Implicit trust in clinical decision-making by multidisciplinary teams

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established

Implicit trust in clinical decision-making by multidisciplinary teams

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established

THE CONCEPT OF LAW AND EFFICACY

Jedno od značenja izraza ‘učinkovitost’ odnosi se na činjenicu da se adresati pravnih normi stvarno ponašaju onako kako to od njih zahtijevaju pravne norme. To se značenje izraza obično koristi u filozofskopravnim raspravama glede toga je li učinkovitost bitan element pojma prava. Prema pravnom pozitivizmu, učinkovitost je u nekim slučajevima i na određene načine uvjet važenja (vrijeđenja) pravnih normi i pravnih sustava. S druge strane, pravni je realizam sklon potpunom poistovjećivanju pravnog važenja s učinkovitosti ili njegovu svođenju na učinkovitost. Prema tome, u oba je filozofskopravna pravca učinkovitost u pravilu uključena u oblikovanje njihovih pojmova prava. Međutim, dok pravnopozitivističko shvaćanje ne utječe na najuobičajenije značenje važenja pravne norme (pripadanje pravne norme pravnom sustavu), a utvrđivanjem učinkovitosti kao kriterija postojanja pravnog sustava ne dodaje mnogo objašnjenju pojma prava, pravnorealističko se shvaćanje suočava s ozbiljnim prigovorima glede svoje objašnjavalačke prikladnosti.One of the senses of the term ‘efficacy’ refers to the fact that norm-addresses actually behave as is required of them by legal norms. This sense of the term is one which is generally used within the jurisprudential discussions about whether efficacy is the essential element of the concept of law. According to legal positivism, efficacy is in some cases and in certain ways the condition of legal validity of both legal norms and legal systems. On the other hand, legal realism tends to entirely identify legal validity or reduce it to efficacy. Thus, in both jurisprudential approaches, efficacy tends to play a role in shaping their respective concepts of law. However, while the legal positivistic view does not affect the most standard sense of legal validity of the legal norm (i.e. the legal norms’ membership in the legal system), and does not add much to the explanation of the concept of law by identifying efficacy as the criterion of legal systems’ existence, the legal realistic view is faced with some serious objections regarding its explanatory adequacy

Is It Bad to Be Good? An Exploration of Aggressive and Prosocial Behavior Subtypes in Adolescence

Research in aggressive behavior development has distinguished between proactive (i.e., intended to achieve an instrumental goal) and reactive (i.e., emitted as an emotional response to provocation) subtypes of aggression. A similar distinction has not been made with regard to prosocial behavior. In this study, subtypes of both aggressive and prosocial behavior and their relation to aggression-supporting social cognitions were examined in a sample of 250 early and middle adolescents. Adolescents completed behavior rating scales and a measure of their beliefs about the acceptability of responding aggressively. Principal components analysis identified 3 subtypes of aggressive and prosocial behavior: aggressive, prosocial, and proactive prosocial. Proactive prosocial behavior was positively correlated with aggression and aggression-supporting beliefs, while other prosocial behavior was negatively correlated with these constructs. Findings are discussed in the context of aggressive behavior development and with regard to traditional views of prosocial behavior as altruistic.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45296/1/10964_2004_Article_478822.pd

National cultural autonomy and linguistic rights in Central and Eastern Europe

The theory and practice of national cultural autonomy (NCA) are examined from the perspective of national minorities’ linguistic rights in four countries of Central and Eastern Europe (CEE): Hungary, Estonia, Serbia and Russia. The idea of NCA dates back to the end of the nineteenth century and is based on the principle of ethnic communities’ autonomy—within a multi-ethnic state—to manage their own linguistic and cultural affairs. The notion of NCA was rediscovered in the 1990s and incorporated into the law and practice of the said four countries. Using a comparative approach, the chapter reflects upon NCA’s potential contribution in advancing the linguistic rights of national minorities in CEE. It concludes that, while the actual autonomy afforded to minority institutions in CEE is often restricted, NCA may serve as a platform to articulate concerns of great salience to national minorities, encompassing minority participation and multilingual education