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

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

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

Background The American Society for Bioethics and Humanities (ASBH), a professional organization that certifies ethics consultants who pass the qualifying examination, published standards for the conduct of ethics consultations (EC). A national survey of adult hospital ethics consultants identified adherence to these standards, but no assessment of pediatric hospitals’ adherence has been done.Methods In this cross-sectional study, a national questionnaire was distributed electronically in 2022 to pediatric ethics consultants at children’s hospitals, collecting information about adherence to the ASBH standards. Hospital (...) characteristics were extracted from the Children’s Hospital Association Annual Benchmark Report. Quantitative analysis included descriptive statistics to assess adherence and analyses of variance to investigate associations between hospital characteristics and the time taken to respond to consultations.Results Of the 181 eligible pediatric hospitals, we received 104 completed surveys (57%) from 45 states. Pediatric EC have similar adherence rates to ASBH standards as adult hospitals. High-adherence (>75%) areas included having an expert available for EC and permitting any staff member to request EC. Low-adherence areas included having comprehensive policies covering all aspects of EC activities, having a response plan for egregious violations, and the elicitation of formal feedback after EC. There is an increased average response time for ethics consultation services in smaller pediatric hospitals and church-operated hospitals.Conclusions Pediatric hospitals overall have moderate adherence to the ASBH EC standards, with the highest rates occurring for standards that are shared by the American Academy of Pediatrics. Additional research into the barriers to standard adherence and the effectiveness of standards is warranted with emphasis on the impact of adherence on consultation quality. (shrink)

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

Stota je obljetnica obnove olimpijske ideje postavila pitanje o europejstvu olimpijskog ideala u globaliziranoj stvarnosti – stota je Olimpijada, 1996. godine, bila poklonjena rodnom gradu tvrtke Coca-Cola, dok Atena sve do 2004. godine nije dobila priliku proslaviti obljetnicu, a Olimpijske igre 2008. godine održale su se u Kini. Olimpijska je ideologija u kineskom kontekstu poprimila oblik slavljenja dične kineske tradicije. Rad analizira pitanja vezana uz te zadnje Olimpijske igre te ih istražuje iz perspektive interkulturalne filozofije. Kao prvo, analizira se ideja (...) grčkog podrijetla Olimpijskih igara u svom imanentnom kasnodevetnaestostoljetnom eurocentričnom kontekstu te ju se uspoređuje s kineskom reinterpretacijom. Kao drugo, ideje usavršavanja tijela uspoređuju se u tim dvjema tradicijama , pri čemu je posebna pažnja poklonjena vezi između vlastitog rada na tijelu i interesa države/nacije. Naposljetku, olimpijska se ideologija analizira kroz svoj odnos prema interkulturalnim pitanjima te su Olimpijske igre u Pekingu 2008. godine interpretirane kao znak smjene paradigme u olimpijskoj ideologiji.The 100th anniversary of the revival of the Olympic idea questioned the Europeanness of the Olympic ideal in the globalised reality – the 1996 centennial Olympics were given to the hometown of Coca-Cola Company, and it wasn’t until 2004 that Athens got the chance to celebrate the anniversary, while the 2008 Olympics went to China. In Chinese context the Olympic ideology was refurbished into a celebration of the glorious Chinese tradition. The paper analyses the issues brought about by this last Olympic Games and examines them through the perspective of intercultural philosophy. First, the idea of Greek origin of the Olympics is analysed in its immanent late 19th century Eurocentrist context and compared to its Chinese re-interpretation. Secondly, the ideas of cultivation of body are compared in the two traditions with special attention given to the connection between self-cultivation and the interests of the country/nation. Finally, the Olympic ideology is analysed through its attitude towards inter-cultural issues and the Beijing 2008 Olympics are interpreted as an indication of a paradigm shift in the Olympics ideology. (shrink)

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

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

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

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

Butte, Montana, lies at the headwaters of the nation's largest Superfund site. Donald MacMillan's book is a morality tale about this environmental travesty—a story of damaged health and environment, futile efforts by citizens and government to halt that damage, and demoralization resulting from those failed efforts.MacMillan's story covers the period from the 1880s to the 1930s. In the first phase, he describes the struggle between the young city of Butte and negligent smelter owners. In the second, the smelter owners shifted (...) the problem to a nearby town and surrounding farmers. In the third, the federal government attempted to enforce conservation policy.When miners first settled Butte in the 1860s, they found a lush valley high amid the peaks of the Continental Divide. By 1890 Butte was a major source of copper for a growing nation. Ore was roasted in open heaps a city block long. Sulfur and arsenic fumes killed vegetation for miles around. When winter inversions trapped smoke, residents suffered nosebleeds and vomited in the streets. Up to eighty people a month died in this town of just 40,000.The city sent abatement notices. Mine owners ignored them, arguing, “No smoke, no wages for workingmen.” Though open heap roasting ended because it was inefficient, new roasting furnaces did little to ease the problem. The growth of the Anaconda Copper Mining Company did end the problem—at least for Butte residents. By 1906 nearly all of Butte's ore was shipped twenty‐six miles down the valley to ACM's Anaconda smelter. Each day it belched thirty tons of arsenic and 2,500 tons of sulfur into the air. Whole herds of horses, cattle, and sheep lay wasted in the fields. ACM paid $330,000 for damages within five miles of the Washoe but refused compensation to more distant farmers.Afflicted farmers filed a lawsuit, offering to settle for a $1,175,000 buyout of their 60,525 acres. ACM declared their land not worth $500,000 and then spent nearly $1 million to prove it. Farmers lost when the judge—who socialized with ACM executives—found against the farmers in 1909. ACM had utilized “best known methods” and therefore should not be liable for any damages.Smoke poisoned national forest lands as well as farmers' fields. Trees within twenty‐five miles of Anaconda were dead or damaged. President Theodore Roosevelt and Chief Forester Gifford Pinchot initiated an investigation through the U.S. attorney general's office that eventually sought $4 million in damages from ACM. The company stalled, hoping for a more tolerant administration following the elections of 1908. In 1911 President William Howard Taft, trusting industry to do the right thing, created the “Anaconda smoke commission”—a group of industry and government advisors—to oversee ACM's implementation of pollution controls. In 1916 ACM's smelter still emitted sixty‐two tons of arsenic and 1,700 tons of sulfur each day.In 1924 ACM finally took effective steps to remove most of the arsenic from its emissions. Because of high demand for arsenic insecticides to fight boll weevils, ACM made considerable profit on arsenic recovery. Problems with farmers ended when the farmers, financially bankrupt from their lawsuit, sold “smoke rights” or easements to ACM. Problems with the federal government ended after 1928 when President Herbert Hoover, who promoted government‐industrial partnership, approved the swap of healthy ACM timberlands for damaged national forest.As a resident of Butte, it is hard for me to keep in mind that this is a historical account. Although ACM's smelting operations ended in 1974, the legacy of cultural and environmental damage lingers on. The morning newspaper reported forty‐six homes in Butte contaminated with lead and arsenic: “The federal Agency for Toxic Substances and Disease Registry is conducting an investigation, and encourages all children to be tested.”. (shrink)

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

Quine's metalogical 'quasiquotation' is formally added to classical first-Order logic; the resulting system lq is stronger and more natural than all former systems of quotational logic. Lq contains object-Variables ranging over the universe u and expression-Variables ranging over the set e of all expressions of lq; e is a subset of u. Object-Quantifiers are referential, Expression-Quantifiers are substitutional; only the latter ones bind into quasiquotations. Lq contains its own syntactic metatheory and arithmetics. Natural proofs of godel's and tarski's theorems are (...) given for lq. (shrink)

율곡은 생애를 철학자로서의 삶과 경세가로서의 삶으로 병행했다. 그의 학문은 이학(理學)으로서의 성리학과 기학(氣學)으로서의 경세학으로 구성되어 있다. 경세학의 철학적 근거가 성리학이고, 성리학의 현실적 구현이 경세학으로 드러난다. 성리학과 경세학이 체용일원으로 하나가 되고 회통하는 논리를 갖는 것이다. 그러므로 율곡학을 참으로 이해하는 것은 성리학과 경세학을 아울러 알 때 가능하다. 율곡은 세계에 내놓아도 부족함이 없는 위대한 철학자다. 그는 관념적인 철학자가 아니라 시대정신에 투철하고 나라와 백성에 대한 우환의식을 가지고 개혁에 앞장섰던 실천적 지성이었다. 이러한 율곡에 대한 이해는 이 시대를 살아가는 우리 모두의 교양이다.

В работе ставится вопрос о роли изобразительного начала в абстрактном искусстве Франции периода после Второй мировой войны. Рассматривая творчество и теоретические суждения ведущих мастеров пейзажной абстракции, ташизма, оп-арта, автор приходит к заключению, что принцип мимесиса был не исключен из их искусства, но переосмыслен: задача правдоподобного воссоздания зримых форм сменилась поиском способов обобщенной передачи процессов и структур внешнего мира. Творчество таких мастеров, как Альберто Джакометти и Никола де Сталь, «вырастивших» фигуративные формы из нефигуративных, показывает, что между двумя системами нет непроходимой границы, (...) но существует множество переходных стадий. Заключительная глава посвящена направлению повествовательной фигуративности и роли абстрагирующих моделей реальности в нем. (shrink)