Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM’s rigid hierarchy of evidence as the culprit of (...) its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal. -/- . (shrink)

The usefulness of machine learning algorithms has led to their widespread adoption prior to the development of a conceptual framework for making sense of them. One common response to this situation is to say that machine learning suffers from a “black box problem.” That is, machine learning algorithms are “opaque” to human users, failing to be “interpretable” or “explicable” in terms that would render categorization procedures “understandable.” The purpose of this paper is to challenge the widespread agreement about the existence (...) and importance of a black box problem. The first section argues that “interpretability” and cognates lack precise meanings when applied to algorithms. This makes the concepts difficult to use when trying to solve the problems that have motivated the call for interpretability. Furthermore, since there is no adequate account of the concepts themselves, it is not possible to assess whether particular technical features supply formal definitions of those concepts. The second section argues that there are ways of being a responsible user of these algorithms that do not require interpretability. In many cases in which a black box problem is cited, interpretability is a means to a further end such as justification or non-discrimination. Since addressing these problems need not involve something that looks like an “interpretation” of an algorithm, the focus on interpretability artificially constrains the solution space by characterizing one possible solution as the problem itself. Where possible, discussion should be reformulated in terms of the ends of interpretability. (shrink)

Through the use of culturally appropriate videos on precision medicine research (PMR) that were developed and tailored to five racial and ethnic groups of patients, and subsequent focus-group discu...

Pandemics first and foremost hit those who are most vulnerable, and the COVID-19 pandemic is not different. Although the infection rate in the nation’s poorest neighborhoods is twice as it is in th...

Since the inception of large‐scale human genome research, there has been much caution about the risks of exacerbating a number of socially dangerous attitudes linked to human genetics. These attitudes are usually labeled with one of a family of genetic or genomic “isms” or “ations” such as “genetic essentialism,” “genetic determinism,” “genetic reductionism,” “geneticization,” “genetic stigmatization,” and “genetic discrimination.” The psychosocial processes these terms refer to are taken to exacerbate several ills that are similarly labeled, from medical racism and psychological (...) fatalism to economic exploitation and social exclusion. But as genomic information becomes more familiar in clinical and research settings as well as other life activities, do we need to continue to worry so much about this family of attitudes and their impact on existing problems?In genomics, the underlying anxiety has been that disclosure of genomic information will trigger a series of (seemingly unavoidable) negative responses that will affect individuals, their families, and their communities at large. The fundamental social challenges that hyperbolic genomic messaging, low genomic literacy, and “folk biology” help sustain remain to be addressed. If we hope to break the cycle of genomic isms and ations, we will have to get better at resisting overinterpretations of the relevance that genomics has for people’s future potentials, ancestral vulnerabilities, community memberships, and ethnic affiliations. (shrink)

This paper offers a theoretical discussion on why the nursing profession has had a delayed response to the issue of climate change. We suggest this delay may have been influenced by the early days of nursing's professionalization. Specifically, we examine nursing's professional mandate, the generally accepted metaparadigm, and the grand theorists’ conceptualizations of both the environment and the nurse–environment relationship. We conclude that these works may have encouraged nurses to conceptualize the environment, as well as their relationship with it, mainly (...) in terms of the individual patient, and as such, nurses have not been encouraged to understand these concepts from a broader perspective. By not having the philosophical and theoretical foundations to understand the environment in relation to society, it is not surprising that nurses have had a delayed response to climate change and may not have viewed it as a professional concern. A planetary health perspective is suggested as a theoretical basis for nursing education, research and practice. Taking on a planetary health perspective could help nurses progress the profession and move healthcare systems towards supporting a climate‐resilient future. (shrink)

The public rejection of scientific claims is widely recognized by scientific and governmental institutions to be threatening to modern democratic societies. Intense conflict between science and the public over diverse health and environmental issues have invited speculation by concerned officials regarding both the source of and the solution to the problem of public resistance towards scientific and policy positions on such hot-button issues as global warming, genetically modified crops, environmental toxins, and nuclear waste disposal. The London Royal Society’s influential report (...) “Public Understanding of Science”, which spearheaded the now-thriving area of science... (shrink)

The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920–1950). At the same time, the term ‘‘evidence-based medicine’’ has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should (...) be challenged on the grounds of how ‘evidence’ has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause. (shrink)

While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despair over the “subjective elements” that values introduce to clinical reasoning, demonstrating that they do not (...) subscribe to feminist science studies’ normative program——where contextual values can enable good science and justified decisions. In this paper, I investigate why it is that the critics of evidence-based medicine adopt feminist science’s characterization of the problem but resist the productive solutions offered by those same theorists. I suggest that the common feminist empiricist appeal to idealized epistemic communities is impractical for those working within the current biomedical context and instead offer an alternate stream of feminist research into the empirical content of values (found in the work of Elizabeth Anderson and Sharyn Clough) as a more helpful recourse for facilitating the important task of legitimate and justified clinical decision-making. I use a case study on clinical decision-making to illustrate the fruitfulness of the latter feminist empiricist framework. -/- See response by Sharyn Clough: http://wp.me/p1Bfg0-1aN See reply by Maya Goldenberg: http://wp.me/p1Bfg0-1oY. (shrink)

Whole genome and exome sequencing techniques raise hope for a new scale of diagnosis, prevention, and prediction of genetic conditions, and improved care for children. For these hopes to materialize, extensive genomic research with children will be needed. However, the use of WGS/WES in pediatric research settings raises considerable challenges for families, researchers, and policy development. In particular, the possibility that these techniques will generate genetic findings unrelated to the primary goal of sequencing has stirred intense debate about whether, which, (...) how, and when these secondary or incidental findings should be returned to parents and minors. The debate is even more pronounced when the subjects are adolescents, for whom decisions about return of SFs may have particular implications. In this paper, we consider the rise of “genomic citizenship” and the main challenges that arise for these stakeholders: adolescents' involvement in decisions relating to return of genomic SFs, the types of SFs that should be offered, privacy protections, and communication between researchers and adolescents about SFs. We argue that adolescents' involvement in genomic SF-related decisions acknowledges their status as valuable stakeholders without detracting from broader familial interests, and promotes more informed genomic citizens. (shrink)

Meier et al. describe a pilot study that developed METHAD, an AI-based Medical Ethics Advisor tool that draws on the principlism approach and was tested using text-book cases and clinical et...

Corporeality: Emergent consciousness within its spatial dimensions develops our understanding of what we can experience through our bodies in relation to the space around us. Rather than considering architecture as being about manifestation and mediation of fixed meanings, the book focuses instead on architectural space as a field that envelopes us incessantly, intimately, and affectively. We are in immediate contact with that space, and the way we relate to it determines how we are able to grasp the realities of the (...) social and material worlds around us. This enquiry considers architectural space and its impact on and relation to us from a range of disciplines and perspectives, leading from space to sense and to sensibility. The theatre becomes a central point of reference on this journey, allowing us to understand how space “works” by linking concrete spatial conditions to corresponding “forms of experience”. It allows showing how the ways we feel, think, and act emerge from within the rich texture of the pre-conscious and non-contemplative. That texture is induced and nourished by our bodily encounters with space. Offering a view of how immediate experience is generated in the body, this book enhances empirical research into the links between space, body, experience and consciousness. Maya Nanitchkova Öztürk is Associate Professor in Theory and Criticism of Architecture. Her academic interests and publications focus on space-body relationships and experience of space/place, as grounds for developing analytical methodologies and interdisciplinary links in discourse, and teaching. She works at Bilkent University (Ankara), Faculty of Art, Design and Architecture, Department of Interior Architecture and Environmental Design. She is on the editorial boards of ISI journal Space and Culture, and the web-journal Consciousness, Literature and the Arts. (shrink)

The United States’ ambitious Precision Medicine Initiative proposes to accelerate exponentially the adoption of precision medicine, an approach to health care that tailors disease diagnosis, treatment, and prevention to individual variability in genes, environment, and lifestyle. It aims to achieve this by creating a cohort of volunteers for precision medicine research, accelerating biomedical research innovation, and adopting policies geared toward patients’ empowerment. As strategies to implement the PMI are formulated, critical consideration of the initiative's ethical and sociopolitical dimensions is needed. (...) Drawing on scholarship of nationalism and democracy, we discuss the PMI's construction of what we term “genomic citizenship”; the possible normative obligations arising therefrom; and the ethical, legal, and social challenges that will ensue. Although the PMI is a work in progress, discussion of the existing and emerging issues can facilitate the development of policies, structures, and procedures that can maximize the initiative's ability to produce equitable and socially sensitive outcomes. Our analysis can also be applied to other population-based, precision medicine research programs. (shrink)

Color conveys critical information about the flavor of food and drink by providing clues as to edibility, flavor identity, and flavor intensity. Despite the fact that more than 100 published papers have investigated the influence of color on flavor perception in humans, surprisingly little research has considered how cognitive and contextual constraints may mediate color–flavor interactions. In this review, we argue that the discrepancies demonstrated in previously-published color–flavor studies may, at least in part, reflect differences in the sensory expectations that (...) different people generate as a result of their prior associative experiences. We propose that color–flavor interactions in flavor perception cannot be understood solely in terms of the principles of multisensory integration but that the role of higher-level cognitive factors, such as expectations, must also be considered. (shrink)

The standard counterexamples to David Lewis’s account of intrinsicality involve two sorts of properties: identity properties and necessary properties. Proponents of the account have attempted to deflect these counterexamples in a number of ways. This paper argues that none of these moves are legitimate. Furthermore, this paper argues that no account along the lines of Lewis’s can succeed, for an adequate account of intrinsicality must be sensitive to hyperintensional distinctions among properties.

It has been almost 20 years since the field of bioethics was galvanized by a controversial series of multinational AZT trials employing placebo controls on pregnant HIV-positive women in the developing world even though a standard of care existed in the sponsor countries. The trove of ethical investigations that followed was thoughtful and challenging, yet an important and problematic methodological assumption was left unexplored. In this article, I revisit the famous “double standard of care” case study in order to offer (...) novel consideration of the placebo orthodoxy that underlies much of the ethical debate. This majority view found in medical research is that placebo-controlled trials are methodologically superior to comparative trials that use active controls. I challenge this orthodoxy and argue that lives were unnecessarily lost in these trials as a result. Furthermore, current HIV research on vaccines and microbicides is now poised to repeat the error of subscribing to the placebo orthodoxy. (shrink)

Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current (...) ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. Summary The "empirical turn" in bioethics signals a need for reconsideration of the methods used for moral evaluation and resolution, however the options should not include obscuring normative content by seemingly neutral technical measure. (shrink)

The once animated efforts in medical phenomenology to integrate the art and

science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literature—the problem of the absent body—and highlight how evidence-based medicine has (...) refigured medical phenomenology’s historical nemesis, “biomedicine.” What we now need is a phenomenology of the embodied subject in the age of evidence-based medicine. (shrink)

Volume 20, Issue 7, July 2020, Page 187-190.

Resemblances obtain not only between objects but between properties. Resemblances of the latter sort - in particular resemblances between quantitative properties - prove to be the downfall of a well-known theory of universals, namely the one presented by David Armstrong. This paper examines Armstrong's efforts to account for such resemblances within the framework of his theory and also explores several extensions of that theory. All of them fail.

Medical discourse currently manages two broad visionary movements: "evidence-based medicine," the effort to make clinical medicine more responsive to the medical research, and "patient-centered care," the platform for a more humane health-care encounter. There have been strong calls to synthesize the two as "evidence-based patient-centred care" (Lacy and Backer 2008; see also Borgmeyer 2005; Baumann, Lewis, and Gutterman 2007; Krahn and Naglie 2008), yet many question the compatibility of the two competing programs.This might sound to some like a new version (...) of an old story. Despite the fact that evidence-based medicine and patient-centered care are relatively new programs, the story of their oppositional .. (shrink)

In recent years, Cesar Chavez’s life and legacy have been subjected to increased scrutiny. The ensuing reevaluations of Chavez, wittingly or not, are matters of ethical, as well as historical and biographical, concern. This article has two aims. First, it reconstructs Chavez’s account of exemplarity and uses it to assess his legacy. Second, it provides an account of exemplarity situated within social practices. As I argue, exemplarity operates through social practices, rather than mystically as posited by a contagion model. The (...) end result is an ethically nuanced reassessment of Chavez and an account of exemplarity that includes its social dimension. (shrink)

Affective forecasting refers to the ability to predict future emotions, a skill that is essential to making decisions on a daily basis. Studies of the concept have determined that individuals are often inaccurate in making such affective forecasts. However, the mechanisms of these errors are not yet clear. In order to better understand why affective forecasting errors occur, this article seeks to trace the theoretical roots of this theory with a focus on its multidisciplinary history. The roots of affective forecasting (...) lie mainly in economics, with early claims positing that utility (i.e. satisfaction) played a role in decision-making. Furthermore, the philosopher Jeremy Bentham’s descriptions of utilitarianism played a major role in our understanding of whether to define utility as a hedonic quality. The birth of behavioural economics resulted in a paradigm shift, introducing the concept of cognitive biases as influences on the accuracy of predicted utility. Daniel Gilbert and Timothy Wilson, the earliest researchers of affective forecasting errors, have proceeded with the concept of the accuracy of predicted affective utility to conduct experiments that seek to determine why our predictions of future affect are inaccurate and how such errors play a role in our decision-making. (shrink)

La relación existente entre el Estado y los ciudadanos remonta épocas antiguas, donde se le exigía la contribución para el pago de los gastos de la monarquía, con el desarrollo del hombre moderno nace la Relación Jurídica Tributaria, donde esta representa la personificación tanto de la potestad de imposición como del deber de contribución, mejor conocidos y aceptados como Sujeto Activo y Sujeto Pasivo, a través de las distintas acepciones, en tal sentido se analiza esta relación a la luz del (...) ordenamiento jurídico venezolano, enmarcada en una investigación de tipo documental, mediante la observación directa y aplicándola hermenéutica jurídica y teniendo como bases fundamentales la Constitución de la República Bolivariana de Venezuela (Asamblea Nacional Constituyente, 1999), Código Orgánico Tributario (Asamblea Nacional, 2001), jurisprudencia patria y de la doctrina tanto nacional como extranjera, se determinó en esta investigación la génesis de la Relación Jurídica Tributaria a través de los actores intervinientes, Sujeto activo, Sujeto Pasivo en sus distintas posiciones, contribuyente solidario, contribuyente Responsable, de igual forma la Relación Jurídica Tributaria desencuentra fundamentada en el hecho imponible, siendo esta la raíz de la tributación a cualquier nivel, bien sean impuestos, tasas o contribuciones. Igualmente la base imponible, significa representación monetaria del hecho imponible la cual será objeto de un tratamiento fiscal para una determinación de un tributo a pagar. (shrink)

Not a single day goes by without some news about personalized medicine, especially in its genomic context (precision medicine). In tandem with the scientific excitement, however, come the cautionary notes. These include worries about Big Brother surveillance, concerns about the impact of genomic results on the psychosocial well‐being of patients and research subjects, and attention to issues of social and distributive justice. Personalised Medicine, Individual Choice and the Common Good, coedited by Britta van Beers, Sigrid Sterckx, and Donna Dickenson, falls (...) squarely into this discourse with an aim to “fuel and stimulate the debate about personalised medicine and enable its participants to come to a more balanced understanding of the interests and values at stake.” At its core, the book laments the shift from “We Medicine” to “Me Medicine,” with ostensibly all authors highlighting that, on balance, the costs associated with “Me Medicine” far outweigh the benefits. This is both a strength and a weakness of the book. (shrink)

With twentieth- and twenty-first-century philosophy of science’s unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. The (...) worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that non-epistemic values can be rationally evaluated and that standpoint epistemology’s universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding, I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. I further argue that my recommended empiricist methodology is preferable to Psillos’s search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science. (shrink)

This article seeks to explore the relationship between populism, 21st-century socialism, and the emergence of what has been referred to as an ‘ estado delincuente’ (criminal state), in the case of Venezuela. That is, a state structure permeated with transnational organized crime mafias in the executive and the judiciary, in the financial system, the prosecutor’s office, the police, the armed forces, the prison system, state-owned companies, governorships, and city councils, among other state institutions. First, I review conceptual aspects of populism (...) to understand how this served as the basis for creating the postulates of 21st-century socialism, which promoted the institutional destruction of Venezuelan democracy and created the conditions for the unbridled dissemination of state corruption. Second, emblematic cases of white-collar and blood crimes, nepotism and other corrupt activities are discussed to provide an idea of the magnitude of the issues that permeate the state apparatus. To conclude, I provide a critical summary of the consequences of this way of doing politics in contemporary Venezuela. (shrink)

One of the most fundamental and recurring issues in the social sciences--the relation between language and thought--is examined in this work from a broad and coherent interdisciplinary perspective. Many of the great historical issues are also addressed and newly examined such as: the multifunctionality of language, the role of natural logic in the structuring of linguistic rules, and the place of linguistic disambiguation and repair in particular cultures.

Pinhas Sadeh was considered as an unorthodox writer as regards his environment, the “State Culture” in Israel. In the first part of this paper I present the biography of the author and his most representative work, Life as a parable, published in 1958, as well as his romantic and frankist roots and his leaning towards Christianity according to the Gospel. In the second part a mythical analysis of this work is made according to the inner journey of hero, through which (...) the main character is looking for his life meaning. In this second part I present my methodology, based on works of the Eranos Society (Mircea Eliade, C.G. Jung, Gilbert Durand). Afterwards, I analyse the mithems that I have found in Life as a parable. Finally, I make a mythical comparison between this novel and Siddharta, of Hermann Hesse. (shrink)

Nursing as a profession seems to avoid considering the problem of racism. There is, however, a need to address this topic and to evaluate its implications for nursing practice. This article attempts to establish a rationale for nursing to address racism and introduce it into academic discourse. The results of a small-scale study by the author are analysed and the implications for ethical-moral reasoning in nursing practice are discussed in relation to professional codes of conduct developed by nurses’ professional organizations (...) in the UK and elsewhere. (shrink)

MA Thesis. Biomedical ethics does not lend itself to easy categorisation as either a 'theoretical' or a 'practical' enterprise because inquiry into the quandaries of morality requires both situational and 'translocal' perspectives. These types of investigation bring into question the legitimacy of the theory/practice divide that has dominated intellectual thought since antiquity. This division hinders the development of bioethics by fostering internal dispute within the discipline regarding appropriate methodology and the practice of clinical ethics. In this thesis, I argue that (...) much of these disciplinary disjunctions are due to an undue labeling of bioethics as either 'applied ethics' or 'practical ethics', and a failure to recognise the intricate way in which theory and practice inform each other and are integral and interrelated parts of moral deliberation. I argue for an integration of the theory and practice of bioethics. (shrink)