User:Oliveoilandgarlic/sandbox

This is my sandbox! Here I play with Wikicode and write things before they're ready to go elsewhere.

structured by disciplines
Dementia group of related symptoms associated with a gradual decline in brain functioning. There is currently considerable concern about it's exponentially increasing prevelence in due to the ageing population.  The euthanasia of dementia patients is a peticularly contencious issue as it brings up issues

Ethics
Given the declining role of religion as a supplier and upholder of moral values in western society, medicine and law have been given increasingly more responsibilities in building society-wide value systems {ref from mcgill study} and upholding the strong enough societal consensus on which healthcare and a trustworthy medical law can be built. The case of euthanasia or physician assisted suicide, medical ethicists have had to increasingly approach the issue secularly and provide arguments that reconcile the continually conflicting values of the right to life, self-determination, dignity, and the power of the state. As it is practiced wholly theoretically, and is not bounded by overarching codes or goals, an ethical exploration is able to subsume the biases that could impair an approach by medics or legal scholars. As such, the ethical arguments for and against euthanasia reach only for the four axioms of formal Ethics[gensler] and for the basic values of the ethicist and those who share them. While lending the discipline apparent [ref] impartiality, Ethics’ lack of a uniform approach has done little to attack the underlying dilemma since the 19th century, though our understanding of the practical and moral consequences of each of the values, once agreed upon, has been well developed [ref]. As many ethical arguments (and popular movements advocating) for euthanasia in general stipulate terminal illness as a necessary condition, many progressive debilitating conditions, like dementia are excluded. Thus, dementia patients, who are very often unable to make legally competent decisions, also excluding them from the necessary condition of informed, competent consent, are left out by ethicists ‘strong’ arguments. Legally, even in countries most permissive of physician assisted suicide in particular The Netherlands, many dementia patients would have no recourse but clauses such as the proposed, but not legalised, “Over 70 and Tired of Life” petition [ref].

Practically, the ethical approach to dementia patients who are believed to want to die, whether or not such a desire is recognised legally, has been reduced to

In Ethics, patients of dementia who are believed to want to die, whether or not such a desire is recognised legally, have been excluded from arguments based on long prognoses, infirm mental capacities, and in proposed laws, by not being old enough. Practically it can be argued that medicine has been more effective in

ethics is bad at dealing with dementia and euthanasia because of the fact that d3mentia patients cant give competent consent and are not terminally ill. more practically medicine is able to deal with these patients because many doctors are already practicing it because they are 'double dosing' and using the doctrine of double effect to practice euthanasia. Ethics is limited by its lack of grounding (only axioms are personal values) and so is unable to crystalline a consensus that a healthcare or legal system can be based on.

Medicine as a Discipline
“Medicine is the science or practice of the diagnosis, treatment, and prevention of disease”. It primarily draws upon quantitative evidence, such as randomised controlled trials (RCTs) and systematic review, which are designed to remove any forms of bias. This objectivity, coupled with medicine's inherent focus on saving and prolonging life, makes its empirical approach to euthanasia and dementia one that often meets tension with other disciplines that are more holistic, or grounded in axiology.

QALY
Quality Adjusted Life Years (QALY) "is routinely used as a summary measure of health outcome for economic evaluation, which incorporates the impact on both the quantity and quality of life."(5) It is a large, useful part of medical economics that allows for the objective comparison of diseases, populations and programs(6), and guides the distribution of healthcare resources. Due to the objective, quantitative nature of its evidence, QALY inevitably favours those in a better position to benefit, and is often criticised by other disciplines for its systematic discrimination against the ageing and disabled. (7)(8) This is especially true in dementia patients, who then face both the stigmatisation of their condition, and financial pressures to carry out their "special duty to die".(9)(10) We must also consider whether the experience of life can be adequately represented by numerical evidence.

The Biomedicalisation of Dementia
The medical diagnosis of dementia involves cognitive and neuropsychological tests, lab tests, brain scans, psychiatric evaluation, and genetic tests (11). These procedures generate the quantitative evidence that medicine's highly biomedical focus is grounded in. Medicine pays little attention to social or psychological factors, viewing what was once a natural part of ageing as a medical problem, rather than the group of symptoms that dementia is.(12)(13) This biomedicalisation of dementia has led to pressures for timely diagnosis and rapid transition into care programs (14)- programs that are undoubtedly important, but that create a sense of fatalism around the condition, perhaps contributing to many people's decisions to request for euthanasia.

Interdisciplinary Tensions
Where medicine is a discipline largely centred on objective evidence, ethics draws from qualitative, subjective evidence. This creates inevitable interdisciplinary tension when it comes to the euthanasia of dementia patients. Medicine centres around the culture of "[dedication] completely to life under all circumstances.”(15), as shown in Rurup et al's study that found that physicians were far less likely to demonstrate tolerant behaviour towards life terminating attitudes (16%) in comparison to nurses (57%) and relatives (90%). (16) This tension plays out in the quality of life debate.

The quality-of-life approach to euthanasia believes that a person with dementia should be granted euthanasia when they feel their life is not worth living. Evidence for quality of life is purely subjective, varying from person to person, leaving vulnerable dementia patients at risk of having different values projected onto them by the people around them. In line with this ethical perspective, and in contrast to that of medicine, our palliative care should focus not so much on the protection of life, but of the autonomy of the patient.(16)

Sociology
Sociology is the science of society; the study of the collective aspects of human behaviour and the dynamics of the groups and organisations that make it up. It's demographic, relational, and experiential focus and the complexity of the systems it investigates lead to a greater focus on qualitative data and the use of hypothetical frameworks than many of the other disciplines addressing dementia and euthanasia. There are two major branches that generate tension with other disciplines in the sociological work on dementia and euthanasia.

The Experience of the Community
First, there is a tension between the perspective of individualist ethicists and a significant portion of the sociological literature adressing this issue. This can be understood in terms of ethics drawing on the evidence of subjective experience that suggests that decisions are autonomous and should therefore be respected, paying less attention to the influences on their decisions than sociology. By definition sociology finds the comonalites between the behaviour and experience of individuals based on their demographic groups, and is therefore concerned with the influences on decision making and the effects of those decisions associated with a group as a whole.

Although many of the relevant studies are published in medical journals, the value of their sociological approach in adding to the medical and ethical discussion is evident. In these studies some important conclusions are drawn which contrast with the individualist ethical naratives. Several studies explore the effects of euthanasia and dementia on the experiences of family members, suggesting that euthanasia may decrease the levels of grief, trauma and depression experienced. Roest (2019) conducted a study which found that despite the legal, ethical and medical narratives suggesting otherwise, family relations and values played a key role in both physician and patient decisions regarding assisted suicide, especially relevantly it is suggested that the suffering that may be experienced by the patients family should be considered, questioning the individualist narrative of autonomy and the primacy of the individual.

Social Construction
The second branch explores the issue through a social constructionist framework, looking at the cultural, social and demographic factors that impact the prevelence and perception of the disease. This approach leads to a view of dementia very much at odds with the prevailing medical view by studying the experience of living with dementia as an intersection of demographic class and the concept and symptoms of dementia itself. Due to this wider evidential pool and understanding dementia as socially constructed by medical classifications and media presentation, Johnstone (2013) and others argue that the stigma and fear around the ageing process has been generated by the biomedicalisation of dementia leads to the depersonalisation of patients. This combined with the literature showing how dementia prevelence and the suffering of patients is increased by low economic status and experiences of descrimination has lead to considerable concern that allowing the euthanasia of dementia patients would become discriminatory.

Beard (2017) encapsulates the tensions between this view and that of the medical community as an unresolved dichotomy between the medical view of dementia as a pesemistic 'black hole of aging', drawing paralells to the living dead archetype, in contrast to the sociological literature presenting the possibity of living and ageing well despite the disease. They also critisise the neglect of research into the social factors and management of the disease in preference of finding a cure. This tension is the result of the different forms of evidence the two disciplines are exposed to and value. Sociology studies individuals with dementia across the course of the disease and by dividing them by demographics and gathering qualititive evidence sees the affects of thier position in society and subjective experience on the course of the disease and the wider benefits and risks of allowing them euthanasia. Medicine on the other hand focuses on the quantitively measurable indicators of the disease and physical causes proposing corresponding interventions that may extend the life of a patient, often focussing on the later stages of the disease with little regard for their personal experience or social situation. There is, however, an encouraging movement towards holistic care and incorperation of sociological methods and evidence throughout the medical journals studying dementia and euthanasia as can be seen in many of the citations in this section.

Sociological Perspective
Sociology is the science of society, the study of the collective aspects of human behavior and the dynamics of the groups and organisations that make it up. It's collective, relational and experiential focus and the complexity of the systems it investigates leads to a greater focus on qualititive data and the use of hypothetical frameworks than many of the other disciplines adressing dementia and euthanasia.

The sociological work on dementia tends to explore

experience of carers and family and how this interacts with the experience of patients https://academic.oup.com/gerontologist/article/59/5/e597/5033595 the affects of race and class on dementia prevelance, experience and treatement https://journals.sagepub.com/doi/full/10.1177/1039856219878645 the affectiveness of care from an experiencial perspective https://journals.sagepub.com/doi/full/10.1177/0269216311423443 https://journals.sagepub.com/doi/pdf/10.1191/0969733002ne554oa

there is also a considerable amount of literature critisizing the 'biomedicalization' of humans and their incorperation into the economy in reference to the allocation of medical resources and euthanasia

(oliveoilandgarlic)

Topic Sentance
Sociology is the science of society: the study of the collective aspects of human behavior and the dynamics of the groups and organisations that make it up. https://onlinelibrary.wiley.com/doi/pdf/10.1002/%28SICI%291520-6696%28199610%2932%3A4%3C379%3A%3AAID-JHBS4%3E3.0.CO%3B2-M https://www.britannica.com/topic/sociology It's collective and relational focus, as well as its interest in human experience focus and the complexity of the systems and causal relationships it studies leads to a greater focus on qualititive data and the use of hypothetical frameworks than other disciplines. https://www.jstor.org/stable/2096141?seq=1 https://www.britannica.com/topic/sociology DONE What is the consensus stance on euthanasia and dementia in sociology?

https://academic.oup.com/gerontologist/article/59/5/e597/5033595 meta analysis of 26 studies on the experience of carers of people with dementia, found that up to 80% of carer's experience depression. but that the literature is unclear as to a causal relationship. this highlights the sociological focus on human experience and relations etc

'''what is the DALY measure for dementia? are DALY's more the work of sociology, economics or medicine?'''

what is the distribution of dementia acrosses the divisions between groups sociology draws?

https://jamanetwork.com/journals/jamaneurology/article-abstract/2729093 economic status as well of health are greater predictors of dementia than race or culture. This is thought to be due to access to education and nutrition as well as healthcare.

https://journals.sagepub.com/doi/full/10.1177/0269216311423443 meta analysis of qualitive research conducted in the uk into the transition into paliative care (the closest thing to euthanasia that exists in the uk) for dementia patients, highlights the lack of the 'long view' in the medical community, also a failure to except that dementia might be a cause of death in it's own right was noted, as patients usually die from complications or accidents caused by the disease rather than the disease itself.

How is sociology defined? DONE

Google definition:
 * -the study of the development, structure, and functioning of human society.
 * -the study of social problems.

Encyclopedia Britannica https://www.britannica.com/topic/sociology
 * -studies the dynamics of society by looking at its organisations and drawing division within it, looking at the interactions between these parts.
 * -studies the "collective aspects of human behaviour" especially looking at the way an individual's group influences their behaviour

Methods and Evidence
What types of evidence are prioritised in sociology and how are they wieghted? DONE Encyclopedia Britannica https://www.britannica.com/topic/sociology :
 * -ecological patterning - the way groups, behaviour, wealth, industry and land value change over time and relate to one another
 * Experimental methods - observing social interactions in controlled enviroments,

https://www.jstor.org/stable/2096141?seq=1 an analysis of the uncertainties around this issue and the confusion interaction between theory and evidence in the evidence's interpretation, mentions as a side point the importance of statistical methods and computing in sociology.

'''What theoretical frameworks and axiomatic assumptions are used to interpret this data? especially in reference to euthanasia in dementia. '''

How do tensions form?
Differences in evidence, assumptions and interpretation? - maybe best summerised once we have the methods and evidence section for all the disciplines

https://journals.sagepub.com/doi/pdf/10.1191/0969733002ne554oa this study interviewing carers at one hospital found that carer's understoon dementia patients decision to starve but thier moral and ethical beliefs hampered them in respecting patients autonomy.

Examples of direct clashes or contrasting quotes
note: assess how sociological these papers and articles actually are

points, there is a considerable push back against the 'biomedicalization' of human being in the sociological literature https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.12152 more sociological literature on the dehumanisation of dementia patients by the media, and how this leads to increased use of euthanasia

https://journals.sagepub.com/doi/full/10.1177/1471301217709661 critisizing the 'hegemony of american allopathic medicine' due to is depersonalization of people with dementia using fairly strong language. It argues that the combination of medical attitudes and media presentation conflate dementia with it's final stages (loss of agency, contact with reality and finally life). It critisises the dichotomy between positive and negative aging, and claims that this medical view eclipses the diversity between aging processes and the effects of race, culture and sex on these processes. It argues that is 'a social construct created by people and within social institutions'. 'it says 'If forgetfulness in seniors continues to be medicalised, then we might well find that we have destroyed the precious little space within which we as modern humans can age meaningfully'. criticises the medical perspective as 'oversimplifying the lived experience'- this is a clear example of the clash between empirical scientific evidence and sociology's qualitive more experience focussed aproach

https://rgs-ibg.onlinelibrary.wiley.com/doi/full/10.1111/tran.12055 a critique of the DALY (disability adjusted life year) a common measure used in medicine to evaluate treatment efficiency and make decisions on it's distribution due to it's assumption that the life of someone with a disibility is less valuable than the life of someone without it, it argues this is due to the blurring of the line between the human biological being, and the economy and political sphere. It also speaks of how the DALY measurement leaves out the poorest classes due to thier lack of access to medical care leading to a lack of generation of data. this is a direct tension between the medical and economic perspectives and the ethical and sociological perspectives. although it does not mention dementia specifically it is highly revavent due to the increasing importance of the DALY and QALY in medical decisions.

https://journals.sagepub.com/doi/full/10.1177/1039856219878645 in oregon over 50% of people requesting euthanaisa claim 'being a burden to their families' as the main reason for the decision, this article argues that poverty and old age contribute largely to these decisions, creating a class discrepancy.

https://www.researchgate.net/profile/Bernadette_Roest/publication/332237833_The_involvement_of_family_in_the_Dutch_practice_of_euthanasia_and_physician_assisted_suicide_a_systematic_mixed_studies_review/links/5caaebc5299bf118c4ba88be/The-involvement-of-family-in-the-Dutch-practice-of-euthanasia-and-physician-assisted-suicide-a-systematic-mixed-studies-review.pdf doctors struggled to empathise with patients citing existential reasons for thier request for euthanasia, and psychological suffering was given less consideration than physical symptoms. the more sociological aspects of the paper reveal the importance of family relations and 'being a burden' in decision making, doctors are resistant to consider the suffering of the family as a whole due to the medical focus on the experience, especially the physical experience, of thier single patient over wider more sociological considerations of the suffering of the family unit as a whole and the impacts of the implimentation or non implementation of euthanasia at these different levels.

Introduction
There is an ardent debate as to how facts should be determined and the way the models of philosophy and science can be mapped onto reality, both within and between both disciplines, psychology has had a fruitful interplay with both of these areas.

The roots of psychology reach deep into the philosophical tradition. In the late 18th century Immanuel Kant hypothesized the first dimensional model of personality, paving the way for a huge variety of personality models as well as statistical psychology. Friedrich Nietzsche, although now thought of as a philosopher, often referred to himself as a psychologist and criticized much of the preceding philosophical tradition as overly introspective and self-indulgent. This foreshadowed the rift that formed over the coming century between the psychologist-philosophers and the institutions of psychology.

The Rift
This rift was largely due to the rapid progress was made in understanding the brain and human behavior and the desire of psychology departments to establish themselves as equals to the already established natural sciences. Psychology suceeded in this through the use of empirical and statistical methods and rigorous scientific methodology and experimental protocols in conjunction with technologies such as magnetic resonance imaging and advances in biochemistry that were facilitated by quantum mechanics. However, this materialistic focus led to a loss of confidence in the utility of psychoanalytic theories and widespread criticism of the psycho-philosophers that claimed knowledge or predictions about human behavior individually and societally based on introspective experiences or enumerative inductivism (the repeated observation instances which fit a framework or hypothesis).

Conclusion
Freud, Jung, and Addler, for example, thought of themselves as psychologists and scientists. However, by the end of the twentieth century their work was respected and taught more in fringe institutions, humanities, and social science departments. In psychology departments, if taught, these thinker's work is usually in the context of a historical artifact rather than a working theory. The discussion that lead to this view of psychoanalytical work helped separate psychology, based on empirical evidence and methods of experimentation developed in the natural sciences, from the multitude of observation, interpretation, introspection and enumerative inductivism based hypotheses developed by early 'psychologists', both turned psychology into a true science and advanced the scientific method as a whole as well as producing some fascinating, important and useful philosophies and interpretive models. However, the psychoanalitic discipline has been left in disarray by its dissociation from academic institutions, which still considerably hampers it's developement despite it's continueing importance in theraputic settings and culture.

Generational Issues
Planck's principle, as well as similar ideas presented by Dawin and Lavoisier, state that new idea's do not come to dominate by converting the proponants of the theories it is overturning but by their death and the next generation learning the ideas as given. This is likely to be a result of the power imbalance between the young and old in the universities as it takes a long time to climb to the top of these institutions as older people including scientists are generally less reseptive to new ideas. Research into age discrimination within academia also provides evidence for the presence of power dynamics in academic progression; implying that age and 'time surved' plays large part in decisions regarding promotion as well as competance and experience. This is an example of institutional power, younger people are simply not considered for higher positions in departements due to the observation that most of those with the skills for these positions are older. Overall the issue of idea's and individuals making their way up the academic ladder is a intersection of institutional power and individual's unconcious biases against idea's that they are unfamiliar with.

Gender Issues
In the united states only 20% of physics degrees and PHDs are earned by Women, and similar figures are reflected around the world. The lack of representation of multiple issues of power as well as sex differences in traits. The power issues between genders in physics departments mostly constist of preconceptional biases perpatrated by physics being primerily dominated by men and overrepresented in textbooks and other physics. This is one cause that contributes to most women not considering a career in physics from an early age.

Other power issues contributing to fewer women reaching higher positions in physics include difficulty fitting into a male dominated workplace and the decision making processes affecting career progression. Some factors that contribute to this are; men being likely more to overestimate their skills and women being more likely to underestimate, women being more to feel excluded from making connections across and up the hierachy and expectations of female steriotypes playing out in microagressions and the decision making process. These create an intersectional power imbalance between men and women in physics leading to an inneficient hierachy which is likely to hamper scientific progress by excluding potentially innovative women.

However, it is unlikely that power imbalances and descriminatory biases within physics account for all of the gender discrepancy in the discipline. One factor that explains part of the underrepresentation of women in physics is differences in interests and priorities between men and women. Especially that women are, on average, more likely than men to prioritise 'balance and relationships' over material success and have a considerable statistical tendancy towards an interest in people (in the broadest sence refering to arts, humanities, care, etcetera) in contrast to the male tendancy towards interest in things (again in a very broad sense; STEM, data, construction, etcetera). Some more possible factor is the female bias towards verbal intelligence as opposed to the male average tending towards spacial intelligence and maternity (especially in the high status and income positions that require a long and constant career path to reach).

Some argue that the difference is due to the width of the male general intelligence distribution increasing the male to female ratio at the extremes. However, measuring mean gender differences is extremely difficult due to the huge overlap in distrabution and the time and energy required on the part of the respondants to collect good psychometric data and many of the studies contradict oneanother.

Conclusion
Generational issues of power in physics and other sciences may well hamper scientific progress. Gender issues of power represent a portion of the reasons for the underepresentation of women in physics but it is unlikely that by eliminating the power issues the outcome would be equal representation due to the statistical differences in interests and traits.

It remains unclear in the literature how the power issues can be adressed as a whole. However, there is evidence that diversity cognative learning and reactions training had small but significant and lasting effects in combating unconcious biases. It is also suggested that increasing the representation of women in physics related content would increase the number of women enroling in physics courses. This is likely to increase the number progressing onto PHD level and academic posts, diluting the male dominated culture and increasing the likelyhood of innovation by a greater proportion of humanities best minds working in the field of study.