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(1998) has written of similar moral dilemmas in the conduct of fetal surgery. |
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This proposed new grouping of diseases is very different from the grouping in the ICD, yet it is both consistent and possibly useful. It serves to remind us that the "rational and general" is only ever specific to time, practice, and place. |
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From the early 1920s, with the use of Hollerith cards and Powers machines, the history of the ICD is interwoven with that of computing. The chief advantage that computing offers today to the ICD and similar schemes is the ability to maintain uncertainty at the level of closure on analysis. When the list involved a relative handful of categories arrayed along one dimension, then a whole series of decisions were forced, whether the disease was environmental (e.g., of industrial origin), genetic, or viral, and so forth. Even when the maximal degree of ambiguity was kept, it was impossible to compare large bodies of data because the original wealth of material simply could not be maintained. Now that more numbers can be crunched and more axes added to the disease descriptions encoded by computers, the time of diagnostic decision can be held off. This theoretically brings closer the prospect of true comparability, although the range of practical and even ontological problems are unlikely to disappear even with the most advanced multivalent, object-oriented system. |
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The growing literature in organizational and managerial computing and its impact on knowledge attests to the importance of ambiguity as an organizational resource (see Kraemer, Dickhoven, Tierney, and King 1987 for an example using computerized information modeling; Pinsonneault and Kraemer 1989 review this literature for decision support). Since March and Simon's first conception of satisficing in the absence of universal, complete, knowledge (1958), increasingly sophisticated models and metaphors have been advanced to attempt to address this issue (see Morgan 1986 for a review). As shown in chapters 7 and 8, maintaining ambiguity may also consist in organizational autonomy, professional legitimation, and other forms of discretion. |
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The goal of standardizing the ICD is by no means equivalent to rendering it unambiguous. Consider, for example, the following definition of a cause of death produced by a committee seeking to |
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