Machine learning-driven clinical decision support systems (ML-CDSSs) seem impressively promising for future routine and emergency care. However, reflection on their clinical implementation reveals a wide array of ethical challenges. The preferences, concerns and expectations of professional stakeholders remain largely unexplored. Empirical research, however, may help to clarify the conceptual debate and its aspects in terms of their relevance for clinical practice. This study explores, from an ethical point of view, future healthcare professionals’ attitudes to potential changes of responsibility and decision-making (...) authority when using ML-CDSS. Twenty-seven semistructured interviews were conducted with German medical students and nursing trainees. The data were analysed based on qualitative content analysis according to Kuckartz. Interviewees’ reflections are presented under three themes the interviewees describe as closely related: (self-)attribution of responsibility, decision-making authority and need of (professional) experience. The results illustrate the conceptual interconnectedness of professional responsibility and its structural and epistemic preconditions to be able to fulfil clinicians’ responsibility in a meaningful manner. The study also sheds light on the four relata of responsibility understood as a relational concept. The article closes with concrete suggestions for the ethically sound clinical implementation of ML-CDSS. (shrink)

In most U.S. jurisdictions, clinicians providing informal “curbside” consults are protected from medical malpractice liability due to the absence of a doctor-patient relationship. A recent Minnesota Supreme Court case, Warren v. Dinter, offers the opportunity to reassess whether the majority rule is truly serving the best interests of patients.

Decision-making capacity is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally differs from (...) existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

Još od 2001., nakon što je Kina odabrana za domaćina Olimpijskih igara 2008., taj je izbor bio izvorom niza kontroverzi koje su se većinom usredotočile na pitanja ljudskih prava. Na ove kritičke ocjene odgovoreno je mjerama kineskih vlasti: od 2003. godine ustavnim amandmanom koji se referira na »azijske vrijednosti« i uvođenje Hu Jintaovog programa »harmoničnog društva«. Rad se pretežno usredotočuje na međukulturne aspekte rasprave o statusu ljudskih prava u Kini. Prvo se analiziraju glavna pitanja i uspoređuju različiti načini na koje (...) se pristupalo ljudskim pravima kako u Kini tako i u inozemstvu. Zatim se analiziraju neusklađenosti tih ocjena unutar dvaju osnovnih okvira: doktrine univerzalnih ljudskih prava i doktrine harmoničnog društva, zasnovanog na konfucijanskom svjetonazoru. Završno se preispituju aktualne rasprave o problemima ljudskih prava pomoću međukulturne supostavljenosti navedenih dvaju okvira i mogućnosti dijaloga tih dviju ocijenjenih pozicija. (shrink)

Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within (...) the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well. (shrink)

Este escrito es un esfuerzo investigativo de corte crítico que se mueve argumentativamente entre paradojas, en el que se describe una tendencia actual en la sociedad como patológica y deshumanizante. A tal tendencia le hemos llamado sedentarismo-nómada, primera paradoja, que no es más que la tendencia del hombre a ser sedentario de un lugar u objeto tecnológico de moda, mientras que está en la posibilidad de conocer el mundo mediante tal objeto, haciendo un clic, sin salir de su casa o (...) lugar de trabajo, pero al mismo tiempo viajando por todo el mundo. Tendencia que se da entre actores sociales caracterizados como singularidades-plurales-narrativas, segunda paradoja, que a su vez obedece a una política de la homogenización, un proceso de estandarización social en masa; una ética comerciante, un proceso de regulación y caracterización comportamental bajo la lógica del mercado en la instauración de una nueva forma de relacionarse con la vida, con el sí mismo y con el otro, una relación mercantil; como expresiones de una cultura pornográfica audio-visual, el otro hecho objeto de consumo; y una pedagogía del consumo, una cultura que educa por y para comprar y vender a través de objetos tecnológicos. La consideración de un mundo trágico y sin sentido pero al que, hay que hallarle razón de ser, es la última de las paradojas. Radiografía social que deja al hombre transformado en la única cosa que puede ser institucionalmente, mercancía de consumo, objeto prostituido. (shrink)

Pulmonary rehabilitation has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. A 12-week community-based PR will be implemented in (...) primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea, fatigue, cough and sputum, impact of the disease, emotional state, number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion. Other clinical outcomes will be peripheral and respiratory muscle strength, muscle thickness and cross sectional area, exercise capacity, balance and physical activity. Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. The trial was registered in the ClinicalTrials. gov U.S. National Library of Medicine, on 10th January, 2019. (shrink)

Este trabajo aborda el pacto librepensador suscri­to por las autoras Rosario de Acuña y Ángeles López de Ayala. Se examinan sus contribuciones en la prensa librepensadora y su activismo feminista a través de un análisis de sus colabora­ciones en Las dominicales del librepensamiento, El gladiador: órgano de la “Sociedad progresiva femenina” y El gladiador del librepensamiento. La ideología de estas publicaciones les permitió vincular la lucha feminista con la agenda política de ideología progresista. Se parte de dos ejes complementarios cuya (...) intersección permite abordar su pacto de compromiso y transgresión: la lucha por la igualdad social y por la igualdad de género. Se estudian sus reflexiones sobre la explotación del pueblo por las castas, el empoderamiento de la mujer como agente constructor del progreso y la denuncia vehemente de su sometimiento. Se concluye que los escritos de Acuña y Ayala evidencian con el paso de los años una radicalización que pro­picia una postura cada vez más trasgresora y un feminismo más combativo, reflejando así su descontento con la actitud pater­nalista u hostil del librepensamiento y el republicanismo mas­culino en lo que respecta a los derechos de la mujer. (shrink)

Spätestens seit der berühmten Anekdote vom Bild der schönen Helena gilt körperliche Schönheit als ein Kunstprodukt. Für sein Bildnis der Helena soll der griechische Maler Zeuxis die fünf hervorragendsten Jungfrauen ausgewählt und von jedem Modell den jeweils schönsten Körperteil gemalt haben. Nach dieser Vorstellung ist vollkommene Schönheit erst durch einen künstlichen Eingriff zu erzielen; das gilt sowohl für den lebendigen Körper als auch für sein künstlerisches Abbild. Kunst und Körperpflege stehen damit in einem spannungsvollen Wechselverhältnis. Denn die Grundlagen (...) und Mittel zur Erzeugung und Steigerung von körperlicher Schönheit, die in beiden Bereichen zur Verfügung stehen, überschneiden, ergänzen und beeinflussen sich. Das Buch beleuchtet dieses Wechselverhältnis anhand ausgewählter Grundlagentexte in deutscher Übersetzung, ergänzt um fundierte Kommentare zum historischen Kontext. (shrink)

Die Standard-Interpretation von Carnaps Logischer Außau der Welt als unmittelbarer Nachfolger des britischen Empirismus wird anhand einer detaillierten Untersuchung des philosophischen und naturwissenschaftlichen Zusammenhangs, auf den Carnap selbst explizit oder implizit verweist, kritisiert. Es stellt sich heraus, daß Carnaps Unterfangen vor allem auf den Ansätzen einer "psychophysiologischen Erkenntnistheorie" fußt — einer Richtung, die vor allem im deutschsprachigen Bereich am Anfang des 20. Jahrhunderts einflußreich war, und die noch ungenügend erforscht worden ist.

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

Caring for the stranger -- Why compassion in politics? -- Historical perspectives on social welfare and global development -- Historical perspectives on human rights -- Compassion in religious and secular thought -- Justice and moral responsibility -- Altruism, empathy, and the making of "Us" and "Them" -- The moral politics of Liberals and Conservatives -- Politics against compassion in the United States -- Compassion in public policy and law -- Creating a more compassionate and just society.

This study analysed teaching of nurses’ codes of ethics in basic nursing education in Finland. A total of 183 educators and 214 students responded to a structured questionnaire. The data was analysed by SPSS. Teaching of nurses’ codes was rather extensive. The nurse-patient relationship was highlighted. Educators assessed their teaching statistically significantly more extensive than what students’ perceptions were. The use of teaching and evaluation methods was conventional, but differences between the groups concerning the use of these methods were statistically (...) significant. Students’ knowledge of and their ability to apply the codes was mediocre. Most educators and students assessed educators’ knowledge of the codes as adequate for teaching. These educators also taught the codes more extensively and these students perceived the teaching as more extensive. Otherwise educators’ and students’ socio-demographic variables had little association with the teaching. Research should focus on the organization and effectiveness of ethics education, and on educators’ competence. (shrink)

The plurality of discussions and the diversity with which the main ethical questions were approached permit the separation of relative theories elaborated in Islam into three distinct dimentions: religious morality, theological ethics and philosophical ethics. Religious morality was elaborated based exclusively on the precepts of the Koran, and on the teachings of the Tradition (Hadīth). This morality establishes the fundamentals to determine: a) the nature of what is correct, and of what is iniquous; b) that which is within the law (...) and divine power’s reach; c) the liberty, and the moral responsibility of each one. Among the thinkers who elaborated a theological ethic founded on the koranic precepts, and on the Tradition (Hadīth), making use of theological concepts, philosophical categories and, at times, inspirations coming from Sufism, Al-Ghazālī stands out as the most respected theologian of sunni Islam. Among the philosophers, Al-Fārābī, Avicenna, Avempace and Averroes made ample use of Nicomachean Ethics. As they sought to conciliate the teachings of the Koran, and of the Tradition (Hadīth) with philosophy, these philosophers found in the Aristotelian ethics the appropriate indications to realize the ideal model for human society. Miskawayh also stands out who, although did not elaborate any ethical system based on philosophical norms, proficuously utilized the Aristotelian and Platonic doctrines, and the works of Arab philosophers before him such as Al-Kindī, Al-Rāzī and Al-Fārābī. (shrink)

About the Republic is the only commentary left by Averroes, the Commentator, so called on behalf of his commentaries on Aristotle’s work. Although the original in Arabic is lost, there is a medieval version in Hebrew and two later translations in Latin from the Hebrew version. Averroes’ Commentary on the ‘Republic’ – divided in three Books – can be considered an original work as only 1/3 of it corresponds to the platonic treatise. Averroes presents in it aristotelic concepts drawn from (...) the Nicomachean Ethics and also several notions from Alfarabi’s political works. He also presents his own thoughts and offers criticisms of his own society. KEY WORDS – Plato’s Republic; a commentary or an original work? Ethics. Politics. Cardinal virtues. Ideal city. Education. (shrink)