Mild signs of postpartum depression or anxiety are present in up to half of all new mothers. However, the impact of having the “baby blues” on infant development remains largely unknown. The current study explores a potential relation between mother’s self-reported depression or anxiety symptoms and infant’s motor development in a longitudinal sample of 50 mother-infant dyads. Further, we examine whether engaging in fetal kick counting during pregnancy may reduce maternal psychopathology symptoms and thereby positively influence infant motor development and (...) parent-child engagement during the first months of life. We hypothesized that subclinical maternal psychopathology would negatively impact infant motor development, and that completing a fetal kick count activity during the third trimester would reduce overall signs of maternal psychopathology. Results only partially support these hypotheses. Postpartum maternal anxiety seems to negatively affect the emergence of infants’ fine motor skills. However, engaging in fetal kick counting during pregnancy did not reduce maternal depression or anxiety symptoms. Nevertheless, preliminary evidence suggests that engaging in fetal kick counting may impact early child development by altering the mother’s attitudes toward the child. Future research is needed to examine the value of this low-cost intervention strategy more closely. (shrink)

Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical (...) deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it. (shrink)

The shortages of baby formula in the US resulting from the voluntary recall of contaminated products and shutdown of manufacturing facility in February led to increases in the national out-of-stock rate of the baby formula from 18 to 70% over the summer of 2022. This study utilizes social media listening and data analysis to examine how online media reactions to the physical shortage changed over time and how the reaction to the shortage differed from to the initial recall announcements. Improved (...) understanding of reactions to emergent issues in foods through this lens may improve communication efficiency to mitigate potential consequences. (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’. 1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous,... (shrink)

There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...) are bound by our ethical commitments as physicians to balance the obligations of care with the duty to teach. In order to ethically validate the model of ‘surgeon as teacher’, we propose that there must be a reconciliation of the tensions between traditional professional values in medicine with the constraints inherent in a time-bound utilitarian medical system. Ultimately, we must consciously accept that ensuring the longitudinal availability of skilled surgeons in society aligns more closely with our core ethical obligations as outlined in the social contract that medical professionals maintain with the general public than does the ethical demand to provide unreservedly individual-focused patient care. It is the duty of individual practitioners, as a necessity of lineage to maintain and fulfil our greater duties to society, to foster deontological relationships where possible within this utilitarian system while accepting short-term imperfection in our practice. There are no data in this manuscript. (shrink)

As Alfandre and colleagues describe in “Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures”, efforts to maintain standards of care durin...

In this article the author examines Fitzpatrick’s foundational critique of liberal legality and racism, a theme which remained central to his decades-long excavation of modern law’s self-identity. After considering Fitzpatrick’s ‘separation thesis’, the author then turns to consider the ways in which neoliberal legality is parasitic upon liberal legal racial formations while at the same time, obscuring the foundational place of race in contemporary capitalism by subsuming material life within its modes of value extraction.

Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...) not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

ArgumentBy the mid-eighteenth century, governors of the major European states promoted the study of nature as part of natural-resource based schemes for improvement and economic self-sufficiency. Procuring beneficial knowledge about nature, however, required observers, collectors, and compilers who could produce usable and useful descriptions of nature. The ways governments promoted scientific explorations varied according to the form of government, the makeup of the civil society, the state's economic ideologies and practices, and the geographical situation. This article argues that the roots (...) of a major natural history initiative in Denmark-Norway were firmly planted in the state-church organization. Through the clergymen and their activities, a bishop, supported by the government in Copenhagen, could gather an impressive collection of natural objects, receive observations and descriptions of natural phenomena, and produce natural historical publications that described for the first time many of the species of the north. Devout naturalists were a common species in the eighteenth century, when clergymen and missionaries involved themselves in the investigation of nature in Europe and far beyond. The specific interest here is in how natural history was supported and enforced as part of clerical practice, how specimen exchange was grafted on to pre-existing institutions of gift exchange, and how this influenced the character of the knowledge produced. (shrink)

Volume 20, Issue 8, August 2020, Page 51-53.

Analgesia and amnesia represent two complimentary pillars of anesthesia directed, respectively, at mitigating the experience of pain and the processes of encoding that experience into memory. These elements are typically combined in modern anesthetic techniques, but some circumstances exist – such as conscious sedation – in which the conditions of amnesia are satisfied while analgesia plays an auxiliary and often incomplete role. These activities reflect a widely held yet underrecognized belief in clinical practice that although pain experiences may be short-lived, (...) their representation in memory and its subsequent effects on thought and emotion can have enduring consequences for patients. In this exploratory article, we delineate phenomenal and abstract ontological categories of pain experience; advance a claim that they are treated by analgesic and amnestic agents, respectively; and describe how each class of experience is uniquely able to bring about individual harm. Beginning with the question of how it can be permissible to allow any preventable experiences or memories of pain, we identify that both phenomenal and abstract pain manifest on a spectrum of severity, each with an enigmatic threshold – unique to circumstance and individual – that determines whether or not pain will translate into harm, and what permissions therefore surround its treatment. Ultimately, we find that there are compelling physiological reasons for the concurrent use of analgesics and amnestics when pain experience exceeds these thresholds, while the treatment of “sub-threshold” experience in either class is a purely ethical imperative to be balanced with considerations of the potential harms posed by the treatments themselves. (shrink)

Catherine Malabou's concept of plasticity has influenced and inspired scholars from across disciplines. The contributors to _Plastic Materialities_—whose fields include political philosophy, critical legal studies, social theory, literature, and philosophy—use Malabou's innovative combination of post-structuralism and neuroscience to evaluate the political implications of her work. They address, among other things, subjectivity, science, war, the malleability of sexuality, neoliberalism and economic theory, indigenous and racial politics, and the relationship between the human and non-human. _Plastic Materialities_ also includes three essays by Malabou (...) and an interview with her, all of which bring her work into conversation with issues of sovereignty, justice, and social order for the first time. Contributors. Brenna Bhandar, Silvana Carotenuto, Jonathan Goldberg-Hiller, Jairus Victor Grove, Catherine Kellogg, Catherine Malabou, Renisa Mawani, Fred Moten, Alain Pottage, Michael J. Shapiro, Alberto Toscano. (shrink)

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging for healthcare (...) providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's “authentic” wishes from future “inauthentic” changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. (shrink)

Health professionals around the world have played an integral role in state-sponsored torture during numerous historical episodes, at times providing “expertise and a veneer of legitimacy to a process that involved violations of basic human rights.” These incidents demonstrate why legal and ethical standards among health professionals should be upheld, no matter the context. For example, health professionals during the Third Reich in Germany notoriously worked with the Nazi government to perform painful medical experiments on individuals without their consent and (...) to supervise systematic killings. During the dictatorships in Brazil, Chile, and Uruguay and during apartheid in South Africa, medical professionals also participated in torture. In recent years, government documents, news reports, articles, books, and testimonies by detainees and health professionals have exposed the involvement of health professionals in the abuse and torture of detained individuals at U.S. detention facilities around the world. (shrink)

Health professionals around the world have played an integral role in state-sponsored torture during numerous historical episodes, at times providing “expertise and a veneer of legitimacy to a process that involved violations of basic human rights.” These incidents demonstrate why legal and ethical standards among health professionals should be upheld, no matter the context. For example, health professionals during the Third Reich in Germany notoriously worked with the Nazi government to perform painful medical experiments on individuals without their consent and (...) to supervise systematic killings. During the dictatorships in Brazil, Chile, and Uruguay and during apartheid in South Africa, medical professionals also participated in torture. In recent years, government documents, news reports, articles, books, and testimonies by detainees and health professionals have exposed the involvement of health professionals in the abuse and torture of detained individuals at U.S. detention facilities around the world. (shrink)

Human infants begin very early in life to take advantage of multisensory information by extracting the invariant amodal information that is conveyed redundantly by multiple senses. Here we addressed the question as to whether infants can bind multisensory moving stimuli, and whether this occurs even if the motion produced by the stimuli is only illusory. Three- to four-month-old infants were presented with two bimodal pairings: visuo-tactile and audio-visual. Visuo-tactile pairings consisted of apparently vertically moving bars (the Barber Pole illusion) moving (...) in either the same or opposite direction with a concurrent tactile stimulus consisting of strokes given on the infant’s back. Audio-visual pairings consisted of the Barber Pole illusion in its visual and auditory version, the latter giving the impression of a continuous rising or ascending pitch. We found that infants were able to discriminate congruently (same direction) vs. incongruently moving (opposite direction) pairs irrespective of modality (Experiment 1). Importantly, we also found that congruently moving visuo-tactile and audio-visual stimuli were preferred over incongruently moving bimodal stimuli (Experiment 2). Our findings suggest that very young infants are able to extract motion as amodal component and use it to match stimuli that only apparently move in the same direction. (shrink)

Given the complexity of teams involved in creating AI-based systems, how can we understand who should be held accountable when they fail? This paper reports findings about accountable AI from 26 interviews conducted with stakeholders in AI drawn from the fields of AI research, law, and policy. Participants described the challenges presented by the distributed nature of how AI systems are designed, developed, deployed, and regulated. This distribution of agency, alongside existing mechanisms of accountability, responsibility, and liability, creates barriers for (...) effective accountable design. As agency is distributed across the socio-technical landscape of an AI system, users without deep knowledge of the operation of these systems become disempowered, unable to challenge or contest when it impacts their lives. In this context, accountability becomes a matter of building systems that can be challenged, interrogated, and, most importantly, adjusted in use to accommodate counter-intuitive results and unpredictable impacts. Thus, accountable system design can work to reconfigure socio-technical landscapes to protect the users of AI and to prevent unjust apportionment of risk. (shrink)

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools in Canada, the UK and the US to check (...) which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

In their forthcoming article, Shavelson and colleagues (2023) identify a key ethical concern associated with medical aid-in-dying (MAiD) laws in the eleven US jurisdictions where the practice is le...

How are contexts made and narrated? This article addresses the question of how to identify relevant contexts for understanding a work of natural history, in this case The First Natural History of Norway, published in two volumes in 1752 and 1753. In addition to offering a rich and complex description of Norwegian nature, this historical work serves as an important source for investigating the ways in which nature was perceived in the kingdom of Denmark-Norway in the middle of the eighteenth (...) century. Nature was manifold, serving as a source of aesthetic pleasure, economic gain, religious reverence, and political power. It is argued that to understand the different natures presented in this book, we need to relate them to more than one context. But how do we determine the relevant contexts? The approach explored in this article is to read the book closely in search of the specific audiences that are addressed. By focusing on the ways audiences are addressed, it is argued, we can make better historical accounts of how natures are conceived and change in relation to different contexts. (shrink)

Factors such as subsistence turnover, warfare, or interaction between different groups can be major sources of cultural change in human populations. Global demographic shifts such as the transition to agriculture during the Neolithic and more recently the urbanization and globalization of the twentieth century have been major catalysts for cultural change. Here, we test whether cultural traits such as patri/matrilocality and postmarital migration persist in the face of social upheaval and gene flow during the past 150 years in postcolonial South (...) Africa. The recent history of South Africa has seen major demographic shifts that resulted in the displacement and forced sedentism of indigenous Khoekhoe and San populations. During the expansion of the colonial frontier, the Khoe-San admixed with European colonists and enslaved individuals from West/Central Africa, Indonesia, and South Asia, introducing novel cultural norms. We conducted demographic interviews among Nama and Cederberg communities representing nearly 3,000 individuals across three generations. Despite the history of colonial expansion, and the subsequent incorporation of Khoe-San and Khoe-San-descendant communities into a colonial society with strong patrilocal norms, patrilocality is the least common postmarital residence pattern in our study populations today. Our results suggest that more recent forces of integration into the market economy are likely the primary drivers of change in the cultural traits examined in our study. Birthplace had a strong effect on an individual’s odds of migration, distance moved, and postmarital residence form. These effects are at least partially explained by the population size of the birthplace. Our results suggest that market factors local to birthplaces are important drivers of residence decisions, although the frequency of matrilocal residence and a geographic and temporal cline in migration and residence patterns also indicate the persistence of some historic Khoe-San cultural traits in contemporary groups. (shrink)