or accept them. The paper notes three reasons why AI in medicine is uniquely susceptible to the NOPP and urges serious further consideration of this complex dilemma. (shrink)

The principal argument of the present paper is that the human body is as much a reflective formation of multiple discourses as it is an effect of natural and environmental processes. This paper examines the implications of this argument, and suggests that recognizing the body in this light can be illuminating, not only for our conception of the body, but also for our understanding of medicine. Since medicine is itself a discursive formation, a science with both a history, (...) and a future, it is argued that much can be learned by reflecting on the progression of models, or “paradigm-shifts,”, in terms of which modern medicine has articulated the human body that figures at the heart of its discourse. Four historical periods of medicine will be considered, each one governed by its own distinctive paradigm. It is argued, finally, that, with the emergence of behavioural medicine, and, more particularly, psychoneuroimmunology, a new discursive formation in medicine, one can see a new conceptualization of the human body beginning to take shape; and that this new figure of the body makes it possible for the very first time to conceive the construction of testable hypotheses regarding correlations between the objective body of science and the phenomenological body of experienced meaning. (shrink)

While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in (...) a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. (shrink)

The purpose of this paper is to review the rising influence of commercialism in American medicine and to examine some of the consequences of this trend. Increased competition subverts physician collegiality, draws hospitals into for-profit ownership and behavior, and leads clinical investigators into secrecy and possibly into bias and abuse. Medicine faces a deprofessionalization evidenced in loss of control over the clinical setting and over self-regulation. Health care becomes a commodity relying on cultivation of desires instead of satisfaction (...) of needs, even as many basic needs go unmet. Patients become consumers empowered with lawsuits and the connection of medicine to the relief of suffering is attenuated. Medical encounters are increasingly impersonal, dominated by specialization, technology, and bureaucracy. Patients are losing their physician-advocates to new conflicts of interests, physicians are losing their impulse to charity, and trust in the doctor-patient relationship and in medicine generally is eroding. (shrink)

Behavioural variant frontotemporal dementia (bvFTD) is characterized by an absence of obvious cognitive impairment and presence of symptoms such as disinhibition, social inappropriateness, personality changes, hyper-sexuality, and hyper-orality. Affected individuals do not feel concerned enough about their actions to be deterred from violating social norms, and their antisocial behaviours are most likely caused by the neurodegenerative processes in the frontal and anterior temporal lobes. BvFTD patients present a challenge for the traditional notion of autonomy and the medical and criminal (...) justice systems. Antisocial behaviour is often the earliest recognized manifestation of bvFTD. Given that the symptoms are not specific and that atrophy of the frontal lobes is only observable with structural neuroimaging in the later stages of the disease, it is hard to ascertain their autonomy. Recently proposed re-conceptualizations of autonomy (Dworkin’s, Jaworska’s, and Dubljević’s) can, however, be sufficiently redefined to provide explicit rules and offer nuanced guidance in such cases. A combination of notions of autonomy gives the most nuanced guidance with three modifications: 1) including socio-moral judgement in the notion of “normal cognitive competence,” 2) excluding in-principle un-endorsable ideals from the notion of “capacity to value,” and 3) redefining ideal-typical degrees of compulsion (mild, severe, and total). (shrink)

Medicines regulators have generally adopted a scientistic view of medicines evaluation, which they present as an exercise that should—and indeed can—be purely “objective,” based only on knowledge produced through validated research protocols. The growing body of social science literature analyzing the regulation of medicines has questioned this pretense of objectivity and underlined the socio-political construction of evidence on the risks and benefits of medicines. But while the European Medicines Agency has become the dominant regulatory body in Europe and a key (...) player at world level, very few studies have investigated its actual practices. Based on interviews with European regulators, but also on direct observations of several meetings of the European Medicines Agency’s main expert committee, this article aims to analyze how regulatory knowledge is defined and then transformed into regulatory decisions. First, it describes the main characteristics of European medicines regulation and the historical definition of what can count as “objective” evidence on the safety and efficacy of medicines. Second, it demonstrates that experts use many different types of knowledge in building their opinions: the results of studies, but also knowledge about firms’ past and present strategies, about patients’ needs and future behavior, about the state of research and clinical practices, and about legal and policy-making issues. Third, it explains why, in spite of the various forms of knowledge involved, experts manage to produce consensual opinions on medicines and why these opinions are considered genuine decisions in the sector. (shrink)

In light of the human genome project, establishing the genetic aetiology of complex human diseases has become a research priority within Western medicine. However, in addition to the identification of disease genes, numerous research projects are also being undertaken to identify genes contributing to the development of human behavioural characteristics, such as cognitive ability and criminal tendency. The permissibility of this research is obviously controversial: will society benefit from this research, or will it adversely affect our conceptions of (...) ourselves and each other? When assessing the permissibility of this research, it is important to consider the nature and deterministic significance of behavioural genetic information. Whilst todate there has been much discussion and debate about the properties of genetic information per se and genetic determinism, this has not been applied to behavioural genetic research and its ethical implications. Therefore, this paper elucidates how behavioural genetic information can be distinguished from other types of genetic and non-genetic information and also synthesises the determinative significance of genetic factors for the development of human behavioural traits. Undertaking this analysis enables the ethical issues raised by this research to be debated in an appropriate context and indicates that separate policy considerations are warranted. (shrink)

The ongoing conflict between the economic imperative of stimulating consumption as part of the proliferation of neoliberal ideals of consumer supremacy and growing concern to increase environmental protection presents an opportunity to focus on consumption with respect to ethical behavior. Ethical concerns regarding purchasing and consumption behavior are addressed here in relation to the adoption of principles associated with temperance as applied to self-restraint in food purchase and consumption. The paper outlines theological links to the concept of temperance as applied (...) to environmental and health concerns. Employing a virtue ethics perspective, it examines people’s proactive attitudes that value the environment by adopting waste reduction behaviors. Within the context of normative ethics, it is asked: “Is temperance able to fulfill the role of a lever in consumers’ hands and thereby contribute to minimizing negative environmental impacts associated with food waste?” The research bears witness to the role that consumer behavior may play in promotion and application of temperance in daily life. Study results from a survey conducted in Romania extend the scant information on people’s food waste behavior in relation to religion, underscoring the relationship between religion, temperance-oriented behavior and environmental concerns. (shrink)

Cognitive control of physical activity and sedentary behavior is receiving increased attention in the neuroscientific and behavioral medicine literature as a means of better understanding and improving the self-regulation of physical activity. Enhancing individuals’ cognitive control capacities may provide a resilient means to increase physical activity and reduce sedentary behavior. First, this paper reviews emerging evidence of the antecedence of cognitive control abilities in successful self-regulation of physical activity, and in precipitating self-regulation failure that predisposes to sedentary behavior. We (...) then highlight the brain networks that may underpin the cognitive control and self-regulation of physical activity, including the default mode network, prefrontal cortical networks and brain regions and pathways associated with reward. We then discuss research on cognitive training interventions that document improved cognitive control and that suggest promise of influencing physical activity regulation. Key cognitive training components likely to be the most effective at improving self-regulation are also highlighted. The review concludes with suggestions for future research. (shrink)

Ethics of Everyday Medicine: Explorations of Justice examines and analyses the relatively unexplored domain of ethics involved in the everyday practice of medicine. From the author's clinical experience, virtually every decision made in the day-to-day practice of medicine is fundamentally an ethical question, as virtually every decision hinge on some value judgment that goes beyond the medical facts of the matter. The first part of the book is devoted to medical decision cases in several areas of (...) class='Hi'>medicine. These cases highlight elements of the current healthcare ecosystem, involving players other than the physician and patient. Insurers (private, commercial, and governmental), administrators, and regulators' perspectives are surfaced in point of care case analysis. Part two contributes to the development of actionable tools to develop better ethical systems for the everyday practice of medicine by providing a critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics. The chapter on Justice discusses the neurophysiological representations of just and unjust behaviours. The chapter on Ethical Theories follows, describing the epistemic conundrum, principlism, reproducibility, abstraction, chaos and complexity. The following chapter approaches ethical decisions from the logic and statistic perspectives. The following chapter, The Patient as Parenthetical, the author discusses patient-centric ethics, and the rise of business- and government-cetric ethics. The final chapter, A Framework to Frame the Questions for Explore Further, proposes a working framework to deal with current ethical issues. (shrink)

In describing and explaining the sexes, medicine and science participated in the delineation of what was "feminine" and what was "masculine" in the Middle Ages. Hildegard of Bingen and Albertus Magnus, among others, writing about gynecology, the human constitution, fetal development, or the naturalistic dimensions of divine Creation, became increasingly interested in issues surrounding reproduction and sexuality. Did women as well as men produce procreative seed? How did the physiology of the sexes influence their healthy states and their susceptibility (...) to disease? Who derived more pleasure from sexual intercourse, men or women? The answers to such questions created a network of flexible concepts which did not endorse a single model of male-female relations, but did affect views on the health consequences of sexual abstinence for women and men and on the allocation of responsibility for infertility - problems with much social and religious significance in the Middle Ages. Sometimes at odds with, and sometimes in accord with other forces in medieval society, medicine and natural philosophy helped to construct a set of notions that divided significant portions of the world - from the behavior of animals to the operations of astrological signs - into "masculine" and "feminine." Even cases that seemed to exist outside the definitions of this duality, for example, hermaphrodite features or homosexual behavior, were brought under control by the application of gendered labels, such as "masculine women.". (shrink)

A recent study has reported that the successful implementation of cognitive regulation of emotion depends on higher-level cognitive functions, such as top-down control, which may be impaired in stressful situations. This calls for “cognition free” self-regulatory strategies that do not require top-down control. In contrast to the cognitive regulation of emotion that emphasizes the role of cognition, traditional Chinese philosophy and medicine views the relationship among different types of emotions as promoting or counteracting each other without the involvement of (...) cognition, which provides an insightful perspective for developing “cognition free” regulatory strategies. In this study, we examined two hypotheses regarding the modulation of anger and aggressive behavior: sadness counteracts anger and aggressive behavior, whereas fear promotes anger and aggressive behavior. Participants were first provoked by reading extremely negative feedback on their viewpoints (Study 1) and by watching anger-inducing movie clips (Study 2). Then, these angry participants were assigned to three equivalent groups and viewed sad, fear-inducing, or neutral materials to evoke the corresponding emotions. The results showed that participants displayed a lower level of aggressive behavior when sadness was later induced and a higher level of anger when fear was later induced. These results provide evidence that supports the hypothesis of mutual promotion and counteraction relationships among these types of emotions and imply a “cognition free” approach to regulating anger and aggressive behavior. (shrink)

The news media is frequently criticised for failing to support the goals of government health campaigns. But is this necessarily the purpose of the media? We suggest that while the media has an important role in disseminating health messages, it is a mistake to assume that the media should serve the interests of government as it has its own professional ethics, norms, values, structures and roles that extend well beyond the interests of the health sector, and certainly beyond those of (...) the government. While considerable attention has been given to the ways in which uncritical publication of industry perspectives by news media can negatively impact on public understandings of health and health behaviours, we would argue that it is equally important that journalists not become the ‘lapdogs’ of government interests. Further, we suggest that the interests of public health may be served more by supporting the ongoing existence of an independent media than by seeking to overdetermine its purpose or scope. (shrink)

The article defines a comprehensive concept of cognitive objectivity (CCCO) applied to embodied subjects in health care. The aims of this study were: (1) to specify some necessary conditions for the definition of a CCCO that will allow objective descriptions and assessments in health care, (2) to formulate criteria for application of such a CCCO, and (3) to investigate the usefulness of the criteria in work disability assessments in medical certificates from health care provided for social security purposes. The study (...) design was based on a philosophical conceptual analysis of objectivity and subjectivity, the phenomenological notions ‘embodied subject’, ‘life-world’, ‘phenomenological object’ and ‘empathy’, and an interpretation of certificates as texts. The study material consisted of 18 disability assessments from a total collection of 86 medical certificates provided for social security purposes, written in a Norwegian hospital-based mental health clinic. Four necessary conditions identified for defining a CCCO were: (A) acknowledging the patient’s social context and life-world, (B) perceiving patients as cognitive objects providing a variety of meaningful data (clinical, psychometric, and behavioural data – i.e. activities and actions, meaningful expressions and self-reflection), (C) interpreting data in context, and (D) using general epistemological principles. The criteria corresponding to these conditions were: (a) describing the patient’s social context and recognizing the patient’s perspective, (b) taking into consideration a variety of quantitative and qualitative data drawn from the clinician’s perceptions of the patient as embodied subject, (c) being aware of the need to interpret the data in context, and (d) applying epistemological principles (professional expertise, dialogical intersubjectivity, impartiality, accuracy and correctness). Genuine communication is presupposed. These criteria were tested in the work disability assessments of medical certificates. The criteria were useful for understanding both how objectivity fails during work disability assessments and how it can be improved in the writing of certificates. The article specifies four necessary conditions for the definition of a CCCO in health care and social security medicine and the corresponding criteria for its application. Analysis of the objectivity of work disability assessments in medical certificates for social security confirmed the usefulness of the criteria. (shrink)

Although medical centres have established boards, special committees, and offices for the review and redress of breaches in ethical behaviour, these mechanisms repeatedly prove themselves ineffective in addressing research misconduct within the institutions of academic medicine. As the authors see it, institutional design: systematically ignores serious ethical problems, makes whistleblowers into institutional enemies and punishes them, and thereby fails to provide an ethical environment.The authors present and discuss cases of academic medicine failing to address unethical behaviour in academic (...) science and, thereby, illustrate the scope and seriousness of the problem. The Olivieri/Apotex affair is just another instance of academic medicine’s dereliction in a case of scientific fraud and misconduct. Instead of vigorously supporting their faculty member in her efforts to honestly communicate her findings and to protect patients from the risks associated with the use of the study drug, the University of Toronto collaborated with the Apotex company’s “stalling tactics,” closed down Dr Olivieri’s laboratory, harassed her, and ultimately dismissed her.The authors argue that the incentives for addressing problematic behaviour have to be revised in order to effect a change in the current pattern of response that occurs in academic medicine. An externally imposed realignment of incentives could convert the perception of the whistleblower, from their present caste as the enemy within, into a new position, as valued friend of the institution. The authors explain how such a correction could encourage appropriate reactions to scientific misconduct from academic medicine. (shrink)

BackgroundPublic health scholars have long called for preparedness to help better negotiate ethical issues that emerge during public health emergencies. In this paper we argue that the concept of ethical preparedness has much to offer other areas of health beyond pandemic emergencies, particularly in areas where rapid technological developments have the potential to transform aspects of health research and care, as well as the relationship between them. We do this by viewing the ethical decision-making process as a behaviour, and conceptualising (...) ethical preparedness as providing a health research/care setting that can facilitate the promotion of this behaviour. We draw on an implementation science and behaviour change model, COM-B, to demonstrate that to be ethically prepared requires having the capability, opportunity, and motivation to work in an ethically prepared way.MethodsWe use two case examples from our empirical research—one pandemic and one non-pandemic related—to illustrate how our conceptualisation of ethical preparedness can be applied in practice. The first case study was of the UK NHSX COVID-19 contact tracing application case study involved eight in-depth interviews with people involved with the development/governance of this application. The second case involved a complex case regarding familial communication discussed at the UK Genethics Forum. We used deductive qualitative analysis based on the COM-B model categories to analyse the transcripbed data from each case study.ResultsOur analysis highlighted that being ethically prepared needs to go beyond merely equipping health professionals with skills and knowledge, or providing research governance actors with ethical principles and/or frameworks. To allow or support these different actors to utilise their skills and knowledge, a focus on the physical and social opportunity is important, as is a better understanding the role of motivation.ConclusionsTo understand ethical preparedness, we need to view the process of ethical decision-making as a behaviour. We have provided insight into the specific factors that are needed to promote this behaviour—using examples from both in the pandemic context as well as in areas of health research and medicine where there have been rapid technological developments. This offers a useful starting point for further conceptual work around the notion of being ethically prepared. (shrink)

This book examines the relationship between law and scientific advancement, with a particular focus on the theory of evolution and medical innovation. Historically, the law has struggled to keep pace with modern medical advances. The authors demonstrate that the laws that govern human behaviour must evolve in response to such advances."--Provided by publisher.

In this article, we examined the relationship between abusive supervision and deviant workplace behavior and the moderating role of an Islamic Work Ethic. Three hundred and thirty‐six employees in different organizations (specializing in software development, medicine, law enforcement, telecommunication, pharmaceutics, and banking) across Pakistan completed our questionnaire. The results revealed that abusive supervision was positively related to deviant workplace behavior. Moreover, the moderation of an Islamic Work Ethic on the relationship between abusive supervision and deviant work behavior was confirmed. (...) The study contributed in many ways. It expanded literature by revealing a weaker relationship between abusive supervision and deviant behavior when Islamic Work Ethic (IWE) was high. It also tested the conservation of resources theory by providing a plausible reasoning of the role of IWE in employee motivation. By integrating IWE as a resource in the workplace, practitioners would learn that the proper use of resources would produce satisfied workers who would not indulge in deviant workplace behaviors. (shrink)

The Pharmaceutical Benefits Scheme, operating in Australia under the National Health Act 1953, provides citizens equal access to subsidised pharmaceuticals. With ever-increasing costs of medicines and global financial pressure on all commodities, the sustainability of the PBS is of crucial importance on many social and political fronts. Direct-to-consumer advertising (DTCA) of prescription medicines is fast expanding, as pharmaceutical companies recognise and reinforce marketing potentials not only in healthcare professionals but also in consumers. DTCA is currently prohibited in Australia, but pharmaceutical (...) companies continuously lobby for the ban to be lifted. There is evidence that such marketing strategies influence consumer behaviour and concerns have been raised about whether DTCA could affect government expenditure on the PBS in Australia. This pharmacy-based study explored Australian consumer attitudes towards DTCA and whether consumer attitudes regarding DTCA differ based on socioeconomic status, measured in terms of income and education. Consumers from different socioeconomic areas in Sydney were asked to respond to a survey about an advertisement created specifically for the promotion of a mock prescription medicine. Their views about the intent, value and reliability of the advertisement were explored. The study found that consumers of lower socioeconomic status were more likely to perceive DTCA as a source of valuable and reliable medical information, and that they were more likely to request an advertised medication from their physician. If DTCA of prescription medicines was to be introduced in Australia, an increase in government expenditure on the PBS would be anticipated. Findings of this study also expose a deficit in respect for patients’ right to autonomy and informed consent which should be based on evidence-based, unbiased, information rather than advertisements. (shrink)

The ways human behavior is conceptualized need to be refined. Major stumbling blocks have been the reification of verbal descriptions of behavior and the construction of ill-defined clusters of dissimilar problems. The effect of behavior-modifying drugs can be completely dependent on situational details. Behavior is a complex product of many interacting factors and cannot be rigorously predictable as the same behavior may be arrived at in different ways. Thus similar-looking behaviors can be functionally different and conversely different-looking behaviors can be (...) functionally identical. More answerable questions about behavior need to be formulated. (shrink)

RESUMEN La medicina tradicional herbolaria desde su evolución hasta la contemporaneidad ha sido objeto de uso para la medicina convencional. Por eso el objetivo del trabajo es describir el comportamiento de la medicina tradicional herbolaria en los sistemas de salud convencionales. Se realizó la búsqueda y análisis documental de numerosas fuentes sobre la temática pertenecientes a las bases de datos SciELO Cuba, SciELO Regional, Science Direct, Clinical Key, Cumed, Lilacslo. Se concluye que la actualidad social registra manifestaciones alentadoras en el (...) campo de la aceptación de la herbolaria como medicina complementaria por el equipo de salud y un renovado interés en el ámbito mundial por estudiar los efectos que tienen las plantas sobre la salud. ABSTRACT The traditional herbalist medicine from its evolution to the contemporaneity has been an object use for the conventional medicine. That's why the objective of the work is to describe the behavior of the traditional herbalist medicine in the conventional health systems. A search and documentary analysis of numerous sources on the subject-matter belonging to the databases SciELO Cuba, SciELO Regional, Science Direct, Clinical Key, Cumed, Lilacslo was carried out. It is concluded that the social actuality registers encouraging declarations in the field of the acceptance of the herbalist as complementary medicine for the team of health and a renewed interest in the world ambience to study the effects that have the plants on the health. (shrink)

Objective: We aimed to analyze the characteristics and psychological mechanism of depressive symptoms in elderly patients with alcohol dependence under the COVID-19 epidemic and to observe the effect of acupuncture combined with emotional therapy of Chinese medicine treatment on depressive symptoms in elderly patients with alcohol dependence.Methods: Sixty patients were randomly divided into two groups. One group was treated by a set of emotional therapy of Chinese medicine treatment for 12 weeks. One group was treated by a set (...) of acupuncture combined with emotional therapy of Chinese medicine treatment for 12 weeks. We compared the curative effect between the control group and the treatment group, the mean alcohol consumption, the SF-36 scores before and after treatment, and the scores of Hamilton Depression Scale before and after treatment of 3, 6, and 9 weeks.Results: Based on the cognitive behavior model, the characteristics and psychological mechanism of depression in elderly patients with alcohol dependence under the COVID-19 epidemic situation were summarized. The total effective rate of the control group was 60%, and that of the treatment group was 100%. After 12 weeks of treatment, there were significant differences in PF, RF, physical pain, general health status, energy, and mental health between the treatment group and the control group. Before and after treatment, there were significant differences in PF, RF, physical pain, general health, energy, emotional function, and mental health of the treatment group. The PF, energy, and mental health of the control group were significantly different before and after treatment. There was no significant difference between the treatment group and the control group in the scores of Hamilton Depression Scale before treatment. There was significant difference between the treatment group and the control group in the scores of Hamilton Depression Scale at 3, 6, and 9 weeks after treatment.Conclusion: Attention, cognition, emotion, behavior, and physical response reinforce each other, creating a vicious cycle that reinforces and sustains the depressive symptoms of elderly alcohol dependence under the COVID-19 epidemic, and acupuncture combined with emotional therapy of Chinese medicine treatment for improving the depressive symptoms of elderly alcohol dependence during the epidemic period of COVID-19 has a brilliant therapeutic effect. (shrink)

Of central concern to the philosophy of medicine is an understanding of the relationship that arises between science and ethics when decisions involve human beings. To examine this relationship, we must consider the status of claims to medical knowledge and whether there exists within medical practice a style of collecting and analyzing data and mak- ing therapeutic decisions that is properly called science. Since ideally, in medicine, knowledge guides practice, to a significant extent our factual claims will legislate (...) our behavior toward our fellowman. Clearly, other considerations compete with science for influence over medical deci- sions—for example, law, custom, patient preferences, convenience. However, without a "science of clinical medicine" and without a clear understanding of how we distinguish between valid and invalid factual claims, medical opinion loses much of its moral force. (shrink)

This is a case study of a program to address professionalism at the Universidad de la República in Uruguay. We describe a five-year ongoing international collaboration. Relevant characteristics of the context, the program components, activities, and results were analyzed. The expected outcomes were to introduce standards of professional practices in the curricula of medical students and residents and the implementation of a program that might lead to a significant change in the culture of medicine in the University. Traditional didactics, (...) interactive theater, and professional development workshops, issues such as teamwork and communication, professional behavior, and the culture of medicine, and physician wellness were addressed. A total of 359 faculty members, general practitioners, stakeholders, and other healthcare professionals participated in the intervention. The process led to specific achievements including new content in the curricula, the use of educational innovations to address issues of professionalism, a growing institutional culture of accountability, and the establishment of new rules and regulations. The strategies and interventions followed in the case of Uruguay can serve as a model to other developing countries to promote physician professionalism, wellness, and joy. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms (...) on which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Do People Defy Generalizations?Examining the Case Against Evidence-Based Medicine in PsychiatryGloria Ayob (bio)KeywordsPhilosophy, psychiatry, action, contentEvidence-based medicine (EBM) in psychiatry presupposes that it is possible to track the causal efficacy of treatments for psychopathological conditions using scientific methods. One central aim of EBM is to ascertain the causally efficacious component of the treatment of a given condition. This is done by collecting data from randomized control trials, (...) where this data are of groups rather than of individuals (Bolton, 2008).EBM is felt by many to have significant limitations when applied in the field of psychiatric medicine, and these limitations are thought to arise owing to a particular fact about psychiatry, namely that the subject of psychiatry is the human person. For brevity, I will refer to this broad claim as the Unsuitability Intuition (UI), which can be stated as follows:The UI is the intuition that EBM is somehow unsuitable for dealing with people.The aims of this paper are twofold. First, I try to pinpoint the source(s) of anxiety about EBM, and therein to clarify the exact sense(s) in which EBM might be said to be unsuitable or problematic. Second, I evaluate the validity of these concerns, focusing on two broad interrelated questions: (1) Is it actually something about human persons that creates trouble for EBM in psychiatry, and if so, what is the nature of this trouble?; and (2) What assumptions about EBM are made such that EBM is problematic in light of the fact that the subject of psychiatry is the human person?As an empirical point, EBM in psychiatry is applied to two methods of treatment: psychotropic drugs, and more recently, cognitive–behavioral therapies. Each of these throws up slightly different issues in light of the two questions just identified. To accommodate relevant differences, I structure this paper as follows. Bearing in mind that the overall aim of the paper is to scrutinize the intuition that EBM is somehow unsuitable for dealing with people, I begin by exploring one common suggestion as to what underpins this intuition: The problem we are confronted with, in applying EBM to people, is the problem of applying generalizations to particular instances (Wifstad 2008). To anticipate, I argue that this worry concerns a problem that, in fact, applies to the scientific method in general. That is, it is not a [End Page 167] problem arising specifically from the fact that the subject of psychiatry is the human person. So if this is the worry about EBM, then as it stands, it does not satisfactorily explain the intuition that EBM is somehow unsuitable for dealing with people.Against this, the UI theorist might defend his intuition by attempting to specify the reasons why persons, unlike physical material, present a special challenge to the scientific method presupposed by EBM. One way of doing this is to point out that the determinants of human behavior cannot be captured by generalizations (and in particular, by causal generalizations). There are two ways of worrying about EBM here: On the first, the problem of EBM in psychiatry is a pragmatic worry that arises in view of the complexity of the determinants of human behavior and the limited capacity for observation. If this is the worry, though, it can be overcome to a greater or lesser extent within psychiatric practice. The second worry consists in the thought that humans pose a constitutive problem for EBM in psychiatry. However, I argue that this worry turns out to rest on assumptions about human behavior that are not unproblematic in themselves. Thus, UI is underpinned either by a pragmatic worry that can be overcome to some extent, or else it is underpinned by certain assumptions that are problematic, if not altogether wrong. This means that UI cannot be founded on a constitutive point about persons—at least, it does not seem to be, if it arises from a concern about applying generalizations to individual human beings.But there is a very different type of worry that might underpin UI, one that does not issue from considerations about the relation between the general and the particular. UI theorists could be worried about specific... (shrink)

Eating behaviors evolve during the first years of life as biological and behavioral processes directed towards meeting requirements for health and growth. For the vast majority of human history, food scarcity has constituted a major threat to survival, and human eating behavior and child feeding practices have evolved in response to this threat. Because infants are born into a wide variety of cultures and cuisines, they come equipped as young omnivores with a set of behavioral predispositions that allow them to (...) learn to accept the foods made available to them. During historical conditions of scarcity, family life and resources were devoted to the procurement and preparation of foods, which are often low in energy, nutrients, and palatability. In sharp contrast, today in non-Third World countries children's eating habits develop under unprecedented conditions of dietary abundance, where palatable, inexpensive, ready-to-eat foods are readily available. (shrink)

Academia bases reputation and standing on the number of published articles. As a result, the abilities and potential of researchers are also being judged by the number of articles they write, as well as on the impact factor of the journals in which their articles are being published. In itself this is not a problem, although one could of course question the assumption that the quantity of the output reflects the competence of individual researchers. As Altman has stated: “The length (...) of a list of publications is a dubious indicator of ability to do good research.”1 However, if senior faculty decide that the career progress of junior researchers in academia should be based on these criteria, academic medicine is bound to fail in fulfilling its role, namely maximising the quality of medical research and doing research for the right reasons. And to some extent it already has.1 …. (shrink)

African American distrust of medicine has consequences for treatment seeking and healthcare behaviour. Much work has been done to examine acute events that have contributed to this phenomenon and a sophisticated bioethics discipline keeps watch on current practices by medicine. But physicians and clinicians are not the only actors in the medical arena, particularly when it comes to health beliefs and distrust of medicine. The purpose of this paper is to call attention not just to ethical shortcomings (...) of the past, but to the structural contexts of those events and the contributions and responsibilities of popular media and academic disciplines in the production of knowledge. We argue that ignoring context and producing inaccurate work has real impacts on health and healthcare, particularly for African Americans, and thus engenders ethical obligations incumbent on disciplines traditionally recognised as purely academic. (shrink)

In classical physics, the world is considered as a matter-based reality, the arrangement of whose parts in time is uniquely determined by certain dynamic laws. By contrast, modern quantum physics reveals that matter is not composed of matter, but reality is merely potentiality. The world has a holistic structure, which is based on fundamental relations and not material objects, admitting more open, indeterministic developments. In this more flexible causal framework, inanimate and animate matter are not to be considered as fundamentally (...) different but as different order structures of the same immaterial entity. In a stable configuration, effectively all the uncertainties are statistically averaged out, thus the unique and deterministic behavior of ordinary inanimate matter is exhibited; whereas in the case of statically unstable but dynamically stable configurations, the “lively” features of the underlying quantum structure have a chance to surface to the mesocopic level and to be connected with what we observe as the phenomenon of life. This supposition can be more explicitly treated and clarified by identifying the electric dipole moment of biomolecules as the ordering parameter of the corresponding macroquantum system. This has important consequences for biology and medicine. In particular, it suggests the existence of a quantum-based “software,” essential perhaps for the logistics of biological processes, which are hidden behind the matter/energy-based “hardware” that alone is considered in the conventional approach. In medicine it opens an opportunity to build bridges between conventional medicine based essentially on the classical paradigm, and the various forms of complementary medicine, which have strong affinities with the new features of the modern holistic worldview. (shrink)

Due to investments in interdisciplinary research endeavors, the number and variety of interdisciplinary research centers have grown exponentially during the past decades. While interdisciplinary research centers rely on varied organizational arrangements, we know little about the conditions and processes that mediate collaborative arrangements and interdisciplinary research outcomes. This study examines how different collaborative arrangements shape scholars’ experiences of interdisciplinary research and understandings of interdisciplinary knowledge culminations in the context of university-based research centers. We conducted three in-depth qualitative case studies on (...) different centers, which recruited researchers from natural sciences, medicine, and social sciences. We refer to them as the Biotech Center, the Environmental Center, and the Premature Birth Center. Our analysis of 53 interviews with interdisciplinary scholars across the three centers demonstrates that the scholars perceive particular features of the centers’ collaborative arrangements as meaningful for interdisciplinary collaboration. Specifically, the center’s mission, physical architecture, and leadership and task structure were seen as affecting scholars’ motivation, interaction, and inclusion in the centers, which then shaped the interdisciplinary knowledge culminations. At the Biotech Center, knowledge was translated towards concrete products, at the Environmental Center knowledge was pooled together from varied fields to create new problem framings, and at the Premature Birth Center, interdisciplinary collaboration was crafted through top-down knowledge brokerage. (shrink)