This essay will argue for the centrality of empathy in the doctor-patient relationship — as a core of ethically sound, responsible therapeutics. By empathy, I intend an explicitly hermeneutic practice, informed by a reflexive understanding of patient and self. After providing an overview of the history of the concept of empathy in clinical medicine, I discuss current definitions and the use of Balint groups in residency training as a way to develop empathic competence in novice physicians.

Professor Solmsen's interpretation is orthodox; his comprehensive account builds on recent more specialized studies, including his own, and those of Jaeger, Ross, and Cherniss. If in some ways the book contains no large surprises, it nevertheless makes a major contribution by its treatment of Plato. The author has skillfully disengaged Plato's observations about nature from the customary ethical, epistemic, or, as the case may be, metaphysical contexts. He demonstrates that Plato was toward the end of his career a more serious (...) investigator of physical phenomena than is commonly supposed. Moreover, at almost every turn he finds Platonic precedents for Aristotle's thinking in this field. He does not detract from Aristotle's originality, but illumines it, and Plato's as well. (shrink)

Of course private-public terminology has a certain first-hand obviousness for us. No one does my experiencing for me; there are features of myself evident to me simply by virtue of the fact that I live through them. These features are not available in quite the same way to others. And your situation is the same. Meanwhile we all have the same sort of access to what we can see and touch and explore scientifically, i.e., the public common world. These remarks (...) must not be taken to imply that a human's privacy is identical with awareness or with immediate feelings; privacy is not exhausted in consciousness. Nevertheless the importance of the private-public distinction à propos actualities is its promise for clearing up or at least clarifying many puzzles involving consciousness: problems about perception, mind-brain connections, and even perhaps immortality. At least the distinction is promising if you begin by taking us to be indeed individual centers of an awareness which discloses some private content but also discloses real other bodily beings. That is, something like Weiss's conception of private and public or inside and outside seems to be essential if one holds that mentality has a firm non-dubious place in the natural world. (shrink)

This paper has two sections. In the first, I shall deal with the parts of the ontological principle; in the second, with the question of whether to accept or reject its third part.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Discourses of Jewish Identity in Twentieth-Century FranceEllen S. FineDiscourses of Jewish Identity in Twentieth-Century France, edited by Alan Astro; Yale French Studies 265pp. New Haven: Yale University Press, 1994, $17.00.Ever since France became the first European country to grant Jews equal rights as citizens with the enactment of the Declaration of the Rights of Man in 1791, the question of identity has been a central preoccupation of French (...) Jews. Their emancipation brought about assimilation to the universalist principles of the French Republic and led them to detach themselves from their own traditions, generating conflicting emotions about what it meant for a Jew to be French. The topic of French-Jewish identity has been reflected upon by writers ranging from Sartre, Memmi, and Misrahi to Levinas and Finkielkraut, none of whose discourses are included in this volume but whose ideas are discussed in Seth Wolitz’s pertinent article, “Imagining the Jew in France: From 1945 to the Present.”Divided into two main sections, “Literary Texts” and “Cultural Contexts,” this collection contains articles written by authors not familiar to English speaking readers. They are excellently translated, mainly by the editor, Alan Astro. In his introductory essay, Astro notes that his aim is to portray the cultural and ethnic diversity of French Jews of different origins and to show their part in the formation of Jewish identity. The focus is on how French Jews feel about their own identity, and not on how others see them.The first section, “Literary Texts,” represents a variety of genres, generally fiction. Over half of the thirteen texts date from the 1970s to the present, and are mostly personal narratives, anecdotal in nature. The tone often conveys “a certain humor or self-irony,” described by Rachel Ertel in her essay, “A Minority Literature” (in the second section) as identifiable traits of a Jewish work.With no logical sequence to the presentation of the texts, a multiplicity of perspectives is clearly the objective. For example, Bernard Frank, whose ancestors have lived in France since the Revolution, feels “as French as anyone else,” yet recognizes that Jews are different, “because they’ve been made to be different.” Wolf Wieviorka in 1936 exalts his “noble pedigree,” being a naturalized French citizen; he was later murdered by the Nazis.North African Jews who emigrated to Paris in the 1950s and early 1960s, studied sociologically by Michel Abitbol, are portrayed in Gil Ben Aych’s novel, The Chant of Being (Algerian), and in Paula Jacques’s novel, Aunt Carlotta’s Legacy (Egyptian). Jews of Eastern European descent are depicted in the short stories by Cyrille Fleischman, one of which recounts how a Sorbonne professor of sixteenth-century French literature renounces his eminent career and like his father, opens up a delicatessen in the Jewish quarter of the Marais, thus returning to his roots. Henri Raczymow returns imaginatively to a pre-war Poland in Tales of Exile and Forgetfulness, recreating in French the intonations of Yiddish, the language of his grandparents who died in the Holocaust. In an [End Page 378] outstanding essay, “Memory Shot Through With Holes,” Raczymow articulates urgent questions posed by the second generation: “By what right could I speak, I who was not a victim, survivor or witness?”If the first section is multicultural, the second, “Cultural Contexts,” is interdisciplinary. Annette Wieviorka (granddaughter of Wolf Wieviorka) studies accounts by survivors, revealing the impact of Vichy’s imposing a Jewish identity on its citizens. Wieviorka also evokes the importance of the Six-Day War which compelled assimilated French Jews to proclaim their Jewish allegiance, a pivotal event transforming their sense of identity.Other significant contributions are Gérard Haddad’s exploration of the importance of Judaism in the life and work of Jacques Lacan, an outsider who seemed more concerned with Jewish identity than his fellow psychoanalysts. Ora Avni analyzes Patrick Modiano’s repudiation of his Jewish patrimony in his seminal novel, La Place de l’étoile. Elizabeth de Fontenay comments on how the quant-à-soi (“keeping to oneself”), the reserve characteristic of the French, becomes the quant-à-nous (“ourselves”) for the French Jew who is linked to a community beyond the... (shrink)

This interpretation of Plato on epistëmë is refreshing and stimulating. Its central claim that forms are powers, and not predicates or transcendental universals, is not new. It is not now common either. As presented, the interpretation is timely, lucid, comprehensive and notably one which keeps readers close to the expressions Plato uses.

While various interpretations are allowable, questions do arise as to what treatments are legitimate, and what criteria of legitimacy may be invoked. Surely one can demand that an interpreter state his intentions clearly, that he respect the texts, and that--if he possibly can--he heed the spirit in which they were written. Spirit is hard to capture, but the consensus of informed opinion about the texts and their setting should be some help. An introductory account of Aristotle involves the difficult feat (...) of meeting these requirements while remaining fairly simple and presenting its subject in a favorable light. (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might (...) inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might (...) inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

These essays apply influential, pathbreaking psychological studies about women's lives to literature. In their analyses of fictional portraits, contributors both challenge and confirm psychological theories about female identity, about 'connection/separation' as developmental catalysts, and about the impact of gender on 'voice,' moral decision-making, and epistemology in relation to classical and contemporary literary texts, written by both women and men.

2. Thesis 2 I accept insofar as it asserts the relation of possibility to actuality to be a fundamental aspect of things. This relation is sui generis.

Seminal work by Knobe, Prasada, and Newman (2013) distinguished a set of concepts, which they named “dual‐character concepts.” Unlike traditional concepts, they require two distinct criteria for determining category membership. For example, the prototypical dual‐character concept “artist” has both a concrete dimension of artistic skills, and an abstract dimension of aesthetic sensibility and values. Therefore, someone can be a good artist on the concrete dimension but not truly an artist on the abstract dimension. Does this analysis capture people's understanding of (...) cornerstone social categories, such as gender, around which society and everyday life have traditionally been organized? Gender, too, may be conceived as having not only a concrete dimension but also a distinct dimension of abstract norms and values. As with dual‐character concepts, violations of abstract norms and values may result in someone being judged as not truly a man/woman. Here, we provide the first empirical assessment of applying the dual‐character framework to people's conception of gender. We found that, on some measures that primarily relied on metalinguistic cues, gender concepts did indeed resemble dual‐character concepts. However, on other measures that depicted transgressions of traditional gender norms, neither “man” nor “woman” appeared dual‐character‐like, in that participants did not disqualify people from being truly a man or truly a woman. In a series of follow‐up studies, we examined whether moral norms have come to replace gender role norms for the abstract dimension. Implications for the evolution of concepts and categories are explored. (shrink)

The Machiavellian Moment is a classic study of the consequences for modern historical and social consciousness of the ideal of the classical republic revived by Machiavelli and other thinkers of Renaissance Italy. J.G.A. Pocock suggests that Machiavelli's prime emphasis was on the moment in which the republic confronts the problem of its own instability in time, and which he calls the "Machiavellian moment." After examining this problem in the thought of Machiavelli, Guicciardini, and Giannotti, Pocock turns to the revival of (...) republican thought in Puritan England and in Revolutionary and Federalist America. He argues that the American Revolution can be considered the last great act of civic humanism of the Renaissance. He relates the origins of modern historicism to the clash between civic, Christian, and commercial values in the thought of the eighteenth century. (shrink)

Research indicates that consumers are particularly concerned about the safety of meat. More highly processed meat is perceived as more unsafe than fresh or natural meats, i.e., consumers trust processed meat less. This paper studies the relationship between perceived trust and day-to-day purchase behavior for meat, giving special attention to the degree of meat processing. Controlling for trust in food chain actors and demographic and socio-economic variables, actual meat purchases of Canadian households are linked to answers from a commissioned food (...) attitudes survey completed by the same households. Expenditures for processed and total meat (but not for fresh meat) are significantly different by three levels of trust in the food industry. Consumer with the lowest trust levels consume less (especially of processed meat) compared to those with higher trust levels. However, in a multivariate setting, trust shows no effect on fresh or processed meat purchases with or without demographic and socio-economic control variables, suggesting that the impact of trust on meat purchases is only small. However, the low trusting consumer segment could potentially be a target for marketing strategies focused on reputation and quality to increase sales in this particular group. (shrink)

Caretaker-infant attachment is a complex but well-recognized adaptation in humans. An early instance of (or precursor to) attachment behavior is the dyadic interaction between adults and infants of 6 to 24 weeks, commonly called "babytalk." Detailed analysis of 1 minute of spontaneous babytalk with an 8-week infant shows that the poetic texture of the mother’s speech—specifically its use of metrics, phonetics, and foregrounding—helps to shape and direct the baby’s attention, as it also coordinates the partners’ emotional communication. We hypothesize that (...) the ability to respond to poetic features of language is present as early as the first few weeks of life and that this ability attunes cognitive and affective capacities in ways that provide a foundation for the skills at work in later aesthetic production and response. By linking developmental social processes with formal cognitive aspects of art, we challenge predominant views in evolutionary psychology that literary art is a superfluous byproduct of adaptive evolutionary mechanisms or primarily an ornament created by sexual selection. (shrink)

Although there is a significant amount of research on organizational citizenship behavior and its importance to individual and organizational outcomes, relatively little research has explored the process by which such behavior emerges and is established within an organization. Against this backdrop, we combine the perspectives offered by contextualist inquiry and actor–network theory to propose an integrative framework for investigating how organizational citizenship behavior develops in a large, heterogeneous organization. In order to illustrate the framework, we present a detailed case study (...) of recycling at a large university. Like many other organizations, the university does not have a formal organizational structure to address sustainability concerns and the initiatives are therefore mainly voluntary and emerging in nature, and outcomes are, as a consequence, highly uncertain, and fragile. We argue that contextualist inquiry in combination with actor–network theory provides new and important insights into the emergence and establishment of organizational citizenship behaviors, and that outcomes are contingent upon interactions between the context, process, and content of the behaviors in question and the related networks of human and non-human actors. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; (...) 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

Many new genetic tests are used in clinical practice, and the number of available tests is growing. Two important health policy questions arise as these genetic tests become available. The first question, whether a new test should be made available, has been the focus of much recent discussion. The second question concerns defining the appropriate standards surrounding the use of these tests, including patient selection, education, informed consent, test interpretation and counseling.Genetic tests currently move from the research arena, where strategies (...) are put in place to minimize risks,into the clinical context where the practice of medicine is more variable and the risks to patients less understood. In the research setting, risks can be minimized through safeguards including education, consent, and counseling. The frequency and magnitude of psychosocial and clinical risks canbe assessed. In the clinical setting, however, these safeguards may not be used consistently, creating unknown risksfor patients. (shrink)

Many new genetic tests are used in clinical practice, and the number of available tests is growing. Two important health policy questions arise as these genetic tests become available. The first question, whether a new test should be made available, has been the focus of much recent discussion. The second question concerns defining the appropriate standards surrounding the use of these tests, including patient selection, education, informed consent, test interpretation and counseling.Genetic tests currently move from the research arena, where strategies (...) are put in place to minimize risks,into the clinical context where the practice of medicine is more variable and the risks to patients less understood. In the research setting, risks can be minimized through safeguards including education, consent, and counseling. The frequency and magnitude of psychosocial and clinical risks canbe assessed. In the clinical setting, however, these safeguards may not be used consistently, creating unknown risksfor patients. (shrink)

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)