When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before (...) we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively. (shrink)

This paper compares two explanations of the process by which human communication systems evolve: iterated learning and social collaboration. It then reports an experiment testing the social collaboration account. Participants engaged in a graphical communication task either as a member of a community, where they interacted with seven different partners drawn from the same pool, or as a member of an isolated pair, where they interacted with the same partner across the same number of games. Participants’ horizontal, pair‐wise interactions led (...) “bottom up” to the creation of an effective and efficient shared sign system in the community condition. Furthermore, the community‐evolved sign systems were as effective and efficient as the local sign systems developed by isolated pairs. Finally, and as predicted by a social collaboration account, and not by an iterated learning account, interaction was critical to the creation of shared sign systems, with different isolated pairs establishing different local sign systems and different communities establishing different global sign systems. (shrink)

In this paper, we provide an overview of research highlighting the relation between cultural processes, social norms, and food choices, discussing the implication of these findings for the promotion of more sustainable lifestyles. Our aim is to outline how environmental psychological research on urban affordances, through the specific concepts of restorative environments and walkability, could complement these findings to better understand human health, wellbeing and quality of life. We highlight how social norms and cultural processes are linked to food choices, (...) and we discuss the possible health-related outcomes of cultural differences in food practices, their relation to acculturation and globalization processes. We also discuss the concepts of restorative environments and walkability as positive urban affordances, and their relation to human well being, and the possibile link with cultural process and sustainable lifestyles. Finally, we outline issues for future research and areas for policy making and interventions on the links between cultural processes, healthy and sustainable food consumption and urban affordances, for the pursuit of public health, wellbeing and environmental sustainability. (shrink)

This paper contrasts two influential theoretical accounts of language change and evolution – Iterated Learning and Social Coordination. The contrast is based on an experiment that compares drawings produced with Garrod et al’s ‘pictionary’ task with those produced in an Iterated Learning version of the same task. The main finding is that Iterated Learning does not lead to the systematic simplification and increased symbolicity of graphical signs produced in the standard interactive version of the task. A second finding is that (...) Iterated Learning leads to less conceptual and structural alignment between participants than observed for those in the interactive condition. The paper concludes with a comparison of the two accounts in relation to how each promotes signs that are effi cient, systematic and learnable. (shrink)

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; (...) and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches. These clinical case examples are introduced here and several more are included in the Supplementary Material. A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach. (shrink)

We are extremely grateful for the insightful and thought-provoking commentaries on our feature article.1 We have distilled four themes emerging from the commentaries, and we would also like to address one misunderstanding of our argument that has appeared. In our article, we explicitly acknowledge that major decisions relevant for climate protection take place at the mesolevels and macrolevels of healthcare, a point raised again in some of the commentaries.2–4 Climate protection is a societal issue, and we thank these authors for (...) the concrete proposals of potential models to guide action. Yet, to us, it still makes sense to reflect simultaneously on the responsibilities that physicians have themselves. Without wanting to put the main responsibility on them, we argue it is important to start thinking about the scope of action that physicians actually have (or not have). As we have argued the need for climate action comes ever more into focus of society, we wanted to explore whether the professional ethics of the medical professionals needs to be amended. Our argument is that this is the case, based on the reasons that climate change has a big health impact while simultaneously the health system has a strong climate impact. Based on the World Medical Association (WMA) Declaration of Geneva the focus on the individual patient is clear, but this and other important codices do also include a public health perspective. The (model) Professional Code for Physicians in Germany, for example, states in its first article that ‘Physicians serve the health of …. (shrink)

Background Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a “traveling concept”, which also made its way into (...) bioethical research. Methods We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included. Results The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies. Conclusions This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions. (shrink)

Im Zuge des „empirical turn“ der Medizin- und Bioethik ist von verschiedenen Autoren in den vergangenen Jahren die Idee einer „evidenzbasierten Ethik“ diskutiert worden. Die Analogie zwischen evidenzbasierter Medizin und „evidenzbasierter Ethik“ soll in diesem Beitrag kritisch diskutiert und dabei gezeigt werden, dass der Ausdruck „evidenzbasierte Ethik“ irreführend ist. Zentraler Ausgangspunkt der Kritik ist die unterschiedliche Bedeutung, die empirische Informationen für das medizinisch-klinische Urteil zum einen und das ethische Urteil in der Medizin zum anderen haben. Im medizinisch-klinischen Urteil können mit (...) Hilfe empirischer Informationen hypothetische Handlungsnormen generiert werden, welche auf den der Medizin inhärenten Zwecksetzungen basieren. Bei Fragen der Ethik in der Medizin hingegen sind die Handlungsziele selbst Gegenstand des Urteils; diese aber können allein aus empirischem Wissen heraus nicht zureichend bestimmt werden. Die Diskussion um die Möglichkeit einer „evidenzbasierten Ethik“ eröffnet weiterhin aufschlussreiche Perspektiven in Bezug auf empirische Forschung und den Umgang mit empirischen Informationen in der Angewandten Ethik und das Aufgabenfeld der Medizinethik. (shrink)

Eating disorders (EDs) are characterized by marked cognitive distortions and maladaptive schemas. Cognitive models of EDs highlight the direct impact of cognitive dysfunctions on eating-related disturbances, insofar as specific cognitive contents such as thoughts about diet rules and food or loss of control may trigger disturbed eating behavior. Moreover, early maladaptive schemas that reflect perfectionist standards and relate to achievement and performance seem to be associated with disturbed eating, e.g. via their impact on situation-specific appraisals. However, so far, no study (...) has investigated these assumptions. Hence, the present study sought to demonstrate whether and how cognitive content exerts an impact on eating behavior in daily life, and whether maladaptive core schemas impact the occurrence of binge eating via dysfunctional ED cognitions in eating-related contexts. N = 29 females with Bulimia Nervosa (BN), n = 31 females with Binge Eating Disorder (BED) and n = 30 female controls without EDs (NC) participated in the study. All participants received a handheld computer for a 48-hour period to capture antecedents of disturbed eating behavior in daily life. Event-sampling (meals, binge eating, purging, stressful situations) and signal-sampling (five times a day) methods were applied. EMA included a short questionnaire to assess dysfunctional cognitions and level of craving and to capture information about situational contexts. Early maladaptive schemas were assessed using a short version of the Young Schema Questionnaire at baseline. The main results showed specific patterns of dysfunctional eating-related cognitions for BED and BN. Binge eating was predicted by thoughts about loss of control (positively) and dietary restraint (negatively). For meal situations, no significant differences between the two ED groups emerged. All three domains exerted indirect effects on craving via thoughts about ‘eating/loss of control’, whereas neither a direct nor an indirect effect emerged regarding thoughts about ‘dietary restraint’. These results fit well with previous studies and support cognitive models of EDs; schema therapeutic approaches may be a valuable contribution to enhance treatment of EDs. Further studies should explore whether the findings from emerging adulthood can be generalized to younger age groups. (shrink)

ZusammenfassungMit der Vielzahl von Daten aus genetischen Untersuchungsverfahren wächst das Problem von „Zufallsbefunden“, d. h. von zufällig erhobenen Nebenbefunden, die mit der ursprünglichen Fragestellung nicht in Verbindung stehen und dennoch eine Bedeutung für Gesundheit und Reproduktionsverhalten der untersuchten Person selbst oder ihrer Anverwandten haben. In Ermangelung nationaler oder internationaler Richtlinien greifen die Autoren die aktuelle Diskussion um den Umgang mit genetischen Zufallsbefunden in Behandlungs- und Forschungskontext auf. Dabei nehmen sie auf die für Deutschland relevanten rechtlichen und ethischen Rahmenbedingungen Bezug. Nach (...) Gendiagnostikgesetz (GenDG) muss in Deutschland im Rahmen eines Behandlungsvertrages auf die Möglichkeit von Zufallsbefunden hingewiesen werden. Es ist Bestandteil der Aufklärung und Einwilligung, inwieweit Zufallsbefunde mitgeteilt werden, wobei das Recht auf Nichtwissen und der Schutz nicht-einwilligungsfähiger Personen berücksichtigt werden müssen. Im Forschungskontext greift das GenDG nicht, aber auch hier sollte über mögliche Zufallsbefunde aufgeklärt werden, wenngleich eine Rückmeldung nicht zwingend, aber bei Befunden mit hohem klinischen Nutzen ethisch geboten sein kann. Folgende Aspekte sind im Umgang mit Zufallsbefunden zu berücksichtigen: 1) Art und Umfang der Aufklärung und Einwilligung bei einer unüberschaubaren Zahl von möglichen Befunden. 2) Einordnung der klinischen Bedeutung einer genetischen Veränderung im Sinne von gesichertem, wahrscheinlichem, möglichem oder fraglichem/unbekanntem klinischen Nutzen. 3) Prozessierung des Informationsrückflusses für Gegenwart und Zukunft. 4) Ressourcenplanung im Hinblick auf die klinische Validierung, die Erläuterung von Befunden und den Transfer in die klinische Praxis. Im Umgang mit genetischen Zufallsbefunden besteht erheblicher empirisch-ethischer Forschungs- und politischer Regelungsbedarf. Zeitgleich ist es unabdingbar, die Wahrnehmung und das Verständnis der untersuchten Personen sowie die Grundhaltung gegenüber Zufallsbefunden im Rahmen von Studien zu beleuchten und entsprechende Bildungs- und Kommunikationswerkzeuge zu entwickeln. (shrink)

The article analyses what we term governmental ethics regimes as forms of scientific governance. Drawing from empirical research on governmental ethics regimes in Germany, Franceand the UK since the early 1980s, it argues that these governmental ethics regimes grew out of the technical model of scientific governance, but have departed from it in crucial ways. It asks whether ethics regimes can be understood as new ‘‘technologies of humility’’ and answers the question with a ‘‘yes, but’’. Yes, governmental ethics regimes have (...) incorporated features that go beyond technologies of prediction and control, but the overcoming of the technical model also bears some ambivalence that needs to be understood. The article argues that governmental ethics regimes can be understood as a form of ‘‘reflexive government’’ in that the commitment to techno-scientific innovation is stabilized not through an elitist, technocratic exclusion of non-scientific actors and knowledges or a depreciation of normative and emotional dimensions, but through their inclusion, involvement and mobilization. (shrink)

BackgroundPublic involvement activities are promoted as measures for ensuring good governance in challenging fields, such as biomedical research and innovation. Proponents of public involvement activities include individual researchers as well as non-governmental and governmental organizations. However, the concept of ‘public’ in public involvement deserves more attention by researchers because it is not purely theoretical: it has important practical functions in the guidance, evaluation and translation of public involvement activities.DiscussionThis article focuses on collective agency as one property a public as a (...) small group of participants in a public involvement activity could exhibit. It introduces a prominent theoretical approach to collective agents as one specific kind of social entities and demonstrates how this approach can be applied to current practice in public involvement activities. A brief discussion of different types of representation as they are used in the existing literature on this topic is also included because representation and collective agency can be closely related to each other. Suggestions and ideas that are derived from this reasoning include the proposal to use a ‘validity check’ for the generation of collective agents as a regular element of certain types of public involvement activities, the consequences of combining collective agency and representativeness as a further property a public could exhibit, and standards for reporting the content of public involvement activities in scientific publications.SummaryThis article discusses the importance of the concept of ‘public’ in public involvement activities, with a focus on biomedical research and innovation. It introduces various practically relevant ideas that are based on a theoretical analysis of collective agency as an important property a public can possess. (shrink)

There is much debate on how social values should influence scientific research. However, the question of practical applicability of philosophers’ normative proposals has received less attention. Here, we test the attainability of Matthew J. Brown’s (2020) Moral Imagination ideal (MI ideal), which aims to help scientists to make warranted value-judgements through reflecting on goals, options, values, and stakeholders of research. Here, the tools of the MI ideal are applied to a climate modelling setting, where researchers are developing aerosol-cloud interaction (ACI) (...) parametrizations in an Earth System Model with the broader goal of improving climate sensitivity estimation. After the identification of minor obstacles to applying the MI ideal, we propose two ways to increase its applicability. First, its tools should be accompanied with more concrete guidance for identifying how social values enter more technical decisions in scientific research. Second, since research projects can have multiple goals, examining the alignment between broader societal aims of research and more technical goals should be part of the tools of the MI ideal. (shrink)

Ce volume envisage l'amour en tant qu'objet polymorphe : Eros, Philia, Agapé, mais aussi Storgé. Les mots grecs rendent compte, du large spectre amoureux : amour romantique, amour sexuel, amour de soi, de l'autre, pour l'autre... des catégories qui placent les manifestations du sentiment amoureux dans un espace de contraintes et de possibilités qui relève du social et du discursif. Les travaux qui sont ici réunis s'attachent ainsi à interroger des genres artistiques et discursifs dans lesquels s'ancre l'amour, ils abordent (...) la littérature et le cinéma, mais aussi l'histoire, l'histoire des idées, la sociologie l'ethnologie ou la psychologie. Ces recherches mettent en avant que l'amour constitue une manière d'appréhender et d'expliquer le monde puisqu'on peut lire à travers lui les rapports qui définissent nos sociétés et qui le définissent à leur tour. (shrink)

Black Knowledges/Black Struggles: Essays in Critical Epistemology explores the central, but often critically neglected role of knowledge and epistemic formations within social movements for human emancipation. This collection examines the systemic connection that exists between the empirical subordination of "Black" peoples globally and the conceptual negation that subordinates or renders this population invisible within the epistemes of the West. The collection recognizes that as peoples of "Black" African and Afro-mixed descent mobilize against their dehumanized status within Western modernity, they are (...) involved in a struggle that is both contemporary and of long standing, one where local and national battles have a global dimension. The essays in this collection foreground the extent to which liberation from imposed subordination necessarily entails critiques of, challenges to, and counter-formulations against the epistemic formations that work to "naturalize" subordination. The essays in the collection engage primarily with knowledge formations and empirical practices generated from within the discourse of "race," but also in its relation to other socio-human discourses of Western modernity. These essays also analyze the critiques, challenges, and counter-knowledge/epistemic formulations put forth by specific individuals, schools, movements, and/or institutions of the "Black" world. Through these examinations, the collection's authors implicitly point towards, and sometimes explicitly take part in, the formulation of a new kind of critical - but also emancipatory - epistemology. What emerges is a more comprehensive view of what it means to be human, an epistemic construction that can serve as an instrument of liberation rather than subordination. (shrink)

Assuming GCH, we prove that for every successor cardinal μ > ω1, there is a superatomic Boolean algebra B such that |B| = 2μ and |Aut B| = μ. Under ◊ω1, the same holds for μ = ω1. This answers Monk's Question 80 in [Mo].

Seit ihrer Begründung im 18. Jahrhundert war die Ästhetik auch ein Korrektiv der Logik, indem sie die Sinnlichkeit des Menschen - Wahrnehmungen, Gefühle, Erinnerungen sowie deren Ausdruck in Kunst, Literatur und Wissenschaft - in den Blick genommen hat. In diesem Band wird die Vielfalt ästhetischer Perspektiven dokumentiert: Als Gesellschaftskritik und Erkenntnistheorie, als Lehre vom Schönen und Theorie der Kunst ist die Ästhetik nicht wegzudenken, wenn man den Menschen in seiner kulturellen Existenz begreifen möchte.

On peut considérer que ce qui se produit dans le travail familial thérapeutique avec une famille dans une institution donnée est révélateur du fonctionnement de la famille tel que cette dernière le projette sur l’institution. Mais ce qui se passe dans cette thérapie peut aussi refléter le fonctionnement de l’institution à ce moment précis : ce qui se vit dans l’institution a souvent des répercussions sur les prises en charge thérapeutiques.

Mit seiner Sportwetten-Grundsatzentscheidung vom 28. Marz 2006 hat das Bundesverfassungsgericht die verfassungsrechtlichen Rahmenbedingungen fur das Glucksspielwesen in Deutschland prazisiert und den Gesetzgeber mit dessen Neuregelung beauftragt. Zum 1. Januar 2008 ist ein neues Glucksspielrecht in Deutschland in Kraft getreten. Allein die Ziele der Suchtvermeidung und Suchtbekampfung rechtfertigen Glucksspielmonopole, durch die private Glucksspielanbieter vom deutschen Glucksspielmarkt ausgeschlossen werden. Damit rucken neben okonomischen und rechtlichen Fragengerade auchdie Erkenntnisse der Glucksspielsucht-Forschung in den Mittelpunkt des Interesses. Dem versucht dieses interdisziplinar angelegte Buch Rechnung zu (...) tragen, indem namhafte Wissenschaftler und Praktiker - Okonomen, Juristen, Suchtfachleute - das Glucksspielwesen umfassend analysieren. Die Autoren beziehen Position und verdeutlichen die unterschiedlichen Sichtweisen und Interessenlagen zum Thema. Das Buch gibt dem Leser zugleich eine Idee von der geschichtlichen Dimension und der Bedeutung des Glucksspiels fur den Einzelnen und die Gesellschaft insgesamt.". (shrink)