Research regarding the drivers of acceptance of clinical decision support systems by physicians is still rather limited. The literature that does exist, however, tends to focus on problems regarding the user-friendliness of CDSS. We have performed a thematic analysis of 24 interviews with physicians concerning specific clinical case vignettes, in order to explore their underlying opinions and attitudes regarding the introduction of CDSS in clinical practice, to allow a more in-depth analysis of factors underlying acceptance of CDSS. We identified three (...) general themes from the results. First, ‘the perceived role of the AI’, including items referring to the tasks that may properly be assigned to the CDSS according to the respondents. Second, ‘the perceived role of the physician’, referring to the aspects of clinical practice that were seen as being fundamentally ‘human’ or non-automatable. Third, ‘concerns regarding AI’, including items referring to more general issues that were raised by the respondents regarding the introduction of CDSS in general and/or in clinical medicine in particular. Apart from the overall concerns expressed by the respondents regarding user-friendliness, we will explain how our results indicate that our respondents were primarily occupied by distinguishing between parts of their job that should be automated and aspects that should be kept in human hands. We refer to this distinction as ‘the division of clinical labor.’ This division is not based on knowledge regarding AI or medicine, but rather on which parts of a physician’s job were seen by the respondents as being central to who they are as physicians and as human beings. Often the respondents’ view that certain core parts of their job ought to be shielded from automation was closely linked to claims concerning the uniqueness of medicine as a domain. Finally, although almost all respondents claimed that they highly value their final responsibility, a closer investigation of this concept suggests that their view of ‘final responsibility’ was not that demanding after all. (shrink)

An extensive body of research documents that women experience a motherhood penalty at work whereas men experience a fatherhood premium. Yet much of this work presupposes that employers are aware of a worker’s parental status. Given the different consequences that parenthood has on outcomes such as pay and promotions, it is conceivable that men and women may deploy their status as parents differently when interacting with employers. Drawing on in-depth interviews with a racially diverse sample, this article examines how mothers (...) and fathers working in the service sector use their parental status when negotiating work and child care responsibilities. Mothers, particularly black mothers, were less likely to openly discuss their children at work. In some cases, women purposefully concealed from their employers the fact that they were mothers or found other ways of signaling their commitment to their jobs. Fathers, on the other hand, were more likely to discuss their children with their employers and overwhelmingly characterized their managers as understanding of their parenting obligations. Together, these findings help us understand how mothers and fathers navigate the consequences of parenthood in the workplace and add nuance to previous studies of motherhood penalties and fatherhood premiums. (shrink)

The last decade has seen a new wave of interest in philosophical and theoretical circles in the writings of Walter Benjamin. In _Body-and Image-Space_ Sigrid Weigel, one of Germany's leading feminist theorists and a renowned commentator on the work of Walter Benjamin, argues that the reception of his work has so far overlooked a crucial aspect of his thought - his use of images. Weigel shows that it is precisely his practice of thinking in images that holds the key (...) to understanding the full complexity, richness and topicality of Benjamin's theory. (shrink)

A semantics for interrogatives is presented which is based on Karttunen's theory, but in a flexible manner incorporates both weak and strong exhaustivity. The paper starts out by considering degree questions, which often require an answer picking out the maximal degree from a certain set. However, in some cases, depending on the semantic properties of the question predicate, reference to the minimal degree is required, or neither specifying the maximum nor the minimum is sufficient. What is needed is an operation (...) which defines the maximally informative answer on the basis of the Karttunen question denotation. Shifting attention to non-degree questions, two notions of answerhood are adopted from work by Heim. The first of these is weakly exhaustive and the second strongly exhaustive. The second notion of answerhood is proven to be equivalent to Groenendijk and Stokhof's interrogative semantics. On the basis of a wide range of empirical data showing that questions often are not interpreted exhaustively, it is argued that a fairly rich system of semantic objects associated with questions is needed to account for the various ways in which questions contribute to the semantics and pragmatics of the utterances in which they appear. (shrink)

Management of the renewable natural resources in Madagascar is gradually being transferred to the local communities, particularly that of forest resources. However, these local communities are struggling to assess the consequences of management plans that they themselves must develop and implement on ecologically, economically and socially sustainable grounds. In order to highlight key aspects of different management options beforehand, we have developed MIRANA, a computer model to simulate various scenarios of management plan implementation. MIRANA differs from other simulation models by (...) not only taking into account individual practices and economic exchanges, but also by accounting for the applicable regulations. These regulations are taken into consideration by means of a multiplicity of normative structures within a spatial context. The objective of this paper is to describe the representations of institutions, norms and territories proposed by MIRANA and to discuss these representations in relation to the state of the art in the field of normative multi-agent systems. (shrink)

Considéré de nos jours comme l’un des principaux représentants de la phénoménologie expérimentale, le psychologue Albert Michotte (1881-1965) n’a adopté que sur le tard le terme de « phénoménologie expérimentale » pour qualifier sa démarche. Dans cet article, j’étudie l’usage qu’il fait de cette dénomination, les implications de ce choix ainsi que l’interprétation qu’il en a donnée. Je montre, notamment, comment une discussion entre Michotte et le traducteur anglais de son livre, Tim R. Miles, a été importante pour déterminer l’orientation (...) de la seule présentation explicite que Michotte a publiée de sa phénoménologie expérimentale. L’étude des différents rôles que ce terme a été amené à jouer dans l’œuvre de Michotte montre également les problèmes soulevés par la communication entre différentes disciplines (la philosophie et la psychologie expérimentale) et écoles psychologiques dans lesquelles ce concept a été à la fois employé et débattu : cette communication demandait un véritable travail de traduction. (shrink)

We expand on Della Croce’s ambition to interpret “epistemic injustice” as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce’s attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of (...) epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson’s concept of “contributory injustice” and Scheman’s concept of “perceptual autonomy,” we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. (shrink)

(1) a. Satoshi sent Thilo the Schw¨abische W¨orterbuch. b. Satoshi sent the Schw¨abische W¨orterbuch to Thilo. Many have entertained the notion that there is a rule that relates sentences such as these. This is suggested by the fact that it is possible to learn that a newly coined verb licenses one of them and automatically know that it licenses the other. Marantz (1984) argues for the existence of such a rule in this way, noting that once one has learned of (...) the new verb shin by exposure to (2a), the grammaticality of (2b) is also learned. (2) a. Thilo shinned the ball to Satoshi. b. Thilo shinned Satoshi the ball. This is explained if there is a rule that ties the double object frame together with the NP+PP frame, making it sufficient to know that a verb licenses one if it licenses the other. Frequently, the rule involved has been taken to be syntactic in nature. See, among many others, Fillmore (1965), Oehrle (1976), Baker (1988), and Larson (1988). The leading idea under this view is that the two frames are simply different surface manifestations of the same underlying structure. Typically, this approach posits that the NP+PP frame represents that underlying structure from which the double object frame is transformationally derived. There is evidence, however, that the two frames instead have different underlying structures, and are not related by transformation. This evidence, then. (shrink)

An ‘Information Centre’ has recently been established by law which has the power to collect, collate and provide access to the medical information forall patients treated by the National Health Service in England, whether in hospitals or by General Practitioners. This so-called ‘care.data’ scheme has given rise to major and ongoing controversies. We will sketch the background of the scheme and look at the responses it has elicited from citizens and medical professionals. In Autumn 2013, NHS England set up a (...) care.data website where citizens could record their concerns regarding the collection of health-related data by the Information Centre. We have reviewed all the comments on this website up until June 2015. We have also analysed the readers’ comments on the coverage of the care.data scheme in one of the main national UK newspapers. When discussing the responses of citizens, we will make a distinction between the problems that citizens detect and the solutions they propose. The solutions that are being perceived as the most relevant ones can be summarized as follows: citizens wish to further the common good without being manipulated into doing it, while at the same time being safeguarded against various abuses. The issue of trust turns out to figure prominently. Our analysis of reactions to the scheme in no way pretends to be exhaustive, yet it provides various relevant insights into the concerns identified by citizens as well as medical professionals. These concerns, moreover, have a more general relevance in relation to other contexts of medical data-mining as well as biobank research. Our analysis also offers important pointers as to how those concerns might be addressed. (shrink)

In this paper I argue for a restriction on certain types of LF movement, which I call ‘wh-related LF movement’. Evidence comes from a number of wh-in-situ constructions in German, such as the scope-marking construction and multiple questions. For semantic reasons, the in situ element in those constructions has to move at LF to either a position reserved for wh-phrases, or even higher up in the structure. The restriction (the Minimal Quantified Structure Constraint, MQSC) is that an intervening quantified expression (...) blocks this movement. In the case of every, the MQSC leads to an unambiguously distributive interpretation of the question. In the case of all other intervening operators, including negation, it leads to ungrammaticality. (shrink)

ABSTRACTMore than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them.One of the important determinants of access to drugs is the working of the patent system. This paper (...) first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO‐TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so‐called ‘Doha Declaration on the TRIPs Agreement and Public Health’, which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors. (shrink)

This paper proposes that elementary reciprocal sentences have four semantic readings: a strongly reciprocal interpretation, a weakly reciprocal interpretation, a situation-based weakly reciprocal reading, and a collective reading. Interpretational possibilities of reciprocal sentences that have been discussed in the literature are identified as one of these four. A compositional semantic analysis of all of these readings is provided in which the reciprocal expression is uniformly represented as 'the other ones among them' (recasting Heim, Lasnik and May 1991a, b). A reciprocal (...) sentence is thus a special kind of relational plural. Interpretational variability comes about by the same mechanisms of plural predication at work in relational plurals: pluralization operators, LF operations like QR, and addition of contextual information. (shrink)

Proceeding from the statement that «reading» images is not at all analogous to any culturally codified lecture of written texts, Sigrid Weigel develops a crucial critic of the anthropological paradigm linked to the left-right problem in the visual arts. Focusing on various examples of painted and sculpted Annunciations, the author argues how the decline of the traditional orientation, based on the figure of God in central position, leads to a growing importance of the spectator gaze and to a new (...) relation between iconic narration and symbolic meaning. (shrink)

The paper provides a semantic analysis of intervention effects in wh-questions. The interpretation component of the grammar derives uninterpretability, hence ungrammaticality, of the intervention data. In the system of compositional interpretation that I suggest, wh-phrases play the same role as focused phrases, introducing alternatives into the computation. Unlike focus, wh-phrases make no ordinary semantic contribution. An intervention effect occurs whenever a focus-sensitive operator other than the question operator tries to evaluate a constituent containing a wh-phrase. It is argued that this (...) approach can capture the universal as well as the crosslinguistically variable aspects of intervention effects, in a way that is superior to previous approaches. Further consequences concern other focus-related constructions: multiple focus data, NPI licensing, and alternative questions. (shrink)

Since the 1980s in the US and the 1990s in Europe, patenting and licensing activities by universities have massively increased. This is strongly encouraged by governments throughout the Western world. Many regard academic patenting as essential to achieve ‘knowledge transfer’ from academia to industry. This trend has far-reaching consequences for access to the fruits of academic research and so the question arises whether the current policies are indeed promoting innovation or whether they are instead a symptom of a pro-intellectual property (...) (IP) culture which is blind to adverse effects. Addressing this question requires both empirical analysis (how real is the link between academic patenting and licensing and ‘development’ of academic research by industry?) and normative assessment (which justifications are given for the current policies and to what extent do they threaten important academic values?). After illustrating the major rise of academic patenting and licensing in the US and Europe and commenting on the increasing trend of ‘upstream’ patenting and the focus on exclusive as opposed to non-exclusive licences, this paper will discuss five negative effects of these trends. Subsequently, the question as to why policymakers seem to ignore these adverse effects will be addressed. Finally, a number of proposals for improving university policies will be made. (shrink)

The object of this dissertation is to discover a ground for our common-sense view that a person is morally responsible for her actions. I begin with the assumption that if we are justified in holding an agent morally responsible, it must be possible for her to do better or worse than she does. Using Bergson's concept of duration as the model for how conscious experience develops, I construct a schema for how actions happen that shows how it is possible for (...) the agent to act otherwise than she does. I adopt Bergson's approach to understanding persons and their relationship to their actions because it accounts for the durational/mental aspect of the human being as well as the spatial/physical aspect. We can better understand how the person produces an action if we think of her not only as a living body with repeating life processes but also as an ongoing mental process. ;Bergson's approach can help us to understand and support theories of agent-causation. I have focused on Chisholm's concept of agent-causation and the difficulty in explaining how immanent causation happens. In Bergson's schema, making events happen is an integral part of the process of conscious experience that the human being is. As a physical body a person undergoes events; however, as a process of conscious experience, that same person becomes aware of those events in the context of her experience and can evaluate them in order to envision and implement a new approach to her situation. When the person operates in this creative mode, viewing her situation from what Bergson calls the natural standpoint, she immanently causes her own action. ;For morality, the important choice the agent makes is whether or not to assume the natural standpoint as the point of departure for her efforts. The agent can take the most credit for an action that she has developed herself. Such an action fully engages the agent's knowledge and abilities, and so best represents the person that the agent becomes through completing the action. Even in allowing habit to direct her efforts, however, the agent is minimally responsible for her action insofar as she could have chosen to bypass those directions and to act creatively. (shrink)

Limits of a (historico-)philosophical discourse vis-a-vis the rutpure in the fabric of civilization marked by the shoah. Examines the textual place of those aspects of history which elude rational analysis.

The paper develops a uniform compositional analysis of the various readings of the scalar particle still and its German counterpart noch. Noch/still is a presuppositional scalar particle that gives rise to implicatures. Interpretive possibilities arise through different choices for the scale that the particle associates with, different attachment sites in the syntax, and interaction with focus. These interpretive parameters allow for a wide range of possible sentence interpretations, which overlap, but do not coincide for still and noch. The contrastive perspective (...) allows us to examine the role of scales in the grammar. The implicatures triggered by the scalar item open an interesting perspective for the generation of implicatures in general. (shrink)

Continuous sedation until death is an increasingly common practice in end-of-life care. However, it raises numerous medical, ethical, emotional and legal concerns, such as the reducing or removing of consciousness, the withholding of artificial nutrition and hydration, the proportionality of the sedation to the symptoms, its adequacy in actually relieving symptoms rather than simply giving onlookers the impression that the patient is undergoing a painless 'natural' death, and the perception that it may be functionally equivalent to euthanasia. This book brings (...) together contributions from clinicians, ethicists, lawyers and social scientists, and discusses guidelines as well as clinical, emotional and legal aspects of the practice. The chapters shine a critical spotlight on areas of concern and on the validity of the justifications given for the practice, including in particular the doctrine of double effect. (shrink)

This paper develops a semantic analysis of data like It is getting colder and colder. Their meaning is argued to arise from a combination of a comparative with pluractionality. The analysis is embedded in a general theory of plural predication and pluractionality. It supports a semantic theory involving a family of syntactic plural operators.

This paper examines the effect that focus has on repetitive versus restitutive again. It is argued that a pragmatic explanation of the effect is the right strategy. The explanation builds largely on a standard focus semantics. To this we add an anaphoric analysis of again’s presupposition and a detailed analysis of the alternatives triggered when focus falls on again.

An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed (...) and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature. (shrink)

ZusammenfassungDie empirische Ethik sieht ihre eigene Aufgabe darin, soziale und kulturelle Aspekte der Medizin zu berücksichtigen. Damit trennt sie den wissenschaftlich kognitiven Aspekt der Medizin von kulturell normativen Aspekten, die einzig sozialwissenschaftlich zu erforschen wären. Wenn Medizin aber als gesellschaftliche Praxis begriffen wird, wird die saubere Trennung zwischen naturwissenschaftlicher Medizin, kulturell-normativen Aspekten und ethischer Reflexion durchbrochen. Wir schlagen vor, ethische Reflexion und empirische sozialwissenschaftliche Forschung in mehrstufiger Weise aufeinander zu beziehen. Den Sozialwissenschaften kommt dabei die Funktion einer ersten Reflexionsinstanz der (...) medizinischen Praxis zu, an die in einem zweiten Schritt die Medizinethik reflexiv anschließt und sich dabei wieder einer soziologischen Kritik stellen muss. (shrink)

New-born screening programs for congenital disorders and chronic disease are expanding worldwide and children “at risk” are identified by nationwide tracking systems at the earliest possible stage. These practices are never neutral and raise important social and ethical questions. An emergent concern is that a reflexive professionalism should interrogate the ever earlier interference in children’s lives. The Flemish community of Belgium was among the first to generalize the screening for hearing loss in young children and is an interesting case to (...) study the public justification of early interventions for families with deaf children. This article uses a critical lens to study the archive of the government child healthcare organization in Flanders in order to uncover underlying constructions of childhood, deafness, and preventive health. We focus on two interrelated themes. The first is the notion of exclusion of the human factor through the mediation of technology. The second is the idea of deafness as endangering a healthy development, an impairment that can nevertheless be treated if detected early enough. It is argued that, since deafness cannot be viewed as a life-threatening condition, the public interest which is implicitly defended is not the rescue of deaf children rather the exclusion of otherness. (shrink)

Wie müssen wir zurückschauen, um Was sehen zu können und darüber unseren Blick für das Gegenwärtige und Kommende zu schärfen?0Die Beiträge des Bandes, der zu Ehren von Sigrid Schade erscheint, beziehen sich auf vielschichtige Diskursgeschichten an den Schnittstellen von Kunst-, Kultur- und Medienwissenschaften. Sie beleuchten künstlerische, kulturelle und soziale Praktiken und Ordnungen als Aushandlungsort komplexer Bedeutungs- und Beziehungsgefüge.

The semantic literature takes degree operators like the comparative, but also measure phrases, the equative, the superlative and so on, to be quantifiers over degrees. This is well motivated by their semantic contribution, but leads one to expect far more scope interaction than is actually observed. This paper proposes an alternative-semantic analysis of certain degree constructions, in particular constructions with little and other negative antonyms. Restrictions on scope can then be explained as intervention effects.

Since the adoption of the WTO-TRIPS Agreement in 1994, there has been significant controversy over the impact of pharmaceutical patent protection on the access to medicines in the developing world. In addition to the market exclusivity provided by patents, the pharmaceutical industry has also sought to further extend their monopolies by advocating the need for additional ‘regulatory’ protection for new medicines, known as data exclusivity. Data exclusivity limits the use of clinical trial data that need to be submitted to the (...) regulatory authorities before a new drug can enter the market. For a specified period, generic competitors cannot apply for regulatory approval for equivalent drugs relying on the originator's data. As a consequence, data exclusivity lengthens the monopoly for the original drug, impairing the availability of generic drugs. This article illustrates how the pharmaceutical industry has convinced the US and the EU to impose data exclusivity on their trade partners, many of them developing countries. The key arguments formulated by the pharmaceutical industry in favor of adopting data exclusivity and their underlying ethical assumptions are described in this article, analyzed, and found to be unconvincing. Contrary to industry's arguments, it is unlikely that data exclusivity will promote innovation, especially in developing countries. Moreover, the industry's appeal to a property rights claim over clinical test data and the idea that data exclusivity can prevent the generic competitors from ‘free-riding’ encounters some important problems: Neither legitimize excluding all others. (shrink)

This paper offers a few elements of an answer to the question to what extent drug patents can be morally justified. Justifications based on natural rights, distributive justice and utilitarian arguments are discussed and criticized. The author recognizes the potential of the patents to benefit society but argues that the system is currently evolving in the wrong direction, particularly in the field of drugs. More than a third of the world’s population has no access to essential drugs. The working of (...) the patent system is an important determinant of access to drugs. This paper argues that drug patents are not easily justified and that the ‘architecture’ of the patent system should be rethought in view of its mission of benefiting society. (shrink)

Three attempts are usually made to justify patents: natural rights, distributive justice, and consequentialist arguments, all of which I contest.The natural rights argument is traced back to John Locke, defender of the ‘labour theory of property,’ who essentially holds that persons have a right to property insofar as they have mixed their labour with it, and insofar as they have appropriated natural things without exhausting them or taking more than their share. Yet, the inventor’s mixing of labour is often the (...) last step of a longer historical process, and patents seem to encourage waste, since they restrict the use of an idea.The distributive justice argument holds that patents reward the initiative of inventors – with out this reward, ‘free riders’ would be able to compete unfairly; the exclusivity granted by patents corrects this hole in the free market. However, our current system does not necessarily reflect this principle; it is difficult to clarify the criteria on which an inventor deserves a reward; unsuccessful inventors and basic researchers also invest much initiative, and yet are not rewarded; it is unclear that justice should reward someone by granting them the exclusive right to determine what is done with knowledge; and no link exists between the social usefulness of an invention and the scope of protection granted by a patent.The consequentialist justification holds that patents encourage innovation, and the disclosure of knowledge. Although it is clear that patents encourage inventions, it is not clear that they encourage progress – they may even limit progress by restricting use of previous knowledge. As for the disclosure of knowledge: such knowledge is hard to keep secret in the first place, and patent offices grant overly broad patents.In conclusion, this paper offers some suggestions concerning the true costs of the patent system. (shrink)

In 1975, a delegation of U.S. entomologists traveled to socialist China to observe Chinese insect control science. Their overwhelmingly positive reports highlighted in relief the pernicious effects of pesticide corporations on U.S. agriculture; some entomologists hoped this would goad the United States to catch up to China in environmentally sensible insect control practices. Of course, insect control in socialist China carried its own political baggage, some of which—for example, mass mobilization and self-reliance—the state made highly visible to visitors, and some (...) of which—for example, harsh treatment of scientists—it sought to obscure. For both the U.S. and the Chinese participants, the act of comparison itself was of primary significance in the exchange, allowing them to construct socialist Chinese science as refreshingly different from U.S. science. At the same time, however, this construction of difference meant forgetting the much longer transnational history in which U.S. and Chinese entomology had been intertwined. (shrink)