Michi De R

The aim of the article is threefold: to argue and motivate that unnecessary surgery is a worldwide phenomenon, that it exposes patients to unwarranted risks and that patients should actively participate in decision-making and take a shared responsibility to protect their interests. There is a firm belief that the enterprise of medicine is something of value – both intrinsically because being healthy is good and instrumentally since being healthy allows us to do what we wish to, to attain happiness and to live valuable lives. However, this can only hold if treatment is justified in terms of accepted evidence-based criteria. Imperative for all forms of treatment, including costly and invasive investigations, this is particularly true for surgical interventions because no surgery is without risk. Surgery performed outside of the norms of accepted indications constitutes a grave form of assault. Medicine is a noble cause if we stick to the rules and help each other to do so. As professionals, our most fundamental regulation is by ourselves.

We study a propositional bimodal logic consisting of two S4 modalities £ and [a], together with the interaction axiom scheme a £ϕ → £ aϕ. In the intended semantics, the plain £ is given the McKinsey-Tarski interpretation as the interior operator of a topology, while the labelled [a] is given the standard Kripke semantics using a reflexive and transitive binary relation a. The interaction axiom expresses the property that the Ra relation is lower semi-continuous with respect to the topology. The class of topological Kripke frames characterised by the logic includes all frames over Euclidean space where Ra is the positive flow relation of a differential equation. We establish the completeness of the axiomatisation with respect to the intended class of topological Kripke frames, and investigate tableau calculi for the logic, although tableau completeness and decidability are still open questions.