Next SectionEvidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically (...) unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. (shrink)

Research from behavioural sciences shows that people reach decisions in a much less rational and well-considered way than was often assumed. The doctrine of informed consent, which is an important ethical principle and legal requirement in medical practice, is being challenged by these insights into decision-making and real-world choice behaviour. This article discusses the implications of recent insights of research on decision-making behaviour for the informed consent doctrine. It concludes that there is a significant tension between the often non-rational choice (...) behaviour and the traditional theory of informed consent. Responsible ways of dealing with or solving these problems are considered. To this end, patient decisions aids are discussed as suitable interventions to support autonomous decision-making. However, current PDAs demand certain improvements in order to protect and promote autonomous decision-making. Based on a conception of autonomy, we will argue which type of improvements are needed. (shrink)

Signed utterances are densely packed with pointing signs, reaching a frequency of one in six signs in spontaneous conversations (de Vos, 2012; Johnston, 2013a; Morford & MacFarlane, 2003). These pointing signs attain a wide range of functions and are formally highly diversified. Based on corpus analysis of spontaneous pointing signs in Kata Kolok, a rural signing variety of Bali, this paper argues that the full meaning potentials of pointing signs come about through the integration of a varied set of linguistic (...) and extralinguistic cues. Taking this hybrid nature of pointing phenomena into account, it is argued that pointing signs may become an intrinsic aspect of sign language grammars through two mechanisms: morphemization and syntactic integration. Although not entailed in this research, this approach could implicate that some highly systematized pointing systems of speaking communities may to a degree be grammatical as well. (shrink)

Our study examines how a company’s engagement in corporate social responsibility influences word of mouth about the company on Twitter, particularly during a service delay. We use the airline industry as the study context. On the popular social medium Twitter, people post tweets about airline services and raise concerns about service delays when flights are delayed, canceled, or diverted. Drawing on the literature on legitimacy and the halo effect, we argue that a company’s CSR engagement enhances its corporate image, which (...) in turn, influences WOM about the company on Twitter. We predict and find that airlines with better CSR engagement receive more positive word of mouth and less negative word of mouth on Twitter. We also find that service delays reduce PWOM and increase NWOM, with the additional finding that the positive relationship between service delays and NWOM is less strong for airlines with better CSR engagement. We conduct additional analyses to investigate the effects of environmental, social, and governance CSR on PWOM and NWOM. Our study has practical implications in informing companies about the benefits of CSR engagement in relation to public opinion during service delays. (shrink)

Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients’ intention and perceived ability to act in future situations where they risk experiencing abuse.

John Duns Scotus is arguably one of the most significant philosopher theologians of the middle ages who has often been overlooked. This book serves to recover his rightful place in the history of Western philosophy revealing that he is in fact one of the great masters of our philosophical heritage. Among the fields to which Scotus has made an immense contribution are logic, metaphysics, philosophy of mind and action, and ethical theory.The Philosophy of John Duns Scotus provides a formidable yet (...) comprehensive overview of the life and works of this Scottish-born philosopher. Vos has successfully combined his lifetime of dedicated study with the significant body of biographical literature, resulting in a unique look at the life and works of this philosopher theologian. (shrink)

Although justice is a central principle in clinical ethics, work that centers social justice is often marginalized in clinical ethics. In addition to institutional barriers that may be preventing clinical ethicists from becoming the activists that Meyers argues we should be, we must also recognize the barriers embedded in the field of clinical ethics itself. As clinical ethicists, we have an opportunity to support anti‐racism work in particular by altering our own organizational structures to be more inclusive and reflective of (...) the Black, Indigenous, and other communities of color we serve, enhancing clinical ethics education and training by making critical theories foundational, and decolonizing our clinical ethics consultation tools and practices. (shrink)

Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

This article explores nation building as an organizational accomplishment and uses the concept of boundary object to explain how the groups that compose the nation cooperate. Specifically, the article examines the mechanisms devised to secure a flow of money from the Irish-American and Jewish-American diasporas to their respective homelands. To overcome problems associated with conventional philanthropy, Irish and Jewish nationalists issued bonds and sold them to their American compatriots as a hybrid of a gift and an investment. In the Irish (...) case, disagreements about the entitlement to the proceeds resulted in the termination of the bond project. In the Jewish case, the bond served as a boundary object allowing American and Israeli Jews to cooperate despite ongoing tensions. The Israeli bond provided Jewish-Americans with an additional way to invest themselves financially and emotionally in Israel. This bond is an example of a socio-technical mechanism used to create national attachments. (shrink)

Byun et al. describe how deaf signers deal with communication problems in first encounters with signers of different languages. They show that the basic Conversation Analytic repair mechanisms for dealing with verbal troubles are largely reproduced in gesture and sign, including details of turn‐taking structure, timing and form. This underlines the role of repair as a basic resource for linguistic and interactional creativity across modalities.

Aristotle’s use of the term ‘eironeia’ in the Nicomachean Ethics (NE) appears to be inconsistent: first, he attributes the attitude termed ‘eironeia’ to the great-souled man (megalopsychos), who is defined by his virtuousness, then he classifies ‘eironeia’ as one of the two vices which are central to his account of the virtue of truthfulness. Modern attempts to explain and to solve the “riddle of the great-souled eiron” have not been satisfying. This paper argues that the riddle results from Aristotle trying (...) to reconcile aristocratic values with democratic reality. In the process, some insight will be gained on the concept of the megalopsychos in general, on Aristotle’s notion of the virtue of truthfulness and on his depiction of Socrates. Finally, it is argued that Aristotle’s use of the notion of ‘eironeia’ in the NE bears some resemblance to the use of the notion of ‘irony’ in modern political theory. (shrink)

This article develops a theory of simulation as a nation building mechanism by exploring the production of national belonging in Massad, a Jewish-American summer camp that operated in the Pocono Mountains, Pennsylvania, between 1941 and 1981. Trying to inspire campers to Zionism, the camp organizers shaped Massad as a “mini Israel.” This simulation engendered national attachments by lending credence to the belief that others, in Israel, experience more authentic national belonging. Rather than tempting campers to imagine the nation as a (...) “horizontal camaraderie” (Anderson 1991), national simulations allow members to account for their distinct and often ambivalent position from within the nation. From this perspective, nation building is not simply a matter of relativizing internal differences and dramatizing differences between the groups that make up the nation and “outsiders.” Instead, nation building also is centrally a matter of creating institutional routines and practices that allow members to account for their differential position from within the nation. (shrink)

Research on interaction in speaking assessment suggests that both verbal and nonverbal interaction are integral parts of the construct of interactional competence (Galaczi & Taylor, 2018; Plough et al., 2018; Young, 2011). However, little has been done to investigate which features significantly contribute to interactional competence scores. This study, therefore, examined which interaction features that raters noticed in individual scripted interview and paired discussion tasks to gain an insight into the interactional competence construct, providing validity evidence for an inclusion of (...) interactional competence in speaking assessment. Sixty-eight student performances were rated based on interaction rating scales. Exploratory factor analysis revealed four factors: nonverbal communication, topic management, interactional management, and interactive listening. Logistic regressions showed that while raters attended to more topic management features in the individual scripted interview task, they noticed more interactional management features in the paired discussion task. Simple regressions showed that nonverbal communication and topic management features predicted interactional competence scores in the individual scripted interview task, whereas nonverbal communication, topic management, interactional management, and interactive listening features were predictors of scores in the paired discussion task. The findings suggest that both nonverbal and verbal interaction features are important in the interactional competence construct with the paired task providing test-takers with more opportunities to demonstrate their interactional ability. (shrink)

The knower paradox states that the statement ‘We know that this statement is false’ leads to inconsistency. This article presents a fresh look at this paradox and some well-known solutions from the literature. Paul Égré discusses three possible solutions that modal provability logic provides for the paradox by surveying and comparing three different provability interpretations of modality, originally described by Skyrms, Anderson, and Solovay. In this article, some background is explained to clarify Égré’s solutions, all three of which hinge on (...) intricacies of provability logic and its arithmetical interpretations. To check whether Égré’s solutions are satisfactory, we use the criteria for solutions to paradoxes defined by Susan Haack and we propose some refinements of them. This article aims to describe to what extent the knower paradox can be solved using provability logic and to what extent the solutions proposed in the literature satisfy Haack’s criteria. Finally, the article offers some reflections on the relation between knowledge, proof, and provability, as inspired by the knower paradox and its solutions. (shrink)

Signed utterances are densely packed with pointing signs, reaching a frequency of one in six signs in spontaneous conversations . These pointing signs attain a wide range of functions and are formally highly diversified. Based on corpus analysis of spontaneous pointing signs in Kata Kolok, a rural signing variety of Bali, this paper argues that the full meaning potentials of pointing signs come about through the integration of a varied set of linguistic and extralinguistic cues. Taking this hybrid nature of (...) pointing phenomena into account, it is argued that pointing signs may become an intrinsic aspect of sign language grammars through two mechanisms: morphemization and syntactic integration. Although not entailed in this research, this approach could implicate that some highly systematized pointing systems of speaking communities may to a degree be grammatical as well. (shrink)

This book argues that Protestant theological ethics not only reveals basic virtue ethical characteristics, but also contributes significantly to a viable contemporary virtue ethics. Pieter Vos demonstrates that post-Reformation theological ethics still understands the good in terms of the good life, takes virtues as necessary for living the good life and considers human nature as a source of moral knowledge. Vos approaches Protestant theology as an important bridge between pre-modern virtue ethics, shaped by Aristotle and transformed by Augustine of Hippo, (...) and late modern understandings of morality. The volume covers a range of topics, going from eudaimonism and Calvinist ethics to Reformed scholastic virtue ethics and character formation in the work of Søren Kierkegaard. The author shows how Protestantism has articulated other-centered virtues from a theology of grace, affirmed ordinary life and emphasized the need of transformation of this life and its orders. Engaging with philosophy of the art of living, Neo-Aristotelianism and exemplarist ethics, he develops constructive contributions to a contemporary virtue ethics. (shrink)

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.

BackgroundIt has been well documented that patients can feel abused in health care and that many patients suffer from these experiences. Insight lacks into contributing factors behind such events. Silence surrounding the abuse has been suggested as a possible mechanism. The present study explores silence surrounding the abuse as a possible contributing factor. We have explored whether this silence is connected with the staff’s hierarchical position and with the staff’s own experiences as patients abused in health care.MethodsDuring January 2008, a (...) paper questionnaire was sent to all staff members at a Swedish women’s clinic. The questionnaire included questions on sociodemography and profession and multiple questions about abuse in health care. After univariate testing, a binary logistic regression model including variables concerning profession and staff’s own experiences of abuse was built.ResultsOur data show that in contrast to midwives and gynaecologists, auxiliary nurses seldom report hearing about cases of abuse in health care. Staff who themselves experienced abuse in health care as patients, so-called wounded healers, were more likely to have heard about abuse in health care during the last 12 months.ConclusionsThis study suggests that a form of silence reigns over events of abuse in health care that is not randomly distributed over staff. Professional hierarchies and staff’s own experiences of abuse as patients could be considered in the design of interventions to break the silence surrounding patients’ experiences of abuse in health care. (shrink)

Bowers et al. counter deep neural networks (DNNs) as good models of human visual perception. From our color perspective we feel their view is based on three misconceptions: A misrepresentation of the state-of-the-art of color perception; the type of model required to move the field forward; and the attribution of shortcomings to DNN research that are already being resolved.

Humanitarian aid’s psycho-therapeutic turn in the 1990s was mirrored by the increasing emotionalization and subjectivation of fund-raising campaigns. In order to grasp the depth of this interconnectedness, this article argues that in both cases what we see is the post-Fordist production paradigm at work; namely, as Hardt and Negri put it, the direct production of subjectivity and social relations. To explore this, the therapeutic and mental health approach in humanitarian aid is juxtaposed with the more general phenomenon of psychologization. This (...) allows us to see that the psychologized production of subjectivity has a problematic waste-product as it reduces the human to Homo sacer, to use Giorgi Agamben’s term. Drawing out a double matrix of a de-psychologizing psychologization connected to a politicizing de-politicization, it will further become possible to understand psycho-therapeutic humanitarianism as a case of how, in these times of globalization, psychology, subjectivity and money are all interrelated. (shrink)

It is important and urgent to question therelationship between evidence-based medicineand power shifts in health care systems.Although definitions of EBM are phrased as ascientific approach to medicine, EBM is anormative concept: it aims to improve medicineand health care. Both proponents and opponentsuse a normative concept. More particularly,they provide particular views on positions,responsibilities, possibilities, norms andrelationships between professionals, patientgroups, governments and other parties in healthcare and society. From this perspective, wewant to analyse the role of EBM in modernwestern societies. By using (...) citizenshiptheory, we will argue that the role of EBM isnot fixed but depends on the relation betweenstate and society. We will first analyse thefundamental change in western societies duringthe past decades, from modern to post-modernsocieties. Then, we will elaborate a fourfoldmodel of possible relationships between stateand society, and discuss the issue of how EBM mayfit in, by giving some examples of the practiceof EBM in different European countries. On thisbasis, we conclude to consider EBM as a publicforum where proponents and opponents of EBMdiscuss diverse and possibly conflicting waysof changing medicine, health care, and healthpolicy. This requires the incorporation of theperspective of citizens and their socialnetworks, professionals with practical andtacit knowledge, and diverse public views onwhat is regarded as `a good life'. Inasmuch asEBM is expected to be practically relevant, itought to be tied to rather than separated fromthe normative world of emancipated patients anddiverse health care practices. Proponents andopponents of EBM should be prepared to defendthe normative claims and power effects that areinherently tied to any presentation ofevidence. (shrink)

The long standing reign of psychology as the privileged partner of education has, arguably, now been superseded by the neurosciences. Given that this helped to drive the emergent field of neuroeducation, it is crucial to ask what changes in education, if anything does in fact change, when the hitherto hegemonic psychologising discourse is substituted for a neurological one. The primary contention of this paper is that with the neuro-turn a process of “neurologisation” has also been initiated, which can be analysed (...) by taking into account its genealogical predecessor, psychologisation. In doing so, I argue, one ultimately discerns a primordial incompatibility between education and neuroscience, one that can be traced back to the fundamental and problematic reflexivity of modern subjectivity itself, which the discipline of psychology was never able to wholly resolve. From here, I proceed with the argument that while the eagerness of the psy-sciences to embrace neuroscience testifies to how much psychology needs neurology, the neurosciences are structurally incapable of disconnecting from the paradigms of the psy-sciences. Following on from this proposition, other strong/weak factors are brought into the equation: strong/weak nature, strong/weak culture, strong/weak subjectivity and, most pertinently, strong/weak education. Finally, the critical question becomes: if education in itself needs to take recourse to both the psy-sciences and the neurosciences, then how can we begin to account for the fact that these sciences invariably end up becoming captured within educational discourses themselves; that is, the fact that teachers, parents, and pupils themselves are taught the key insights of neuropsychology. (shrink)

Since virtue and the virtues have been important in Reformed theology for most of its history, this essay is devoted to the question of how this tradition may contribute to and interact with contemporary virtue ethics. Reformed concepts of sanctification as open to moral growth, covenant as a narrative context of divine commandments, and unio cum Christo as defining human teleology and virtuousness provide valuable contributions to the development of such an ethics. On the other hand, Reformed conceptions of reform, (...) natural law, common grace and christological eschatology offer theological arguments for overcoming Hauerwas’s problematic overemphasis on the distinctiveness of the church’s ethic. (shrink)

Das Buch eröffnet ein neues Forschungsfeld praxeologischer Demokratieforschung. Statt von bestimmten theoretischen Konzeptionen auszugehen, was Demokratie ist oder sein soll, wird untersucht, wie Demokratie praktisch gemacht wird. Wie wird der,,demos" zum Subjekt des Regierens gemacht, als politischer Akteur mit kollektivem Willen und Handlungsmacht? Das Buch verfolgt den Ansatz, nach konkreten praktischen Formen zu suchen, in denen Repräsentationen des Willens von kollektiven Subjekten hergestellt und geltend gemacht werden. Dabei entfaltet sich ein Blick auf die Multiplizität und Dynamik der Demokratie. Die Herausgebenden (...) Dr. Jan-Peter Voß ist Gastprofessor für Technik und Gesellschaft an der RWTH Aachen. Dr. Hagen Schölzel ist Universitätsassistent am Institut für Politikwissenschaft der Universität Wien. (shrink)

Humanitarian aid’s psycho-therapeutic turn in the 1990s was mirrored by the increasing emotionalization and subjectivation of fund-raising campaigns. In order to grasp the depth of this interconnectedness, this article argues that in both cases what we see is the post-Fordist production paradigm at work; namely, as Hardt and Negri put it, the direct production of subjectivity and social relations. To explore this, the therapeutic and mental health approach in humanitarian aid is juxtaposed with the more general phenomenon of psychologization. This (...) allows us to see that the psychologized production of subjectivity has a problematic waste-product as it reduces the human to Homo sacer, to use Giorgi Agamben’s term. Drawing out a double matrix of a de-psychologizing psychologization connected to a politicizing de-politicization, it will further become possible to understand psycho-therapeutic humanitarianism as a case of how, in these times of globalization, psychology, subjectivity and money are all interrelated. (shrink)

Introduction. Eating Disorders (EDs) are serious psychiatric disorders, impacting physical and psychosocial functioning, often with a chronic course and high mortality rates. The two continua model of mental health states that mental health is a complete state, that is not merely the absence of mental illness, but also the presence of mental health. This model was studied among ED patients by comparing the levels of well-being to the Dutch general population and by examining the of well-being and psychopathology. Method. A (...) total of 468 female ED patients participated in this study during application and intake at a specialized ED treatment centre in the Netherlands. They filled out questionnaires about well-being (MHC-SF), general psychopathology (OQ-45), and ED psychopathology (EDE-Q). Categorical and mean well-being levels were calculated. Also, the correlates of these variables were examined with Pearson correlation and multiple hierarchical regression analysis. Results. ED patients showed lower levels of emotional, psychological and social well-being on average compared to the general population. About 26% of the ED patients experienced low levels of well-being (languishing). However, also 13% experienced high levels of well-being (flourishing), varying between 9% in Anorexia Nervosa to 25% in Binge Eating Disorder. ED psychopathology and general well-being showed a moderate negative correlation. For patients with Bulimia Nervosa and Binge Eating Disorder however no such correlation was found. Lower general psychopathology, not having a history of hospitalization for the ED, and adaptive personal functioning were correlated with well-being among ED patients. Conclusion This study shows initial support for the two continua model of mental health among ED patients. Psychopathology and well-being should be considered as related, but distinct dimensions of mental health in ED patients. Further research should focus on the possible reciprocal relationships between psychopathology and well-being during recovery. It is recommended to monitor well-being during treatment and to implement interventions for well-being to realize complete recovery for those patients with inadequate levels of well-being. (shrink)

Purpose The purpose of this study is to examine public perceptions and attitudes toward using artificial intelligence (AI) in the US criminal justice system. Design/methodology/approach The authors took a quantitative approach and administered an online survey using the Amazon Mechanical Turk platform. The instrument was developed by integrating prior literature to create multiple scales for measuring public perceptions and attitudes. Findings The findings suggest that despite the various attempts, there are still significant perceptions of sociodemographic bias in the criminal justice (...) system and technology alone cannot alleviate them. However, AI can assist judges in making fairer and more objective decisions by using triangulation – offering additional data points to offset individual biases. Social implications Other scholars can build upon the findings and extend the work to shed more light on some problems of growing concern for society – bias and inequality in criminal sentencing. AI can be a valuable tool to assist judges in the decision-making process by offering diverse viewpoints. Furthermore, the authors bridge the gap between the fields of technology and criminal justice and demonstrate how the two can be successfully integrated for the benefit of society. Originality/value To the best of the authors’ knowledge, this is among the first studies to examine a complex societal problem like the introduction of technology in a high-stakes environment – the US criminal justice system. Understanding how AI is perceived by society is necessary to develop more transparent and unbiased algorithms for assisting judges in making fair and equitable sentencing decisions. In addition, the authors developed and validated a new scale that can be used to further examine this novel approach to criminal sentencing in the future. (shrink)

Recent work in the history of science has questioned the Eurocentric nature of the field and sought to include a more global approach that would serve to displace center–periphery models in favor of approaches that take seriously local knowledge production. Historians of Iberian colonial science have taken up this approach, which involves reliance on indigenous knowledge traditions of the Americas. These traditions present a number of challenges to modern researchers, including availability and reliability of source material, issues of translation and (...) identification, and lack of systematization. This essay explores the challenges that emerged in the author’s attempt to compile a pre-contact Nahua pharmacopeia, the reasons for these challenges, and the ways they may – or may not – be overcome. (shrink)