Précising definitions as a way to combat overdiagnosis

Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or précising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this disease_ODx, aimed at distinguishing cases where it would be beneficial to identify (and treat the condition) from those where diagnosis is more likely to harm than benefit. A preliminary definition of disease_ODx is that X is a disease_ODx iff there is dysfunction that has a significant risk of causing severe harm. This paper examines the 3 concepts in this definition, using a naturalistic account of function, a Feinbergian account of comparative harm, and a probabilistic understanding of risk. We then test the utility of this approach using examples of clinical conditions that are currently overdiagnosed.     

Moral uncertainty: A case study of Covid-19

BackgroundMost writing about uncertainty in healthcare has addressed empirical uncertainty – that is, resulting from insufficient or conflicting facts.ObjectiveTo consider moral uncertainty by exploring how different theories apply to a single clinical case.MethodIn this philosophical reflection, I briefly acknowledge empirical uncertainty before introducing and exploring the topic of moral uncertainty – defined as the question of what to do when we do not know what (morally) to do—using a case study of my own mother’s deterioration and death from Covid-19.ResultsI identify and apply a number of philosophical theories relevant to managing moral uncertainty, including utilitarianism, deontology, practical rationality and feminist philosophy.ConclusionDifferent moral theories lead to different conclusions about the best course of action in situations of moral uncertainty.Practice implicationsDetailed analysis and close reading of a single case can provide insights into how to act in morally complex situations, but learning is in the form of enriched understanding, not formulaic rules.     

Evidential Proximity,Independence, and the evaluation of carcinogenicity

This paper analyses the methods of the International Agency for Research on Cancer (IARC) for evaluating the carcinogenicity of various agents. I identify two fundamental evidential principles that underpin these methods, which I call Evidential Proximity and Independence. I then show, by considering the 2018 evaluation of the carcinogenicity of styrene and styrene‐7,8‐oxide, that these principles have been implemented in a way that can lead to inconsistency. I suggest a way to resolve this problem: admit a general exception to Independence and treat the implementation of Evidential Proximity more flexibly where this exception applies. I show that this suggestion is compatible with the general principles laid down in the 2019 version of IARC's methods guide, its Preamble to the Monographs.     

北京哲学社会科学研究基地建设经验和科学发展研究

研究基地的建设和发展是繁荣发展哲学社会科学的要求.本文从提炼北京基地建设经验展开论述,以战略地位、打破体制和思想束缚、鼓励民间参与等思路,提出通过提高对哲学社会科学重要性的认识、建立科学体系、增加各方资金投入等方法,以解决影响研究基地健康发展的关键问题.并从战略预见、科学发展、增强实力、创新和容错、主张适当支持非主流观点等新角度,来深入研究和拓展研究基地的主要功能与作用.     

Medical good luck and medical bad luck

Every individual experiences good luck and bad luck. Three features characterize medical events associated with good luck or bad luck: There is no control over the event, the event occurs through chance or accident, and the event is of significant interest. These characteristics can be used to develop a working definition of medical luck. Medical good luck and medical bad luck are typically assigned to either the individual or to the event, but assigning these instead to the relationship between individual and event provides the opportunity for intervention. By assigning valences to each individual‐event relationship and summating them, the total good luck or bad luck associated with the event can be determined. Intervening in the medical event by increasing the valence of the significance for each affected individual to the event will increase that event's total good luck. A total valence of zero before or after intervention does not, however, imply absent medical luck but simply a combination of medical good luck and medical bad luck because significance interest in the event persists. Therefore, there is no medical luck simpliciter, only medical good luck and medical bad luck. Medical events are especially helpful to understanding good luck and bad luck, because they are non‐fictional, often generate significant interest, and are modifiable.     

Double degree destinations: Nursing or midwifery

BackgroundDouble degrees in nursing and midwifery have evolved in Australia as a proposed solution to possible impending shortages of qualified midwives in the healthcare workforce. The double degree is seen as a more acceptable option in non-metropolitan areas in particular. Concern has been expressed however, about dilution of midwifery philosophy and graduates’ opportunities in respect of future clinical practice.AimThis study aimed to provide a better understanding of motivations and intentions of students who undertake the Bachelor of Nursing Science/Bachelor of Midwifery double degree.MethodsA cross-sectional survey design was employed at four universities that offered double degrees in nursing and midwifery in three states of Australia. Students enrolled in first and fourth year of a double degree and graduates of a double degree were invited to complete an online survey comprised of Likert scales and items requiring free text responses. Quantitative data was analysed using SPSS and thematic analysis was used to analyse the qualitative data.FindingsParticipants indicated a clear preference for midwifery as a career with this preference increasing for each cohort at each stage of study.DiscussionPrimary reasons for selecting a double degree were perceived increased opportunity for employment and use of nursing skills to enhance midwifery practice in a population with growing co-morbidities. A strong identification with midwifery philosophy and identity was also demonstrated.ConclusionAn understanding of motivations and career intentions of students undertaking double degree studies can inform future program development and workforce planning.     

把握工具理性的正义

工具理性是与价值理性相对应,是一种把实现个人目标作为评价标准的思维模式.工具理性的正义观是将正义作为保护和获得个人利益或集团利益的工具.工具理性的正义观不是正义的本意,而是其反面,而且已经给人类带来危害.     

Bewertung der ärztlichen Ausbildung an der McMaster Universität,Kanada, anhand des Konzepts der „Fallmethode“

Summary Students of three different levels and the chairman of the MD-Program evaluated the educational system of McMaster University, Canada, using the six criteria of the case method as defined by Renschler. This analysis provided a very differentiated evaluation of the McMaster curriculum, demonstrating a systematic progress of learning methods from the second to the last phase.The instrument showed differences in the ratings of the demonstrative lectures between the chairman and the students. Free access to patients and responsibility, gradually growing during the 3-year program, are important features of the educational system. The problem-based system provides a unique integration of acquiring theoretical knowledge in the basic sciences through clinical problem solving which was highly rated in all analysed phases. Ratings given by the interviewed students for evaluation of documented work were lower than expected by the chairman and the authors. The results are discussed in relationship to the McMaster Philosophy and to the conditions of studying medicine in America and in Germany.