SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

Studies have shown that in the mammalian neuromuscular system stretch reflexes are localized within individual muscles. Neuromuscular compartmentalization, the partitioning of sensory output from muscles, and the partitioning of segmental pathways to motor nuclei have also been demonstrated. This evidence indicates that individual motor nuclei and the muscles they innervate are not homogeneous functional units. An analysis of the functional significance of reflex localization and partitioning suggests that segmental control mechanisms are based on subdivisions of motor nuclei–muscle complexes. A partitioned (...) organization of segmental control mechanisms could utilize (1) the potential functional diversity of muscle fiber types, (2) the variety of mechanical actions of individual muscles arising from their distributed origins and insertions, and (3) diverse architectural features such as intramuscular variations in pinnation and complex in-series and in-parallel arrangements of muscle fibers. The differentiated activity observed in some muscles during natural movements also calls for localized segmental control mechanisms. Partitioning may also play a role in mechanical interactions between contracting motor units and in increasing the stability of neuromuscular systems. The functional advantages of reflex localization and partitioning suggest they are probably common features of segmental systems, whose organization reflects the structure and function of their associated neuromuscular systems. (shrink)

Machine learning algorithms may radically improve our ability to diagnose and treat disease. For moral, legal, and scientific reasons, it is essential that doctors and patients be able to understand and explain the predictions of these models. Scalable, customisable, and ethical solutions can be achieved by working together with relevant stakeholders, including patients, data scientists, and policy makers.

In this paper I present both a critical appraisal of Humphreys' probabilistic theory of causality and a sketch of an alternative view of the relationship between the notions of probability and of cause. Though I do not doubt that determinism is false, I claim that the examples used to motivate Humphreys' theory typically refer to subjective rather than objective chance. Additionally, I argue on a number of grounds that Humphreys' suggestion that linear regression models be used as a canonical form (...) for the description of causal relations is untenable. I conclude by exploring the variety of ways in which probabilistic elements can be embedded into the structure of causal mechanisms. This investigation suggests both that deterministic mechanisms can produce stochastic behavior and stochastic mechanisms can produce deterministic behavior. (shrink)

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

In this paper I criticize Cartwright's analysis of capacities and offer an alternative analysis. I argue that Cartwright's attempt to connect capacities to her condition CC fails because individuals can exercise capacities only in certain contexts. My own analysis emphasizes three features of capacities: 1) Capacities belong to individuals; 2) Capacities are typically not metaphysically fundamental properties of individuals, but can be explained by referring to structural properties of individuals; and 3) Laws are best understood as ascriptions of capacities.

A dozen papers by internationally known scholars explore questions largely unthinkable without Richard Watson's classic Downfall of Cartesianism: Descartes in Holland, Descartes and Simon Foucher, and issues raised by Descartes for philosophy of mind, philosophy of science, translation and toleration.

This paper reports the introduction of electronic handsets, like those used on the television show 'Who Wants To Be A Millionaire?' into the teaching of philosophical logic. Logic lectures can provide quite a formidable challenge for many students, occasionally to the point of making them ill. Our rationale for introducing handsets was threefold: to get the students thinking and talking about the subject in a public environment; to make them feel secure enough to answer questions in the lectures because the (...) system enabled them to do this anonymously; and to build their confidence about their learning by their being able to see how they were progressing in relation to the rest of the students in the class. We have achieved all of these and more. Our experience has revealed that the use of handsets encourages a more dynamic form of student interaction in an environment - the lecture - that can, in the wrong hands, be utterly enervating, but they also provide an opportunity for the lecturer to respond to students' difficulties at the time when they really matter. In this paper, we discuss our case of rapid adoption, our grounds for judging it a success, and what that success seems to have depended on. (shrink)

Stuart M. Shieber’s name is well known to computational linguists for his research and to computer scientists more generally for his debate on the Loebner Turing Test competition, which appeared a decade earlier in Communications of the ACM. 1 With this collection, I expect it to become equally well known to philosophers.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Each of the following papers gives an account of a different UK clinical ethics committee. The committees vary in the length of time they have been established, and also in the main focus of their work. The accounts discuss the development of the committees and some of the ethical problems that have been brought to them. The issues raised will be relevant for other National Health Service (NHS) trusts in the UK that wish to set up such a committee.

From machine learning and computer vision to robotics and natural language processing, the application of data science and artificial intelligence is expected to transform health care (Ce...

Purpose The purpose of this paper is to review current practice in sharing and mining medical data revealing benefits, costs and ethical issues. Based on stakeholder perspectives and values, the authors create an ethical code to regulate the sharing and mining of medical information. Design/methodology/approach The framework is based on a review of academic, practitioner and legal research. Findings Owing to the inability of current safeguards to protect consumers from risks related to the disclosure of medical information, the authors develop (...) a framework for ethical sharing and mining of medical data, security, transparency, respect, accountability, community and quality, which espouses security, transparency, respect, accountability, community and quality as the basic tenets of ethical data sharing and mining practice. Research limitations/implications The STRACQ framework is an original, previously unpublished contribution that will require modification over time based on discussion and debate within and among the academy, medical community and public policymakers. Social implications The framework for sharing borrows from the Fair Credit Reporting Act, allowing the collection and dissemination of identified medical data but placing strict limitations on use. Following this framework, benefits of shared and mined medical data are freely available with appropriate safeguards for consumer privacy. Originality/value Mandates for adoption of electronic health-care records require an understanding of medical data mining. This paper presents a review of data mining techniques and reasons for engaging in the practice of identifying benefits, costs and ethical issues. The authors create an original framework, STRACQ, for ethical sharing and mining of medical information, allowing knowledge exploration while protecting consumer privacy. (shrink)

In 1950, Alan Turing proposed his eponymous test based on indistinguishability of verbal behavior as a replacement for the question "Can machines think?" Since then, two mutually contradictory but well-founded attitudes towards the Turing Test have arisen in the philosophical literature. On the one hand is the attitude that has become philosophical conventional wisdom, viz., that the Turing Test is hopelessly flawed as a sufficient condition for intelligence, while on the other hand is the overwhelming sense that were a machine (...) to pass a real live full-fledged Turing Test, it would be a sign of nothing but our orneriness to deny it the attribution of intelligence. The arguments against the sufficiency of the Turing Test for determining intelligence rely on showing that some extra conditions are logically necessary for intelligence beyond the behavioral properties exhibited by an agent under a Turing Test. Therefore, it cannot follow logically from passing a Turing Test that the agent is intelligent. I argue that these extra conditions can be revealed by the Turing Test, so long as we allow a very slight weakening of the criterion from one of logical proof to one of statistical proof under weak realizability assumptions. The argument depends on the notion of interactive proof developed in theoretical computer science, along with some simple physical facts that constrain the information capacity of agents. Crucially, the weakening is so slight as to make no conceivable difference from a practical standpoint. Thus, the Gordian knot between the two opposing views of the sufficiency of the Turing Test can be cut. (shrink)

As a field spanning interests among researchers and business professionals, business ethics aims to provide guidance on what can be considered morally right, socially acceptable and legally transparent dealings in the human activity of providing goods or services for trade. Yet, cohesive theory of the ethics of business is lacking, and current ethical practices often fall victim to fluctuating business conditions and circumstances. Thus, stewardship theory is proposed as a more enduring and empowering orientation to more mindful business ethics that (...) is borne out of organizational character, and knowledge stewardship is introduced as a set of practices that can support improved ethical behavior in organizations from an ethos-driven perspective. A definition of knowledge stewardship is provided in this article, and its associated outcomes of authenticity, authority and advocacy are highlighted. Practical recommendations are put forward to assist organizations in their development of stronger stewardship behavior, and exploratory research questions that heighten attentiveness to knowledge stewardship are presented. (shrink)

Systematic semantic ambiguities result from the interaction of the two operations that are involved in resolving ellipsis in the presence of scoping elements such as quantifiers and intensional operators: scope determination for the scoping elements and resolution of the elided relation. A variety of problematic examples previously noted - by Sag, Hirschbüihler, Gawron and Peters, Harper, and others - all have to do with such interactions. In previous work, we showed how ellipsis resolution can be stated and solved in equational (...) terms. Furthermore, this equational analysis of ellipsis provides a uniform framework in which interactions between ellipsis resolution and scope determination can be captured. As a consequence, an account of the problematic examples follows directly from the equational method. The goal of this paper is merely to point out this pleasant aspect of the equational analysis, through its application to these cases. No new analytical methods or associated formalism are presented, with the exception of a straightforward extension of the equational method to intensional logic. (shrink)

Although social contracts theory has been applied to organizations (Donaldson & Dunfee, 1994), rarely has the theory been tested empirically. This article uses the traditions of communitarianism and individualism to instantiate an ideal-type economic social contract. We asked 269 subjects to complete the Ideological Orientation Scale and to make judgments on eight downsizing scenarios. Using social judgment theory, we assess the direct and indirect influences of ideology on judgments of fairness. Our findings suggest that ideology indeed shapes individual’s conceptions of (...) organizational fairness. (shrink)

By combining normative philosophy and empirical social science, we craft a research framework for assessing differential expectations embodied in normative conceptions of the economic social contract in the United States. We argue that there are distinctviews of such a contract grounded in individualist and communitarian philosophical ideologies. We apply this framework to organizational downsizing, postulating that certain human resource practices, in combination with the respective ideological orientations, will affect perceptions of the justice of downsizing policies.Living up to one’s word is (...) a decisive measure of moral character. Within the microsocial realm of the family, promises and commitments derive their social force and cultural meaning from the idea that love or biology binds people together in an absolute way. But outside of this world, in the larger society, the only thing binding people together is a sense that there is a social contract, a set of common obligations held collectively by society as a whole. But today’s workers say no one seems to care whether these promises are kept. (shrink)

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)