New Zealand is one of two OECD countries in the world where direct-to-consumer advertising of prescription medicine (DTCA-PM) is permitted. Increase in such activity in recent years has resulted in a disproportionate increase in dispensary volume of heavily advertised medicines. Concern for the potential harm to healthcare consumers and the public healthcare system has prompted the medical profession to call for a ban on DTCA-PM as the best way of protecting the public interest. Such blanket prohibition however also interferes with (...) the public’s right of access to information. This paper will examine if banning DTCA-PM would constitute a justified form of paternalism in the context of today’s New Zealand. (shrink)

Metacognition is the capacity to evaluate the success of one's own cognitive processes in various domains; for example, memory and perception. It remains controversial whether metacognition relies on a domain-general resource that is applied to different tasks or if self-evaluative processes are domain specific. Here, we investigated this issue directly by examining the neural substrates engaged when metacognitive judgments were made by human participants of both sexes during perceptual and memory tasks matched for stimulus and performance characteristics. By comparing (...) patterns of fMRI activity while subjects evaluated their performance, we revealed both domain-specific and domain-general metacognitive representations. Multivoxel activity patterns in anterior prefrontal cortex predicted levels of confidence in a domain-specific fashion, whereas domain-general signals predicting confidence and accuracy were found in a widespread network in the frontal and posterior midline. The demonstration of domain-specific metacognitive representations suggests the presence of a content-rich mechanism available to introspection and cognitive control. (shrink)

Hong Kong is a territory of only 400 square miles in size, but with a large population of six million people. We have excellent medical facilities in both the public and private sector and the general health indices of the population are good, with low infant mortality rates and long life expectancies.

Experimenters generally infer whether participants have visual experiences based on metacognitive responses. We showed a well-studied blindsight participant, GY, several definitions of the term “qualia” and then questioned him about whether he felt or he experienced qualia in his normal and blind fields. We found, contrary to others who have used different methods for measuring qualia, that GY does not have qualia for stationary stimuli in his blind field. This novel method for directly assessing qualia embraces the idea that experiences (...) should be related by the experiencer, not the experimenter. (shrink)

From virtue ethics and interactionist perspectives, we hypothesized that personal justice norms (distributive and procedural justice norms) were shaped directly and multiplicatively by ethical dispositions (equity sensitivity and need for structure) and ethical climates (egoistic, benevolent, and principle climates). We collected multisource data from 123 companies in Hong Kong, with personal factors assessed by participants’ self-reports and contextual factors by aggregations of their peers. In general, LISREL analyses with latent product variables supported the direct and multiplicative relationships. Our findings (...) could lay the groundwork for justice research from a morality perspective in future. (shrink)

The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved (...) in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students’ opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students’ opinions of the Statements. (shrink)

Studying the neural correlates of conscious awareness depends on a reliable comparison between activations associated with awareness and unawareness. One particularly difficult confound to remove is task performance capacity, i.e. the difference in performance between the conditions of interest. While ideally task performance capacity should be matched across different conditions, this is difficult to achieve experimentally. However, differences in performance could theoretically be corrected for mathematically. One such proposal is found in a recent paper by Lamy, Salti and Bar-Haim [Lamy (...) D, Salti M, Bar-Haim Y. Neural correlates of subjective awareness and unconscious processing: an ERP study. J Cognitive Neurosci 2009,21:1435-46], who put forward a corrective method for an electroencephalography experiment. We argue that their analysis is essentially grounded in a version of High Threshold Theory, which has been shown to be inferior in general to Signal Detection Theory. We show through a series of computer simulations that their correction method only partially removes the influence of perfor- mance capacity, which can yield misleading results. We present a mathematical correction method based on Signal Detection Theory that is theoretically capable of removing performance capacity confounds. We discuss the limitations of mathemati- cally correcting for performance capacity confounds in imaging studies and its impact for theories about consciousness. (shrink)

The expressive power of logic is believed to be able to model most of the fundamental aspects of information retrieval. However, it is also understood that classical logic is ineffective for handling partiality and uncertainty in IR. Applying non-classical logics such as the AGM belief revision logic and the possibilistic logic to adaptive information retrieval is appealing since they provide a powerful and rigorous framework to model partiality and uncertainty inherent in any IR processes. The maxi-adjustment method, which is an (...) effective computational apparatus of the AGM paradigm, is applied to develop the learning components of the adaptive information agents. Essentially, maxi-adjustment allows the partial representation K of a user's information needs N to be refined gradually based on the user's relevance feedback t. Generally speaking, learning in adaptive information agents is characterised by the AGM belief revision Kt*. On the other hand, possibilistic logic supports a gradated assessment of the uncertainty arising from matching K with the imperfect characterisation d of an information object D. Information matching in adaptive information agents is underpinned by K ƕ d, where ƕ is the possibilistic inference relation. This paper illustrates how maxi-adjustment and possibilistic deduction can be applied to develop the adaptive information agents. Their impact on the agents learning autonomy and explanatory power is also discussed. (shrink)

ABSTRACT In the ‘Cook Ding cutting up an ox’ parable, Zhuangzi advanced a doctrine on craft and its relationship with Dao. With reference to Merleau-Ponty’s philosophy in conjunction with an analysis of Zhuangzi’s epistemological position, we argue that Zhuangzi understood craft as involving the supersession of the cognitive. In craft, the relationship between human and world is non-cognitive and ‘pre-objective’, the living of this kind of relationship gives rise to a non-cognitive ‘practical sense’ which enables the craftsman’s movements to spontaneously (...) constitute wuwei. Zhuangzi’s ideal is that this kind of relationship is generalized to life as a whole, thereby enabling human actions to spontaneously constitute wuwei generally. This is why he stipulated ‘doing away with knowing’ as a self-cultivation technique required for attaining Dao. Thus, craft constitutes an embodiment of Dao in the double-sense of wuwei and the non-cognitive and ‘pre-objective’ relationship between human and world which enables wuwei. (shrink)

Consciousness and confidence seem intimately related. Accordingly, some researchers use confidence ratings as a measure of, or proxy for, consciousness. Rosenthal discusses the potential connections between the two, and rejects confidence as a valid measure of consciousness. He argues that there are better alternatives to get at conscious experiences such as direct subjective reports of awareness (i.e. subjects’ reports of perceiving something or of the degree of visibility of a stimulus). In this chapter, we offer a different perspective. Confidence ratings (...) in general, and metacognitive measures in particular, may offer important advantages over subjective ratings. The arguments we offer here are supported by empirical, practical and socio-strategic considerations. However, we do not suggest consciousness and confidence are interchangeable. We recognize the limitations of confidence ratings in some experimental designs and for some research questions. Nevertheless, we also address a potential conceptual link between consciousness and confidence that stems from Rosenthal’s very own work on mental quality space theory. (shrink)

This book is about the basic principles that underlie critical thinking and creativity. The majority of the content is on critical thinking since more topics are naturally involved and since they can be discussed readily and systematically. The last few chapters are devoted to creativity and research methodology, not typical the book's plethora of competition. Each chapter introduces a specific topic, usually by introducing the relevant theories in conjunction with realistic examples that show how the theories can be applied. Each (...) chapter concludes with a set of exercises whose solutions are detailed at the rear of the book. While the writing style is purposefully informal, the presentation is complete, at least with respect to the intended introductory level. (shrink)

The political activism of Christians in Malaysia is in an emergent phase. Despite significant advances, especially after the milestone general elections of March 2008, many Christians hesitate to engage politically and when they do, their engagement is incoherent. Based upon a survey and critical analysis of media statements by leading Christian organizations, this article argues that Christian activism remains anemic in part due to political theologizing which suffers from incoherency, inconsistency, a diminished view of the political, and an over-reliance (...) on the rational. The article intimates that the kind of political discourse and theologizing adopted by the church would benefit from an application of psychoanalytical categories. It concludes by suggesting that psychoanalysis cannot only provide new categories with which to re-imagine political issues in Malaysia but also reinvigorate the Christian political imagination itself. (shrink)

Virtue epistemology (VE) suggests that S knows just in case S’s true belief is creditable to S’s competence. While Lackey’s ( 2007, 2009 ) objection from testimonial knowledge had raised concerns that VE is too strong, some virtue epistemologists (Sosa 2007, Pritchard 2012 ) adopted a weaker condition requiring only partial credit on agent’s part. This paper, however, argues that in addition to the creditable relation, the agent’s competence manifestation could be partial too—in the sense that only part of his/her (...) whole competence regarding the cognitive task is manifested. Interesting consequences follow as we explore this new way of dissecting cognitive agency—in particular, difficult cases for VE arise when one’s cognitive competence is partly apt and partly Gettiered. (shrink)

Mark Coeckelbergh (Int J Soc Robot 1:217–221, 2009) argues that robot ethics should investigate what interaction with robots can do to humans rather than focusing on the robot’s moral status. We should ask what robots do to our sociality and whether human–robot interaction can contribute to the human good and human flourishing. This paper extends Coeckelbergh’s call and investigate what it means to live with disembodied AI-powered agents. We address the following question: Can the human–AI interaction contribute to our moral (...) development? We present an empirically informed philosophical analysis of how the AI personal assistant Siri changes its users’ way of life, based on the responses obtained from 20 semi-directive individual interviews with Siri users. We identify changes in the users’ social interaction associated with the adoption of Siri. These changes include: (1) the indirect effect of reducing opportunities of human interaction, (2) the second-order effect of diminished expectations toward each other in a community, and (3) the acquired preference to obtain hassle-free interaction with Siri over human interaction. We examine them in relation to concerns that are voiced in the current debates over the rise of AI, namely the suspicion that humans could become overly reliant on AI (Danaher 2019) and the worry that social AI could impede on moral development (Fröding and Peterson, Ethics Inf Technol 23:207–214, 2012; Li, Ethics Inf Technol 23:543–550, 2021). We analyze the ethical costs that come from these changes in light of virtue ethics and address potential objections along the way. We end by offering directions for thinking about how to live with AI personal assistant while preserving favorable conditions for moral development. (shrink)

The comprehension of anaphoric relations may be guided not only by discourse, but also syntactic information. In the literature on online processing, however, the focus has been on audible pronouns and descriptions whose reference is resolved mainly on the former. This paper examines one relation that both lacks overt exponence, and relies almost exclusively on syntax for its resolution: adjunct control, or the dependency between the null subject of a non-finite adjunct and its antecedent in sentences such as Mickey talked (...) to Minnie before ___ eating. Using visual world eyetracking, we compare the time course of interpreting this null subject and overt pronouns (Mickey talked to Minnie before he ate). We show that when control structures are highly frequent, listeners are just as quick to resolve reference in either case. When control structures are less frequent, reference resolution based on structural information still occurs upon hearing the non-finite verb, but more slowly, especially when unaided by structural and referential predictions. This may be due to increased difficulty in recognizing that a referential dependency is necessary. These results indicate that in at least some contexts, referential expressions whose resolution depends on very different sources of information can be resolved approximately equally rapidly, and that the speed of interpretation is largely independent of whether or not the dependency is cued by an overt referring expression. (shrink)

BackgroundInstitutions, funding agencies and publishers are placing increasing emphasis on good research data management (RDM). RDM lapses in medical science can result in questionable data and cause the public’s confidence in the scientific community to crumble. A fledgling medical school in a young university in Singapore has mandated every funded research project to have a data management plan (DMP). However, researchers’ adherence to their DMPs was unknown until the school embarked on routine data auditing. We hypothesize that research data auditing (...) improves RDM awareness, compliance and reception in the school.MethodsWe conducted surveys with research PIs and researchers before and after data auditing to evaluate differences in self-reported RDM awareness, compliance and reception. As it is mandatory to deposit research data in a central data repository system in the school, we tracked data deposition by each laboratory from 2 weeks before to 3 months after data auditing as a marker of actual RDM compliance.ResultsResearch data auditing had an overall positive effect on self-reported RDM awareness, compliance and reception for both research PIs and researchers. Research PIs agreed more that RDM was important to scientific reproducibility, were more aware of proper RDM, had higher RDM strength in their laboratories and were more compliant with the DMP. Both research PIs and researchers believed data auditing helped them to be more compliant with data deposition in the repository. However, data auditing had no significant impact on laboratories’ data deposition rates over time, which could be due to the short sampling period.ConclusionsResearch PIs and researchers generally felt that data auditing was effective in improving RDM practices. It helped to evaluate their RDM practices objectively, propose corrective actions for RDM lapses and spread awareness of the university’s data management policies. Our findings corroborated other studies in medical research, geosciences, engineering and ethics that data auditing promotes good RDM practices. Hence, we recommend research institutions worldwide to adopt data auditing as a tool to reinforce research integrity. (shrink)

To understand how small business entrepreneurs respond to government policy one has to know their risk and time preferences. Are they risk averse, or have high discount rates, such that they are hard to motivate? We have conducted a set of field experiments in Denmark that will allow a direct characterization of small business entrepreneurs in terms of these traits. We build on experimental tasks that are well established in the literature. The results do not suggest that small business entrepreneurs (...) are more or less risk averse than the general population under the assumption of Expected Utility Theory. However, we generally find an S-shaped probability weighting function for both small business entrepreneurs and non-entrepreneurs, with entrepreneurs being more optimistic about the chance of occurrence for the best outcome in lotteries with real monetary outcomes. The results also point to a significant difference in individual discount rates between entrepreneurs and non-entrepreneurs: entrepreneurs are willing to wait longer for certain rewards than the general population. (shrink)

The world faces unprecedented challenges because of the Coronavirus Disease 2019. Existing theories of human flourishing and coping efficacy are too broad and general to address COVID-19 unprecedented mental health challenges. This study examined two main objectives, first the associations between psychological outcomes and psychological wellbeing of this phenomenon, and second, moderating and mediating factors emotions, resilience and coping self-efficacy. A nationwide survey was carried out on a Malaysian sample. Participants completed an on-line survey that assessed psychological outcomes, psychological (...) wellbeing, positive–negative emotions, resilience, and coping self-efficacy. The relationship between psychological states and psychological wellbeing was successfully mediated by coping self-efficacy and resilience. Moreover, positive emotion significantly moderated depression and anxiety with psychological wellbeing. Findings highlighted the importance of these factors in developing a dedicated model to be built into the recovery plan to ameliorate the negative impact of COVID-19 on psychological wellbeing. Hence, the Positive Emotion-Resilience-Coping Efficacy Model was developed. (shrink)

Gender, most feminists agree, isn’t a fact about people in the same way that height or hair color is. Genders are constructed within and are part of a power system circulating through all of society that sets standards for men’s and women’s identities and places men’s interests above women’s. The system is bad for all of us, but especially for women, genderqueer people, and men of color. Here, I want to point out ways in which it’s bad for our health. (...) I’ll start with abortion, as laws recently passed in a number of states have restricted women’s access to the point where it’s nearly nonexistent. (shrink)

Alisdair MacIntyre argues that the virtues necessary for good work are everywhere and always embodied by particular communities of practice. As a general surgeon, MacIntyre’s work has deeply influenced my own understanding of the practice of good surgery. The task of this essay is to describe how the guild of surgeons functions as a more-or-less coherent tradition of moral enquiry, embodying and transmitting the virtues necessary for the practice of good surgery. Beginning with an example of surgeons engaged (...) in a process of moral discernment, I describe how the practice of surgery depends on the cultivation of a certain kind of practical wisdom (phronesis) that effectively orders the techniques of surgery toward particular notions of human flourishing within the limits of what is possible with the particular body on which the surgeon operates. I then argue that one reason why surgeons train in an apprenticeship model of "residency" is to cultivate not only the technical skill but also the practical wisdom to perform good surgery. I conclude by noting that the surgical profession is enduring necessary, but unprecedented, changes in the way it practices and transmits its art; and without deliberate and sustained attention to the character formation of surgeons, the profession runs the risk of creating excellent technicians who are nonetheless ill-equipped to practice wise and good surgery. (shrink)

Physicians are expected to engage patients as partners in identifying the possible benefits and harms associated with treatment options and selecting from among medically appropriate treatment options, rather than simply dictating what treatments patients will and will not receive. This collaborative model reflects the recognition that citizens in multicultural societies have diverse values and are likely to have different views about whether the possible benefits of a medical intervention outweigh the possible harms. However, there are circumstances in which the collaborative (...) process breaks down due to irresolvable disagreement. Especially challenging are cases in which patients are expected to die if they do not receive a treatment and either the patients or their surrogates insist on the treatment despite the physician's belief that providing it is ill advised. The source of disagreement is often differing appraisals of the risks and potential benefits. In such cases, physicians generally judge that there is insufficient likelihood or magnitude of benefit to justify the burdens or expense of treatment, while patients or surrogates believe that the small chance of preventing the patient's death is sufficient to justify the costs and potential burdens to the patient.There is a perception that surgeons enjoy considerable discretion in deciding when the risks of a procedure outweigh the expected benefits. An important contrast can be drawn between surgeons and intensivists—physicians who specialize in the medical management of critically ill patients. We will argue that there are good reasons for subjecting the decisions of both surgeons and intensivists to some oversight. We begin by showing that, for many cases, major professional society guidelines for intensivists recommend oversight via a procedural mechanism rather than unilateral decision‐making by individual clinicians. Next, we present reasons for adopting a procedural approach to dispute resolution, and we argue that these reasons apply to situations in which intensivists believe that patients or surrogates are requesting inappropriate life support as well as to many disagreements between surgeons and surrogates. Finally, we present and respond to several objections. (shrink)

Background There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence. Methods Informants were 12 Israelis, aged 29–81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process (...) upon discharge. Results Our empirical evidence indicates an infringement of patients’ right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants’ moral agency and dignity. Discussion Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons. Conclusions Patient experiences attest to the infringement of a patient’s right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient’s needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent. (shrink)

Aim To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. Design A questionnaire about attitudes towards PAS, including prioritisation of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. Participants All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Main outcome (...) measures Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. Results The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (shrink)

To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively minor (...) afflictions, thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients’ preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results. (shrink)

BackgroundThe attitudes of patients' to consent have changed over the years, but there has been little systematic study of the attitudes of anaesthetists and surgeons in this process. We aimed to describe observations made on the attitudes of medical professionals working in the UK to issues surrounding informed consent.MethodA questionnaire made up of 35 statements addressing the process of consent for anaesthesia and surgery was distributed to randomly selected anaesthetists and surgeons in Queen's Medical Centre, Royal Sussex County Hospital and (...) Eastbourne District General Hospital during 2007. Participants were asked to what extent they agreed with statements regarding consent.ResultsOf 234 questionnaires distributed, 63% were returned. Of the respondents 79% agreed that the main purpose of the consent process is to respect patient autonomy. While 55% of the examined cohort agreed that the consent process maybe inappropriate as patients do not usually remember all the information given to them. Furthermore, 84% of the participants agreed that what the procedure aims to achieve should be explained to the patient during the consent process. While of the participants, over 70% agreed that major risks of incidence greater than 1/100 should be disclosed to the patient as part of the consent process.ConclusionsThe majority of respondents appear to hold attitudes in standing with current guidelines on informed consent however there was still a significant minority who held more paternalistic views to the consent process bringing into question the need for further training in the area. (shrink)

This paper presents and analyzes the practice journal of a barber-surgeon in the town of Münster, in Northern Germany, in which he recorded about 950 cases he treated between 1602 and 1614. Based on this source, it examines the clientele and the fees of a German barber-surgeon in the early seventeenth century, and looks at the injuries and complaints for which patients sought his treatment.

Fundamento. La historia de la Neurocirugía en el territorio está estrechamente relacionada con la de otras especialidades como la Cirugía General y la Ortopedia. Tiene sus primeras referencias establecidas en la etapa colonial en el Hospital General, documentadas en el Boletín del Colegio Médico de Camagüey. Objetivo es resaltar la importancia que tuvieron el Hospital General y el Colegio Médico de Camagüey con su boletín en la historia de la Neurocirugía y la Ortopedia. Método. Es una investigación (...) histórica que se basa en la revisión documental y utiliza el submétodo cronológico para establecer el orden de los hechos que se describen. Desarrollo. El Hospital General a partir de su reconstrucción a finales del siglo XIX, se convirtió en el principal centro médico quirúrgico de la provincia en la época colonial. Muchos de los resultados de la actividad asistencial y científica de sus médicos apareció publicada en el Boletín del Colegio Médico de Camagüey, prestigiosa revista científica que se encargó de divulgar los resultados de la medicina camagüeyana y donde aparecen artículos que evidencian cómo cirujanos generales realizaron las primeras intervenciones neuroquirúrgicas y ortopédicas. Conclusiones. Se consideran al Hospital General y al Colegio Médico de Camagüey y su boletín, como elementos indispensables al escribir la historiografía de la Neurocirugía y la Ortopedia en el territorio. Ground: the history of Neurosurgery in this place is closely linked to other specialties like General Surgery and Orthopedics. The first documented references went back to the colonial period in the General Hospital, documented in the bulletin of the medical college in Camagüey. The objective is to highlight the importance of the General Hospital and the medical college and its bulletin in the history of Neurosurgery and Orthopedics in Camagüey. Methods: This a historical investigation that was carried out taking documented revision and using chronologic sub method to establish the order of the facts that have been described. Development: Since the reconstruction of the General hospital at the end of the XIX century, it became the main medical_ surgical center in the province during the colonial period. Many of the scientific results and medical activities were published in the bulletin of the medical college, which became a well-known scientific magazine that was in charge of publishing the medical success in Camagüey. There are articles to prove that general surgeons performed the first neurosurgical and orthopedic interventions. Conclusions: The General hospital, the medical college and its bulletin are considered crucial elements to describe the history of Neurosurgery and Orthopedics in the territory. (shrink)

This article deals with surgical practice as it is locally organized within the course of the operation; it focuses on the way in which surgical action shaping the body for the local purposes of the operation is organized in a timely, situated, interactive manner. In order to do that, I offer a systematic analysis of the instructions addressed by a chief surgeon to his assistant in the form of directives during a surgical operation, as well as of instructed actions (...) of the assistant following the directives of the surgeon. In this way, I aim to show how surgery is a methodic collaborative achievement, relying on finely tuned coordination between staff members. More generally, the article sketches a systematic and detailed analysis of instructions as situated accomplishments in time, and of instructed action as resulting from an embodied and indexical understanding of directives and requests as they are produced in time and in context. (shrink)

Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 regarding books they would like to see reviewed or books they are interested in reviewing.

ObjectivesTo compare changes in the number and amount of payments received by orthopedic and non-orthopedic surgeons from industry between 2014 and 2017.MethodsUsing the Centers for Medicare and Medicaid Services (CMS) Open Payment database from 2014 to 2017, we conducted a retrospective cohort study of industry payments to surgeons, including general payments and research payments.ResultsAmong orthopedic surgeons, the total number of general payments decreased from 248,698 in 2014 to 241,966 in 2017, but their total value increased from $97.1 million (...) in 2014 to $110.2 million in 2017. Among non-orthopedic surgeons, the total number decreased from 604,884 in 2014 to 582,490 in 2017, while the total value remained stable at approximately $159 million. Between 2014 and 2017, there was a differential increase in the median number of general payments received by non-orthopedic when compared to orthopedic surgeons (incidence rate ratio, 1.09; 95% CI, 1.08–1.09; p < 0.001), but a differential decline in the median value of general payments (− 8.9%; 95% CI, − 9.5%, − 8.4%; p < 0.001). Findings were consistent when stratified by nature of payment. In contrast, between 2014 and 2017, there was neither a differential change in the median number nor median value of research payments received by non-orthopedics.ConclusionExamination of a natural experiment of prior public disclosure of payments to orthopedic surgeons suggests that the Physician Payment Sunshine Act was associated with an increase in the number, but a decline in the value, of general payments received by non-orthopedic surgeons, but not on research payments received. (shrink)

When I was a 7 months pregnant medical student, an attending surgeon asked me to which specialty I would be applying. When I replied that I was hoping to match in general surgery, he touched my pregnant abdomen and said, “Not with that you’re not.” I am not alone. Gender bias and discrimination have been shown to negatively impact women surgeons throughout their careers and deter women from even applying in surgical fields.1 Bias against female surgical trainees leads (...) to less operative autonomy and higher dropout rates.2 3 Once faculty, women surgeons are less likely to reach leadership roles.4 Recent studies confirm the author’s assertion that implicit biases create substantial harm. The author has undertaken an important study, conducting in-depth interviews with 46 women surgeons in Australia that identifies four distinct types of bias causing cumulative harm. In all four types of biases: Workplace factors including leave policies and mentorship. Epistemic injustices, or unfair assessments of women surgeons’ credibility by patients and colleagues. Stereotyped expectations. Objectification, implicit biases were seen. While many of the broad factors impeding women in surgery are well known, the author argues that these subtler factors, including both implicit bias and epistemic injustice, have a large impact. The …. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as (...) well as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started (...) searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance. (shrink)

Character strengths profiles in the specific setting of medical professionals are widely unchartered territory. This paper focused on an overview of character strengths profiles of medical professionals (medical students and physicians) based on literature research and available empirical data illustrating their impact on well-being and work engagement. A literature research was conducted and the majority of peer-reviewed considered articles dealt with theoretical or conceptually driven ‘virtues’ associated with medical specialties or questions of ethics in patient care (e.g., professionalism, or what (...) makes a good physician). The virtues of compassion, courage, altruism, and benevolence were described most often. Only a limited number of papers addressed character strengths of medical students or physicians according to the VIA-classification. Those articles showed that the VIA-character strengthsfairness, honesty,kindness, andteamworkwere considered most often by respondents to be particularly important for the medical profession. Available cross-sectional (time span: six years) and longitudinal (time span: three years) data regarding VIA-character strengths profiles of medical professionals were analyzed (N= 584 medical students, 274 physicians). These profiles were quite homogenous among both groups. The character strengthsfairness,honesty,judgment,kindness, andlovehad the highest means in both samples. Noteworthy differences appeared when comparing medical specialties, in particular concerning general surgeons and psychiatrists, with the former reporting clearly higher levels of e.g.,honesty(d= 1.02) orprudence(d= 1.19). Long-term results revealed significant positive effects of character strengths on well-being and work engagement (e.g.,perseveranceon physicians’ work engagement) but also significant negative effects (e.g.,appreciation of beauty and excellenceon students’ well-being). Further,hopewas significantly associated both positively with physicians’ well-being and negatively with students’ work engagement, possibly indicating specific issues concerning medical education or hospital working conditions. According to the modern-day physician’s pledge, medical professionals should pay attention to their own well-being and health. Therefore, promoting self-awareness and character building among medical professionals could be a beneficial strategy. (shrink)

Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians'' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth''s (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under (...) a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners. (shrink)

The recent discovery of a manuscript has allowed historians to understand the medical routine in a hospital known as the Schneidhaus in Augsburg between the sixteenth and nineteenth century. The context of the manuscript shows that at this institution, non-academic specialists, generally members of the guild of barber-surgeons and barbers, routinely performed surgical cures of intestinal hernia, scrotal swellings, and vesical calculus. The Schneidhaus exclusively admitted patients applying for such specialised treatments and offered no other services. Such a degree of (...) specialisation within medical establishments seems to have only existed in the Holy Roman Empire at this institution founded by the Fugger family in Augsburg. We propose that the Schneidhaus was either itself a model hospital or adopted a model from another site in Europe. In this paper, we investigate the connections of the Schneidhaus to the practice of surgeons in both Italy and Spain. In Italy, a momentous new technique for identifying and removing vesical calculi was first published in 1522. Although surgical treatment was established in Italian hospitals, they tended not to specialise in such surgical treatment exclusively. Moreover, at the time of the hospital’s foundation, the Fugger shifted their economic and social focus from Venice to the Iberian Peninsula. In Spain, research in the history of medicine is complicated by outdated notions about specialised surgery, not unlike those that were recently still current regarding the Holy Roman Empire. We attempt to disprove these notions and use the exemplary textbook of one academic physician, Francisco Díaz, to approach specialized surgical practice in sixteenth-century Spain. In his work, Díaz describes the new Italian surgical method in detail and recognizes the importance of craftsman surgeons to both its development and application. However, he also argues for an expanded role for academic physicians as supervisors of craftsman surgeons’ work. All this is suggestive of a greater network of surgical professionals within which both the methods of the craft and its organisational structures were transported. As such, the Schneidhaus can be seen as a node that embodied the institutionalization of surgical practice as a European phenomenon. Further research is necessary, and we propose how this might be carried out to reveal these historical phenomena in their full complexity. (shrink)

The article discusses the differences between the classical logic of science (17th-20th centuries) and non-classical logic (20th century). While classical logic is based on the general properties of the objects studied, non-classical logic is based on the special, individual. The classical logic singled out in the studied objects their common properties that united them and ensured their independence of human. The scientist and his social connections are volatile and cannot serve as a stable basis for obtaining the only possible (...) true result during examination of particular object. At the same time, it was not taken into account that scientists themselves endowed nature with this property of independence. It would be more correct to say that scientist distinguished from all properties of reality precisely these properties as the most convenient for constructing a logical system that explains the entire surrounding world. All other properties were ignored. In the 20th century attention was shifted to the properties of objects and events that determine their identity, which means their ability to communicate. After all, for a communication at least two interlocutors are needed who differ from each other. Each of them has its own origin, which is formed by the context. At the origin of the formation of knowledge there is still no division between subject and object. The surgeon works with his hands guided by his theoretical knowledge. When he encou difficulty, he can modify the theory, thus solving the practical problem that has arisen. In the structure of science, knowledge is embedded in this form, without division between man and the surrounding world. However this last division remains only possible but not essential for logic. The main problem that needs to be further seriously considered is to understand how the social is included in the philosophy of science. (shrink)

Surgical ethics have generally been framed as general medical ethics applied to surgical contexts. This model is helpful, but may miss some of the special features of the surgical process and relationship. It is suggested in this paper that there are five categories of experience and relationship which are especially important in surgery —rescue, proximity, ordeal, aftermath and presence. The sense of rescue, the feeling of relational proximity, the ordeal and the aftermath of surgery are things which the patient (...) experiences. Understanding these experiences allow surgeons to understand what may be asked of them in an ethical sense. Recognition of the reality and validity of each category in the surgical process highlights the importance of presence, the acts by which the surgeon demonstrates that he is present to the patient throughout the surgical process and its aftermath. While the teaching of communication skills may never compensate for insensitivity, the ideal of presence as virtue and duty can be taught by precept and example. (shrink)

This article presents evidence regarding aspects of the gendered nature of care women with gynaecological cancer receive from their (usually) male surgeons and oncologists in Australia. We argue that despite women’s general preference for female gynaecologists, those with a gynaecological cancer develop a strong therapeutic relationship with their male medical specialist, not extended to their (usually) female nurses and other allied health professionals. Given the highly sensitive and sexualized nature of gynaecological cancer, this requires explanation. These findings can be (...) partly explained by examining the division of labour between nurses and doctors, specifically issues of control over this process and the development of specializations. The findings also bring into stark relief the way in which power and status differences can be used by medicine to create a positive therapeutic relationship with patients while simultaneously de-eroticizing the intimate procedures necessary in assisting women throughout their cancer treatment. Importantly, this relationship also has relevance for policy makers, particularly those concerned with the highly gendered division of labour of the medical specialty workforce in Australia. (shrink)

While there seems to be much evidence that perceptual states can occur without being conscious, some theorists recently express scepticism about unconscious perception. We explore here two kinds of such scepticism: Megan Peters and Hakwan Lau's experimental work regarding the well-known problem of the criterion -- which seems to show that many purported instances of unconscious perception go unreported but are weakly conscious -- and Ian Phillips' theoretical consideration, which he calls the 'problem of attribution' -- the worry that many (...) purported examples of unconscious perception are not perceptual, but rather merely informational and subpersonal. We argue that these concerns do not undermine the evidence for unconscious perception and that this sceptical approach results in a dilemma for the sceptic, who must either deny that there is unconscious mentality generally or explain why perceptual states are unique in the mind such that they cannot occur unconsciously. Both options, we argue, are problematic. (shrink)

It is an orthodoxy in cognitive science that perception can occur unconsciously. Recently, Hakwan Lau, Megan Peters and Ian Phillips have argued that this orthodoxy may be mistaken. They argue that many purported cases of unconscious perception fail to rule out low degrees of conscious awareness while others fail to establish genuine perception. This paper presents a case of unconscious perception that avoids these problems. It also advances a general principle of ‘phenomenal coherence’ that can insulate some forms of (...) evidence for unconscious perception from the methodological critiques of Lau, Peters and Phillips. (shrink)

Historians are now generally agreed that the Darwinian recognition and institutionalization of the polygenist position was more than merely nominal.194 Wallace, Vogt, and Huxley had led the way, and we may add Galton (1869) to the list of those leading Darwinians who incorporated a good deal of polygenist thinking into their interpretions of human history and racial differences.195 Eventually “Mr. Darwin himself,” as Hunt had suggested he might, consolidated the Darwinian endorsement of many features of polygenism. Darwin's Descent of Man (...) was published in the same year that the Anthropological Institute was founded, and it was no coincidence that it was broadly congruent with Knoxian/ Anthropological race science. Recent scholarship has stressed the derivative character of the Descent, and Darwin's views on race were clearly influenced by the earlier interpretations of the abovecited Darwinians.196However, although the Descent was written in the light of the anthropological struggles of the 1860s, it is essential to acknowledge its origins in Darwin's notebooks of the late 1830s and early 1840s. A good deal of the congruence between Darwinian and Knoxian conceptions of race may be traced back to these early notebook constructions. As these document, Darwin, like Knox, brought to his very earliest conceptions of human evolution a “commitment to the idea of human races as discrete biological units with distinct moral and mental traits.”197 The young Darwin had been concerned with the same sorts of questions on racial biological and cultural differences that preoccupied Knox around the same time, and he was committed to as ruthless a naturalism. Apart from their individual and independent debts to Quetelet's “moral statistics,” both Darwin and Knox drew heavily on the general themes of struggle and adaptation in the contemporary “common context” of biological and social thought.198 Given their common context, the broad general similarities between the Knoxian laws of race antagonism and subordination and the Darwinian struggle for existence between races need occasion no strained historical explanation of direct influence.199Nevertheless, in more explicit ways, the Descent does show the conflation of Knoxian/Anthropological and Darwinian racial views, and Darwin located his discussion of these issues squarely within the dispute “of late years” between polygenists and monogenists.200 His mature views on race were shaped by the contemporaneous confrontations and negotiations between the Darwinians and the Anthropologicals. It is within this context that the minor historical puzzle of Darwin's failure to acknowledge Knox's “generic descent” may be explained. Apart from the difficulties of integration and interpretation of his scattered theoretical writings, Knox, through his adoption by Hunt and the Anthropologicals, became identified with anti-Darwinism and therefore with antievolutionism.201 Moreover, Knox, the disreputable and marginal “savage radical” and lately resurrected and equally unsavory “Anthropological,” was hardly an acceptable “precursor.” Yet, paradoxically, it was via the antithetical medium of the Anthropological platform that Knox's race science made an indirect and unacknowledged, but lasting, impact on the Darwinian anthropological model.In the Descent, Darwin argued that racial traits arose very early in the prehistory of man, were not biologically adaptive, and were therefore relatively fixed in character. By viewing race formation as a distant and closed episode of human history, Darwin endorsed the Knoxian categories of race as fixed and unalterable types. Although he thought it irrelevant whether human races were called species or subspecies, he conceded more to the Knoxian view than Huxley by granting that a naturalist confronted for the first time by specimens of Negro and European man “might feel himself fully justified in ranking the races of man as distinct species.”202 Consistent with the Knoxian interpretation, struggle, competition, and survival occurred between racial units rather than between individuals and, in Darwin's view, accounted for the superiority of the Anglo-Saxon and the inevitable triumph of the more intellectual and moral races over the lower and more degraded ones.Darwin was as insistent as Knox on the biological basis of intellectual and moral differences, and, through his tendency to reduce social and cultural differences to biology, he maintained the essential Knoxian/Anthropological link between race and culture.203 For above all, the Descent did much more than offer a naturalistic explanation of human evolution: it proffered social interpretation, justification, and prescription, and its timely appearance gave a powerful boost to the “moralizing naturalism” of Huxley and Galton, and to Spencer's “Social Darwinism.”204 We may draw a straight line from Knox's “moral anatomy,” through Hunt's “anthropology,” and on to “Social Darwinism” and the “social surgeons” of the eugenics movement.The Darwinians did not, of course, we their tendency to naturalize existing economic and social relations to Knox or Hunt and the Anthropologicals—they were simply reflecting the same general intellectual trend that had affected Knox and the Anthropologicals as well. And in the larger context, the forces that had created a climate receptive to Knox's racism had intensified: in the seventies, the need to justify white imperialism and class and racial inequalities was greater than ever. Scientific racism no longer appeared an aberration but the very essence of the scientific study of man, taking on a newfound respectability in the “new” evolutionary anthropology. But in more specific ways, through the struggle between the Darwinians and Anthropologicals for scientific and ideological hegemony, Knox's “moral anatomy” was institutionalized and perpetuated in late Victorian scientific racism. In the process, the delicate balance that Knox had maintained between his radicalism and his racism was outweighed by conservative institutional and social needs, and his “moral anatomy” was retooled — first by Hunt, and then by the Darwinians — to fit those needs. (shrink)

Berger and Mylopoulos (2019) critique recent scepticism about unconscious perception, focusing on experimental work from Peters and Lau, and theoretical work of my own. Central to their wide-ranging discussion is the claim that unconscious perception occupies a default status within both experimental and folk psychology. Here, I argue to the contrary that a conscious-perception-only model should be our default. Along the way, I offer my own analysis of Peters and Lau's study, assess the folk psychological status of unconscious perception, discuss (...) vision-for-action, and confront an important dilemma which Berger and Mylopoulos raise for the sceptic concerning the existence of unconscious mentality in general. (shrink)