Distinguishing treatment from research: a functional approach.
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The best way to distinguish treatment from research is by their functions. This mode of distinction fits well with the basic ethical work that needs to be carried out. The distinction needs to serve as an ethical flag, highlighting areas in which the goals of doctors and patients are more likely than usual to diverge. The distinction also allows us to illuminate and understand some otherwise puzzling elements of debates on research ethics: it shows the peculiarity of exclusive conceptions of the distinction between research and treatment; it allows us to frame questions about therapeutic obligations in the research context, and it allows us to consider whether there may be research obligations in the therapeutic context. (+info)
Studying delays in breast cancer diagnosis and treatment: critical realism as a new foundation for inquiry.
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PURPOSE/OBJECTIVES: To examine how delays in breast cancer care currently are conceptualized and to introduce philosophical and theoretical tenets of critical realism as an alternative approach. DATA SOURCES: Health and social sciences literature. DATA SYNTHESIS: Diagnostic and treatment delays in breast cancer most frequently are conceptualized as patient, provider, or system related. The approach has limited utility in guiding explanatory analysis because it does not acknowledge the social context in which the delays occur. The philosophical tenets of critical realism and two related theoretical approaches are an alternative. They illustrate how an individual's biologic, social, and material resources may undermine or support structural inequities in access to breast cancer care. CONCLUSIONS: Critical realism provides a useful framework for analysis of links between social inequalities and delays in breast cancer diagnosis and treatment. IMPLICATIONS FOR NURSING: Access to breast cancer care could be better understood and conceptualized by basing future research and theoretical endeavors on a critical realist perspective. (+info)
Expressing freedom and taking liberties: the paradoxes of aberrant science.
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Complete freedom does not exist, despite people's preparedness to die for it. Scientific freedom is much defended and yet much misunderstood. Scientists have limits imposed on their freedom by the disciplines and discourse communities in which they place themselves. Freedom within these socially constructed constraints needs to be distinguished from taking liberties with the rules and practices that make up these constraints, and validate the activities of special groups within society. Scientists (and the public) perceive taking liberties with science's rules and practices as aberrant science, and they often react punitively. Aberrant science can be broadly examined under four headings: wicked science, naughty science, dysfunctional science, and ideologically unacceptable science. When we examine examples of perceived aberrant science, we find that these categories of "misconduct" are connected and often confused. Scientific freedom needs to be redefined with due regard to current understandings of scientists as human beings facing powerful social pressures to deliver results of a particular kind. (+info)
Healthcare access as a right, not a privilege: a construct of Western thought.
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Over 45 million Americans are uninsured or underinsured. Those living in poverty exhibit the worst health status. Employment, education, income, and race are important factors in a person's ability to acquire healthcare access. Having established that there are people lacking healthcare access due to multi-factorial etiologies, the question arises as to whether the intervention necessary to assist them in obtaining such access should be considered a privilege, or a right. The right to healthcare access is examined from the perspective of Western thought. Specifically through the works of Aristotle, Immanuel Kant, Thomas Hobbes, Thomas Paine, Hannah Arendt, James Rawls, and Norman Daniels, which are accompanied by a contemporary example of intervention on behalf of the medically needy by the The Johns Hopkins Urban Health Institute. As human beings we are all valuable social entities whereby, through the force of morality, through implicitly forged covenants among us as individuals and between us and our governments, and through the natural rights we maintain as individuals and those we collectively surrender to the common good, it has been determined by nature, natural laws, and natural rights that human beings have the right, not the privilege, to healthcare access. (+info)
Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression.
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Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedonia--the inability to experience pleasure from previously pleasurable activities--and because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive symptomatology in otherwise treatment-resistant depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, psychotherapy, and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Additionally, brain metabolism was assessed 1 week before and 1 week after stimulation onset. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto-striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. Dysfunctions of the reward system--in which the nucleus accumbens is a key structure--are implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These preliminary findings suggest that DBS to the nucleus accumbens might be a hypothesis-guided approach for refractory major depression. (+info)
Sherrington's philosophical writings--a 'zest for life'.
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Sherrington's late writings are often described as dualistic, yet Sherrington was deeply uneasy with theories that radically separate mind and brain. His questioning, open-minded and historically-informed approach to their relationship eschews dogmatic solutions. (+info)
Complexity seems to open a way towards a new Aristotelian-Thomistic ontology.
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Today's sciences seem to converge all towards very similar foundational questions. Such claims, both of epistemological and ontological nature, seem to rediscover, in a new fashion some of the most relevant topics of ancient Greek and Mediaeval philosophy of nature, logic and metaphysics, such as the problem of the relationship between the whole and its parts (non redictionism), the problems of the paradoxes arising from the attempt to conceive the entity like an univocal concept (analogy and analogia entis), the problem of the mind-body relationship and that of an adequate cognitive theory (abstraction and immaterial nature of the mind), the complexity of some physical, chemical and biological systems and global properties arising from information (matter-form theory), etc. Medicine too is involved in some of such relevant questions and cannot avoid to take them into a special account. (+info)
Genetics, biometrics and the informatization of the body.
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"Genetics" is a term covering a wide set of theories, practices, and technologies, only some of which overlap with the practices and technologies of biometrics. In this paper some current technological developments relating to biometric applications of genetics will be highlighted. Next, the author will elaborate the notion of the informatization of the body, by means of a brief philosophical detour on the dualisms of language and reality, words and things. In the subsequent sections she will then draw out some of the questions relevant to the purposes of Biometrics Identification Technology Ethics (BITE), and discuss the ethical problems associated with the informatization of the body. There are, however some problems and limitations to the currently dominant ethical discourse to deal with all things ethical in relation to information technology in general, and biometrics or genetics in particular. The final section will discuss some of these meta-problems. (+info)