The development of artificial intelligence (AI) in medicine raises fundamental ethical issues. As one example, AI systems in the field of mental health successfully detect signs of mental disorders, such as depression, by using data from social media. These AI depression detectors (AIDDs) identify users who are at risk of depression prior to any contact with the healthcare system. The article focuses on the ethical implications of AIDDs regarding affected users’ health-related autonomy. Firstly, it presents the (ethical) discussion of AI (...) in medicine and, specifically, in mental health. Secondly, two models of AIDDs using social media data and different usage scenarios are introduced. Thirdly, the concept of patient autonomy, according to Beauchamp and Childress, is critically discussed. Since this concept does not encompass the specific challenges linked with the digital context of AIDDs in social media sufficiently, the current analysis suggests, finally, an extended concept of health-related digital autonomy. (shrink)

Doctors occasionally make diagnoses in strangers outside of formal medical settings by using the medical skill of visual inspection, such as noticing signs of melanoma or the symptoms of hyperthyroidism. This may cause considerable moral unease and doubts on the side of the diagnosing physician. Such encounters force physicians to consider whether or not to intervene by introducing themselves to the stranger and offering an unsolicited medical opinion despite the absence of a formal doctor-patient relationship. A small body of literature (...) has addressed the topic of the unsolicited medical opinion, often with a primary focus on practical advice. This article seeks to establish an ethical-theoretical basis for physicians' ethical obligation to offer an unsolicited medical opinion when they make a diagnosis by visual inspection in a stranger outside of the formal medical context. Using a utilitarian approach, it is argued that, if it is in the physicians' power to prevent a possible loss of well-being, without thereby sacrificing anything of equal value, physicians have an ethical obligation to intervene. (shrink)

Bell’s theorem is often said to imply that quantum mechanics violates local causality, and that local causality cannot be restored with a hidden-variables theory. This however is only correct if the hidden-variables theory fulfils an assumption called Statistical Independence. Violations of Statistical Independence are commonly interpreted as correlations between the measurement settings and the hidden variables. Such correlations have been discarded as “fine-tuning” or a “conspiracy”. We here point out that the common interpretation is at best physically ambiguous and at (...) worst incorrect. The problem with the common interpretation is that Statistical Independence might be violated because of a non-trivial measure in state space, a possibility we propose to call “supermeasured”. We use Invariant Set Theory as an example of a supermeasured theory that violates the Statistical Independence assumption in Bell’s theorem without requiring correlations between hidden variables and measurement settings. (shrink)

Women who suffer from fertility issues often use in vitro fertilization (IVF) to realize their wish to have children. However, IVF has its own set of strict administration rules that leave the women physically and emotionally exhausted. Feeling alienated and frustrated, many IVF users turn to internet IVF-centered forums to share their stories and to find information and support. Based on the observation of Dutch and Greek IVF forums and a selection of 109 questionnaires from Dutch and Greek IVF forum (...) users, we investigate the reasons why users of IVF participate in online communities centered on IVF, their need for emotional expression and support, and how they experience and use the information and support they receive through their participation in the online community. We argue that the emotional concerns expressed in such forums should be taken into account by health care ethics committees for IVF-related matters in order to promote more patient-oriented care and support for women going through IVF. (shrink)

The concepts of disease, illness and sickness capture fundamentally different aspects of phenomena related to human ailments and healthcare. The philosophy and theory of medicine are making manifold efforts to capture the essence and normative implications of these concepts. In parallel, socio-empirical studies on patients’ understanding of their situation have yielded a comprehensive body of knowledge regarding subjective perspectives on health-related statuses. Although both scientific fields provide varied valuable insights, they have not been strongly linked to each other. Therefore, the (...) article aims to scrutinise the normative-ethical implications of patient perspectives in building a bridge to the empirical ethics debates. Three potential fields of tension between the illness and the disease perspective are presented. Consequently, findings from empirical research examining patient perspectives on illness are displayed and the practical implications and associated ethical issues which arise are discussed. This leads to the conclusion that an explicit and elaborate empirical-ethical methodology is needed to deal appropriately with the complex interaction between patients’ views and the medico-professional view of disease. Kon’s four-stage model of normative-empirical collaboration is then applied against the background of empirical data on patient perceptions. Starting from this exemplary approach, the article suggests employing empirical-ethical frameworks for further research on the conceptual and normative issues, as they help to integrate perspectives from the philosophy of medicine with socio-empirical research. The combination of theoretical and empirical perspectives suggested contributes to a more nuanced discussion of the normative impact of patients’ actual understanding of illness. Further empirical research in this area would profit from explicitly considering potential ethical issues to avoid naturalistic fallacies or crypto-normative conclusions that may compromise healthcare practice. Vice versa, medico-theoretical debates could be enriched by integrating subjective views of those people who are immediately affected. (shrink)

During the last three decades, there have been great advances in our understanding of the neural mechanisms of selective attention, at the network as well as the cellular level. The Oxford Handbook of Attention brings together the different research areas that make up contemporary attention research into one comprehensive and authoritative volume.

There is an ongoing expert debate with regard to financial incentives in order to increase organ supply. However, there is a lacuna of empirical studies on whether citizens would actually support financial incentives for organ donation.

Background Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-term home care and discussed these empirical perspectives regarding moral responsibilities. Objectives To identify the subjective concepts of the health of (...) non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-term home care and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals’ responsibilities and rights concerning health. Research design A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring. Participants and research context Twenty-eight interviews were conducted with non-professionals and professionals in long-term home care arrangements in Northern Germany. Ethical considerations Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16). Findings Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it. Discussion Normative guidelines applicable to practice in long-term home care discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals’ subjective concepts of health. Conclusion Individuals’ concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively. (shrink)

In this comment we take up two points made by Douglas Hollan in his article “Emerging Issues in the Cross-Cultural Study of Empathy,” and discuss their possible philosophical implications. Hollan‘s concept of complex empathy may give rise to the idea that we can learn about other people’s beliefs via empathy, which is something we do not believe is possible. Furthermore, Hollan’s description of possible negative effects of empathy, such as manipulations of a person on the basis of knowledge about their (...) emotions, might pose a problem for proponents of care ethics, who generally start from the assumption that empathy fosters altruistic behavior. (shrink)

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps (...) with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

Gender inequalities in education – in terms of systematic variations in access to educational institutions, in competencies, school marks, and educational certificates along the axis of gender – have tremendously changed over the course of the 20 th century. Although this does not apply to all stages and areas of the educational career, it is particularly obvious looking at upper secondary education. Before the major boost of educational expansion in the 1960s, women’s participation in upper secondary general education, and their (...) chances to successfully finish this educational pathway, have been lower than men’s. However, towards the end of the 20 th century, women were outperforming men in many European countries and beyond. The international contributions to this book attempt to shed light on the mechanisms behind gender inequalities and the changes made to reduce this inequality. Topics explored by the contributors include gender in science education in the UK; women’s education in Luxembourg in the 19 th and 20 th century; the ‘gender gap’ debates and their rhetoric in the UK and Finland; sociological perspectives on the gender-equality discourse in Finland; changing gender differences in West Germany in the 20 th century; the interplay of subjective well-being and educational attainment in Switzerland; and a psychological perspective on gender identities, gender-related perceptions, students’ motivation, intelligence, personality, and the interaction between student and teacher gender. This book was originally published as a special issue of _Educational Research. _. (shrink)

At the same time new versions of foundationalism were crafted, that were claimed to be immune to the earlier criticisms. This volume contains 12 papers in which various aspects of this dialectic are covered.

In his metaphysics Francis of Marchia (~1290-1344) introduces for the first time, on the basis of a freshly revised doctrine of the transcendentals, a systematic division of general and special metaphysics, a significant development for the ...

To organise future behaviour, it is important to remember both the central and contextual aspects of a situation. We examined the impact of contextual threat or safety, learned through verbal instructions, on face identity recognition. In two studies (N = 140), 72 face–context compounds were presented each once within an encoding session, and an unexpected item/source recognition task was performed afterwards (including 24 new faces). Hierarchical multinomial processing tree modelling served to estimate individual parameters of item (face identity) and source (...) memory (threat or safety context) as well as guessing behaviour. Results show that language was highly effective in establishing threatening and safe context conditions. In Study 1, a fleeting picture stream (1 s per picture) led to poor item and source recognition. Prolonged presentation times (Study 2 with 6 s per picture) improved face memory but no contextual modulation was observed. Thus, incidental face learning was surprisingly poor and rapidly changing contextual settings might have interfered with the accurate encoding of face identity information and item–source binding. (shrink)

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)

Definition of the problem Interprofessional learning of nursing trainees and medical students offers numerous opportunities for future cooperation aiming to provide high-quality care for patients. Arguments Expert panels, therefore, demand early integration of interprofessional teaching and learning structures in order to be able to achieve effective and sustainable improvements in practice. In Germany, interprofessional learning formats are increasingly used in undergraduate education of the two professions in selected—compulsory and optional—themes and courses. Conclusion So far, the field of health care ethics (...) has scarcely been taken into consideration. The article examines the situation of interprofessional ethics teaching in Germany and highlights its opportunities and limitations against the background of a pilot project. (shrink)

The umbrella-term ‘executive functions’ includes various domain-general, goal-directed cognitive abilities responsible for behavioral self-regulation. The influential unity and diversity model of EF posits the existence of three correlated yet separable executive domains: inhibition, shifting and updating. These domains may be influenced by factors such as socioeconomic status and culture, possibly due to the way EF tasks are devised and to biased choice of stimuli, focusing on first-world testees. Here, we propose a FREE test battery that includes two open-access tasks for (...) each of the three abovementioned executive domains to allow latent variables to be obtained. The tasks were selected from those that have been shown to be representative of each domain, that are not copyrighted and do not require special hardware/software to be administered. These tasks were adapted for use in populations with varying SES/schooling levels by simplifying tasks/instructions and using easily recognized stimuli such as pictures. Items are answered verbally and tasks are self-paced to minimize interference from individual differences in psychomotor and perceptual speed, to better isolate executive from other cognitive abilities. We tested these tasks on 146 early adolescents of both sexes and varying SES, because this is the age group in which the executive domains of interest become distinguishable and in order to confirm that SES effects were minimized. Performance was determined by Rate Correct Scores, which consider speed-accuracy trade-offs. Scores were sensitive to the expected improvement in performance with age and rarely/inconsistently affected by sex and SES, as expected, with no floor or ceiling effects, or skewed distribution, thus suggesting their adequacy for diverse populations in these respects. Using structural equation modeling, evidence based on internal structure was obtained by replicating the three correlated-factor solution proposed by the authors of the model. We conclude that the FREE test battery, which is open access and described in detail, holds promise as a tool for research that can be adapted for a wide range of populations, as well as altered and/or complemented in coming studies. (shrink)

Ce volume envisage l'amour en tant qu'objet polymorphe : Eros, Philia, Agapé, mais aussi Storgé. Les mots grecs rendent compte, du large spectre amoureux : amour romantique, amour sexuel, amour de soi, de l'autre, pour l'autre... des catégories qui placent les manifestations du sentiment amoureux dans un espace de contraintes et de possibilités qui relève du social et du discursif. Les travaux qui sont ici réunis s'attachent ainsi à interroger des genres artistiques et discursifs dans lesquels s'ancre l'amour, ils abordent (...) la littérature et le cinéma, mais aussi l'histoire, l'histoire des idées, la sociologie l'ethnologie ou la psychologie. Ces recherches mettent en avant que l'amour constitue une manière d'appréhender et d'expliquer le monde puisqu'on peut lire à travers lui les rapports qui définissent nos sociétés et qui le définissent à leur tour. (shrink)

In the film Never Let Me Go, clones are forced to donate their organs anonymously. As a work of fiction, this film can be regarded as a negotiation of limited agency, since the clones are depicted as vulnerable individuals. Thereby, it evokes a confrontation with underprivileged positions in technocratic societies, encouraging the audience to take the perspective of the marginalised. The clones are situated in ‘privileged deprivation’; from the audience’s point of view, they are unable to evolve into autonomous agents—but (...) from their own perspective within the dystopian system, they are still ‘privileged’. In this paper, we analyse the depiction of the clones’ personal development. Further, we examine references to bioethical aspects as well as technologies that affect the human body both on a micro and macro level—cloning and its impact on the human embryo and organ donation practised on the full-grown human body. We argue that this film as a reference for the discussion in popular culture focuses on individuals who do not profit from modern technical progress or do not have enough agency to refuse it. To make this point, we analyse the film’s fictional story, set in a form of alternate history, as a negotiation of a historical context which brings out the idea of neglected voices. (shrink)

The COVID-19 pandemic has been a threat to both physical and mental health. The spreading disease and its impacts, the containment measures and the way all of our lives have dramatically changed ha...

Acoustic signals serving intraspecific communication by predators are perceived by potential prey as warning signals. We analysed the acoustic characteristics of howling of wolves and found a striking similarity to the warning sounds of technical sirens. We hypothesize that the effectivity of sirens as warning signals has been enhanced by natural sensory predisposition of humans to get alerted by howling of wolves, with which they have a long history of coexistence. Psychoacoustic similarity of both stimuli seems to be supported by (...) the fact that wolves and dogs perceive the sound of technical sirens as a relevant releasing supernormal stimulus and reply to it with howling. Inspiration by naturally occurring acoustic aposematic signals might become an interesting example of biomimetics in designing new warning sound systems. (shrink)

The semantic fluency task is a widely used clinical tool in the diagnostic process of Alzheimer's disease. The task requires efficient mapping of the semantic space to produce as many items as possible within a semantic category. We examined whether healthy volunteers and patients with early Alzheimer's disease take advantage of and travel in the semantic space differently. With focus on the animal fluency task, we sought to emulate the detailed structure of the multidimensional semantic space by utilizing word2vec-method from (...) the natural language processing domain. To render the resulting multidimensional semantic space visually comprehensible, we applied a dimensionality reduction algorithm, which enabled a straightforward division of the semantic space into sub-categories. Moving in semantic space was quantified with the number of items created, sub-categories visited, and switches and returns to these sub-categories. Multinomial logistic regression models were used to predict the diagnostic group with these independent variables. We found that returning to a sub-category provided additional information, besides the number of words produced in the task, to differentiate patients with Alzheimer's dementia from both amnestic Mild Cognitive Impairment patients and healthy controls. The results suggest that the frequency of returning to a sub-category may serve as an additional aid for clinicians in diagnosing early Alzheimer's disease. Moreover, our results imply that the combination of word2vec and subsequent t-SNE-visualization may offer a valuable tool for examining the semantic space and its sub-categories. (shrink)

Background: In order to fully understand nurses’ ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. Research questions: What is the influence of context on nurses’ decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? Research design: A qualitative descriptive study inspired by the Grounded Theory approach was carried out. (...) Participants and research context: In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. Ethical considerations: The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. Findings: Relationships with nursing colleagues and the patient’s family form an inter-personal network. Nurses also point to the importance of the procedural–legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses’ decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. Discussion: The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. Conclusion: An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions. (shrink)

Causation is a core feature of human cognition and language. How children learn about intricate causal meanings is yet unresolved. Here, we focus on how children learn verbs that express causation. Such verbs, known as lexical causatives (e.g., break and raise), lack explicit morphosyntactic markers indicating causation, thus requiring that the child generalizes the causal meaning from the context. The language addressed to children presumably plays a crucial role in this learning process. Hence, we tested whether adults adapt their use (...) of lexical causatives to children when talking to them in day-to-day interactions. We analyzed naturalistic longitudinal data from 12 children in the Manchester corpus (spanning from 20 to 36 months of age). To detect semantic generalization, we employed a network approach with semantics learned from cross-situational contexts. Our results show an increasing trend in the expansion of causative semantics, observable in both child speech and child-directed speech. Adults consistently maintain somewhat more intricate causative semantic networks compared to children. However, both groups display evolving patterns. Around 28–30 months of age, children undergo a reduction in the degree of causative generalization, followed by a slightly time-lagged adjustment by adults in their speech directed to children. These findings substantiate adults' adaptation in child-directed speech, extending to semantics. They highlight child-directed speech as a highly adaptive and subconscious teaching tool that facilitates the dynamic processes of language acquisition. (shrink)

The anonymous treatise De sex inconvenientibus is a good example of the calculatores’ approach when dealing with motion. It is organized around four main questions relating to the determination of rapidity in four kinds of changes, i.e. in the generation of substantial forms, in alteration, in increase, and in local motion. In some arguments the author points out the paradoxes to which the two ways of determining the rapidity of a motion can lead: rapidity is determined by the effect produced (...) (the degree of quality generated, the space covered, etc.) or it results from the ratio between the moving power and the resistance of the mobile or patient. While this twofold approach to determining rapidity appears in the majority of calculator texts, the two points of view – the analysis according to its effects and the analysis according to its causes – have rarely been confronted. (shrink)