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

The initial successes in recent years in harnessing machine learning technologies to improve medical practice and benefit patients have attracted attention in a wide range of healthcare fields. Particularly, it should be achieved by providing automated decision recommendations to the treating clinician. Some hopes placed in such ML-based systems for healthcare, however, seem to be unwarranted, at least partially because of their inherent lack of transparency, although their results seem convincing in accuracy and reliability. Skepticism arises when the physician as (...) the agent responsible for the implementation of diagnosis, therapy, and care is unable to access the generation of findings and recommendations. There is widespread agreement that, generally, a complete traceability is preferable to opaque recommendations; however, there are differences about addressing ML-based systems whose functioning seems to remain opaque to some degree—even if so-called explicable or interpretable systems gain increasing amounts of interest. This essay approaches the epistemic foundations of ML-generated information specifically and medical knowledge generally to advocate differentiations of decision-making situations in clinical contexts regarding their necessary depth of insight into the process of information generation. Empirically accurate or reliable outcomes are sufficient for some decision situations in healthcare, whereas other clinical decisions require extensive insight into ML-generated outcomes because of their inherently normative implications. (shrink)

Developments in Machine Learning (ML) have attracted attention in a wide range of healthcare fields to improve medical practice and the benefit of patients. Particularly, this should be achieved by providing more or less automated decision recommendations to the treating physician. However, some hopes placed in ML for healthcare seem to be disappointed, at least in part, by a lack of transparency or traceability. Skepticism exists primarily in the fact that the physician, as the person responsible for diagnosis, therapy, and (...) care, has no or insufficient insight into how such recommendations are reached. The following paper aims to make understandable the specificity of the deliberative model of a physician-patient relationship that has been achieved over decades. By outlining the (social-)epistemic and inherently normative relationship between physicians and patients, I want to show how this relationship might be altered by non-traceable ML recommendations. With respect to some healthcare decisions, such changes in deliberative practice may create normatively far-reaching challenges. Therefore, in the future, a differentiation of decision-making situations in healthcare with respect to the necessary depth of insight into the process of outcome generation seems essential. (shrink)

Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This study (...) makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities. (shrink)

Definition of the problemHealth Apps are becoming increasingly important for a preventive and responsible orientation of the health system. Currently, most of these digital health applications (DiGA) are based on so-called self-tracking technologies which record physiological and psychological data via sensors, usually combined with personalized everyday information. In the last few years, these digital developments have launched an intense and clearly polarized debate about the opportunities and dangers of self-tracking in healthcare.ArgumentsAfter a brief overview of medical self-tracking, this essay wants (...) to systematize and check the polarized discourse on the basis of its decisive individual and social potentials. It turns out that self-measurement techniques have long been an integral part of medical practice in diagnostics and therapy.ConclusionThe area of tension between individual empowerment and potential loss of control by the users will be emphasized as being especially important for the implementation of health Apps in primary health care. Finally, possible implications for the current design of the new German Digital Care Law (Digitale-Versorgung-Gesetz) are shown and some existing “blind spots” are highlighted. (shrink)

Zunehmend gewinnen Health Apps an Bedeutung für eine präventive und eigenverantwortliche Ausrichtung des Gesundheitssystems. Die meisten dieser digitalen Gesundheitsanwendungen basieren derzeit auf sog. Selftracking-Technologien, mit deren Hilfe physiologische und psychische Daten sensorgestützt aufgezeichnet und diese zumeist um personalisierte Alltagsinformationen ergänzt werden. Die digitalen Entwicklungen dieser Art lösten in den letzten Jahren eine intensive und deutlich polarisierte Debatte über die Chancen und Gefahren von gesundheitlichem Selftracking aus. Ziel dieser Arbeit ist es, nach einem kurzen Überblick über das Feld des medizinischen Selftracking (...) den polarisierten Diskurs zunächst anhand seiner entscheidenden individuellen und gesellschaftlichen Potenziale zu systematisieren und zu prüfen. Es stellt sich heraus, dass Selbstvermessungstechniken keineswegs ein neues Phänomen, sondern vielmehr seit langem fester Bestandteil medizinischen Wirkens in Diagnostik und Therapie sind. Als für die Implementierung von Health Apps in die medizinische Regelversorgung besonders bedeutend wird das Spannungsfeld zwischen individuellem Empowerment und potentiellem Kontrollverlust der Nutzenden herausgestellt. Abschließend werden mögliche Implikationen für die aktuelle Ausgestaltung des neuen Digitale-Versorgung-Gesetzes aufgezeigt und auf einige bestehende „blinde Flecken“ hingewiesen. (shrink)

Giorgia Pozzi’s feature article1 on the risks of testimonial injustice when using automated prediction drug monitoring programmes (PDMPs) turns the spotlight on a pressing and well-known clinical problem: physicians’ challenges to predict patient behaviour, so that treatment decisions can be made based on this information, despite any fallibility. Currently, as one possible way to improve prognostic assessments of patient behaviour, Machine Learning-driven clinical decision support systems (ML-CDSS) are being developed and deployed. To make her point, Pozzi discusses ML-CDSSs that are (...) supposed to deliver physicians an accurate estimation of the likelihood of narcotic, sedative and stimulant opioid misuse by a given patient (like, e.g., ‘NarxCare’). Regarding cases of deviating assessment between human evaluators and automated systems, the medico-ethical discussion has so far mainly focused on disagreement between clinicians and Machine Learning (ML) algorithms,2 for example in ‘second opinions’ that have been reconstructed as disagreements between physician testimony and ML-CDSS testimony.3 Examples such as those of PDMPs, by contrast, draw attention to situations in which patient testimony potentially contradicts ML-CDSS testimony. Pozzi examines decision-making situations in which ML-CDSS testimony factually overrides the testimony of the person affected. Thus, in the presented case of patient Kathryn, the testimony of her own physical and mental condition was insufficient to overturn the unfavourable outcome for …. (shrink)

Zusammenfassung Die Forschungs- und Regulierungsebene bei datenintensiver Forschung in der Medizin liegen auseinander. Ein heterogenes Feld aus regulierenden Institutionen mit regional ungleichen Regelungen, sowohl hinsichtlich der Dichte als auch der Restriktivität von Regelungen, steht einer globalen Entwicklung der Technologien entgegen. Trotz oder gerade wegen mangelnder global-gültiger Regulierungen können auch unverbindliche oder nur bedingt verbindliche normative Vorgaben der Orientierung dienen. Doch wie soll eine solche normative Regulierung angesichts datenintensiver Forschung in der Medizin ausgestaltet werden und woran soll sie sich orientieren? Die (...) Frage, wie konkret und detailliert man eine solche Forschung regulieren sollte, lässt sich nur im Einzelfall für bestimmte Situationen und Institutionen beantworten. Ob dabei neue Normen oder Gewichtungen von Normen vorgenommen werden sollen, oder ob die Normen und deren Gewichtung weiterhin bestehen bleiben sollen, lässt sich nur mit Verweis auf starke normative Argumente beantworten. An zwingenden Argumenten für neue Normen angesichts der datenintensiven medizinischen Forschung mangelt es bisher. Dennoch ist eine Umsetzungsarbeit von Normen, egal ob neue oder alte, und deren Anwendung auf eine neue Methode oder Technologie allemal zu erbringen. Es bedarf daher – wie schon bisher – beider: sowohl etablierter und transparent kommunizierter Normen als auch des unabhängigen Urteils zur Anwendung dieser Normen. Angesichts der besonderen Eignung für diese Aufgabe sollten auch weiterhin Ethik-Kommissionen als prozedurale Instanz bei der Bewilligung von datenintensiver Forschung in der Medizin gefordert und befähigt werden, die als unabhängige Institution ein Urteil im Einzelfall anhand vorgegebener Normen fällen. Nichtsdestotrotz können sich die veränderten Praktiken datenintensiver Forschungsprojekte auch in neuen Anforderungen an Ethik-Kommissionen niederschlagen, denen mit Reformen der Arbeitsweise begegnet werden sollte. (shrink)

Funeral Orations as Indicators of what a Good Life Ought to Be The central aim of this study was to uncover, based on funeral orations, what the Igbo of South-East Nigeria regard as the good life. Over two hundred and fifty funeral orations/tributes were investigated. These were classified into: tributes by spouses; by offspring; by close family members; by friends, associates and organizations. The study revealed that the notion of the good life among the Igbo was based on primary duties (...) and obligations at each of the four levels identified above and on related secondary duties and obligations. The good life was measured by the extent to which these duties and obligations were discharged and in the way their performance manifested in the provision of social amenities, help to educate members of the community and so on. What would ordinarily be regarded as virtues were considered desirable only in so far as they helped people fulfill their primary and secondary obligations, otherwise they were regarded as sterile or "bottled" virtues. (shrink)

The centrality of death rituals has in anthropologically informed studies of Buddhism been little documented. The current volume brings together a range of perspectives on Buddhist death rituals including ethnographic, textual, historical and theoretically informed accounts, and presents the diversity of the Buddhist funeral cultures of mainland Southeast Asia and China. It arises out of the University of Bristol's Centre for Buddhist Studies research project Buddhist Death Rituals in Southeast Asia and China, funded by the United Kingdom's Arts and Humanities (...) Research Council. This project involved extensive new research in Thailand, Laos and China. Other items from that project included several public exhibitions, extensive stills photographs, and several video films. The project-team produced two 30 minutes films on the ghost festival in Laos and China, one on urban funerals in Chiang Mai (Thailand) and several shorter clips dealing with funeral cultures in Laos, Thailand and China. Most of this material (and an extensive bibliography on the topic) is available free of charge from the project website located at the webpage of the Department of Theology and Religious Studies (Centre for Buddhist Studies) at the University of Bristol. (shrink)

During the Covid-19 pandemic, funerals have been conducted consistently in Norway, but, of course, the ceremonies were subject to rules and regulations, while digitization was on the increase. Against the background of already ongoing discussions, both in contexts related to the Church of Norway and in practical-theological discourses, this article analyses scenes and excerpts from interviews conducted in 2021 and asks: What does the sociologist Hartmut Rosa’s concept of resonance convey in the pandemic situation? – This concept aims at (...) a mode of relating that empowers fulfilling, resonant relationships between subjects and between subject and world; the aim here is to bring it into play as a sensitizing concept, in a situation of supposedly increased distance and unaffectedness between people. The article discusses where the concept conveys the need for stable frameworks, and where it conveys the need for ongoing work with an ecclesiastical-theological self-understanding in the field of church funerals. (shrink)

I discuss the problem that Kant’s ethics seems to be incapable of capturing our strong intuition that emergencies create a context for actions that is very different from other cases of helping and from other opportunities to further obligatory ends. I argue that if we pay attention to how Kant grounds beneficence we see that distress and emergency function as constitutive concerns. They are vital to establishing the duty of beneficence in the first place, and they also guide the application (...) of duties to specific cases. Kant’s conception of imperfect duties to others, when understood correctly, offers a way to understand why emergencies are morally important, but also why other factors have a place in our moral reasoning. (shrink)

Buddhist Funeral Cultures of Southeast Asia and China. Edited by Paul Williams and Patrice Ladwig. Cambridge: Cambridge University Press, 2012. Pp. xiv + 296. £60.

The purpose of this paper is to indicate the slightness of the foundation on which a commonly received doctrine about Roman funerals rests, and to discuss a point in connexion with the ritual of funera acerba.

The purpose of this paper is to indicate the slightness of the foundation on which a commonly received doctrine about Roman funerals rests, and to discuss a point in connexion with the ritual of funera acerba.

The theme of death is of great consequence in Jean-Paul Sartre and Martin Heidegger because most of the existentialist views about death are encapsulated in the debate between them. While Heidegge4 carrying with a certain religious conviction, is of the view that death confers meaning on human existence, Sartre believes that death is a great evil which makes life meaningless. Sartre's position obviously sprouts from his atheistic persuasion which does not accommodate a presage of a future existence or embrace the (...) ideals associated with the good life. For the Yoruba, however Sartre's position does not make sense and is preposterous; they believe strongly that the human personality survives death. In this paper I want to show that the Yoruba conception of human existence and death-as conveyed by the Iremore - reflects an extracosmic and a more comprehensive reading of existence that reinforces the values associated with an honorable lift. (shrink)

This article examines the political controversy in the United States surrounding a new process for the disposition of human remains, alkaline hydrolysis. AH technologies use a heated solution of water and strong alkali to dissolve tissues, yielding an effluent that can be disposed through municipal sewer systems, and brittle bone matter that can be dried, crushed, and returned to the decedent’s family. Though AH is legal in eight US states, opposition to the technology remains strong. Opponents express concerns about public (...) health and safety and about the dignity of our mortal remains. Proponents focus on AH’s environmental benefits over cremation and earth burial, aligning the technology with the “green burial” movement. Drawing from historical sources, Science, Technology, and Society literature, interviews with funeral professionals, industry literature, and various media sources, this article examines four prominent conceptions of the dead human body as they are deployed by various funeral stakeholders seeking to exercise authority over the dead human body, to influence the trajectory of AH technology in the United States, and to chart a course for US deathcare culture in the twenty-first century. (shrink)

There is much to like in Bermúdez's analysis, yet it is incomplete and at times problematic for social decision making and, by extension, interpersonal conflict. Here I explain how four frames – gains, losses, me, we – operate in conjunction and how humans gravitate toward a “me–loss” frame that, without intervention, leads to a breakdown of cooperation and an arguably tragic funeral of the commons.

This article aims to show how critical-feminist studies can improve research on funerals by contributing to a more complex understanding of ritualization and how it can be explored. The article discusses central issues within critical-feminist theory in relation to previous studies of funerals in Sweden and presents theoretical approaches that may improve the field of funeral studies. Intersectionality, queer phenomenology and ritual practice theory are introduced as examples of approaches that might help the researcher deal with questions of (...) representation in research, rejection of othering and application of non-essentialism – central issues in critical-feminist theory. Critical-feminist studies may, for example, uncover intersections of power relations in the ritual field, reveal experiences of inclusion/exclusion and contribute to a relational and dynamic understanding of ritual practice. Thereby, they provide complex knowledge of funerals, essential for understanding their functions for individuals and societies in times of ritual change. (shrink)

The proliferation of unconventional death practices in North America, however innovative, is in part an expression of societal confusion about the nature of death and grief. If the church can recover the theological and liturgical fabric of funerals, reclaiming their main purpose as public confession rather than private pastoral care, Christian funerals can serve as a hopeful counter-witness to an uncertain culture.

Cordus, who gave Pompey's body decent burial, is apostrophizing Fortune: Pompey asks no splendid burial, no incense, no loyal Roman shoulders to carry the father of his country, no funeral procession displaying mementos of former triumphs, no solemn music in the fora, no mourning army circling about the pyre and casting their arms in it.

Gricean pragmatics seems to pose a dilemma. If semantics is limited to the conventional meanings of types of expressions, then the semantics of an utterance does not determine what is said. If all that figures in the determination of what is said counts as semantics, then pragmatic reasoning about the specific intentions of a speaker intrudes on semantics. The dilemma is false. Key points: Semantics need not determine what is said, and the description, with which the hearer begins, need not (...) provide the hearer with knowledge of what was said, or the ability to express what was said, from the hearer's context. (shrink)