La idea de que los delirios son creencias es apoyada por la observación de que los delirios, al igual que las creencias, son usados en el razonamiento. Sin embargo, los delirios tienen otras características que son difíciles de explicar por medio de una teoría doxástica —por ejemplo, los delirios persisten a pesar de la evidencia en su contra y algunas veces entran en conflicto con las acciones del agente (de maneras en que las creencias parecerían no hacerlo), dando lugar a (...) lo que se conoce como el fenómeno de la doble cuenta—. Estas características han motivado teorías no doxásticas, que argumentan que los delirios son otro tipo de fenómeno mental (e.g., imaginaciones o actos de habla vacíos). Mientras que las teorías no-doxásticas pueden explicar dichas características de los delirios—como su persistencia a pesar de la evidencia en su contra y el fenómeno de la doble cuenta— estas teorías tienen dificultades para explicar las características de los delirios que los hacen similares a las creencias. Nos encontramos entonces en un punto muerto en el que ni los enfoques doxásticos ni los no doxásticos pueden explicar todas las características de los delirios. En este artículo, propongo avanzar en este debate mostrando que la propuesta doxástica puede, después de todo, dar cuenta tanto de las características de los delirios que los hacen similares a las creencias como de sus demás características. Basándome en literatura reciente en epistemología, argumento que las creencias (racionales) puede estar motivadas por factores no evidenciales (e.g. pragmáticos o emocionales) y que estos factores sirven para explicar las características aparentemente desconcertantes de los delirios. También propongo que categorizar las creencias a través de dos compartimentos funcionales, el implícito y el explícito, nos ayuda a entender la interacción dinámica entre creencias delirantes y no delirantes. (shrink)

In his account of probable reasoning, Poincaré used the concept, or at least the language, of conventions. In particular, he claimed that the prior probabilities essential for inverse probable reasoning are determined conventionally. This paper investigates, in the light of Poincaré's well known claim about the conventionality of metric geometry, what this could mean, and how it is related to other views about the determination of prior probabilities. Particular attention is paid to the similarities and differences between Poincaré's conventionalism as (...) it applies to probabilities and de Finetti's subjectivism. The aim of the paper is to suggest that in accounts of the development of ideas about probable reasoning, particularly those customarily described as Bayesian, Poincaré's discussion deserves more attention than it has so far received. (shrink)

As I had rejected en bloc references to Bacchanalia as indications of date, it was a mere chance which led me, after the above had left my hands, to look up Cas. 980 ‘ nunc Bacchae nullae ludunt,’ quoted in Schanz, R. Lit.3, p. 78. As this affords an excellent opportunity of testing my conclusions, perhaps a word or two will not be out of place.

Medical confidentiality is a core concept of professionalism and should be an integral part of pregraduate and postgraduate medical education. The aim of our study was to define the factors influencing attitudes towards patient confidentiality in everyday situations in order to define the need for offering further education to various subgroups of physicians. All internists and general practitioners who were registered members of the association of physicians in Geneva or who were working in the department of internal medicine or in (...) the medical polyclinic of the University Hospital of Geneva in 2004 received a standardised questionnaire. Physicians were asked to indicate for seven vignettes whether a violation of confidentiality had occurred and whether the violation was not important, important or serious (scores 1–3; no violation = 0). 508 completed questionnaires were returned (participation rate 55%). Physicians who had worked in the hospital for more than 20 years identified violations of confidentiality more often than physicians with less hospital experience. Binary logistic regression showed that ethics education, total years of professional experience, being an internist, having a private practice, the length of working in private practice and gender were factors associated with correct identification of violations and their severity. However, each factor played a specific role only for single cases or a small number of situations (Cronbach α <0.6). Postgraduate education programs on confidentiality should be offered to a wide range of physicians and should address specific hypothetical situations in which there is a risk of avoidable breaches of confidentiality. (shrink)

Simultaneous discovery in science has been a subject of close historical investigations, not only for assessing claims of priority, which occasionally generate controversy rather than consensus, but also for understanding the cultural and intellectual context of the time. Thomas S. Kuhn is a pioneer in the contextual study of simultaneous discovery, and his paper on the formulation of the first law of thermodynamics has already become a classic.

Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)