Shared decision making has become the standard of care, yet there remains no consensus about how it should be conducted. Most accounts are concerned with threats to patient autonomy, and they address the dangers of a power imbalance by foregrounding the patient as a person whose complex preferences it is the practitioner's task to support. Other corrective models fear that this level of mutuality risks abdicating the practitioner's responsibilities as an expert, and they address that concern by recovering a nuanced (...) but genuinely directive clinical role. Cribb and Entwistle helpfully categorize models of shared decision making as ‘narrower’ and ‘broader’ and praise the latter's ‘open‐ended and fully dialogical ways of relating’. However, they stop short of providing a philosophical account of how that dialogue works. In this paper, a nurse–midwife and a philosopher collaborate to argue that the Socratic model of dialogue offers a solution to the practitioner–patient dilemma. In the Theaetetus, Socrates compares dialogical reasoning to ‘midwifery with all its standard features’. By means of a three‐way analogy, elements of midwifery practice are used to illuminate features of Socrates' claim that his dialogue is like midwifery; those features are then translated into an approach to shared decision making as the ‘midwifery of good thinking’ which both midwives and physicians would do well to adopt. A key concept that emerges is the need for practitioners to make a risk‐confidence assessment of the particular content of any decision to appropriately modulate their role in the practice of shared decision making. (shrink)

This book explores Goethe's ethics of happiness and the role of resignation within them. Prandi has carefully separated autobiographical material from literary expository of these themes in order to clarify the misunderstanding that has resulted from relying on Goethe's fictional works to document his personal ethical convictions. The book aims in part at working out in detail the usefulness of Spinoza's Ethics in evaluating ethical views expressed in poetry and fiction; and in part at correcting erroneous and confused ideas about (...) Goethean resignation. Prandi studies the 'natural morality' Goethe developed and practiced, using Lucretius and Spinoza as models of influence. All three define the good as what makes people rationally happy; each has his own resignation model to offer. From a deep analysis of views on happiness and resignation, the author's discussion leads to some surprising new conclusions. (shrink)

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

Antibiotic resistance has become a problem of global scale. Resistance arises through mutation or through the acquisition of resistance gene(s) from other bacteria in a process called horizontal gene transfer (HGT). While HGT is recognized as an important factor in the dissemination of resistance genes in clinical pathogens, its role in the environment has been called into question by a recent study published in Nature. The authors found little evidence of HGT in soil using a culture‐independent functional metagenomics approach, which (...) is in contrast to previous work from the same lab showing HGT between the environment and human microbiome. While surprising at face value, these results may be explained by the lack of selective pressure in the environment studied. Importantly, this work suggests the need for careful monitoring of environmental antibiotic pollution and stringent antibiotic stewardship in the fight against resistance. (shrink)

We know that reading involves coordination between textual characteristics and visual attention, but research linking eye movements during reading and comprehension assessed after reading is surprisingly limited, especially for reading long connected texts. We tested two competing possibilities: (a) the weak association hypothesis: Links between eye movements and comprehension are weak and short‐lived, versus (b) the strong association hypothesis: The two are robustly linked, even after a delay. Using a predictive modeling approach, we trained regression models to predict comprehension scores (...) from global eye movement features, using participant‐level cross‐validation to ensure that the models generalize across participants. We used data from three studies in which readers (Ns = 104, 130, 147) answered multiple‐choice comprehension questions ~30 min after reading a 6,500‐word text, or after reading up to eight 1,000‐word texts. The models generated accurate predictions of participants' text comprehension scores (correlations between observed and predicted comprehension: 0.384, 0.362, 0.372, ps <.001), in line with the strong association hypothesis. We found that making more, but shorter fixations, consistently predicted comprehension across all studies. Furthermore, models trained on one study's data could successfully predict comprehension on the others, suggesting generalizability across studies. Collectively, these findings suggest that there is a robust link between eye movements and subsequent comprehension of a long connected text, thereby connecting theories of low‐level eye movements with those of higher order text processing during reading. (shrink)

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester’s arguments are based (...) on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011—the welfare of the child, the illegitimacy of a “right to a child,” and the defense of the so called “social order”—are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters’ own ethical concerns in the ongoing political debate over access to ART. (shrink)

The study explored the motivations behind Australian wool producers’ intentions regarding mulesing; a surgical procedure that will be voluntarily phased out after 2010, following retailer boycotts led by People for the Ethical Treatment of Animals. Telephone interviews were conducted with 22 West Australian wool producers and consultants to elicit their behavioral, normative and control beliefs about mulesing and alternative methods of breech strike prevention. Results indicate that approximately half the interviewees intend to continue mulesing, despite attitudes toward the act of (...) mulesing being quite negative. This indicates that attitudes alone are unlikely to be good predictors of this goal directed behavior. Most respondents believed mulesing was more effective and involved less cost, time, and effort than the currently available alternatives to prevent breech strike. Further, they felt relatively little social pressure, as they believed few consumers were concerned about mulesing. However, they noted that if consumer sentiment changed they would likely change their practices. Thus, attitudes are likely to be only one of several factors influencing intentions to change farm practices to address societal concerns about animal welfare. Further, mulesing appears to be goal - directed behavior , suggesting that other factors depicted by the Model of Goal-directed Behavior (MGB; Perugini and Bagozzi In: Br J Soc Psychol, 40: 79–98, 2001 ) may be worth exploring in this context. Finally, these results provide insight into how policy makers may influence farmers to change practices in response to societal pressure for improving farm animal welfare. (shrink)

The Protein Ontology (PRO; http://proconsortium.org) formally defines protein entities and explicitly represents their major forms and interrelations. Protein entities represented in PRO corresponding to single amino acid chains are categorized by level of specificity into family, gene, sequence and modification metaclasses, and there is a separate metaclass for protein complexes. All metaclasses also have organism-specific derivatives. PRO complements established sequence databases such as UniProtKB, and interoperates with other biomedical and biological ontologies such as the Gene Ontology (GO). PRO relates to (...) UniProtKB in that PRO’s organism-specific classes of proteins encoded by a specific gene correspond to entities documented in UniProtKB entries. PRO relates to the GO in that PRO’s representations of organism-specific protein complexes are subclasses of the organism-agnostic protein complex terms in the GO Cellular Component Ontology. The past few years have seen growth and changes to the PRO, as well as new points of access to the data and new applications of PRO in immunology and proteomics. Here we describe some of these developments. (shrink)

There is a critical inconsistency in the literature on analogical retrieval. On the one hand, a vast set of laboratory studies has found that people often fail to retrieve past experiences that share deep relational commonalities, even when they would be useful for reasoning about a current problem. On the other hand, historical studies and naturalistic research show clear evidence of remindings based on deep relational commonalities. Here, we examine a possible explanation for this inconsistency—namely, that remindings based on relational (...) principles increase as a function of expertise. To test this claim, we devised a simple analogy‐generation task that can be administered across a wide range of expertise. We presented common events as the bases from which to generate analogies. Although the events themselves were unrelated to geoscience, we found that when the event was explainable in terms of a causal principle that is prominent in geoscience, expert geoscientists were likely to spontaneously produce analogies from geoscience that relied on the same principle. Further, for these examples, prompts to produce causal analogies increased their frequency among nonscientists and scientists from another domain, but not among expert geoscientists (whose spontaneous causal retrieval levels were already high). In contrast, when the example was best explained by a principle outside of geoscience, all groups required prompting to produce substantial numbers of analogies based on causal principles. Overall, this pattern suggests that the spontaneous use of causal principles is characteristic of experts. We suggest that expert scientists adopt habitual patterns of encoding according to the key relational principles in their domain, and that this contributes to their propensity to spontaneously retrieve relational matches. We discuss implications for the nature of expertise and for science instruction and assessment. (shrink)

Mentoring Away the Glass Ceiling in Academia: A Cultured Critique describes how women of diverse backgrounds perceive their mentoring experiences or the lack of mentoring experiences in the academy. This book provides a space for envisioning strategies and practices to improve mentoring practices and the collegiate environment.

Pourquoi Sextus Empiricus, au chapitre 34 du livre I des Esquisses Pyrrhoniennes, refuse-t-il d’identifier la méthode des médecins empiriques à la « voie sceptique » qu’il tente de définir au livre I du même ouvrage – ce qui le distingue en particulier de Galien, qui ne semble pas mettre en doute la nature sceptique de la médecine empirique? L’examen de cette question nous donnera l’occasion de faire le point sur les procédures logiques utilisées par ces mêmes médecins empiriques, en particulier (...) sur l’épilogisme, ainsi que sur les conceptions étiologiques de l’école empirique, que nous opposerons à ce que l’on peut connaître des principes méthodologiques et physiologiques de la médecine méthodiste. (shrink)

Cet article aborde le péché capital d’ acedia ou acédie, pour déterminer s’il se caractérise plus essentiellement comme aversion ou comme indifférence. À partir de sa figure originaire, livrée par le théologien-ermite Évagre le Pontique, sera dépassée sa formulation comme odium professionis, haine de l’état monastique, au profit d’une hypothèse mettant en jeu à la fois indifférence et aversion, celle de l’insupportable indifférence. Cette hypothèse sera ultimement dépassée par la mise au jour d’un état plus profond d’indifférence à soi, menant (...) à la thèse ultime, kierkegaardienne, d’une défaillance éthique profonde dans l’acédie. (shrink)

Ce livre jette une lumière nouvelle sur l'empirisme d'Épicure et des épicuriens par le jeu d'une comparaison entre les méthodologies scientifiques épicurienne et médicale. C'est à partir d'une conception commune du savoir comme technè (art ou technique) que ces deux ensembles doctrinaux comprennent la nature et la source de la connaissance. L'épistémologie épicurienne apparaît comme une conception originale de la forme du discours scientifique et de l'explication causale.

Qu’est-ce qu’une écriture clinique? Quelle est son intention, son objet, son propos? Et peut-on réellement appliquer cette notion aux écrits hippocratiques? Pour explorer cette question, nous nous pencherons brièvement sur la notion générale d’écriture médicale telle qu’elle est abordée en plusieurs endroits de la littérature hippocratique et galénique. Nous analyserons ensuite plus spécifiquement et longuement, au sein du corpus hippocratique, le cas des livres I et III des Épidémies qui offrent un exemple à la fois remarquable et problématique de ce (...) qu’on peut attendre, dans l’Antiquité, d’une écriture clinique. (shrink)

Dès le début du xixe siècle, Jeanne d’Arc connaît la célébrité dans toute l’Europe. Élevée au pinacle, installée au panthéon des Français, elle devient un sujet en or pour les compositeurs et leurs librettistes, parce qu’elle permet d’aborder les thèmes les plus divers, de l’héroïque au religieux en passant par le pastoral et le tragique. Elle fait l’objet de nombreuses mises en scène dans des genres musicaux aussi variés que l’opéra, l’opéra-comique, le ballet, la mélodie, la pantomime ou le théâtre (...) en musique. La question centrale qui se pose pour chaque compositeur est la suivante : comment représenter Jeanne d’Arc, cette « figure sublime »? Comment donner voix à une héroïne que l’on a vue sous tous les jours, tour à tour grandiloquente, simple et pieuse, puis égérie nationale avant de devenir sainte en 1920? Au travers d’une étude sur la voix donnée à Jeanne, dans deux œuvres majeures du répertoire qui lui a été consacré, Giovanna d’Arco de Verdi, créée à la Scala de Milan en 1845, et Jeanne d’Arc au Bûcher de Paul Claudel et Arthur Honegger, créée à Bâle en 1938, nous essaierons de déceler l’esprit d’une époque, et par là de mieux distinguer quelques-unes des facettes données à la Pucelle d’Orléans. (shrink)

L’objet de cet article est d’analyser la version formulaire la plus connue de l’éthique épicurienne, souvent appelée dans la littérature critique tetrapharmakos ou quadruple remède. On tentera de trancher la question de l’authenticité de cette formule, et d’en déduire certains éléments concernant la pédagogie éthique épicurienne et le rôle qu’y jouent abrégés et florilèges.

Issus de deux journées d’étude organisées en 2008 et 2010 dans le cadre du programme de recherche « Modèles familiaux et cultures politiques » (École française de Rome), les neuf articles de ce volume examinent la construction des liens familiaux à l’époque moderne dans des territoires (Italie, France, espace germanique, péninsule Ibérique et son empire) et des configurations politiques, juridiques, sociales et économiques variées. La première partie s’attache à la formation du lien matrimon...

Du renforcement de la « monarchie paternelle » à l’existence d’un « empire des mères », la confrontation des sources du droit civil et des archives criminelles du Châtelet, au premier XVIIIe siècle, donne une vision complexe des rapports noués entre l’expérience de la maternité et l’exercice de l’autorité. Statutairement, les mères légitimes sont associées, sur un mode mineur ou de plein droit dans le cas du veuvage et de l’institution tutélaire, à l’exercice de l’autorité paternelle. Mais en débordant ces (...) catégories juridiques admises, en les utilisant à leur avantage ou en les contournant, les mères de la société parisienne se révèlent plus autoritaires que tendres, usant des prérogatives du patriarche, tout en revendiquant l’existence d’une sphère d’autorité purement féminine, dont elles assurent d’ailleurs, avec leurs filles, la reproduction. Par le biais des statuts octroyés ou des rôles assumés, les mères jouissent ainsi de pouvoirs, qui participent de l’institution paternelle et de la culture féminine. (shrink)

'You're 82 years old. You've shrunk six centimetres, you only weigh 45 kilos yet you're still beautiful, graceful and desirable' – so begins André Gorz's 'open love letter' to the woman he has lived with for 58 years and who lies dying next to him. As one of France's leading post-war philosophers, André Gorz wrote many influential books, but nothing he wrote will be read as widely or remembered as long as this simple, passionate, beautiful letter to his dying wife. (...) In a bittersweet postscript a year after Letter to D was published, a note pinned to the door for the cleaning lady marked the final chapter in an extraordinary love story. André Gorz and his terminally ill wife, Dorine, were found lying peacefully side by side, having taken their lives together. They simply could not live without one another. An international bestseller, _Letter to D_ is the ultimate love story – and all the more poignant because it's true. (shrink)

Depuis plusieurs décennies, la numérisation des textes anciens et les progrès du TAL pour les traiter et les interroger ont largement modifié nos habitudes de travail. Il est désormais possible d’obtenir des données quantitatives massives qui affinent notre perception des phénomènes linguistiques et stylistiques dans des corpus écrits dans des états de langue anciens. Les corpus numériques créés depuis maintenant près d’un quart de siècle permettent d’envisager plus facilement la dynamique du...