Sunday, October 30, 2005

Informed Consent - Definition From Widipedia: Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of any actions. The individual needs to be in possession of all of his faculties (for example, not mentally retarded or mentally ill), and his judgment not impaired at the time of consenting (by sleep, illness, intoxication, alcohol, drugs or other health problems, etc.). Some acts cannot legally take place because of a lack of informed consent. In other cases, consent of someone on behalf of a person not considered able have informed consent is valid.... Judgement ...(several examples for context)... One should be cautious in attributing, without a rigorous analysis, a rigid set of criteria to all forms of judgment. Often this results in unnecessary restrictions to judgment methodologies, excluding what may otherwise be considered legitimate judgments. For analogous difficulties in science and the scientific method see the Wikipedia entry on the scientific method.... Many forms of judgment, including the above example, require that they be supported by, and support, known facts which are themselves well supported, and its negation must be shown to be unfounded, before it is accepted as well founded. Elements of the scientific method: The essential elements of a scientific method are iterations, recursions, interleavings and orderings of the following: Characterizations (Quantifications, observations and measurements) Hypotheses (theoretical, hypothetical explanations of observations and measurements) Predictions (reasoning including logical deduction from hypotheses and theories) Experiments (tests of all of the above)  Werner Heisenberg in a quote that he attributed to Albert Einstein many years after the fact stated [Heisenberg 1971]: It is quite wrong to try founding a theory on observable magnitudes alone. In reality the very opposite happens. It is the theory which decides what we can observe. You must appreciate that observation is a very complicated process. The phenomenon under observation produces certain events in our measuring apparatus. As a result, further processes take place in the apparatus, which eventually and by complicated paths produce sense impressions and help us to fix the effects in our consciousness. Along this whole path - from the phenomenon to its fixation in our consciousness - we must be able to tell how nature functions, must know the natural laws at least in practical terms, before we can claim to have observed anything at all. Only theory, that is, knowledge of natural laws, enables us to deduce the underlying phenomena from our sense impressions. When we claim that we can observe something new, we ought really to be saying that, although we are about to formulate new natural laws that do not agree with the old ones, we nevertheless assume that the existing laws - covering the whole path from the phenomenon to our consciousness - function in such a way that we can rely upon them and hence speak of "observation." I had the great fortune of taking a college class in the Philosophy of Science. This was in the middle '60's. One of the the paperback textbooks was The Structure of Scientific Revolutions by Thomas Samuel Kuhn. This was the book that articulated the concept of Paradigm Shift. GeeWiz stuff in the 60's. "A paradigm shift is the term first used by Thomas Kuhn in his famous 1962 book The Structure of Scientific Revolutions to describe the process and result of a change in basic assumptions within the ruling theory of science. It has since become widely applied to many other realms of human experience as well." The sociology of knowledge is the study of the social origins of ideas, and of the effects prevailing ideas have on societies. Logic (from Classical Greek word logos), originally meaning the word, or what is spoken, (but coming to mean thought or reason) is most often said to be the study of arguments, although the exact definition of logic is a matter of controversy amongst philosophers (see below). However the subject is grounded, the task of the logician is the same: to advance an account of valid and fallacious inference to allow one to distinguish good from bad arguments.... [wiki entry] from Wikipedia entry on Philosopy of Science: Nature of scientific statements and concepts Science draws conclusions about the way the world is and the way in which scientific theory relates to the world. Science draws upon evidence from experimentation, logical deduction, and rational thought in order to examine the world and the individuals that exist within society. In making observations of the nature of individuals and their surroundings, science seeks to explain the concepts that are entwined with everyday lives. 1:05:24 PM    comment []

Human Nature. The difficulties of informed consent. I heard Kurt Vonnegut on a TV show recently. What struck me was a comment about our basic nature involving being in a gang. I looked it up online. Found it, PBS' NOW program, 10/7/05 with David Brancaccio: (excerpt of online transcript) DAVID BRANCACCIO: Well, I want to ask you about this. You ask in the book a question that actually you don't answer so I want to - KURT VONNEGUT: I'm old. DAVID BRANCACCIO: But I want to -- think about answering this one. You write "what can be said to our young people now that psychopathic personalities -- which is to say persons without consciences, without senses of pity or shame -- have taken all the money in the treasuries of our government and corporations and made it their own?" What can we say to younger people who have their whole lives ahead of them? KURT VONNEGUT: Well, you are human beings. Resourceful. Form a little society of your own. And, hang out with them. Get a gang. DAVID BRANCACCIO: You're preaching getting into gangs? KURT VONNEGUT: Yes. Well, look, it's -- DAVID BRANCACCIO: A good gang. KURT VONNEGUT: Look, I don't mean to intimidate you, but I have a master's degree in anthropology. DAVID BRANCACCIO: I'm intimidated. KURT VONNEGUT: From the University of Chicago -- as did Saul Bellow, incidentally. But anyway, one thing I found out was that we need extended families. We need gangs. And, of course, if they're tribes and clans and so forth have been dispersed by the industrial revolution by people looking for work wherever they can find it. And a nuclear family, a man, a woman and kids and a dog and cat is no survival scheme at all. Horribly vulnerable. So yes, I tell people to formulate a little gang. And, you know, you love each other. (continues) Kurt Vonnegut On Telling A Story Forbes.com, 10.24.05, 9:00 AM ET Kurt Vonnegut is among the very few grandmasters of contemporary American letters. His novels include Cat's Cradle, Slaughterhouse Five, and Breakfast of Champions. His newest best-selling book, Man Without A Country, is a collection of essays and articles. All of the arts, with the exception of architecture, are practical jokes, making people respond emotionally and at no risk to themselves, because things aren't really happening. A good example would be "The Last Supper" by Leonardo da Vinci. What I do, which is becoming more and more impractical I think, is make people respond to idiosyncratic arrangements of 26 phonetic symbols and ten Arabic numbers in horizontal lines on a page. And there was a time when this was a form of home entertainment, and so it was worthwhile for people to learn how to read. But reading it is actually quite difficult -- I mean it is as hard as learning to read music, and it's a remarkable skill. And if you take ink on paper and make people respond to it, they themselves are going to have to be performers. It's like arriving at a concert hall and being handed a violin, and you're expected to play. That's what we expect readers to do, perform themselves, because they're half of the performance. But ink on paper is no way to tell a story anymore. Film and movies are the best way to tell a story today. That works, so you don't have to be a performer yourself anymore. Because of our terrible high schools, we have a huge illiterate population, but they can sure as hell watch a movie. I would guess that people who are literate somehow get their minds improved, or they get more personally involved in a story when they read it because their own brains are involved. Watching TV or a movie, your brain need not be involved, and you can just kill time. -- Excerpted from an interview with Lacey Rose on Oct. 17, 2005. It's been a long time since I've read any science fiction. It used to be a passion. Then it seemed like life had become science fiction. Odd isn't it, that this age leads us back to science fiction. As a way to comprehend the performances around us. 10:29:14 AM    comment []

Good News, Bad News Good (knowledge improvement) Ten Medical Tests You Need, Forbes Magazine And discussion of their advantages and weaknesses (that it isn't perfect knowledge). Bad (as in useless?) Not Communicating Very Well Somehow not a single linguistic anthropologist got included in the Forbes Magazine special report on communicating. When they wanted an article on "cross-cultural communication" they went to a zoologist! [Savage Minds: Notes and Queries in Anthropology [~] A Group Blog] 9:53:20 AM    comment []

Informed Consent: what does that mean now? This is simply posed as a trial balloon. Whatever "Informed" Consent means will evolve as our technologies evolve in complexity and capability. "For it is the artist who brings the image of mythology to manifestation, and without images (whether mental or visual) there is no mythology. Moreover, it is the nonjudgemental way of seeing that is proper to the arts which allows things to stand forth and be seen simply as they are, as neither desirable nor to be feared, but as statements, each in its own mode, of the nature of being." Joseph Cambell, The Inner Reaches of Outer Space - Metaphor as Myth and as Religion, 1986, A. van der Marck Editions, and paperback published 1986, Harper & Row Somehow, I think, it is in images, whether mental or visual, that we come to informed consent. The problem then is this evolution toward either "countries of one" or various enforced lockstep "countries" where the images do not fit reality - real choices. The Four Fundamental Types of Design and How to Recognize Them "from the point of view of a technologically less advanced civilization, the technology of a very advanced civilization is essentially indistinguishable from magic " Emergency transport by copter may be curbed Ambulances often reach Valley's hospitals faster Judi Villa, The Arizona Republic, Oct. 30, 2005 12:00 AM Valley cities have begun curtailing their use of medical helicopters, saying ground ambulances may actually get patients to the hospital faster. That idea is contrary to long-held beliefs that helicopters are the quickest way to go. But in urban areas such as the Valley, where five trauma centers are centrally located, ground ambulances could actually save minutes.... 9:15:32 AM    comment []

There's been a healthcare series in the New York Times. What is informed consent? This one discusses company benefits packages and strategies to stretch your lifetime healt dollar. For the Thinking Employee, No-Brainer Health Care Is Passé It's a time-honored ritual of autumn in corporate America: you get your thick company benefits package. You are asked to choose from a "cafeteria" of benefits. Has anything good ever come out of a cafeteria? You sigh. And you sign up for exactly what you had last year because it is all too daunting. That might have worked in years past, but more companies are demanding that employees take more control of their health care spending in much the same way employees took over management of their retirement funds. The shift seems unstoppable. Companies like Wal-Mart, the nation's largest private employer; General Motors; and Chrysler are using high-deductible insurance plans coupled with health savings accounts to get control of health care costs. Are such plans bad news for employees? When you consider that 73 percent of Americans incur less than $500 a year in medical expenses, it pays to figure out if you can save some money with lower-premium, high-deductible plans buttressed by a tax-advantaged health savings account.... Given that the average couple at age 65 is predicted to need $190,000 in savings to cover medical expenses for the rest of their lives, the smart thing to do is leave the money in the health savings account to accumulate for use in old age and pay for current medical expenses out of your pocket.... This is a second one on Wal-Mart and describe the delima for us all. Wal-Mart's Health Care Struggle Is Corporate America's, Too Back in the spring, amid relentless criticism that Wal-Mart Stores was failing to provide affordable health care to employees, executives at the company decided to take a detailed look at its benefits. Wal-Mart knew its health costs were spiraling upward out of control, said M. Susan Chambers, the senior executive who led the initiative, but it was surprised to discover that its critics had a point. Almost half of the children of employees were covered only by government social-service programs like Medicaid or had no insurance at all.... For various social and economic reasons - including limited access to preventive medical care - low-income workers and their families often have the greatest health care needs, with the least ability to meet them. The Wal-Mart quandary involves a fundamental national issue: Who, if anyone, should provide care to the bulk of Americans. "Whose responsibility is this?" said Carolyn Watts, a health professor at the University of Washington. "Is it the government's responsibility or the employer's?".... And this one follows up on the one yesterday "For a Retainer, Lavish Care by 'Boutique Doctors'" Before You Buy, Determine What You're Paying For As with all luxury items, consumers should purchase concierge care with their eyes wide open. Consumer advocates warn that unlike medical care itself, which is regulated by the state, concierge services have virtually no regulations or oversight. Whether consumers get their money's worth depends entirely on whether all expectations are realistically examined at the beginning. The arrangement is based on a written contract between the patient and either the physician or the concierge corporation that coordinates the physician's practice. The contract is generally renewed every year. Any dispute would be adjudicated not by state medical agencies but through the usual legal channels open to consumers. "You have to read the fine print in the contract," said David Barton Smith, professor of health services administration at Temple University. "There is no guarantee that what is promised this year will also be provided next year." We have backed into cascading complexity - which we take for dishonest collusion or magic. "Any sufficiently advanced technology is indistinguishable from magic." (Arthur C. Clarke) It will take time to unravel, to make it less "magic" - assuming we seriously try. "'Whose responsibility is this?' said Carolyn Watts, a health professor at the University of Washington. 'Is it the government's responsibility or the employer's?'" How do we, as a society, shape fair healthcare for all? How do we move from the realm of magic and confusion to managed, equitable advanced technology? As another essay puts it: "Don't Blink!" What is informed consent? 7:56:06 AM    comment []

© Copyright 2005 Russ Savage. Last update: 11/2/05; 5:45:42 AM.