The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i) its interventive capacity, ii) its expansiveness and iii) its influence on the concept of disease, iv) its generalising character, v) its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its (...) factual face is evaluative. (shrink)

Like some ethical dilemmas, this question has an obvious answer that may not be right. On first reflection, it seems entirely unreasonable and inappropriate to expect staff members to withhold supportive care. Legally, a designated surrogate has the authority to refuse pain medication on the patient's behalf, but is it ethically defensible? A patient lacking decisionmaking capacity is crying out in pain; can we really imagine just closing the door? What do we say to other patients, visitors, and staff members, (...) such as physicians, nurses, housekeepers, and dietary workers, who might hear the patient? Do we place a sign on the door, one noting that the surrogate has refused, on behalf of the patient, to authorize the administration of pain medication and that the hospital or nursing home must comply with the surrogate's decision? (shrink)

The following description is based upon an actual case in which a patient initiated legal action after suffering a complication subsequent to an invasive diagnostic procedure performed by a senior fellow. Named as codefendants were the senior fellow, attending physician, and the hospital. Because any hospital with house staff is potentially vulnerable to similar litigation, Ethics Committees at Work is addressing the questions raised by this dilemma.

The belated but formal acknowledgment of medical errors and their impact has been well documented. Curiously, the topic of management or executive mistakes in healthcare is not raised in professional meetings nor, until recently, addressed by an article in health administration journals.

Our ethics committee is revising the organization's policy on forgoing life-sustaining treatment. The current policy now includes the statement, “When life-sustaining treatment is forgone, supportive care will be provided to relieve pain and ensure the patient's comfort, unless the patient or surrogate refuses those measures.” Is it reasonable, however, for the surrogate to have the authority to refuse consent for pain medication and/or other supportive care?

This paper presents a challenge to conciliationist views of disagreement. I argue that conciliationists cannot satisfactorily explain why we need not revise our beliefs in response to certain moral disagreements. Conciliationists can attempt to meet this challenge in one of two ways. First, they can individuate disputes narrowly. This allows them to argue that we have dispute-independent reason to distrust our opponents’ moral judgment. This approach threatens to license objectionable dogmatism. It also inappropriately gives deep epistemic significance to superficial questions (...) about how to think about the subject matter of a dispute. Second, conciliationists can individuate disputes widely. This allows them to argue that we lack dispute-independent reason to trust our opponents’ moral judgment. But such arguments fail; our background of generally shared moral beliefs gives us good reason to trust the moral judgment of our opponents, even after we set quite a bit of our reasoning aside. On either approach, then, conciliationists should acknowledge that we have dispute-independent reason to trust the judgment of those who reject our moral beliefs. Given a conciliationist view of disagreement’s epistemic role, this has the unattractive result that we are epistemically required to revise some of our most intuitively secure moral beliefs. (shrink)

Is technology value-free or is it value-laden? How does technology affect human autonomy? These questions, viewed within the context of medicine, are the focus of attention in this article. The central argument is that we need neither to subscribe to the value-neutrality dictum nor to the all-encompassing value-ladenness thesis to explain the pertinent position of technology in medicine. Technology is constitutive of and strongly implicated in difficult questions of value. This, however, does not mean that technology is identical to (or (...) neutral to) these value-laden questions. Technology poses issues of value, but only some of these relate to technology qua technology. Hence, it makes a difference whether we discuss general questions of value posed by technology or whether we discuss the value-ladenness of technology. Admitting technological value-ladenness does not imply that we are subject to a technological imperative that reduces our autonomy, on the contrary, it explains how technology increases our responsibility. This is particularly prominent in medicine. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

According to Ramsey and colleagues the main constituent psychological processes of innovation are response to novelty, exploration, and the ability to recognize a novel solution. I fully support this view but point out that novelty reactions are often context-specific. I will expand on this and discuss the possible consequences of context-specific novelty reactions on the emergence of innovations.

--2. Bd. Des Sokrates Apologie. Kriton. Euthydemos. Menexenos. Gorgias. Menon. Bearb. von H. Hofmann.--3. Bd. Phaidon. Das Gastmahl. Kratylos. Bearb. von D. Kurz.--4. Bd. Politeia. Der Staat. Bearb. von D. Kurz.--5. Bd. Phaidros. Parmenides. Briefe. Bearb. von D. Kurz.--6. Bd. Theaitetos. Der Sophist. Der Staatsmann. Bearb. von P. Staudacher.--7. Bd. Timaios, Kritias. Philebos. Bearb. von K. Widdra.--8. Bd. Nomōn. Gesetze. Bearb. von K. Schöpsdau. 2 v.

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

It is a commonly held belief among many psychological scientists that the more plausible a hypothesis, the better it is scientifically. It is also often believed that if there are two alternative theories which are equally strong in terms of explanatory power, one should choose the plausible theory over the implausible one. The goal of this article is to challenge these assumptions. Based on Popper's philosophical views, it will be argued that psychological scientists should be encouraged to formulate implausible hypotheses (...) and theories. Examples from other scientific disciplines will be presented to illustrate this argument. 2012 APA, all rights reserved). (shrink)

Hegel's Philosophy of History can be characterized as Eurocentric and one finds in it many problematic passages, and even racist statements, as well as a legitimization of colonialism which is presented as a means of education (Bildung). Nevertheless, this article argues that it is possible to reject such judgements and at the same time hold on to the basic intention of Hegel's theories of freedom and Bildung. While the concept of freedom as self-determination is certainly applied in a Eurocentric manner (...) by Hegel in his Philosophy of History, this concept is not Eurocentric at its core. To understand this ‘core’, one has to go back to Hegel's logic of the concept, which finally leads me to a concept of ‘concrete Bildung’. The struggles for self-determination of the colonized peoples must be understood in terms of a further development of the realization of the concept of freedom. If one wants to think Hegel's Philosophy of History meaningfully beyond Hegel's own time, one is inevitably led to the necessity of a liberation of the colonized, for there is a need for a further extension of the consciousness of freedom that actually is inclusive. This demand is contained in Hegel's thought itself, but it still remains abstract with him and must therefore be developed beyond him. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is (...) acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

Computer simulation is shown to be philosophically interesting because it introduces a qualitatively new methodology for theory construction in science different from the conventional two components of "theory" and "experiment and/or observation". This component is "experimentation with theoretical models." Two examples from the physical sciences are presented for the purpose of demonstration but it is claimed that the biological and social sciences permit similar theoretical model experiments. Furthermore, computer simulation permits theoretical models for the evolution of physical systems which use (...) cellular automata rather than differential equations as their syntax. The great advantages of the former are indicated. (shrink)

First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

It is demonstrated that the reduction of a physical theory S to another one, T, in the sense that S can be derived from T holds in general only for the mathematical framework. The interpretation of S and the associated central terms cannot all be derived from those of T because of the qualitative differences between the cognitive levels of S and T. Their cognitively autonomous status leads to an epistemic as well as an ontological pluralism. This pluralism is consistent (...) with the unity of nature in the sense of a substantive monism. (shrink)

"Vortrag, gehalten auf der Vortragsveranstaltung der Nieders'achsischen Landesregierung am 15. Mai 1975.".

Nanoethics seeks to examine the potential risks and rewards of applications of nanotechnology. This up-to-date anthology gives the reader an introduction to and basic foundation in nanotechnology and nanoethics, and then delves into near-, mid-, and far-term issues. Comprehensive and authoritative, it: -/- - Goes beyond the usual environmental, health, and safety (EHS) concerns to explore such topics as privacy, nanomedicine, human enhancement, global regulation, military, humanitarianism, education, artificial intelligence, space exploration, life extension, and more -/- -Features contributions from forty (...) preeminent experts from academia and industry worldwide, reflecting diverse perspectives -/- -Includes seminal works that influence nanoethics today -/- -Encourages an informed, proactive approach to nanoethics and advocates addressing new and emerging controversies before they impede progress or impact our welfare -/- This resource is designed to promote further investigations and a broad and balanced dialogue in nanoethics, dealing with critical issues that will affect the industry as well as society. While this will be a definitive reference for students, scientists in academia and industry, policymakers, and regulators, it's also a valuable resource for anyone who wants to understand the challenges, principles, and potential of nanotechnology. (shrink)

Theories of embodied cognition assume that concepts are grounded in non-linguistic, sensorimotor experience. In support of this assumption, previous studies have shown that upwards response movements are faster than downwards movements after participants have been presented with words whose referents are typically located in the upper vertical space. This is taken as evidence that processing these words reactivates sensorimotor experiential traces. This congruency effect was also found for novel words, after participants learned these words as labels for novel objects that (...) they encountered either in their upper or lower visual field. While this indicates that direct experience with a word's referent is sufficient to evoke said congruency effects, the present study investigates whether this direct experience is also a necessary condition. To this end, we conducted five experiments in which participants learned novel words from purely linguistic input: Novel words were presented in pairs with real up- or down-words ; they were presented in natural sentences where they replaced these real words ; they were presented as new labels for these real words ; and they were presented as labels for novel combined concepts based on these real words. In all five experiments, we did not find any congruency effects elicited by the novel words; however, participants were always able to make correct explicit judgements about the vertical dimension associated to the novel words. These results suggest that direct experience is necessary for reactivating experiential traces, but this reactivation is not a necessary condition for understanding the corresponding aspects of word meaning. (shrink)

We conducted the largest multiple-iteration retelling study to date (12,840 participants and 19,086 retellings) with two different studies that test how emotional appraisals are transmitted across retellings. We use a novel Bayesian model that tracks changes across retellings. Study 1 examines the preservation of appraisals of happy and sad stories and finds that retellings preserve the story’s degree of happiness and sadness even when length shrinks and aspects of story coherence and rationalisation deteriorate. Study 2 compared the transmission of appraisals (...) of happiness and sadness with embarrassment, disgust, and risk. Appraisals of happiness, sadness, and also embarrassment showed high appraisal preservation, while disgust and risk were not well preserved. We conclude that participants in our studies encoded happy and sad stories by encapsulating the events and details into an overall emotional appraisal of the story and that this processing strategy might also apply to stories involving other emotions like embarrassment. The emotional appraisal played a key role in retelling by helping to guide the selection, invention, and ordering of the story elements. Hence, we posit that emotion appraisals can operate as anchors for remembering and retelling stories, thus playing an important role in narrative communication. (shrink)

Criteria are given to characterize mature theories in contradistinction to developing theories. We lean heavily on the physical sciences. An established theory is defined as a mature one with known validity limits. The approximate truth of such theories is thereby given a quantitative character. Superseding theories do not falsify established theories because the latter are protected by their validity limits. This view of scientific realism leads to ontological levels and cumulativity of knowledge. It is applied to a defense of realism (...) against recent attacks by Laudan. (shrink)

In a seminal article in the Journal of Medical Ethics, Søren Holm and Tuja Takala analysed two protechnology arguments in bioethics: the hopeful principle and the automatic escalator. They showed how these arguments relate to problematic arguments such as the precautionary principle and the empirical slippery slope argument, and argued that they should be used with great caution. The present article investigates the recent debate on proton beam therapy, where the hopeful principle and the automatic escalator are identified. However, the (...) debate reveals a series of other arguments that deserve similar caution. An analysis of these arguments indicates that the roots of their fallacies are to be found in the ignorance of the uncertainties about risks and benefits and an overly optimistic attitude towards technology and progress. The point is not to argue against proton therapy, but rather to point out that flawed arguments for new technologies, such as proton therapy, can actually hamper their implementation instead of promoting it. Patients deserve the best technology available, not only on the basis of the best available evidence, but also on the basis of the best arguments. (shrink)

A collection of articles by leading authorities presenting an interdisciplinary approach to key issues of information science. Debates how information science affects various fields.

This paper presents the principal findings from a three-year research project funded by the US National Science Foundation on ethics of human enhancement technologies. To help untangle this ongoing debate, we have organized the discussion as a list of questions and answers, starting with background issues and moving to specific concerns, including: freedom & autonomy, health & safety, fairness & equity, societal disruption, and human dignity. Each question-and-answer pair is largely self-contained, allowing the reader to skip to those issues of (...) interest without affecting continuity. (shrink)

Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence (...) for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

This article points out, descriptive moral psychology of human behavior patterns in the handling, in fact, from the outset exceed the boundaries of philosophy, and Cole tried to resort to ethics Fort formalism in order to avoid this problem in practice, can not be established. • Henry Rachael is further motivation for ethical behavior and the psychological concept of Cole Castle together. Although this is certainly an important contribution to the Fort Cole, but Cole Fort critical reflection on the lack (...) of methodology adopted only; secondly that the ideology behind their psychological factors; finally made ​​sense to remedy in the treatment program: to give up on life and psychological describe their condition or results of work. Authors propose a new proposal of psychology, first identified the relationship between psychologists and their research object, this object is, as the subject of people; secondly, from the possibility of speech. Description, either by himself or a third person described in the description, will be replaced by speech interaction. Authors proposed the concept of an interactive framework of doctrine, in which Cole and Rachael • Fort Henry's theory of language games can get a different position. This article attempts to demonstrate that the descriptive psychology, in its treatment of ethical problems, seems to have transgressed the boundary line against philosophy. This problematic situation cannot be circumvented by resorting to an ethical formalism-as L. Kohlberg does in his research program. Rachael M. Henry pushes one step forward to tie the psychodynamic aspect of moral behavior with Kohlberg's concept. The present author, all in affirming the important contribution of Kohlberg to psychology, indicates the insufficiency of a mere reflection of methods in Kohlberg's works. Then he dissects the ideologemes behind Kohlberg's psychology. At last he suggests a therapeutic proposal: the demand for describing psychic life, its conditions or effects, shall be dropped. The author proposes instead a program of new psychology that derives first from the relation of psychologist to his object, the human as subject; and second, from the possibilities of speech in communicative interaction. Description, whether made by oneself or by a third person, shall be substituted by speech interactions. These interactions are considered as successful when the partners in a discussion declare themselves to be understood. Within the framework of this interactionist concept, Kohlberg's and Rachael M. Henry 's theories could assume the status of various language-games. (shrink)