Historians of medicine generally credit the hospital standardization movement of the early 20th century with establishing the record as a sign of hospital and staff quality. The medical record's role had already been the subject of intense interest at the New York Hospital several decades before, however. In the 1880s malpractice and insurance concerns caused the administration to attempt to supervise record creation, quality, and access, over the objections of physicians. Contemporary concerns about the uses of the medical record were (...) in play well before 1910. (shrink)

Medical records contain important clues about the history of medicine. These documents, which ostensibly describe the course of a patient's illness, are “unique constructions that allow us to observe the social and technical structure of contemporary healing.” As such, the 21st-century hospital medical record reflects the many components of inpatient care: medical interventions, billing, legal documentation, research, and education. It is comprised of a wide array of elements: professionals' notes; vital signs and other descriptive information; laboratory data and test results; (...) demographic information; orders, charges, diagnostic and treatment codes; and other utilization data. It is well understood that many people share and need this information. Current controversies over records involve not control, but computerization, security, and accessibility. Although health professionals offer input, decisions about hospital medical records have been considered largely an administrative responsibility. (shrink)

At the beginning of 2020, COVID-19 became a global problem. Despite all the efforts to emphasize the relevance of preventive measures, not everyone adhered to them. Thus, learning more about the characteristics determining attitudinal and behavioral responses to the pandemic is crucial to improving future interventions. In this study, we applied machine learning on the multi-national data collected by the International Collaboration on the Social and Moral Psychology of COVID-19 (N = 51,404) to test the predictive efficacy of constructs from (...) social, moral, cognitive, and personality psychology, as well as socio-demographic factors, in the attitudinal and behavioral responses to the pandemic. The results point to several valuable insights. Internalized moral identity provided the most consistent predictive contribution—individuals perceiving moral traits as central to their self-concept reported higher adherence to preventive measures. Similar was found for morality as cooperation, symbolized moral identity, self-control, open-mindedness, collective narcissism, while the inverse relationship was evident for the endorsement of conspiracy theories. However, we also found a non-negligible variability in the explained variance and predictive contributions with respect to macro-level factors such as the pandemic stage or cultural region. Overall, the results underscore the importance of morality-related and contextual factors in understanding adherence to public health recommendations during the pandemic. (shrink)

The mapping of therapeutic collaboration throughout counseling deepens our understanding of how the helping relationship fosters client change. To better understand the process of career construction counseling, we analyzed the therapeutic collaboration on six successful face-to-face cases. The participants were six Portuguese adults, five women and one man, real clients of a career counseling service, and four psychologists, three female and one male trained in the career intervention model. The participants completed demographic questions and measures of career certainty, vocational identity, (...) career indecision, and psychological functioning. The Therapeutic Collaboration Coding System was used to track collaboration throughout all interactive episodes. The clinical significance of the intervention was calculated by analyzing pre-post-test statistical differences for each case, with the Reliable Change Index and Z score. The findings evidenced a pattern of therapeutic collaboration evolution for good outcome cases. Based on this pattern, we propose a model of process-outcome evolution for the three phases of CCC. (shrink)

Nous nous référerons dans cet article à la mémoire de l’homme, incarné et historique, déterminé par les médiations spatio-temporelles et exposé aux dilemmes éthiques que doit affronter l’ipséité dans sa capacité d’accueillir l’autre telle que la définit Ricœur. Notre réflexion vise la mémoire inquiétée par des médiations propres à la condition existentielle et corporelle du soi moderne, dans un contexte d’ébullition culturelle et technologique. Un tel contexte a en effet des conséquences qui affectent aussi bien l’identité personnelle et collective, que (...) l’exercice des capacités du soi agissant et souffrant – et tout spécialement celui de sa mémoire. Nous examinerons la dimension tant réceptive que dynamique de la mémoire exposée aux fragilisations qui affectent l’identité narrative humaine, en déterminant ses pouvoirs qui laissent des traces au niveau de la conscience et du corps. Nous terminerons enfin notre réflexion par une analyse des effets volontaires et involontaires qui mettent en question la capacité même de la mémoire, en influant sur l’imagination et sur la réponse éthique du soi. (shrink)

Le dispositif des groupes multifamiliaux favorise l’expression et l’élabora-tion des conflits psychiques chez chaque participant, notamment à partir d’une approche originale dite « de confrontation intergénérationnelle ». À travers le cas de trois adolescentes enclines aux actings et aux manifestations comportementales, les auteurs montrent comment ces groupes thérapeutiques conduisent non seulement à l’élaboration de conflits réels intersubjectifs entre les adolescents et leurs parents tels qu’ils se les présentent dans la réalité, mais aussi au renforcement de leur activité fantasmatique et in (...) fine au réaménagement des liens intergénérationnels. (shrink)

À Santiago deux femmes s’affrontent. La procédure du délit d’injures nécessite, dans cette société orale de la première moitié du xviiie siècle, l’exposé de questions sensibles qui concernent, dans ce cas particulier, les identités féminines. Croisées par de multiples variables, dont l’ethnie est l’une des plus importantes, ces identités de femmes s’expriment dans des lieux sociaux plus ou moins contestés : la fragilité de ces identités s’observe dans l’expression de la violence privée et dans les discours juridiques. Réfléchir sur la (...) manière d’appréhender et de vivre les possibilités d’être femme dans une des villes de l’Amérique hispanique est un des objectifs de cette analyse. L’autre, montre comment les discours sur le métissage et les valeurs qu’ils portent s’incarnent dans les sujets au niveau des conflits mineurs, quotidiens, jusqu’à faire basculer, à travers la parole et l’opinion sur autrui, des parcours individuels. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Refusals of Treatment and Requests for DeathTom L. Beauchamp (bio)It would be hard to overestimate the importance of two decisions on physician-assisted suicide delivered recently by the Ninth and Second Circuit Courts (Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc), aff’g 850 F.Supp. 1454 (W.D. Wash. 1994), rev’g 49 F.3d 586 (9th Cir. 1995); Quill v. Vacco, 80 F.3d 716 (2nd Cir. (...) 1996). They are the highest courts yet to render an opinion on this subject, and their decisions have set the stage for the U.S. Supreme Court to take one of two paths: It will either say that (1) all citizens have a liberty interest in physician-assisted suicide, or that (2) each state may set its own policy on such matters. Whichever path is elected, a right to request physician-assisted suicide is a virtual certainty, at least in some states.These opinions are later segments of an evolving legal history in which courts have held that no criminal liability exists for withholding or withdrawing a life-sustaining treatment when physicians are directed to do so by a patient or an authorized surrogate (see Alan Meisel 1992). The decriminalization of suicide and the right to refuse a life-sustaining treatment now appear to be evolving into a rule that a patient has a legal right to control his or her death, or at least to obtain a lethal prescription. We are at a delicate point in this evolving history. Neither in law nor in bioethics is the justification of physician assistance in suicide the received opinion at the present time, but support for physician assistance in dying could soon become the received opinion in both disciplines.The leading edge of the wedge producing these changes has been widespread acceptance of an extensive right to refuse treatment. This right is today axiomatic in even conservative quarters of bioethics, but 20 years ago it was far from axiomatic that all patients have a right to refuse treatment. Few at that time judged that it would be both immoral and illegal for a physician not to forgo treatment in the face of a competent, authoritative refusal of any form of medical service or treatment.The justification for assistance in bringing about death in medicine is an extension of the justification for letting patients die. Letting a patient die by accepting a valid refusal to continue in life is directly analogous to helping a patient die by accepting a valid request for help. The high value we place on [End Page 371] rights of autonomy thereby spills over from the right to refuse to the underexplored right to request active assistance. 1 As the autonomy interest in this choice increases, denial of help to the patient becomes more burdensome.Those who defend the view that euthanasia and physician-assisted suicide are morally prohibited typically assume that assistance involves an act of killing, that acts of killing are impermissible, and that a defensible distinction exists between killing and letting die. However, this distinction has proved difficult to explicate, and the category of killing often seems distant from the problem at hand. For example, it is an eccentric view that a physician who prescribes a lethal medication to a patient thereby kills the patient (or, for that matter, lets the patient die) when the patient voluntarily ingests the medication and dies. So poor are the conceptual understandings of “killing” and “letting die” that conceptual confusion abounds as to which term to use in almost all morally difficult and controversial cases.A common view is that “letting die” is a matter of “ceasing useless treatments” after which patients die (Gaylin, Kass, Pellegrino, and Siegler 1988). This account is attractive, but too narrow. “Letting die” occurs in medicine under at least two circumstances: cessation of treatment because it is useless and cessation of treatment because it has been refused (which can occur even with useful treatments). Neither conceptually nor morally is “ceasing useless treatment” the proper way to state the condition under which many “letting-die” cases occur. It follows that the type of action—killing or letting... (shrink)

This paper outlines a theory and computer implementation of causal meanings and reasoning. The meanings depend on possibilities, and there are four weak causal relations: A causes B, A prevents B, A allows B, and A allows not‐B, and two stronger relations of cause and prevention. Thus, A causes B corresponds to three possibilities: A and B, not‐A and B, and not‐A and not‐B, with the temporal constraint that B does not precede A; and the stronger relation conveys only the (...) first and last of these possibilities. Individuals represent these relations in mental models of what is true in the various possibilities. The theory predicts a number of phenomena, and, contrary to many accounts, it implies that the meaning of causation is not probabilistic, differs from the meaning of enabling conditions, and does not depend on causal powers or mechanisms. The theory also implies that causal deductions do not depend on schemas or rules. (shrink)

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

Bioethics, Volume 36, Issue 5, Page 486-493, June 2022.

In this paper we ask whether the two-factor theory of delusions is compatible with two claims, that delusions are pathological and that delusions are adaptive. We concentrate on two recent and influential models of the two-factor theory: the one proposed by Max Coltheart, Peter Menzies and John Sutton (2010) and the one developed by Ryan McKay (2012). The models converge on the nature of Factor 1 but diverge about the nature of Factor 2. The differences between the two models are (...) reflected in different accounts of the pathological and adaptive nature of delusions. We will explore such differences, considering naturalist and normativist accounts of the pathological and focusing on judgements of adaptiveness that are informed by the shear-pin hypothesis (McKay and Dennett 2009). After reaching our conclusions about the two models, we draw more general implications for the status of delusions within two-factor theories. Are there good grounds to claim that delusions are pathological? Are delusions ever adaptive? Can delusions be at the same time pathological and adaptive? (shrink)

In the present paper, we substantiate the theory according to which the ailments of imagination presented by Immanuel Kant, especially in his work Anthropology from a Pragmatic Point of View, are sources of artistic creation. It is obvious that not anyone suffering from melancholia, nostalgia, hypochondria or any other ailment of the soul, which Immanuel Kant refers to, becomes a creator of culture. Genius is required for this, but instead of diminishing the creative power of the genius, it seems to (...) be enhanced by the ailments of imagination or generally, by the ailments of the soul. The hypertrophic imagination in the case of a genius plays a major role in the process of fixation in the individual and collective memory of what Immanuel Kant names. (shrink)

Among the meritorious attempts to unravel the enigma of artistic creation are the views of Immanuel Kant and Arthur Schopenhauer. In the following, we want to emphasise an aspect that is less discussed in the specialised literature, namely the relation between memory and creation. We are talking about the authentic creation that Kant and Schopenhauer consider to be the one that carries in itself the Aesthetic Ideas. With minor differences, the concept, as well as the associated linguistic expression, come together (...) in the work of both German philosophers. An authentic work of art is the work of genius and it has the role of transmitting Ideas. Thus, we will be able to observe “the secret” of a work of art – the Aesthetic Idea. (shrink)

In Working Virtue: Virtue Ethics and Contemporary Moral Problems, leading figures in the fields of virtue ethics and ethics come together to present the first ...

In Rita Charon's account of narrative medicine, empathy seems to be an essential element of the clinical relationship. However, empathy has not received much attention, which I believe is problematic. First, I show that not only is there no clear definition of what empathy is, but that this conceptual gap creates ambiguity about its role in the practice of narrative medicine. Second, I argue that certain passages in Charon's work seem to implicitly characterize empathy as a combination of cognitive empathy, (...) affective empathy, and sympathy, and that its inclusion in the practice of narrative medicine can be problematic. Third, following Dan Zahavi, I argue that a phenomenological account of empathy not only seems most compatible with the practices, values, and theoretical framework of narrative medicine, but is also capable of resolving the problems posed by alternative definitions of empathy and the ambiguity about the role of empathy in narrative medicine. (shrink)

Delusions are usually considered as harmful and dysfunctional beliefs, one of the primary symptoms of a psychiatric illness and the mark of madness in popular culture. However, in recent times a much more positive role has been advocated for delusions. More specifically, it has been argued that delusions might be an answer to a problem rather than problems in themselves. By delivering psychological and epistemic benefits, delusions would allow people who face severe biological or psychological difficulties to survive in their (...) environment - although this has obvious epistemic costs, as the delusion is fixed and irresponsive to compelling counterevidence. In other words, it has been argued that delusions are biologically adaptive. The adaptiveness of delusions has been compared by Ryan McKay and Daniel Dennett to a shear pin, a mechanism installed in the drive engine of some machines which is designed to shear whenever the machine is about to break down. By breaking, shear pins prevent the machine from collapsing and allow it to keep functioning, although in an impaired manner. Similarly, when delusions form, they would allow a cognitive or psychological system which is about to collapse to continue its functioning, although in an impaired manner. However, this optimistic picture of delusions risks being undermined by both theoretical and empirical considerations. Using Sarah Fineberg and Philip Corlett’s recent predictive coding account as a paradigmatic model of the biological adaptiveness of delusions, I develop two objections to it: principles of parsimony and simplicity suggest that maladaptive models of delusions have an upper hand over adaptive models; and the available empirical evidence suggests that at least some delusions stand good chances of being psychologically adaptive, but it is unlikely that they also qualify as biologically adaptive. (shrink)

Delusions are symptoms of psychiatric disorders such as schizophrenia and dementia. By and large, delusions are characterized by their behavioral manifestations and defined as irrational beliefs that compromise good functioning. In this overview paper, we ask whether delusions can be adaptive notwithstanding their negative features. Can they be a response to a crisis rather than the source of the crisis? Can they be the beginning of a solution rather than the problem? Some of the psychological, psychiatric, and philosophical literature has (...) recently suggested that they can. We consider different types of delusions and different ways in which they can be considered as adaptive: psychologically (e.g., by increasing wellbeing, purpose in life, intrapsychic coherence, or good functioning) and biologically (e.g., by enhancing genetic fitness). Although further research is needed to map the costs and benefits of adopting and maintaining delusional beliefs, a more nuanced picture of the role of delusions in people's lives has started to emerge. (shrink)

Gustave Le Gray was one of the most technically accomplished and aesthetically enlightened of the early "artist-photographers." Trained as a painter of portraits and landscapes, Le Gray was attracted in the 1840s to the artistic potential of photographic processes. As a photographer he evolved and refined much of photography's primary aesthetic theory. By 1855 he had influenced, if not taught, every important photographer in France. Drawing on entirely new material Eugenia Parry Janis fully analyzes the life and work of (...) Le Gray and demonstrates the originality of his artistic achievement in the context of discoveries about his personal and professional history. Janis, approaching the photographs of Le Gray with the methods and sensibilities of an art historian, reveals telling connections between Le Gray's choices of subject matter and formal means of presentation and the existing pictorial practice of other media such as painting. This same approach makes her sensitive to Le Gray's departures from such traditional practice, and she skillfully illustrates how he evolved from student painter into master photographer. In doing so she gives us a glimpse of the way in which Le Gray's manipulation of the photographic process was always informed by his pictorial needs and by his developing style. (shrink)

Empathizing with others is thought to be a useful, if not necessary, skill for a wise person to possess. Beyond this general conceptual assonance, however, there have been few systematic attempts to conceptualize this relationship. This paper aims to address this issue by investigating what role empathy is said to play in phronesis and whether there is a legitimate place for it in Aristotelian (or neo-Aristotelian) accounts of practical wisdom. First, after a brief overview of Aristotle’s account of phronesis, I (...) will try to define three different ways in which empathy is thought to contribute to it according to the existing literature, based on a conceptual distinction between affective empathy, cognitive empathy, and sympathy. Second, I will ask whether empathy is the best conceptual candidate for Aristotle’s account of phronesis and, more generally, whether the wise person should always rely on empathy in order to deliberate and act well. My tentative answer will be that empathy does not seem to be perfectly compatible with the concept of phronesis, nor is it its best ally. (shrink)

Starting with Gottfried Leibniz, Isaac Newton's theology has often been caricatured as putting forward a “God of the gaps” argument for God's existence and continued involvement in the world. Peter Harrison has pointed out that this characterization of Newton's theology is “not entirely clear.” A closer look at Newton's letters and the drafts to the Opticks reveals that, rather than arguing God's providential ordering and care over the world, he takes these for granted and is reluctant to specify instances of (...) this order and care based on his physical research. He certainly believes in gaps in mechanical causes but is more eager to fill those gaps with nonmechanical natural causes than with God. Further, his system does not exhibit the two most prevalent weaknesses attributed to “God of the gaps” theologies: (1) that by describing God as intervening in natural causes his skill as a designer is maligned and (2) that by describing the physical details of God's involvement in the world one puts too much weight on theories likely to be replaced as science advances. Newton avoids the former weakness because it is only God's masterfulness as designer that he ties in any way to his theories of the physical world. He avoids the latter because he never points to God as the direct cause of any specific physical processes. Newton hoped that his system would cause his readers to marvel not only at God's providence but also at humankind's inability to sufficiently understand it. (shrink)

The sociocultural landscape of contemporaneity can be represented as a porous inhomogeneous space consisting of border zones. These zones, understood by P. Galison as “local coordination of beliefs and actions,” can be deployed due to already existing conditions, for example, a project may arise at a university. However, such zones do not create sustainable social configurations and infrastructures associated with new areas of knowledge. In this article, we expand the concept of trading zones and call them zones requiring local ontologies (...) that arise on the border between different knowledge and imagination systems and, in turn, require their own infrastructure. This approach supports the view on humanities not as “pre-packaged” knowledge, but as special “technique” forming local ontologies. For a humanities-as-technique to emerge, it is necessary that two or more systems of knowledge coincide in time and form an intermediate zone, on the basis of which some local ontology can unfold. Thus, for example, when combining contemporary philosophy and contemporary mathematics, new images of knowledge emerge. Humanities-as-technique are considered as the basis for the establishment of trading zones, which are understood as local ontologies. We also propose a system of concepts that can be used to describe and construct these trading zones on the territory of the humanities in a techno-oriented cultural environment. (shrink)

The rapid changes that syphilis underwent after the first major outbreak that occurred in Naples in the mid-1490s are believed to constitute the first well-documented example of a human disease. The new plague was of exceptional virulence, highly contagious and causing severe ulceration at the site of infection. According to medical and other historical sources, the ‘genius epidemics’ changed some years after this onset, and a slower-progressing form of syphilis seems to have replaced the initial severe form, as do many (...) virulent epidemic infectious diseases that appear in devastating forms in a previously uninfected population. But what exactly were the features of the disease at the moment of its appearance in Europe at the end of the fifteenth century? How many years did it take for the early, virulent form to be replaced and become endemic? What was the pace of these changes through the decades following the onset of the epidemic? In this essay, I review these issues through an analysis of a large number of chronologically-ordered primary historical sources. (shrink)

Several theologians have pointed to resonances between the Greek Patristic doctrine of deification or theosis and recent transhumanist narratives: both discourses indicate death as the final enemy of humankind and invest heavily in a hoped-for transcendence of life as we know it. These resonances will be investigated further by comparing the approach to human nature found in Maximus the Confessor and in the prominent transhumanists Nick Bostrom and John Harris. In addition to sharing with transhumanists a disavowal of death and (...) a trajectory towards transcendence, Maximus also shares a view of human nature that is more dynamic and open-ended than is commonly attributed to his Late Antique context. On the other hand, Maximus also insists on the persistence of this dynamic nature in its integrity even into the eschaton. He does so for a number of reasons that should give Christians pause about any rhetoric that calls for an abandonment of human nature: that theosis depends precisely on sharing a human nature with Christ; that our vocation as mediators in creation depends on our physical bodies as the locus of shared existence with the material world; and that corruption has a providential use in binding us together with our neighbors and in cultivating virtue as we strain for the incorruptible and supernatural gift of theosis. (shrink)

The Goods and Services Directive adopted in December 2004 is the very first European Community instrument to implement the principle of gender equality outside the workplace. As such it has the potential to close an important gap in European Union law. This note, however, contends that the limited scope of application of the Directive, together with doubts surrounding its legal base and position within the overall gender equality framework of the Union, have significantly undermined its potential. Nevertheless, it is suggested (...) that for the future, should these criticisms be adequately addressed, then the Directive may provide an important platform for the wider diffusion of the gender equality principle beyond the sphere of European employment law. (shrink)

Resumen: En el presente ensayo nos apoyaremos en algunos escritos fundamentales de Talcott Parsons, especialmente en lo referente a su disputa epistemológica contra el empirismo, para luego mostrar sus propias inconsistencias e ir más allá de él en la propuesta de una forma novedosa de trabajo teórico para las ciencias sociales: la teorización sistemática dinámico-estructuralista, como distinta a la teoría sistémica funcional-estructural. La idea principal es trascender las posturas representacionalistas y antiteoricistas en pos de miradas teóricas abiertas a la crítica (...) y la autocrítica. Así, frente a una mirada que confunde distintas dimensiones del continuo empírico-metafísico sin otorgarles su relativa autonomía analítica, que a nivel teórico-social y de modelos de la sociedad piensa en términos funcionales y sistémicos, que considera que cada uno de sus conceptos refiere de manera cabal a dicho mundo social y que cree que es factible la construcción de teorías acabadas, nuestra mirada busca distinguir dimensiones, complementar tradiciones plurales, y mantenerse siempre abierta a la crítica externa y la autocrítica.: In this essay we will rely on some of the key writings of Talcott Parsons, especially with regards to his epistemological dispute against empiricism, to show his own inconsistencies and go beyond him in proposing a new form of theoretical work for the social sciences: systematic and dynamic-structuralist theorizing, as distinct from functional-structural systemic theory. The main idea is to transcend the representationalist and anti-theoretical positions in favour of a view of theory open to criticism and self-criticism. In this way, and against those outlooks that confuse the different dimensions of the empirical-metaphysical continuum without giving them their relative analytic autonomy, that think in terms of functions and systems when talking about models of society, that consider each concept to be a representation of the social world, and that believe theories can be closed for good, our own outlook seeks to distinguish dimensions, complement plural traditions, and stay open to external critique and self-criticism. (shrink)