Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Reanimated for the contemporary literature in the writings of Quine, [16]) and Kuhn [7], the conventionalism of Duhem [2] and Poincaré [12] has emerged in the last few years as one of the genuinely interesting topics in the philosophy of science. The theory in question—let us follow Grünbaum [3] in calling it the D-thesis, after its founder, Pierre Duhem—claims three things: a single scientific hypothesis H is never disconfirmable in isolation from its fellow; every single hypothesis H of science presupposes, (...) explicitly or implicitly, the support of a conjunction A = A, • A2 • … • Am of auxiliary assumptions or hypotheses; the failure of an observational consequence of H in face of contradictory evidence disconfirms only the conjunction of H and A, not H alone—i.e. establishes only ∼. The logical picture is as follows. (shrink)

The aim of this paper is to explore the conditions under which generalisation from single case studies, in the sense of making inferences concerning a wider class of phenomena beyond a case, is reasonable. Two sets of conditions, in particular, provide the basis for our consideration of this issue. The first is an exploration of the impressive amount of empirical knowledge that is contained within the theories that are used to make observations, to classify phenomena, and to understand and interpret (...) cases. The second is recognition of the role of a pattern of inference known as abduction, or inference to the best explanation, in drawing conclusions from case studies. It is argued that these two conditions, when applied to the procedures for conducting case studies, can be used to defend, as reasonable, the making of certain provisional generalisations from single cases. An epistemological procedure for testing and further justifying these generalisations, with a particular emphasis on dealing with the problem of confirmation bias, is then discussed and recommended. (shrink)

Is logic normative for reasoning? In the wake of work by Gilbert Harman and John MacFarlane, this question has been reduced to: are there any adequate bridge principles which link logical facts to normative constraints on reasoning? Hitherto, defenders of the normativity of logic have exclusively focussed on identifying adequate validity bridge principles: principles linking validity facts—facts of the form 'gamma entails phi'—to normative constraints on reasoning. This paper argues for two claims. First, for the time being at least, Harman’s (...) challenge cannot be surmounted by articulating validity bridge principles. Second, Harman’s challenge can be met by articulating invalidity bridge principles: principles linking invalidity facts of the form 'gamma does not entail phi' to normative constraints on reasoning. In doing so, I provide a novel defence of the normativity of logic. (shrink)

Moral reasoning traditionally distinguishes two types of evil:moral and natural. The standard view is that ME is the product of human agency and so includes phenomena such as war, torture and psychological cruelty; that NE is the product of nonhuman agency, and so includes natural disasters such as earthquakes, floods, disease and famine; and finally, that more complex cases are appropriately analysed as a combination of ME and NE. Recently, as a result of developments in autonomousagents in cyberspace, a new (...) class of interesting and importantexamples of hybrid evil has come to light. In this paper, it is called artificial evil and a case is made for considering it to complement ME and NE to produce a more adequate taxonomy. By isolating the features that have led to the appearance of AE, cyberspace is characterised as a self-contained environment that forms the essential component in any foundation of the emerging field of Computer Ethics. It is argued that this goes someway towards providing a methodological explanation of whycyberspace is central to so many of CE's concerns; and it isshown how notions of good and evil can be formulated incyberspace. Of considerable interest is how the propensity for anagent's action to be morally good or evil can be determined evenin the absence of biologically sentient participants and thusallows artificial agents not only to perpetrate evil but conversely to `receive' or `suffer from'it. The thesis defended is that the notion of entropy structure,which encapsulates human value judgement concerning cyberspace ina formal mathematical definition, is sufficient to achieve thispurpose and, moreover, that the concept of AE can be determinedformally, by mathematical methods. A consequence of this approachis that the debate on whether CE should be considered unique, andhence developed as a Macroethics, may be viewed, constructively,in an alternative manner. The case is made that whilst CE issues are not uncontroversially unique, they are sufficiently novel to render inadequate the approach of standard Macroethics such as Utilitarianism and Deontologism and hence to prompt the search for a robust ethical theory that can deal with them successfully. The name Information Ethics is proposed for that theory. Itis argued that the uniqueness of IE is justified by its beingnon-biologically biased and patient-oriented: IE is anEnvironmental Macroethics based on the concept of data entityrather than life. It follows that the novelty of CE issues suchas AE can be appreciated properly because IE provides a newperspective. In light of the discussion provided in this paper, it is concluded that Computer Ethics is worthy of independent study because it requires its own application-specific knowledge and is capable of supporting a methodological foundation, Information Ethics. (shrink)

There are many echoes of Descartes and of other Cartesians in Locke's Essay. There is one particularly curious passage in the Essay which is clearly taken from the Regulae. This passage may be the one clear instance of the method of analysis and synthesis in Locke. Before I cite that passage, I want to raise a few questions about some of the claims in Professor Schouls’ paper. Professor Schouls is right to call attention to the need for some careful analysis (...) of the concept of experience in Locke. He concentrates upon the form experience takes initially : lf“he means temporally first, as with infants, the examples he cites do not fit this concept. The quotes he gives on p. 583 all refer to adult, sophisticated experience, not to the learning experience of children. There is a rudimentary genetic psychology in Locke's Essay and in his Education. He does list some brief order in the acquisition of ideas by children, in the very earliest stages of experience, e.g., with the foetus, “some faint ideas of hunger, and thirst, and warmth, and some pains” are acquired. (shrink)

Sense of agency refers to the sense of initiating and controlling actions in order to influence events in the outside world. Recently, a distinction between implicit and explicit aspects of sense of agency has been proposed, analogous to distinctions found in other areas of cognition, notably learning. However, there is yet no strong evidence supporting separable implicit and explicit components of sense of agency. The so-called ‘Perruchet paradigm’ offers one of the few convincing demonstrations of separable implicit and explicit learning (...) systems. We adopted this approach to evaluate the implicit–explicit distinction in the context of a simple task in which outcomes were probabilistically caused by actions. In line with our initial predictions, we found evidence of a dissociation. We discuss the implications of this result for theories of sense of agency. (shrink)

When philosophers put forward claims for or against 'property', it is often unclear whether they are talking about the same thing that lawyers mean by 'property'. Likewise, when lawyers appeal to 'justice' in interpreting or criticizing legal rules we do not know if they have in mind something that philosophers would recognize as 'justice'. J. W. Harris here examines the legal and philosophical underpinnings of the concept of property and offers a new analytical framework for understanding property and justice.

Abortion is one of the most divisive topics in healthcare. Proponents and opponents hold strong views. Some health workers who oppose abortion assert a right of conscientious objection to it, a position itself that others find unethical. Even if allowance for objection should be made, it is not clear how far it should extend. Can conscientious objection be given as a reason not to refer when a woman requests her doctor to do so? This paper explores the idea of the (...) general practitioner (GP) who declines to make a direct referral for abortion, asking the woman to see another GP instead. The purpose is to defend the claim that an appeal to conscientious objection in this way can be reasonable and ethical. (shrink)